Inspection on 04/11/08 for The Coach House

This inspection was carried out on 4th November 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Coach House 24/01/08

The Coach House 18/07/06

The Coach House 05/01/06

The Coach House 10/08/05

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Coach House Trevaylor Manor Newmill Road Nr Gulval Penzance Cornwall TR20 8UR     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Alan Pitts     Date: 0 4 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: · · · · Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 30 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: The Coach House Newmill Road Trevaylor Manor Nr Gulval Penzance Cornwall TR20 8UR 01736332133 Telephone number: Fax number: Email address: Provider web address: coachhouse@swallowcourt.com Name of registered provider(s): Name of registered manager (if applicable) Swallowcourt Limited Type of registration: Number of places registered: care home 9 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Date of last inspection Brief description of the care home The Coach House is a care home offering personal care and accommodation for up to 9 adults with physical and complex needs, who have a learning disability. The aim of the home is to provide specialist support in a homely environment where people can experience a quality of life with the support and care of the staff. Nursing care is not provided, apart from that which can be provided or overseen by the local community or district nursing team. Swallowcourt, the registered provider, is an organisation that provides specialist care for people with special needs and which also owns three nursing homes. The Coach House has its own entrance drive from the Newmill Road, but is in the grounds of and adjacent to Trevaylor Manor, one of the company?s nursing homes. Penzance town is two miles away, and a bus service passes the home twice a day. There is a parking area, and walled gardens for people living at the home Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 9 Brief description of the care home to use. The home has recently acquired its own car transport, with occasional use of staff cars or a minibus shared with the other homes, for leisure outings, to get people to health appointments, etc. Accommodation is on two floors, with a shaft lift between floors for those who cannot use the stairs. One bedroom is registered for double occupancy, should two people wish to share. Each bedroom has an en suite toilet, with special door locks fitted on the bedroom doors to give greater privacy if wished. There is a bathroom upstairs, and a level access shower room/wet room on the ground floor, as well as separate toilets. The kitchen off the lounge is used for some food preparation, although the main meal of the day is usually sent from the kitchen of the adjacent nursing home. The dining area is in the conservatory, which looks out over the walled gardens. Weekly fees were from 902.00 - 1400.00 pounds per week, at the time of our visit. These did not include items for personal use such as toiletries and clothing. Care Homes for Adults (18-65 years) Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place on the 4th November 2008, over a period of approximately 6 hours. The inspection included: discussion with staff, a tour of the premises, examination of relevant documentation, and the inspector met with some of the people that live there. We also looked at the responses from surveys received from the people that use the service and others, which were sent out prior to the inspection. The staff have a good understanding of the care needs of the people that live at The Coach House, and the overall rating reflects the staffs continued hard work to meet the needs of the residents without the clear leadership and direction afforded by a registered manager. Care Homes for Adults (18-65 years) Page 6 of 30 The Commission has confidence that the parent organisation, Swallowcourt Ltd, will be able to rectify this in the very near future with the appointment of a registered manager. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 Care Homes for Adults (18-65 years) Page 8 of 30 240 7535. Care Homes for Adults (18-65 years) Page 9 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home does not have a current statement of purpose and service users guide that provides information about the home in an appropriate format. A thorough assessment is not always carried out for all prospective residents. Evidence: The inspector was advised that the statement of purpose and service users guide is currently under review, and once completed will be provided to all residents and/or their representatives in an appropriate format. There is an existing brief easy read service user guide in each clients file. The staff assist the people that live at The Coach House to maintain good links with families and people important to them. There have been two new admissions since the last inspection. The care documentation for one shows a Department of Adult Social Care (DASC) assessment, which was received on the day of admission. The inspector was advised that whilst this was an urgent admission the home did have at least 48 hours notice, yet there is no evidence of a pre-admission assessment. One resident confirmed that they had a look Care Homes for Adults (18-65 years) Page 11 of 30 Evidence: round the home prior to admission, whilst another said that they were told what they needed to know. The home currently provides care and accommodation for 8 people. Care Homes for Adults (18-65 years) Page 12 of 30 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of residents, who are involved to the best of their capabilities in decision-making and self-determination. Evidence: The manager from another home owned by the parent organisation and staff demonstrated a detailed understanding of the complex range of needs that are presented by residents and the records inspected detailed how the relevant support is provided. The plans of care involved health care issues, and residents aims and aspirations in educational or social interactions. The plans of care are developed with input from other agencies, such health or the Department for Adult Social Care (DASC). The care plans were seen to be informative and provided direction to staff how to meet the care needs of the resident. There was insufficient evidence that care plans are reviewed at the frequency stated in the national minimum standards and with the involvement of Care Homes for Adults (18-65 years) Page 13 of 30 Evidence: the resident and/or their representative. Daily records were seen to be detailed and informative of the residents day and lifestyle, including choices made. The residents have key staff to assist them. The manager from another home owned by the parent organisation was aware of capacity issues, though training for staff about the Mental Capacity Act has yet to be arranged. The staff do liaise with other professionals to ensure the rights of the residents are safeguarded, and their right to self-determination is not compromised. Residents were seen to be assisted discreetly and sensitively. Risk assessments are completed for various aspects of residents needs, capabilities, and activities, and include instruction how the identified risk is to be managed. Care Homes for Adults (18-65 years) Page 14 of 30 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of social and recreational opportunity is provided in keeping with known preferences and capabilities. Residents engage with the local community, and all have appropriate contact with people important to them. Residents rights and capacity as adults is recognised. A balanced diet is provided. Evidence: The residents, staff, and care records confirm that residents are involved in a range of appropriate leisure activities and maintain contact with people important to them. Staff did say they would like to see a greater range of activities, though the inspector was advised that this is being looked into (including possible work placements). The staff recognise the residents right to determine their own waking day within the parameters of meeting their health care needs, and this is reflected in the daily care notes. Residents are able to choose when to be alone or in company, and when not to join an Care Homes for Adults (18-65 years) Page 15 of 30 Evidence: activity. Contact with family members and friends is encouraged and assisted where necessary. Social/recreational activities are recorded in individual plans and the home provides appropriate staff to support these activities. The parent organisation has its own vehicles to assist residents attend appointments, events, or meet with people important to them. The residents at home at the time of the inspection interacted freely with the staff and the inspector. Interactions between staff and residents were seen to be adult, friendly, and professional. All staff have a responsibility for meal preparation and relevant training has been undertaken. The kitchen is domestic, well equipped and clean. Lunch meals are prepared in the adjacent care home, Trevaylor Manor, kept in a hot trolley and transported across to the kitchen by staff. The route between the two homes is open to the weather. Although advised that there is a choice available at meals, it is not clear how individuals preferences are ascertained. The inspector was shown a pictorial menu tool, which is under development. The kitchen was inspected by an Environmental Health Officer (EHO) in September of this year. The home has now implemented the Making Food Safely programme as directed by the EHO inspection. Care Homes for Adults (18-65 years) Page 16 of 30 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal and health care needs of residents are met with evidence of promoting privacy, dignity and good multi-disciplinary working taking place. Evidence: The care records, and discussion with the manager from another Swallowcourt home and staff show that the residents waking day is flexible, within the parameters of their care plan. Two residents confirmed that they are free to determine their own lifestyle. The staff ensure that the residents receive health care services as required, and in accordance with the residents known preferences. Staff keep contact records for all healthcare professionals and services in the daily notes. On the day of the inspection an occupational therapist visited to assess one of the bathrooms and a hoist for suitability for one of the people that live at The Coach House. Also, an optician visited to assess residents. The care plans detail health care needs and how these are met. These records evidence that residents healthcare needs are monitored and addressed. All residents are registered with local GPs. Daily records and correspondence document the monitoring and addressing of residents healthcare needs and referral to Care Homes for Adults (18-65 years) Page 17 of 30 Evidence: appropriate healthcare professionals and specialist workers. A number of residents have regular contacts with consultants and other clinical specialists for specific health issues. The manager from another Swallowcourt home confirmed that listening devices are still used for monitoring people prone to seizures. There is no policy or procedure setting out the parameters of proper use for these devices. The medication records, procedures and storage facilities are appropriately maintained. Medicine Administration Records were seen to be in order. The home uses the Monitored Dosage system for medicines. The policy and procedure covers the required areas, and there is a record of receipt and disposal of medicines. Records of administration were consistently signed and appeared well maintained, and included a photo of the respective resident. Staff who administer medicines have completed a course in the safe handling of medicines. There is a record kept of any medication errors. The supplying pharmacist inspected the medication system in September of this year. The staff described the action taken and liaisons made with other agencies to ensure the comfort of one resident, including pain-control advice. Care Homes for Adults (18-65 years) Page 18 of 30 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents were seen to interact with staff in a relaxed manner. The staff have a clear understanding of Adult Protection issues and procedures that will protect service users from abuse. Evidence: The people that live at The Coach House are enabled to maintain contact with relatives and friends, and external agencies through visits and telephone calls. The homes complaints procedure is available in the service users care file, though this is not currently provided to residents or their representatives. The home has a policy and procedure regarding complaints and concerns. Neither the home nor Commission for Social Care Inspection have received any complaints since the last inspection. Two residents confirmed that they would be able to voice any concerns, should they have any. Advice regarding various forms of potential abusive situations and procedure are available to staff and are raised during induction training. The home has a written policy and procedure for protecting residents against abuse and supplementary guidance on the nature of abuse. The home has a copy of the Cornwall Multi-Agency Code of Practice on the Protection of Vulnerable Adults, and staff have undertaken relevant training. The parent organisation, Swallowcourt Ltd, fully aware of the need for prompt reporting of any concerns. As discussed with the manager from another of Care Homes for Adults (18-65 years) Page 19 of 30 Evidence: the parent organisations homes, none of the staff have received any training about the Mental capacity Act. Care Homes for Adults (18-65 years) Page 20 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The quality of furnishings and fittings is good and residents live in a safe, clean, and homely environment. Evidence: Everywhere was tidy, pleasantly decorated and furnished in a homely way. The bedrooms seen were personalised, reflecting individuals interests and preferences. One room had sensory lighting. Residents appeared to be very satisfied with the accommodation and facilities provided. Rooms are well furnished and comfortable and have been personalised by the occupants. There is a communal bathroom on the first floor. Three of the bedrooms are on the first floor and two on the ground floor. There is a shaft lift to assist residents using the first floor. The home looked well maintained, and there was documentary evidence of maintenance and safety checks. The home was clean throughout. Blinds have been fitted to the roof of the sun lounge so that the room does not get unbearably hot for those using it. There was easy access to the garden from the sun lounge, and both residents and staff were seen making use of the garden. One resident commented that the home is a clean home, and that they were very comfortable. Care Homes for Adults (18-65 years) Page 21 of 30 Evidence: Staff are required to carry meals between the adjacent Trevaylor manor and The Coach House. Whilst this is only a short distance the journey is open to the elements. Visiting opticians were observed to carry out their duties in the lounge, as the sun lounge was in use by residents. The lounge affords access to other parts of the home and there was therefore human traffic through this area during the opticians visit. The inspector was advised that consideration is being given to the addition of a conservatory to the home. The laundry room had a washing machine with appropriate programmes for cleaning laundry properly. The home has proper equipment for dealing with soiled items, including use of alginate bags and the sluice cycle. Disposable gloves and aprons were seen available around the home. There was a sink in the laundry with paper towels, but nothing for actually washing hands. Care Homes for Adults (18-65 years) Page 22 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The registered provider must do more to encourage and promote staff training. The home adheres to a robust employment procedure. Staffing levels must be reviewed to provide flexible support to the residents. Evidence: There is 14 care staff, plus a housekeeper. The registered manager position is currently vacant. At the time of the inspection there were 5 care staff on duty. Only 4 of the 14 care staff have achieved NVQ Level 2 or above, though it is noted that a further 3 staff are booked to commence this training. New staff undertake an in-house induction as well as a National Training Organisation core standards induction. There is a stable staff team available that is providing continuity and a consistent approach to care. The staff team are involved in training, which is continuing and a manager from another Swallowcourt home, is establishing effective monitoring of training needs. Training was being provided on the day of the inspection. The recent improvement in the homes commitment to training is noted, but further improvement is needed. It is anticipated that further improvement will result from the appointment of a registered manager at The Coach House. Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: Two personnel files were inspected, and this showed that the home is adhering to a robust recruitment procedure in order to protect the people that live at The Coach House. The staff were knowledgeable of the residents needs and capabilities, and were observed to exhibit a positive regard and appropriate attitudes in their interactions. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home continues to provide for the safety and welfare of residents. The home does not have a registered manager. Evidence: Two potential managers have been in post since the last inspection. The home is currently being overseen by the registered manager from another Swallowcourt home. The inspector met with a new manager who was appointed on the day of the inspection, and will shortly commence employment. Overall, the service continues to meet the needs of the people that live there, but the recommendations identified in this report are primarily of a managerial nature and the clear leadership and direction afforded by a registered manager should be a priority. There has been sporadic use of internal quality assurance tools, and residents are consulted as part of everyday normal practice. Quality assurance was discussed with a view to the home actively seeking the views of others about the service provided. Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: Relevant maintenance and safety records are kept (e.g. fire equipment, insurance), and the registered providers ensure that there is regular maintenance and safety checks of the equipment and premises. There is a comprehensive risk-assessment tool provided by an external company. The inspector was advised that window restrictors are on order and will be fitted on receipt. Thermostatic controls are fitted to all hot water outlets, and the inspector was advised that the monitoring of these devices will be added to the maintenance programme of the home. There was evidence too of previous instances of staff supervision, but the format for this was inconsistant and this is not a regular occurence. Care Homes for Adults (18-65 years) Page 26 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The registered provider should provide a current Statement of Purpose and Service User Guide in a format suitable to the needs of the people that live at The Coach House. The registered provider should ensure that all potential clients are properly assessed prior to admission. The registered provider should ensure that there is evidence of the plans of care being regularly reviewed. The registered provider should explore the options available to provide an increased variety of activities, including work placements and access to the local community. The registered provider should explore the options available to ensure the offer of choices to residents at meals (e.g. picture cards). The registered provider should ensure that there is written guidance for staff on the use of devices that could potentially intrude on an individuals right to privacy. The registered providers should ensure that the homes complaints procedure is made available in a suitable format to all residents and/or their representatives. The registered providers should arrange for the provision of staff training in the Mental capacity Act. 2 3 4 2 6 13 5 17 6 18 7 22 8 23 Care Homes for Adults (18-65 years) Page 28 of 30 9 10 24 24 The registered providers should ensure the provision of handwashing facilities in the laundry room. The registered providers should consider how facilities for visiting practitioners might be improved to improve the privacy and dignity of clients. The registered providers should consider providing covered access between the adjacent care homes in the interests of staff safety. The registered providers should continue the improvements in staff training, including NVQ training, achieved since the last inspection. The registered providers should appoint a registered manager. The registered providers should implement a quality assurance programme to ascertain the views of the people that use the service, and others, and publish a summary of the findings. The registered providers should ensure that staff receive regular supervision and that this is recorded. 11 24 12 32 13 14 37 39 15 43 Care Homes for Adults (18-65 years) Page 29 of 30 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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