Inspection on 14/11/06 for 34-36 Langstone Road

This inspection was carried out on 14th November 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 19 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

34-36 Langstone Road 22/02/08

34-36 Langstone Road 11/09/07

34-36 Langstone Road 22/02/06

34-36 Langstone Road 17/08/05

34-36 Langstone Road 17/02/05

34-36 Langstone Road 03/09/04

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 34/36 Langstone Road Russells Hall Estate Dudley West Midlands DY1 2NJ Lead Inspector Jayne Fisher Key Unannounced Inspection 14th November 2006 08:30 34/36 Langstone Road DS0000024966.V319435.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 34/36 Langstone Road DS0000024966.V319435.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. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 34/36 Langstone Road Address Russells Hall Estate Dudley West Midlands DY1 2NJ 01384 234510 01384 357752 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) Langstone Society Mrs Patricia Joan Brookes Care Home 8 Category(ies) of Learning disability (7), Learning disability over registration, with number 65 years of age (1) of places 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 22 February 2006 Brief Description of the Service: Langstone Road is a residential care home registered for eight people with a learning disability. Originally two semi-detached properties It maintains a similar appearance to other residential properties in the area and is situated close to local shops and public transport links. The Registered Provider is Langstone Society which is a Registered Charity who rent the premises from the Churches Housing Association of Dudley District Limited (CHADD). Facilities include 6 single and 1 double bedroom, kitchen, dining room, 2 sitting rooms, and sufficient numbers of bathrooms and toilets. Car parking is available at the front of the property with gardens at the rear. The home’s aim is to provide a homely and stimulating environment, ensuring that each person exercises maximum choice and control over their own life and maintains independence. A statement of purpose and service user guide are available to inform residents of their entitlements. The charge for accommodation is £631 per week as reported by the care home. There are additional charges for hairdressing, toiletries and transport (plus activities and therapeutic interventions – see comments in standard 5 and 23). 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first key inspection for this inspection period 2006 – 2007. As it was a key inspection this means that all core National Minimum Standards were assessed. This inspection was unannounced meaning that no one received prior notification. The Inspector arrived at 8.30 a.m. and left at 7.30 p.m. A range of inspection methods were used to make judgements and obtain evidence which included: interviews with 2 senior staff and 5 support workers. Four relatives and visitors completed comment cards. There are currently eight residents living at Langstone House and all were seen during the inspection. Formal interviews were not appropriate therefore the inspector relied upon brief chats, observations of body language and gestures, and interaction between staff and residents. Eight residents completed questionnaires with the assistance from staff. Where possible, responses were discussed with residents in order to make judgements about the service. A number of records and documents were examined, a tour of the building was undertaken and three residents’ care was case tracked through interviews with staff and examination of relevant documents. Other information was gathered prior to the inspection from reports of visits undertaken by the owner’s representative and a pre-inspection questionnaire. The manager was not present at this inspection. Staff however were very welcoming, helpful and co-operated fully with the inspection process. What the service does well: What has improved since the last inspection? 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 6 Professional support and advice has been sought on behalf of one resident with weight and eating problems. There are two options planned for their lunch and dinner and staff have completed training in healthy eating. Other training has taken place including infection control, first aid awareness and vulnerable adult abuse awareness. Staff are also now undergoing specialist induction training. Some improvements have been made towards ensuring safer systems for residents with regard to the control and administration of medication. Wardrobes are now securely fixed to bedroom walls and one resident has had a new headboard for their bed. More staff have been employed allowing for flexibility in the duty rota and on occasions there are extra staff on duty to support residents. Residents have been offered the choice of an extra weekend break this year as well as their annual holiday. Improvements have also taken place in order to promote residents’ health and safety. What they could do better: Slight improvements have taken place with regard to care planning and risk assessments although these still do not adequately provide staff with all of the guidance required to support residents. They require expansion particularly with regard to managing challenging behaviour as current strategies employed by staff are not detailed in care plans and risk assessments. Staff need training in understanding and managing challenging behaviour. More opportunities need to be offered for residents to participate in stimulating activities and outings particularly at weekends. At present there are generally only three staff on duty at weekends which means there is little opportunity to undertake spontaneous activities based on the individual preferences of eight residents. One service user has increased mobility problems and is using equipment for which he has not been assessed by a suitably qualified person. The subject of food and allowing residents’ to make their own choices remains a source of conflict between staff and management. As a result, records are not being maintained to demonstrate that a range of snacks are being offered to residents or how they are supported to make their choices. According to records which are being maintained, staff are not always following one resident’s specialist guidelines with regard to nutrition and are not fully familiar with the content of the care plan. The standard of décor and furnishings require improvement and although the premises was generally clean and tidy, some areas of infection control need more rigorous attention. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 8 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 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is an holistic assessment process so that new residents can be assured their individual needs will be measured and met. Service users would benefit from updated contracts/terms and conditions of occupancy whereby they could have accurate information regarding what is included as part of their basic contract fee and additional charges. EVIDENCE: Langstone House is fully occupied and has remained so for some time. There is an assessment proforma which covers all of the subjects required by the National Minimum Standards (NMS) 2.3 (this proforma is currently used as a care planning document). There remains a longstanding requirement to review residents’ contracts. As previously noted a system of Licence Agreements between the landlords: Churches Housing Association of Dudley District Limited (CHADD) and the individual service user is in place. This document is included in service user plans and a copy is contained within the service user guide. The documentation needs review to comply with all of the requirements of the National Minimum Standards (NMS) 5.2. For example to include details of the 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 10 specific room number occupied, additional charges and arrangements for review of the care plan. On examination of financial records residents are still being charged for activities, and during interviews staff remain unclear as to what should be included as part of the basic contract fee. Since the last inspection a new therapeutic activity has been introduced which two residents attend on a regular basis. This is a ‘tranquillity’ session at an external resource centre. A member of staff has to accompany them and therefore not only are residents paying for their own fees (£6.00 per session), but also that of the escort. During interviews staff stated that felt it was unfair particularly as one of the residents seems to be paying for the staff escort on more occasions than the other resident who accompanies them. This did seem to be the case on examination of the records, and on one occasion (1 November 2006), neither resident was charged for the cost of the staff member who accompanied them. This remains an outstanding requirement from previous inspections. The Registered Person must demonstrate that consultations have taken place with the Commissioning Authority as to what is included in the contract fee particularly as some residents do not attend external day centres on a daily basis, and therefore may be incurring more costs for the funding of their activities. Any additional charges must be agreed with the Commissioners, the resident (and advocate) and included in the contracts. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments require expansion, updating and review as they do not cover all aspects of personal and social, and health care in sufficient detail; this has the potential to place service users at risk. EVIDENCE: A sample of care plans were examined and staff were interviewed to determine whether improvements had taken place since the last inspection in the care planning system. A member of staff stated “we haven’t changed them much, just added to them”. During interviews some staff demonstrated that they were still unaware of the content of care plans and as a result inconsistent strategies are in place to support residents (see further comment in standards 17 and 18). There is an individual sheet containing goals and objectives dated September 2004. There is no evidence to confirm that these have been reviewed and the goals and objectives are broad and non-specific. For example “to promote 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 12 health and happiness”. There was no mention of personal hygiene, nutritional, challenging behaviour etc. Care plans are entered onto a proforma which is more in keeping with an assessment of need. Ideally each care plan should have an objective, goals and actions required to meet needs identified, and monitoring and review procedures. There is an section entitled ‘ assessment of daily living skills’. Information within this section broadly identifies needs around feeding, bathing, mobility and dressing. However, this tends to identify the needs of the person, rather than provide a detailed description of how that person would like their care delivered. From interviews with staff and observations made during the inspection, it became apparent that one service user has been exhibiting increasing challenging behaviour during the last few months. There were no up to date management behavioural guidelines or a detailed care plan in place. There was a range of information contained within different sections of the service user’s folder which provided conflicting advice. For example, there were undated management behavioural guidelines which make reference to a staff meeting in 1995. There was no confirmation as to who had ratified these strategies and neither did they describe the current behaviours. There was another entry found in another part of the case file covering behaviours dated October 2006 describing the current physical aggression being exhibited but there were no triggers, diffusion or de-escalation techniques identified, support mechanisms for the service user, other residents and staff. There was a third behavioural management support sheet found in the care plan folder. This was not dated or signed and referred to the resident throwing items and advising staff to use plastic cups and plates. One resident had been diagnosed with MRSA on 14 September 2006. There was no care plan in place as to how staff supported and helped the resident to manage this infection. There was a statement made by staff dated 21 October 2006 indicating how district nurses and the General Practitioner (G.P.) had been involved and provided personal protective clothing. During interviews staff reported that one resident is now using a wheelchair for negotiating long distances outside of the home. There was no separate care plan regarding his mobility and neither was this equipment mentioned his ‘assessment of daily living skills’. During interviews staff discussed how they had requested the assistance of the district nurses for one resident as they had identified a potential pressure area. As a result a pressure relieving mattress and cushion had been obtained. There was no care plan in place regarding pressure area care, details of pressuring relieving equipment or guidelines for staff with regard to observing and monitoring and how to identify a pressure area. It was pleasing to see that case files still contained very detailed communication packages. However, as previously identified, care plans need 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 13 to be developed with regard to the support and assistance required by service users in managing their finances. Similar to care plans, risk management processes identify shortfalls. There were risk assessments which covered subjects such as use of the cash point machine, self medication, falls and finances. However there was no risk assessment in place for the resident who is exhibiting increased challenging behaviour. Staff reported that they had carried out a risk assessment with regard to this resident travelling on the home’s vehicle in view of his behaviours. This document was not available. Staff stated that the manager had removed this as she felt that there was no risk involved. Nonetheless staff are still using control measures as they feel there is an associated risk. This was further confirmed when a member of staff was overheard complaining that the resident had been sitting behind her in the vehicle and had been kicking her chair and hitting her ‘hard’ on the shoulder. There was no risk assessment in place with regard tissue viability for another resident who is prone to pressure sores. There was no risk assessment regarding one resident and the use of a wheelchair. The same resident requires the assistance of staff when bathing yet his risk assessment made no mention of this and gave details of the use of the bath lift, which he is reported to never use. Other residents who display challenging behaviours did not have risk assessments in place. Staff identified that one resident who does enter the kitchen to make drinks, is at risk of scalding. Staff report they have discussed this with the manager who is reluctant to restrict accessibility to the kitchen so as not to compromise this resident’s rights. Whilst this approach is commendable, where risks are clearly identified the Registered Person must consider this as part of the risk management framework. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst some improvements have taken place, links with the community remain intermittent and only limited planned and spontaneous activities take place. Staff support residents and their families to maintain their important relationships. Professional support and advice regarding one resident’s specialist nutritional needs has been sought although staff require more guidance. The home has made some progress with providing more daily food options, although further improvements are needed to enable residents to exercise choice over their diet. EVIDENCE: Seven of the eight residents living at Langstone House attend external day centres. Four residents attend their day centre every day during the week, 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 15 whilst the other three residents attend three or four times per week. Although there are activity programmes detailing on which days residents attend day centres, these do not identify what they like to do when they are not at their centres. There are monthly key worker reports which summarize the activities and outings which have taken place. There are also monthly planners, although on examination these are completed retrospectively and there cannot be deemed a planning tool. Four of the five staff who were interviewed regarding activities and lifestyles stated that they felt residents should be offered more opportunities to participate in stimulating activities, particularly within the community. On examination of monthly reports, during September 2006 one resident had participated in three community based activities (other then attending his day centre). These had consisted of visiting a social club on two evenings and going on an outing to a garden centre. Another service user who was case tracked during a one month period had gone to a pub, been for a ride to Stourport and went shopping at Merry Hill. There was little information contained within daily reports as to how this resident spent his time when not attending his day centre during the evening or at weekends. During a fourteen day period one resident had not been on any community based activities. Staff stated that they found it difficult to organise spontaneous activities as the manager required them to forward plan in order to arrange sufficient staffing. At weekends there are generally only three support staff on duty, which means there is little opportunity to undertake spontaneous activities based on the individual preferences of eight residents. All residents have been on an annual holiday this year, although according to staff they still fund the cost of the holidays themselves. Residents have also had the option of going on a weekend break this year. Destinations have included York and Stourport. During interviews residents said that they liked going to their day centres. One resident stated that she liked living at the home “because I have good friends”. Another resident said “I’m looking forward to Christmas, I like going shopping”. Staff continue to support residents to maintain important links with their families. One resident spoke about going to visit her family at Christmas. All four relatives who completed feedback questionnaires stated that they were made to feel welcome when visiting the home and could see their family member in the privacy of their bedroom if they wished. Observations made during the day demonstrated how staff were flexible. For example, when the Inspector arrived at 8.30 a.m. seven residents were up and dressed and were either awaiting their day centre escorts or were going to a hospital appointment. However one resident was having a lie-in. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 16 On the evening some residents decided that they did not wish to attend the planned activity (Langstone annual general meeting) and staff respected this. Case files contained residents’ consent to staff opening their mail and risk assessments with regard to the withholding of bedroom door keys. Some improvements have taken place with regard to nutrition since the last inspection. Professional support and advice has been obtained from the community dietician, psychiatrist and psychologist. As a result there are detailed management behavioural guidelines in place for one resident with weight and eating problems. A senior member of staff had introduced a new care plan in October 2006. This stated that up to four nutritional supplements could be given per day. However, during interviews not all staff were not aware of the contents of the care plan which was confirmed on examination of food intake records. It is recommended that a copy of the care plan and relevant management guidelines are made more readily available to staff. Staff have now received the planned training in healthy eating and two options are available for lunch and dinner. However, on examination of food records residents are generally having the same meal option. From evidenced gathered during this inspection food remains a contentious issue between the manager and staff. Five staff were interviewed and all raised issues regarding lack of choice and variety. Staff commented that the manager is overriding service users’ choice in order to follow a healthy eating regime. Comments from staff included: “they still don’t have what they want. I give them a supper but don’t record it as she wouldn’t like it”. “we’re not allowed to do toast unless they ask for it”. “X was looking forward to a Cornish pasty tonight but it was crossed out and I had to prepare chicken stir fry”. “we can’t buy ‘X’ cocoa pops as the manager won’t allow it, yet she loves them”. Staff said that they are instructed only to provide supper upon request. They added that residents wouldn’t be inclined to ask for supper as they were not used to receiving the option, apart from on Fridays and Saturdays. This fails to demonstrate choice. There remains an outstanding requirement for service users to be offered opportunities to participate in shopping, preparing and serving meals. Thought should be given to alternating shopping days in order to offer all residents opportunities to develop independent living skills. Not all service users nutritional screening assessments have been updated. See the Requirements section for any other items discussed during inspection of these standards. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 17 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents continue to receive personal support according to their preferences and requirements in most aspects of care, but further improvements are needed. Service users’ physical and emotional health needs are generally very well met but progress is needed with regard to health care screening and routine health appointments to enhance current practice. The systems for the control and administration of medication are sufficient only slight improvement is needed in order to provide greater protection. EVIDENCE: On examination care plans contain residents’ preferences with regard to getting up, going to bed, bath times and staff gender care. There is a designated key worker system to ensure consistency of support. Interviews with staff confirmed that they were aware of individual residents’ likes and dislikes. All four relatives who completed feedback questionnaires stated that they were satisfied with the overall care provided. One person commented “X is very happy at the home and is cared for very well”. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 19 At the last inspection a requirement was made for reviews of the practice of three hourly night checks for all service users. As discussed at that time, any monitoring at night time must be based on clinical good practice as to whether there is a justified medical reason for this level of monitoring, (and recorded in the care plan and risk assessment). This must be discussed and agreed with the service user or within a multi-disciplinary team. On examination one service user’s care plan stated that he required three hourly night checks to maintain continence. However an entry dated 2006 stated that he had not been incontinent for twelve months. Examination of records maintained by night staff confirmed that he is still receiving night time checks and there is no consistency. For example on one evening he received three checks and on the following evening two checks. A senior member of staff who was interviewed stated that she felt he did not need checking during the night time. One resident is now using a wheelchair to negotiate long distances. There was no assessment from an Occupational Therapist (O.T.) or other suitably qualified person contained within his case file to demonstrate that he had received an assessment with regard to his mobility, and the need for this equipment. Staff were unclear as to whether one had taken place. Staff stated that the wheelchair had been borrowed from a former employee. This is not safe practice. Service users must not use equipment for which they have neither been assessed as requiring, or assessed as being the correct type of equipment to meet their needs. Interviews and examination of records confirm that where a problem is identified that staff seek urgent medical advice. upon the discovery of any issues. For example, staff noted that one resident had a potential pressure area and had called in the district nurses for their advice and guidance. However this is not consistent with regard to routine medical screening. For example, one resident had not received a dental check since July 2005 and another since September 2003 (although this resident has dentures in place, checks should still be undertaken). There were no care plans in place with regard to screening and monitoring from potential complications such as breast, cervical and testicular cancer (for example attendance at well person clinics and observations by staff when assisting with personal hygiene). Staff report that they no longer use the Priority for Health Screening Tools as the community learning disability nurse no longer visits Interviews with staff, observations and examination of medication practices confirms that some improvements have taken place. For example, care plans now contain up to date medication profiles for residents, there is improved record keeping in respect of medication administration record (MAR) sheets. No gaps were seen. Staff were seen to sign the MAR sheets following the administration of medication and not before. There were detailed records of outcomes of G.P. visits which correlated with changes in medication on MAR sheets. Advice has now been sought from the G.P. with regard to complimentary medicines. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 20 Some items previously identified remain outstanding. For example, when staff are changing or adding to instructions on computerized MAR sheets two staff must sign their initials to witness and indicate that accurate changes (or additions) have been made. Some case files contained detailed guidelines regarding ‘as and when required’ (PRN) medications however this was not consistent in all files. Some new items were identified and are contained within the Requirement and recommendation sections of this report. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a comprehensive complaints system which ensures that users’ views are listened to and acted upon although record keeping requires improvement. Further development is needed to demonstrate that service users are fully safeguarded. EVIDENCE: The Statement of Purpose gives details about how to make a complaint. This includes information regarding how to contact the Commission for Social Care Inspection (CSCI) as required by the Care Homes Regulations 2001. There is also a pictorial complaints procedure which is included in the service user guide and in a booklet regarding choices. A complaint was made regarding the home in 2005 which was investigated by the provider. A thorough investigation was undertaken and appropriate action taken. The complaints log book was examined. This did not contain the details or outcome of the complaint made in 2005; the last entry being made in 1997. This must be kept up to date. Three out of the four relatives who completed comment cards stated that they were aware of the home’s complaint procedure. Since the last inspection the majority of staff have received training in vulnerable adult abuse; there are only three out of the existing seventeen staff team who have not yet undertaken this training. During interviews staff gave appropriate responses as to how they would deal with any potential incidents of abuse. A copy of the Local Authority multi-agency vulnerable adult abuse procedures are held on the premises. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 22 As already mentioned in this report there is one resident with increased challenging behaviour for whom urgent medical advice is being sought. During interviews staff gave differing versions as to how they dealt with behaviours including “I give him space and I tell him it is naughty”. Another member of staff stated that there were no triggers for the behaviours whilst others said that crowds, noise and heat all could impact upon his mood. The majority of staff said that they felt safe however one stated that she didn’t feel safe all of the time, although there were seniors always on duty who she could turn to for support. She was concerned about another service user who had told her “he scares me”. Not only are techniques for management unrecorded, some staff comments would indicate inappropriate management. There are seventeen support staff employed eight of whom have received no training in managing challenging behaviour. Some staff have not undertaken any further training since 1998. This must be given a priority. There are records maintained of all financial transactions with two staff signatures for all expenditure and receipts obtained. A sample of records examined balanced accurately. However, there remains an issue with regard to the contributions made by service users towards transport owned by one resident, as opposed to using the vehicle provided by the home. One member of staff stated that service users pay towards the petrol because “they get more money than X”. Clearer guidelines are needed for staff to ensure equity and that residents are not paying for transport, when it is already included as part of their basic contract fee. In addition procedures regarding management of service users’ finances and control measures need expansion, for example with regard to the staff using residents’ personal identification numbers (PIN). 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are provided with an attractive and homely environment however the standard and quality of the décor and furnishings have deteriorated slightly. Generally infection control measures are satisfactory although some improvements are necessary. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 24 EVIDENCE: A tour of the premises was undertaken. Generally communal areas are bright, warm and comfortably furnished although some improvements are needed. For example, the curtains in the dining room have shrunk with a hole appearing in one curtain. Dining chairs have been recovered but the seats had not been refitted in the correct position; one chair had a loose back and needs repair. Residents’ bedrooms were viewed. These remain individually decorated however some furniture and furnishings are worn and require replacement. Some of the furniture and furnishings appear dated and staff who were interviewed said that they felt the quality of décor and furnishings could be improved. Finishing touches are required where remedial work has been undertaken. Staff were seen to follow good infection control practice when carrying out domestic and catering tasks. However, improvements are necessary. Some duvet covers were stained and had to be removed; carpets in some bedrooms and one bathroom were marked and stained. There were a couple of areas where the bathroom requires attention. There is a small laundry area. This is too small to accommodate a separate wash hand basin however a risk assessment has been completed. There was a supply of liquid soap and paper towels available for staff. The laundry door has not been fitted with a lock as previously required. The laundry contained two unsecured containers of substances hazardous to health (COSHH). During interviews staff stated that there is only one resident who is able to use the laundry. However they raised concerns that this service user requires supervision to do so as on occasion she had tried to empty the washing machine whilst it was still in mid cycle. Therefore the requirement to fit a lock remains outstanding. Some staff raised concerns that the toilet which is accessed via the manager’s office is not a designated area for their sole use. They feel that this can compromise infection control measures as service users are able to use this toilet. They stated that this has been raised with the manager who is reluctant to restrict residents’ access and compromise their rights. As there are no separate facilities for staff for the purpose of changing as required by the Care Homes Regulations 2001, this would be a suitable compromise and should be considered. Any other items discussed during inspection of these standards are contained within the Requirements and recommendations section of this report. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 25 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a stable and relatively well trained staff group who understand the complex needs of the service users. There are robust recruitment and selection procedures which offer safeguards to service users. EVIDENCE: Information supplied by the manager indicates there is good progress towards ensuring that 50 of the staff team are qualified to NVQ II or above. Eight of the current seventeen support staff have the required qualification. As already stated in this report staff require training in managing challenging behaviour. Fourteen staff have received training in epilepsy awareness and twelve staff have received training in autism awareness. Since the last inspection more staff have been recruited allowing for greater flexibility. Examination of the duty rota confirms that there are three staff on duty per day time shift and on occasions this rises to four per shift. There are however only three staff on shift at weekends and this must be reviewed in order to provide service users with more opportunities for activities, or community outings based on their individual preferences. There are regular 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 27 staff meetings. It was not possible to discern from the duty rota as to how many supernumerary management hours are provided. Examination of a newly recruited member of staff’s personnel file confirms that thorough recruitment and selection procedures are followed. All preemployment checks had been undertaken and appropriate references obtained. Two students are on a short term placement at the home. Both had criminal record bureau (CRB) disclosure checks in place. Improvements have taken place with regard to providing staff with induction and foundation training by an accredited trainer in the learning disability awards framework (LDAF). However, staff are not completing this training within the first six weeks, and first six months of employment. During interviews one new member of staff confirmed that she had undertaken all units but had yet to receive her certificate. Staff still require training in equal opportunities and disability equality. Examination of supervision records confirmed that staff are receiving the required number of six supervision sessions per annum as identified by the NMS 36.4. Content, quality and details covered varied from file to file. It is recommended that all of the topics are discussed and recorded as detailed in the NMS 36.4. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 28 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager is supported well by her senior staff although a more open and positive approach would enable an inclusive atmosphere for staff and service users to affect the delivery of the service. Quality assurance systems require development so that residents and other users can be confident their views underpin the development of the service. The manager ensures so far as is reasonably practicable the health, safety and welfare of residents and staff, slight improvement is necessary. EVIDENCE: Mrs. Brooke has been Registered Manager at Langstone Road for the past five years, and has worked at the Home for the last twelve years. She has already obtained an NVQ in management and care and is also an NVQ assessor. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 29 Mrs. Brooke was not present for this inspection and therefore was unable to be afforded an opportunity to respond to some of the issues raised by staff. Six out of seven staff who were interviewed felt that they were unable to influence service delivery and their opinions were not taken into account on certain matters. The subject of food and choice remains a source of conflict, and other issues are identified in this report which include management of challenging behaviour, risk management in general and activities. However, staff indicated that they did feel supported by the manager in other areas and gave positive examples of why they enjoyed working at the home. On examination of the quality assurance folder further development is still required for example with regard to service users and stakeholder consultations. This remains an outstanding requirement. Staff personnel files continue to be held at the provider’s head office and as a result information required by the Care Homes Regulations 2001 are not held on the premises. New guidance was issued by CSCI in November 2005. The provider needs to decide whether this is applicable to the organisation and make applications for a formal agreement to CSCI to retain documents at their head office. CSCI must be notified of any incidents involving challenging behaviour that impact upon other service users or staff. This is a requirement of the Care Homes Regulations 2001, Regulation 37. A sample of maintenance and service records were examined. These were found to be largely up to date with only a couple of anomalies noted. There are monthly fire evacuation drills although not all staff had participated on a bi-annual basis. As already stated in this report, one resident is now using a wheelchair. There were no records found to confirm that routine health and safety checks have been undertaken or an annual inspection and service. Good standards are maintained towards providing staff with all of the required mandatory training. A sample of staff training certificates was examined which correlated with the information held on the central training matrix. The majority of staff have undertaken annual fire safety training, there were only few exceptions, these being new and sessional workers. However there were two members of staff who had commenced employment in March 2006 who have still to receive fire safety training. As these staff work nights, (and there is only one member of night staff on duty per shift), this must receive priority. There was also one senior support worker who has not received training since April 2005. Improvements have taken place with regard to food hygiene practice. There is now more consistent checking and recording of cooked food temperatures and all dried foods are stored correctly. Frozen foods are still not being labelled with the date of freezing as previously identified and a fly insecutor still needs to be installed as per the Food Safety Officer’s recommendations. On the day 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 30 of the inspection staff had left frozen chicken to defrost on a kitchen work surface. This does not comply with Food Safety Regulations. Any other items discussed during this inspection are contained within the Requirements section of this report. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 31 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 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 2 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 2 X 2 X 2 2 X 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 32 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 YA5 Regulation 5(1)(b) Requirement To review the contract/licence agreement to include all information contained within Standard 5.2 of the National Minimum Standards for Younger People. (Previous timescale of 1/1/04 is not met). To undertake a documented liaison with the Local Authority Commissioning Department to establish the exact nature of what the basic contract fee covers in terms of service users expenditure on activities and the nature of the central activity fund and how this is to be disseminated. (Previous timescale of 1/12/05 is not met). 2. YA6 15 To update and review care 01/03/07 plans to reflect changing needs of service users. For example with regard to nutrition, finances and continence management etc. DS0000024966.V319435.R01.S.doc Version 5.2 Page 33 Timescale for action 01/04/07 34/36 Langstone Road (Previous timescale of 1/06/06 is not fully met). 3. YA9 13(4)(c) To review and expand risk assessments. For example with regard to continence management, challenging behaviour. All risk assessments must be reviewed at least annually (or sooner depending upon level of risk). (Previous timescale of 1/1/06 is not met). To provide more opportunities for service users to undertake community based activities on an individual and group basis based on their individual preferences and needs, (and ensure that there are sufficient staff on duty to accommodate their wishes. (Previous timescale of 1/12/05 is not fully met). Service users should be given the option to have a minimum seven-day annual holiday, outside of the home, as part of the basic contract price. (Previous timescale of 1/1/04 is not met). To improve recording systems for daily and/or weekly activity planning and evaluation. All refusals to participate in activities such as community outings must be clearly recorded. (Previous timescale of 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 34 01/03/07 3. YA13 16(2)(m) 01/04/07 4. YA14 16(2)(n) 01/04/07 1/12/05 is not fully met). 5. YA17 16(2)(i)12(1)(a) To carry out reviews of nutritional assessments (using a suitable tool such as one recommended by the community dietician). The assessments must demonstrate whether the there is a high, medium or low risk and must identify the ideal weight for the service user using the body mass index. (Previous timescale of 1/5/05 is not met). To ensure more consistent recording of the provision snacks, desserts and suppers on the menu. (Previous timescale of 1/05/06 is not fully met). To ensure that service users are offered opportunities to plan, shop, prepare and serve meals. Care plans and risk assessments must be completed. (Previous timescale of 1/5/05 is not met). To ensure that one service user’s management guidelines for nutrition and associated care plan, are fully implemented and actively followed by staff. 6. YA18 12(1)(a) To review the practice of three hourly checks undertaken during the night on all service users. Outcomes and guidelines for staff to be documented in DS0000024966.V319435.R01.S.doc 01/02/07 01/03/07 34/36 Langstone Road Version 5.2 Page 35 individual care plans. (Previous timescale of 1/6/06 is not met). To ensure that an assessment is carried out by a suitably qualified person (e.g. O.T.) with regard to one service user’s mobility, in order to ascertain whether or not he requires the wheelchair which has been ‘borrowed’ from an exmember of staff. The assessment must also include whether or not the wheelchair is suitable for his requirements with regard to size, shape etc. To establish care plans with regard to specific health care screening in respect of breast, testicular and cervical cancer. All refusals and consent issues must be discussed within a multidisciplinary forum including the General Practitioner. (Previous timescale of 1/6/06 is not met). To ensure that all service users have access to annual ophthalmic tests. (Previous timescale of 1/06/06 is not met). To ensure that all service users have access to regular dental checks (either six monthly or annually, whichever frequency is determined necessary by their dentist). 6. YA20 13(2) To make the following improvements to the control and administration of DS0000024966.V319435.R01.S.doc 7. YA19 12(1)(a) 01/04/07 01/03/07 34/36 Langstone Road Version 5.2 Page 36 medication: 1) To ensure that guidelines are established in individual care plans for the administration of P.R.N. medication. (Previous timescale of 1/1/05 is partly met). 2) To pursue plans to ensure that all staff receive training in the safe handling of medication from an accredited trainer. (Previous timescale of 1/11/05 is partly met). 3) To obtain written consent from service users with regard to the administration of medication and record in care plan (or to discuss within a multidisciplinary team review meeting). (Previous timescale of 1/5/06 is not met). 4) To ensure that when any changes of medication are made on the MAR sheets by staff, such as the addition of new medication, two staff initials are obtained to confirm accurate instructions have been recorded. (Previous timescale of 1/5/06 is not met). 5) To ensure that prescriptions are held securely at all times. 6) To clarify any ‘as directed’ doses with the prescriber and ensure 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 37 detailed administration instructions are recorded on the MAR sheet. 7) To remove extraneous items from the drugs cupboard such as nail varnish, disposable gloves etc. Internal and external drugs must be kept separate. 7. YA23 13(6) 1) To ensure that a written procedure is established with regard to service users financial contributions towards the use of a vehicle owned by one of the service users. To ensure that written consent is obtained with regard to the procedure and the use of this car. (Previous timescale of 1/1/05 is not fully met). 2) To review and expand the written procedure with regard to assisting service users with the withdrawal of personal monies. (Previous timescale of 1/12/05 is not fully met). 8. YA24 23(2)(b) To undertake the following improvements to the premises: 1) To establish a written maintenance and renewal programme for the fabric and decoration of the premises together with timescales for completion. A copy to be forwarded to the Commission for Social Care 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 38 01/04/07 01/04/07 Inspection 2) To clean (or replace) all stained bedroom and bathroom carpets. 3) To redecorate any bedrooms and bathrooms which have damaged wall paper. 4) To pursue plans to replace worn mattress in the 2nd bedroom (on right hand side). 5) To carry out an audit and remove all stained or worn duvets and poor quality bed linen. 6) To ensure that the bedroom door which has been identified as not closing firmly into the rebate, is repaired. Procedures must be in place to ensure that bedroom doors are routinely checked to ensure that they close appropriately. 7) To replace or repair all worn or damaged furniture and furnishings in bedrooms and communal areas. 8) To remove television wire hanging from the ceiling in the sixth bedroom and remove electrical multiadaptor which been fixed to wall. Remove screws from wall and make necessary repairs and redecoration. 8. YA30 13(3) To improve infection control DS0000024966.V319435.R01.S.doc 01/03/07 Page 39 34/36 Langstone Road Version 5.2 practice by: 1) To fit a suitable lock to the laundry area. (Previous timescale of 1/12/05 is not met). 2) To repair or replace bath in the ‘green’ bathroom which has a damaged and worn enamel surface. 3) To replace worn and stained grouting in the green bathroom. 4) To introduce a cleaning schedule to include the regular washing/cleaning of bedroom carpets. 9. YA32 18(1)(c) To progress plans to ensure that 50 of the care staff team are qualified to NVQ II or above by 2005. (Previous timescale of 31/12/05 is not fully met). To provide all staff with training in understanding and managing challenging behaviour. (Previous timescale of 1/6/06 is not met). 10. YA33 18(1)(a) 01/04/07 To ensure that the Manager is allocated and carries out dedicated supernumerary hours and to forward written proposals to the Commission for Social Care Inspection. (The duty rota must identify the supernumerary hours worked by the manager). (Previous timescale of 1/11/05 is not met). DS0000024966.V319435.R01.S.doc Version 5.2 Page 40 01/01/07 34/36 Langstone Road 11. YA35 18(1)(c) All staff must receive structured induction (within six weeks) and foundation training (within six months) to Sector Skills Council specification and provided by a LDAF (Learning Disability Award Framework) accredited trainer. (Previous timescale of 1/1/05 is partly met). To ensure all staff complete training in equal opportunities and disability equality. (Previous timescale of 1/1/05 is not met). 01/04/07 12. YA39 24 To develop an effective quality assurance system to include feedback from service users, stakeholders in the community etc. (Previous timescale of 1/1/05 is not met). To produce an annual development plan based on a systematic cycle of planning-action-review, reflectng aims and outcomes for service users and to explore methods for obtaining feedback from service users. 01/04/07 13. YA41 17(2) To obtain and hold information and documents on the premises in respect of persons carrying on, managing or working at a care home as listed in Schedule 2 and 4 of the Care homes Regulations DS0000024966.V319435.R01.S.doc 01/04/07 34/36 Langstone Road Version 5.2 Page 41 2001. (Or to make a formal request to CSCI to retain documents at head office and obtain approval). (Previous timescale of 1/1/05 is not met). To ensure that CSCI is notified of any incidents that affect the well being or safety of service users including incidents of challenging behaviour where other residents or staff have been involved. 14. YA42 13(4)(c) To undertake the following improvements with regard to fire safety and health and safety: 1) To ensure that all substances hazardous to health (COSSH) are held secure at all times. 2) To ensure that all staff participate in a bi-annual fire evacuation drill. 3) To ensure that all staff undertake fire safety training at least on an annual basis. 4) To ensure that wheelchairs receive an annual service inspection and regular health and safety checks (recorded) in the intervening period. 15. YA42 13(4)(c) To make the following improvements to food hygiene practice: 01/03/07 01/03/07 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 42 1) To ensure all foods frozen by the home are labelled with the date of freezing. (Previous timescale of 1/5/05 is not met). 2) To comply with all of the requirements identified by the environmental officer food hygiene in report dated 1 February 2005. (Previous timescale of 1/11/05 is not met). 3) To ensure that all frozen foods are defrosted appropriately. 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. Refer to Standard YA6 YA17 Good Practice Recommendations To ensure that staff date and sign any additions that they make to care plans as part of the review process. To consider producing a pictorial menu plan and other strategies for assisting service users with menu planning and choosing daily food options. To consider introducing an improved system for recording how individual residents choose the weekly menu and are enabled to make daily choices. To consider keeping a copy of the management guidelines and care plan for the resident who requires extra nutritional support in the kitchen area with the resident’s daily food intake records – in order to provide staff with easier reference. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 43 3. YA20 To consider obtaining a more suitable drugs cupboard. Preferrably one which has been designed specifically to store medication. It is recommended that nutritional supplements administered to a service user are recorded on a MAR sheet. 4. 5. 6. YA22 YA24 YA30 To ensure that the complaints log is kept up to date and includes details of the complaint which was made in 2005. To undertake a written consultation with service users with regard to the provision of a television in the 2nd lounge/dining room area. To cease storing the ironing board in the laundry area. To consider designating a toilet specifically for staff use. 7. YA36 8. YA37 To ensure that formal supervision is expanded to include topics: monitoring of work with individual service users and identification of training and development needs as per the National Minimum Standards 36.4. It is recommended that the home is enabled to access and use e-mail and web site facilities to assist with communication and researching current good practice and guidance. Appropriate facilities for communication by facsimile transmission must also be provided. It recommended that a photo-copier machine is provided. 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 44 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 34/36 Langstone Road DS0000024966.V319435.R01.S.doc Version 5.2 Page 45 - 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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