Care Home: St Laurence

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What the care home does well Prospective residents receive detailed information about the home to assist them in making an informed decision about accommodation. Care plans provide detailed information about the abilities and needs of the residents and how staff can best support each resident. Staff are provided with extensive opportunities to update their knowledge and skills to ensure that they remain equipped to meet the needs of the residents. Six staff have completed an NVQ (national vocational qualification) at level two and three have completed level three. A further five staff are working towards level three and two are working towards level four. Staff receive regular supervision and a staff member spoken with stated that they find supervision very beneficial, `you can express opinions and views freely`. Another staff member said that they don`t have to wait until their supervision as the manager is always available. What has improved since the last inspection? A new admission procedure was drawn up and this was available for use when a new resident was admitted to the home. Each of the residents now has a health action plan in place, which details their needs in relation to their healthcare and assists staff to ensure that all identified needs are met. Staffing levels have improved and the manager`s contracted hours are now split evenly enabling her to have twenty hours a week to concentrate on managerial tasks. The manager has completed the RMA (Registered Manager`s Award). Staff reported that staff recruitment and retention has improved in recent months which has ensured greater consistency in approach when dealing with residents that can at times present with challenging behaviour. What the care home could do better: Three requirements were made at the last inspection of the home in June 2007. Two were fully met. In relation to the third, which related to providing meaningful activities for residents, it was noted that some improvement had been made in this area. However further progress would benefit residents. No requirements were made as a result of this inspection. Key inspection report Care homes for adults (18-65 years) Name: Address: St Laurence 33 Tower Road West St Leonards-on-sea East Sussex TN38 0RJ     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: Caroline Johnson     Date: 2 8 0 7 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 26 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 26 Information about the care home Name of care home: Address: St Laurence 33 Tower Road West St Leonards-on-sea East Sussex TN38 0RJ 01424438262 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: stlaurence@ilg.co.uk Evesleigh (East Sussex) Ltd care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users to be accommodated is 7. The registered person may provide the following category/ies 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 categories: Learning disability (LD). Date of last inspection Brief description of the care home St Laurence is one of four Evesleigh homes based in East Sussex and it is located in a residential area of St Leonards-on-Sea. The home is close to local transport and amenities. The seafront is within two miles of the home. The home is la large detached property with spacious grounds. It currently provides services for four people with high dependency needs. However, it is registered to provide services for seven people in line with its statement of purpose. All residents have a single bedroom some of which are double-sized. There is a range of spacious communal areas and sufficient bathroom and toilet facilities throughout. Information on the range of fees charged is contained within the homes current Care Homes for Adults (18-65 years) Page 4 of 26 Over 65 0 7 Brief description of the care home statement of purpose/service user guide and at the time of inspection they ranged from 1150 to 2800 per week. Inspection reports are not routinely sent out to families and advocates after each publication although copies are kept in the office and can be accessed by asking any member of staff. Care Homes for Adults (18-65 years) Page 5 of 26 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: For the purpose of this report the people living at St Laurence will be referred to as residents. As part of this inspection a site visit was carried out on 23/07/2009 and it lasted from 10.35 am until 16.40 pm. A senior carer facilitated the inspection. Over the course of the day there was an opportunity to observe staff working with residents. In addition there was an opportunity to speak with one staff member in private and to speak with three care staff generally. Two care plans were examined in detail. In addition a wide range of documentation was examined including staff training, medication, menus, health and safety documentation, quality assurance and leisure activities. In advance of the inspection the home submitted a detailed AQAA (annual quality assurance assessment) which contained information about the home and how it is run. Information from the AQAA is used within this report. Care Homes for Adults (18-65 years) Page 6 of 26 Care Homes for Adults (18-65 years) Page 7 of 26 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 26 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 26 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. The home ensures that they can meet the assessed needs of the residents in the home. Evidence: The statement of purpose was not seen on the day of inspection but information received in advance of the inspection showed that the home is working in line with the document. A new admissions procedure was drawn up in October 2008. The company now has a placements team who work alongside the manager in assessing and determining prospective residents for the home. Records were seen in relation to one resident that had been admitted to the home since the last inspection. A very detailed pre admission assessment had been carried out in relation to the prospective residents abilities and needs. In addition a report was provided by the college that the resident attended. Detailed information was provided by the relatives of the resident and the placement authority also provided an assessment of needs and abilities. Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: A transition plan was then drawn up and it was decided that the move would be fairly quick so two visits were carried out and the resident moved in on a third visit. The resident appeared content in their surroundings and record keeping showed that the home are meeting the assessed needs and using advice and support of professionals as required. There is a contract of the terms and conditions of residence in place and in some cases this is presented in a symbol format. Care Homes for Adults (18-65 years) Page 11 of 26 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 plans provide detailed information about the needs and abilities of residents and how they are to be met. Evidence: Two care plans were examined in detail as part of this inspection. Both contained a wealth of information and advice and guidance for staff to follow to ensure that each residents needs were met. The information is presented using a person centred approach. Daily routines are also detailed. Where risks are identified or perceived there is a detailed risk assessment in place. There is evidence that they are reviewed and updated at regular intervals but when changes are made to the risk assessments they are not currently dated and signed. Staff are not always signing that they have read the risk assessments. Where residents present with challenging behaviour there are detailed guidelines in place to assist staff in managing this. The guidelines have been written with the support of a behavioural specialist. In each care plan there are a number of goals that residents are working on. There is Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: evidence that residents are given the opportunity to participate in the activities specified but very little evidence of specific progress made. This was also identified in a recent monitoring visit of the home carried out by the company. It was noted that some of the goals have been in place since 2007 with very few changes since. Discussion was had with staff about the need to review the goals and consider if they are still appropriate. Each keyworker writes a monthly report and reviews of care plans are held six monthly. Residents meetings are held every other month. At the last meeting there was evidence that residents were encouraged to choose some fittings for their lounge area. In addition they were advised that they would be getting new dining room chairs. All residents were asked if they would like anything different over the summer. There is no evidence that there is any planning in advance of the meeting to decide what they are going to discuss and to actually present residents with ideas/pictures of what could be done. Care Homes for Adults (18-65 years) Page 13 of 26 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. Improvements have been noted in relation to the provision of day activities but work needs to continue to ensure that residents receive varied, meaningful and stimulating activities. Evidence: Some progress has been made in relation to increasing the number of activities that residents participate in but there continues to be room for improvement in this area. Two of the residents hire a sensory room at a local day centre for an hour each week and staff from the home provide support with this activitiy. Inhouse activities include literacy and numeracy, computer skills, keyboard, cooking and general household tasks around the home. Residents also have access to an aromatherapy session once a week. Residents have regular opportunities to take a walk, to use local shops and amenities Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: and to have car rides. Some enjoy pub trips and also attend a disco locally once a week. One resident has a car ride everyday. Staff stated that this resident is very obsessional about this activity and will often state where they want to be driven to but it can prove difficult to encourage the resident to come out of the car. On the day of inspection one resident was at a day centre for a few hours, one was out bowling, one took a walk and had a car ride and another went to town for lunch and a haircut. Arrangements were being made for one resident to go on holiday the following week and a staff member stated that they were getting brochures for another resident to choose a holiday from. The home has a seven seater car and they also share a fiesta with a sister home that is situated across the road from St Laurence. In addition there is a bus route that runs close by the home and the train station is also close by. Residents receive visits from their relatives on a regular basis and where appropriate staff support residents with visits and phone calls. Residents are given a choice of two meals for their evening meal and staff advised that this can be easily accommodated as they are close to the shops. Records of meals served show that residents have varied and well balanced diets. However, in relation to one resident this was not the case. Records showed an over emphasis on chicken, meals were regularly refused and there was very little reference to fruit and vegetables. Staff stated that this resident sometimes eats very well and at other times less so. It is recommended that if this continues to be the case the home should consider seeking specialist advice on this matter. Care Homes for Adults (18-65 years) Page 15 of 26 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. The systems in place ensure that residents healthcare needs are met. Evidence: Records showed that residents are supported to attend a wide range of healthcare appointments such as dentist, opticians and chiropodist. Each of the residents has a health action plan in place and this assists staff in ensuring that individual healthcare needs continue to be met. The arrangements in place for the storage and handling of medication were in order. Some of the residents receive specialist advice and support regarding behavioural issues and it was noted that a behavioural specialist has attended a staff meeting in recent months to provide training and ensure that staff are being consistent in their approach. There are detailed guidelines in place to ensure consistency of approach. Staff were observed to be courteous and were seen to treat residents with respect and dignity. All staff receive training on the medication in use in the home. In one of the files seen it was noted that the home had consulted with the relatives of the resident regarding their wishes in the event of their relative dying. Care Homes for Adults (18-65 years) Page 16 of 26 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. There are clear procedures in place to enable anyone wanting to make a complaint to do so. Evidence: There is a detailed complaint procedure in place along with a simplified version of the procedure, a copy of which is included in the service user guide. Records showed that there was one complaint received by the home. The home had made some attempts to resolve the situation but the complainant expressed dissatisfaction with the action taken. The manager was in the process of making further arrangements to resolve the situation. There is a detailed procedure in place on adult protection and prevention of abuse. The home has a copy of the multi-agency guidelines on the protection of vulnerable adults. All staff receive training on the subject. Records were seen in relation to the day to day management of residents monies and there were good procedures in place to ensure accurate recording of all expenditure. Care Homes for Adults (18-65 years) Page 17 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents live in a home that is well maintained and decorated to a good standard. Evidence: The home is well maintained and decorated to a good standard. Communal areas consist of a main lounge, dining room, conservatory and there is a large garden to the rear of the home. The home is very spacious and as there were only four residents at the time of inspection this meant that residents are able to choose whether to be on their own or to share the communal areas. Documentation received in advance of the inspection indicated that the bathroom on the first floor would be redecorated. However, staff spoken with stated that they were not sure if it would be going ahead. It was noted that there is some permanent staining on the bath and that the seal around the bath appears rusty in places. It was also noted that the lock on the door to the first floor toilet was not appropriate for the residents and that there were no facilities to dry hands in this room. The manager confirmed following the inspection that a more suitable lock has been fitted to the door. Care Homes for Adults (18-65 years) Page 18 of 26 Evidence: All areas of the home seen were clean. The majority of the staff have had training on infection control. A staff member stated that staff are being extra vigilant in respect of hygiene as a result of the recent outbreak of swine flu. Care Homes for Adults (18-65 years) Page 19 of 26 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. Residents benefit from a dedicated staff team that are well trained and equipped to meet the needs of the residents. Evidence: Staffing levels have improved since the last inspection of the home. Fifty percent of the managers hours are carrying out managerial tasks and the remaining hours are worked on shift. It was reported that there is always a minimum of three care staff on duty throughout the day and for 2.5 days there is a fourth member of staff on shift. A member of staff works a waking night shift. One resident is funded to receive nine hours one to one support a day and another is funded to receive five hours one to one a week. At the time of inspection there were four residents accommodated. Information provided in advance of the inspection showed that there had been some problems with retention of a very small number of staff positions. However, a staff member spoken with stated that since they had been employed in April there had been no staff turnover and in addition a member of staff had returned from long-term leave, which means that staffing levels are better than they have been for some time. Recruitment records were not examined on this occasion as the manager was on leave and she is the only person that has access to the records. However, information Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: provided in advance of the inspection showed that the company ensures that thorough recruitment procedures are followed. Staff spoken with confirmed that they have access to an extensive list of training courses. Records showed that mandatory training is up to date in all almost all cases. Records showed that seven staff required training in first aid. However, staff spoken with stated that staff had attended training recently and that they presumed that the matrix just needed updating. In addition to mandatory training staff also have opportunities to attend training on scip (strategies for crisis intervention and prevention), MCA (mental health act), autism, makaton and report writing. Records showed that six staff have completed NVQ (national vocational qualification) at level two, three have completed level three and another five staff are working towards this qualification. In addition two staff are working towards NVQ level four. All staff have had at least one supervision session but the majority have have at least two to three sessions this year. One of the senior staff advised that following a meeting of the senior staff the day prior to the inspection, they had been allocated responsibility for supervising a couple of staff. As a result of the new allocations this would mean that the home would be able to keep up with the provision of supervisions more easily. A staff member spoken with stated that they find supervision very beneficial, you can express opinions and views freely. Care Homes for Adults (18-65 years) Page 21 of 26 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 run well and the systems in place ensure that the health, welfare and safety of residents is protected. Evidence: The registered manager is very experienced in the care of adults with learning disabilities and has worked at St Laurences for almost six years. She has completed the RMA (registered managers award). She also continues to keep abreast of changes in care practices and attends regular training courses. Staff meetings are held every other month and detailed minutes are kept of the outcome. All staff are expected to sign that they have read the minutes. Staff stated that the meetings are very beneficial and ensure that everyone is working consistently. Staff stated that the manager is very supportive and that they dont need to wait for supervision to talk her door is always open. There are various procedures in place to monitor the quality of care provided. A member of the senior management team visits the home once a month unannounced Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: to report on the conduct of the home. Detailed records are kept of the findings. However, there is no reference to staff views and no reference to what residents were doing at the time of the visit. In addition it does not state who was in charge at the time of the visit or the duration of the visit. A more detailed internal compliance report was carried out in February 2009. An annual development plan was drawn up this year. Areas where improvements are to be made are detailed but are described in broad rather that specific terms that can be easily measured. As part of quality assurance a range of questionnaires are distributed to residents, relatives and visiting professionals. Overall the feedback was positive. In respect of the resident surveys it was noted that three of the surveys had been completed by a staff member on behalf of the residents and the comments on the three were the same. On the fourth questionnaire there were no comments. It was not clear what could be obtained from the questionnaires. The home needs to demonstrate more clearly how they seek the views of the residents on the quality of care they receive. A series of audits are carried out throughout the year. It was noted that so far this year audits have been carried out in relation to the home, medication procedures, the kitchen and food and health and safety. In addition arrangements were made to have a fire risk assessment carried out in October 2008 and all action points recommended have been signed off as having been completed. A test for legionella was also carried out in May 2009 and this was found to be all clear. The outcome of the surveys is presented in a statistical format. There was no documentation to show that feedback was given to anyone that had raised issues and a staff member advised that no one had responded to them regarding the issues they raised. Care Homes for Adults (18-65 years) Page 23 of 26 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 24 of 26 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 Care Homes for Adults (18-65 years) Page 25 of 26 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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