Inspection on 19/04/06 for 89-91 Bessborough Road

This inspection was carried out on 19th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 no outstanding requirements from the previous inspection report, but made 18 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

89-91 Bessborough Road 22/05/07

89-91 Bessborough Road 10/02/06

89-91 Bessborough Road 06/06/05

89-91 Bessborough Road 13/01/05

89-91 Bessborough Road 10/08/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOME ADULTS 18-65 89-91 Bessborough Road 89--91 Bessborough Road Harrow Middlesex HA1 3BD Lead Inspector Richard Adkin Key Unannounced Inspection 19th April 2006 10:00 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 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 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 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. 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service 89-91 Bessborough Road Address 89--91 Bessborough Road Harrow Middlesex HA1 3BD 020 8423 1116 020 8864 4191 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) Harrow Consortium for Special Needs Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th February 2006 Brief Description of the Service: 89 - 91 Bessborough Road is a care home for up to 12 adults who have enduring mental health problems and require medium to long-term support. The home is run by Harrow Consortium for Special Needs (the registered providers), staffed by the Family Welfare Association, and with premises supplied by Paddington Churches Housing Association. At the time of inspection there were no service user vacancies; one vacancy was expected shortly. The home is situated on a busy link road to Harrow that includes bus access. It is fifteen minutes’ walk to Harrow town centre where there are shops, leisure facilities and further transport links. There is space for two cars to park on the forecourt, and there is unrestricted but regularly used parking on the road. The home is made up to two interlinked semi-detached properties that span three floors. Access is by stairs only. Bedrooms are situated on the 1st and 2nd floors. Each service user has their own single room. The ground floor has communal living and dining rooms, a new conservatory, a laundry room, and office space. There is a well-kept garden at the rear of the property. The Service User Guide details the facilities provided at the home. 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on a weekday during the day over 5½ hours. The focus of the inspection was to look at the key standards and follow up requirements from the previous inspection. The senior on duty made herself available and was joined early on by the homes’ Manager. The Inspector had the opportunity to meet residents, look at records and policies and have a tour of the premises. The Inspector would like to thank everyone at the home for their contribution to the inspection. What the service does well: What has improved since the last inspection? What they could do better: A number of requirements arose around not following procedure and properly recording a POVA incident. There are several environment issues that remain needing to be addressed at the home. The Manager must formally register with CSCI. Some practices need to be tightened up such as visitors signing the visitors book. Care plans need to encompass and reflect the wider Care Programme Approach (CPA). 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 6 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. 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 Quality in this outcome area is good. This judgement has been made using available evidence, including a vist to this service. Prospective residents are provided with relevant information and appropriate assessment in a participatory manner. EVIDENCE: A long-standing requirement has been that the Service Users Guide must be given to each service user. This guide was reviewed over two days by the staff group and residents all of whom attended the away days. A final draft has been produced; this is at the point of being printed off and given to each resident. Residents have seen the drafts throughout this process. This seems to have been a positive collaborative experience for staff and residents. This final draft should now be distributed to residents and a copy sent to CSCI. The guide covers the purpose and ethos of the house, the residents views of living in the home, information about the home, the complaints process and contacts, staff details, rights as a resident advocacy, rental agreement, emergency procedures etc. There is a new ‘Resident Assessment Form’ in place. The Inspector was provided with the assessment of the most recent resident. This is a facilitative process involving the service user and key worker over a four week period where both contribute to the assessment which is substantial and comprehensive covering mental health, physical health, self care domestic 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 9 tasks, communication, social contacts, activities lifestyle. There is a helpful checklist that expands on all these areas. An in house care plan is developed and worked on from this assessment, which is of a good standard to address the individual residents’ needs and aspirations. The background referral information was available for this most recent resident. There was an issue of the finances of the resident not being properly sorted out with the resident drawing from their own savings to pay the rent and this must be resolved. There was also no photo of the resident on file. 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a vist to this service. Care plans and risk assessments need to capture broader issues in the residents’ lives and service users making decisions. EVIDENCE: Several requirements arose previously around individual plans. Residents CPA plans needed to be reviewed and updated six monthly and a copy provided to the resident unless there was a recorded reason why this should not take place. The Manager has devised a new format which is in the process of being completed for all residents by the keyworkers and will meet the deadline of 1/6/06 of each resident having an updated care plan. Four completed formats were looked at by the Inspector. This process ensures that plans are updated, current and relevant and not simply a transfer of old information. These are signed by the resident and care worker with comments recorded by both parties. 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 11 A stronger link needs to be made from these individual plans to the wider Care Programme Approach review process as this was not captured in several residents’ files looked at by the Inspector. Evidence was considered concerning residents making decisions about their own lives with assistance as needed. Positive interaction was observed during the course of the inspection with residents and staff; consultation, support, participation and empowerment was evident in the delivery of care and in the accounts of residents. The Manager, at the previous inspection, needed to ensure that key hazards to each resident are identified, risk reduction plans discussed and implemented and that findings are recorded and reviewed. No risk assessment was in place for the resident who made an allegation of abuse outside of the home (see Standard 23) or any contemporary record in the case file of the incident. 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence, including a vist to this service. Residents have appropriate opportunity to develop themselves and contribute to the running of the home. Their independence skills are promoted. EVIDENCE: Residents take part in a range of daytime opportunities and were attending the following range of services: Welldon Centre, Bridge, Wiseworks, Sneh Care, Marlborough Hill Day Service. Local facilities are used like cinemas and leisure centres. Residents spoken to said that family contact was encouraged and supported at the care home. Birthdays and festivals are celebrated within the care home. A recommendation that arose previously was that residents should have a greater say in the decision making of the home. Residents meetings take place once a week with minutes and agendas at suppertime. The Manager 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 13 does attend but the meeting is resident led with support from staff. Residents spoken to by the Inspector were confident and secure in expressing their views and felt they were given opportunity to do this. Residents had taken part in two away day sessions at The Grail where policies, procedures and philosophy of the care home had been discussed and developed. A collective planned meal takes place of an evening. Residents were cooking their own lunches during the inspection that looked appetising. Vegetarians and culturally appropriate food was available for cooking. There was a good range of fruit and vegetables available, enhanced by a trip to the grocers earlier in the day. Some food in the fridge was not labelled or dated which needs addressing as a health and safety issue. 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence, including a vist to this service. Residents needs are protected by the home’s health needs policies and procedures. Care staff are seen as being supportive by residents. EVIDENCE: In relation to medication, requirements that arose previously were that the home’s medication policy must accurately describe the processes and safeguards used in respect of enabling residents to self medicate and the Manager needed to ensure that staff accurately sign for medication administered to residents. Work is in hand that the Medication policy reflects guidance on enabling residents to self-medicate; this should be completed. The Inspector looked at the MAR sheets, which were in order. Health needs of residents are addressed through the care plans and were addressed in three files looked at by the Inspector. The support of staff was viewed positively by residents spoken to, in areas such as self-care. CPA reviews and care plan reviews were happening regularly in files looked at. 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is poor. This judgement has been made using available evidence, including a vist to this service. The home must follow Protection of Vulnerable Adults procedures to protect their residents from harm. The complaints process has been improved. EVIDENCE: The Inspector received a monthly proprietors visit for 89/91 Bessborough Road for March 2006. In the report there was an incident recorded concerning the possible abuse of a resident whilst in a taxi. CSCI had not been informed of this incident. (Regulation 37 notification). There had been police involvement around this incident. No incident report was in place for this incident, no risk assessment was in place on the file or reference to the incident in the running records of the residents’ file. The POVA coordinator for the London Borough of Harrow had not been notified. Notes had been made in the handover log, but a page had been torn out so that it could be typed up. Records need to be up to date and complete. There was some evidence in the handover records of follow up of the incident but the record keeping was most unsatisfactory around the incident in many aspects. The adult protection policy also needed expanding to include response times. It is linked to the London Borough of Harrow POVA guidance. 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 16 In relation to complaints, previously it arose that the Manager must ensure that complaints are investigated and responded to within 28 days and the Manager needed to ensure that complaint processes include the process of establishing formal conclusions and follow up actions and that these are recorded. This has been achieved. The complaints records were satisfactory, though there is a long-standing complaint where resolution is being sought. 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good. This judgement has been made using available evidence, including a vist to this service. Residents live in a comfortable, clean and homely environment. EVIDENCE: Several requirements arose at the previous unannounced inspection concerning the fabric of the environment. The carpets in the corridors remain needing to be replaced, they are badly worn and there are gaps at the thresholds of a number of doors, particularly between the hallway and smoking lounge that is a tripping hazard and needs to be addressed. Requirements that arose at the previous inspection concerning the homes environment have been addressed, though the home does experience some delays in repairs being followed through. The home was clean and hygienic at the time of the inspection and free of offensive odours. There are a number of rotas where residents take part in the 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 18 chores of the house such as laundry, shopping, cleaning kitchen bathroom cleaning etc. 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good. This judgement has been made using available evidence, including a vist to this service. Residents are supported by a competent trained staff team, who are regularly supevised. EVIDENCE: Some issues arose previously concerning the home’s recruitment policy and practices around employment details and POVA/CRB checks. These processes in conjunction with the administrative headquarters of the organisation have been addressed. Copies of POVA first checks are not kept on the personnel files of staff held at the home. Training is being taken forward. Recovery model training for all staff had taken place over a couple of days earlier this year. Boots medication training took place for all staff the previous month. The Manager is driving through appraisals for all staff members. Supervision is taking place monthly and is recorded. FWA are developing a supervision framework for all their services. 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 20 The agency induction folder needed to be updated to contain appropriate and accurate information about residents and the home – though currently no agency staff are employed at the home. 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41, 42 Quality in this outcome area is good. This judgement has been made using available evidence, including a vist to this service. Residents’ views underpin the development of the home; they benefit from the leadership ethos of the home. EVIDENCE: It was required that the Manager applies for registration with CSCI, as the home’s Manager and the Manager need to finalise this. Currently, the deputy’s post was vacant. There had been a lack of a permanent Manager at the care home between August 2004 and November 2005. However, on meeting the staff group in the team meeting, there was a strong sense of leadership and purpose in the running of the home. 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 22 Other requirements that arose at the last unannounced inspection were that systems must be designed to enable the visitors’ book to be kept up to date – the Inspectors signature however was the only entry for a month. The Manager needed to ensure that the home’s portable appliance testing is kept up to date, internal water temperature checks needed to result in actions being taken where temperatures are too hot or cold. This has led to new valves being installed and this should be fully completed. A permanent and workable solution to the laundry room ventilation issues needed to be found and this remains the situation. The meter cupboard in the alleyway at the side of the home was not covered or secure for a number of months. This work had been delayed because the meter needed to be disconnected (the cover was in the shed). This needs to be rectified. It was recommended that a fire safety professional considered evacuation processes as part of a fire safety risk assessment, given the rose ceiling on the top floor and the pre-fab construction. A process is successfully in place where key policies are finalised and shared with residents. A service review over two days with all staff and residents had been a successful example of engagement. 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 2 X 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 24 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 YA2 Regulation 14 Requirement Resident’s financial position meeting the rent must be established and put in place at the outset of the placement. A photo of each resident must be on file. The individual plans need to reflect any updated CPA meeting decisions. (Previous timescale of 1/5/05 not met) Risk assessments need to be in place for significant developing risks or risks that have occurred to residents. Food in the fridge needs to be fully labelled, described and dated. The home’s Adult Protection Policy must include timescales for response. CSCI must be informed of any event in the care home that adversely affects the well-being or safety of any resident and POVA procedures followed. Incident reports must be completed when an untoward incident or accident takes place. DS0000017519.V288326.R01.S.doc Timescale for action 19/04/06 2. 3. YA2 YA6 17(3)(a) 15(2) 01/06/06 01/06/06 4. YA9 14(2)(b) 13(4)(c) 13(3) 13(6) 37(c) 01/06/06 5. 6. 7. YA17 YA23 YA23 01/07/06 01/07/06 19/04/06 8. YA23 17 19/04/06 89-91 Bessborough Road Version 5.1 Page 25 9. 10. 11. YA23 YA23 YA24 17(1)(a) 13(6) 23(2) 12. YA24 23(2)(b) Records of incidents must be continuous and not torn out. The staff group must revisit the POVA guidelines. The carpets in the corridors leading to the bathroom and in the hallways need to be replaced. (Previous timescale of 9/10/03 not met) The gap between the hallway and the smoking lounge, which is a tripping hazard, needs to be addressed. (Previous timescales of 15/12/04 and 15/4/05 not met) The agency induction folder must be updated to contain appropriate and accurate information about service users and the home. (Previous timescale of 1/5/06 not met) It is required that the Manager applies for registration with the CSCI as the home’s Manager. A system must be in place to enable the visitors’ book to be up to date. The meter cupboard in the alleyway at the side of the homes needs to be covered and made secure. A fire safety professional must consider evacuation processes as part of a fire safety risk assessment. A permanent and workable solution to the laundry room ventilation issues must be found. 19/04/06 01/06/06 01/07/06 01/07/06 13. YA35 13(1)(c) 01/06/06 14. 15. 16. YA37 YA37 YA42 10(1) 17(2) 23(2)(b) 01/06/06 01/06/06 01/07/06 17. YA42 13(4) 01/06/06 18. YA42 13(4) 01/07/06 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard YA1 YA20 YA39 YA42 YA42 Good Practice Recommendations The final draft of the Service User Guide should be distributed now to residents and to CSCI. Work on revision of the medication policy should be finalised. CSCI should receive a summary of the service review. Work completing regulating the variations in water temperatures should be completed. The design and layout of the sleeping-in room/office should be addressed. 89-91 Bessborough Road DS0000017519.V288326.R01.S.doc Version 5.1 Page 27 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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. 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