Inspection on 04/07/06 for 145-147 Masons Road

This inspection was carried out on 4th July 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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

145-147 Masons Road 19/06/07

145-147 Masons Road 08/12/05

145-147 Masons Road 16/08/05

145-147 Masons Road 07/03/05

145-147 Masons Road 29/06/04

145-147 Masons Road 17/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 145-147 Masons Road 145-147 Masons Road Stratford On Avon Warwickshire CV37 9NX Lead Inspector Martin Brown Key Unannounced Inspection 4th July 2006 3:00pm 145-147 Masons Road DS0000057999.V302164.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 145-147 Masons Road DS0000057999.V302164.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. 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 145-147 Masons Road Address 145-147 Masons Road Stratford On Avon Warwickshire CV37 9NX 01789 414551 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) Turning Point Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th December 2005 Brief Description of the Service: 145-147 Masons Road is a care home for four adults with learning disabilities. The Primary Care Trust owns the home and the service providers are Turning Point. The home comprises two maisonettes one ground floor and one first floor. There is a small office and laundry on the ground floor separate to the maisonettes. The home was opened in 1994. Up to two service users are accommodated in each of the maisonettes. The home is a domestic property close to a supermarket and is close to the town of Stratford on Avon. All of the bedrooms are singles without en-suite. Each maisonette has two bedrooms, a lounge, kitchen and bathroom. There is a shared laundry, garages and gardens. The home is only suitable for service users who are independently mobile. The acting manager informed me that current fees per person are £1,312 per week. Additional charges are made in the form of contributions towards the running of the home’s vehicle. 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Tuesday afternoon and lasted three and a half hours. Staff and service users were welcoming and helpful. The acting manager was not present, but was contacted by phone later to clarify issues as necessary. The inspection was also informed by the pre-inspection questionnaire returned by the acting manager, the most recent regulation 26 visit report, and service user comment forms, filled in by the three residents, with help from staff. What the service does well: What has improved since the last inspection? What they could do better: Work is still required to improve the environment. In particular, the hot water and heating systems must be made satisfactory. It was extremely disappointing to note that the radiators are still malfunctioning, with some being warm, and one, in the bathroom, being hot, on one of the hottest days of the year. The overhauling of the heating system, with replacement of the radiators as necessary, must be a priority. 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 Page 6 Improvements in the home are noted, but so is the fact that it has not had a registered, and appropriately qualified manager for over a year.The service needs to continue to ensure that the management of the home is effective and fully supported through this period of change, as it seeks to improve the ways in which service users receive support, particularly in supporting one person who wishes to move on to a more independent setting. The needs of the service users result in a high level of wear and tear on the building and its contents. This should be recognised by giving swift and effective maintenance a higher priority. 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. 145-147 Masons Road DS0000057999.V302164.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 145-147 Masons Road DS0000057999.V302164.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): The quality for this outcome area was not judged on this occasion. It is extremely unlikely that the home will have any further service users in its present configuration. EVIDENCE: These standards were not inspected on this occasion, on the understanding that this service will not take further service users as it plans to reduce numbers to two, prior to re-registering as a care home, and becoming part of a domiciliary care service. The current service users have been there a number of years. 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 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 the following standard(s): 6,7,9 The quality for this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual plans reflect individual needs, and service users are able to make decisions, within the framework of acceptable risks and working towards greater independence. EVIDENCE: Each service user has a comprehensive folder, detailing needs and how they are met. There is also a service user-friendly guide, well illustrated by photographs, for each person. These are kept in the office, rather than in service user’s rooms, as they had been frequently damaged when this has been attempted. Service users are able to look at them when they wish, as one person did when I looked at his file. Service users sign or make their mark to indicate agreement with what is written or depicted; one service user in particular was keen to have his signature much in evidence on his file. Service users are supported in making decisions about their lives; this was evident in recording, observation, and discussion with staff and service users. Staff recognised the conflict between service user choice and, for example, the need for a basic level of hygiene; this is being managed at present by nonconfrontational persuasion and prompting. 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 Page 10 One service user has expressed a long-held wish to move to a more independent setting. The service is supporting him in meeting this wish, which, staff advised, is taking far longer than originally anticipated. Individual risks are assessed and managed, often within guidance concerning overall living arrangements, choice, and independence. 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 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 the following standard(s): 12,13,15,16,17, The quality for this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users enjoy a great deal of supported freedom in what they do, and are supported in benefiting from a broadly healthy lifestyle and diet that does not conflict with their wishes. EVIDENCE: Service users continue to be supported to take part in activities that they find fulfilling. Two service users attend college regularly, one enjoys gardening activities. The college has closed for the summer, leaving them more time for home-based activities. Staff advised that they try to arrange locally based activities such as picnics and shopping trips wherever possible. One service user was keen to show me his latest purchases. One service user does not generally enjoy the company of other than female staff, and staff have to bear this in mind when organising activities. One service user had recently returned from a holiday, which staff said he enjoyed, although he was keener on focusing on more immediate matters, rather than on something that had taken place a week ago. 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 Page 12 Service users access the local community, using local shops, and going to a local college. One service user went with a staff member to the local supermarket to stock up with provisions during the inspections. It was clearly something he looks forward to. Meals are flexible, with staff supporting service users in preparing meals and encouraging healthy balanced meals and a variety of experiences. Service users make themselves snacks and drinks. This was in evidence during the inspection. One service user requested a toaster, as bread is currently being toasted under the cooker grill. A staff member pointed out that toasters tended to get broken very quickly. A toaster was seen on a list of requested items. One service user smokes. He has a seat by the front door that facilitates this. In pleasant weather, at least one other service user also congregates in this area. 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 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 the following standard(s): 18,19,20 The quality for this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service endeavours to ensure that service users receive support that is required in ways that they are comfortable with. Medication is dispensed appropriately to service users. EVIDENCE: Much staff support involves encouraging positive behaviour and avoiding situations that could trigger negative behaviours. Staff were observed doing this with great skill and understanding, whilst trying to encourage greater social and independence skills. Staff were seen to have good supportive relations with service users, and interactions observed were easy-going and good-natured. The policy on Managing Behaviours is now signed by all staff. One service user was able to confirm that he is supported in regular health appointments, as noted in individual records. One service user has a walking aid for walking any distances outside the home. One particular area of need is that of communication. Staff advised they have received makaton training, and that communication aids have been used in the past, but that the service users have tended to develop their favoured terms of communication and make themselves understood, most readily to those who 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 Page 14 are familiar with them through prolonged contact. This was observed, service users being very persistent in getting their views and wishes across. Medication recording was accurate; proper stock control accounting is now in place for non ‘blistered’ medication, and a sample examination showed this to be correct. Medication records included photographs of each service user, a brief guide to how they prefer medication to be administered, and a clear policy and procedure for ‘as required’ medications. 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 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 the following standard(s): 22,23 The quality for this outcome area is adequate. Service users can feel confident that their immediate views are listened to and acted upon, and that they are protected from abuse, neglect and self-harm. Whilst there is no suggestion of financial abuse, service users may benefit from greater clarity in respect of transport costs. EVIDENCE: Service users are persistent in getting their views across and one service user in particular was keen to show me areas of deficiency within the home, as he saw it, as well as to request items, such as a toaster. Where appropriate, these have been included in the requirements and recommendations. Staff were observed to heed service users’ views and to try and accommodate them wherever possible. The complaints log book was seen, but had no entries. Staff advised that most of the issues brought up are of the sort I encountered, or concerning other service users, which are dealt with informally, and recorded in daily records, as appropriate. Two service users, who have no relatives, are visited by an advocate twice yearly. Service users’ finance records were looked at, and seen to be accurate. Contributions towards petrol costs were noted. Staff advised that there was some uncertainty regarding how payments were calculated, and that excessive costs could have a particular impact on one service user. 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 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 the following standard(s): 24, 25,26,27,29,30 The overall quality for this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users benefit from an improved environment, but are still poorly served by a poorly functioning and wasteful heating system. Prompter repair of damaged items would promote a more positive image and more ‘homely’ feel within the home. EVIDENCE: The downstairs flat has been re-carpeted, as previously required. The lounge and kitchen are satisfactory. The neon light in the downstairs bathroom was without a cover, the extractor fan in the downstairs toilet was not working. One service user showed me the shower head, which he wanted to be reattached to the shower bar, so that it could be moved up and down to the right height, and so be used ‘hands free’. The garden is now much tidier, and more accessible and an amenity to the home. Lights in the hallway have no covers on them. A number of notices, principally aimed at staff, were on display in the kitchen. Staff agreed that these could detract from the ‘homely’ nature of the home. 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 Page 17 The front drive has now been re-surfaced, removing the tripping hazard that it previous constituted. The upstairs bathroom is still badly in need of renovation, the handle on the door to this room was broken. Staff advised that this had been recently done, and was awaiting repair. The door of the cupboard housing the boiler in the rear bedroom has been pulled off, and needs replacing. It was later discussed with the acting manager as to whether the service user might prefer the staff sleep-in room, which does not house a boiler. Two fascias on cupboards in the upstairs kitchen had been pulled off, and the door handle to the bathroom was broken. Staff advised that these were due to be repaired. The home was free from unpleasant odours, and generally clean and tidy, although the upstairs bathroom and the radiators are in such a state of dilapidation that it is difficult to make them appear clean and tidy. One service user was pleased to show me his bedroom; on the survey returned, he had indicated that he was not happy with its small size, but on this occasion he did show any unhappiness with it. 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 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 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): 32,33,34 The quality for this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a consistent staff team who are familiar with their needs. EVIDENCE: The staff on duty were competent, knowledgeable and sufficient to meet the needs of the service users. In the absence of the acting manager, staff files were not seen. Recruitment procedures had not been an issue previously; the acting manager advised the following day that these were in order. The training matrix showed a programme of training that covered basic and identified needs for the home. Staff were complimentary about the training programme, although it was acknowledged that some training had been cancelled on several occasions. Further training on managing potentially violent and aggressive behaviour is booked for all staff. Rotas evidenced little use of agency staff, other than two who are regularly employed, and on the evidence observed, have worked at the home sufficiently to have the knowledge and skills base of permanent staff. This is an improvement from previous inspections. 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 Page 19 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): 37,39,42 The quality for this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although there have been material improvements in the service, and the acting managers have been well-supported by the organisation, the service users do not benefit from having a permanent, appropriately qualified manager in post. Service users views are not fully reflected in any quality assurance system in respect of the development of the service. The home endeavours to promote the welfare and well-being of service users, but this is compromised by the current deficiencies of the heating system. EVIDENCE: Following the departure of the previous acting manager, who had hoped to gain the appropriate qualifications and register as manager, the home now has another acting manager. The service aims to re-house one gentleman elsewhere, in accordance with his expressed and agreed wishes, but this is 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 Page 20 taking far longer than anticipated. Once this has been achieved, the service would hope to de-register and provide a supported living service for the remaining two service users. While improvements are noted since the last inspection, particularly in addressing environmental needs, deficiencies already noted under the Environment section, particularly the heating system, are detrimental to the well-being of service users. The pre-inspection questionnaire details regular fire and equipment checks taking place. There was no evidence that the fire officer’s written concerns regarding smoke seals on fire doors being compromised by over-painting had been addressed. Regular and details of provider visits under regulation 26 of the Care Standards Act 2000 show that quality of the service is regularly assessed by the organisation. There was no evidence of quality reviews of the service reviews involving service users or significant others. One additional issue raised by staff was the inefficiencies raised by only having one set of keys, which meant one staff frequently having to seek the shift leader in order to open particular doors. This was observed during the inspection, leading to delays in accessibility for staff and service users to, for example, items in the office, and to the laundry. Staff in the downstairs flat are still required to use the lounge as a sleeping room, in the absence of an available bedroom. There was no risk assessment in place regarding the transport of service users, although it was acknowledged by staff that there were potential flashpoints. 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 Page 21 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 x 2 x 3 x 4 x 5 x 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 1 25 3 26 3 27 2 28 x 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 x 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 x 2 x x 2 x 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 Page 22 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 YA24 Regulation 23(2) Requirement Evidence must be produced that the heating system is to be overhauled or replaced to ensure that radiators work appropriately.(This is a requirement outstanding from the previous inspection). Cupboard doors in the upstairs kitchen must be repaired. Ceiling lights must have covers where needed. The door of the cupboard housing the boiler must be replaced. Evidence must be produced that the upstairs bathroom is to be renovated. The door handle to the upstairs bath room must be repaired. The extractor fan in the downstairs toilet must be repaired. When a vacancy arises in the downstairs flat, this must be used as a sleeping -in room, to end the practice of staff having to sleep-in in the service users lounge. DS0000057999.V302164.R01.S.doc Timescale for action 15/08/06 2. 3. 4. 5. YA24 YA24 YA27 YA27 23(2) 23(2) 23(2) 23(2) 15/08/06 15/08/06 15/08/06 15/08/06 6. 7. 8. YA27 YA27 YA37 23(2) 23(2) 23(3) 15/08/06 15/08/06 15/08/06 145-147 Masons Road Version 5.2 Page 23 9. YA37 8,9 The service must detail its proposals to have a registered manager to run this registered service.(This is an outstanding requirement from the previous inspection) Service users views must be reflected in a quality assurance system. The home must evidence that it has responded appropriately to the fire officer’s concerns regarding heat and smoke seals being painted over. A risk assessment is required regarding the transportation of service users. 15/10/06 10. 11. YA39 YA42 24 23(4) 15/10/06 15/08/06 12. YA42 13(4) 15/08/06 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 Page 24 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. Refer to Standard YA17 Good Practice Recommendations It is recommended that the service purchases a new toaster, and has a programme in place to support and encourage responsible use of it, as part of progress towards independence. It is recommended that the policy for transport costs be reviewed and made more transparent. It is recommended that notices directed at staff be kept in relevant folders, rather than displayed on walls other than the office. It is recommended that the service gives a higher priority to prompt maintenance, repair, and replacement of damaged or worn items. It is recommended that consideration be given upstairs to exchanging staff and service user bedrooms, if having the boiler in the bedroom currently occupied by the service user causes difficulties It is recommended that the downstairs showerhead is reattached to the shower bar, in line with the service user’s expressed preference. It is recommended that the service consider the benefits of keys being available to both staff members on duty. 2. 3. 4. 5. YA22 YA24 YA24 YA26 6. 7. YA27 *RCN 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 145-147 Masons Road DS0000057999.V302164.R01.S.doc Version 5.2 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. 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!