Inspection on 02/08/06 for 1-2 Downer Court

This inspection was carried out on 2nd August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

1-2 Downer Court 20/07/07

1-2 Downer Court 18/01/06

1-2 Downer Court 05/07/05

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 1-2 Downer Court 1-2 Downer Court 1-2 Downer Court Wilson Avenue Rochester Kent ME1 2SA Lead Inspector Jo Griffiths Key Unannounced Inspection 2nd August 2006 09:30 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 1 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 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 1-2 Downer Court Address Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 1-2 Downer Court 1-2 Downer Court Wilson Avenue Rochester Kent ME1 2SA 01622 769100 MCCH Society Limited Ms Tracey Vivenne Mateer Care Home 7 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (1) of places 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2006 Brief Description of the Service: 1-2 Downer Court provides accommodation for seven residents with learning disabilities and high dependency needs. All of the accommodation is situated on the ground floor. Service users with physical disabilities can be accommodated. 24-hour support is provided by a team of support staff led by a registered Manager. This service is part of the MCCH society. The fees charged for this service average £1385. Fees are agreed based on an assessment of individual need. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was unannounced. The site visit took place between 09.30am and 2.00pm on 2nd August 2006. The Manager was at the home during the visit. The inspector observed the service users being supported in their daily activities. Some records were inspected. Feedback was received from some relatives and health professionals by comment card. What the service does well: What has improved since the last inspection? What they could do better: There are a number of outstanding issues from the last inspection report that have not been addressed due to dispute with the housing provider over the responsibility for the work. This includes making the laundry safe, providing boilers that supply enough hot water and wheelchair access to the garden from the lounge. MCCH must ensure these issues are resolved for the people living at the home. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 6 2 service users have to share a small bedroom. They are not able to clearly say that they wish to do this and their privacy is being compromised by this arrangement. The bedroom is not big enough for 2 people and there is not enough room for staff to safely provide the care they need. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Service users are given the information they need to make a decision about the home. Service users have their needs fully assessed and know the home can meet these needs. Service users have the opportunity to test drive the home. Service users have a contract for their care. The overall outcome in this area is good. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: The Statement of Purpose .has been reviewed and updated. The Service User Guide has also been reviewed and this is presented in symbols and includes photographs to help service users get the information they need about the home. One service user had moved to the home since the last inspection. His needs had been fully assessed by the previous home and the Manager of Downer Court. Person Centred Planning had been used to help the service user plan 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 9 their move to Downer court. A number of planned visits to the home took place to help the person test out their new home. Service users needs are generally well met at this home. There are some issues of concern about 2 service users having to share a bedroom and this is being addressed through person centred planning to gain their wishes and needs. Service users have been issued with a contract from MCCH for their care. This states the terms and conditions of the service and the fees that will be charged. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Service users have an individual plan that meets their needs. Service users are supported to make their own decisions and to take control of their lives. Service users are supported to take reasonable risks. The overall outcome in this area is excellent. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: Service users have an individual plan that addresses their needs and is kept up to date. The newest service user has an excellent individual plan, pictures and symbols have been used to make it user friendly. It was evident that the individual plans are working documents as staff had made amendments as they found new information about the service users. The Manager ensures all staff are aware of the content of individual plans. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 11 In addition to the individual planning used to address service users daily needs Person centred planning is being used. This supports service users to map their hopes, dreams and aspirations for the future. All service users have a circle of support and have had at least one planning meeting. An example of effective Person centred planning is for the service users who are sharing a bedroom. They are being supported to give their view on this with the help of their family and advocates. The Manager and staff have an excellent understanding of the principles of Person centred planning. Service users are supported to make choices within their daily lives. The way that they make choices and communicate had been included in their plan. Examples of choices offered are meals, activities, daily routines, privacy and clothes. Larger decisions are being supported through Person centred planning. Service users are supported to take reasonable risks, for example, going swimming and using public transport. All risks have been assessed and minimised. Staff keep all risk assessments under review. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16, 17 Service users enjoy a range of activities within the home and the local community. Service users are supported to have appropriate relationships. Service users engage in appropriate leisure activities. Service users rights are respected and they are aware of their responsibilities. Service users enjoy a healthy diet. The overall outcome in this area is good. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: Service users interests are identified in their individual plan. There is a range of activities regularly available each week and they can choose to do any 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 13 others if they wish. Staff help them to choose activities by offering the things they know they like and benefit from. Activities that service users are involved in include, cinema, bowling, social clubs, swimming, aromatherapy, prospects club, pubs and meals out. Records showed that service users take part in lots of activities each week. This is with the exception of one service user who has clearly expressed her wish for activities at home. At the time of the visit one service user went out for lunch. Service users are supported to maintain contact with their family and friends. The staff have made efforts to help service users rebuild contact with relatives they may have lost contact with. An excellent example of the support offered was that a service user was supported to meet his brother regularly in the pub as this worked better for both of them. Service users can come and go from the house as they wish and have a key to the front door, however most service users rely on staff support to go out. Service users have either chosen not to have a key to their bedroom or would not be able to use a lock. Service users are aware of their responsibilities in the home. They are encouraged to be involved in the preparation of meals although the layout of the kitchen does not promote this. Service users can choose to be alone when they wish and their privacy is respected. Service users can choose from the set menu that is available or can choose something different if they wish. The staff said that choices are offered by showing the service user items of food to choose from. The Manager and deputy have completed an in-depth course in food hygiene and nutrition. They are planning to review the menu to ensure it is nutritionally balanced. Nutrition assessments for all service users have not yet been completed as the Manager is waiting for the book ordered to help her to do this. The service users records show the make choices of meals and enjoy their food. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Service users personal care needs are met, but for two service users their privacy is not always maintained. Service users health needs are met. Service users are protected by the homes medication procedures. The overall outcome in this area is adequate. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: Service users’ personal needs are included in their plan. Staff have a good understanding of their needs and are trained and competent to meet them. Service users have the equipment they need for personal care. Unfortunately for two service users their privacy is compromised by having to share a bedroom. There are no privacy screens in the room because there is not the space for them. Staff make every effort to ensure that each service user is alone in their room for personal care, but this cannot always be achieved at night and affects the right of the other service user to enter their own bedroom. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 15 Service users’ health needs are met by the GP and other health professionals. Records of all appointments are kept. The home now has seated scales so that service users with nutritional issues can be weighed regularly. There are no service users in the home that retain their own medication. The home stores the medication within a double locked cupboard and uses an MDS system. Records of medication administration are accurate. All staff have attended Medication training and have had a recent assessment of their competence. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Service users know they can complain and that any concerns they have will be taken seriously. Service users are protected from abuse. The overall outcome in this area is good. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: Service users have a symbol copy of the complaints procedure. Keyworkers and relatives help them to express any concerns they have. There have been no complaints received in the home. Feedback from relatives indicated they knew how to complain if needed. There is a policy in the home for the Protection of Vulnerable Adults. Whilst all staff have addressed abuse issues through their NVQ they would benefit from an update in their 1-day adult protection course. This has been requested by the Manager. There is a clear intervention plan in place to protect the service user who can become self-abusive. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 Service users live in a homely environment. Service users bedrooms do not meet their needs. Service users do not have the furniture they need in their bedrooms due to a lack of space. Service users do not have sufficient communal space in house No2. The home does not provide adequate bathing facilities, due to a lack of hot water. Service users have the specialist equipment they need. The home does not meet infection control standards. The overall outcome in this area is poor. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 18 The home is comfortable, kept clean and has a homely atmosphere for service users. Each bungalow has a small kitchen, lounge, small dining area and either a shower or bathroom. Most service users have a single bedroom and whilst some of these are small they have been personalised to reflect their own taste. Two service users in bungalow No2 have to share a small double bedroom. There is insufficient space for their belongings and for staff to safely provide the support that is needed to move the service users with hoists. The Manager is aware of the issues and is advocating on behalf of the service users to have this reviewed. Only one service user has an armchair in their bedroom, as the other bedrooms are too small to accommodate one. This means they cannot relax in private without sitting on the bed. There are three people living comfortably in bungalow No1 and the space provided is adequate for their needs. The accommodation in bungalow No2 should be reviewed as it is not providing sufficient space for the four people living there, two of whom use wheelchairs and hoists. Priority should be given to addressing the shared bedroom issue. Not only is the bedroom too small for two people, there are issues of concern around lack of privacy and the service users disturbing each other in the night. These two service users do not have any private space to be alone, meet with relatives or receive personal care. One of the service users has aromatherapy massage on his bed, which means the other service user cannot access their bedroom at this time. The bathroom and shower facilities are appropriate for the needs of the service users. However, at the time of the visit House No1 had been without hot water for seven days due to ongoing problems with the boiler. Service users had to use the shower next door or have a wash only. This has been raised in previous inspection reports and not resolved. The Manager said that the housing association had now requested a quote for replacement boilers for both homes. MCCH must ensure this issue is resolved as a matter of urgency as it is unacceptable for service users to be without hot water due to a problem that has been identified some time earlier. The Manager said the boiler would be fixed in the interim on 7th August 2006. The laundry facilities remain in the garage. Whilst the equipment is appropriate the location does not meet the standards in terms of infection control. Again there has been some dispute with the housing provider about this issue and MCCH must ensure this is resolved. The garden was looking beautiful. Staff had worked extremely hard in their own time to plant, tidy and refurbish the furniture ready for a service users birthday the previous weekend. The garden provides a sensory environment with a water feature, scented plants and wind ornaments. Staff should be congratulated on making this a pleasant environment for the service users. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 19 The only access to the garden is through the lobby, as the French doors in the lounges cannot be used by people in wheelchairs due to a step over the frame. This is not only an issue of disability access but also of fire safety. The only fire exit from the home is past the kitchen. The manager is advised to review the fire risk assessment and contact the fire officer to discuss the safety of this. Service users have the equipment they need to aid their mobility. Grab rails are situated around the home and ceiling hoists fitted. Ramps allow access to the home through the front entrance. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 35, 36 Service users are supported by competent and qualified staff. Service users are supported by an effective team. Service users are supported by trained staff. Service users would benefit from staff being supervised more frequently. The overall outcome in this area is good. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: 70 of the staff team have achieved their NVQ award and the rest are working toward the award. New staff are enrolled onto their NVQ course once they have completed their induction programme. Staff have completed update training in manual Handling and medication. Adult Protection updates are planned for all staff. Staff are supervised by the Manager or senior staff. This had not been happening regularly due to staff sickness but has recently started to improve in frequency. There are sufficient staff employed to meet the needs of the service users. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 21 The Provider Relationship Manager for MCCH will assess standard 35 later this year and a summary will be included in the next report. There are no reasons for concern about the recruitment procedures for the home. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42 Service users benefit from a competent Manager and a well-run service. Service users benefit from clear leadership of the service. Service users and their representatives are asked to give their views on the home. There are some areas of risk to service users welfare due to outstanding environmental requirements. The overall outcome in this area is adequate. This judgement has been made from evidence gathered during the inspection, which included a site visit. EVIDENCE: The Manager has almost completed the NVQ 4 in care. She is also working toward the Registered Manager Award. The Manager demonstrated clear leadership of the service and a commitment to the rights of the people using it. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 23 Questionnaires are sent to relatives before the service users care review. This gives relatives the opportunity to give their views on the home. Service users are encouraged to share their views through Person centred planning. The Manager reviews all records in the home weekly and sees all accident reports to ensure the quality of the service is maintained. Regulation 26 visits are taking place each month. There is not a quality assurance policy in the home. Risk assessments have been completed for the environment. The Manager was concerned that, due to the lack of wheelchair access through the lounge doors, the only fire escape is past the kitchen. The Manager is advised to consult with the fire officer and review the fire risk assessment. There are some risks of infection in the home, as the laundry room does not comply with safety standards. Service users are supported by trained staff. 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 1 26 2 27 1 28 2 29 3 30 2 STAFFING Standard No Score 31 X 32 4 33 3 34 X 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 3 3 X 2 3 3 X X 2 X 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 25 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA30 Regulation 13(3) Requirement The Registered Person shall ensure that adequate laundry facilities are provided that meet with Infection Control guidelines. Action plan required. This has not been completed following the last inspection. 2. YA42 23(2)(p) The Registered Person shall ensure that a suitable boiler is provided that supplies adequate amounts of hot water to meet the needs of the residents. Action plan required. This has not been completed following the last inspection. 3. YA24 13(4)(a) The Registered Person shall ensure that service users can access the rear/side gardens. All areas of the home must be accessible to all service users. Action plan required. This has not been completed following the last inspection. 01/09/06 01/09/06 Timescale for action 01/09/06 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 26 4. YA25 12(4a) The registered person shall make 01/09/06 suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users; In that, service users must be offered a single bedroom. 5. YA42 23(4b) The registered person shall, after 01/09/06 consultation with the fire and rescue authority, provide adequate means of escape. In that, the Manager must ensure that the fire risk assessment addresses the risk of the only escape route from the building being past the kitchen. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA17 YA28 YA28 Good Practice Recommendations It is recommended that the Manager assess the nutritional needs of service users. It is recommended that the kitchen be made more user friendly for service users in wheelchairs. It is recommended that the shared space available to service users in house 2 be reviewed to ensure service users have access to sufficient lounge and dining room space to meet their needs. This is particularly important as service users have small bedrooms. It is recommended that staff are formally supervised 6 times per year. It is recommended that the home have a policy for quality assurance. 4. 5. YA36 YA39 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 1-2 Downer Court DS0000064406.V306691.R01.S.doc Version 5.2 Page 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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