Care Home: Clifton Road, 52

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What the care home does well All the householders said that they are happy living at Clifton Road. They all said that they are happy with the staff and feel they have a good quality of life. They said they get choices as to what they do. The atmosphere in the home was calm and happy and the householders seemed to get on very well with each other and with staff. Staff have good knowledge about the needs of the householders, and of their likes and dislikes, hobbies etc. Householders` health care needs are carefully assessed and properly met. Householders are encouraged to take part in age, peer and culturally appropriate activities, and to to be fully engaged with their local community. They have a good diet, with choice of menu, and involvement in planning, shopping, food preparation and cooking. They are encouraged to maintain appropriate family and personal relationships. Householders are asked for their views and these are taken seriously. Their rights are respected. All the householders have had their needs fully assessed, and are currently being reassessed. The home is spacious, clean, comfortable, safe and in good repair, and provides a suitable environment for the householders, each of whom has his or her own bathroom. No obvious hazards were seen. Householders` right to privacy is respected and they have keys to their bedrooms, which they can keep locked. Staff are carefully selected, and householders have some input into this process. What has improved since the last inspection? All established staff have had training in the `Safeguarding` of vulnerable adults since the last inspection. Staff were able to correctly describe the procedure to follow, should any allegation of abuse or neglect come to their attention. Staff are now being given formal supervision on a more regular basis. Householders have been encouraged to become even more independent, and improvements in lifeskills have been noted. Householders have benefited from some extra availability of staff in early evenings and at some weekends.Monitoring visits by senior staff of the Trust are now being properly minuted. What the care home could do better: Care plans have not improved since the last inspection, and do not provide appropriate guidance to the staff. Some areas of the recruitment documentation need to be reviewed and amended. The Trust should send clear results and feedback to the home regarding the householders` surveys. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Clifton Road, 52 52 Clifton Road Grainger Park Newcastle upon Tyne NE4 8DQ     The quality rating for this care home is:   two star good 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 Baxter     Date: 1 4 0 5 2 0 0 9 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. 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. 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 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) 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.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Clifton Road, 52 52 Clifton Road Grainger Park Newcastle upon Tyne NE4 8DQ 01912983614 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : None The Edward Lloyd Trust care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: Date of last inspection Brief description of the care home 5 Number 52 Clifton Road provides residential care for adults who have a learning disability. Nursing care is not provided. The home is a large semi detached house in the West End of Newcastle and looks the same as the other houses in the area. Public transport is available a short distance away. The nearest local amenities are on the West Road. All of the householders have their own bedroom with bathroom. The house has gardens to the front and rear. Inspection reports and copies of the homes statement of purpose are available from the home. Each householder is charged £737.85p per week to live at the home. Care Homes for Adults (18-65 years) Page 4 of 27 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: two star good 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 is an overview of what the inspector found during this inspection. The quality rating for this service is 2 star. This means that people using this service experience good quality outcomes. Before the visit we looked at information we have received since the last inspection on 2nd May 2007. We looked at how the service has handled any complaints or concerns since the last visit, and whether there have been any changes to how the service is run. We looked at the providers view of how well they care for people, and also the views of people who use the service, their families, and the staff. Care Homes for Adults (18-65 years) Page 5 of 27 An unannounced visit was made to the service on 6th May 2009, with a follow up visit on 14th May 2009. This visit took 7.5 hours in total. During the visit we talked with householders, the staff and the manager. We looked at information about the people who use the service and how well their needs are met. We looked at other information that must be kept. We checked that the staff have the knowledge, skills and training to meet the needs of the people they care for. We looked around parts of the building to make sure it was safe, clean and comfortable. We checked what improvements have been made since the last inspection. We told the manager what we found. What the care home does well: What has improved since the last inspection? All established staff have had training in the Safeguarding of vulnerable adults since the last inspection. Staff were able to correctly describe the procedure to follow, should any allegation of abuse or neglect come to their attention. Staff are now being given formal supervision on a more regular basis. Householders have been encouraged to become even more independent, and improvements in lifeskills have been noted. Householders have benefited from some extra availability of staff in early evenings and at some weekends. Care Homes for Adults (18-65 years) Page 7 of 27 Monitoring visits by senior staff of the Trust are now being properly minuted. 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.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 8 of 27 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 9 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Householders have their needs fully assessed, so they know the home can meet those needs. Evidence: Householders have had their needs assessed in good detail by their referring care manager/social worker. These assessments are kept up to date by regular six monthly reviews. All householders are also being reassessed by their care managers regarding the proposal for them to go to Independent Supported Living status. This involves a minimum of three assessment visits for each person, and is expected to be completed shortly. The in-house assessments focus on health issues. An example of a new form of assessment document was requested, and was submitted shortly after this inspection. It was completed in reasonable detail and was more holistic in nature. Care Homes for Adults (18-65 years) Page 10 of 27 Care Homes for Adults (18-65 years) Page 11 of 27 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. Individual householders have their individual needs assessed, but their care plans are not clear or detailed enough to fully show that those needs are being fully met. They are encouraged to be as independent as possible. Evidence: Although social services personal assessments and risk assessments are clear and detailed, there was little evidence of clear in-house structures for holistic care planning. There is a personal health care plan that includes brief sections on physical contact, intimate care, behaviour management and skills relating to self-care. Also, a personal care plan that is basically a description of the weekly activities programme for each person. A brief description of each householders personality, habits, behavioural trigger points etc is kept in the front of the daily record book, but this does not replace the need for clear, detailed and holistic care planning to meet individual householders needs. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: A requirement is repeated from the last inspection report regarding this issue. Householders can and do influence their daily lives. Weekly speakeasy meetings are also held, in which the householders are encouraged to contribute to the running of the home and to raise any issues or concerns they may have.There was evidence that staff listen to and respond to householders wishes and views, with examples of decisions regarding social activities and outings, and of changes to routines to fit in with individuals requests. There was ample evidence of a high level of social activities during the day, with outings, artwork and photographs. No specific restrictions were in place on the movements or habits of the householders, and some previous restrictions around food and meals have been lifted or eased. There was also evidence that, following appropriate risk assessments, householders are encouraged and supported to have lifestyles as independent as possible. Recent improvements in the management of some challenging behaviours of one householder has resulted in this person now being able to safely use public transport, with support, thereby significantly improving the persons social life. Each householder has a copy of the organizations Charter of Rights on his or her personal file. Care Homes for Adults (18-65 years) Page 13 of 27 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. Householders are encouraged to take part in age, peer and culturally appropriate activities, and to to be fully engaged with their local community. They have a good diet, appropriate family and personal relationships, and have their rights respected. Evidence: Discussions with householders and study of records show that they are encouraged to enjoy activities of their own choice and wishes. Regular activities include ten pin bowling, golf, attending football matches, swimming, going shopping and to pubs. Householders eat out at least once a week, with their key worker. In-house activities include karaoke, art class and knitting. Householders are also encouraged to be involved in the local community, and examples of this include attendance at a weekly coffee morning, a musical drop-in Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: and a cookery class. Householders vote in elections, when they so choose. They visit friends in the community, and can see their guests in their rooms. There is a budget for householders holidays, and these are arranged individually with the householders. The Trust has its own caravan at Berwick, and householders make good use of this. Three householders get regular visits from family members, and two get occasional visits. All the householders have good social networks, and the manager feels that they are becoming more socially adventurous. None of the householders is in any paid employment, but one does voluntary domestic work within the Trust. Householders may develop and maintain intimate personal relationships, subject to an assessment of mental capacity. Householders can decide whether or not they wish to see a visitor. They can lock their bedrooms, and staff always knock and ask for permission to enter bedrooms. They are given their personal post unopened. The weekly menu is planned in the weekly speakeasy meeting, with each householder choosing the meal for one day. This process is aided by using menu books and pictures of different foods. Although the home tries to promote a healthy diet, it does not stick strictly to the menu, and tries to encourage good choices, rather than being prescriptive. Fresh fruit is always available in the kitchen. Clear records are kept of the meals served. Householders are encouraged and supported to help with the shopping, meal preparation and table setting. Householders are weighed every month. Care Homes for Adults (18-65 years) Page 15 of 27 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. Householders physical and emotional health care needs are met, and they are protected by the homes policies and practices regarding their prescribed medicines. Evidence: People who live in the home are able to do most things for themselves, including taking a bath. Householders decide for themselves when they get up and retire to bed, what to wear, hairstyles etc, and shop for their clothes themselves, with support, where needed. Each householder has their health care needs fully assessed and has a choice of GP. Detailed records are kept of visits to or from health professionals. One householder has input from a nurse specialist. No-one is currently being seen by a Consultant. Annual eye tests are arranged, as is an annual health check at their GP for each householder. Four of the five householders are currently receiving prescribed medicines. None are self medicating at the moment. Only staff who have received the appropriate training Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: give out the medicines, and two staff take joint responsibility on any shift. Medication Administration Records (MAR) are received from the Chemist, and the home also uses an in-house system of recording medicines. Records were up to date, and showed no unexplained gaps. Drugs are securely stored in the staff office. No controlled drugs are held on the premises. Care Homes for Adults (18-65 years) Page 17 of 27 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. Householders know that their views (including any complaints) are listened to and acted upon, and they are protected from abuse and neglect. Evidence: The home has developed a pictorial style of complaints policy to be more accessible to householders. It includes photos of various representatives of the Trust who can be contacted about any complaint or concern a householder may have. It is being amended to include their direct phone numbers, so a householder wouldnt have to make a complaint via the staff. The weekly speakeasy meeting for householders and staff is the main channel for anyone with a complaint or concern. Minutes of these meetings showed that concerns are raised occasionally, with a recent example being a complaint by one service user about the volume of another householders television. Staff responded appropriately to this concern, and it was sorted out promptly. All established staff have had training in the Safeguarding of vulnerable adults since the last inspection. Staff were able to correctly describe the procedure to follow, should any allegation of abuse or neglect come to their attention. The whistle blowing policy was also known by staff. Care Homes for Adults (18-65 years) Page 18 of 27 Care Homes for Adults (18-65 years) Page 19 of 27 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 home is spacious, clean, comfortable, safe and in good repair, and provides a suitable environment for the householders. Evidence: Each householder has a single bedroom, four with en suite bathrooms, one with an adjacent bathroom. Those seen (with the permission of the occupants) were very comfortable, and had been personalised to reflect the taste and wishes of the individual householders. Each householder has a key to his or her room, and one chooses to keep the room locked at all times. Householders said they are very happy with their bedrooms. The home is spacious, comfortable and in good repair. A previously noted problem of mould in a shower room appeared to have been resolved. There were no obvious hazards in the home. All areas of the home that were seen were clean and hygienic. Householders do their own domestic work and washing, with support where necessary. Care Homes for Adults (18-65 years) Page 20 of 27 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. Staff are carefully selected, and are given appropriate training and supervision. Staffing levels are being re-assessed. Evidence: All but one member of staff either holds National Vocational Qualification (NVQ) levels 2 or 3 (or an equivalent qualification), or is currently working towards such a qualification. The manager is working towards NVQ level 4. Staff personnel records were not available on the first day of this inspection, as they are held at the Trusts main office. Arrangements were made for them to be brought to the home on a second day. All the required elements of a robust recruitment and selection process appeared to be in place, with fully completed application forms, proof of identity, three written references taken up, interview minutes, etc. The application form does not ask for sufficient detail of the dates of previous periods of employment, and does not clearly state that the posts involve working with vulnerable people and are thus exempt from the Rehabilitation of Offenders Act. Householders have some input into the staff selection process, and are introduced to applicants at the shortlisting stage of the process. Householders views regarding the Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: applicants are taken seriously and contribute to final decision made. At the last inspection it was found that householders activities were being limited by there not being enough staff at weekends and after 5pm during the week. This meant that 1 to 1 time was very limited, as was householders ability to pursue individual social lives or hobbies. A requirement was made to for sufficient staff to be employed to meet the needs of the householders. This has been partly carried out. Some extra hours have been provided, mainly in the form of relief staff hours, and cover of at least three staff is now provided until 7pm on most weekdays, and until 9pm on some Saturdays. As part of the Trusts current application to close as a care home and to register as an Independent Supported Living scheme, Social Services have been involved in a detailed re-assessment of needs that, when concluded shortly, will specify the numbers of staff hours allocated to each individual service user. Staff training records showed that all staff are given mandatory training (i.e. that required by law) at the appropriate frequencies. All staff are also given training in how to handle challenging behaviours and personal care planning. Staff supervision records showed that, in recent months, staff are being supervised at the required frequency. Supervision sessions are fully recorded and kept on each staff members personal file. Annual appraisal is given to all staff. It is recorded in reasonable detail, demonstrates that any issues arising are properly addressed, and sets clear objectives for the following year. Care Homes for Adults (18-65 years) Page 22 of 27 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The current manager is in the process of achieving the required qualifications to demonstrate his fitness to run the home. Householders views are regularly sought, are taken seriously and are responded to positively. The health, safety and welfare of the householders and staff are protected. Evidence: The current manager, Mr Garry Spry, has yet to be registered with the Commission. He has three years experience in a managerial position, and is working towards his NVQ level 4 in care. He holds the Management Core Leadership qualification, and has undertaken all the mandatory training required. Copies of all the monitoring visits made to the home by the responsible individual are now being kept in the home. An annual survey of the views of the householders is undertaken, as part of the Trust wide annual assurance system. Unfortunately, the results are published only in the Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: form of overall results across all the Trusts services. This means there is no specific information about Clifton Road that the manager and staff can use to improve the service being given. It is recommended that the Trust also breaks down the statistics and comments received on a service by service basis. Advocacy posters are displayed in the home. The home is also working towards a system whereby householders can independently contact the Trusts chief executive with their views by means of a ready-addressed post card, if they so wish. It has yet to solve the problem that staff currently have to frank the post cards in question. Quarterly Forum meetings are held with the householders. Families and friends are invited to come to these meetings and give their views. There was evidence that staff respond to issues raised in these meetings. One example was a request by one householder to attend more matches at the Newcastle United ground, which has been agreed and met. A named senior member of staff is the health and safety representative for the home. This member of staff has had two days health and safety training in the past year, and carries out the health and safety part of induction for new staff. He also carries out the required safety checks and risk assessments of the building. The fire logbook was up to date and fully completed. There is a pictorial fire evacuation plan in place. The accident book showed that there had been no accidents within the home in the past year. Servicing and maintenance records were up to date. No obvious hazards were encountered during the tour of the building. Care Homes for Adults (18-65 years) Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes R No £ 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 1 6 15 The registered person must make sure that the care plans are complete and contain up to date accurate information. 01/07/2007 Care Homes for Adults (18-65 years) Page 25 of 27 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 6 15 The registered person must make sure that the care plans are complete and contain up to date information. This is to make sure that all the assessed needs of each householder are clearly and fully met. 30/06/2009 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 34 The application for employment form should be revised to ask for more detail of the dates of previous periods of employment, and to clearly state that the posts involve working with vulnerable people and are thus exempt from the Rehabilitation of Offenders Act. The Trust should break down the statistics and comments received as part of its overall system of annual surveys on a service by service basis, so that each service can respond individually to the feedback it receives from its own householders. 2 39 Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 or Textphone: or 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) 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. 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