Care Home: Marlin Lodge

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What the care home does well Residents expressed a high level of satisfaction in respect of the quality of service they receive. Their views/comments including those of staff have been reflected throughout the report. The preadmission assessment and care planning process is effective. The implementation of health and personal care needs is being monitored internally through a monthly review system; the placing authority undertakes its own annual review for each resident; this ensures that identified needs are being met and unmet needs, closely monitored. Both review systems focus on the individual residents, thus ensuring that they are fully involved in all aspects of their lives and supported in the decision making process. Activities offered are wide ranging and include work, education and leisure. This ensures a good level of stimulation for residents, which promotes their welfare and development. Quality and diversity issues are being promoted and residents are treated with respect. `I am very happy here`, stated a resident in their survey. Staff members are committed and they have a good understanding of residents` needs, including equality and diversity issues. We saw that staff were courteous, sensitive and helpful towards the residents. Care and staff management systems are being implemented to good effect. NVQ training for staff is being given a high profile, which means that staff have the skills and knowledge to deliver a good service to residents. What has improved since the last inspection? There were no requirements or recommendations arising from the last inspection report dated 4 May 2007. The manager has completed the Registered Manager`s Award, and NVQ 4 in health and social care. She is hoping to submit her application to the Commission in April this year to become the registered manager for the home. Staff confirmed that they feel well supported by both the manager and the provider. The home is being managed well by the new manager. The residents` interests are the main focus of the decision making processes. This is clear from documentation viewed, discussions with staff and people using the service and observations of care practices. Evidece shows that the overall standard of care and support for the residents has continued to improve, a view echoed by the owner, manager, staff and residents spoken to. `We improve the care for our service users at all times` said a staff member and `We respect their wishes always` stated another member. What the care home could do better: There are 2 recommendations arising from this report that need addressing. Given the resident`s learning disability, the terms and conditions of residence shouldinclude their representative`s signature where appropriate; this would also demonstrate their involvement in drawing of this document. The care plan should reflect the name and signature of the resident`s representative. This would demonstrate their involvement in the care planning process and their agreement with its content. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Marlin Lodge 31 Marlborough Road Luton Beds LU3 1EF     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: Neil Fernando     Date: 0 9 0 4 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 29 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 29 Information about the care home Name of care home: Address: Marlin Lodge 31 Marlborough Road Luton Beds LU3 1EF 01582723495 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) : Quality Care (Surrey) Ltd care home 15 Number of places (if applicable): Under 65 Over 65 0 0 dementia learning disability Additional conditions: 1 Service User with DE 1 15 Number of places: 15 Age: 18 - 65 years Category: Learning Disability The provider must appoint a full time permanent manager and submit an application to the CSCI for registered manager in 3 months time from the date of this registration. Date of last inspection Brief description of the care home Marlin Lodge consists of 2 adjacent large detached houses that provide residential accommodation for up to 15 adults with learning disabilities. All the accommodation is in single bedrooms. There is a lounge and dinning area/conservatory on the ground floor. The property is within easy reach of local amenities and Luton town centre. The home provides care for adults between the ages of 18 to 65 with learning disabilities, most of whom attend day activities outside of the home during weekdays. Bedrooms on the first floor of the home cannot take people who have significant physical disabilities in addition to their learning disabilities. Care Homes for Adults (18-65 years) Page 4 of 29 Brief description of the care home A copy of the last inspection report is kept in the office and is available to residents, visiting families and professionals. The charges for care range between £550 and £2000 per resident, per week. Care Homes for Adults (18-65 years) Page 5 of 29 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: The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. We, the Care Quality Commission, undertook this unannounced key inspection on 9 April 2009. We spoke with 5 residents, the owner, manager and 3 staff. We spent time discretely observing residents and staff care practices. We had a look round the home and viewed a range of records the home must keep. We have received a completed AQAA (Annual Quality Assurance Assessment), a document, which gives the manager the opportunity to tell us how the home is meeting the standards and regulations. We have also received surveys from 5 Care Homes for Adults (18-65 years) Page 6 of 29 residents and 5 members of staff. At the time of the visit, there were 14 people in residence with 1 vacancy. The owner and manager were present throughout the inspection. An annual service review was carried out on 17 March 2008. What the care home does well: What has improved since the last inspection? What they could do better: There are 2 recommendations arising from this report that need addressing. Given the residents learning disability, the terms and conditions of residence should Care Homes for Adults (18-65 years) Page 8 of 29 include their representatives signature where appropriate; this would also demonstrate their involvement in drawing of this document. The care plan should reflect the name and signature of the residents representative. This would demonstrate their involvement in the care planning process and their agreement with its content. 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 9 of 29 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 29 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. Information available about the home helps prospective residents decide whether or not the home is where they wish to live. Their needs are appropriately assessed and this ensures a place is only offered to the resident whose needs it can meet. Evidence: The AQAA tells us Manager going to visit prospective resident in either their current care placement or day centre (whichever is choice is preferred by the service user). Brochure provided. The statement of purpose and service users guide have been recently reviewed and updated by the manager and owner. These documents provide information in writing and in pictorial form, which are very user friendly and suitable to the needs of residents accommodated at Marlin Lodge. A copy of the service users guide and the last inspection report from the Commission is available at the home for any residents and visitors to read. Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: The home receives detailed assessment information on the potential resident from the placing authority. There have been new admissions to the home since the last inspection undertaken on 4 May 2007. The manager said that she carries out a needs assessment using the homes own assessment form. Case files examined for 3 residents indicates that individual pre-admission assessments have been completed prior to the residents being offered a place. Also, reports are received from other health care professionals, where required, including speech and language therapists, and psychologists. This means that the home is careful to only admit residents whose identified needs could be met. Evidence shows that the prospective residents, their representatives and social workers are encouraged to visit the home as part of the assessment process, in order to ensure that the residents needs can be fully assessed. I came to see the home and spoke to the staff. I know people here as well reflected a resident in their survey. Each resident is issued with a copy of the terms and conditions of residence. Given the level of learning disability of some residents, this document should include their representatives signature where appropriate; this would also demonstrate their involvement in drawing of this document. Care Homes for Adults (18-65 years) Page 12 of 29 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. Individual plans guide staff in ensuring people who live in the home are able to lead a varied lifestyle, with choice and in safety. Evidence: The AQAA states Plans are in place for each resident linking identified needs to the action that is needed to be taken to meet them. We have well written care plans that are evaluated every month. The care plans for three residents were examined. Information in the care plans is clear and comprehensive. Any specialist requirements are detailed and the input from other services acknowledged. Records show that each resident has their care plan reviewed internally every month. Residents also have an annual review each, which is carried out by the placing authority. Staff members spoken with were aware of the identified needs of residents and how these needs are being met. The key worker takes time to read minutes and explain the outcomes of reviews, thus ensuring the resident is aware of changes and Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: how these would be addressed. The care plan should however include the name and signature of the residents representative as appropriate. This would demonstrate their involvement and agreement with its content. There is information on files to demonstrate how staff could recognise how individuals make choices. Good evidence of this is available from the residents and staff members spoken with. Daily routines are in place and each resident has time during the week to undertake domestic tasks such as house chores, including washing and shopping, where appropriate. I have started helping out on Sundays which I really enjoy said a resident in their survey. Appropriate action is taken so as to minimize any risks. Residents are assisted to understand the reason why strategies are used to reduce any risks. Risk assessments are in place and these have been reviewed and updated regularly. Care Homes for Adults (18-65 years) Page 14 of 29 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A variety of activities are available, both leisure and educational giving the people living in the home an excellent opportunity to lead a full and varied lifestyle. Evidence: Each of the individual plans seen during this inspection include aims and objectives for personal development. This is achieved through a variety of leisure, educational and some work based activities. 3 people living at this home attend college courses and 9 of the residents also have between 4 and 5 days attendance at various day centres. Activities programme is organised by residents and staff on a weekly basis. Activities that have occurred regularly include shopping, bus rides, discos, visiting family and friends, trips to the local pubs and clubs, bowling, drama, various board games and music and television. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: Plans are being made for holidays to Butlins and Blackpool for this Summer. Residents needs in respect of quality and diversity are being identified through ongoing assessments. 1 resident attends church every Sunday and 2 others, occasionally. Staff are currently exploring with residents for the local priest/church representative to visit residents at the home. The AQAA tells us Staff and management have taken part in an Introduction to Equality & Diversity in- house based course, targeting the need of our residents. The people living at Marlin Lodge have a good relationship within their local community. They are viewed as a part of the local community. Staff take steps to minimise risks, whilst allowing residents to maximise their independence as far as possible. Staff members and other residents only enter rooms when invited. Residents are able to spend their time as they wish. Staff members respect residents rights to live as they like in their own space. We would promote and respect the rights of each resident, said 2 staff members. My key worker knocks before coming into my room, said one resident. Residents are fully involved in the choices of food in the home. A weekly menu is organised. Choices are clearly offered and snacks and drinks are available as required. The dining rooms are spacious and well equipped. Evidence of staff promoting healthy eating is available. The service encourages the involvement of families. Evidence is available of regular contact, both with families visiting the home and people using the service supported to visit their parents. Care Homes for Adults (18-65 years) Page 16 of 29 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. Residents receive assistance with their personal and health care in the manner they prefer; this ensures that their identified needs are being met in a dignified and respectful manner. Evidence: Residents decide what they do and the daily routines are pretty flexible. The times for getting up or going to bed are led by the residents. They also confirmed that they choose their own clothes and hairstyle. Staff treats me with respect said one resident. Guidance and level of support required from staff in respect of personal hygiene is reflected in the care plans examined. The staff helped me get in touch with the council so I can get an appointee to help me with my finances, said a resident in their survey. The care files examined for 3 residents show that their health care is supported and overviewed with residents being enabled to access all relevant services. Staff support residents to receive the full range of health care facilities; also, they are conscientious in establishing good liaison with all relevant professional bodies that may be able to advise and enhance residents health. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: The policy and procedure on medication remains satisfactory. The home utilises a Blister pack system for the administration of medication. The storage and handling of medication is carried out appropriately. The medication administration records for 9 residents were viewed and these are in order. The manager said that all staff are able to administer medication; training records and information from staff spoken to indicates that all staff have received training on the subject. Care Homes for Adults (18-65 years) Page 18 of 29 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. The complaints and safeguarding procedures are well publicised; thus ensuring residents are listened to if dissatisfied with any aspects of the service and they are protected from harm. Evidence: The AQAA indicates Residents feel their views are listened to and acted on. Residents are protected from abuse, neglect and self-harm. The homes complaints procedure has been recently updated. Residents are given information in writing and in pictorial form on how to make a complaint if they are unhappy with any aspects of the care and support they receive. Completed surveys from 5 residents show that they feel able to make a complaint. I would speak to my manager or community nurse, reflected a resident in their survey. Equally, surveys from 5 staff members show that they Know what to do if they receive a complaint. I will speak to the staff and give the complainant the relevant documents if they wish to complain. I will also meet with them and discuss and work out ways to resolve the problem, stated a staff in their survey. There have been no complaints recorded in the home complaints file, since the last annual service review report in March 2008. There have been no complaints made to the Commission in the previous year. Overall, evidence shows that good systems are Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: in place to ensure that any concerns expressed by residents or relatives would be listened to and acted on. The policy and procedure in relation to safeguarding of vulnerable adults is satisfactory. Staff members spoken to and records examined show that they have attended the required training in relation to safeguarding adults. There has been one matter referred to the local safeguarding team, in relation to an alleged financial incident that occurred in the previous placement of a resident. The home management followed the local protocols for the protection of vulnerable adults. Information gained shows that staff take swift and appropriate action to protect and promote the welfare of residents. Care Homes for Adults (18-65 years) Page 20 of 29 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 domestic style furnishings and fittings in both houses help to create a very homely environment for the residents to live in. A high standard of cleanliness was evident. Evidence: Marlin Lodge is situated in a residential area of Luton and blends well with the properties in the vicinity. The home consists of 2 adjacent large detached houses known as wing A and wing B. 10 single bedrooms are offered in wing A and 5 in wing B. 7 bedrooms, communal areas and some of the bathroom and toilet facilities were viewed. All areas have been redecorated to a good standard. Some of the bedrooms are of a high standard; they contain numerous items that help in creating a homely and personal space for the resident. The residents spoken with said that they are very happy with their room, which contained photographs, pictures, television, music equipment and ornaments. There are 2 good size gardens to the rear of both properties, which are well maintained. A high standard of cleanliness was evident throughout. There were no health hazards noted. Care Homes for Adults (18-65 years) Page 21 of 29 Care Homes for Adults (18-65 years) Page 22 of 29 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The recruitment processes are robust, which means that residents are protected from harm. NVQ training ensures that staff have the knowledge and skills to meet residents needs. Evidence: The AQAA tells us Rota shows that there are enough staff to meet the needs of the residents.1:1 support is given to one person at all times and 1:1 support is given to one other at mealtimes. Information from staff and duty rota for a period of 4 weeks shows that there are adequate numbers of staff available at all times. In terms of skill mix, the staffing arrangements are appropriate to ensure that the needs of the people in residence could be met. All new members receive induction tailored to their needs. Yes, this was covered very well stated a staff member. Evidence shows that staff receive relevant training on a range of subjects including person centered planning, aggression and violence, dementia, medication, mental health, epilepsy awareness and rectal diazepam. Of the current 10 care staff, 9 hold an NVQ level 2 or 3; one member is currently doing an Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: NVQ level 2. This demonstrates that a high ratio (90 ) of care staff hold an NVQ Level 2 or equivalent. The recruitment policy and procedure was discussed with the manager and owner. Examination of personnel files for three staff members evidence that the required checks are in place, including references and Criminal Records Bureau checks. Staff interviewed said that the above checks had been carried out before they started work at the home. Evidence of recorded supervision sessions is available. Staff members spoken with confirmed that they receive formal 1 to 1 supervision regularly. Care Homes for Adults (18-65 years) Page 24 of 29 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 home is well-managed and robust policies and procedures ensure that residents receive a good and safe standard of care. Evidence: The manager has been managing this service for almost 2 years. She has completed the Registered Managers Award and an NVQ 4 in health and social care. The manager reported that she would be submitting an application to the Commission in April this year, for the registered managers post. She is being well supported by the owner. A formal quality monitoring system (form of annual surveys), based on seeking the views of residents and other stakeholders, in order to improve the quality of its service for residents is in place. The last annual survey was completed in November 2008; the manager is aware that a copy of the published survey report must be sent to the Commission. The owner visits the home regularly to support the manager and staff. He also undertakes monthly visits and evidence shows that a copy of the visits reports is provided to the home manager. Care Homes for Adults (18-65 years) Page 25 of 29 Evidence: The care and staff management systems within the home are well organised. Management supports us very well whenever we have any problems said a staff. We looked at some of the records the home is required to keep; these were found to be in order. Comprehensive policies and procedures are available and accessible to staff. Various checks are undertaken and good records are maintained. Fire drills are carried out monthly and checks of break glass points, weekly. The annual fire risks assessment has been completed. Staff receive the required health and safety training to promote the safety of residents and their colleagues. Care Homes for Adults (18-65 years) Page 26 of 29 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 29 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 5 Given the residents learning disability, the terms and conditions of residence should include their representatives signature where appropriate; this would also demonstrate their involvement in drawing of this document. The care plan should reflect the name and signature of the residents representative. This would demonstrate their involvement and agreement with its content. 2 6 Care Homes for Adults (18-65 years) Page 28 of 29 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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