Care Home: Wisteria House

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What the care home does well People who live at the home have active lifestyles and routinely enjoy using community facilities and resources. Care plans focus on individual needs and reflect peoples likes and preferences and encourage independence. The environment is homely and meets the needs of the residents. People who live at the home are encouraged to voice their opinions and participate in decisions about their day to day life. What has improved since the last inspection? Since the last inspection the medication administration policy has been amended to include guidance on managing covert administration of medicines or altering medicines from the format licensed by the manufacturers. Medication Administration Records (MAR sheets) were suitably completed. Risk assessments had been undertaken to minimise the risk of scalding to residents that participate in washing up or use the kitchen sink. What the care home could do better: Although there have been no requirements made at this inspection a number of shortfalls were identified which the manager had in hand or agreed to address. The manager agreed to amend the Statement of Purpose to include the current fees and details of the new Commssion. The manager agreed to ensure Moving and Handling Assessments are undertaken for everyone as a matter of urgency. Staff training, including moving and handling, needs to be planned so that training and staff practice is always up to date. Key inspection report Care homes for adults (18-65 years) Name: Address: Wisteria House Wisteria House 492 Nacton Road Ipswich Suffolk IP3 9QB     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: Tina Burns     Date: 1 5 0 5 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 27 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 27 Information about the care home Name of care home: Address: Wisteria House Wisteria House 492 Nacton Road Ipswich Suffolk IP3 9QB 01473726326 01473320436 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Kingsley Care Homes Ltd Name of registered manager (if applicable) Mrs Romayne Coleman Type of registration: Number of places registered: care home 7 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Any of the 7 younger adults accommodated, whose primary care needs are a result of their learning disability, may also have associated mental health problems. The registered manager will sucessfully complete NVQ 4 in Care by 1st June 2007. Date of last inspection Brief description of the care home Wisteria House is a detached house set back from a main road leading into the centre of Ipswich. There are local shops and other amenities within walking distance of the house and a regular bus service into the town. The house provides accommodation for up to seven younger adults with a learning disability. The service was taken over by Kingsley Care Homes Ltd. in November 2006. The building offers a large kitchen/diner, a comfortable lounge and a single bedroom for each resident. En suite facilities are only hand basins but there are sufficient Care Homes for Adults (18-65 years) Page 4 of 27 Over 65 0 7 Brief description of the care home bathrooms and showers to meet the needs of the group. The house is set in its own grounds that extend quite a distance to the rear of the property. There is a patio, greenhouse and activities room in the garden that the residents are planning to make into a snoozelem. There is off road parking to the front of the house. Fees range between £555.00 and £714 weekly but do not include toiletries, clothing, hairdressing, chiropody, magazines and books, dry cleaning and some transport costs. Care Homes for Adults (18-65 years) Page 5 of 27 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 was an unannounced key inspection, which focused on the core standards relating to care homes for Adults. The report has been written using accumulated evidence gathered prior to and during the inspection. The inspection process included a tour of the premises and examination of a wide range of documents and records including three staff files and the records of two people who live at the home. We also met and spoke with one visitor and people who live and work there. Information has also been gathered from the homes Annual Quality Assurance assessment (AQAA) and survey forms completed by 6 service users, three staff and one friend or relative. The registered manager was present throughout most of our visit and fully contributed to the inspection. Care Homes for Adults (18-65 years) Page 6 of 27 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 7 of 27 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 8 of 27 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. Prospective service users can expect to have the information they need to decide whether the home is suitable for their needs. Evidence: The manager provided us with a copy of the homes Statement of Purpose and Service Use Guide. Overall they were suitably detailed and provided good information about the home and the nature of service it provides. The Service User Guide was available in an easy read format that had been designed especially with the needs of the service user group in mind. The manager agreed to amend the Service User Guide so that it specified the current fees. They also agreed to update both documents to reflect that the Care Quality Commission had replaced the Commission for Social Care Inspection. We looked at the records of someone that had moved into the home since the last inspection and spoke with them about what it was like to move into the home. We also spoke with the manager about the homes admission procedures. There had not been a pre admission assessment undertaken by the home but the local authority had carried out an assessment and provided the home with a summary of the individuals Care Homes for Adults (18-65 years) Page 9 of 27 Evidence: needs. Further more the manager advised that they had visited the prospective service user with their line manager and the social worker involved, to discuss the home and decide whether it was suitable. The service user confirmed that they had visited the home before they moved in and initially stayed there on a trial basis, they also confirmed that they had received a warm welcome and been given appropriate support to settle in. Care Homes for Adults (18-65 years) Page 10 of 27 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. People who use this service are involved in decisions about their lives and play an active role in planning the care and support they receive. Evidence: We looked at the care plans of two people who live at the home. The care plans were highly individual and written in a style that respected the service user and promoted their involvement, for example, there were sections entitled; What people need to know or do to support me to stay healthy and safe at home, work and in the community, Things about me and the things I do that people dont yet understand and get in the way of everyday life at times, How I take care of myself and Things about my religion and culture. The care plans went on to detail the assistance required in all areas of the individuals day to day life. The Service User Guide we looked said; Care plans are written down so we know what you want and how we can help you. They tell us lots of things like how much help you need, how you can go out to the shops, how to keep you safe, what we need Care Homes for Adults (18-65 years) Page 11 of 27 Evidence: to do to help you, help if you take any medicine. Feedback from people who live and work at the home confirmed that people are fully involved in the development of their care plans. Care plans were regularly reviewed and kept up to date and the detail in the documents we examined reflected the needs and aspirations of the two people we tracked. Although there was no evidence of a formal audit of risks to individual service users the records we looked at included a range of risk assessments for specific activities such as making hot drinks, getting in and out of the bath and getting out and about. They showed us that risks to service users are considered by the home and strategies are put in place to safeguard them from harm. Observations made, records examined and feedback received confirmed that people living at Wisteria House are appropriately supported to make individual choices and decisions. The manager advised us that everyone has support from close family or friends but they are all encouraged to speak for themselves and generally self advocate. This was evidenced through the minutes of residents meetings, the homes Annual Quality Report based on the surveys completed by residents and the daily records we looked at. The AQAA did not provide us with evidence of what the home does well in this outcome group. Care Homes for Adults (18-65 years) Page 12 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service are able to make choices about their lifestyle and enjoy a wide range of opportunities and activities. Evidence: People we spoke with and records we looked at confirmed that people that live at Wisteria House have access to a wide range of activities and pastimes. There was lots of evidence that people had good opportunities to get out and about and activities were wide ranging and varied. During the day time people told us that they attended different classes at adult community centres or colleges. One person told us that they also went to college on Tuesday evenings to learn computer skills. We also heard all about the hobbies and interests people enjoyed and the places that they like to go in their leisure time. At the time of our visit there was great excitement about a May ball that was planned Care Homes for Adults (18-65 years) Page 13 of 27 Evidence: at a local hotel for the coming week and some people enjoyed showing us what they had bought to wear for the occasion. They also enjoyed telling us about their plans to celebrate one persons birthday. They said that they always celebrate each others birthdays and usually go out for a meal or have a buffet tea. The care plans we looked at detailed how to support people in the areas of occupation, education and leisure and individual activity programmes had been developed for everyone. It was evident that people were fully involved in the development of their programmes and they reflected their interests and preferences. People had also been supported to set personal goals based on their aspirations and dreams for the future and they were being actively supported to achieve those goals, for example by planning special trips or holidays to places they had always wanted to go. Feedback we received and people we spoke with confirmed that the home provides good support to enable individuals to maintain personal relationships with their friends and families. Comments we received and observations we made confirmed that visitors are made welcome at the home. People we spoke with and observations we made confirmed that people who live at Wisteria House are encouraged to participate in the daily routines of the home for example; shopping, preparing and cooking food, cleaning the home and doing laundry. Meals at the home are prepared and cooked by the service users and support workers. The kitchen is homely and domestic in style and on the day of our visit it looked clean and tidy. There was an appropriate food safety policy in place and staff are provided with food hygiene training. On the day of our visit people had a choice of Toad in the Hole or Cheese and Potato Pie for their main meal. People told us that they have at least two options every day. They also said that the meals were good and the manager took account of their likes and dislikes when they planned the menu. Care Homes for Adults (18-65 years) Page 14 of 27 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 who use this service can expect to have their personal and health care needs met. Evidence: The care plans we examined were detailed; they included the assistance required with personal care and accounted for the individuals personal preferences. Routines, such as getting up or going to bed and bathing were flexible and reflected peoples needs and choices. Care plans included how people liked to be assisted with matters such as their mobility and getting in and out of the bath. However, moving and handling assessments had not been carried out and two of the three staff that we tracked had not undertaken moving and handling training. The manager agreed to have manual handling assessments in place as a matter of urgency to ensure that people are safely supported and confirmed that moving and handling training was already planned. Discussion with the manager and records examined confirmed that the home had Care Homes for Adults (18-65 years) Page 15 of 27 Evidence: appropriate procedures in place for the safe handling and administration of medication. Staff responsible for administering medication had undertaken medication training and the two requirements made at the last inspection relating to medication had been addressed. Medication Administration Records (MAR sheets) we examined were correctly completed and the homes policy for administering medication had been developed to include the covert administration of medicines. Observations made and records examined confirmed that people living at the home are supported to access community healthcare services. We were shown Health Action Plans that had almost been completed for everyone and the records of the two people we tracked included information about their individual health care needs, health care instructions and outcomes of health care appointments. Care Homes for Adults (18-65 years) Page 16 of 27 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 who use this service can expect to have complaints taken seriously and be protected from abuse. Evidence: The homes complaints policy is displayed in the entrance hall of the house. It tells people how to make a complaint and who they can contact. The manager told us that there has been no complaints received by the home in the last twelve months, they said that issues are usually addressed quickly and before they become complaints. Feedback from people that live at the home tells us that they know who they can talk to if they have any concerns. Staff we spoke with and records we examined confirmed that training is provided so that staff can recognise the signs and symptoms of abuse and know how to report it. Furthermore there were appropriate policies and procedures in place on safeguarding adults from abuse, whistle blowing and restraint. Since the last inspection there has been one safeguarding adult investigation. A matter of theft from a service users bank account was reported by the home and investigated by the police. Consequently the home responded by ensuring that procedures in place for supporting people to manage their money are more stringent and a more robust risk assessment has been put in place to ensure that everyone is Care Homes for Adults (18-65 years) Page 17 of 27 Evidence: better safeguarded. Care Homes for Adults (18-65 years) Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service can expect to live in a pleasant, homely environment that is clean and hygienic. Evidence: At the time of inspection all areas seen were tidy, safe and clean and there were no unpleasant smells. Of the six surveys returned by service users five said that the home was always clean and one said sometimes. The furniture, decor and facilities were comfortable and pleasant and created a suitable, homely and relaxing environment. With the exception of one bedroom carpet that was worn and unsightly and due to be replaced all areas appeared safe and well maintained. The AQAA told us that people who live at the home are encouraged to personalise their rooms and choose their own furniture, carpets and colour schemes. This was confirmed by the people we spoke with and the observations we made during our visit. Four people showed us their rooms and they were all highly individual and reflected their personalities and interests. Care Homes for Adults (18-65 years) Page 19 of 27 Evidence: People that live at the home benefit from a large garden that is safe and enclosed. On the day we visited it was tidy and well maintained. People told us that they sometimes enjoyed barbeques in the garden. It also provided plenty of space to house one of the residents pet rabbit. The laundry room was small but clean, tidy and appropriately equipped. There were suitable hand wash facilities and disposable gloves in place and the AQAA confirms that there are infection control procedures in place. Care Homes for Adults (18-65 years) Page 20 of 27 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. People who live at the home are safeguarded by robust recruitment procedures but training needs to be more timely to ensure that staff practice is current and up to date and safeguards people. Evidence: Two people that completed staff surveys confirmed said there is usually enough staff on duty to meet everyones needs and one said there was always enough staff. When we visited there were two staff on duty in addition to the manager and everyone appeared to have the support or assistance they required. Three staff recruitment records were examined and included individuals photographs, evidence of ID checks, evidence of CRB checks, copies of application forms, written references and health checks. Feedback from staff and records we examined confirmed that new staff initially work under supervision and undertake induction programmes that meet the Skills for Care induction standards. The AQAA tells us that six out of eight permanent staff hold the NVQ level two in care or above. Staff spoken with and records seen confirmed that care workers undertake appropriate Care Homes for Adults (18-65 years) Page 21 of 27 Evidence: training icluding; Safeguarding Adults, Basic Food Hygiene, Fire Safety, First Aid, Health and Safety, COSHH (control of substances hazardous to health), Infection control, Moving and Handling and Medication. The manager told us that they had also undertaken Mental Capacity and Deprivation of Liberty safeguards training. The staff training matrix told us that sometimes staff training was not provided in suitable time frames. This was particularly evident with the moving and handling training. The manager advised that this was an area for improvement that they intended to address. Feedback from care workers and discussion with the manager confirmed that a programme of regular formal supervision and team meetings is still in place. Care Homes for Adults (18-65 years) Page 22 of 27 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 who use this service can expect to be consulted about it and have their welfare protected. Evidence: Since the last inspection in May 2007 a new manager, Mrs Alison Coleman, has been appointed by the company. They had their registered managers application approved by the Commission for Social Care Inspection in December 2008. Mrs Coleman has several years experience managing care homes for people with learning disabilities. The Statement of Purpose confirms that since becoming the registered manager for Wisteria House Mrs Coleman has completed the Registered Managers Award. Mrs Coleman was at the home during most of our visit. She was fully co-operative with the inspection process and provided us with the information we asked for. Further more discussion with the manager, observations on the day and feedback from staff and people living at the home confirmed that they viewed service users interests as paramount and they were committed to providing a high standard of service in a safe Care Homes for Adults (18-65 years) Page 23 of 27 Evidence: and homely environment. The homes AQAA was received by the Commission after the given deadline. It included some useful information but overall it did not provide us with enough detail to tell us what they do well and how they can evidence it. The manager sent us a copy of the homes Annual Quality Report for 2008 that was based on the outcome of their survey of service users views. The report was written in a style that was suitable for the service user group and included pictures and symbols. It covered areas such as the environment, mealtimes and meals, care and management. People we spoke with also told us that they had regular residents meetings where they could voice their opinions about matters regarding the home and their day to day lives. There were routine maintenance and health and safety checks in place that related to fire prevention, hot water temperatures and food hygiene. Following a requirement made at the last inspection risk assessments have been completed for residents that use the kitchen sink so that the risk of scalding is minimised. Care Homes for Adults (18-65 years) Page 24 of 27 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 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 9 There should be a full and thorough audit of risks undertaken for each service user so that we can be sure that potential risks are identified and appropriately managed. The Annual Quality Assurance Review should be completed in more detail so that it effectively evidences what the home does well, how they self monitor and where they intend to improve. 2 39 Care Homes for Adults (18-65 years) Page 26 of 27 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. 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