Care Home: Stoke House

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Stoke House 145 Harborough Road Northampton NN2 8DL one star adequate service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kim Cowley Date: 0 5 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to:  Put the people who use social care first  Improve services and stamp out bad practice  Be an expert voice on social care  Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (20092008) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Information about the care home Name of care home: Address: Stoke House 145 Harborough Road Northampton NN2 8DL 01604715169 01604715169 lchamberlain@mentaurltd.uk www.mentauruk.com Mentaur Limited care home 12 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 Over 65 12 12 0 0 learning disability mental disorder, excluding learning disability or dementia Additional conditions: It is a condition of this registration that the home may continue to care for older people who have lived in the home long term, for the duration of their lives, unless the Community Health services can no longer support any health or nursing care needs that the service user may develop. The home will limit its services to the following service user categories: No person falling within the category Learning Disabilities (LD) can be admitted where there are already twelve persons of category LD in the home. No person falling within the category Mental Disorder (MD) can be admitted where there are already twelve persons of category MD in the home The total number of Service Users in the home must not exceed twelve (12) Date of last inspection A bit about the care home Stoke House is in Northampton. It is close to shops, bus stops, and a park. All the bedrooms are single There are two lounges and a dining room. There is a garden at the back of the home. You can get more information about the home from the staff. 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 How we did our inspection: The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. The inspection lasted seven hours. We looked at the care provided to three of the people living at the home. We met them, looked at their records, and talked to the staff who look after them. We also met some of the other people who live in the home. What the care home does well Everyone who lives at Stoke House has an activity programme. One of them told us, I do lots of things. I play with my Playstation. I go to work. I go to the pub. I go out for meals. I watch football. The people who live in the home told us they liked the food and there was always a choice. One said, I pick the menus and the staff write them down. Another said he sometimes cooked his own meals helped by the staff. We saw that the people who live in the home get on well with the staff. One service user had a big smile on his face as he told us the name of every member of staff who worked in the home. I like them all! he said. The staff we met during the inspection were enthusiastic about their roles and keen to help make a difference to the lives of the people who live in the home. What has got better from the last inspection Care plans have been updated and risk assessments reviewed. The homes routine has also been changed to help ensure the people who live there get enough time with the staff. The small lounge and dining room have been redecorated. The people who live in the home helped to choose the colour schemes. There are more staff working at the home. There is also a new Registered Manager who is well qualified and experienced. What the care home could do better The homes current Statement of Purpose/Service Users Guide is not easy to read. The Manager is currently working on a new, pictorial version. Service user files should be tidied up to make it easier for staff to access key information. Activities must be provided for all the people who live in the home, and records kept showing what they have been doing. A GPs advice must be sought for a person who lives in the home who has a health problem. Staff must ensure that fire doors are not propped open. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Kim Cowley Regulatory Inspector Care Quality Commission Maid Marion House 56 Hounds Gate Nottingham NG1 6BG tel: 01223 771300 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 03000 616161 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 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. Quality in this outcome area is good. People who want to come to the home have their needs assessed to ensure it is suitable for them. The Statement of Purpose/Service User Guide should be re-written to make it more accessible to potential service users, This judgement has been made using available evidence including a visit to this service. Standards 1 and 2 were inspected. Evidence: At the last inspection we were concerned that the mix of people accommodated sometimes led to tension and conflict in the home. We discussed this with the Manager and she told us she had reviewed the admission procedure and now, when potential service users are assessed, the main consideration is whether or not they are likely to get on with the people already living in the home. This approach will help to ensure that future relationships between service users are more harmonious. We looked at the admission procedure and saw that people who want to live at Stoke House first have a written assessment to see if the home is suitable for them. The Manager and a Team Leader complete this, taking into account their views, and the views of their families and friends. Health and social care staff who are involved in their care are also consulted. This helps to ensure that the home will be able to meet their needs if they decide to move in. They are then invited to visit the home as many times as they like, staying overnight if they wish, until they are ready to move in. There have been no new admissions since the last inspection. Evidence: We also looked at the homes Statement of Purpose/Service Users Guide. Although it contains all the relevant key information about the home, it is not particularly user friendly being primarily in a written form. The Manager acknowledged this and said she is currently working on a new, pictorial version. This will make it easier for potential service users to get an idea of what the home is like before they decide to move in. 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. Quality in this outcome area is good. Detailed care plans help staff to identify and meet the needs of the people who live in the home. This judgement has been made using available evidence including a visit to this service. Standards 6, 7, and 9 were inspected. Evidence: Since the last inspection all the people who live in the home have had their cases reviewed. We looked at their updated care plans and saw they were of a good standard. They were written in the first person, from service users perspectives, and gave detailed information to staff about how to address care needs. All those we inspected had been regularly reviewed (at least every two months and some weekly). This will help to ensure that the people who live in the home have their needs met. A review of risk in the home has also been carried out. This has involved analysing the data concerning Regulation 37 incidents (serious accidents/occurrences in the home). Through doing this the Manager has identified which service users are most at risk and addressed this by updating their risk assessments and providing extra staff where necessary. We looked at the homes risk assessments and saw they were up to date and that staff had signed to say they have read this. Staff have also had extra training in dealing with challenging behaviour. These measures should help to reduce risk in the home. At present one of the people who live in the home is funded for one to one staffing for Evidence: a period of time each day. We discussed this with the Manager who told us a designated member of staff was responsible for this. The homes rota provided evidence that these one to one hours are being provided. Service user files would still benefit from reorganisation (this was identified at the last inspection and a Recommendation made). Most contain information that is no longer relevant and this is confusing for anyone looking at them. Files should be tidied up and out date information archived. This will make it easier for staff to access key information without having to sift through piles of unnecessary paperwork that is no longer relevant. 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is adequate. No everyone living in the home has a suitable activity programme. Wholesome and varied meals are provided and specific dietary requirements addressed. This judgement has been made using available evidence including a visit to this service. Standards 12, 13, 15, 16, and 17 were inspected. Evidence: Stoke House is based in a residential area opposite a park, and with shops, bus stops, and other amenities close by. Staff help the people who live there to make use of local community facilities by accompanying them on walks, drives, shopping trips, and Visits to see friends and family. Visitors are welcome at the home at any time. All service users have one annual holiday supplied by the Owning Body and this is in their contracts. They do not have to pay extra for this, although they do need to take their own spending money. Everyone who lives at Stoke House has an individual activity programme. On the day of inspection service users were taking part in a wide range of activities including a visit to a dog show, day centre attendance, volunteer work at a local charity, and a trip to a fast food restaurant for tea. We talked to two service users about the activities they took part in. One told us, I do Evidence: lots of things. I play with my Playstation. I go to work. I go to the pub. I go out for meals. I watch football. Another said, I go to the day centre and make things and sell them. However, although it is recognised that some service users have plenty of activities, others do not appear to. During the inspection two service users roamed the house aimlessly and appeared bored. One of them was meant to be listening to music, according to their activity plan, but although music was being played in the lounge they did not appear to be actively listening to it and instead spent their time wandering in and out of the room and trying to get the attention of the staff. The other resident sat in the lounge and stared into space. We looked at the records of activities for these service users and found they were incomplete with only the occasional entry, for example in the house or resting in the lounge written down. We discussed this with the Manager who said these service users had taken part in regular and varied activities, but staff had neglected to make a record of them. A suitable programme of activities must be provided for all the people who live in the home, and records kept to show what they have been doing. This will help to ensure they have the opportunity to develop their interests and lead active and fulfilling lives. Meals are prepared on site by the care staff. There are at least two choices at every meal and a list of standard alternatives. Two service users have specific dietary requirements. These are recorded in their care plans and posters in the kitchen remind staff what they can and cannot eat. Menus showed the food served is wholesome and varied. We talked to some of the people who live in the home about the meals served there. They told us they liked the food and there was always a choice. One service user told us, I pick the menus and the staff write them down. Another told us he sometimes cooked his own meal, helped by the staff. 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. Quality in this outcome area is adequate. Medical advice and treatment must be sought where necessary. This judgement has been made using available evidence including a visit to this service. Standards 18, 19 and 20 were inspected. Evidence: The people who live in the home are encouraged to be as independent as possible and are supported to care for themselves. Care plans provide the information staff need to provide assistance, and alert them to individuals likes and dislikes. Records showed that the people who live in the home use local health care services, for example GPs, opticians and dentists, and more specialist services where necessary. During the inspection we observed that one of the people who live in the home appeared to be underweight. Records were checked and a risk assessment was found for weight loss. This stated that staff to weigh (service user) on a regular basis. It went on to say that should the service users weight fall below a certain level, a GP appointment should be made for them. We looked at the relevant weight charts and saw that between August 2008 and January 2009 staff had not weighed the service user. And when they had been weighed, records did not appear to be accurate as fluctuations in the service users weight seemed unlikely. The Manager said this may have been because the homes scales were not working properly. We were concerned that staff had not complied with the service users risk assessment and as a result the service user appeared to have dropped below an acceptable weight without medical assistance being sought. We discussed this with the Manager who straight away made an appointment for the service user to visit their GP the next day Evidence: to have their weight assessed. While it is acknowledged that prompt action was taken once the matter was raised, it is on concern that this situation had been allowed to occur in the first place. See Requirements. Medication systems were reviewed and were found to be in good order. Appropriate records are maintained to ensure an accurate audit trail. Medication is kept securely and service users are encouraged to self medicate where possible. 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. Quality in this outcome area is good. Staff know how to safeguard the people who live in the home and help them express any concerns they might have. This judgement has been made using available evidence including a visit to this service. Standards 22 and 23 were inspected. Evidence: The home has an easy read complaints procedure, which uses symbols to make it more accessible. Two service users we spoke to said they knew what to do if they had a complaint. One said, If someone was being nasty Id tell the staff, and the other commented, If someone upset me Id tell the staff. No complaints about the service have been made to CSCI since the last inspection. At the last inspection we were concerned that the people who live in the hope werent being properly protected as there was a high incidence of assaults between service users. This was completely unacceptable and we told the Registered Person to address this issue as a matter of urgency. Concerns were also raised about the use of restraint, staff training, recording, and knowledge of the safeguarding protocol. Since then there has been considerable improvement. The homes safeguarding procedure has been reviewed and improved and staff have had training on who to refer safeguarding concerns to and how they go about doing this. They have also had training in dealing with challenging behaviour. Records, which were of a good standard, showed that staff at the home have acted appropriately when incidents have occurred and restraint has been kept to a minimum. In addition a review had been carried out of accidents and incidents in the home, and as a result of this a change had been made in the homes routine. Previously all the people who live in the home had tended to be in the lounges from 3.30 - 4.30 pm Evidence: when they returned from their various activities. The Manager said problems had arisen because they all wanted to talk to staff about their day simultaneously, and this had led to tensions. To address this half the service users go out for tea at this time, leaving the remaining half to have a meet and greet in the lounge with staff. We saw this arrangement in action during the inspection and it appeared to be working well. Those who were going out for tea with staff were enthusiastic about this and keen to get going. And those in the lounges were relaxed and seemed to be enjoying tea and cakes with staff. Despite the above, two service users told the inspector they were frequently upset by the behaviour and comments of one of the other people who lived in the home. This was discussed with the Manager who was aware of the problem, and said action was being taken with regard to this matter. Records showed this was the case, and a longterm solution had been found. The service users involved have been made aware of this. 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. Quality in this outcome area is good. The home is community-based, comfortable, and reasonably well maintained. This judgement has been made using available evidence including a visit to this service. Standards 24 and 30 were inspected. Evidence: The home is spacious and situated in a residential area close to local amenities. The road outside is busy so service users may need to be accompanied when going out. Inside the home is a large sitting room, a smaller sitting room, and a dining room. All bedrooms are single and on the ground and first floors. The home is not ideal for wheelchair users as there is a step up to the front door, corridors and doorways are narrow, and there is no lift to the first floor. However there is wheelchair access via a ramp at the side of the home if this is needed. since the last inspection the small lounge and dining room have been redecorated, and two bedrooms have new floor coverings. The people who live in the home were involved in choosing colour schemes when the work was carried out. One of the people who live in the home told us they would like a satellite dish fitted so they could receive certain TV channels. We discussed this with the Manager who said she is looking into this possibility for the service user in question. Two other service users already have cable TV in their rooms. All areas inspected were clean and tidy. Minor redecoration is needed in some parts of the home. The Manager is aware of this and has addressed it in the homes proposed redecoration programme. 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. Quality in this outcome area is good. The people who live in the home have their needs met by friendly and professional staff. This judgement has been made using available evidence including a visit to the service. Standards 32, 34 and 35 were inspected. Evidence: We saw that relationships between staff and the people who live in the home were good. All the service users we met appeared to like the staff and responded well to them. One service user had a big smile on his face as he told us the name of every member of staff who worked in the home. I like them all! he said. Since the last inspection staffing levels have improved, and suitably qualified and experienced staff are now on duty at all times. Previously we have been concerned about high staff turnover in the home, but the staff team is now more stable and more them half of those employed have worked at the home for over two years. This helps to provide continuity to the people who live there. The staff we met during the inspection, some of who were newly recruited, were enthusiastic about their roles and keen to help make a difference to the lives of the people who live in the home. One new member of staff came in to take part in the inspection, even though it was their day off. The Manager told us she feels the current staff team is right for the home and the service will now improve as more activities are introduced. All staff have satisfactory references and CRB/POVA checks before starting work. They Evidence: then undergo a three week induction period. This helps to ensure that service users are safeguarded and staff have the basic skills they need to begin working in the home. Staff then go on to do National Vocational Qualifications in Care, and other relevant courses. Since the last inspection the programme of staff supervision has been improved and expanded. This will help to ensure that staff have the support they need to work effectively in the home. 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. Quality in this outcome area is good. The home is well managed and the people who live there are involved in the way it is run. Improvements are needed to fire safety. This judgement has been made using available evidence including a visit to this service. Standards 37, 39, and 42 were inspected. Evidence: Since the last inspection a Registered Manager has been appointed. Under her leadership the home has become more stable, with both service users and staff benefiting from having an experienced person in charge. The Registered Manager is well-qualified and has substantial experience in care, including the management of challenging behaviour. She is supported by two team leaders, one who has worked at the home for seven years, and another, a social worker, who is new. The new management team has the skills and experience to run the home effectively. To encourage to the people who live in the home to get involved in how it is run, regular meetings are held. We looked at the minutes of the most recent one (18.02.09) and saw that seven service users attended. Menus, activities and holidays were discussed. Other service users prefer to make choices on a one to one basis, and staff use pictures to help them make decisions. Annual surveys are also issued to service users, staff, and relatives. During the inspection we saw that some of the people who live in the home propped open their bedroom doors with shoes when they got home from their day time activities. Staff said they did this so they wouldnt have to keep opening and closing Evidence: the doors when they went in and out. We discussed this with the Manager who said staff had been told to close any bedroom doors they saw propped open, and this was in the homes Fire Risk Assessment. However a more permanent solution should be found, for example fitting all bedrooms with self-closing magnetic fire doors (that shut automatically when the fire alarm goes off). Advice should be sought from the Fire Department where necessary. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action 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 Description 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 Description Timescale for action 1 13 Medical advice and treatment 14/04/2009 must be sought where necessary. To help to ensure service users are healthy. 2 12 16 A suitable programme of 05/05/2009 activities must be provided for all the people who live in the home, and records kept to show what they have been doing. To help ensure that service users have the opportunity to develop their interests and lead active and fulfilling lives. 3 42 23 The problem of service users 05/05/2009 propping open fire doors must be addressed, and consideration should be given to the fitting of self- 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 Description Timescale for action closing magnetic fire doors. To increase fire safety in the home. 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 1 The homes Statement of Purpose/Service User Guide should be re-written to make it more accessible to potential service users. Service user files should be reorganised so current, relevant information about their assessed and changing needs is easy to locate. 2 6 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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