Inspection on 05/09/05 for Andrin House

This inspection was carried out on 5th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Andrin House 22/04/09

Andrin House 01/04/08

Andrin House 02/04/07

Andrin House 19/04/06

Andrin House 18/04/05

Andrin House 27/09/04

Andrin House 05/04/04

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Andrin House 43 Belper Road Derby DE1 3EP Lead Inspector Janet Morrow Uannounced Inspection 5th September 2005 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. Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Andrin House Address 43 Belper Road Derby DE1 3EP 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) 01332 346812 Rosecare Homes Limited Patricia Peart-Stubbs Care Home with Nursing 37 Category(ies) of Older People (OP) registration, with number of places Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: One named individual aged under 65 years, in the category of physical disability. One off variation for named person (DG) under 65 years Date of last inspection 18.4.05 Brief Description of the Service: Andrin House is a 37 bedded home with nursing for older people situated in a residential area close to the city centre of Derby. The property was originally a private dwelling, which has been converted into a care home. Service user bedrooms are located on the ground floor and first floor and are accessed by passenger shaft lift and staircase. Two bedrooms have en suite facilities. Personalised items are in the bedrooms. There are four communal rooms. Support services are in place with a choice of GPs, chiropodist, dentist and optician. Nursing services are provided as part of the care services of the home. Community psychiatric nurses, occupational therapists, physiotherapists and dieticians are accessed as required. Staff training takes place. Some entertainment is provided. Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was unannounced and took place over two days for a total of 7.5 hours. A second inspector, Jenny Thornton, assisted with the inspection for an additional three hours on the 5th September 2005. Staff and care records were examined. The home had six vacancies. Six of the thirty-one residents, five members of staff and one relative were spoken to during the inspection. One relative was contacted by telephone following the inspection. Concerns about standards of care had been raised by care managers for three different residents and this had resulted in adult protection procedures being implemented. The concerns raised were addressed during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Assessments and care plans need to be more detailed to ensure that staff know what to do for all service users. Risks identified on assessments were not Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 Page 6 being addressed consistently and must have a corresponding care plan. This must take place immediately to prevent further risk of health problems. Medication administration procedures must be improved to ensure that the guidelines set by the Royal Pharmaceutical Society are being followed. Plans to ensure the quality of the service provided must be devised and implemented. They must take into account residents’, relatives’ and visiting professionals’ views. Further improvements to the physical environment were needed such as more replacement chairs and tables in the main lounge and smoking area and tidying of the garden area. Terms and conditions of residence (contract) should be clearer to ensure that nursing care costs are identified. Reporting of accidents to the Health and Safety Executive should always take place, where appropriate. Additional training for staff in specialist areas such as palliative care would be beneficial. A greater number of activities to suit a range of needs and interests would improve residents’ quality of life. 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. Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.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 Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.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) 2, 3 and 4 The home’s assessment information lacked sufficient detail, which had contributed to individual residents’ needs not being met. Terms and conditions of residence (contract) did not fully meet legal requirements, which had the potential for confusion about contractual obligations. EVIDENCE: Three care files were examined in relation to adult protection issues. A further two care files were examined for general purposes. There were specific needs identified by the information provided from social services but these had not been addressed through the home’s assessment. For example, on one file skin integrity was a major need but the home’s own assessment documentation had not addressed this in sufficient detail to ensure that the problem was fully addressed. This could have contributed to the subsequent problems experienced by the individual resident. Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 Page 9 On another care file there was no history of falls documentation although the individual resident had experienced numerous falls. This lack of assessment could also have contributed to subsequent problems experienced by the individual. Lack of full assessment information was raised as an issue at the previous inspection in April 2005 and an immediate requirement notice was therefore issued to rectify this. A sample terms and conditions of residence (contract) was examined. This provided information on fees and services covered by the fee. However, they did not specify the breakdown of costs into accommodation, personal care and nursing care as required by the Care Homes Regulations 2001. Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 11 There had been a deterioration in the consistency of care and lack of attention to detail in care planning had put residents at risk. EVIDENCE: Five service users’ care files were examined. Care plans were in place in all examined. However, there was a lack of consistency and attention to detail that meant some service users care needs and health problems had not been acted on quickly enough. For example, in one file there was no detailed assessment by the home of skin integrity and it was unclear whether dressings had been applied consistently. An infection had not been noticed quickly enough, resulting in a hospital admission. In another file, where a resident’s health had deteriorated, there was no clear recording to indicate whether care needs had been re-assessed or what action had been taken in response to the deterioration, for example regular monitoring of blood pressure, temperature etc. There had been some improvement in providing care plans for social needs but psychological needs were not routinely assessed for all residents. Lack of comprehensive care planning was raised as an issue at the previous inspection in April 2005 and an immediate requirement notice was therefore issued to rectify this. Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 Page 11 Two relatives had expressed concerns regarding the care to care managers. However, a relative interviewed during the inspection stated staff were ‘very good’ and a resident interviewed described them as ‘marvellous’ . One relative contacted by telephone following the inspection stated that they were pleased with the progress their relative had made. A random sample of medication administration record (MAR) charts was examined. These were found to be completed accurately. However, two handwritten MAR charts were not signed and dated by two people and pharmacy labels were also being used on the charts. There was one entry on one chart that contained a permanent erasure (i.e ‘tipex’). There was a policy on death and dying that had been reviewed in 2004 and contained information on how to deal with terminal illness. Staff interviewed demonstrated knowledge of what to do and signs to look out for if someone was terminally ill but there had been no recent training in this area and some staff stated that this would be beneficial. Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 Contact with visitors was on an open basis and meals were varied and nutritious which enhanced residents’ quality of life. Activities were limited and led to a lack of stimulation for some residents. EVIDENCE: There was a limited amount of regular activity and many residents appeared to spend most of the day sitting in the lounge. Movement to music occurred weekly, bingo occurred twice weekly and musical entertainment was arranged periodically. Residents interviewed stated that there was not much activity and greater variety would be beneficial. Residents were observed to have their own routines with some choosing to use the smoking room and others choosing to stay in their bedrooms. There were games and books available and although those residents who were able to use them took advantage, there appeared to be little stimulation for less able residents. Those residents and relatives interviewed stated that they were able to visit at any time and were always made to feel welcome. The lunchtime meal was observed and was plentiful and nutritious. Those residents spoken to at lunch time stated that generally the food was enjoyed and was cooked well although there were occasions when it was not to their individual taste. Specialist diets such as diabetic were catered for. Those residents needing assistance with feeding were helped in a sensitive manner by staff. Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.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) 18 Clear procedures and staff awareness ensured that residents were protected from abuse. EVIDENCE: An up to date adult protection policy was in place and the manager was aware of Derby and Derbyshire Social Services Local Authority procedures. Staff training in adult protection had taken place and the manager stated that more was booked for November 2005. Although there were current incidents being investigated via adult protection procedures, these were not consistent with abusive behaviour. Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.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 and 26 The environment was generally safe for residents but further refurbishment would enhance the ongoing comfort of service users. EVIDENCE: The home was generally reasonably maintained although continued attention in some areas was needed, such as scratched paintwork and the refurbishing of armchairs and tables. Parts of the garden were untidy. There was a patio area that residents made good use of. The manager stated that four new armchairs, including two reclining chairs, had been provided in the lounge but there were still a number that were shabby and required either replacing or refurbishing. The dining room tables and the table in the smoking room also needed upgrading. There was a broken privacy lock on the identified upstairs bathroom. Those residents spoken with were pleased with their bedrooms. The manager stated that those residents who had requested locks on their doors had been provided with them. There were no records to suggest that residents had been offered additional items of furniture such as two comfortable chairs or a table Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 Page 15 to sit at or why these had not been supplied. This had been raised as an issue at the previous inspection in April 2005. The written information supplied by the home stated that there had been no changes to the building, apart from the redecoration of one bedroom. The premises were clean and tidy and odour free. However, the information supplied by the home showed that training in infection control had not been undertaken by staff. Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.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, 29 and 30 The procedures for the recruitment of staff were generally robust and provided safeguards for people living in the home. There were sufficient qualified and experienced staff deployed to meet residents’ needs but additional training in specialist areas would improve the care provided. EVIDENCE: Staff rotas for the 25th July 2005 –18th September 2005 were examined and showed that there were sufficient staff on duty to meet service users’ needs. There were two trained nurses on the morning shift and two in the afternoons until six p.m. There were five care staff on each shift. The written information provided by the home indicated low use of agency staff and discussion with the manager and staff also confirmed that there were no issues regarding staff shortages. The written information provided by the home indicated that 10 care staff had achieved National Vocational Qualification (NVQ) to level 2, which meant that the home had met the target of 50 of care staff achieving this qualification by 2005. Mandatory health and safety training took place and other training relevant to the home such as nutrition and wound healing, catheter training and managing challenging behaviour had occurred since August 2004. Staff interviewed stated that access to training was good but also indicated that some courses were not available for all staff. However, due to recent issues regarding care, more specialist training in areas such as tissue viability and palliative care would be beneficial for all staff. Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 Page 17 Four staff files were examined and three had relevant identity information in place. One did not have a photograph and other identity information such as birth certificate or passport. All had Criminal Record Bureau (CRB) checks in place with the exception of one, which was being processed. There was evidence that the application had been made. The written information supplied by the home also confirmed that CRB checks were either available or had been applied for, for all staff. A recent employee’s application form supplied information on previous employment and any gaps in employment could therefore be followed up. Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 Page 18 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) 31, 32, 35, 36, 37 and 38 The service was not run in the best interests of residents. Due to recent concerns raised about the care in the home, it was unclear if the management systems that were in place were being fully implemented and adhered to, which had resulted in residents being put at risk. EVIDENCE: The registered manager had completed the Registered Manager’s award and had four years experience in running the home. Residents and staff interviewed were clear that the manager was in charge, with one resident describing her as ‘marvellous’. The owner, manager and staff all stated that they wanted to provide a good service and staff stated that teamwork was good and their communication systems were clear. However, recent concerns raised had highlighted areas where other professionals, such as General Practitioners, had not been called in quickly enough and there had also been an incident when it was unclear if instructions had been followed properly. This led to confusion about how the Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 Page 19 concerns raised had been allowed to happen when systems were in place that should prevent such occurrences. The manager stated that there had been no further progress on implementing quality assurance systems since the last inspection in April 2005. There was no evidence available of any resident or relative surveys or feedback from any professional visitors. Financial records for two residents were examined and found to be accurate and receipts for purchases available. Staff interviewed stated that supervision occurred but that it was mainly on a clinical basis and not used as an opportunity to look at other issues such as career development and philosophy of care within the home. Records for the running of the home were in place. Some of those examined such as staff files and care files needed additional information to fully meet the requirements of the Care Homes Regulations 2001. The written information provided by the home stated that maintenance checks on emergency lighting, electrical wiring and disability equipment were up to date. It also stated that a visit by the Fire Officer had taken place in October 2004 and that fire training and drills were up to date. There was also written confirmation that staff training on health and safety issues such as moving and handling, food hygiene and first aid had taken place within the last twelve months. However, there was no record of training on infection control. The accident book was examined and was completed accurately and corresponded with entries in residents’ files. However, accidents had not been reported to the Health and Safety Executive, where appropriate, and an immediate requirement notice was therefore issued to rectify this. Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 Page 20 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 x 2 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 x 3 x x x 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 3 3 1 x 3 3 2 2 Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP8 Regulation 12 (1) Requirement Interventions to maintain psychological health and mobility must be fully recorded.Previous timescales of 1.3.04 and 1st June 05 not met Assessment documentation must be fully completed. Previous timescales of 1.2.05 and 1st June 2005 not met. A care plan must be available for needs identified in assessment documentation. Previous timescale of 1.12.04 and 1st June 2005 not met All bedrooms must be provided with two comfortable seats, two double electrical sockets and a table to sit at. Reasons not to provide these items must be recorded in service users’ files.Previous timescales of 1.1.05 and 1.8.05 not met An annual development plan for quality assurance must be available.Previous timescales of 1.1.05 and 1.8.05 not met Nursing care costs must be detailed in the terms and conditions of residence. Previous timescale of 1.8.05 not met. Timescale for action 1.10.05 2. op3 14 (1) (a) now immediate now immediate 3. op7 15 (1) 4. op24 16 (2) (c) 1.12.05 5. op33 24 (1) 1.11.05 6. op2 5A (2) 1.11.05 Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 Page 22 7. op20 8. op37 9. 10. op8 op9 11. op12 12. 13. 14. 15. op19 op19 op29 op38 23(2)(d) Armchairs in the lounge must be & 23(2)(c) replaced or refurbished Still within timescale and improvements made. 17, All information required by Schedules Schedules 1 - 4 of the Care 1-4 Homes Regulations 2001 must be in place in staff and service user files. Previous timescale of 1.8.05 not met. 12 (1) (a) There must be proper provision & (b) made for the care, health and welfare of residents 13 (2) Arrangements for recording, handling, safe keeping, safe administration and disposal of medicines must be made 16 (2) (n) There must be consultation with residents about a programme of activities and provision of facilities for recreation.. 23 (2) (b) The premises must be kept in a good state of repair externally and internally 23 (2) (o) External grounds must be appropriately maintained. 19 (1) & Staff files must contain the Schedule information and documents 2 specified in Schedule 2 37 (1) All accidents must be reported to the appropriate authority. 1.11. 05 1.11.05 1.10.05 1.11.05 1.1.06 1.11.05 1.1 06 1.11.05 immediate 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. Refer to Standard op27 op33 op8 op9 Good Practice Recommendations Care staff hours at peak times of day should be reviewed. The review of policies and procedures should indicate the outcome and any action required. Regular monitoring of resdients health should take place, including blood pressure, temperature etc. Handwritten MAR charts should be signed and dated by C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 Page 23 Andrin House 5. 6. 7. 8. 9. 10. 11. 12. 13. op9 op9 op11 op12 op19 op19 op19 op19 op30 14. 15. 16. 17. 18. op29 op33 op33 op36 op38 two people. There shold be no permanent deletions on MAR charts. Pharmacy labels should not be used on MAR charts. Staff training in terminal and palliative care should be arranged. A variety of activities and entertainment should be arranged with residents to suit a range of needs Scratched paintwork should be repaired. The broken lock on the identified bathroom should be repaired Dining tables and the table in the smoking room should be upgraded. The garden should be tidied and rubbish cleared away. Staff training needs should be reviewed in relation to core areas such as tissue viability, moving and handling and infection control and specialist needs such as palliative care. All staff files should contain identity information such as a birth certificate or passport. The views of residents, relatives and visitors should be sought and their views acted on. Management systems, including monitoring of care, should be in place to ensure quality of care. Staff supervision should take place every two months and include career development needs, philosophy of care in the home. Accidents resulting in fractures should be reported to the Health and Safety Executive. Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.doc Version 1.40 Page 24 Commission for Social Care Inspection Cardinal Square Nottingham Road Derby DE1 3QT 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 Andrin House C52 CO2 S2150 Andrin House V247433 050905 Stage 4a.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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