Care Home: Signpost Children's Services Ltd

What the care home does well Appledore Farmhouse provides people with a spacious, homely environment that has been equipped to ensure that people with a hearing impairment can lead an independent life as possible. People currently living at the home said `I love care home, very safety good fresh things look excellent.` `this is the best, more confidential and peace, but work hard and learn lots of work or projects and household develop or own life and friendship care and support each other.` Care and support is delivered by a staff team who understand the needs of the people they support. They have excellent training and supervision offered on a regular basis. One staff member commented `I travel from a long way because I love working for this organisation and they really support staff to develop skills.` The home provides an excellent range and choice of meals and people are encouraged to be involved in cooking, shopping and learning skills for more independent living. People have opportunities to be involved in a range of activities and staff work hard to ensure that activities are geared to meet the needs of the young people including their diverse needs socially and culturally. The home is well run with good systems in place for ensuring that individuals views are listened to and acted upon. The management approach is open and inclusive and both individuals who live at the home and staff feel their concerns and ideas are listened to and acted upon. What has improved since the last inspection? As this is the first inspection for this service we are unable to comment on any improvements over the last year. The service has only been running for 6 months, but they have clear ideas of where they wish to improve and have detailed this to us within their AQAA. What the care home could do better: Individuals could be encouraged to take some responsibility toward their medications by having their medications in locked cabinets within their own room. The service needs to consider how it will formally demonstrate that quality of care and support is being reviewed over the next year, with the use of surveys and audits. Key inspection report Care homes for adults (18-65 years) Name: Address: Signpost Childrens Services Ltd Appledore Farm House Burlescombe Tiverton Devon EX16 7LQ     The quality rating for this care home is:   two star good 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: Joanne Walsh     Date: 1 7 1 2 2 0 0 9 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 27 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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 CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 27 Information about the care home Name of care home: Address: Signpost Childrens Services Ltd Appledore Farm House Burlescombe Tiverton Devon EX16 7LQ Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Ian Heppell Type of registration: Number of places registered: care home 3 Signpost Childrens Services Ltd Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 sensory impairment Additional conditions: 1.The registered person may provide the following category of service only; Care home only (code PC) to service users of either gender whose primary care needs on admission to the home are within the following category: Sensory Impairment - Code SI - maximum of 3 places 2. The maximum number of service users who can be accommodated is 3. Date of last inspection Brief description of the care home Signpost childrens service-Appledore Farmhouse is a detached house in a rural location, but close to the M5 and local towns of Tiverton, Exeter and Wellington. It provides 24 hour care and support to young adults who have complex needs including hearing impairment or deafness, autist specrum disorder, ADHD and challeging behaviour. Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 3 Brief description of the care home The home provides single spacious bedrooms and commual space includes a lounge, dinning room, kitchen and two bathrooms. All staff are qualified in British Sign Language (BSL), have training and experience in working with behaviours that challenge. The ethos of the home is to provide a stepping stone for individuals to learn daily living skills and be ready for moving onto more indpendent living within an agreed timeframe. Fees can be obtained driectely from the home and CQC reports are made available to individuals who live at the home, staff and interested parties as requested. Care Homes for Adults (18-65 years) Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place during a week day in December and lasted approximately 5.5 hours. During this time we spoke to 2 people about their experiences of living at the home. We used a British sign language interpreter as this is the primary language used by people who live at this home. We spent time observing how care and support was being delivered to people, including the lunchtime period. We also spoke to three care staff, the manager and the operations manager. We looked at some of the key documents including plans of care, pre admission assessment information, staff recruitment and training files, records relating to medication and individuals monies. This helps us to understand how well the home is run and managed. The home had been notified that a review of the home was due and had been asked to complete and return an AQAA (Annual Quality Assurance Assessment). This shows us Care Homes for Adults (18-65 years) Page 6 of 27 how the home has managed the quality of the service provided over the previous year. It also confirms the dates of maintenance of equipment and what policies and procedures are in place. Information from this document was used to write this report. During the inspection 2 people were case tracked. This involves looking at peoples individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process we try ask as many people as possible for their opinion on how the home is run. We sent questionnaires out to people living at the home; representatives, health and social care professionals (including GPs and care managers) and staff. At the time of writing the report, responses had been received from 2 people living at the home, and 4 from staff. Their comments and views have been included in this report and helped us to make a judgment about the service provided. As this is the first inspection since the registration of this service our systems do not allow us to give them an overall rating of excellent, as they do not have a proven track record. We have however acknowledged that they are working to a very high standard and exceed standards in some outcome groups. Care Homes for Adults (18-65 years) Page 7 of 27 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 on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 27 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Clear and detailed pre admission assessment processes ensure that the service will only offer a placement once they have established they can meet all assessed needs. Evidence: The service have developed a really good clear guide for people who may wish to consider a placement at the home. The individuals who currently reside at the home said hat they were given this information, that they were given the opportunity to look around the home before making the decision to move in. They said that they had both previously been at a service for young adults also run by the same company who already knew their needs well. We saw from the information on each person that the service had obtained care management assessments and care plan information, clinical assessments and had completed their own detailed assessments of each persons needs. This information has helped them to develop a comprehensive plan of care that covers personal, health social and diverse needs for each person. Care Homes for Adults (18-65 years) Page 10 of 27 Evidence: Staff that we spoke to and those who returned surveys felt that the senior management team always ensured that assessment information was available to staff so that they could fully understand the needs of people they support. One of the individuals living at the home told us that they continued to be consulted about any potential third person moving in and they said that when someone visits they are asked their opinion about the person and their views about whether they will fit in. Care Homes for Adults (18-65 years) Page 11 of 27 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care and support is well planned and risk assessed so that individuals are able to be supported to make their own decisions and choices about their lives. Evidence: The two people currently living at the service were asked about how care and support is planned and what involvement they had in developing their plans of care. They told us Plans are in the staff office, we do have access to care plan, healthy care plan when we want. It is kept in office because we dont want anyone to see personal stuff, but we can see them and do with our staff help to write them. We saw that each person had a detailed plan of care that included what each persons personal, health and emotions needs are and how these are to be met. It also includes details of any identified risks and how these are to be minimised or reduced. Plans had been signed by the individual and there was evidence to show that they are being updated and reviewed on a regular basis. Care Homes for Adults (18-65 years) Page 12 of 27 Evidence: The AQAA states Each service user has an individual, tailor-made placement plan which includes, the reason for and purpose of the placement, accommodation, education, training and employment, health and diet, independence training and family and other contact. This plan is freely available for the service users to read and is regularly reviewed and amended in line with their independent progress, needs and aspirations. For each and every service user, we also formulate other key plans, which are; a risk assessment, a behaviour management plan and a health plan. These additional plans detail the services and treatment they will receive in order to help the individual gain greater control over their behaviour, which negatively impacts upon their lives and relationships. The people who live at the service said that they believed they were able to make decisions and choices about their everyday lives. One gave the example of when they first moved into the home staff wanted them to decide how it should be decorated we both decided what we wanted, then all done it together, we did these pictures for around the house. The service ensures that everyones view is listened to via regular meetings, including a house meeting where one of the individuals who lives at the home told us they were chair, and had to do the minutes. We saw that individuals are supported to manage their own finances with some minimal support from staff. Care Homes for Adults (18-65 years) Page 13 of 27 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals diverse and social needs are well met. Evidence: The two current people living at the service are very active and busy with college, work placement and various social activities. They told us I am full time at Exeter college, art and design course I go to the deaf college at Exeter, yes full time They also told us that staff always ask them what they would like to do around the house and for outside activities. One person said that staff are helping them to develop their independent living skills with cooking and that they share household tasks and chores. One person told us At the weekend we do things like pool, bowling, night club, we choose and we need to plan it. Another person said We have gots loads of things to do, we are going to start bike riding in January. Care Homes for Adults (18-65 years) Page 14 of 27 Evidence: When we asked what people enjoyed doing during their free time we were told that they enjoy watching TV, computer games, playsation and Wii games. The AQAA says We encourage and support the service users to participate in training courses which are available to staff, in order to increase their own skill set. We encourage the service users to participate fully in education and nurture aspirations for further education. We support the service users to find appropriate jobs and provide communication support in interview situations. We have with the assistance of the Exeter Royal Academy for Deaf Education identified a suitable work experience venue for one service user, a member of staff attends the work placement and provides communication support. Staff that we spoke to and those who returned surveys felt that they were able to offer individuals a good range and choice of activities as the staffing ratios were high. They said that activities are tailored to individuals needs and wishes. Being a small service the menus and meals are very much planned around individuals likes and dislikes and where possible individuals are fully involved in the shopping , menu planning and meal preparation. Both individuals said they were very happy with the quality, quantity and variety of meals they were offered. One person told us that had lost weight had had been helped to learn about healthy options. One of the things that the home are currently developing is a Do It Yourself independence guide. This will be for the use of the service users, and will be in a question format. It will contain questions, activities and helpful hints, including how to turn off the water in an emergency and how the most economic way to wash clothes is. This will be a useful guide for moving onto more independent living. Care Homes for Adults (18-65 years) Page 15 of 27 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals personal and health care needs are well met Evidence: The current people living at the home need minimal support in their personal care and it is clear they are supported to express their individuality in the way they dress and personalise their rooms. Both individuals said they were treated with respect and as adults. Technical aids are available within the house to maximise independence, such as to special equipment that enables them to use the telephone. Televisions have text and sub title adaptations. Individuals health care needs are clearly identified within their plan of care and special support is used for any additional health care needs, such as counseling. Medication is currently kept in a locked medication cabinet in the staff office. Records in relation to receiving and administering medications are well organised and up to date, providing a clear audit trail. We discussed the fact that individuals could be encouraged to take on some responsibility for their medications, by having a locked medication cabinet in their own bedrooms. The registered manager agreed this would Care Homes for Adults (18-65 years) Page 16 of 27 Evidence: be a good step forward and will look into this. Care Homes for Adults (18-65 years) Page 17 of 27 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Individuals views are listened to and acted upon Evidence: The home has a simple complaints process that has been developed in a format that individuals can easily understand. The two people currently living at the home when asked could they made their concerns known said yes, One said I would be comfortable to talk to staff, always solve the problems, we dont tell them, we could get angry, but talk about it, help staff to help us. Staff we spoke to and those who returned surveys said that the home had proved good clear training on what to do if they suspected abuse and that policies were available at all times for them to refer to. One staff member said that a senior manager was always available to contact and talk to if they had any concerns or worries. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home provides a clean, safe and homely environment that has adaptations for people with a hearing impairment, allowing them independence. Evidence: The house provides care for individuals who are Deaf and who have associated communication difficulties and as a result, is fully fitted with appropriate environmental equipment including, strobe alarms, vibrating pads, flashers on bedroom doors etc. The Individuals have access to special equipment that enables them to use the telephone. Televisions have text and sub title adaptations and the residents are provided with any additional equipment that might assist with their communication needs. Each person has their own large bedroom, which is fitted with a lock, to ensure that they have privacy. Individual bedrooms are fully fitted with furniture to meet their current needs and wishes. Each person has access to a shared bathroom and shower. The home can accommodate up to 3 young people with two bathrooms. The house is safe and well-maintained. As detailed in the house strategies, the front door remains locked at all times, to ensure that unauthorised persons cannot gain admittance. The staff team and individuals work together to ensure that the house is clean and tidy. There is an Infection Control policy which is adhered to in order to promote good Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: hygiene practices. The utility room houses the washing machine and tumble dryer and as such is separate to the kitchen. The individuals who currently live at the home, with the help and encouragement of the staff team have taken steps to personalise the house with the use of their own artwork. Care Homes for Adults (18-65 years) Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well trained and supported to do their job. Evidence: The staffing levels are high in line with the needs assessments and complex needs of the people using the service. Recruitment and training information shows us that there is a highly qualified and experienced staffing team, who are all able to communicate in the service users primary language of British Sign Language. Staff we spoke to and those who returned surveys all said that they had received excellent training and support to do their job. Comments from staff included Every aspect of care is done well. The knowledge of the senior team is fanatic, and this is a lovely working environment. Love working for signpost, work very hard as a team, including the service users. Another staff member told us the organisation work with our strengths and we are all encouraged to gain more qualifications. We looked at three recruitment files during this inspection and saw that they have a robust system in place. They always make sure appropriate checks and references are completed prior to new staff being offered a job. This ensures that only people suitable to work with vulnerable young people are offered employment. Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: We saw that staff training is comprehensive and includes all core health and safety skills as well as more specialist training to help them understand and support the people living at the home. Care Homes for Adults (18-65 years) Page 22 of 27 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and run in the best interests of the people who live there. Evidence: The registered manager is qualified and experienced to run the service which offers specialist support to young adults with hearing impairment and autistic spectrum disorder. Individuals who live at the home and staff we spoke to all said that the manager was very approachable and believed that there was an open door policy and they could talk to him about any concerns or ideas for the home. In the AQAA the home states they have A specific induction workbook which meets the requirements of the National Minimum Standards. Each staff member has an individual supervision record book which is held in the lockable personnel cabinet. The Manager has 9 years experience in care and 4 years as a Manager he holds NVQ level 4 in care and the ILM Mangers award. The home Aims and objectives are clearly stated and are reviewed on a regular basics to ensure objectives are achieved, all policies and procedures are available for staff and are fully implemented, the home has a weekly budget for the day to running of the care home this is agreement with Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: the staff team and the service user, any extra expenditure is requested to the house Manager or Deputy the budget is reviewed on a monthly basics. Each service user has a written contract they are asked to read and discuss the contract with their key worker and any issues are taken up with the house Manager. All the staff team update their training needs and develop their job skills regularly this is reviewed in house meeting and in supervision. The home operates an open door policy in which the service users know they can speak to the house Manager or staff team at any time about any concerns or issues they may have, they also have regular meetings with the house Manager to voice their options. The home has been open for approximately six months and is still developing ways of ensuring that quality assurance is monitored and reviewed. They have already developed good ways of making sure the voice of the individuals who live at the home is listened to. They have regular house meetings, one to one time and key worker time. The home ensures that staff have key training in all areas of health and safety. This ensures staff are able to do their job safely. The pre inspection questionnaire (AQAA) evidences that the home ensures all safety checks are completed, that equipment is serviced and policies and procedures are in place for all health and safety matters. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 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 42 The service needs to further develop its systems for ensuring that quality assurance is measured, including internal audits on an annual basis. Care Homes for Adults (18-65 years) Page 26 of 27 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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