Care Home: The Hollies

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What the care home does well The Hollies provides people with a homely and cheerful environment to live in, the ethos of the home promotes people`s independence and choice and Service Users tell us that they are happy living there. People can access a variety of day care and educational opportunities, they are part of their local community and receive good healthcare support and advice. There is a robust recruitment process in place and the staff team receive a high level of training, induction and are supervised. There is a good rapport between the staff team and Service Users and their is an ongoing programme for the development of the home. What has improved since the last inspection? Some areas of the home such as bathrooms and communal corridors have been updated and refurbished and some service users have had their bedrooms redecorated. The home is in the process of updating and improving care plans and the use of a visual aid communication`s board has proved successful in lessening Service User`s anxiety levels. The Registered Manager has recently completed the NVQ4 Registered Manager`s Award What the care home could do better: In order to ensure that the home can fully evidence the care and support being provided to people, records should be kept current and in good order. This includes daily record, healthcare records and complaints and concerns. In order to ensure that people are living in a safe, clean and hygienic home at all times, floor coverings in the hall and bathroom should be replaced and the level of support people need to keep their bedrooms in an acceptable state of cleanliness and redecoration re-assessed. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Hollies 84 Barnham Road Barnham Chichester West Sussex PO22 0ES     The quality rating for this care home is:   two star good service 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: Annie Taggart     Date: 0 5 0 5 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. 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. 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. Care Homes for Adults (18-65 years) Page 2 of 28 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) 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. 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 Care Homes for Adults (18-65 years) Page 3 of 28 Information about the care home Name of care home: Address: The Hollies 84 Barnham Road Barnham Chichester West Sussex PO22 0ES 01243555230 Telephone number: Fax number: Email address: Provider web address: None Name of registered provider(s): Type of registration: Number of places registered: United Response care home 14 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 14. 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 The Hollies is a care home registered to accommodate up to fourteen residents with a learning disability, aged 18 to 65. The home consists of a detached property, with accommodation provided between the main house, with eight bedrooms across two floors and an attached bungalow that accommodates six Service Users. All areas are accessible to service users via a passenger lift if necessary. Some of the bathrooms are specially adapted for people with a disability and everyone has their own room. In Care Homes for Adults (18-65 years) Page 4 of 28 Over 65 0 14 Brief description of the care home addition there are extensive grounds that can be easily accessed by the residents. The home is located in a residential area of Barnham, with easy access to nearby bus and train services. The current scale of weekly charge is between six hundred and seventy nine to seven hundred and forty three pounds per week. Additional charges are made for personal items. The registered provider is United Response, for whom the Responsible Individual is Mr T Jones. The registered manager is Mr D Oaten-Wareham. Care Homes for Adults (18-65 years) Page 5 of 28 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: In order to prepare for this inspection visit, an Annual Quality Assurance Assessment (AQAA) was sent to the manager for completion, this was returned within the given timescales and contained clear and concise information about the services being provided in the home. Surveys were sent to service users, staff and professionals involved with the home - none were returned. Following the inspection the Registered Manager told us that the surveys had not been received. We also looked at the last inspection report and any information we have received since the last visit. The unannounced visit was carried out by Annie Taggart at 9.30am on Tuesday 5th May and the visit lasted for six hours. During that time we spoke to service users both in their private bedrooms and in communal areas, we spent time talking to the staff on duty and observed staff practice. Care Homes for Adults (18-65 years) Page 6 of 28 Four care plans and all supporting documentation were tracked and we looked at medical records and evidence of the day care opportunities being offered to people. Four staff files were tracked and all contained the required documentation. We also saw the system for the administration and recording of medication. We saw records for the running of the business including health and safety records, complaints and concerns, Regulation 26 Registered Providers visits reports, Service Users money management and the homes quality assurance process. The Registered Manager, Mr Oaten-Wareham was present and received feedback following the visit. 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 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 –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 28 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 28 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. There is clear and accessible information available about the services on offer in the home. People have their individual needs and wishes assessed and recorded and contracts of terms and conditions of residency are agreed. Evidence: The home has a Statement of Purpose and Service User Guide in place that gives clear and accessible information about the services on offer and there are processes in place to assess the needs of prospective service users. We saw three samples of contracts of terms and conditions of residency that are called Individual Agreements and the samples that we saw had been signed by service users. No new service users have been admitted to the home since the last key inspection visit Care Homes for Adults (18-65 years) Page 10 of 28 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. There is clear and detailed information in care plans to guide the staff team to the needs and wishes of the people they are supporting. Care plans are kept under review but day to day records need to be improved. Evidence: For each person living in the home there is a detailed care plan in place that is person centred and gives clear information to the staff team on how service users individual needs and wishes are to be met. Care plans cover areas such as personal care preferences, communication profiles, behaviour management plans, physical and mental healthcare support and they also detail routines that are important to the way people wish to live their lives. There are also very clear risk assessments in place that have been completed with the assistance of relevant professionals and the local learning disability team. An example of this is that for one person there are very clear communication plans in place that gives step by step guidance to staff about the way the person is to be supported. These guidelines have been discussed with the service user, who has signed to say that they agree with the way support is offered and the Care Homes for Adults (18-65 years) Page 11 of 28 Evidence: staff on duty told us that this has considerably reduced the levels of anxiety displayed by the person. We were told that care plans are currently being updated and reviewed and we saw that those that had already been completed were concise and detailed. Service users have a monthly one to one meeting with their named key worker at which time they can review the past month and agree goals for the coming month. From looking at a selection of records of meetings we saw that although goals are agreed and recorded, the home does not complete daily records and there is no process in place to evidence if the goals were met or carried forward. We spoke to the Registered Manager, Mr Oaten-Wareham about the need to improve evidence of outcomes for service users and a Requirement has been made regarding record keeping. From talking to service user and observation during the visit, it is clear that service users are involved in decision making about their lives, they participate in the running of their home and are supported to take risk in an assessed and monitored way. Care Homes for Adults (18-65 years) Page 12 of 28 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. For most of the people living in the home there are a range of educational and social activities being provided but for some people these need to be improved. People are offered a choice of home cooked meals, they have contact with families and friends have a choice about their daily routines. Evidence: Most of the people living in the home have access to a range of activities and outings and are given opportunities for personal development. Activity plans showed us that a number of people attend activities such as local colleges, adult literacy classes and a horticultural centre. People are supported to visit or telephone their families and friends and they use the local shops, pubs and other facilities. During the visit people told us that they enjoyed going to discos and days out and were exited about their planned annual holidays. One group of people told us they they were going to Center Parcs and another group were going to Disney, Paris. In order for people to be aware Care Homes for Adults (18-65 years) Page 13 of 28 Evidence: of what their planned weekly activities are, a visual communication board has been put in place and service users are supported to complete this each evening, with photos and symbols. The board also displays the staff that will be on duty and who will support the person with the activity. During the visit the local college was closed for the day and people were involved in chores within the home, we saw staff support people to complete puzzles or art work and others went to the shops or to the bank. One person was at work in the horticultural centre. Although there are a variety of activities available to people we saw that for some people there were very few weekly activities recorded or detailed in their care plans. We discussed this with Mr Oaten-Wareham who agreed that for some people, activities and outings needed to be improved and we were told that this was being addressed. We looked at menus and food records and saw that people are offered a choice of fresh, home cooked meals. Menus showed us that service users are involved in the choice of menu and also in preparation and cooking. Most lunch tome meals were recorded as sandwiches but people had a full cooked meal in the evening. Care Homes for Adults (18-65 years) Page 14 of 28 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 people living in the home have access to good personal and emotional healthcare support and medication is being well managed. Improvements are needed to record keeping Evidence: The people living in the home have their personal and emotional healthcare needs recorded in a health action plan and there is good evidence to show that the home works well with healthcare professionals. We saw that people have the support of their local doctors, the learning disability team, psychiatrists and psychologists and the district nurse team. In the AQAA we were given an example of how the home is working with healthcare professionals to a support person with a terminal illness and we saw that proactive action such as assessments with specialists are carried out in order to address peoples changing needs such as the aging process. Care plans show evidence that people are being supported to be as independent as possible and we saw that their personal care routines are carried out in a flexible and supportive manner that promotes their privacy and dignity. Each person has a small locked medication cabinet in their own bedroom and there is Care Homes for Adults (18-65 years) Page 15 of 28 Evidence: a system in place for recording when medicines are received by the home and placed in the cabinets. We observed medication being administered to three people and saw that it was carried out in a sensitive manner. The staff member gave the service user a key to open their cabinet, administered the medication and both people signed the records. Records show us that there have been some medication errors since the last inspection visit but their in now a weekly audit system in place and spot checks are carried out during the Registered Providers Regulation 26 visit. Although there is evidence in care plans to show that people are receiving a good standard of healthcare support, as previously identified in this report, there needs to be improvements in recording. When tracking service users records we saw that for some people there were no visits to chiropodists, dentists or opticians recorded since for example, 2005, 2006 or 2007. When asked about this the staff on duty were able to evidence through diaries and written records that visits had regularly been carried out but this took some time and a lot of documentation had to be gone through to evidence this. We spoke to Mr Oaten Wareham again about the need to clearly evidence and have an audit system in place to evidence the care that people are receiving. Care Homes for Adults (18-65 years) Page 16 of 28 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 people living in the home have their concerns and complaints recorded and acted upon and the homes staff training and working practices are designed to protect service users from risk of abuse or harm Evidence: There is a clear and accessible complaints procedure in place that is available in a number of formats for service users. We saw a version that was in pictures and symbols and this was displayed in the home. When talking to service users we were told that they felt confident in making a complaint and records of one to one meetings and service user meetings showed that people are able to voice their concerns and opinions In the AQAA we are told that three complaints had been received and investigated by the registered manager, two had been upheld. When looking at the records we found that there was not a system in place to clearly monitor and audit the complaints and concerns and documentation was spread around various files in the office. Mr Oaten- Wareham told us that he is currently in the process of reviewing and updating his recording systems but we saw that at the present time this has not been achieved. From looking at training records we saw that the staff team attend training in protecting vulnerable adults from risk of abuse and harm, the staff on duty were aware of their responsibilities and said that they would report any suspected abuse straight away. Care Homes for Adults (18-65 years) Page 17 of 28 Evidence: We were told that seven referrals had been made to the West Sussex Safeguarding team and five of these have been completed. One referral has been made to the POVA list. Care Homes for Adults (18-65 years) Page 18 of 28 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. Although the home is bright, homely and cheerful, improvements are needed to levels of cleanliness and general upkeep of service users bedrooms in order to ensure that people are living in a clean and hygienic environment at all times. Evidence: The Hollies operates as two separate units divided by a corridor and closing door. It is a large building over two floors set in gardens near to the village, shops, railway and other facilities. There are two lounge areas, two kitchens and communal areas leading to the gardens. Communal areas were generally clean and bright and were comfortable and homely. People have the bathing equipment they need including specialist bathrooms and showers but in the downstairs bathroom the floor covering was cracked and stained. The carpet outside one of the kitchens was also very dirty and stained and both could pose an infection control hazard. Service Users bedrooms have been personalised to suit their individual taste but there is a need to redecorate and update several of them. In three service users bedrooms we saw that they were in an unacceptable state of cleanliness and disarray, one having a broken door frame and walls in a poor state. Two beds were stripped ready to be changed and we saw that the duvets on them were old, shabby and unclean. many of the sinks in the bedrooms are also lime scaled and unclean. We brought Care Homes for Adults (18-65 years) Page 19 of 28 Evidence: these concerns to the attention of Mr Oaten-Wareham who said that some service users refused to have help with cleaning their rooms. We discussed that it was a requirement that people live in a home that was safe, clean and hygienic and that it was the responsibility of the Registered Manager to assure that this was the case. Mr Oaten-Wareham also said that he would telephone to arrange for the carpet and floor covering to be replaced and see if there could be an independent advocate who could work with service users to come to a decision on the levels of support that could be agreed. Care Homes for Adults (18-65 years) Page 20 of 28 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. Service Users are being supported by a competent, caring and committed staff team, they are being protected by the homes robust recruitment processes and the staff team have the training and support they need to ensure that they are effective. Evidence: From looking at the staffing rotas and observation on the day of the visit we saw that on the early shift there were two people in each unit and in the afternoon two in one unit and one in the other. There is also a sleeping person on duty in each part of the house overnight. We asked the staff on duty if they found that this was sufficient numbers to meet peoples identified needs and were told that usually this was sufficient in the day when people were out but that sometimes going out in the evenings was curtailed because of the numbers of staff on duty. We asked Mr Oaten Wareham about this and he told us that if activities are arranged then extra staff are provided to take people out. Observation during the day also showed us that the staff on duty had a good rapport with the people they are supporting and they were aware of the individual needs of each service user. The atmosphere was calm and friendly and if a service user did become distressed this was quickly and calmly diffused. We tracked the records for four members of staff and found that there is a robust recruitment process carried out before people commence employment. There is Care Homes for Adults (18-65 years) Page 21 of 28 Evidence: evidence of an application and interview process and people had all of the required documentation including a current Criminal Bureau Check (CRB) and references on file. All new staff undergo an induction period in line with the Learning Disability Qualification and during this time mandatory training such as health and safety, first aid and fire safety is attended. We saw that there is a comprehensive programme of training in place and courses attended included, conflict management and managing challenging behaviour, medication management and equality and diversity issues. In the AQAA we are told that of thirteen staff, four have NVQ in care at level 2 or above and one person told us that they were completing NVQ 4 . Records show us that the staff team have supervision on a monthly basis and regular team meetings and awareness sessions are also held. Care Homes for Adults (18-65 years) Page 22 of 28 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 Registered Manager of the home has the required skills and experience in working with people with a learning disability. There are processes in place to monitor and evaluate the service being provided and service users monies are safely managed. Improvement are needed to record keeping in the home. Evidence: The Registered Manager has worked at the home for a number of years and has the required experience and qualifications, having recently completed The NVQ4 Registered Managers Award. The staff on duty and service users were complimentary about the way Mr Oaten-Wareham manages the home, describing him as accessible with an open management approach. We saw that regular Regulation 26, Providers visits are carried out and these include discussions with service users and staff, a report being completed and a three monthly audit of of all Care Standards. The organisations quality assurance process is linked to the audits of the Standards and elicits the views of service users and other people involved in the service. Mr Oaten Wareham showed us evidence of a consultation Care Homes for Adults (18-65 years) Page 23 of 28 Evidence: process that had been carried out with service users and their families to agree a plan for the future development of the home. There is a clear, well documented system in place for the management of service users monies. All transactions are recorded and receipts kept and regular spot checks and audits are carried out. Two service Users were happy for us to look at their records and we found them to be current and correct. From looking at records we saw that regular health and safety and maintenance checks are carried out, fire equipment had been recently serviced, accidents and incidents recorded and Regulation 37 reports sent to the Commission as required. As previously recorded in other parts of this report, improvements are needed to record keeping in the home and this includes, service users daily records and medical records,and complaints and concerns, Care Homes for Adults (18-65 years) Page 24 of 28 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 24 23 All parts of the care home are to be kept clean and reasonably decorated. 30/06/2007 Care Homes for Adults (18-65 years) Page 25 of 28 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 30 23 The registered manager 06/06/2009 must ensure that all areas of the home, including service users bedrooms are kept in a good state of repair and redecoration and that the home is kept clean. This is to ensure that people are living in a clean, safe and hygienic environment at all times and that infection control issues are addressed. 2 41 17 All records in the home 06/06/2009 including daily records, complaints and concerns and health monitoring forms should be kept current and in good order. This is to ensure that there is an audit trail of the care being provided to the people living in the home Care Homes for Adults (18-65 years) Page 26 of 28 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 27 of 28 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. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 28 of 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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