Care Home: Tennyson Road, 104

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What the care home does well The home is a small home that is run like an extended family. Staff and residents appear to have a good relationship with each other and people using the service are encouraged and supported to do as much as possible for themselves. At the time of the inspection there were five people living inn the home and all completed our questionnaires. We received comments such as;` I like the home it is peaceful`, `my laundry is done for me`, and `I am happy that there is day and night access to the fridge`. What has improved since the last inspection? Since the last inspection the staff team appear a lot more settled and this is reflected in the behaviours of the residents. There have been many improvements and the staff team appear to understand the ethos of the home. Staff are working with, and encouraging, residents much more than they used to and as a result residents are starting to take responsibility for themselves and some aspects of their care. This is the first stage of working towards independence. What the care home could do better: There were few requirements and recommendations made as a result of this inspection. It would be hoped that the service will have a registered manager very soon. The support plans need to be written in a more person-centred way to reflect how the care is now being delivered. There are some outstanding environmental issues that need consideration. Key inspection report Care homes for adults (18-65 years) Name: Address: Tennyson Road, 104 Tennyson Road, 104 Luton LU1 3RP     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: Sally Snelson     Date: 1 5 1 0 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 29 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 29 Information about the care home Name of care home: Address: Tennyson Road, 104 Tennyson Road, 104 Luton LU1 3RP 01582418858 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mr Geoffrey Plane,Miss Deborah Newman care home 8 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: The maximum number of service users who can be accommodated is: 8 The registered person may provide the following categories of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Mental Disorder, excluding learning disability or dementia - Code MD Date of last inspection Brief description of the care home 104 Tennyson Road is a care home, which is registered for a maximum of eight adults with mental health needs. The accommodation is a three-storey house with eight single bedrooms. The office is on the ground floor. The lounge, dining room, and the kitchen are also located on the ground floor. The laundry room is located at the back of the house. There is a small parking space at the front and a garden at the back. The rear garden is secluded and has some shrubs, trees, flowerbeds, and a small patio area with a barbeque. The home is situated approximately one kilometre from the shopping centre of Luton. A bus stop is located within walking distance of the home. There is a regular bus service to the town centre. The fee for this home is around Care Homes for Adults (18-65 years) Page 4 of 29 Over 65 0 8 1 9 1 1 2 0 0 8 Brief description of the care home £800.00 per week, but varies according to assessed needs. Care Homes for Adults (18-65 years) Page 5 of 29 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 was carried out in accordance with the Care Quality Commissions (CQC) policy and methodologies, which requires review of the key standards for the provision of a care home for younger adults that takes account of residents views and information received about the service since the last inspection. Information from the home, through written evidence in the form of an Annual Quality Assurance Assessment (AQAA) has also been used to assess the outcomes within each standard. Evidence used and judgments made within the main body of the report include information from this visit. Prior to the inspection we sent out questionnaires to the residents, these were completed and returned to us and also used to make judgements about the service and the outcomes for the people using the service. The inspection was a key inspection, was unannounced and took place from 10.20 am Care Homes for Adults (18-65 years) Page 6 of 29 on 15th October 2009. The manager, who is in the process of becoming the registered manager was available throughout the inspection to assist with information. During the inspection the care of two people who used the service (residents) was case tracked. This involved reading their records and comparing what was documented to what was provided. We also looked at recruitment, training health and safety documentation, medication records and food planning as well as touring the building. We would like to thank all those involved in the inspection for their input and support. Care Homes for Adults (18-65 years) Page 7 of 29 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 29 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 29 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. This home understood the importance of having sufficient information for prospective residents. The statements of purpose and service user guide were clear. Evidence: The home had a Statement of Purpose and a Service Users Guide that was up-to-date. We were told these documents were reviewed annually and altered as circumstances changed. They had been produced with colour pictures and photographs and would be suitable for all the people using the service. Each of the people using the service had been provided with a copy. There had been no new admissions to the home since the last inspection, so in order to assess this standard, we looked at the policy and the paperwork that the manager intended to use. The AQAA told us that the recently updated referral procedures would ensure that the staff team could meet the needs of the people living at 104 Tennyson Road before a place was offered. There was currently vacancies within the home as the home was registered for up to eight residents and only five people were currently living there. Care Homes for Adults (18-65 years) Page 10 of 29 Evidence: There was a signed contract of residency on each file. This contract appeared to accurately reflect what was provided and what the resident was expected to pay for. Care Homes for Adults (18-65 years) Page 11 of 29 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. The service involved individuals in the planning of the support which affected their lifestyle and quality of life. Plans and assessments were reviewed and updated as required. Evidence: During the inspection we looked in detail at the support plans of two people living at the home and also looked at how the care described reflected the care delivered. People using the service had clear, well-written plans of care, that identified a need, a goal, and how staff were to support the need. Plans had been kept under review and were altered as care needs changed. It was apparent from the way that support plans had been written that the people using the service had been involved. We also saw that in some cases care managers had agreed plans along with the individuals involved. The manager was aware that in order to ensure consistency, all staff should be supported to complete support plans to the same standard, and in a more person centered style. Care Homes for Adults (18-65 years) Page 12 of 29 Evidence: Throughout the support plans there was evidence that residents had made decisions about their lives, and how these decisions were made and supported. For example where a resident wanted to cut down on his/her alcohol consumption there was a record of the decision, why the decision was made, and how this was to be supported by staff. Wherever necessary staff identified risks and planned with the resident how these could be minimised. These risks usually centered on behaviours such as smoking, or staying in bed, and there was evidence that the person using the service was provided with sufficient information to make an informed decision about risk. As the residents took more risks, more risk assessments would be expected. For example people were doing more and were working towards some independence, such as travelling alone which would create the need for further assessment of risk. While speaking to people using the service we had no information that suggested that residents felt information about them would be unnecessarily shared. All felt that they could trust staff. Care Homes for Adults (18-65 years) Page 13 of 29 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. Generally staff were aware of the need to support residents to develop their skills, including social, emotional, communication, and independent living skills. Where appropriate some residents were involved in working towards independence, this could be developed further. Evidence: The manager continued to investigate a range of activities that might interest people inside and outside the home. She told us that although people showed an initial interest in a certain activity, once this was arranged some were less inclined to take part. Staff were working with people to encourage them to do more, and to take advantage of what was offered. We were aware that decisions about activities were made as part of regular residents meetings and people living at the home had the opportunity to put forward opinions Care Homes for Adults (18-65 years) Page 14 of 29 Evidence: and ideas. However many plans for activities were made at the last minute, according to the weather and moods. Throughout this inspection the atmosphere in this home was relaxed and homely, and there was a friendly banter between staff and residents. During this visit two residents went out with the operational manager for a trip to a visitor centre, one person was enthusiastic about the trip, while the other had not wanted to leave the comfort of the car. The staff team were building on increasing peoples confidence and independence. Another resident was out independently at a Church meeting. Residents met together and chose the menu for the main meal for the next week. Recipes and pictures were used to inform these decisions and a record kept on file of the choices made. A shopping list was produced weekly and residents were encouraged to help with the shopping. On the whole meals were taken together and were a social occasion. One resident had asked to make a Christmas cake and this was being supported. Care Homes for Adults (18-65 years) Page 15 of 29 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. People were supported and helped to be independent and to take responsibility for their personal care needs. Staff listened and took account of what was important to them. Evidence: None of the people living at 104 Tennyson Road needed assistance with care continually, but many needed prompting and intermittent support. Support plans reflected this. At the time of the inspection Community Psychiatric Nurses (CPNs) were frequent visitors to the home and staff had good relationships with them, and the GPs, and consultants, involved in a residents care. We saw evidence of people being supported to keep medical appointments and consider treatments. The manager had made an appropriate safeguarding referral when she believed a lack of support, and different messages from different professionals, had possibly been the cause of an emergency hospital admission. It was hoped that this would bring all the professional together and ensure that lessons could be learned. Care Homes for Adults (18-65 years) Page 16 of 29 Evidence: Staff encouraged people to regularly attend health screening and health appointments, including opticians and dentists. Plans indicated that staff were now supporting people to make healthy choices and were, with agreement, withholding cigarettes or rationing food, alcohol or cigarettes to help this process. The medication record sheets (MAR) in the home were excellent and provided a clear audit trail. All of the medications that we checked reconciled, and it was clear that staff were vigilant about signing medications into the home, administering and storing medications and returning unused medicines. They also had a process to regularly audit the medications. Care Homes for Adults (18-65 years) Page 17 of 29 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. The service had a complaints procedure that was clearly written and easy to understand. The policies and procedures for safeguarding adults were available, and gave clear specific guidance to those using them. Staff working at the service knew when incidents needed external input and who to refer these incident to. Evidence: Since the last inspection the complaints policy had been reviewed, it was summarised in the service user guide and accessible to everyone entering the home. We viewed the complaints file during this inspection. There had been no complaints logged since the last inspection. The AQAA told us that residents were reminded of the complaints procedure at each resident meeting. Returned completed questionnaires confirmed that all five residents knew how, and to whom, a complaint should be made. The manager and staff in this home had a clear understanding of Safeguarding procedures. Training records showed that all the staff had attended training in safeguarding during the past year. The records of residents personal expenditures were examined. These were all accurately recorded and balanced with funds available. Care Homes for Adults (18-65 years) Page 18 of 29 Evidence: There was a healthy petty cash deposit available at all times in the home, and this was replenished as required by the manager via head office. Staff told us that if they were out with a resident the petty cash would pay for them to have a drink or a meal with the resident, if this was appropriate. Since the last inspection the management of the home received the final outcome of an investigation by the Health and Safety Executive into an incident involving a resident jumping from a window in June 2007. They had received a financial penalty for pleading guilty to not having window opening restrictors fitted to first floor rooms, which is contrary to section 33 of the Health and safety at Work Act 1974. There had also been a break-in to the home which had been correctly reported and investigated. Care Homes for Adults (18-65 years) Page 19 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home was comfortable and had a programme to improve the decoration, fixtures and fittings. Occasionally there was slippage of timescales and maintenance tended to be reactive rather than proactive. Evidence: There had been no major changes to the environment of the home since the last inspection and the changes made at that time had been sustained. For example the lounge had been cleared of clutter, however the new curtains that we saw at the last inspection had been washed frequently and as a consequence were frayed. The manager told us that it had been necessary to wash curtains regularly because of the smell from smoking. Recently the residents had made the decision to only smoke outside the home, and on the whole this was happening; this would help to keep the home fresher. With the support of a cleaner, people using the service were involved in keeping the home clean and tidy. Individuals were supported and encouraged to personalise their bedrooms to suit them and decorators were working through the home. The operational manager and the manager did not appear to be fully aware of the exact programme for the re-decoration. Care Homes for Adults (18-65 years) Page 20 of 29 Evidence: While there were vacant bedrooms the staff were not using the office as a sleep-in room, which made the office more conducive to its purpose. We were disappointed that the only shower available was off the office and residents had to access it via the lounge which obviously compromised their privacy. The laundry area was separate to the kitchen but access was via the dining room or the outside. This access area had been covered. Some staff and residents were taking an interest in the garden and had grown some vegetables in pots. Care Homes for Adults (18-65 years) Page 21 of 29 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service recognised the importance of training, and tried to deliver a programme that met any statutory requirements and the National Minimum Standards. The manager was aware that there were some gaps in the training programme and planned to deal with this. Evidence: Once again there had been some changes to the staff team since the last inspection. The team had a variety of qualifications and training and the manager provided us with a training matrix for the next year, that covered a range of training both mandatory and that that was needed to meet the needs of the client group. Most of the training was sourced through the Local Authority, but she told us it had been necessary to go to external providers for some of the more specialist training, including mental health awareness. By looking at the diagnosis snd assessed needs of the residents it was apparant that their were some gaps in some staffs knowledge. At the time the AQAA was completed there were seven staff employed as care workers, four had a qualification to NVQ level 2 or above and others were working towards this qualification. All new staff undertook an accredited induction and the manager had undertaken an induction specifically for managers. Care Homes for Adults (18-65 years) Page 22 of 29 Evidence: There was a minimum of two staff on duty during the day until 7pm and then one from 7pm to 9pm when that member of staff became a sleep-in. As mentioned in past reports it is expected that residents may want to engage in evening activities and this staffing level would not be able to support this. This must be kept under review as residents become more interested in social activities. When staff were working alone there was an on call system for the senior carers or management to provide support if needed. Staff told us that they did not have to do sleep-ins until they felt confident to do so. Three staff files were sampled and it was apparent that staff had been recruited correctly and had not started work until all the appropriate checks and references had been undertaken. Staff commented that they wished to try and encourage service users to become involved in the recruitment process. Staff files provided the evidence that staff were having regular supervision from the manager. The deputy had recently completed the necessary training and would also be supervising some of the staff. Care Homes for Adults (18-65 years) Page 23 of 29 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 manager had a clear understanding of the key principles and focus of the service, based on organisational values and priorities. She must continue the process to become the registered manager of the service. Evidence: Despite the fact that there had not been a registered manager in post for some time the home was being effectively run. The acting manager had started the process to become the registered manager by having her CRB verified at our London office. One of the owners and the operational manager were also involved in the day-to-day running of the home. Quality assurance questionnaire had been sent out for the current year and notice had been taken of any points raised. Residents views were regularly gathered at residents meeting. People told us that if the home looked after any money on their behalf this was handled correctly and they could have instant access if they needed. Some people had Care Homes for Adults (18-65 years) Page 24 of 29 Evidence: agreed, as part of their care plan, to have agreed amounts of money, or cigarettes, given to them either weekly or daily to help them manage. The manager had reviewed all the policies and procedures and updated information as necessary. Health and safety checks were routinely carried out. One of the residents was involved in supporting this process. Care Homes for Adults (18-65 years) Page 25 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 37 8 The service must appoint a person to become the registered manager as soon as possible. To ensure consistency for staff and people using the service. 01/04/2009 Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 13 16 The manager must continue 01/01/2010 to work to with the residents to make arrangements to enable them to engage in local, social and community activities. This will help to increase confidence and develop independence. 2 24 23 There should be a more structured plan of improvements for the home This would ensure that changes given a priority at some stage do not slip because something else occurs. 01/01/2010 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 6 Support plans should be more person centered. Page 27 of 29 Care Homes for Adults (18-65 years) 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 2 3 9 32 Staff should look at all areas of possible risk and work with the person using the service to minimise these risks. The manager should ensure that all staff have the training they request and require to carry out their role. Care Homes for Adults (18-65 years) Page 28 of 29 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). 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. 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