Care Home: Chatting Independently Orchard View

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What the care home does well People living in the home are supported to live independent lives by staff who are caring, experienced and enabling. A hydrotherapy pool is available to people who live in the home. Physiotherapy and speech therapy is provided on site. Transport and the necessary staffing is provided for all trips. What has improved since the last inspection? Staff have been enrolled on NVQ Level 3 courses. The recording of medication has improved for people living in the home. A new quality assessor has been appointed to ensure the policies and procedures in the home have the corresponding paperwork completed, as well as looking at the quality of care being provided. New care plans written by the quality assessor are personalised and detailed. What the care home could do better: Where children are accommodated in the home the manager should be aware there are further regulations that need to be adhered to. The statement of purpose must be updated to reflect the changes in client group and provision of services. Staff must have training in safeguarding children. Staff must have training in the care of children when they are staying in the home. Anyone in the home (including respite stays) must have a care plan; or in the case of a child a placement plan, so that staff know what their needs are and how to meet them. People must only be given medication from correctly labelled and identifiable containers. Where people are prescribed medication on a `when required` basis there must be detailed guidance for staff in care plans on the circumstances these are used. A system for the review and improvement of the home must be established and maintained in consultation with people who live there. The provision of a service to children requires the manager to have skills and experience; qualifications or another person with those abilities for the purposes of working with children. Key inspection report Care homes for adults (18-65 years) Name: Address: Chatting Independently Orchard View March 42A Wimblington Road Cambridge PE15 9QN     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Alison Hilton     Date: 1 8 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. that people have said are important to them: They reflect the things 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. Care Homes for Adults (18-65 years) Page 2 of 28 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: Chatting Independently Orchard View March 42A Wimblington Road Cambridge PE15 9QN 01354657444 01354650767 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Chatting Independently Ltd care home 6 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users who can be accomodated is: 6 The registered person may provide the following category of service only: Care home only - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Physical disability - Code PD Date of last inspection Brief description of the care home Chatting Independently Ltd. is situated in a converted bungalow at Orchard View, 42a Wimblington Road, March which is a private road near to the town centre. The service is designed to cater for 6 people with a physical disability, who will be learning how to use Augmentative Alternative Communication AAC, which is an electronic device to assist people with speech and communication problems. There are six single rooms and residents share the kitchen/dining area, bathroom and lounge facilities. There is a lift to the bedrooms upstairs. There are sleeping-in facilities for the staff. The fee levels vary depending on the needs of individuals accommodated and can be requested on application. On the day of inspection there were five people in residence and one child on a respite stay. Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 6 Brief description of the care home There is a second home owned by Chatting Independently Ltd in March and this has the same manager and responsible person. It is registered separately and is therefore inspected in its own right. Care Homes for Adults (18-65 years) Page 5 of 28 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: A random inspection had been completed on Tuesday 8th December 2009 when we looked at medication, care plans, staff training, staffing and accidents/incidents. We found that the care plans were not kept under review, records of medication were not accurate or well kept and accidents/injuries were not recorded as required by the policies and procedures in the home. We, the Care Quality Commission (CQC) carried out this key unannounced inspection of Chatting Independently, Orchard View on Monday 18th January 2010 between the hours of 09:40 and 17:25, using the methodology described below. This report makes judgements about the home based on the evidence we have gathered. A Pharmacist Inspector was present for some of the inspection and his comments can be seen in the personal and healthcare support section of the report. Care Homes for Adults (18-65 years) Page 6 of 28 Staff, people who live in the home, the manager, responsible person and new quality assessor were all spoken to as part of this inspection. We looked at files of people in the home, staff files and other records. Care Homes for Adults (18-65 years) Page 7 of 28 What the care home does well: What has improved since the last inspection? What they could do better: Where children are accommodated in the home the manager should be aware there are further regulations that need to be adhered to. The statement of purpose must be updated to reflect the changes in client group and provision of services. Staff must have training in safeguarding children. Staff must have training in the care of children when they are staying in the home. Anyone in the home (including respite stays) must have a care plan; or in the case of a child a placement plan, so that staff know what their needs are and how to meet them. People must only be given medication from correctly labelled and identifiable containers. Where people are prescribed medication on a when required basis there must be detailed guidance for staff in care plans on the circumstances these are used. A system for the review and improvement of the home must be established and maintained in consultation with people who live there. The provision of a service to children requires the manager to have skills and experience; qualifications or another person with those abilities for the purposes of working with children. Care Homes for Adults (18-65 years) Page 8 of 28 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 28 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 28 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 Statement of Purpose does not provide people with up to date information about the service, with which to make a decision about choosing this home. Evidence: The statement of purpose does not reflect the fact that the home provides respite care; caters for young people between the ages of 16-17 years, or how their differing needs will be met. Young people between 16-17 years of age require different paperwork in terms of placement plans and how the placement will be assessed. None of these were in place on the day of inspection. A comprehensive needs assessment had been completed by the responsible person, but none of this information had been made into a placement plan setting out the young persons needs, how they were to be met by staff or what the objectives of the placement were . People have introductory visits before they agree to move into the home and these visits are well documented. Care Homes for Adults (18-65 years) Page 11 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Young people accommodated in the home must have a plan of care so that staff know what their needs are and how they will be met. Evidence: A new quality assessor (QA) has been appointed and she has started to update all care plans with input from facilitators (staff) and the person they are written about. We discussed risk assessments with the new QA and these have yet to be completed. It was discussed that facilitators could take a key role in the completion of care plans and risk assessments in the future since they deal with the day to day issues for those they facilitate for. For adults living in the home there has been a general improvement in the content and personalisation of their care plans, however we found one person aged 17 in the home on respite care who had no information about their assessed needs or how these were to be met by staff. We asked staff if there was a care plan or risk assessment or any information about this child anywhere in the building. They commented that there was not. They were asked how they knew how to care for and meet the needs of the young person. They stated that family members had informed Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: them but the details had not been recorded, just passed by word of mouth. The manager stated We could have written one with the information we had but we had been there at the other home. His present one (from a care agency) is out of date. I should have followed up more. I was not well last week. This refers to information held in another home owned and run by Chatting Independently. Accommodation of a young person (between the ages of 16-17) has supplementary standards to be applied that the manager has not taken account of. On one file there was evidence that the care plan and risk assessments should have been reviewed in March 2009 but there was no information that they had been. The new quality assessor stated she had completed a new care plan and it just needed to be printed and put on file. Staff also said that the physiotherapist had seen the person but there were no details about this on file. There was also some information that the person had problems with their temper but there was nothing in a care plan or risk assessment to indicate how this manifested itself or how staff should deal with it, although each incident was recorded. It was not clear from staff what happened to these incident records or how they helped manage the persons anger outbursts. The QA said she was reviewing risk assessments and after the inspection sent us a prototype basic assessment that will be used in the future. It was evident during the inspection that people who live in the home make decisions about their lives on a day to day basis and staff support them to do this. One staff member commented that people can also make poor decisions and will be supported through any consequences of bad judgement. Staff were heard talking to people living in the home about choices in different areas such as meals, outings and completing household tasks. Timetables for individuals are kept on their files, but the daily records do not show a correlation between what should occur and what actually happens. Staff need to document when an element of the timetable does not occur and why; and if it is rescheduled that also needs to be detailed. Care Homes for Adults (18-65 years) Page 13 of 28 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. People have the opportunity to take part in varied activities to develop their independence. Evidence: Since there was no placement plan for the young person we were unable to assess what their needs were in relation to leisure and daily routines. The daily notes show most time was spent watching videos. People who were resident in the home were involved in daily tasks such as ironing and making shopping lists with their facilitators. One person went to the cinema and was then going for a meal. All of these activities are undertaken to promote independence and for people living in the home to be able to direct staff to meet their needs. Mealtimes are whenever the person living in the home wants them to be and again Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: they direct staff to prepare the meal that they (the person) want. If they are unsure, their facilitator will tell them what is available from their own stock of food, and they will choose from that. When stocks are low the person makes a shopping list with their facilitator and goes to purchase the food. This all encourages an independent outlook with the knowledge that the support is there when needed. A record of meals eaten by young people must be kept. None was available and details were not recorded in the daily notes. People in the home have attended concerts, holidayed in the UK and abroad, go shopping locally and further afield and are encouraged to undertake any activity possible. Care Homes for Adults (18-65 years) Page 15 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Medication records are completed to an adequate level that means people living in the home are protected from risks to their health and welfare. Evidence: We looked at medication and medication records for several people resident in the home. Medicines are stored securely for the protection of residents. Records are made when medicines are received into the home and, with the exception of one medicine, these records were acceptable. Records are also made when medicines were given to people and when they are disposed of. These provide an audit trail to account for medicines in use. Records made when medicines are given to people have improved since the last inspection and with the exception of one persons records, they were acceptable. The one exception related to a person admitted for short-term care where there was no record made of the medication given on the morning of the inspection. Additionally the medication had been given to the person from a container which did not carry a label identifying the contents. Staff would therefore not know if they were administering the correct medication. A requirement has been made about this. We saw that some people are prescribed medication on a when required basis but Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: could not find any guidance in care plans as to the circumstances these are used. Although staff could describe such circumstances, it is important that instructions are contained within the persons care plan to ensure consistency in use and safeguard people by preventing the inappropriate use of medicines. A requirement has been made about this. Care Homes for Adults (18-65 years) Page 17 of 28 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There must be staff training, policies and procedures in place to ensure the protection of children and young people. Evidence: The Commission has not received any complaints about the service. We looked at the complaints book kept in the home and none were recorded there. Staff said they had received training in the protection of adults and were confident about how to deal with issues. Staff commented that there were sometimes small niggles from people living in the home that were recorded and dealt with but no-one could provide details of these. When asked, staff said they had not received any training in the protection of young people. Senior staff said the home did not have a copy of the Area Child Protection Committee (ACPC) procedures or any policy on countering bullying. Care Homes for Adults (18-65 years) Page 18 of 28 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 premises were clean and free from offensive odours, ensuring people live in a pleasant environment. Evidence: The home continues to be suitable for its purpose, is wheelchair accessible, safe and well maintained. There is a lift to the first floor where four of the six individual bedrooms are located. People were seen to use the lift unaided. Checks are completed on all equipment in the home. On the ground floor there is a living/dining area and fully fitted, newly installed (on the day of inspection) kitchen. People living in Orchard View have access to a hydrotherapy pool and physiotherapy room in an adjacent home (also run by Chatting Independently). There were no offensive odours in the home during the inspection. The laundry is situated on the ground floor and is accessible without going into the kitchen/dining area. Care Homes for Adults (18-65 years) Page 19 of 28 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 manager must ensure care staff working with young people between the ages of 16 and 17 are trained and competent to do so. Staff must not be employed until the minimum checks have been completed to ensure the protection of those living in the home. Evidence: The most recent staff file was seen. This showed the persons start date as 23/11/09 before the ISA First (used to be PoVA First) dated 9/12/09 was returned, however we were informed that the person did not work in the home until this had been received. The two references were not received until 11/12 & 21/12, which clearly shows them to be after the date the person started work in the home. This indicates the member of staff started work before all the appropriate checks had been completed, which means people in the home could have been at risk. Rotas are displayed in the home and have all the necessary information completed. Staff are completing NVQ Level 3 in Care, but this does not include children and young people. Staff who care for children and young people must receive training to support this role; this must include child safeguarding training. Care Homes for Adults (18-65 years) Page 20 of 28 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 ethos of the home remains excellent, however the management understanding of basic requirements under different legislation does not ensure the wellbeing of children staying in the home. Evidence: The philosophy of the home and the staff interaction with people living there cannot be faulted, however the leadership and management of the home is not clearly defined. The issues and extra requirements around the respite stay of a child do not appear to have been considered; or the impact on staff and other people in the home. A new quality assessor has been employed who will look at all aspects of the care provided in the home and the documentation of this. Some elements were seen during this inspection and are detailed in other areas of this report. A new role of senior, checking care provision in the mornings has been made so that staff and people who live in the home have another senior contact who can feed information up through the management structure. The responsible person said there were four more staff waiting to start work but their Criminal Record Bureasu (CRB) checks had not come through Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: yet. The manager has still not completed any quality assurance assessment of the service, but has employed a quality assessor (QA), who we spoke to, and who understands that this is necessary to ensure the service provision is reviewed and developed. The QA said she would send out further surveys and collate them into a report, which will be sent to the Commission. Staff said they had taken part in fire drills and were clear on the procedure in the home. Other safety checks are completed by the caretaker who keeps full records. Most staff said they had received supervision from the new QA. One file showed that the last supervision was November 2009. Care Homes for Adults (18-65 years) Page 22 of 28 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 23 of 28 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 1 1 6 The Statement of Purpose must be reviwed and updated to show the services the home provides. It must describe what the staff do specifically for people aged 16-17 years of age. This is to ensure that people know the staff and home can meet the needs of young people being placed in their care. 08/02/2010 2 6 32 Children must have a placement plan in place. This will ensure staff know how to meet the needs of the young person. 01/02/2010 3 14 16 Children must be able to take part in age appropriate activities. This is to ensure their safety and wellbeing. 15/02/2010 Care Homes for Adults (18-65 years) Page 24 of 28 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 4 20 15 Where people are prescribed 15/02/2010 medication on a when required basis there must be detailed guidance for staff in care plans on the circumstances these are to be used. This will safeguard people by preventing the inappropriate use of medicines. 5 20 13 People must only be given medication from correctly labelled and identifiable containers. This will ensure people receive the medication as prescribed. 31/01/2010 6 23 32 Arrangements for the protection of children must be made. This is to ensure the health and safety of any child or young person accommodated in the home. 08/02/2010 7 32 32 Staff must receive training in the safeguarding of children where children are accommodated. This is to ensure the safety of any child in the home. 31/03/2010 8 34 19 Adequate references must be obtained before a person is employed in the home. 22/01/2010 Care Homes for Adults (18-65 years) Page 25 of 28 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 This is to ensure the protection of people living in the home. 9 35 33 Staff must have the qualifications, skills and experience to work with children. This is to ensure children accommodated in the home have staff who understand their needs and how to meet them. 10 39 24 A system for the review and improvement of the home must be established and maintained in consultation with people who live there. This is to ensure the quality of the home is reviewed and improved. 11 40 32 The provision of a service to children requires the manager to have skills and experience; qualifications or another person with those abilities for the purposes of working with children. This is to ensure children can be safely cared for. 30/04/2010 30/04/2010 31/03/2010 Care Homes for Adults (18-65 years) Page 26 of 28 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 Care Homes for Adults (18-65 years) Page 27 of 28 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.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 © (2009) Care Quality Commission (CQC). 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. 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