Inspection on 27/09/07 for Annabel House

This inspection was carried out on 27th September 2007.

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

Annabel House 05/09/06

Annabel House 01/03/06

Annabel House 12/09/05

Annabel House 18/01/05

Annabel House 17/06/04

Annabel House 21/01/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOMES FOR OLDER PEOPLE Annabel House 6 Clifton Street Stourbridge Dudley West Midlands DY8 3XR Lead Inspector Mrs Jean Edwards Unannounced Inspection 27th September 2007 08:00 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 Annabel House DS0000024976.V346035.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. Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Annabel House Address 6 Clifton Street Stourbridge Dudley West Midlands DY8 3XR 01384 397104 NONE 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) Mrs D L Braham Lisa Braham Care Home 9 Category(ies) of Learning disability over 65 years of age (9) registration, with number of places Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3 service users (female) with a dual diagnosis of LD/MD currently living at the home may be accommodated for as long as the home is able to demonstrate that their needs can be met. 4 service users in the category of LD currently living at the home may be accommodated for as long as the home is able to demonstrate that their needs can be met. 5th September 2006 Date of last inspection Brief Description of the Service: Annabel House is registered to provide care to a maximum of 9 service users. This Home is unusual in that it currently caters for a mixed age range, some being under 65 years the majority being over 65 years. The Homes categories of registration are for people who have a diagnosis of learning disability (LD (E), Mental ill health / disorder (MD (E) or a dual diagnosis. Annabel House is a large detached property located in a residential area, near to the Stourbridge ring road. The Home comprises of two floors, with bedrooms located on each. It has a lounge and dining room, kitchen, laundry, office with toilet and bathing facilities available on both floors. There are seven single bedrooms and one double bedroom. The Home has a staff team of 9 people including the Registered Manager. The level of fees for this home, according to information provided by the home, is currently between £380.00 and £ 445.00 per week. There is an additional fee of £13 per month per person for usage of the homes mini bus. It should be noted that fee information included in the report applied at the time of this inspection and people may wish to obtain more up to date information from the care home. Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the unannounced key inspection visit for 2007 - 8, undertaken by an inspector from the Commission for Social Care Inspection (CSCI), over a weekday for approximately 10 hours. All Key National Minimum Standards have been assessed at this visit. The range of inspection methods to make judgements and obtain evidence includes: discussions with the registered manager, and staff on duty during the visit, together with examination of records and documents and discussions with residents, where possible. Other information was gathered before this inspection visit from the homes Annual Quality Assurance Assessment (AQAA). Service user surveys, relatives, social care and healthcare surveys have been sent out by the CSCI, and the analysis of surveys returned is contained throughout this report. There are currently 8 residents living at the home. During the visit the inspector has spoken to the majority of residents. Longer discussions have taken place with the residents whose care was looked at in depth. Comments indicate that staff are friendly and helpful. There has been a tour of the premises, including the grounds, communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and residents’ bedrooms, with their permission. What the service does well: The home has a very committed registered manager, who has worked at the home in various roles for many years and has achieved an NVQ level 4 in Care & Management and the Registered Managers Award. She takes action to develop herself and the staff team and continues to improve the services offered by the home for the benefit of the residents. Members of staff encourage residents to treat Annabel House as their own home and to be as independent as possible. Residents are encouraged to make their own decisions and choices and there are residents meetings, with notes of discussions and decisions agreed. All aspects of the running of the home are discussed including meals, activities, and holidays. The staff provide activities within the home and all residents have enjoyed a two week holiday in Rhyl in August with the proprietor, manager and a member of staff. Some residents are able to visit their families on a regular basis. There are some residents who attend daytime activities provided by the Local Authority, which they say they enjoy. Some of the older residents choose to stay at Annabel House. Responses to the CSCI health professional surveys Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 6 relating to what the home does well, comments, responds to the individual needs of the service user and home provides well for clients elderly needs and idiosyncrasies and liaises with others when there are problems. There are good relationships between the home and other agencies and the registered manager has taken action to improve the residents access to chiropody services, with the NHS mobile chiropody unit regularly visiting the home to attend to residents foot care. The manager also seeks advice as residents need change. This is confirmed with a comment from a health professional survey, service monitors mental as well as physical health needs, and liaises with appropriate psychiatry services. The premises are generally maintained to high standards and the home is clean, tidy and homely. Annabel House continues to have a small group of staff that have worked at the home for a long time and know the residents well. They are caring, committed and flexible, often willing to work extra shifts for the benefit of residents. One resident says, staff are lovely, they are my friends. This inspection was conducted with full co-operation of the Registered Manager, staff and residents. The atmosphere through out the inspection was relaxed and friendly. The Inspector would like to thank staff, and residents for their hospitality during this inspection visit. What has improved since the last inspection? The manager has improved the service, with action to fully meet 13 and partly meet 8 of the 27 requirements from the previous inspection visit. The manager has introduced more improvements to the way each residents care is planned and provided, with an easy to read format, though not all information is completed. Some further improvements, such as pictures or symbols are needed mainly for the residents unable to read or understand written information. The homes system for managing the residents medication continues to be improved and there are only a few further minor improvements needed, to provide as many as safeguards as possible for the residents. Examples are confirmation of accredited medication training for all staff, and fuller details in medication records. There is an activity programme and this is now produced in pictorial formats, with records of individual residents participation or refusals. The registered manager has produced the complaints procedure in a pictorial format to accompany the improved easy read version of the homes complaints procedure. Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 7 The registered manager has made very good progress with the staff training programme and individual training profiles, which show that all staff are supported and trained to be aware of the needs and rights of vulnerable people. Training has also been put into place for staff to be able to respond appropriately to any behaviour from residents, which can be described as challenging. The two new staff have completed appropriate induction packs and are being trained in essentials such as food hygiene and health & safety. A major improvement to the premises is the installation of a new radio pager call system, which replaces the outdated, out of order and deactivated staff call system within the home. The new system is easy to use and provides improved safeguards for residents and staff. There is an on-going redecoration programme, with residents bedrooms being redecorated and refurnished. The home has one vacant bedroom, which is used on a temporary basis whilst each bedroom is completed. Renovation and redecoration of the ground floor corridors has taken place since the last inspection. The registered manager gave out service user surveys in January 2007 and has analysed the results and has planned actions in areas requiring improvement. A response from the CSCI health professional surveys states, the service asks clients regularly about what they would like e.g. planning holidays as well as in a formal forum of reviews. Improvements have been put in place to control potential infections and staff are completing an accredited distance learning infection control course. Staff use colour coded disposable aprons for different tasks, for example blue for food handling, white for personal care. What they could do better: The homes Annual Quality Assurance Assessments (AQAA) submitted to the CSCI should contain fuller information and better detail of the supporting evidence of what the home does well and how the improvements have been made. Information about the services the home provides needs to be updated and produced in easy to read and alternative formats, suited to each persons level of understanding. Improvements must continue to the way residents care is planned to involve them more and to include more detailed information for residents with complex conditions such as self-harm and deteriorating health, and there must be fuller support for people with the capabilities to be more independent. Health professional surveys include the comment that the way the home could improve, possibly by introducing a more person centred planning approach and social activities related to individuals rather than groups. Care plans for Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 8 younger people living at home must show that they are person centred and the residents and their relatives must be actively involved in planning all aspects of care required. Additional improvements in a small number of areas, such as medication records, are needed to make the homes system of medication administration as safe as possible. The activities provided by the home need to include more opportunities for socialising, trips and outings of interest to the residents, with sufficient numbers of staff available to support residents. The registered persons must show that all staff are aware of the up to date version of Dudley MBCs multi-agency procedure to protect the rights of vulnerable people Safeguard and Protect. The residents and families must also be made aware of the easy read, pictorial versions of this procedure. During the tour of the home a number of repairs and improvements are now needed, such as the repair of the bathroom door, grab rail, wardrobes must be secured in a number of bedrooms, hall carpet and chair in lounge need to be replaced, and the registered manager must put in place a formal programme of all maintenance and renewals required in the home. The staffing levels at the home must be kept under review to make sure that there are sufficient numbers of competent, trained staff for all residents to have opportunities for stimulating social activities inside and outside the home. All staff at the home undertake many duties, which include caring, cleaning, catering, laundry in addition to care and activities. Currently the registered provider and manager are covering some care shifts because of staff vacancies. Assessment of staffing rotas shows that there are currently insufficient numbers of staff with inadequate numbers of contracted hours. The registered person is required to provide formal staffing proposals to the CSCI for consideration. The home is required to make improvements to a small number of areas of health and safety such as the electric wall heater in a residents bedroom, which must be guarded or replaced, and an area of damp on a wall with electric sockets, which must be investigated and rectified. 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. Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 9 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 Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 10 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): 3 Quality in this outcome area is good. There is statement of purpose and service user guide and all residents have contracts / terms and conditions of occupancy. This has the effect that residents and their advocates have adequate information regarding their rights and entitlements, and any agreed restrictions, and how care will be provided. The home uses comprehensive assessment tools, which means that residents’ needs are thoroughly assessed to ensure that care needs will be met. This home does not provide intermediate care; therefore Standard 6 is not applicable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a statement of purpose; setting out the objectives and philosophy of Annabel House and this is supported with a service user guide, providing clear information about the home. There is documentary evidence, such as residents or their relatives signatures to demonstrate receipt of the Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 11 service user guide and contract, on the sample of residents case files assessed. Recent CSCI inspection reports and information about advocacy services are available in the office, with easy access. However none of the information is in an easy read or pictorial format. Each resident is provided with a contract or statement of terms and conditions. The registered manager has included the management of each persons finances in their individual contract and there is documentary evidence that the £13 .00 per month mini bus charge has been discussed with each persons social workers. There is separate documentary evidence of each persons monthly usage of the homes minibus. The home has not admitted any new residents since the last inspection visit in September 2006. Evidence from examination of residents records and discussions confirm that each person has a regular review, conducted professionally and sensitively and has involved the family or representative of the resident, wherever possible. Examination of a sample of 2 residents files shows that the registered manager has introduced new person centred planning process. There is a comprehensive Initial Assessment section however no information has been entered or transferred from existing documentation. Personal preferences are recorded on existing documents, which are signed by the resident or their relative. Staffing remains stable, with many long-serving staff members, who generally know and understand the residents needs. The registered manager is making progress to implement additional staff training to develop a more person centred approach so that all residents can be supported to realise or maintain their potential. Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 12 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): 7,8,9,10 Quality in this outcome area is adequate. The are some further improvements to care planning and monitoring, which provide staff with better information and guidance needed to adequately meet residents needs. There is good evidence of multi disciplinary working taking place on a regular basis, which results in the health needs of residents being appropriately met. The home has made very good progress with regard to the arrangements for administration of medication, which means residents are safeguarded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is in the process of implementing new person centred plans for each resident. Although these are in an easy read format there are no pictures or symbols, which would be helpful for residents who cannot read or see easily. There is some evidence showing good practice of involving residents in the development and review of the plans, though one file examined has the managers signature and residents mark on the first section of the person centred plan and no information has been entered, which is not good practice. Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 13 The new person centred planning formats include: My life so far, My assessment of risks in my life, Medical services, which may help my life, My Plan, How my care is reviewed, Other information that you may need to know, such as accidents and incident reports. The language used is clear for example my name is, I would like you to call me, this is what I look like, this is my life. Two of the eight residents files have been examined in depth; one has the person centred planning format in place, with very limited information completed, and though the other has fuller information it is incomplete. Information held in previous care plans is still held on file, such as weight on admission and care instruction needs supervision with diet to avoid weight gain however there is no indication in either plan that the person may self harm or written details of triggers or distraction strategies. It has been noted during the visit that this person has an open lesion on right hand, which staff state she has caused. There is no written record of the injury and no evidence that medical attention has been sought. The staff state, this is what she does and nothing works. The manager and staff are not aware of services provided by a specialist intervention team, which will accept direct referrals and provide support and advice to manage difficult and damaging behaviours. The registered manager has previously devised and implemented risk assessments and risk management strategies for the majority of areas of risk, however this information has not yet been completely transferred to the person centred plans, for example the moving and handling sections are not completed. There are risk assessments previously devised, in place to manage behaviours from residents, which challenge the service, together with behaviour monitoring charts, which the manager evaluates. However the chart examined at this inspection does not contain the time or circumstances when the episode started. Following the previous inspection visits the registered manager made initial contact with the Dudley Learning Disability Forum but has not yet attended any meetings or sought formal support with developments needed at Annabel House. Care staff have made some additional improvements when completing daily notes, however there is still insufficient detail to show what level of assistance and care is provided and any outcomes linked to goals in care plans. One resident has deteriorating health, she has recently returned from hospital and staff describe her mobility as poor. Examination of this persons case file shows that the person centred care planning commenced in January 2007 has not been updated, especially changed needs in her care plans. Additionally the moving and handling assessment and other health screening tools have not been updated and she now requires wheelchair assistance inside the home as well as outside of the homes environment. There is good information recorded in monthly reviews completed by the key workers, with lots of information about what has happened to each resident during the month. During Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 14 conversations some residents are able to confirm their involvement in developing their plan and know about decisions made during reviews. Residents generally have good access to health care services to meet their assessed needs both within the home and in the local community. Each resident has a health passport from priority health. All residents are registered with a GP sensitive to their needs, and there is documentary evidence that all residents have access to individual dentists, either in the community or at day centres. The registered manager arranges for residents to see an optician, as needed. One of the residents files sampled contains good evidence of health care visits and contacts with health care professionals, for example she has been seen by epilepsy nurse and now has a diary to record any seizures. She has also been seen by a cardiologist and has been prescribed Digoxin, however her person centred plan has not been updated with these changes. There are now improvements to access to NHS chiropodist services, with all residents having regular chiropody care from an NHS Chiropody Mobile Service, which visits the home. The home has a medication policy which is accessible to staff. There are currently no residents who able to administer their own medication. Observations of the way in which staff administer medication to residents show satisfactory practices. Examination of the records identify a small number of areas to be improved, examples are: a handwritten entry on the MAR sheet for ferrous sulphate 200 mg TDS has no date or signature for receipt of the medication or second signature as a witness and another MAR sheet has gaps for medication administration on 13/9/07 for 4 items at 2200 hours (Adcal D3, Primidone, Sodium Valporate, Sodium Chloride.) The resident is recorded elsewhere as being in hospital but the appropriate code has not been entered. There is also an increased dose of Sodium Valporate from 500 mg to 600 mg entered on the MAR sheet, which has not been signed and witnessed. Other medication records are up to date, with medicines received, administered and disposed of are recorded. Where medication systems are in need of action the registered person is working towards improvement. The registered manager has completed distance learning medication training accredited by ASET. She states that she has been informed by Lloyds pharmacy that their training - module one is accredited. Currently there is no documentary evidence to support this claim and advice will be sought from the CSCI Pharmacist regarding the status of the training, which had been provided by Lloyds pharmacy as an interim measure. Throughout the inspection visit evidence has been observed that staff treat residents with respect and consider their rights to privacy and dignity when delivering personal care. The home arranges for residents to enjoy the privacy of their own rooms and has offered screens in a shared room, though both residents have declined the offer and this is documented on both residents case files. Conversations with residents who are able to verbally communicate Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 15 indicate that they are happy with the way that the staff care for them. One persons states she likes it at the home and the staff are her friends. Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 16 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): 12,13,14,15 Quality in this outcome area is adequate. There is limited evidence of further progress to make planned and spontaneous activities available on a regular basis, which does not give residents sufficient opportunities to take advantage of and develop socially stimulating activities. Residents are offered some opportunities to exercise choice and control over their personal environment and lifestyle at this home. Whilst attempts are made to offer residents a nutritious diet, there is insufficient information of balanced menus and choices offered. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is evidence from observations and discussions during this visit that the residents at Annabel House can let the manager and staff know what makes them happy and what they dislike and want changed. The registered manager and staff take residents feedback seriously and strive to make changes where possible. The home has a key worker system, which enables closer resident / staff relationships where residents likes, dislikes and needs are shared. Key Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 17 workers should use the information to plan activities, which residents will enjoy. Although there is an understanding for the need to increase the level and variety of activities and to improve access to social stimulation, there is limited evidence of progress to make this happen, since the last inspection. There is some evidence that some residents prefer to spend some time on their own or choose not to be involved in group activities. The home does not have an activities coordinator and all activities have to be undertaken by staff employed at the home, who also undertake cleaning, catering and laundry duties in addition to personal care, which means time for activities and outings in limited. The registered manager has introduced a revised activities programme, which is also in picture format. The two members of staff on duty throughout this visit explained that residents are shown the pictorial planner and choose which, if any activities they wish to do, on a daily basis. We are told activities include music, dance, drawing, colouring, jigsaws, cooking, cards, bingo, foot spa, manicures, talking newspaper, videos and Church. One resident attends local Free Church for Sunday services, with transport provided by the church members; and two residents attend church services held at the Local Authority day centre for older people. A comment from the CSCI health professional surveys is that the home could improve social activities related to individuals rather than groups. All 8 residents went to Rhyl, North Wales for two weeks in August2007, accompanied by the proprietor, registered manager, and one member of staff. We have seen evidence through notes and discussion with residents willing to chat, that they thoroughly enjoyed this holiday. It is positive that during case tracking, on one residents file there is a copy of a letter written by her previous key worker to this persons sister giving details about case life at Annabel house including her holiday, and outings from the day centre for example to the safari park. During discussion we established that the key worker has left the homes employ and the resident has a new key worker, she agrees that it would benefit the residents relationship with her family if letters were resumed. The home has information available relating to Dudley Advocacy Service, however there are no residents that the home at present using this service. During case tracking we noted that at least one person has no real contact with her family and it is recommended that the home contact the advocacy service to support her with choices and decisions. The resident previously had an advocate, however she is no longer involved as it was felt the resident is settled at this home. Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 18 There is a visiting policy in the statement of purpose and service user guide and displayed in the home. There is limited evidence that families actually visit Annabel House and staff say that generally families take the residents out to their own homes or take them for other outings. Residents are able to have personal possessions in their room, but may be not always be able to bring large items of furniture due to, space restrictions or health and safety considerations. There are inventories of residents personal possessions on the sample of files examined, which are updated regularly, and signed and dated by staff, the resident or their representative. The home has some pictorial menus, however these are not planned on a daily or weekly basis. The manager and staff state that residents are asked for their preferences at each mealtime. There has been little progress to act upon the findings of the last inspection, which reported that the home needed to introduce menus, which include suppertime choices as well as soup and other alternatives. These should be displayed in large print and pictorial formats appropriate to residents understanding. On the day of this visit breakfast consisted of cereals, toast, jam or Marmite. There appeared to be no clear plan of what are the mid-day meals would be and after some discussion the senior member of staff cooked egg, chips, beans, followed by rice pudding for the four residents at home. All residents ate everything and appeared to enjoy the meal. Again during the evening there appeared to be no particular plan and a member of staff asked residents to choose what they wanted to eat. A selection of sandwiches was provided. It is difficult to judge the nutritional content of meals provided in this way, especially as some people had eaten a meal at their day centre placement. All residents to look well nourished and there is no evidence that this visit to suggest unplanned weight loss. Food likes and dislikes are recorded; these were seen in the assessment information of the two residents case files sampled. However it is not possible to judge whether there has been progress to introduce sufficient fresh fruit and vegetable to encourage people to have their five portions of fruit or vegetables as part of a healthy diet. The proprietor or manager do the food shopping and we are told sometimes residents help with this activity, though evidence of this needs to be documented. There is evidence that staff have received training to help those residents who need help when eating and are sensitive in their approach. Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 19 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, 18 Quality in this outcome area is adequate. There is progress to improve arrangements for protecting residents and whilst residents generally feel complaints are listened to not everyone is aware of the complaints and safeguarding policies and procedures. The home is providing ongoing staff training to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the tour of the premises we noticed that there is an out of date version of a written complaints procedure displayed in the dining room. After bringing this to the managers attention she has agreed to remove this document and replace it with the new pictorial version, which is being made available to each resident. The home has not received any complaints since the last inspection visit. There is evidence that the home responds proactively to any concerns raised and a comment from a health professional states, there has been an issue of communication between the home and centre and contacting staff at the home, this was resolved. There have not been any allegations or incidents of abuse reported and there is evidence through case tracking or examination of residents daily notes or staff communication book to indicate any incidents. Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 20 The home has an up-to-date copy (January 2007) of Dudley MBC multi-agency procedure to safeguard adults, Safeguard and Protect. This has a quick reference flow chart, useful appendices, including a body chart and easy read procedure, which can be used in discussions with the residents. The manager acknowledges that the residents have not been made aware of Dudley MBC easy read Safeguard & Protect procedure. We strongly recommend that ways to discuss this document with them be explored such as using their key workers and residents meetings. Although staff on duty have been able to tell us what action they would take in the event of an allegation of abuse, they have not yet been made aware of or read the updated version of Dudley MBC Safeguard & Protect procedure. The homes policies and procedures regarding protection of residents are generally satisfactory, however they need to be continually reviewed to remain in line with regulations and other external guidance. Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 21 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): 19,21,22,24,26 Quality in this outcome area is adequate. Significant and positive changes to the décor and furnishings continue to be introduced. The incremental improvements contribute to creating a pleasing and pleasant environment for residents to live in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Annabel House is a traditional detached property situated in a residential area of Stourbridge, local amenities are within walking distance and local towns are accessible by public transport. The interior and exterior of the premises are generally maintained to a satisfactory standard. The home is furnished with domestic and comfortable fixtures and fittings and has a homely atmosphere. It is very positive that a long-standing requirement to replace the outdated and out of use call system has been replaced. A new wireless call system has been purchased and installation is almost complete, with bathroom and toilet Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 22 call points/pull cords remaining to be installed. The system sounds at central point in the office and identifies the call, which can only be cancelled at the origin of the call. This system provides improved safeguards for residents and staff. The tour of the premises showed that the home is generally clean and free of any malodours. From discussions and comments from surveys everyone says, the home is always fresh and clean. There is evidence of on-going redecoration of the residents bedrooms. The vacant room is used whilst redecorating takes place. The completed bedrooms are bright and attractive and arranged according to each persons taste. However there is not a documented audit or a formal planned and prioritised maintenance programme. As identified at the previous inspection the registered manager needs to undertake a written audit of the home from which a prioritised programme of repairs, redecoration and replacement of equipment is devised. During the inspection day we noted that the temperature in the home felt cold and requested that the heating, which is on a timer, be switched on. The ambient temperature needs to be monitored and maintained at a comfortable and safe temperature for residents at all times. A sample of residents bedrooms have been viewed with their permission and we noted that bedroom 1, on the first floor, which is vacant, is cold and damp with black areas under the wallpaper. The manager states that there is a programme for this to be completely renovated and redecorated, though this is not formally documented. In bedroom 2 there are small areas of wallpaper peeling away from the wall, around the window. In bedroom 5 the manager needs to investigate and rectify the squeaking floorboards in front of vanity unit with washbasin. In Bedroom 4 the wardrobes are not secured and there is a slight malodour and we are told that the residents may need a continence assessment. In bedroom 3, which is a double room it is positive to see that this room has been redecorated according to the residents choice, though the have not yet been wardrobes secured. On the ground floor in bedroom 6 there is a wall mounted electric radiator, which is not guarded. The manager states this is not to be used as resident prefers bedroom to be cold. The radiator must be removed or guarded as a priority with a risk assessment put in place as an interim measure. The manager has agreed to action this. We noted that the resident living in bedroom 7 uses a wheelchair and space in this room is very limited. The residents needs must be kept under review, with the involvement of an occupational therapist or professional moving and handling assessment as necessary. Furthermore the outside wall in bedroom 7 feels wet to the touch and the wallpaper is peeling on this wall, which also has electrical sockets. This is an issue, which must be investigated as a priority. In bedroom 8 the wardrobe must be secured, which is an outstanding requirement from the last inspection visit. Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 23 The majority of bedrooms are attractive, with beds and furniture in generally good condition and individualised with personal possessions. There is evidence that small electrical items, such as lamps, radios and TVs have been, tested for safety. The home does not have en-suite facilities in bedrooms. There are adequate bathing and toilet facilities on the ground and first floors. However the first floor shower room - WC needs thorough de-scaling and the first floor bathroom has a grab rail beside WC missing, and needs to be replaced. The outside door handle to this bathroom has been removed leaving an exposed screw (this has been removed during the visit and made safe) door handle must be replaced as a priority. In the communal areas, the manager states that the previous requirement to re-stretch the carpet in the first floor corridor has been actioned, however she has cleaned the carpet causing it to need to be re-stretching again to avoid it being a tripping hazard. The hall carpet remains faded and has not yet been replaced. The lounge is a large comfortable room with a variety of chairs, however there are now signs of general wear and tear and in particular one residents armchair has splits on the arms and needs refurbishing or replacing. There are improvements to decor and the peeling wallpaper on the lower areas in the ground floor corridors have been resolved and repainted. The manager states that there is new carpet on order, which will resolve the issues of the fraying joins in the carpet in communal areas, which also have faded areas, showing signs of wear. The laundry area is generally well organised and some improvements have been maintained, with cleaning products stored securely in compliance with the Control of Substances Hazardous to Health (COSHH) Regulations and there is much less clutter or extraneous items. The homes kitchen is maintained to high standards of cleanliness, is very well organised, and there is a good variety of fresh, frozen, dried and canned foods. Infection control measures at the home are generally satisfactory with colour coded disposable aprons are used for different tasks, for example blue for food handling and white for personal care. All members of staff have undertaken comprehensive infection control training, through distance learning with Solihull College, which safeguards the residents. Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 24 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): 27,28,29,30 Quality in this outcome area is adequate. There is a well-motivated, well-trained staff team and residents receive generally consistent care, though the home is not currently fully staffed. Recruitment practices provide safeguards for vulnerable adults. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are currently 8 residents living at Annabel House, with a variety of dependency levels and diverse needs. Assessment of staffing rotas for 3 weeks including the week of this inspection visit show that Annabel House has a staff team of only 7 staff in addition to the registered manager and Proprietor. The staff are not contracted to work full time hours and one member of staff works bank hours to accommodate her personal caring responsibilities. We have indicated at previous inspections that an illustration using the Department of Health Staffing Forum Guidance identifies the need for at least 10.69 Full Time Equivalent (FTE) staff. The rotas show that the registered manager and registered provider are providing cover for vacancies on care shifts, particularly night duties. There is no evidence that the registered provider has up to date mandatory training. During discussions with the registered manager, she states that the home has one night staff vacancy for 2 nights each week and the cover arrangements are short term. Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 25 There is continuing evidence that all staff carry out a range of duties on each shift, such as cleaning, catering, laundry, care and activities. There are no additional ancillary staff employed at the home; and there is no designated activities co-ordinator or designated hours for activities. The registered manager must keep the staffing levels under review and a formal staffing proposal must be forwarded to the CSCI office, for consideration. There is evidence from observations and discussions during this inspection visit that current staffing levels are not sufficient to facilitate residents going out and taking advantage of community-based activities. During discussions with the manager and staff, they have indicated that the residents do not wish to go out. This may be because they do not go out on a regular basis. The manager has been advised to explore suitable community based opportunities for the residents to make realistic choices to experience a social life outside their home. Three staff have left the homes employ and two new staff have commenced employment, one care assistant working 28 hours on days and one night each week and one care assistant working 14 hours on days each week. The files of the two new staff have been examined and contain all satisfactory clearances, references. One person has a gap in her employment history, which is adequately explained. The other member of staff aged 18 years has been employed directly from school. There is evidence on the sample of two staff files of induction and training provided. The home uses the Mulberry house introduction pack and the new staff have also undertaken food hygiene training, health and safety training and training relating to the safeguarding of adults. The manager demonstrates a strong commitment to staff training and development, together with support measures such as structured supervision. The AQAA submitted by the home indicates that it meets the ratio of 50 of care staff with an NVQ 2 (or equivalent) award and that it has a training matrix and individual training plans in place. Examination of records show there is evidence to support these statements. During discussions the two staff on duty show that they are knowledgeable about what residents and there is a warm rapport with residents. Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 26 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): 31,32,33,35,36,37,38 Quality in this outcome area is good. The registered manager is effective in providing leadership and good clear communication systems throughout the home. The systems for resident consultation at Annabel House are generally good with some evidence that indicates that efforts are made to ensure that residents’ views are both sought and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Lisa Braham is the registered manager at Annabel House. She has worked at the home for many years, promoted from carer to senior and to her current role. She has developed personally and professionally, achieving the NVQ Level 4 care and management Award together with the Registered Managers Award (RMA), and she continues to demonstrate commitment to her own Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 27 ongoing professional training and development. She has involved herself in mandatory training alongside staff, has achieved safe handling of medication through distance learning Accredited through ASET. She is currently undertaking distance learning to achieve the health and safety IOSH qualification. Residents and staff say that she is very approachable, supportive. Although the registered provider visits the home regularly and is currently covering night care shifts there is no evidence that she is undertaking the required regulation 26 visits or providing reports to the home or to CSCI. Furthermore there is no evidence that the registered provider provides formal documented supervision for the registered manager. These are outstanding requirements from previous inspections, which must be met. The registered manager intends to use the Mulberry House quality assurance system and progress with implementation is ongoing. It is positive that the registered manager has devised an annual development plan for the home. She has also introduced service user questionnaires in pictorial form, circulated in January 2007, with outcomes analysed. She has not yet introduced relative questionnaires or stakeholder questionnaires. Discussions have taken place relating to the new Regulation requiring the home to submit an annual AQAA on request by the CSCI and it is recommended that the registered manager proactively use this as an additional tool. In addition the evidence to support statements made in the AQAA need to be more detailed and accurate, as the evidence will be tested and verified during inspections. In response to a request, records of two staff meetings have been produced for November 2006 and February 2007. There is evidence from discussions with the manager and staff that a further staff meeting took place in August 2007 but no minutes of this meeting are available as yet. The registered manager holds monthly meetings with residents and there are written notes of these meetings. As the majority of residents cannot understand written information it is strongly recommended that the registered manager uses easy read and pictorial formats for the agenda and notes of residents meetings; and that residents meetings are used to introduce and discuss the easy read pictorial complaints procedure, and Dudley MBC easy read Safeguard & Protect procedure. None of the residents at this home are able to manage their own finances. There are now financial records at the home for each resident, and a sample of records and balances have been assessed. These are generally satisfactory, with clear records of transactions, two signatures and receipts. The registered manager conducts a regular documented reconciliation of residents temporary Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 28 safekeeping balances. Additionally there is evidence that the residents financial accounts managed by the home are independently audited. Record keeping continues to improve, providing safeguards for residents. However some records required by care homes legislation is not available at the home. The registered manager states that some records relating to the home are held at the home of the administrator, which has recently been flooded. It is stressed that all records required by legislation must be held at the home for the specified time. Assessment of the fire safety, maintenance service and mandatory training certificates show that records are generally satisfactory. The manager strives to make sure that all staff receive mandatory training commensurate with their roles. For example recently all staff have recently received fire safety training and fire drills and new staff have received food hygiene, safeguarding adults and health and safety training in 2007. The accident records examined are generally satisfactory. There has been 1 accident since the inspection visit in September 2006. The registered manager is proactive with analysis for any potential hazards, identifying any corrective measures needed. Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 29 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 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 2 2 X X 2 2 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 3 2 2 Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15(1) Requirement 1) To ensure service user plans are signed by the service user / representative (Timescale of 01/05/06 and 01/12/06 Partly Met) It is the home’s responsibility to notify the CSCI when this requirement is met. 2) To complete the development of plans according to the principles of person centred planning, especially for younger service users (Timescale 01/12/06 Partly Met) It is the home’s responsibility to notify the CSCI when this requirement is met. 2. OP7 13(4) 15(1) To review and update residents moving & handling risk assessment where there are changes to mobility (KT) (Timescale of 01/10/06 Not Met) It is the home’s responsibility Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 31 Timescale for action 01/12/07 01/12/07 to notify the CSCI when this requirement is met. 3. OP7 15(1) 17(1) To expand daily notes to provide fuller detail of care provided and outcomes (Timescale of 01/05/06 and 01/12/06 Partly Met) It is the home’s responsibility to notify the CSCI when this requirement is met. 4. OP8 13(1) To implement a risk assessment for the resident who self harms, obtain medical advice for any injury and refer to the specialist intervention team for advice and support for this behaviour The staffing levels at the home must be kept under review to make sure that there are sufficient numbers of competent, trained staff for all residents to have opportunities for stimulating social activities It is the home’s responsibility to notify the CSCI when this requirement is met. 6. OP29 17(2) 19(1) To ensure that the home has copies of public liability insurance, POVA/CRB, qualifications for the hairdresser and any other independent therapists, (Timescale of 01/11/06 Partly Met) It is the home’s responsibility to notify the CSCI when this requirement is met. 7. OP30 18(1)(c) To provide staff training relating to person centred care planning, especially for younger service users (under 65 years) with a DS0000024976.V346035.R01.S.doc 01/12/07 01/12/07 5. OP27 18(1)(a) 01/12/07 01/12/07 01/12/07 Annabel House Version 5.2 Page 32 learning disability (Timescale of 01/11/06 Not Met) It is the home’s responsibility to notify the CSCI when this requirement is met. 8. OP31 19(1) To ensure that the registered manager is issued with an up to date, relevant job description and contract of employment (Timescale of 01/11/06 Partly Met) It is the home’s responsibility to notify the CSCI when this requirement is met. 9. OP33 24 To continue to develop and implement the homes quality assurance system, including: 1) To progress the use of service user questionnaires, with collated results forwarded to the CSCI office, Halesowen 2) To progress the use of relatives questionnaires, with collated results forwarded to the CSCI office, Halesowen 3) To progress the use of stakeholder questionnaires, with collated results forwarded to the CSCI office, Halesowen (Timescale of 01/12/06 Partly Met) It is the home’s responsibility to notify the CSCI when this requirement is met. 10. OP33 24 1) The Registered Provider, who must provide regular formal DS0000024976.V346035.R01.S.doc 01/12/07 01/04/08 01/12/07 Annabel House Version 5.2 Page 33 documented supervision for the registered manager (Timescale of 01/12/06 Not Fully Met) 2) To ensure that documented Regulation 26 visit from the registered provider are conducted consistently on a monthly basis, with reports to the Home and the CSCI Satellite office - Halesowen. (Timescale of 01/12/06 Not Met) It is the home’s responsibility to notify the CSCI when this requirement is met. 11. OP33 17(1)(2) 01/12/07 1) To ensure that all records required by legislation are held securely at the home for the specified time, for example 3 years from the date of the last entry or 7 years for financial records It is the home’s responsibility to notify the CSCI when this requirement is met. 2) To retrieve any records relating to the home, which are held at the home of the administrator, which has recently been flooded. It is the home’s responsibility to notify the CSCI when this requirement is met. 12. OP38 13(4) 18(1)(c) To ensure that all areas of risk associated with individual service users are clearly documented, such as challenging behaviours, personal safety and on any activities where the Home has a duty of care, especially outside the homes environment. (Timescale of 01/11/06 Partly Met) DS0000024976.V346035.R01.S.doc 01/12/07 Annabel House Version 5.2 Page 34 It is the home’s responsibility to notify the CSCI when this requirement is met. 13. OP38 13(4) To ensure that the wall heater in the ground floor bedroom is guarded or removed It is the home’s responsibility to notify the CSCI when this requirement is met. 01/11/07 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 OP3 Good Practice Recommendations That the Initial Needs Assessment section of the new person centred plans is completed for each resident, including all care and support needs That all person centred plans, especially for resident with plan dated January 2007 should be completed and updated to reflect changed needs. That the documented checklist implemented to demonstrate personal care provided should be signed by staff rather than ticked That the moving and handling risk assessment dated October 2006, falls risk assessment November 2006, and tissue viability assessment should be updated to reflect the residents changed condition following hospital admissions (12/9/07) and return to home. That the manager makes use of the MUST (malnutrition and universal screening tool) provided following previous inspection and after multi-agency review as an alternative for residents unable to be weighed on the homes stand on scales. DS0000024976.V346035.R01.S.doc Version 5.2 Page 35 2. OP7 3. OP7 4. OP8 5. OP8 Annabel House 6. 7. 8. OP9 OP9 OP9 That medication listed in the personal centred plans should be updated to accurately reflect any changes That handwritten entries on MAR sheets should be signed and witnessed by 2 competent staff That the receipt of all medication should be recorded and dated on the MAR sheet That carried forward balances of medication should be recorded on the MAR sheets and the manager should carry out regular recorded medication audits The Registered Provider/Manager should give consideration to providing suitable facilities for service users to meet with visitors in private - Not Met That the home should explore options for increased community contact / involvement / activities outside the home That fuller details of daily living activities during mornings, evenings and weekends are recorded for each resident to demonstrate how the home is supporting social skills and socialisation. That there is fuller documentary evidence of menu planning and balanced, nutritious dietary intake for each resident That the home introduces taster sessions to encourage residents to try different foods, which can be an activity as well as an introduction to more healthy eating options That all staff read & to demonstrate their awareness of the updated version of Dudley MBC Safeguard & Protect That the residents are made aware of Dudley MBC easy read Safeguard & Protect procedure and that this is documented That the home contacts the independent advocacy service to support any residents, without regular family contact, to make choices and decisions. That the registered manager continues regular audits of the premises and devise a planned programme of DS0000024976.V346035.R01.S.doc Version 5.2 Page 36 9. OP9 10. OP10 11. OP12 12. OP12 13. OP15 14. OP15 15. 16. 17. OP18 OP18 OP18 18. OP19 Annabel House maintenance, renewal and repairs, with prioritised timescales and include - Re-stretching first floor corridor carpet - Rectify the fraying joins in carpets in communal areas - Plan replacement of any areas of worn carpet - To explore and rectify the damp areas (peeling wallpaper) in bedrooms - First floor shower room - WC needs thorough de-scaling - First floor bathroom grab rail beside WC is missing, needs to be replaced. - First floor outside door handle is off leaving exposed screw (this has been removed during the visit and made safe) door handle must be replaced as priority - Armchair in lounge has splits on the arms and needs refurbishing or replacing - Bedroom 7 - wet patches on wall with electric point to be investigated and resolved 19. OP24 That all wardrobe in the residents bedrooms are secured (including bedroom 8 - not met from previous inspection visit) That there are sufficient numbers of staff available to explore and facilitate suitable community based opportunities for the residents to make realistic choices to experience a social life outside their home That evidence is available to show that the registered provider, providing personal care, has up to date mandatory training That all relevant policies and procedures are developed in alternative formats suitable for residents capabilities - in progress That the registered manager uses easy read and pictorial formats for the agenda and notes of residents meetings and residents meetings are used to introduce and discuss the easy read pictorial complaints procedure, and Dudley DS0000024976.V346035.R01.S.doc Version 5.2 Page 37 20. OP27 21. OP30 22. OP33 23. OP33 Annabel House MBC easy read Safeguard & Protect procedure 24. OP33 That the homes Annual Quality Assurance Assessments (AQAA) submitted to the CSCI should contain accurate, verified information and fuller details of the supporting evidence of what the home does well and the improvements made Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Halesowen Local Office West Point Mucklow Office Park Mucklow Hill Halesowen B62 8DA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Annabel House DS0000024976.V346035.R01.S.doc Version 5.2 Page 39 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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