Inspection on 07/09/05 for 88 - 90 Offham Road

This inspection was carried out on 7th September 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

88 - 90 Offham Road 06/08/07

88 - 90 Offham Road 17/05/06

88 - 90 Offham Road 17/05/05

88 - 90 Offham Road 20/01/05

88 - 90 Offham Road 01/04/04

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

CARE HOMES FOR OLDER PEOPLE 88 - 90 Offham Road West Malling Maidstone Kent ME19 6RD Lead Inspector Lynnette Gajjar Announced 07 September 2005 09:40 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 88 - 90 Offham Road Address West Malling Maidstone Kent ME19 6RD 01732 874295 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) MCCH Society Limited Grahme Patrig Kennedy CRH Care Home 7 Category(ies) of Learning disability (7) registration, with number of places 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two service users whose date of birth are: 11/05/1934 and 27/03/1926 2. Service Users to be 50 years and over Date of last inspection 17 May 2005 Brief Description of the Service: 88/90 Offham Road is one of a number of registered care homes managed by MCCH Society Ltd in the south east of England. The home offers 24-hour care to 7 service users who have learning and physical disabilities who are aged 50 years and over, with a strong emphasis on older persons care for the current service users. The home is accessible for 3 wheelchair users on the ground floor with a further 4 bedrooms on the first floor. There are 4 bathrooms (2 on the ground floor and 2 on the first floor) .The ground floor bathrooms are equipped with specialist equipment to assist people with physical disabilities. The premises are not equipped with a shaft lift, consequently not all areas of the home are accessible to wheelchair users or those with limited mobility. Service Users accessing the first floor are required to be ambulant in using a stairway. Each sevice user has his/her own bedroom. There is open plan communal space on the ground floor, with no separate communal space available to Service Users to use for privacy or personal leisure activities away from the main routines of the home. The premises are within a few minutes walk of West Malling town centre, which offers a range of local facilities and services 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection, the second in the year running from April 1st 2005 to March 31st 2006. The visit lasted from 09:40am until 15.15pm. The home currently has seven service users and has no vacancies. The visit was spent talking directly with service users both privately and collectively; three support staff, senior support staff and the registered manager. Due to the nature of the service, it is difficult to reliably incorporate accurate reflections of the service in the report. Some judgements about quality of life and choices were taken from direct conversation with service users and observation followed by discussion with support staff and evidencing records held at the home. Feedback was also received through comment cards from others who visit the home and pre inspection questionnaire completed by the manager. A tour of the premises was undertaken. What the service does well: What has improved since the last inspection? What they could do better: Service users would receive continuity of care and activities through robust management of staff sickness absences and monitoring, consistent casual and agency staff and the recruitment to current and pending vacant staff posts. 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 6 Improved measures through the installation of hand basins to bedrooms; washing machine with sluicing facility and sluices for the cleaning of commodes will ensure a safer living/working environment and promote effective infection control. The lifestyle and living space for the elderly and frail service user group would be greatly improved if there were separate quiet communal area/s, which could be used away from the more noisy open plan living area. The garden could be used to greater advantage by elderly and frail service users with limited mobility, including wheelchair users, if safer access, pathways and seating were installed. Due to current staffing issues and regular cancelling of leisure activities this is particularly relevant. Service users privacy and security could be improved by installing fences and gates to the side of the property. Staff would have a better awareness of the changes to service users care needs if care plans were better monitored through a robust audit system to ensure they were regularly reviewed and updated. Staff shortages have hindered in-house updating and reviewing of care plans. 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. 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,6 Service users and representatives are given information they need to be able to make an informed decision to live at 88/90 Offham Road. EVIDENCE: The homes statement of purpose and service user guide is currently under review to include more photographic and pictorial information. The home has not had any new admissions for over 18 months and has no vacancies. MCCH have a thorough admission, consultation and settling in process to follow if a vacancy occurs. This home does not provide intermediate care. 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 High use of casual and agency staff at the home for past 6 months has had a serious impact on continuity of care and support for service users. Health care needs continue to be maintained by staff on an individual basis. Service users are treated with genuine respect and dignity by care staff. EVIDENCE: Through discussion with a service users and sharing of their care plan, it is clear that service users are given full support and encouragement to maintain personal contact with practices nurses, GP, community learning disability staff, epilepsy specialist nurse and consultants, as well as chiropodist and dentists, to maintain good standards of health and well being. Health care has been a major priority for two service users with evidence of good support from health professionals. These high demands on staff time has been detrimental to others living at the home. Due to the high sickness levels experienced in the home for past 6 months, continuity of care and support has been seriously affected. There is high use of casual bank and agency staff many of which have not worked in the home on a regular basis. Medical records seen were sufficiently detailed and contained clear information to support staff to meet the needs of the individual. Reviews of risk assessments and guidelines have not taken place due to direct care priorities and limited permanent staff resources. Monthly in house reviews are not 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 10 taking place for those over 65years. Six monthly reviews have taken place with placing authorities. Medication is stored securely. Good practice recommendations were made regarding MAR sheet records maintained by staff. 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The ongoing high use of different casual and agency staff has adversely affected service users daily lifestyle, routines and limited outings to local amenities. The open plan communal area adversely affects service users individual choice and personal space. EVIDENCE: Two service users continue to go out unaccompanied locally within their agreed care plan and maintain their independence within the village. However due to the staffing shortages, and those staff covering vacancies not always able to drive, other activities and outings in the local community have been affected or ceased completely for the other five service users. Ground floor building alterations were carried out 24 months ago. Resulting in the open plan communal area, that is busy, noisy, and constantly in use. Due to service users ill health it was observed that two staff were often tied up with their care needs, restricting staff time with others living in the home. Service users do not have access to any quiet areas other than their own bedrooms. A service user who smokes cigarettes respects the homes no smoking policy by smoking outside. When discussing how service users felt about care in the home and if there is anything they would like to change, three clearly stated “more staff” “we don’t get out as much now as not all staff drive”. Staff offered to walk to the village with two service users during this visit. The garden has limited access to the frail and elderly service users, a valuable 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 12 resource that cannot be utilised or enjoyed fully. Service users discussed regular contact with family and friends and recent birthday celebrations. 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 Service users feel confident to raise concerns or complain. Protection from abuse is promoted through staff training and understanding of the support and actions they may need to take. EVIDENCE: Service users spoken with had a clear understanding of who to talk to if they had any concerns or were unhappy. Copies of the written and pictorial complaint procedure are available in the home. The home has received three complaints from service users, which are being investigated. It was noted that this investigation had exceeded the 28 days response time and no formal feedback or letters were evident on file. Staff spoken with continue to evidence a good understanding of how to protect and prevent abuse, including reporting under local procedures. 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,22,23,24,25,26 Service users live in a warm, nicely decorated and clean home. Personal choice and lifestyle is restricted by the open plan communal living area and unsafe access to the garden. EVIDENCE: Following major building alterations 24 months ago, communal living is now shared between 7 service users rather than the smaller homes of 3 & 4. Service users have to share the open plan kitchen/dining area and lounge. The only private areas are staff and individual service users rooms. Those with limited mobility are unable to access friends’ bedrooms on the first floor. During this and previous visits, service users, staff and relatives continue to comment and express how restrictive this is and that it’s not nice to have nowhere to go to get away from the hustle and bustle of daily routines or have private conversation. The majority of service users continue to say they do not wish to use their rooms to talk with friends and visitors, or just to get away from the TV. Doorways and hallways continue to be damaged due to the width and size of electric wheelchairs. One services user now has a smaller chair, which reduces such damage. Redecoration, furnishings and carpets are in 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 15 hand for service users private rooms from this year’s budget. Rooms visited were personally decorated to individual tastes and had personal effects. The garden is not fully accessible by those service users who are elderly and frail, or with physical disabilities. There is no safe flat surface to walk on. Pathways with railings, suitable adaptations and well-placed seating would greatly improve access and use of the garden. Quotes have been requested to address this. Security is of concern, security lighting has been installed to the sides of property but staff stated local youths still use the garden as a short cut to housing situated behind the home. The home has adequate bathing and toilet facilities with adaptations and equipment to meet their needs. Risk assessments need to be completed in relation to infection control, cleaning and use of commodes in service users bedrooms. No bedrooms have washbasins and interim measures have been implemented where staff carry antibacterial vaporisers to clean their hands. Quotes have been requested to look at installing hand basins to bedrooms. Due to the increased double continence care and increased handling of soiled clothing and linen, a full review is required and hand basins installed as appropriately assessed, in addition to the installation of a washing machine with sluicing facility and sluicing / cleaning of the commode pans. 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 The high levels of staff sickness are limiting the stability and consistency of care provided to service users, and effective team working. EVIDENCE: Rosters seen during the inspection showed staff self-certification sickness to be very frequent, this has affected the stability of the staff team and restricts consistent support to service users. Two staff continue to be on long-term sick leave. One staff member has left since the last inspection and has not been replaced. A further two permanent staff leave at the end of this month. The home is reliant on casual bank and agency staff to cover the roster. Casual and agency staff have covered a total of 732 hours over the past eight weeks. The few remaining permanent staff are under considerable pressure to maintain consistent care and work effectively with unfamiliar bank staff. Two staff hold NVQ 2 in care, one of these is leaving this month. One member of staff is due to commence NVQ level 3. Due to pressures on the roster, other NVQ training has currently been suspended. One senior support worker has completed NVQ 4 in care and the other holds the NVQ Assessors award. Currently the home staffing agreement is for one sleep over staff on duty from 10pm to 7am. This can restrict service users choice of times to get up and go to bed when requiring two carers for safe moving and handling. 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33,35,38 The manager is supported well by two senior staff who together promote direction in the home. Changes to the registered manager will be unsettling but offer alternative leadership and management to the home and promote the service provided. EVIDENCE: The home has a management structure offering lines of accountability and understanding of roles and responsibilities. However due to staff shortages the manager has been concentrating on covering care needs of service users and management responsibilities have been a low priority. Service users and staff expressed a high regard for the hands on approach by the manager at this time. Service users felt the registered manager was approachable and staff said they felt well supported by him. The manager and senior staff demonstrated through discussion a clear understanding of the needs of current service users and the changing issues relating to their care. Monitoring health and safety in the home is to a good standard with weekly walking routes carried out. Equipment is serviced as required to maintain a safe home and 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 18 facilities. Risk assessments are completed for individuals, staff activities in the home and care duties but many are now in need of review due to changing care needs. As detailed previously in the report, a review of access and security to the side and back garden of the property should be undertaken and action taken to reduce risk of unauthorised persons accessing the property. Staff evidenced a clear understanding of accident/incident reporting. The commission have not received any regulation 26 monitoring visit reports for this home from the organisation for this inspection year. Clear and accountable financial records are maintained for all monies held by service users and staff support with their financial affairs. Double signatures are required on all transactions and checks. The inspector was advised that following a review of management of this home, the registered manager was transferring to another home in the organisation and an experienced registered manager was transferring to 88/90 Offham Road. Application to register with the commission has yet to be submitted. 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 3 COMPLAINTS AND PROTECTION 2 2 2 2 3 3 2 1 STAFFING Standard No Score 27 2 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 3 x x 2 x 3 x x 2 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 20 NO 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 OP19 YA24 Timescale for action 23 The registered person shall by 31st (2)(h)(i)(o having regard to the number and March )(4) (a)(c needs of the Service Users 2005 provide: · Communal space provided for Service Users must be suitable for the provision of social, cultural and religious activities appropriate to the needs of the Service Users · Suitable facilities must be provided for Service Users to meet with visitors in private having accommodation which is separate from the Service Users private rooms · External grounds which are suitable for and safe for use by Service Users, must be provided and appropriately maintained. Staff stated that work requests had been submitted to the housing dept and MCCH Society Ltd and they are aware of this. No further action has occurred. 2. OP 19 YA24 13(4)(c) The registered person shall by 30 Version 1.40 Page 21 Regulation Requirement 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc 3. OP 26 YA30 23(2)(j) (k) & 5 13(3) ensure that—(c) Unnecessary risks to the health or safety of Service Users are identified and so far as possible eliminated. A full review of security and access to the property must be undertaken particularly regarding side entrances and the back garden which are currently used by local youths as a shortcut to houses behind the home The registered person shall make suitable arrangements to prevent infection, toxic conditions, and the spread of infection in the care home. The registered person shall having regard to the number and needs of the service users ensure that: · Appropriate provision of washbasins must be fitted. · Any necessary sluicing facilities must be provided. Following the last three inspections it was identified from a site visit by the Housing dept that major work was required to the shower and bath water inlets to the home, this has been completed. Due to funding issues and work priorities, it was agreed to suspend installation of the sinks until 2005 budget year. Staff stated that quotations have been sought, but due to complexity of the work no further action has occurred. Due to the increased personal care needs and increased double incontinence, this must be addressed immediately. Action must include assessment of the December 2005 Immediatel y 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 22 need for a washing machine with a sluicing facility and sluicing facility for cleaning of commode pans. 4. OP27 YA33 18(1)(a)( b) The registered person shall having regard to the size of the care home, the statement of purpose and the number and needs of service users: · ·Ensure that at all times suitably qualified, competent and experienced persons are working in the care home in such numbers as are appropriate to the health and welfare of service users. · Ensure that the employment of any persons on a temporary basis at the care home will not prevent service users from receiving such continuity of care as is reasonable to meet their needs. Consistent and regular casual and bank staff must be used to cover the roster pending recruitment to permanent staff posts 5. OP33 YA39 26 The registered person shall undertake unannounced visits at least monthly where they will talk to staff and service users, inspect events and records held in the home, prepare a written report on the conduct of the home and submit this to the commission and registered manager by 31 October 2005 thereafter. Immediatel y 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 23 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 OP7 YA6 OP7 YA9 Good Practice Recommendations Simple auditing and monitoring sheets and colour coding should be introduced to the care plans to assist staff with the review process. It is strongly recommended that risk assessments and care guidance relating to those service users over 65 years be reviewed at least monthly, or more often where care needs change, to ensure consistent care is provided and personal preferences are known. It is recommended that hand written directions on MAR charts correlate directly with the label on the medication prescribed. It is recommended that two staff sign and check the details are correct. It is recommended that PRN medication when dispensed and adminsitered is recorded in detail on the pre printed chart on the back of the MAR sheet. 4. OP26 YA30 It is recommended that risk assessments and clear infection control assessments are undertaken with detailed procedures for handling, disposing and cleaning of waste from commodes put in place. It is strongly recommended that advice be sought from Kent and Medway infection control Unit. 3. OP9 YA20 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 88 - 90 Offham Road H56-H06 S29266 88-90 Offham Road V239201 070905 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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