Care Home: Thornfield

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What the care home does well People care needs are properly assessed and they are given the opportunity to stay at the home before they move in permanently. This helps them make an informed decision about whether Thornfield is the right place for them to live. The information kept about people is good and is the right kind of information needed; this helps staff support people properly all of the time. Staff believe it is important for people to make choices of their own. This helps them become more independent. The staff makes sure everyone at Thornfield has a happy and fulfilling lifestyle. The staff at Thornfield promotes peoples health care, staff are quick to contact health professionals to seek support and advice. The training staff have means they understand about what people with learning disabilities need and this helps make sure that people are treated properly. When staff come for a job at Thornfield all the right references and police checks are completed, this means that it is less likely that unsuitable staff are employed to work at the home. What has improved since the last inspection? More staff have completed NVQ training, this means staff have better knowledge and understanding to support people with learning disabilities. What the care home could do better: The provider and registered manager must be confident there are enough staff working during the night to meet peoples needs and keep them safe. To make sure people and staff are protected the registered manager must make sure all the appropriate agencies are informed of any safeguarding incidents in the home. People or their representatives should be aware of and sign the terms and conditions of the home. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Thornfield 261 Highfield Road Idle Bradford BD10 8QY     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: Caroline Long     Date: 1 4 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: Thornfield 261 Highfield Road Idle Bradford BD10 8QY 01943865654 01274414165 thornfield@woodleighcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Isand Ltd Name of registered manager (if applicable) Mr Patrick Feane Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 7 The registered person may provide the following category 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: Learning disability - Code LD Date of last inspection Brief description of the care home Thornfield is registered to provide accommodation and care for seven people with a learning disability. The home is situated in a residential area in the Idle district of Bradford with easy access to the city centre. The home has been extensively renovated and refurbished. All bedrooms are for single occupancy and furnished and equipped to a good standard. All of the bedrooms have en-suite bathing facilities Care Homes for Adults (18-65 years) Page 4 of 28 care home 7 Over 65 0 7 Brief description of the care home Communal areas are spacious and comfortable with well maintained, safe and accessible garden areas. 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: Information provided by the manager on the 13th May 2009 indicated that the current weekly fee for the home are dependent upon peoples assessed care needs. Additional costs include the provision of extra support by staff, toiletries, hairdressing, holidays, leisure activities and clothes. This is what we used to write this report:We looked at information we have received about the home since the last key inspection. We asked for information to be sent to us before the inspection, this is called an annual Care Homes for Adults (18-65 years) Page 6 of 28 quality assurance assessment. One inspector visited the home unannounced. This visit was over two days and lasted over seven hours and included talking to the staff and the registered manager about their work and the training they have completed, and checking some of the records, policies and procedures the home has to keep. We spent time talking with and observing staff working with people who live in the home. We looked at two peoples care records to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. We focused on the key standards and what the outcomes are for people living in the home, as well as matters, which were raised at the last inspection. We have reviewed our practice when making requirements, to improve national consistency. Some requirements from previous inspection reports may have been deleted or carried forward into this report as recommendations but only when it is considered that people who use services are not being put at significant risk of harm. In future, if a requirement is repeated, it is likely that enforcement action will be taken. 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. To make sure Thornfield is the best place for people to live, people will be fully assessed before they move in. Evidence: Information is made available to anyone interested in moving into the home. Usually the registered manager will visit them at their home and complete an assessment to make sure Thornfield will be able to provide a service that will meet the persons needs. As part of this process they will also gather information from any other agencies and relatives involved. Where possible the person is then encouraged to visit the home, for a day or overnight providing them with the opportunity to meet everyone and to get a feel for the home. People are also kept under review until they are completely settled and it can be confirmed the home can meet the individuals needs and the person is happy with the arrangements. Care Homes for Adults (18-65 years) Page 10 of 28 Evidence: The registered manager and team leader told us significant time and effort is made to make sure admissions to Thornfield are personal and well managed. Two peoples files who had recently moved into the home were looked at in detail both confirmed good practice. Both assessments were carried out before people moved into the home and both contained details of every aspect of peoples daily life and health needs. Examples of the information included were religion, daily living, social interests, and nutrition. The staff records showed and staff confirmed they had the necessary training; to enable them to look after people properly. The registered manager explained because people have very complex needs and may display their needs in their behaviour, before the staff start working alone they have all been trained about managing challenging behaviour. The two files examined contained a contract, however the contracts had not been signed by the person or their representative. For good practice the provider should make sure people or their representatives are made aware of and sign the terms and conditions. Three people who returned their surveys stated they were provided with enough information before they moved into the home. The registered manager told us that he is at present reviewing the information guide and making it available in pictorial format. Care Homes for Adults (18-65 years) Page 11 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. Thornfield helps people to make decisions about their lives, with clear support plans and risk assessments to maximise their safety. Evidence: Two people told us they were able to make choices about their lifestyles and three people who returned their surveys also stated they could make the choices they wanted about their daily routine. Staff were observed encouraging people to make choices about their lives. For instance did they want to go out, or did they want drinks. Two peoples case records were looked at in order to check that a plan had been formulated which would help staff provide support to people according to their needs and wishes. The support plans had recently been completely reviewed and rewritten by the registered manager. Overall the information in the support plans was person centred, Care Homes for Adults (18-65 years) Page 12 of 28 Evidence: quite detailed with people personal preferences and choices. They promoted independence and provided people with the care they needed in the way they wanted. Where risks were identified, risk assessments were carried out which provided staff with the actions they needed to take to minimise any risk whilst promoting independence. Also in some instances there was very good guidance available about how to manage specific challenging behaviours. People were aware of their care plans, one person was able to tell us about their plan and the plans had very personal information which showed us that people had been involved in developing them. Staff also told us how they often read the support plans and felt very well informed about peoples needs and of any possible risks. However there was one plan which had not been updated with new information about a persons needs. We discussed with the registered manager and the team leader who agreed they would look at developing a way to ensure the plans remained up dated. We saw the staff have a can do attitude and risks are managed positively to help people using the service lead the life they want. An example of this was although a person been displaying challenging behaviour, when they were calmer the staff continued to follow the persons planned social activities. One person told us how the home has regular meetings where people living in the home can make their views known. Care Homes for Adults (18-65 years) Page 13 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. People are helped and supported by the staff to make choices about their lifestyle and develop their life skills; this results in them leading a full and active life. Evidence: The service supports people to identify what they want to do and how they want to do it and then supports them to achieve this. Two people told us about the activities they carry out, and how they made an informed choice of whether they wanted to take part or not. These followed their social interests, and educational activities. Also staff confirmed they were able to support people to carry out the activities or go on holiday when they choose. Peoples records also confirmed this. Care Homes for Adults (18-65 years) Page 14 of 28 Evidence: The registered manager told us how they are constantly reviewing peoples daily activities to make sure they are peoples currrent preferred choices. We observed the staff interacting with people and encouraging them to make choices about their daily routine. Staff described how for one person they use a communication board. In a morning when the person has made their choice of activities for the day these are put on the board, so they are able to see and refer to their daily routine regularly thoughout the daily. The staff explained this helps the person to remain calm. The home a car and a people carrier available for staff to take people out. During our visit we saw people going to the park, bowling, the shops and day centres. Staff were able to tell us about what people prefered activities were and when they enjoyed doing them. We were also able to see how people were supported by the staff to keep in contact with their relatives. For instance letters and cards were made and delivered to relatives. All the staff and two people living in the home said they had a choice of food, and there was always enough. The kitchen had a very homely atmosphere and we observed how staff support people in the kitchen when they wanted to make drinks or be involved in making the meals. Care Homes for Adults (18-65 years) Page 15 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. People can be confident the health and personal care they receive is based on their individual needs. The principles of respect, dignity and privacy are followed. Evidence: Looking at peoples support plans showed they promoted both sensitivity and respect and gave detailed descriptions of how people preferred to be supported with personal care. There are male and female staff, this enables people in the home to have their personal care needs carried out by a gender they feel most comfortable with. We saw people were appropriately dressed in clean matching clothes of their choice and staff were treating people with respect and helping to maintain their dignity. Staff told us about the different ways they communicated with people through the use of makaton, or pictures or by communication boards so they could establish if people were in pain or distress. Care Homes for Adults (18-65 years) Page 16 of 28 Evidence: By looking at peoples records and talking to staff we were able to evidence that people are helped to access the health care they need, and when there are issues identified these are followed up and monitored, such as peoples nutritional needs, weight and behaviour. Where people had specailist needs staff had been provided with the necessary training to enable them to care for people properly and safely. The training staff told us about was how to manage people displaying challenging behaviour and autism. The registered manager told us how people have access to a private pyschiatrist in the home if needed. Surveys were returned from two health professionals both gave positive responses. Medication is locked away and a monitored dosage system is used. Staff who give out medication have received training. A sample of medication administration sheets were checked and found to be correct. The team leader explained how there were systems in place to monitor the medication given. Care Homes for Adults (18-65 years) Page 17 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. People are able to express their concerns and are safeguarded from harm. Evidence: Two people living at Thornfield told us they feel able to make their views known if they have any concerns or complaints. All the three surveys returned said they knew who to speak to if they were unhappy, and knew how to make a complaint. People were seen talking to the registered manager, the team leader and the staff and making their views known. Staff told us they were able to understand peoples needs and if they had any concerns. We have not received any complaints about the home. The registered manager showed us the compliments and concerns book, this had two complaints which had both been responded to by the registered manager. We explained to the registered manager how the book did not protect peoples confidentiality and would no longer meet the data protection guidelines, he agreed to introduce a new system which would ensure this. There are regular meetings in the home where people can make their views known, people are also encouraged to use the local advocacy service for support if they have any concerns. Care Homes for Adults (18-65 years) Page 18 of 28 Evidence: The staff explained they have sometimes needed to restrain people to protect both themselves and the individual. They explained as people had become more used to living at Thornfield this was not used as frequently and they were now using more distraction techniques to calm people. The staff and the registered manager also explained all staff are provided with specailist training on how to carry out physical interventions to enable them to protect individuals and themselves before they start working in the home. We found staff are completing incident forms, this is required so the staff can identify any patterns and to protect peoples rights. We looked at the incident forms and found they had all been completed with enough information by staff, however where restraint was used it was not always recorded following the home procedures. Discussion with the registered manager showed he was aware of the actions to take to safeguard adults. Although staff could not always tell us if they had received adult protection training , they were aware of whom to alert if an incident occurred. Although people living in the home can often display behaviours which either present risk to themselves or to others, which means incidents may occur regularly, we have not been notified. To protect everyone the registered manager needs to inform all the appropriate agencies of any safeguarding issues. We discussed this with the registered manager who told us he would be discussing with the local authority safeguarding team what was the best way of keeping them and the Commission informed. People are supported with their finances. Detailed records are kept of all financial transactions carried out by the individual or by staff on their behalf. Care Homes for Adults (18-65 years) Page 19 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. People live in a clean and generally comfortable home. Evidence: Thornfield is a large detached house, which has a communal lounge, activity room and dining room and kitchen, and toilet and bath facilities. All the bedrooms are single, some have en-suite facilities. The registered manager explained how people living at Thornfield and staff had helped to decide on the colour of the communal areas and had been involved in helping to decorated them. Generally the communal areas were very sparse. The registered manager told us this was because of peoples behaviour, however he was hoping to decorate the walls with secure pictures and purchase further durable furniture for the rooms in the future. We looked at two peoples rooms which were clean, and comfortable, and were decorated in the way they preferred and contained their personal possessions. One had sensory equipment for the person to use. There is a maintannce man who works in the home and in the garden for three days a week. We observed he was helping people to make their preferred changes to the Care Homes for Adults (18-65 years) Page 20 of 28 Evidence: garden. Generally we found the home was clean and support staff were involving people in cleaning the home. This both increases peoples independence and makes if feel more like their home. To help prevent the spread of infections we saw gloves are available and anti bacterial soap dispensers are installed at wash points and staff are receiving infection control training. Care Homes for Adults (18-65 years) Page 21 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. Staff in the home are trained, skilled and generally in sufficeint numbers to support people who use the service during the day. However this may be compromised on a night due to the numbers of staff working. Evidence: Staff told us they were enough staff available to meet peoples needs and to make sure people could access the activities they choose, unless staff were off work due to unexpected illness. The staff rotas showed there is normally five staff on during the day and six staff on an evening. During the site visit staff had the time to sit and talk to people. The registered manager and the staff told us there is one membe of staff awake and one who sleeps in the on a night. The staff and the registered manager also said generally this was enough staff to meet peoples needs, because most people went to bed at at about 10pm and a manager was also available on call if they were needed. However there are four people at Thornfield who need one to one support during the day and one member of staff told us there are not always enough staff on a night if people wake up early. We discussed this with the registered manager who agreed to Care Homes for Adults (18-65 years) Page 22 of 28 Evidence: review the staffing with the provider on a regular basis to make sure that people were not put at risk. Staff are clear about their role, they knew what is expected from them and showed a good understanding of the actions they needed to take to meet peoples needs in the way they prefer and need. People told us they liked the staff and got on well with them. We were able to see how well the staff interacted with people, how the staff displayed warmth to people and treated them in a respectful and kind manner. We looked at four staff records all to make sure the home were employing suitable people for the job. We found that all the necessary police checks had been carried out to make sure only suitable people were employed at the home. There is an induction programme in place that ensures new staff members are given the right information to be able to do their jobs well. Staff who had recently been appointed were able to tell us about their inductions and how it helped them settle into the home. There is a training plan in place this helps to ensure that training is provided to staff throughout the year. The 2009 plan showed staff have received fire, first aid, food hygiene, and health and safety and managing challenging behaviour. Staff also told us about how they had received training in restraint and the registered manager told us specialist training is incorporated into the staff meetings such as autism and mental health issues. Staff told us they received regular supervision and appraisals from their manager and do feel supported by the management. Staff confirmed they have regular meetings and the registered manager explained these are used as a opportunity to recap policies and to make sure staff are kept up to date and able to carry out their roles properly. The annual quality assessment questionnaire states over half of the staff have or have started their National Vocational Qualification level two or above in care, this qualification helps to make sure staff are properly trained to carry out the work. Care Homes for Adults (18-65 years) Page 23 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. People benefit from a home that is managed in their best interests. Evidence: The registered manager has considerable experience and has their registered managers award. During the site visit people were seen to be comfortable when approaching him to discuss the home, he always listened and responded with warmth and respect. Staff said they felt extremely well supported by the registered manager and how things had improved since he started working at Thornfield. The registered manager completed the annual quality assurance assessment which contained, clear, relevant information which was supported by a range of evidence. The AQAA tell us about changes the home has made and where they still need to make improvements. The data section of the AQAA is fully completed. Quality assurance systems consisted of an annual survey for people in the home to complete, regular house meetings, and reviews of the complaints and accidents Care Homes for Adults (18-65 years) Page 24 of 28 Evidence: records to identify any patterns etc. Also regular visits by the provider where they check on the quality of the services provided to people. The home has also recently been awarded the investors in people award. Two people living in the home said they felt involved in decisions that were made about Thornfield. The registered manager told us the maintenance and service records are in order. Care Homes for Adults (18-65 years) Page 25 of 28 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 26 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 33 18 The staffing levels must be kept under review and where necessary increased to make sure that peoples needs are met at all times. This is to make sure peoples needs are met and keep them safe. 13/07/2009 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 2 5 23 People or their representatives should be aware of and sign the terms and conditions of the home. To make sure people and staff are protected the registered manager must make sure all the appropriate agencies are informed of any safeguarding incidents in the home. 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. 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