Care Home: Penn House

What the care home does well Service users are provided with the key information on the home to enable prospective service users to make a decision as to whether the home can meet their needs. Service users have access to work and college placements to promote their well being. Family and friends involvement is promoted which benefits service users. Service users have access to a range of health professionals which records maintained to evidence this which promotes their health and well being. The complaints procedure is up to date and made accessible to service users to ensure they know how to raise concerns to safeguard them. The home is clean and homely which provides a comfortable environment for service users. The home has a dedicated manager who has addressed requirements and enforcement notices from the previous inspection as well as putting opportunities in place to promote service users involvement in the home and in building a very committed, motivated and trained staff team. What has improved since the last inspection? Systems are in place to ensure that prospective service users are assessed prior to admission to ensure that the home can meet their needs and promotes their well being. Service user plans include completed contracts to safeguard service users . Person centred care plans are in place which outlines service users needs and how those needs are to be met, including support required with finances. They are kept up to date and reviewed and show evidence of service users involvement which promotes their health, safety and well being. Detailed individual and generic risk assessment are included in care plans which address risks for individuals and safeguards service users. Opportunities for leisure activities have improved which benefits service users. Service users independence is being promoted with service users life skills being developed to promote this. Service users are more involved in meals at the home which includes making a choice of meal and participating in the preparation and cooking of meals which promotes their well being and independence. Accurate records are being maintained to evidence that complaints are being dealt with appropriately to safeguard service users. Staff are trained to recognise a potential safeguarding situation and report accordingly to safeguard service users. Individual risk assessments are in place to address any potential risks posed to service users by the use of free standing radiators, to promote their health and safety. The dampness in the downstairs shower room has been addressed to promote a clean and comfortable environment for service users. Regulation 37 reporting is taking place as required to safeguard service users. Permanent staff have the required mandatory training and specialist training to support them in their roles to benefit service users. Improvements have been made to the recruitment records to evidence that staff are being suitably recruited to safeguard service users. Records are available to evidence that that staff are properly inducted and supervised in their roles to benefit service users. The organisation has carried out an internal investigation in relation to issues raised by staff with appropriate action taken to safeguard service users. Records required for regulation have been reorganised and made more accessible which safeguards service users. The service is being effectively managed with improvements being made to how this is monitored to safeguard service users. What the care home could do better: Care plans and risk assessments should include written evidence of a review to ensure that any required changes are acted on to safeguard service users. The recording of information in service users daily files should be improved to accurately reflect the action taken. Effective monitoring of medication must be put in place to ensure that medication is given as prescribed The Organisation is reminded that the complete Criminal Records Bureau certificate for new staff is made available for inspection. The Organisation must ensure that a system is put in place to effectively monitor the training for bank staff with the manager of the home having access to this information. Key inspection report Care homes for adults (18-65 years) Name: Address: Penn House The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 0RJ     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Maureen Richards     Date: 2 8 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 39 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: Penn House The National Society For Epilepsy Chesham Lane Chalfont St Peter Gerrards Cross Bucks SL9 0RJ 01494601435 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): www.epilepsysociety.org.uk The National Society for Epilepsy Name of registered manager (if applicable) Type of registration: Number of places registered: care home 22 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 physical disability Additional conditions: The maximum number of service users to be accommodated is 22 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category : Physical disability (PD) Date of last inspection Brief description of the care home Penn House is one of a number of homes situated on the Chalfont Centre for Epilepsy. The home is registered to provide residential care to for up to twenty two adults with a physical disability, including one relief bed. 0 3 1 2 2 0 0 9 22 Over 65 0 The home provides care and support to individuals with a range of personal care Care Homes for Adults (18-65 years) Page 4 of 39 Brief description of the care home needs. The home is made up of five flats each with their own kitchen, sitting area and shower. Downstairs is wheelchair accessible. The Centre provides on site work placements which a number of service users from Penn house access. Alongside this there is an internet cafe, a shop and restaurant. There is access to public transport and the home is accessible to Chalfont St Peter Village, which allows for access to the towns of Amersham, High Wycombe, Uxbridge and Slough. Please contact the provider for the current range of fees. Care Homes for Adults (18-65 years) Page 5 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced key inspection was conducted over two days and covered all of the key National Minimum Standards for younger adults. Prior to the inspection, a detailed self assessment questionnaire known as the Annual Quality Assurance Assessment document was sent to the manager for completion and comment cards were sent to a selection of people living at the home and staff. Replies were received from nine service users and five staff. Those replies have helped to form judgements about the service and their responses have been included under the relevant sections of the report. Information received by the Commission since the last inspection was also taken into account and is reported on under the concerns, complaints and protection section. The inspection consisted of discussion with the manager, senior staff, support staff, service users and examination of some of the homes required records, observation of practice and a tour of the some areas of the home. Care Homes for Adults (18-65 years) Page 6 of 39 Feedback on the inspection findings and areas needing improvement was given to the manager and an Assistant Director of the Organisation at the end of the inspection. Enforcement notices and requirements from the previous inspection have been complied with, with remedial action taken by the manager to fully address one outstanding requirement.This inspection has resulted in two new requirements. The staff and service users are thanked for their co-operation and hospitality during this unannounced visit. Care Homes for Adults (18-65 years) Page 7 of 39 What the care home does well: What has improved since the last inspection? Systems are in place to ensure that prospective service users are assessed prior to admission to ensure that the home can meet their needs and promotes their well being. Service user plans include completed contracts to safeguard service users . Person centred care plans are in place which outlines service users needs and how those needs are to be met, including support required with finances. They are kept up to date and reviewed and show evidence of service users involvement which promotes their health, safety and well being. Detailed individual and generic risk assessment are included in care plans which address risks for individuals and safeguards service users. Opportunities for leisure activities have improved which benefits service users. Service users independence is being promoted with service users life skills being developed to promote this. Service users are more involved in meals at the home which includes making a choice of meal and participating in the preparation and cooking of meals which promotes their well being and independence. Accurate records are being maintained to evidence that complaints are being dealt with appropriately to safeguard service users. Care Homes for Adults (18-65 years) Page 8 of 39 Staff are trained to recognise a potential safeguarding situation and report accordingly to safeguard service users. Individual risk assessments are in place to address any potential risks posed to service users by the use of free standing radiators, to promote their health and safety. The dampness in the downstairs shower room has been addressed to promote a clean and comfortable environment for service users. Regulation 37 reporting is taking place as required to safeguard service users. Permanent staff have the required mandatory training and specialist training to support them in their roles to benefit service users. Improvements have been made to the recruitment records to evidence that staff are being suitably recruited to safeguard service users. Records are available to evidence that that staff are properly inducted and supervised in their roles to benefit service users. The organisation has carried out an internal investigation in relation to issues raised by staff with appropriate action taken to safeguard service users. Records required for regulation have been reorganised and made more accessible which safeguards service users. The service is being effectively managed with improvements being made to how this is monitored to safeguard service users. 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 on page 4. Care Homes for Adults (18-65 years) Page 9 of 39 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 10 of 39 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 11 of 39 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. Service users are provided with the key information on the home with completed contracts in place to safeguard service users. Systems are in place for assessments to take place prior to admission to ensure that the home can meet identified needs to promote service users well being. Evidence: Service users plans included an up to date service users guide with a copy of the statement of purpose displayed on the notice board and accessible to service users. At two previous key inspections it was evidenced that new admissions to the home, including those being admitted to the home for respite care were not being assessed and/or reassessed on admission with care needs not being reviewed and revised to take account of a change in their needs to promote their health, safety and well being. An enforcement notice was served following the key inspection in December 2009 that a system was to be put in place to ensure that a full assessment of needs is undertaken for each service user prior to them being admitted to the home, including those service users who are admitted to the home on a respite basis and to ensure Care Homes for Adults (18-65 years) Page 12 of 39 Evidence: that care needs are kept under review and revised when there is a change in service users circumstances or needs, including those service users admitted to the home on a respite basis. The timescale for compliance was by the 16th February 2010. Since the previous key inspection the home has had no new admissions.The Annual Quality Assurance Assessment document tells us that an initial health needs assessment and Epilepsy needs assessment are completed prior to admission to ensure that the home can meet the needs of the person. A blank template of this assessment document was viewed and found to be detailed and comprehensive. The Annual Quality Assurance Assessment document tells us that a service user considering moving into Penn House on a permanent basis will participate in transition meetings, day visits and weekend stays and their opinion is sought, listened to, and they aim to act on their comments to make improvements. The organisation has a referral and assessment policy in place dated July 2005 which supports this practice but does not outline the procedure for respite admissions. Alongside this the manager has developed a written protocol for respite admissions which includes a checklist prior to arrival, on arrival, during stay and on discharge. This enforcement notice is assessed as being complied with. At the previous inspection a requirement was made that the registered person must ensure service users contracts are completed in ink, signed and dated by the relevant people. Service users plans include a copy of their contract which was completed in ink, included the fees, the name of the current manager and were dated and signed by the service user and staff. This requirement is assessed as being complied with. Written feedback from service users confirm that seven out of nine service users were asked if they wanted to move into the home. One person indicated they were not asked if they wanted to move into the home and one person could not remember. All nine service users who responded indicated they were given enough information about the home before they decided if it was the right place for them. Care Homes for Adults (18-65 years) Page 13 of 39 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. Service users plans are person centred, up to date and specific as to how identified needs are to be met which promotes decision making, with a range of up to date risk assessments in place to safeguard service users. Evidence: Four service user care plans were viewed. Care plans contained a photograph of the service user and a personal details information sheet with two of the four care plans viewed containing a whats important to me information sheet. Since the previous inspection care plans have been developed in a person centred way and outlines the support required in relation to all aspects of care which include personal care, health care, daily activities, family contact, behaviours, spiritual and cultural needs and finances. These were found to be detailed and specific as to the level of support required under each area. The care plans viewed showed evidence of being reviewed monthly with a full review and updating of care plans scheduled to take place three monthly. Care plans included service users signatures to evidence service users involvement and awareness of their care plan. Following the previous key inspection Care Homes for Adults (18-65 years) Page 14 of 39 Evidence: an enforcement notice was served that all of the service users needs are clearly recorded on their care plans, that care plans are sufficiently detailed with clear action plans in place to ensure the identified needs of all of the service users are fully met, that care plans are kept under review and revised where appropriate to provide up to date and accurate information, that is cross referenced and corresponds to information on assessments. The timescale for compliance was the 23rd February 2010. The care plans viewed at this inspection evidences that this enforcement notice has been complied with. The care plans viewed outlined service users specific communication needs and support required in making choices and decisions in all aspects of their lifes, including day to day life at the home. This was an outstanding requirement from the previous inspection that has been complied with as part of the development of the care plans. The home can access advocates for individuals if required with an Independent Mental Capacity Advocate involved for individuals, where this was assessed as being required. Monthly resident meetings take place with minutes available to evidence this. The minutes indicate discussions and consultation on the meals, staffing, activities and holidays. A requirement was made at the previous inspection that the registered person must ensure that service user plans clearly and accurately reflect the arrangements in place in relation to who is supporting a service user with their finances, how it is accessed and what support is required from staff. The care plans viewed outlined the support required with finances and an up to date money management risk assessment. This requirement is assessed as being complied with. At previous inspections some service users had restricted access to their cigarettes with a protocol in place on how this was to be managed. This has since being reviewed with a person centred risk assessments in place for individuals which aims to give the service user more responsibility for managing their cigarettes. Written feedback from service users confirm that six out of nine service users always make decisions about what they do each day. Three service users fed back that they usually make decisions about what they do each day. Service user plans included person centred specific risk assessments in relation to risks associated with challenging behaviours, behaviours pre and post seizure, risks associated with individuals medical conditions and disabilities. These were cross referenced to care plans and showed evidence of being up to date and reviewed. It is recommended on review of the risk assessments and care plans that it includes written evidence of a review to ensure any changes required are made to care plans and risk assessments. Service users plans included a series of generic risk assessments in relation to fire, smoking, use of kettle, cooker, transport and risks Care Homes for Adults (18-65 years) Page 15 of 39 Evidence: associated with the promotion of service users independence and life skills. These were found to be up to date and reviewed. Service user plans included an up to date moving and handling risk assessment. An enforcement notice was served following the previous key inspection that each identified risk has a clearly documented action plan in place to ensure that the risk to the person health and safety is minimised or eliminated and to ensure that the risk assessments and corresponding action plans are reviewed at least monthly and updated according to the persons changing needs. The timescale for compliance was the 23rd February 2010. The risk assessments viewed at this inspection evidences that this notice has been complied with. Written feedback from five staff, confirm that two staff indicate they are always given up to date information about the needs of the people they support. Three staff indicate they are usually given enough information about the people they support. Care Homes for Adults (18-65 years) Page 16 of 39 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. Service users have access to some leisure activities, their independence is being promoted and they are provided with a choice of meals which benefit service users. Evidence: Some service users attend work placements on site and college. Service user plans include a weekly timetable of work/college activities that individuals attend with a record maintained in daily records and handover sheets of their participation. A record is being maintained of leisure activities that have taken place and are being offered which include day trips to Windsor castle, London Museum, Eastbourne, Henley on Thames, cinema trip, pub lunch and regular shopping trips. It also evidences some service users refusal to participate in activities. The home has recently acquired a part time activities coordinator with his role being developed to meet the needs of the service user group which includes facilitating in house activities and to promote the development of life skills for individuals in preparation for the closure of the home. Care Homes for Adults (18-65 years) Page 17 of 39 Evidence: The programme of activities indicates that a 2 weekly in house scrabble session and gentle exercise session takes place. Staff on duty confirmed that they had recently applied for travel concession cards for individuals which they felt would promote more individual activities off site. The rota indicates that extra staffing are provided at the weekends to enable activities to take place which include attendance at church services for individuals. There was an requirement made at the inspection in December 2008 that the registered provider must ensure that opportunities are made available to enable service users to access a range of leisure activities. This was assessed as not been complied with at the inspection in December 2009. At this inspection it was assessed that opportunities for leisure activities have improved with activities being made more available and accessible and the aim being now to motivate service users to participate. This requirement is assessed as being complied with. The residents meetings minutes and discussions with staff confirm that they are being supported to make a choice of an annual holiday with records available of how those choices were made. Care plans outline family involvement and the support required by individuals in maintaining those relationships. A requirement was made at the inspection in December 2008 that the registered person must ensure that opportunities are made available to enable service users to develop their independence and take a more active role in the day to day running of the home. At the key inspection in December 2009 it was assessed that this requirement was not complied with. At this inspection care plans, risk assessments and practices evidence that service users are being supported to take a more active role in day to day tasks which promote their independence and develop life skills in preparation for the closure of the service. Service users were observed to be much more involved in tasks which include menu planning, shopping and cooking. This requirement is assessed as being complied with and continues to need to be developed and expanded on. Service users care plans outline the support required with managing their post with up to date risk assessments in place in relation to keys to the home and bedrooms. Care plans indicate that staff enter service users bedrooms at night to check on individuals to promote their safety with service users consenting to this. At the previous inspection it was noted that the maintenance man and builder entered the home without knocking or ringing the bell. A good practice recommendation was made within the report to address this. At this inspection it was noted that visitors to the home including maintenance staff rang the door bell and then entered without being invited in. This should be further addressed. Care plans outline service users preferred form of address and service users can choose when to be alone or in company. During the inspection service users were observed spending Care Homes for Adults (18-65 years) Page 18 of 39 Evidence: time in their bedrooms and lounges with some service users watching TV in the main dining area. Staff were observed and heard engaging with service users with staff confirming that they are now encouraged to spend time with service users in particular the service users that they are key workers to. Service users are being encouraged to become more involved in housekeeping tasks and this is particularly evident in service users involvement in meals. Service users are supported to have three meals a day. Service users choose their own breakfasts and can prepare this in their own flats or in the main kitchen. Each service user gets the opportunity to choose the main meal on one day over a two week period with records maintained to evidence this. Alternatives can be provided for service users who do not like what is on the menu. All service users choose their own snack type evening meal which they prepare independently or with staff support if risk assessments deem this is required. A requirement was made at the previous inspection that the registered person must ensure that service users become involved in menu planning and choice of meals provided with alternative meal choices and options being made available to suit individuals likes. This is assessed as being complied with. One service user had expressed the wish to become fully self catering and a small hob was provided to enable this to happen with occupational therapy sessions scheduled to take place to further promote this. Service users are now being encouraged to participate in the main meal preparation on a rotational basis with this observed to be taking place during the inspection. The service users spoken to were very positive about their inclusion in meal preparations and cooking and appeared to be enjoying the experience. Records are maintained of meals eaten and food temperatures. Some staff expressed concern as to whether the meals being provided were balanced and nutritional as service users choose to have the same dishes on a regular basis throughout the week. This was evident on the menus viewed. Staff commented that they feel this should be the next stage in the development of the meals. Written feedback from service users confirm that eight out of nine service users can do what they want during the day, in the evening and at the weekend. One person indicated they were unable to due to their disability. Service users commented under what the home does well outings, meals out, nice meals, meal time support, good holidays. Service users commented under what the home could do better is more outings, spend more time with us, games, cards etc. Staff commented under what the home could better is to ensure all the residents are taken out. Care Homes for Adults (18-65 years) Page 19 of 39 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users health and personal care needs are met with care plans outlining the support required to ensure all needs are met in safe and consistent way. Improvements are required to medication recording and monitoring to safeguard service users. Evidence: Service users plans makes reference to the support required with personal care. Service users plans included up to date moving and handling risk assessments. Times for getting and going to bed are flexible with service users being encouraged to get up to attend work placements and colleges during the week. Care plans viewed evidences this. The Annual Quality Assurance Assessment document tells us that service users have access to a range of specialist health professionals with records maintained of appointments with health professionals. Staff act as key workers to service users and are involved in the development of care planning and risk assessments. Staff spoken with, were clear of this role with key working, care planning and risk assessment training having taken place to support this. A requirement was made at the previous inspection that the registered person must ensure that staff have training in key working, care planning and risk assessments to support them in their roles. This Care Homes for Adults (18-65 years) Page 20 of 39 Evidence: requirement has been complied with. Service users spoken with knew who their key worker was, with one service user particularly positive about how their key worker had supported them. Two of the four service users plans viewed included a whats important to me sheet which outlined service users preferred routines, likes and dislikes. The Annual Quality Assurance Assessment document tells us service users have access to the on site Neurologist, Psychiatrist, Psychologist, Epilepsy Specialist Nurse and Occupational Therapists. A dentist and General Practitioner hold regular clinics at the centre and services users would be supported to choose and access a General Practitioner or dentist of their choice if they so wish. Service users plans outline the specific support required in meeting all of their health needs and is specific as to the support required for individuals who are unable to express those needs. Alongside this records are maintained of appointments with individual health professionals and the outcome of the visit and follow up required. During the inspection it was noted that a number of service users were reviewed by the relevant health professionals due to changes in their health and well being. The Annual Quality Assurance Assessment document tells us that for immediate assessment of injuries and wounds, they have access to a First Line Nurse service over a 24 hour period who will travel to the service users homes to provide treatment and advice. At the time of this inspection ten of the thirteen service users were self medicating. Care plans made reference to the support required with medication and for service users who were self medicating there was an up to date medication assessment in place to support this decision with a record of spot checks and action taken to address any issues. The home has designated staff who are trained to administer medication. Staff undergo medication training and nine assessments of medication administration prior to being signed off to administer medication. A copy of a completed assessment was viewed. This was found to be a thorough and comprehensive document.The written test had highlighted some gaps in knowledge of that staff member.The team leader confirmed that the written test had been retaken and passed but the previous manager had been given that report to sign off and it had not been returned. This should be accessed and placed on file.The home had a member of staff who had been on long term sick and records were maintained to evidence that on her return to work she had been reassessed to confirm her competency to be involved in medication practices and administration. Staff have 2 yearly updates in medication management training with this training up to date or booked for all staff involved in medication administration. Senior staff are responsible for the ordering, receipt, storage and disposal of medications with records maintained of all medication in and out, including those taken on leave from the home. The home has individual medication records with Care Homes for Adults (18-65 years) Page 21 of 39 Evidence: a photograph, which includes a General Practitioner prescription medication administration record and a Consultant medication administration record. All medications administered are prescribed including homely remedies. Seven medication administration records were viewed. In three of the seven medication administration records viewed there was no gaps in administration of prescribed medication. In two medication administration records service users prescribed creams and bath lotions were not signed for. One service users care plan viewed indicated that the service user self adminstered this. The medication administration records need to reflect this and the manager confirmed in writing after the inspection that this was being addressed with the pharmacist as the current medication records do not allow for staff to indicate if medication is self administered. Two medication administration records showed gaps in administration of prescribed medication however the medication disposal records did not indicate that this medication was returned or disposed of to the pharmacy. The daily records did not make any reference as to whether the medication was given or not. The manager advised she felt the gaps were missing signatures as opposed to medication not being administered. The manager confirmed in writing after the inspection that this was being addressed through the introduction of a daily audit signature check which will be included on the shift planner. One service user who was self administering their medication had a weeks gap in signature for the administration of their medication. However on investigation it was confirmed that this medication was given the previous week as the service user was going away on leave and it was recorded on the previous weeks administration records and taken as prescribed. The medication administration records and daily records did not accurately reflect this. The manager confirmed in writing after the inspection that this was being addressed through planned training sessions with staff involved in medication administration. Service users records include a seizure description sheet and a protocol for administration of their as required emergency medication and as required medication to deal with challenging behaviours. In one service users medication administration record it indicated that their emergency medication was prescribed to be given as required with the protocol indicating it was to be administered twice a day. The medication administration records viewed evidences that on one occasion it was administered three times a day as opposed to twice a day as indicated on the protocol. The team leader confirmed that he dealt with this and the extra dose of medication was administered on the advice of the first line nurse. The daily records make some reference to this but do not make it clear that the third dose was administered on the advice of the first line nurse and the protocol does not indicate that there is the option for a third dose to be administered. The manager confirmed in writing after the inspection that the prescribing Doctor will be asked to make the protocol clearer on the medication administration record during his visit to the home the week following the inspection. A Care Homes for Adults (18-65 years) Page 22 of 39 Evidence: requirement was made at the previous inspection that the registered person must ensure that all medication administered is prescribed and that prescribed medication is given as per the Doctors instructions. The remedial action taken after the inspection evidences that this requirement has now been met with a new requirement made to ensure effective monitoring of medication takes place. Since the last inspection the team leader responsible for overseeing medication has introduced a stock check of all medication with records maintained to evidence this. She has introduced spot checks of medication records for service users who are self administering their medications and intends to set up a weekly audit of medications. The manager confirmed in writing after the inspection that the team leader will educate staff on medication issues identified at the inspection and provide procedural prompts and guidance for staff to reinforce practice. As a good practice recommendation the manager should also ensure that the recording of information in daily records improves to accurately reflect a situation. A medication management incident report is completed for all medication errors with those being reported to the Commission as a regulation 37 and to the Local Authority Safeguarding team for them to consider whether they are a safeguarding issue. Three service users commented under what the home does well is care for me well. Two service users commented under what the home could do better was to be more understanding of their needs, with one person given an example of medication level. Staff commented under what the home does well is quality of care. Care Homes for Adults (18-65 years) Page 23 of 39 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. Policies, procedures and training are in place to safeguard service users which promotes their safety and well being. Evidence: The Organisation has a complaints procedure in place, which was reviewed in March 2009. A summary of the complaints procedure is displayed on the notice board in the dining room and includes the Commissions up to date contact details. The Annual Quality Assurance Assessment document tells us that the home has two complaints which were dealt with within 28 days. The home has a complaints log in place which indicates those complaints were investigated and responded to. At the time of the inspection a complaint from a service user was being investigated. A requirement was made at the previous inspection that the registered person must ensure that all complaints are logged, investigated and responded to in a timely fashion. This is assessed as being complied with. Since the previous inspection the Commission received one complaint which was referred to the provider to investigate. The outcome of the investigation was that the complaint was unfounded. Written feedback from service users confirm that all of the service users that responded know who to speak to if they are not happy and know how to make a complaint. Written feedback from staff confirm that four staff indicated they know what to do if Care Homes for Adults (18-65 years) Page 24 of 39 Evidence: someone has concerns about the home. One staff member did not answer this question. The Organisation has a vulnerable adults and whistle blowing policy in place. The whistle blowing policy was reviewed and updated in March 2008. The abuse policy was last updated in March 2004.The home did not have a copy of the Local Authority safeguarding of vulnerable policy. This was accessed during the inspection and available on day two of the inspection. The Annual Quality Assurance Assessment document tells us that the home has made four safeguarding of vulnerable adults referrals and one investigation has taken place. The Commission made a safeguarding of vulnerable adults referral in relation to the complaint referred to above and was made aware of a safeguarding referral made by a family member. At the time of the inspection the outcome of those referrals and investigations have not been confirmed to the Commssion by the Local Authority safeguarding team. Staff spoken with confirmed their responsibility to report bad practice and abuse. At previous inspections it was assessed that all staff did not have up to date safeguarding of vulnerable adults training. An enforcement notice was served that all staff undertake training appropriate to needs of the service users in order to ensure that the service users needs are fully met and that they are protected from harm and abuse. The timescale for compliance was 23rd February 2010. The training records viewed indicate that all staff, including bank staff used on a regular basis have up to date safeguarding training with an update booked for the staff member who was on sick leave. This notice is assessed as being complied with. The Assistant Director present for the feedback from the inspection confirmed that all safeguarding referrals are reported to her and she then collates this information which enables her to pick up on trends. The service has some service users with challenging behaviours. An enforcement notice was served following the previous key inspection to ensure that all of the staff at the home have training to acquire the skills to support service users with challenging behaviours. The timescale for compliance was the 23rd February 2010. The training records viewed indicates that permanent staff have this training with this training booked to take place in June for bank staff used at the home on a regular basis. This enforcement notice is assessed as being complied with. Care plans viewed include guidelines and risk assessments on managing behaviours that challenge. A requirement was made at the previous inspection The registered person must ensure that staff are trained to assess whether a situation is a potential safeguarding incident and report accordingly. The in house safeguarding training that took place explored this and regulation 37 reports indicate this is happening. This requirement is Care Homes for Adults (18-65 years) Page 25 of 39 Evidence: assessed as being complied with. Service user plans made reference to the support required with finances and as outlined under standard 7 they included an up to date money management risk assessment with a separate finance folder in place where individual records are maintained of all financial transactions for individuals. Two service users money and records were checked and found to be in good order. Care Homes for Adults (18-65 years) Page 26 of 39 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is clean, homely and adequately maintained, with some improvements being made to areas of the home to promote a positive environment for service users. Evidence: The home is a detached house situated in the grounds of the Chalfont Centre. The house consists of five flats, each of between three and six bedrooms. There are four flats on the ground floor and one on the first floor. Each flat comprises of single bedrooms, kitchenette, lounge, shower, toilet and storage area. The Annual Quality Assurance Assessment document tells us that the individual kitchens in the flats have all been equipped to allow service users to prepare their own suppers in their own kitchens if they choose to. One of the lounges is used as a smoking area as the service users who live in that flat all smoke or they can choose to smoke outside. The home does not have a lift. The ground floor is accessible to a wheelchair user. The home has a bathroom with chairlift for service users who require support. The home has a communal sitting area and main kitchen. On the day of the inspection the home was found to be homely, welcoming, clean and generally well maintained. A requirement was made at the previous inspection for the damp in one of the shower rooms to be addressed. This requirement has been complied with. The Annual Quality Assurance Assessment document tells us that there are daily Care Homes for Adults (18-65 years) Page 27 of 39 Evidence: cleaning tasks which are carried out by the support staff, as per shift planners and service users have a timetable which is integrated into the shift planners, as to when they have agreed to clean and tidy their bedrooms, with staff support. At the previous inspection a requirement was made that the registered person must ensure that the use of free standing electric radiators do not pose risks to service users with individual risk assessments in place to confirm this. Service users care plans viewed evidences that this requirement has been complied with. Written feedback from service users confirm that they think that the home is usually fresh and clean. Care Homes for Adults (18-65 years) Page 28 of 39 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. Staff are suitably recruited, inducted, trained, supervised and supported in their roles with the need for bank staff training to be effectivley managed to safeguard service users. Evidence: Staff on duty during the inspection were found to be approachable and comfortable with service users with an increase in interactions noted from the previous inspection between staff and service users. Staff confirmed that this was being encouraged. Staff spoken with felt they had the skills and training to do the job required with specific training in risk assessments, care planning, key working and report writing provided for some staff to support them in their role as key worker. A requirement was made at the previous inspection that the registered person must ensure that staff have training in key working, care planning and risk assessments to support them in their roles. This is assessed as being complied with. The training records indicate that staff have access to specialist training which include epilepsy, equality and diversity training, dementia awareness, mental capacity act and deprivation of liberty training. The manager confirmed that six staff have achieved a National Vocational Qualification and one staff member is undertaking this training. At the time of the inspection the home had eleven full time staff which included a deputy, three team leaders, one shift leader, six support staff and three night staff. The rota indicates that there is four staff Care Homes for Adults (18-65 years) Page 29 of 39 Evidence: on the morning shift, three staff on the afternoon shift and two staff at night. The rota also evidences that there are five staff at the weekends to allow for activities. The staffing levels have recently being reviewed and decreased from four to three in the afternoon shift in line with a decrease in service users numbers and the staffing budget. The manager confirmed that this will be reviewed. During the day time shift there is always a team leader or shift leader on duty. There is back up medical cover 24 hours a day. The manager confirmed that the home has two full time support worker vacancies which they have recruited into and those staff are due to commence work in May and June. The home has taken on staff from another service that was closing and are less reliant on bank staff. Staff are responsible for the cooking and cleaning and the home has a part time administrator and activities co ordinator. The manager is not included on the rota but works closely with staff in promoting good practice. Staff meetings take place monthly with records available to evidence this. Staff confirmed that they are encouraged to contribute to and be involved in staff meetings. Three staff recruitment files were viewed. The files viewed included an application form, copies of terms and conditions, job descriptions, pre employment health check, confirmation of Criminal Records bureau check and two references. In one of the files viewed which was for a new member of staff their full Criminal Records bureau certificate was not provided as this is blanked off by personnel. The organisation is reminded that the complete Criminal Records Bureau certificate must be made accessible to the Commission for new staff in post from the previous inspection. A requirement was made at the previous inspection that the registered person must ensure that all staff are suitably recruited with all of the required records in place to evidence this. This related to references and has been complied with. A requirement was made at the previous inspection that the registered person must ensure that all staff are suitably inducted into the home with records accessible to evidence this. The Annual Quality Assurance Assessment document tells us that all new staff participate in corporate induction before beginning work on the house and that new permanent staff under go an 8 week induction programme, bank and agency staff complete a short shift induction and there is an induction for shift leaders new to the home. Completed indcution records were viewed which confirmed this and feedback from new staff supported this. This requirement is assessed as being complied with. All new staff complete mandatory training as part of their initial induction by the organisation and the Annual Quality Assurance Assessment document tells us that staff can participate in the pay for knowledge scheme after they have received their Care Homes for Adults (18-65 years) Page 30 of 39 Evidence: permanent contract. The training records viewed evidences that permanent staff have the required mandatory training with training updates already booked for staff where this was required. An enforcement notice was served at the previous inspection to ensure that staff undertake training appropriate to the needs of the service users in order to ensure that the service users needs are fully met and that they are protected from harm and abuse. The timescale for compliance was the 23rd February 2010. This is assessed as being complied with in relation to mandatory training of permanent staff. Bank and agency staff are managed centrally. The home uses regular bank staff to cover their night shifts but the recruitment and training records for those individuals are not made available to the manager, so the manager is unaware of what training those individuals have. Confirmation of training for bank staff was received after the inspection. It evidences that mandatory training updates were overdue for those staff but were confirmed as booked for June 2010. The organisation must ensure that a system is put in place to effectively monitor the training for bank staff with the managers of the home having access to this information. The deputy Director of Services provided an action plan after the inspection as to how the Organisation were going to address those shortfalls in training for bank staff. The home does not have an up to date matrix of training with this information being accessible by looking at a number of different records. The administrator agreed to address this. Staff spoken with confirmed that they get regular supervision and the required support. The sample of supervision records and supervision matrix viewed confirms this. A requirement was made at the previous inspection that the registered person must ensure that staff are regularly supervised to support them in their role. This requirement is assessed as being complied with. At the previous inspection staff raised concerns in relation to how they were supported and managed. This was fed back to the organisation to investigate and a requirement was made that the registered person must ensure that the Commission is informed of the outcome of their internal investigation into issues raised by staff. This requirement was complied with and appropriate action taken. At this inspection staff were very positive about the support and guidance they receive. They feel they work well as part of a team, they feel included as part of a team and feel they are clear of their roles and responsibilities with clear guidance in place to support them. The manager has introduced a shift planner so that work is delegated fairly and a handover sheet to promote communication. Staff have specific responsibilities delegated to them with monitoring systems being put in place to ensure those delegated tasks are carried out. Staff confirmed they were happy with the changes made within the home and appeared motivated and committed to the continous development of the home which they felt had benefited service users. Care Homes for Adults (18-65 years) Page 31 of 39 Evidence: Five out of nine service user fed back that the care staff and managers usually treats them well, two fed back that the care staff and managers always treats them well and one service user fed back that they sometimes treat them well. Four service users fed back that the carers always listens and act on what they say. Five indicated that the carers usually listen and act on what they say. One service user commented under what the home could do better was have more permanent staff. Written feedback from staff confirm that they have all had the required recruitment checks carried out on them before commencing work. Two staff indicated that their induction mostly covered everything they needed to know to do the job, one staff indicated that their induction covered everything they needed to know about the job, very well. One staff member indicated that their induction partly covered everything they needed to know about the job and one staff member indicated their induction did not cover what they needed to know about the job. This person did not make any comments to support this. Four staff confirmed that they have been given training relevant to their role that helps them understand and meet service users needs, that keeps them up to date with new ways of working and gives them enough knowledge about health care and medication. One staff member confirmed they have not been given relevant training to do the job. This person did not make any comments to support this. Written feedback from staff confirm that two staff feel the way they share information about the people they support or care for with others and the home manager always works well. Two staff feel the way they share information about the people they support or care for with others and the home manager usually works well and one staff member did not answer this question. One staff member fed back that there is always enough staff to meet individual needs of service users, two staff fed back that there is usually staff to meet individual needs and one staff member did not answer this question. Two staff indicated that they always have enough support, experience and knowledge to meet the different needs of people who live at the home. Two staff indicated they usually have enough support, experience and knowledge to meet the different needs of people who live at the home. One staff member did not answer this question. Care Homes for Adults (18-65 years) Page 32 of 39 Evidence: Staff commented under what the home does well is that it has improved in standards of communication and have improved their paperwork. There is good management and they help each other. Staff commented under what the home could do better is better staff communication and good teamwork, to have a more open policy, to understand that they need time to change many things. Care Homes for Adults (18-65 years) Page 33 of 39 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is been effectively managed with monitoring systems in place and being developed to safeguard service users. Evidence: Since the previous inspection the home has been managed by the manager who was in the acting role at the time of the previous inspection. She has been proactive in complying with enforcements notices, in ensuring that requirements have been met and in improving the service for service users. There is one requirement which records evidenced had not been fully complied with and the manager was proactive in addressing this, with written confirmation being received after the inspection as to the remedial action taken which evidenced this requirement was now met. This inspection has resulted in two new requirements, with good practice recommendations referred to under various sections of the report. Staff confirmed that the manager is approachable, supportive, a good listener, acts on concerns raised by them, she treats everyone fairly and delegates effectively. She has been instrumental in developing a committed and motivated staff team who appear to work very well together. The manager confirmed she is supported, guided and monitored in her role by the Deputy Care Homes for Adults (18-65 years) Page 34 of 39 Evidence: Director of Services, who she feels have been invaluable in enabling her to improve the service. The manager has obtained a National Vocational qualification level 4 in care and is undertaking a National Vocational qualification level 4 in management. She is in the process of making her application to the Commission to become the registered manager of the service. A requirement was made at previous inspection that the registered person must consider how this service will be managed to ensure that requirements are complied with to improve practice. This is assessed as being complied with and the organisation now needs to ensure that the managers application for registration is made without further delay. Until such time as the manager is registered and she has completed her National Vocational Qualifaction level 4 in management this impacts on the overall rating for this section. Staff commented under what the home does well that they are helping the manager to meet the requirements from the last inspection and feel that the home is much improved. One staff member commented that they really appreciate that the manager and deputy work closely with them and provide support. The organisation has introduced an annual quality monitoring tool which the manager is required to complete in retrospect. Alongside this as part of the new registration process managers have been delegated the task of providing evidence as to whether outcomes are met or not and this is then fed back in to the training for managers. There is currently a system in place to audit aspects of care including accidents, incidents, medication mis-management, seizures, safe guarding referrals, and complaints for the whole organisation as well as a health and safety audit of the service. The manager has also introduced monitoring of staffs practice which includes monitoring of care planning, risk assessments, service users finances, activities and service user room checks and communal areas. Since the previous inspection records evidence that the Regulation 26 monitoring visits have improved with records required for regulation being inspected as part of those visits, as well as feedback being obtained from service users and staff. At the previous inspection the Deputy Director of Services confirmed that they are piloting a new form of Regulation 26 reporting and visits which will include a governor and a manager from another service on site. The Regulation 26 records viewed evidence this has not yet commenced. A requirement was made at the previous inspection that the registered person must ensure that the service is being effectively monitored with records on file to evidence the monitoring that is taking place. This is assessed as being complied and now must be sustained and maintained. The Organisation has the required policies and procedures in place, some of those policies are overdue for review with some recently being updated. Care Homes for Adults (18-65 years) Page 35 of 39 Evidence: At the previous inspection records required for regulation were disorganised, being filed in more than one place, with some records missing. A requirement was made to address this, which has been complied with. At this inspection records have been reorganised, made accessible and staff are aware of where to access them. As outliined under standard 20 there was gaps in medication administration records and daily records did not accuratley reflect action taken. As a good practice recommendation this should be addressed and monitored. All permanent staff have got up to date mandatory training or updates have already been identified and booked where required. An enforcement notice was served at the previous inspection that incidents and accidents which adversely affect the health, safety and welfare of service users are reported to the Commission without delay and ensure that those incidents and accidents are reported to the Commission they are confirmed in writing. The timescale for compliance was the 16th February 2010. The regulation 37 folder has been reorganised and staff have been made aware of their responsibility to report such events. The service folder held by the Commission includes copies of regulation 37 notifications received which correspond with copies of regulations 37 reports, accident/incident reports, medication errors reports on file at the home. This notice is assessed as being complied with The Annual Quality Assurance Assessment document tells us that the maintenance and servicing of equipment is up to date. The home does not have risk assessments in place in relation to safe working practices. The manager had identified this and had intended to address it once other areas of priority in relation to requirements and enforcements notices had been addressed. A sample of health and safety records were viewed and found to be organised and in good order. The home has a nominated health and safety person and fire warden. Care Homes for Adults (18-65 years) Page 36 of 39 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 37 of 39 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 20 13 The registered person must ensure that effective monitoring of medication is in place to ensure that medication is given as prescribed. To safeguard servcie users 04/06/2010 2 35 18 The organisation must 30/06/2010 ensure that a system is put in place to effectively monitor the training for bank staff with the managers of the home having access to this information To safeguard service users and staff. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 38 of 39 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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