Inspection on 09/10/07 for Warwick House

This inspection was carried out on 9th October 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Warwick House 16/11/06

Warwick House 04/10/05

Warwick House 18/05/05

Warwick House 22/11/04

Warwick House 14/06/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Warwick House Warwick House Bonsall Avenue Littleover Derby Derbyshire DE23 6JW Lead Inspector Brian Marks Unannounced Inspection 9th October 2007 09:00 X10015.doc Version 1.40 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 Warwick House DS0000035936.V347489.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 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. Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Warwick House Address Warwick House Bonsall Avenue Littleover Derby Derbyshire DE23 6JW 01332 718720 01332 718720 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) Derby.gov.uk Derby City Council Caroline Brighouse Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That 6 beds be registered for intermediate care only. Date of last inspection 16th November 2006 Brief Description of the Service: Warwick House is a 28 bedded home for older people situated in Littleover, a suburb of the city of Derby. The home has been refurbished to provide six places for intermediate care, with the eventual aim being to provide respite care in the remaining twenty-two places. Currently there are four residents living at the home on a long-term basis. The property was purpose built and is owned by the local authority, Derby City Council. The intermediate care bedrooms are situated on the ground floor and are en suite. The remaining resident bedrooms are situated on the first floor, which is accessed by stair lift and passenger shaft lift. A programme of redecoration and refurbishment of all bedrooms has been continued. There is a garden area with patio and outdoor seating. Support services are in place with a choice of General Practitioners, and visiting district nurses, chiropodist, dentist and optician. Community psychiatric nurse, occupational therapist, physiotherapist and dietician are accessed as required. Transport is arranged for those service users wishing to go out and in-house entertainment is arranged. The fees for respite/short term care at the time of this inspection are £98.60 to £205.00 per week, whilst the intermediate care service is free at the point of delivery. Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a Key unannounced inspection that took place at the home over a period of a day. Additionally, time was spent in preparation for the visit, looking at previous inspection reports and other relevant documents and preparing a structured plan for the inspection. The manager had returned a written annual quality assessment before the inspection, and the information contained in that was also analysed and contributed to the planning process. At the home, apart from examining documents, care files and records, time was spent with two of the assistant managers of the home, who were in charge during the visit, and talking with eight of the staff working on the day shifts. The care records of three people who live at the home were examined in detail and these were interviewed along with a number of others who were living there on the day of the inspection. During the morning of the inspection we were accompanied by an ‘Expert by Experience’, an important part of the inspection team, who spoke with these residents and who helped get a picture of what it is like to live in or use a social care service. Their comments and observations are reflected in this report. No other inspection visits have been made to the home since the last Key unannounced inspection on 16 November 2006. What the service does well: What has improved since the last inspection? Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 6 A number of items were noted during the inspection as well as being highlighted by the manager in the annual assessment provided before the inspection: Improved the laundry system Provided a hot breakfast option Upgraded soft furnishings and furniture throughout the home Better documentation to be used for people who wish to look after their own medication Started regular meetings between residents, relatives and the home’s manager Continued with the staff training programme, particularly in those subjects highlighted by staff themselves Improved the systems in place that assess how well the home is providing its services What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People do not come to live at the home without the care they need being identified, and being reassured that the home is right for them. EVIDENCE: As noted above the home has one of its wings - the Cherry Tree Unit exclusively concerned with providing intermediate care, which is a service that aims to assist people to return home following a period of hospital care, and usually lasts for about six weeks. Heathcare professionals –physiotherapists, occupational therapists and nurses, - routinely offer support to the care staff of the unit, and they are also usually involved in making arrangements for people coming to stay at this unit. Three residents’ files were looked at in detail at this inspection and they were chosen to reflect the three circumstances under which people receive care at the home. The two residents who were at the home for short periods, either for respite or intermediate care had assessments in place that had been undertaken before they had moved into Warwick House. One of the residents Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 9 lived at Warwick House on a permanent basis and assessment of their needs had been part of a recent exercise to bring their care plans up to date. In all these circumstances staff were giving support and care using up to date information, although the person at the home for a respite stay had only left the home a few weeks before being readmitted, and there was little new information available about why she had returned. The care record of the person living at the home on a long-term basis included a new document that contained Terms and Conditions of Residence from the City Council, and that of the person staying for respite care contained a financial contract for their stay also. However this was not true of other files of people staying under similar circumstances, although it was accepted in discussion with the assistant manager that they are dependent on the professional worker who arranges care to supply this, and this does not always occur. The rights and responsibilities of all parties are not being made explicit in these circumstances. People coming to the home for intermediate care do not have a financial contract as their care is provided free under separate funding arrangements between Derby City Council and the Health Service. Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care arrangements at the home promote safety and consistency and care is given in ways that respect individuality and privacy. EVIDENCE: All of the three residents files seen had care plans in place, which had been formulated from the assessments of their care needs that had been carried out by the home staff or by professionals from other agencies. However the ‘short term care plan’ in place for the person who was staying for a period of respite care was brief, and this did not reflect the change in her health care needs she had experienced before returning to stay at the home. The other care plans looked at are more detailed and provide staff with the information required to care and support each resident. These include reference to personal care, nutritional needs, domestic skills, mobility skills and any need for technical aids, communication skills and problems, health and mental health needs, and social and general lifestyle interests. Additionally, by incorporating information from assessments of risk in areas such as safe moving and handling, skin and tissue care, nutrition and falls, a Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 11 full programme of care activities is identified. This is regularly evaluated, and at least annually for the people staying permanently at the home, and revised where necessary. The files indicated that residents had been consulted within the process of planning and reviewing care and the people spoken to confirmed this, so that care and support is given by staff using up to date information. The medication practices at Warwick House were looked and in general were found to be satisfactory. Medication administration records were seen and corresponded accurately with individual prescribed doses and instructions on the medication. However on handwritten instructions there were still a number of omissions where they had not been signed and dated to indicate the person responsible and to provide accountability. Because of the numbers of people in the home for respite care, there is usually a high number who have continued to take responsibility form their own medication; this was managed properly and safely. All of the residents spoken to confirmed that staff were respectful and maintained their dignity both when assisting with any personal care needs and at any other time. Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good opportunities for residents to engage in leisure and social activities and they were encouraged to maintain their independence. The catering services of the home are well organised and enjoyed by the residents. EVIDENCE: Social life at the home is centred on activities organised by the managers and care staff, because a specific person is not employed as activities coordinator. These include games, music, armchair exercises, and individual interests and hobbies. Bingo is a popular pastime but residents commented that this does not always happen as planned, due to staff work priorities. Some of the games such as ‘Connect’ and card games are large-format which enables residents with visual impairment to use them, and a large format television is due to be purchased to improve everyone’s enjoyment. The home does not have its own transport but the manager confirmed that outside transport was available for residents to access community facilities such as shops and leisure outlets. Visiting time at Warwick House is open, although visitors are asked to avoid visiting at meal times if possible to avoid any disruption. Residents spoken to said they are able to receive their visitors within their bedrooms or the lounges Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 13 and, as there are a number of these, this can still be in private. There is a caged bird in one of these, which adds a homely touch. Although none of the residents has used advocacy services, details of a local one are advertised throughout the communal areas of the home. The local church provides religious services at Warwick House on a monthly basis, but if any resident requires a visit from any other religious denomination or faith, the home’s managers are committed to arranging this. Feedback from residents was very positive about the quality of meals at the home and a visit to the kitchen indicated that purchasing, storage, stock managing and cooking arrangements are satisfactory, and catering staff are on shift until 5pm each day to ensure all meals are properly prepared and served to residents. The menus indicated a choice of mealtime options, with cooked alternatives at both breakfast and afternoon tea being available if required. Hot drinks are available for residents to make if it is assessed as being safe and there are cold-water dispensers in the lounges. The cooks spoken to have a good knowledge about the provision of special diets, and are particularly well versed on the needs of people suffering from diabetes. Although they have very rarely been asked to cater for people from other ethnic backgrounds, there is one member of the kitchen staff who is able to respond to this need as it arises. The residents spoken to were generally satisfied with their time spent at the home although for the majority this is usually only temporary: ‘I’m happy to come back rather than being at home alone’. ‘Staff come round at least every hour to check that we’re all right…..The food is good’ ‘I’ve been on lots of short visits to Warwick House and they are always very welcoming. The food is good and varied, with plenty of choice’. ‘Staff can’t do enough for us; it’s a marvellous place’. ‘The home has changed over the years, for the better’. Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home responds to complaints made by residents and their representatives according to a written procedure, and aims to protect residents from harm. EVIDENCE: Residents are made aware of the complaints procedure through their copies of the Service User Guide as well a summary on display. The home’s records indicated that no formal written complaints had been received during the past year. The residents spoken to also said that their concerns were listened to, taken seriously and acted upon. Appropriate procedures are in place to safeguard and protect residents from harm, and these are supported through staff training, provided as part of their preparation when they start work at the home. Records indicate that a number of more established staff have not had any training in this matter for some time, or not at all, and their knowledge may be incomplete. The assistant manager reported that refresher training is available throughout the year from the central training team. There had been no incidents of use of the statutory procedures during the past 12 months. Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, clean and well-maintained environment. EVIDENCE: A tour of the building was undertaken with the assistant manager who identified changes and improvements that had occurred since the last inspection. New washing machines have been provided in the laundry, soft furnishings throughout the communal rooms and bedrooms have been brought up to the same coordinated standard and new armchairs have been provided in all bedrooms. The recommendations made at the last visits by the Environmental Health and Fire Officers have been dealt with or are in hand. However it was noted that both sterilising units had not been in operation for some time and domestic staff commented that this resulted in inefficient cleaning of residents’ commodes, which reduces the effects of infection control measures. Also one of the bathrooms still had an old style ‘medibath’ in place Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 16 that is unpopular with both staff and residents and reduces the facilities available for use. The communal areas and bedrooms of the home visited during this inspection were very clean and tidy and free from odours. Residents spoken to had no complaints about the laundry service of the home and all residents observed in the home wore clean and well-presented clothing. The impact of the home’s physical facilities is positive and provides a light, comfortable and valued environment in which to live and work. Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 17 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides an adequate level of staffing that has the skill mix, training and competency to meet the needs of the residents. EVIDENCE: The staffing rotas for the past two weeks were examined and indicated that the core rota is for one manager and three care staff on duty for each of the three day shifts, one of the latter being assigned to the Cherry Tree Unit, and two care staff at night. The registered manager is also on the rota for the daytimes of Monday to Friday. Whilst residents and staff commented that care needs were being met, and this was particularly true in the Cherry Tree Unit, it was also stated that with the long term absence of a carer, the Adult Services policy of redeploying homecare staff who have excess capacity into its care homes results in regular difficulties with consistency of care and inefficient working patterns. Staff also commented that the regular pattern of admission and discharge of the high numbers of residents at the home for short periods creates extra workloads for care staff that results in time available for social activities being reduced. Because staff morale was said to be high, staff ‘all work well together and pull their weight, even though no day is the same’. The recruitment files of staff are kept at the Adult Services’ Human Resources section and were therefore not available for inspection. At previous inspections, files for recently appointed staff have been examined and found to contain all the required information and details of checks carried out. It is the Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 18 policy of the Local Authority that people do not commence employment until all these checks have been made, and they are safe to work with vulnerable people. Induction training is now undertaken by all new staff using the ‘Skills for Care’ system – a national standard; this includes training in the principles of care, safe working practices, the organisation and workers roles and the needs of the resident group, particularly people suffering from dementia. Key health and safety training has been undertaken by all staff and updated as required and records were in place to demonstrate this. Staff commented positively about general training opportunities available to them and a number described those that they had completed since the last inspection. At the time of this inspection seventeen care staff were employed at the home and of these staff seven hold or are completing a National Vocational Qualification (NVQ) in care at level 2, which is below the required standard. Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 19 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has good administration and management systems and is a safe place to live and work; its operation reflects the wishes and preferences of the people that live there. EVIDENCE: The registered manager was not on duty on the day of inspection but is supported by a small team of assistant and relief managers and two of these were present. Staff spoke favourably about the support provided by the management team and how ‘they are always available to help out and the office door is always open’. Staff also described how they receive formal 1-to1 supervision meetings that give them the opportunity to talk about issues with a manager confidentially and to identify anything they need to help them to work better and to develop professionally. Records supported that this was Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 20 occurring at the required regularity. The registered manager has achieved an NVQ at level 4 and the Registered Managers Award. The residents are also able to express their views about the running of the home and the activities taking place within it through a regular residents’ meeting, and this is the main source of feedback along with day-to-day comments about the home. Satisfaction questionnaires are given to residents and family members on a regular basis, although those given to the former group are returned to Adult Services HQ for analysis. The results of this process are sent to the home on an annual basis and retained in report form, the latest of which indicated high levels of satisfaction with the home. The home’s line manager visits the home very regularly and is involved in the monthly audits of various parts of the home’s operation, which also involve managers from other homes operated by the Council. The whole Quality Assurance and monitoring process is carried out to make sure managers and staff are working to the standards set by the Adult Services Department’s senior managers. The systems for the safe keeping of residents’ personal spending money have been in place for some time and these remain unchanged from the last inspection. Information received before the inspection indicated that servicing of equipment and safety standards at the home were satisfactory and a sample examination of fire safety activity supported this. However some residents did comment that the need for safe practices sometimes gets in the way of their routines and limits the scope for them to do things for themselves. Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 2 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP2 Regulation 5(1,a-b) Requirement Timescale for action 31/12/07 2. OP18 13(6) 3. OP26 23(20(c and k) 4. OP28 18(1) All residents should have an up to date written contract and statement of Terms and Conditions of residence so the rights and responsibilities of all parties are clearly described as are practical arrangements for the payment of any fees. (Previous timescale of 31/05/07 not met). All members of the staff team 31/03/08 must be provided with current training/instruction in relation to their responsibilities to safeguard vulnerable adults so that their knowledge is brought up to date. All equipment used for 30/11/07 sterilisation purposes must be in good working order so that infection control measures are not compromised. The nationally required target of 31/08/08 50 of care staff achieving a National Vocational Qualification (NVQ) level 2 must be met by the due date so that standards of professional practice continue to improve. Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 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. Refer to Standard OP7 Good Practice Recommendations The care records and plans of people coming to the home for respite care should be more comprehensive and contain more detailed information about their recent lives so that staff are able to care for them with consistency and safety. All hand written medication administration records (MAR) charts should be checked, signed and dated by two people so that there is a clear trail of responsibility and accountability when administration practice need to be checked. There should be a wider range of social activities arranged on a regular basis to suit residents’ needs and residents should be informed of the activities available. Inefficient and out of date bathing equipment should be replaced in order to increase the range of facilities available to residents. 2. OP9 3. 4. OP12 OP21 Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Warwick House DS0000035936.V347489.R01.S.doc Version 5.2 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!