Inspection on 20/05/05 for 1-2 Orchard Mews

This inspection was carried out on 20th May 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

1-2 Orchard Mews 22/04/08

1-2 Orchard Mews 03/05/07

1-2 Orchard Mews 07/02/07

1-2 Orchard Mews 14/10/05

1-2 Orchard Mews 14/01/05

1-2 Orchard Mews 08/07/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 1 - 2 Orchard Mews Bakers Drove Rownhams Southampton SO16 8AD Lead Inspector Wendy Thomas Uannannounced 20.05.05 10:30am 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 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 Stationary 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 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service 1-2 Orchard Mews Address Bakers Drove Rownhams Southampton SO16 8AD 023 8073 9076 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Choice Support Ms Suzanne Nolan CRH 6 Category(ies) of Learning Disability - LD - 6 registration, with number of places 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the category LD are only to be admitted between the age of 18-60 years. Date of last inspection 14.01.05 Brief Description of the Service: 1-2 Orchard Mews consists of two purpose built bungalows with through access via the office. Service users have learning disabiities and those living in bungalow 1 require a high level of physical support, have communication difficulties, and are wheelchair users. The occupants of bungalow 2 have greater communication skills and are more physically able. One staff team operates throughout the home, although the servuice users tend to keep their own area of the home. 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which took place on Friday 20 May 2005 between 10:30 and 16:30. The inspector spent time interacting with and observing staff and service users. Time was spent in discussion with three service users, the assistant manager, a senior support worker and a recently appointed support worker. Since the last inspection an acting manager has been brought in to manage the home in the absence of a permanent manager. She had been managing another Choice Support home in another area. She was not available at the time of the inspection, although the inspector did speak with her some days later on the telephone. Time was also spent looking at service users’ files and documentation. Three service users who were able to express their opinion indicated that they were, on the whole, happy in the home. Two would like to go out more, and one indicated that they had a problem with one of the other people living in the home. What the service does well: What has improved since the last inspection? Although the inspector was not able to view any concrete evidence at the time of the inspection, work is underway to improve and update service users’ care plans, assessments and risk management strategies. This was demonstrated in the risk assessments sent to the inspector following the inspection. The timescale given at the last inspection for this work to be completed has not yet 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 6 expired. When this has been completed staff will have the information they need to support service users properly. There has been an increase in the number of opportunities that service users get to out and participate in activities out of the home, such as shopping trips, local walks, visits to the pub. This has, in part, been able to happen due to the increase in the number of staff on duty. This has also meant that service users are better supported in relation to behavioural issues. Some areas of the home have been redecorated since the last inspection, and one of the lounges had a new carpet. What they could do better: 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 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 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 standard(s) These outcomes were not inspected on this occasion, as there have been no new admissions since the last inspection. EVIDENCE: 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 9 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 standard(s) 6, 7, 9 and 10. Although improvements have begun, the care plans did not give sufficient or current information to enable staff to support service users properly. The service users would benefit if plans were to be developed to achieve the goals they had already identified with staff and carers. Removing service users’ personal records from communal notice boards will enhance their dignity and maintain confidentiality. EVIDENCE: The assistant manager reported that work had been carried out in response to the requirement in the previous inspection report that up to date service user plans are developed and that the new assessments, care plans and risk assessments were all at the area office being typed up. The paperwork held in the home continued to be out of date in some cases dating back to 1999. One of the service users whose file was inspected has needs that have changed dramatically in the past year yet the guidelines indicated very little of this. The one piece of work that had recently been added to their file focused only on one particular area of difficulty. 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 10 The three service user files examined contained notes from “service development plan” meetings held since the last inspection. These demonstrated that the service provided to each individual was being reviewed and that their wishes were being sought and goals identified. However there were a number of goals a service user had determined at their meeting in March 2005. When the inspector spoke with the service user she was informed that no progress had yet been made on any of these, even though some of them appeared to the inspector to be easily achievable. The requirement from the previous report concerning care plans and goal setting remains as the timescale has not yet expired and the requirement has not been achieved. Details of who was involved in the consultation and decision-making process concerning the use of listening devices being used to monitor service users’ healthcare needs was not recorded. The assistant manager agreed to remove information relating to service users bodily functions from the kitchen notice board, which was compromising service user’s dignity and issues of confidentiality. In a follow up telephone conversation to the acting manager, the inspector was informed that much of the information the assistant manager had said was being typed up was in fact in files in the unit, but the inspector was not directed towards these. The acting manager faxed copies of risk assessments for the person referred to above, whose needs had changed significantly. These related to the current issues and were a significant improvement on those the inspector saw at the inspection. 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 11 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 standard(s) 12, 13 and 17 Service users are benefiting from more opportunities to take part in age, peer and culturally appropriate activities. Ensuring that the activities and opportunities available are meaningful to the service users will increase their satisfaction with the service. Service users receive a variety of balanced meals. EVIDENCE: One service user attends external day services five days a week and another four days a week. One of these service users spoken with indicated that this was very important to them and a valuable part of their life. The other service users receive eight hours dedicated day service time provided by a member of the staff team. The assistant manager was developing a weekly timetable detailing activities outside the home for service users. Examination of one of the service user’s daily diaries indicates that currently this mainly to do the household or personal shopping. Service users often get the opportunity to have lunch out. Two service users were going out for lunch, one to a pub and one at a shopping centre, during the inspection. 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 12 The assistant manager and a member of staff spoken with were of the opinion that service users were getting more opportunities to spend time out of the home than they were at the time of the last inspection. Increasing the staffing levels so that four staff are working between 8.30 and 15.30 has facilitated this. A “participation index chart” has been developed since the last inspection to help in monitoring service user activities. This focuses on household tasks such as helping with the dishwasher and cleaning their bedroom. The assistant manager explained that she is building on this and developing the weekly timetables so that they also incorporate this and can be used as a monitoring tool. Given that several of the service users spoken with expressed a desire to go out more and to be involved in leisure type activities as opposed to task focused activities such as the shopping, an effective monitoring tool will enable staff and service user to demonstrate this. During the inspection one of the service users went with a member of staff to do some shopping at the supermarket for groceries. The home has a fourweek rolling menu, which the inspector examined. The menus showed a variety of nutritious meals. As the menus are used as a general guideline into which service user requests or seasonal availability are incorporated it would be advisable to keep additional records on a daily basis. In this way puddings, which were not included on the menus, could also be recorded. The inspector observed staff preparing homemade cottage pie for the service users in bungalow 1. The home has a vehicle but this is not fully utilised as there are a shortage of drivers. So service users often tavel by taxi. 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 13 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 standard(s) 18, 19 and 20. Once the new service user plans are implemented the means to meeting service users’ personal support needs should be well documented. Service users’ physical health needs are well supported with help from healthcare professionals. Further consultation and observation would enhance staff’s awareness of service users emotional state, hopes and wishes. The amended medication procedure guides staff to manage and administer medication safely. Further monitoring would help to eradicate any errors. EVIDENCE: A member of staff described to the inspector the support that a service user received around the early part of the morning e.g. getting up having breakfast, personal care etc. However none of this was recorded on the current care plan, nor were the pertinent risks recorded as having been assessed. The inspector was concerned that no draft or provisional guidelines were in place to cover this interim period during which the formal plans were reported to be at the area office being typed up. The member of staff describing these support needs was relatively new and had been well briefed verbally. As long as the new care plans have this level of detail they will comply with the standard. 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 14 There are a number of healthcare professionals involved with the home providing support to staff and service users in relation to specific issues. The home seeks referrals appropriately. One service user discussed ways in which they felt their emotional well-being was not being supported. The issue was one of communication because once pointed out to staff they were keen to support the person. Notes from the “service development plan” meetings show that the home is going some way to try and identify what the service users want. The in-house medication procedure has been amended following a requirement in the previous inspection report. The medication records and cabinets were inspected. There is a system in place to identify any medication errors, however this was not being followed robustly enough in that the inspector found that some medication given had not been signed for. It was also suggested that a signature sheet be kept to ease identification of the person signing especially where the signature resembles the codes given on the sheet. 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 15 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 standard(s) 22 and 23 There are policies and procedures in place to protect service users form abuse identifying the responsibilities of the different agencies in Hampshire. EVIDENCE: The previous inspection report recommended that full details of complaints, and the timescales involved in responding to and resolving these, be held in the home. At the time of this inspection this information was not available. The assistant manager explained that company policy was not to have information about specific complaints available in the office. A log was available containing reference numbers for complaints dealt with. In the absence of the manager it was not possible to ascertain whether the detailed reports were held securely on the premises as would be expected. This will be followed up at a future inspection. The adult protection policy had been amended as recommended at the previous inspection to include the roles of the various agencies as set out in Hampshire’s policy on the protection of vulnerable adults. It had been recommended that a copy of the Department of Health’s document “No Secrets” be obtained. This was not available during the inspection. Checks and balances are in place to protect service users finances. Staff were observed checking the amounts held for service users and the home’s petty cash during the staff handover period. There has been some difficulty for service users accessing their money due to the change of manager. It was reported that this was being resolved. 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 16 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 standard(s) 24 and 30 The home is comfortable and homely. It meets the needs of the service users. Further attention to detail and maintaining high standards of cleanliness throughout the home would enhance the living environment. EVIDENCE: Those service users, who were able, were observed to be moving freely around their bungalow. The environment was pleasant having been repainted throughout. The carpet in the corridor of bungalow 1 continues to look stained. Service users have personalised their rooms to their own taste or have had support to do so. Some furniture had recently been purchased for one of the service user’s bedroom and was in the process of being assembled. The utility room and bathroom floors (including the en suite) looked grimy, as did the sink in the utility room in bungalow 1. The inspector had been told several times that a chair that had been causing bruising to the legs of one service user had been replaced. This was not in fact the case. This chair must be disposed of and a new one purchased. 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 17 The inspector has asked the home to provide a timescale to replace or make good the kitchen units in both bungalows, which are showing signs of wear and tear. In the interim some of these would benefit from being cleaned. The previous two inspections have found the garden in need of attention. There is a good-sized garden to the front and rear of the property. The service users, especially those who use wheelchairs could greatly benefit from this outdoor space if properly maintained. The assistant manager reported that contractors come in every three weeks to look after the garden. At the time of the inspection the grass did not look as if it had been cut for some time. The inspector suggested that new crockery be purchased for bungalow two where it was noted that there was an assortment of parts of several dinner services, but no longer complete matching services. 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 and 36. Care provided to service users is enhanced through regular staff supervision and staff meetings, and planned training in person centred planning to take place shortly. EVIDENCE: The inspector spoke with a new member of staff who had been working in the home for three weeks. The assistant manager reported that there were a further two staff waiting for their statutory checks to be completed and then they would be starting work in the home. Two bank staff had also been recruited and it was hoped that this would reduce the home’s dependence on agency staff. One of the two acting assistant managers at the time of the previous inspection has now been appointed permanently and it has been decided to have just one assistant manager. Recruiting staff has been a long-term problem in the home, however Choice Support are currently running an ongoing recruitment campaign in the area. Three service users asked indicated that they liked the staff and were treated well by them. The introduction of a fourth member of staff working between 8.30 and 15.30 appeared to have brought about a significant improvement in the support that 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 19 the staff team are able to offer service users, especially in relation to behaviour issues and activities outside the home. All staff spoken to confirmed that formal supervision sessions were now being held, so this requirement form the previous inspection report was being met. It was reported that only one member of staff had an NVQ qualification, however the inspector was informed that the acting manager was looking into this so that more staff could undertake this training. Because the inspection was unannounced and the manager not present it was not possible for the inspector to assess progress on two of the requirements made in the previous inspection report (Standards 34 and 35). These requirements are therefore carried over to this report. The requirement in the previous inspection report concerning having sufficient staff to meet service users’ needs has, in part, been met through the “service development planning” meetings and the increase in the staff levels during the first part of the day. Consideration should be given to maintaining that level of staffing throughout the waking day. 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 and 42. Service users and staff have experienced disruption due to continuing changes in the management of the home. Disregard for fire safety measures was putting service users at potential risk. EVIDENCE: Since the departure of the registered manager in November 2004 an acting assistant manager has managed the home with some support from the service manager (responsible for the three local Choice Support services), then by two acting assistant managers. A temporary manager from another Choice Support home was then brought in and continues to work at the home until a permanent replacement is recruited. At the same time the service manager was also replaced by another temporary appointment. This has been disruptive for staff and service users, however the staff spoken to were positive about the current arrangements, although said it had been difficult at times and they had not always felt well supported. 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 21 At the time of the inspection the door of the utility room in bungalow 1, where laundry equipment was in operation, was wedged open, thus putting service users at risk should a fire have broken out there. 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x 2 2 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 x x x 2 Standard No 31 32 33 34 35 36 Score x x x 2 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 1 - 2 Orchard Mews Score 2 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 x x x x x 2 H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 23 Are there any outstanding requirements from the last inspection? Yes: one had not time expired, and in the absence of the manager, the isnpector was not able to assess progress on the other two. 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 6, 9 and 18 Regulation 15 Requirement The registered manager develops and agrees with each service user an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. The chair causing bruising to a service user must be replaced. Timescale for action 14/7/05 2. 24 3. 34 16 (2) (c ) 23 (2) (c ) 19 14/7/05 4. 35 Records as stipulated in Schedule 2 of the Care Standards Act 2000 are held on all staff recruited. (E.g. two references, complete employment history.) (This requirment is brought forward from the previous report as it was not possible to confirm compliance.) 18 (1) (c), An audit of staff training is 23 (4), 13 required in order to evaluate (4) whether this standard is being H54 S59159 1-2 Orchard Mews V224990 200505.doc 14/7/05 14/7/05 1 - 2 Orchard Mews Version 1.30 Page 24 5. 42 23 (4) met. (This requirment is brought forward from the previous report as it was not possible to confirm compliance.) Advice must be sought from the fire safety officer regarding the utility room door. 14/7/05 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. 4. 5. Refer to Standard 10 17 20 30 Good Practice Recommendations Information about service users personal needs should not be on display in communal areas. Records should be kept of food eaten by service users. Measures should be put in place to ensure closer adhersion to the medication procedure. The bathroom floors should be thoroughly cleaned. 1 - 2 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 25 Commission for Social Care Inspection 4th Floor, Overline House Blechynden Terrace Southampton SO15 1GW 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 Orchard Mews H54 S59159 1-2 Orchard Mews V224990 200505.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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