Care Home: Milbury 9 Rosslyn Crescent

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What the care home does well People who live in this home have an excellent lifestyle where the staff support them to enjoy educational and leisure opportunities. The staff have a very thorough understanding of residents, which is particularly important for those who are unable to communicate verbally. Residents receive support that ensures that they receive prescribed medicines appropriately and healthcare needs are attended to through regular appointments with doctors and other healthcare professionals. Residents have individual care plans that reflect the support that they need. The staff have been together for a long time and work well together as a team. The home is managed well by an experienced and competent manager and documents and records pertaining to the smooth running of the home are well structured and easy to understand. What has improved since the last inspection? Since the last inspection, the recording of residents activities has improved as well as overall attendance at healthcare appointments, especially for dental treatment. Professional advice has been implemented to improve a specific residents challenging behaviour which has resulted in considerable reduction of incidents. Maintenance issues have been addressed, for example replacing a radiator and repairs to water taps. What the care home could do better: We have made two requirements in this report; the manager must attain a management qualification equivalent to NVQ level 4. (This has been restated from the last inspection. A date must be set for the refurbishement of the bathroom. We have also recommended that senior managers from Milbury review staffing levels and meet with staff to address their concerns about feeling undervalued. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Milbury 9 Rosslyn Crescent 9 Rosslyn Crescent Wembley Middlesex HA9 7NZ     The quality rating for this care home is:   three star excellent 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: THOMAS McKERVEY     Date: 1 0 0 6 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 28 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 28 Information about the care home Name of care home: Address: Milbury 9 Rosslyn Crescent 9 Rosslyn Crescent Wembley Middlesex HA9 7NZ 02089083410 02089083410 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) : Milbury Care Services Ltd care home 4 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 4 The maximum number of service users who can be accommodated is: 4 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: Learning disability - Code LD Date of last inspection Brief description of the care home 9 Rosslyn Crescent is a detached house situated in a residential turning off East Lane. It is reasonably close to North Wembley station and about 10 minutes walk to the shops. The home accommodates 4 people in 4 single bedrooms. The ground floor accommodation consists of an open plan lounge/dining room, laundry room, toilet, kitchen and a bedroom with en-suite facilities. The first floor accommodation has 3 single bedrooms and a separate bathroom and toilet. There is a garden at the rear of the property. There is off street parking for 3 cars at the front, with street parking also permitted. The homes Service User Guide is available on request. Fees for placement range from £1379 to £1421 per week, depending on the needs of the resident. Care Homes for Adults (18-65 years) Page 4 of 28 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: three star excellent 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 key unannouced inspecion was carried out in a period of four hours. The manager was away from the home, supporting a resident at an appointment when the inspector arrived, but returned soon after. The inspector thanks the manager and the staff for their openness and cooperation during the inspection process. The manager provided the Care Quality Commission with a detailed Annual Quality Assurance Assessment (AQAA) document in advance of the inspection. This document informs us about what the home does well and where improvements are needed. It also provides us with important information numerical about the service. Reference is made to the AQAA in various sections in this report. The inspection consisted of visiting all areas of the home, looking at residents and staffs files and other documents relating to the management of the service. We were Care Homes for Adults (18-65 years) Page 6 of 28 unable to converse with the residents who are non verbal but we were able to assess the quality of the care through observation and examination of records. We also received written comments from one relative and several staff in the surveys we sent out prior to the inspection. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.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 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 9 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users can be confident that full information about the service will be available to enable them to decide about the homes suitability to meet their needs. Evidence: The home has a statement of purpose and service user guide which provide full information about the service for prospective service users. At the time of this inspection, there were no new admissions. This leaves one vacancy outstanding, but the manager stated that one person is currently being assessed for possible admission. There was evidence that annual reviews are carried out by local authority placement officers to assess the homes continued suitability for its residents. These formal reviews were held in March this year and the records showed that family and day services staff were invited, along with the resident themselves and staff from the home. The home has a contract with Community Activity Services, (CAS) who support residents on various community based activities; for example, swimming. Care Homes for Adults (18-65 years) Page 10 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home have excellent care plans that are centred on them as individuals and accurately reflect their needs. They are supported to make decisions about their lives in accordance with their ability to communicate. Evidence: We examined all three care plans in detail. These were written in a person centred way in the first person, which underlines the individuality of the plan.We noted that comprehensive assessments of a wide range of needs had been documented, along with risk assessments relevant to each area of need. The plans are supported by pictures and icons to enable easier understanding for the resident. The persons physical and mental health, communication and mobility needs, spiritual and social needs are all documented. We noted that each resident has a key worker who reviews the care plan with them each month. It was evident that the plan reflects the individual support needs of each resident. Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: None of the residents are able to communicate through language. We observed staff supporting residents to make choices by various means, through verbal explanation, gestures and taking them by the hand. The care plans also provide written guidance about how to support people who are non verbal in decision making. For example; always show me the objects and talk through the activity with me. The staff we spoke to, knew the residents well and had a good understanding of their roles as carers. All of the residents require assistance in managing their personal finances and in dealing with any problems in respect of benefits received. We examined the financial records for two residents. They had a savings account and there was a record in the home of the balances held. The record included information about expenditure, receipts and a running total for money held in the home. The service manager audits the accounts, on a monthly basis as part of service monitoring. Checks of all expenditure on behalf of the residents corresponded with their records. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident of being supported in a range of stimulating and meaningful activities. Holidays are provided, and family relationships are maintained where possible. There is a good standard of healthy and varied meals provided. Evidence: At the front of each residents file, there is a statement about the residents rights to confidentiality. For example, it states; my care plan is private. This is a good example of how peoples rights are protected. Residents are supported to clean their rooms, do their laundry and participate in food shopping and preparation. The menus were varied and well balanced and we noted that fresh fruit was available. The menu for the day of the inspection was posted on the residents notice board. Photographs were also displayed to show the meals being provided each day. We were Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: atisfied that there were adequate food stocks in the home and food was stored and labelled correctly in the frige and freezer, with temperatures being monitored daily. Residents have a holiday each year. The manager stated that this years holiday was being planned and one resident will be holidaying abroad. One resident has regular visits from family; one other has periodic contact with their brother and one person has no know relatives. The Commission received two responses from relatives who filled in our surveys on behalf of residents. The comments were very complimentary about the home. One relative said; J is unable to communicate verbally, but her preferences are always taken into consideration. There is an excellent relationship between staff and Js family. We are kept informed and included in activities. 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be confident that appointments will be made for them with healthcare professionals when necessary and if they are unable to do so themselves, staff will give them their medication safely Evidence: As we noted under previous standards, there are excellent care plans to guide staff about how to meet residents health needs. When the inspector arrived at the home, one resident was at the dentist, accompanied by the manager and a member of staff. This resident had extractions under general anaesthetic and when she returned to the home, the staff were observed attending her in a caring and gentle manner, reassuring her and offering sips of water. The other residents were present and were said to be in good health. Residents were dressed appropriately in suitable clothing. We observed that staff knocked on residents bedroom doors befoer entering. Random checks of bedrooms found there to be a plentiful supply of clothing which was hung neatly. There are clear guidelines in care plans about how each person likes to be supported with personal care. We observed a member of staff sensitively and discreetly, encouraging a resident to visit the toilet. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: Each person had their own health record file which showed that they had attended appointments with health professionals, including the G.P, chiropodist and optician. An aromatherapist also provides sessions at the home. In each file there is a history of the persons health to provide information for health professionals. This is taken with the resident if they have to attend hospital. One person has epilepsy. There was specific guidance in the file about appropriate responses to seizures, along with a chart to record the frequency. There appeared to have been an improvement in these incidents due to appropriate reviews of medication. Staff records showed that they had been trained in the use of rectal Diazepam to treat epilepsy. None of the residents are able to self medicate. The medication stock was stored in an appropriate cabinet which was locked and attached to the wall. We checked the medicines and the records of administration. We were satisfied that they were accurate and tallied with the blister packs supplied by the pharmacist. There was a record of the amount received and what was returned to the pharmacy, and there was no surplus stock being kept. All medications were signed for as appropriate. 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents and their representatives can be confident that if they have any concerns about care in the home, these will be taken seriously and addressed promptly. Staff are trained in dealing with potential abuse so that residents best interests are safeguarded. Evidence: The home has an appropriate complaints book which showed that no complaints had been received since 2006. There have been no complaints to the Commission. A relative stated in a survey that they were very satisfied with the service but knew how to complain if they had any concerns. They were confident that this would be properly addressed by the manager. Each resident has a pictorial complaints procedure in their room. The manager stated that house meetings can be used by the residents to express if they are unhappy about anything. At the last inspection, we were concerned about the challenging behaviour of one of the residents which sometimes impacted on other residents. Subsequently, risk assessments were carried out and triggers for aggressive behaviour were identified so that staff were able to take appropriate action. The manager stated that this behaviour had ameliorated and there were now very few incidents. Where these occured, there was evidence in the records that they were managed safely to avoid injury to other residents and staff. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: Staff records showed that they had attended training in abuse awareness. We spoke to three staff who were very knowledgeable about this subject and described what actions they would take if they suspected abuse taking place. Care Homes for Adults (18-65 years) Page 19 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. Residents can be confident that they have a homely, attractive environment to live in and they can have their own personal possessions in their rooms. Evidence: 9 Rosslyn Crescent is a detached house situated in a pleasant residential estate. The property is domestic in style and provides a homely environment. We visited all areas of the home and we were satisfied that the majority of requirements made about the environment at the last key inspection had been complied with. The property is owned and maintained by Milbury and the manager told us that the response to requests for repairs is very prompt. The standard of decoration throughout the home was very good with the exception of the upstairs bathroom. This looked drab and there was a damp odour. This might be coming from the floor which felt soft and spongy. The manager stated that a complete refurbishment of this room was budgeted for but no date for the work had been agreed. Therefore we have made a requirement for this to be done as soon as possible. The manager said that work was due to commence very soon on repainting the exterior of the building where the paint was peeling. The main communal areas of the house consist of a lounge that seats five on comfortable leather sofas and armchairs. The dining area was well furnished and the Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: large garden was well maintained and looked attractive. Furnitue and lighting is domestic in style. We were informed that new garden furniture was recently purchased. The kitchen units were in a good state and the oven was very clean. All the bedrooms were bright and well furnished. The rooms were well decorated with many personal items in evidence; for example, photographs and ornaments. However, in one persons room the layout of the room did not make maximum use of the available space. The manager agreed with us about how this could be improved to allow the bed to be more appropriately positioned. The home has an ongoing problem with a toilet seat which is constantly damaged by a resident. It was evident that the seat had been replaced several times. The manager said that she is currently seeking advice about a more robust design to replace it. All areas of the home were very clean and tidy and the home smelled fresh. Training records confirmed that all staff have undertaken training in infection control. Care Homes for Adults (18-65 years) Page 21 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home can be confident that the staff who support them are well trained and supervised to ensure that residents needs are being met. Evidence: We examined two weeks of rotas which correctly identified the staff who were on duty at the time of the inspection. The rotas showed that two staff work the weekday mornings and evenings, and one person is on waking night duty. The manager is supernumerary. (CAS) staff also support residents on a sessional basis for various community based activities. At the time of the inspection, there were no staff vacancies and the home does not use agency staff. In discussion with individual staff, we were impressed by their evident committment to providing good care to the residents. However, we were informed that the company recently reduced the staffing level at the weekend from 3 to 2 staff. The staff were unhappy about this reduction which they said impacted on the residents weekend activities. This comment was also made in all eight surveys we received from staff. Some staff also felt undervalued by the company. In view of this, we recommend that senior managers review the staffing levels and address staffs concerns of feeling undervalued. Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: According to the AQAA, four staff have attained NVQs at level 2 or 3, and two others had just started. In discussion with the inspector, it was evident that staff had a thorough knowledge of the residents, particularly where staff were key working with residents. One new person joined the staff team since the last inspection. Their file contained proof of identity, job description and their induction records. All other recruitment records, including CRB checks and references are now stored at the companys head office, following an agreement with the Care Quality Commission. The Commission will be checking that appropriate recruitment checks are in place in due course. We saw a spreadsheeet of all the training staff had undertaken. This included all the mandatory health and safety subjects as well as other relevant subjects eg, crisis intervention. We saw certificates of achievement in the staff files. Staff files also showed that they receive regular one to one supervision. This was also confirmed by staff who were spoken to who said they found this process to be valuable in supporting them in their work. Care Homes for Adults (18-65 years) Page 23 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents benefit from a well run home that takes account of their needs and wishes. Staff are well supported in their role as carers. The residents can be confident that their health and safety is safeguarded by regular monitoring. Evidence: The registered manager has fifteen years experience of working with people who have a learning disability, including many years of working for Milbury. The manager demonstrated a thorough knowledge of the needs of the residents and her management responsibilities. The manager informed us that she had cancelled the course to attain the NVQ4 qualification which was a requirment at the last inspection. However, she is attending a management development programme at present. This qualification must be equivalent to the NVQ at level 4. This is stated as a requirement in this report. Recently, the manager attended training on the new Mental Health Act, including Deprivation of Liberty safeguarding. She also manages a budget for the home for Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: major items of expenditure. There was a relaxed and friendly atmosphere in the home during the inspection and staff were busy attemding to the residents needs. In our observations and in speaking to staff, we were satisfied that they worked effectively as a team. Staff told us that they felt well supported by the manager, but felt undervalued by Milbury senior management; (see comments under the staffing standards above). We saw records of monthy staff and residents minutes which showed that they have a say in how the home is run. We also saw copies of monitoring visits by senior managers from Milbury. We checked one residents financial records at random and found that receipts were kept and the amount of money in the persons cash tin tallied with the balance in the records. We were impressed with how all the required files and documents were structured in a way that made them easy to access and to follow. We noted that accidents were appropriately documented. These are also scrutinised by senior managers from Milbury. The home has a number of health & safety monitoring systems. We looked at various records, for example; fire alarm tests and drills, water temperatures, gas and electic service documents, and we found these were satisfactory. Similar audit checks are recorded for wheelchairs, first aid kits, and the homes vehicle. The AQAA states that all major installations are serviced annually. Care Homes for Adults (18-65 years) Page 25 of 28 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 37 9(2) That the registered manager 31/12/2007 achieves an NVQ level 4 in management and care qualification. Care Homes for Adults (18-65 years) Page 26 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 27 23 A date must be confirmed to 31/07/2009 refurbish the upstairs bathroom. This is to improve the comfort of residents. 2 37 9 The registered manager 31/12/2009 must achieve a management qualification equivalent to NVQ level 4. To ensure that the manager is fully equipped to manage the service. 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 33 Senior managers should review the staffing levels and meet the staff to address their concerns of feeling undervalued. Care Homes for Adults (18-65 years) Page 27 of 28 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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