Inspection on 05/09/06 for Bealey`s Lane Residential Home

This inspection was carried out on 5th September 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 38 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Bealey`s Lane Residential Home 15/06/09

Bealey`s Lane Residential Home 22/07/08

Bealey`s Lane Residential Home 21/01/08

Bealey`s Lane Residential Home 12/10/05

Bealey`s Lane Residential Home 05/05/05

Bealey`s Lane Residential Home 12/11/04

Bealey`s Lane Residential Home 12/07/04

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 HOME ADULTS 18-65 Bealey`s Lane Residential Home 1 Bealey`s Lane Bloxwich Walsall West Midlands WS3 2JT Lead Inspector Lesley Webb Unannounced Inspection 5th September 2006 08:40 Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 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 Bealey`s Lane Residential Home DS0000020833.V310489.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bealey`s Lane Residential Home Address 1 Bealey`s Lane Bloxwich Walsall West Midlands WS3 2JT 01922 492285 F/P01922 492285 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) Swan Village Care Services Limited Miss Vicky Hill Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2005. Brief Description of the Service: Bealeys Lane is a five-bedded care home for individuals with severe learning disabilities and challenging behaviour. It is owned by Swan Village Care Services Limited, which was established in 1988 to offer tailor-made services for adults with learning disabilities both in residential and day care settings. The home is located near to the centre of Bloxwich, opposite the park and close to shops, pubs and other amenities. The home was opened in 1995, originally being a residential dwelling, domestic in nature that has been converted for its present use. All the homes bedrooms are single without ensuite facilities. It has a bathroom and toilet on both floors, a large lounge, conservatory, kitchen, office and utility room. The home has parking facilities to the front of the building and a private garden to the rear with a patio area. The home also provides transport in the form of a mini bus. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days with the home being given no prior notice of the visit. During the visit time was spent interviewing staff, looking at records and observing care practices before giving feedback about the inspection to the registered manager. The people who live at this home have a variety of needs and communication barriers. This was taken into consideration by the inspector when case tracking 3 individuals care provided at the home. For example the people chosen consisted of both male and female, new and established service users, with differing communication needs and from various cultural backgrounds. Due to communication barriers the inspector was unable to have conversations with the service users living at the home, therefore additional time and effort was made examining records and assessing staffs knowledge of service users needs in order to form judgements on care provision. Prior to the unannounced inspection a pre-inspection questionnaire and service user surveys were sent to the home in order that additional information could be gained. These were not completed or returned within the agreed timescales and therefore could not be used as evidence when forming judgements. In March of this year Swan Village Care Services Limited, the company that owned this home was purchased by Minster Pathways resulting in a new Responsible Individual being approved by the Commission for Social Care Inspection. Fees charged to people at the home range from £1,000 to £2,315.36. By the end of the visit the inspector was concerned with the deterioration in some aspects of the service, informing the manager that a random unannounced inspection will be undertaken later on in the year to monitor practices and assess compliance with legislation. The inspector would like to thank service users and staff for their co-operation and assistance during the visit. What the service does well: Many of the staff at this home have undertaken training that has given them extra knowledge so that they can support people. Course that they have undertaken include communication, behaviour management, adult protection and national vocational qualifications. Evidence of their knowledge was Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 6 reinforced when the inspector spoke to staff and observed care practices where service users were observed being treated with dignity and respect. Staff demonstrated a good understanding of protecting service users and supporting them to complain, of supporting people with personal care, understanding of differing behaviours and risk taking and some understanding of communication needs of service users. Examples of comments made by staff include, “if I thought they were unhappy with something, guidelines say to give them easiest form of communicating so they can complain, find advocates or support outside of the home. Because they can’t verbalise, it’s the key worker and everyone’s role to speak up for them. If I thought someone unhappy I would speak up” and “you get to know them, they are all really different, some non-verbal, we look at body language and gestures. Recently had good training on signs and symbols, the approach to use. Makes you think. Doing challenging behaviour training that’s about communication as well”. Recruitment practices are also good at this home. This ensures that people working in the home have had suitable checks made before they are offered employment and do not pose a risk to those living at the home. Attempts have been made to ensure information is available in accessible formats. This includes consent forms, some policies and procedures and some care plans that are in large print and picture format. This helps to obtain the views of service users, particularly those with little verbal communication. What has improved since the last inspection? Since the last inspection many requirements identified in previous visits have been met. This includes purchasing a new easy chair for one service user, replacing worn bedding, repairing the uneven flooring in the kitchen, providing lidded bins for soiled laundry and redecorating the downstairs bathroom. Also the manager has completed a training needs assessment for the staff team as a whole, and an impact assessment of all staff development to identify the benefits for service users and to inform future planning. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 7 What they could do better: The registered manager has been on maternity leave for most part of this year with a senior support worker undertaking this role. No designated hours were allocated to this person who had to undertake this position whilst still continuing with their own role. The inspector found an abundance of evidence that this has had a negative impact of service provision. For example there has been a deterioration in record keeping (reviewing of policies and procedures, ensuring care plans are accurate, maintaining of some health records and the reviewing of information about the home and services it provides), a major reduction in the amount of activities service users have participated in and little evidence that service users are supported to develop personal skills. Whilst the registered manager has been on leave there have been several other vacancies at the home, none of which have been managed appropriately. Staffing levels have not consistently been applied and do not always meet the needs of service users. There is also little evidence that the dietary needs of service users are being met with very little thought given to providing a varied and balanced diet. Menus are not available with little evidence of specific dietary and cultural requirements being met. Also there has been a major deterioration in the decoration and maintenance of the home. The home does not have an on-going maintenance programme in place and essential maintenance is only done when a problem has already arisen (and then not always in a timely fashion). A number of the fixtures and fittings need replacing and some of the décor requires upgrading. Another area of concern is the lack of fire training that staffs, in particularly night staff have undertaken. All service users living at the home would require some level of assistance in the event of a fire. The reduced number of staff on duty during the night and the fact that none are fully qualified poses a risk to service users and must be addressed as a matter of priority. Furthermore some health and medication practices need improving. The home is poor at monitoring that referrals to outside agencies are acted upon in a timely manner. The inspector found evidence that some service users have been waiting appointments with specialists for two years. The manager must take responsibility for following up referrals and taking further action if required. Some medication policies need either reviewing or implementing and systems for the management of respite medication must be introduced that comply with legislation. The home currently uses a vacant bed space for respite use. Documentation to support this service is very poor. No information is included in any of the homes brochures, care plans and risk assessments do not exist and policies and procedures are not in place relevant to this service. Evidence was also found during the inspection that the person who has been accessing this Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 8 service has caused deterioration in service for permanent service users living at the home. Improvements to the management of this facility must be made. Finally other areas where improvements must be made include the levels of staff supervision and frequency of staff meetings, further implementation of the quality assurance systems and corporate management of service users finances must be made. 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. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 and 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Up to date information about the home and services it provides is not available. This results in prospective service users and their representatives having incorrect information on which to base decisions regarding the homes suitability. Generally staff have good understanding of communication needs of service users. EVIDENCE: Since the last inspection there has been deterioration in the reviewing and accuracy of information relating to the home and services it provides to service users and prospective service users. Upon inspection of both the statement of purpose and service user guide both were found to contain out of date information relating to the owners of the home, the commission for social care inspection, management and services provided. The last review of these documents occurred in April 2005. Also since the last inspection a vacant bed space has been used for respite services. No documentation supporting this facility is currently in place at the home. A previous requirement to ensure representatives of service users sign the contracts of residency on their behalf was found still to be partly met. The manager stated that the home is having difficulty in this area for one particular service user as they are unable to sign the contract themselves, have no contact with family and are currently unallocated a social worker. The Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 11 inspector advised that the home contact the duty social work team in order that a referral for guardianship is made in order that the service users legal rights can be protected. All staff that the inspector spoke to demonstrated knowledge of communicating with people living at the home (all of whom have specific needs in this area). Responses include, “you get to know them, they are all really different, some non-verbal, we look at body language and gestures. Recently had good training on signs and symbols, the approach to use. Makes you think. Doing challenging behaviour training that’s about communication as well”. Three service users were case tracked by the inspector (2 permanent and 1 respite). Two people have assessments of need in place completed by the relevant placing authorities prior to moving to the home that detail needs and aims for health, challenging behaviours, communication, personal care social interaction and independence. Neither a community care assessment nor the homes own assessment could be found for the third service user. All three service users files contain contracts of residency, however two had not been reviewed since June and July 2004 and the respite contract is one issued by the placing authority and does not cover all of the national minimum standards. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessment processes for residential service users are adequate in the main ensuring service users needs are met. Care plans and risk assessment processes for respite service user are very poor resulting in inconsistencies to support given. Generally staff have understanding of differing behaviours and risk taking which helps to create an empowering environment. Attempts have been made to ensure information is in accessible formats and where possible service users views are sought. EVIDENCE: Since the last inspection some improvement has been made to person centred plans in place at the home. These now include pictures as aids to communication for service users. Further work must now be undertaken to ensure these are in place for everyone and that all staff undertake training in this area, as some that the inspector spoke to were unsure of the aims and objectives of this process. It was pleasing to find that a previous requirement to ensure staff undertake communication training specific to the needs of people living at the home is now met in full. Many staff confirmed how this Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 13 has assisted them with their roles and improved their understanding in this area. Three service users files were case tracked (2 permanent and 1 respite). The inspector found that the permanent service users files contained care plans that include specific aims and objectives for areas including communication, behaviour, absconding, health, social care and personal support. In addition to these behaviour and communication guidelines are in place where necessary and supporting assessments of risk, all of which have been reviewed at least six monthly by the manager or senior member of staff. The inspector was concerned that in the majority of cases when plans have been reviewed the person completing this task has recorded ‘no change’ despite evidence of changes in circumstances and needs. When discussing this with the manager she stated that ‘no change’ referred to the contents of the care plan and not the needs of the individual. The inspector instructed that if this is the case then this should be recorded, including any changes in needs and circumstances. Minutes of monthly key worker meetings were examined. The inspector found that these records do not read as an overview of events from the previous month and do not correspond with other records e.g. daily records, activity sheets and medical records. Currently they read as a mini assessment but not a review of the month. Minor amendments to risk assessments are required. These include ensuring they have specific review dates and are always completed in full. The respite users file contained very little information; no care plans or risk assessments and no evidence of an allocated key worker despite accessing the service for several months. The inspector raised concerns regarding this as this person has very high needs and specific behaviour and communication issues resulting in the need for a 2 to 1 staffing ratio. Guidelines for management of behaviour on file state that staff should use a picture card system to communicate, in order that the service user can follow a sequence of events. A behaviour incident form on file states that the service user was pulled out of the toilet by the belt around his trousers by staff as he would not listen to reason or get out any other way and they were concerned for his safety. The inspector is concerned with this incident, firstly as staff used verbal communication despite behaviour guidelines stating this is not effective and that no evidence could be found of staff using a picture card system to communicate. Also the inspector raised concern that the person completing the form recorded that physical intervention was not used, when it was and that this practice does not comply with the homes written policy on restraint that states no form of physical intervention is practiced at the home. Both permanent service users files contained an abundance of documents in large print and picture format including consent to administer medication, offer of key to bedroom door, consent to open mail, holidays, photographs, complaints, and consent to the home managing their money. No evidence Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 14 could be found of the home supporting the respite user to be involved in decision-making and participation. No consent forms or documents in alternative formats are on this persons file. Staff that the inspector spoke to regarding the contents of service users behaviour guidelines and the management of risk gave detailed explanations and demonstrated knowledge in this area. However the inspector questioned some practices. For example during the visit the inspector witnessed a service user with autism approaching a member of staff asking when his quilt was going to be put back on his bed. The member of staff explained it was being washed and stated it would be put back once dry. The service user kept asking the same question and appeared to be distressed. After this incident the member of staff explained to the inspector that due to the service users autism he had a fixation about his quilt and bedding and needed constant reassurance that it would be put back. The inspector questioned why 2 quilts had not been purchased in order that one was in place when other is being washed and perhaps this might help the service user. The member of staff stated that no one had thought of that. The inspector instructed the manager when feeding back at the end of the inspection that this should be looked into. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is little evidence that the home supports people to develop based on their individual needs and capabilities. There has been a serious reduction in the number and choice of activities undertaken and little evidence that the dietary needs of service users are being met. EVIDENCE: Records and practices seen on the day of inspection confirmed that daily routines are flexible. Staff were witnessed interacting with service users in a friendly yet respectful manner, respecting their wishes to be left alone or to join in with conversations. Conversations with staff confirmed that due to the level of risk identified for several service users no-one has a key to the front door or to their bedrooms but that two service users had been offered this facility, attempts had been made to support them to use these but had not been successful. Records seen by the inspector confirmed the contents of these conversations as true. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 16 The inspector observed indirectly care practices and did not witness any service user being supported to participate in any personal development. Staff were seen completing all domestic and personal tasks. Comments varied from staff in relation to supporting individuals with personal development with some stating this occurs and others expressing the view that further work could be undertaken. The permanent service users files sampled by the inspector all contained independent living and social skills assessments that have been reviewed yearly. Both of those sampled state that the service users have made no improvements in any living and social skill area for 2 to 3 years. The inspector questioned this when talking to the manager who stated that this was not the case but that recording was incorrect. Discussions with management, staff and viewing of documentation confirm that there has been a severe decline in activities (particularly off site activities) since the last inspection. When asking staff about the quantity of off site activities responses included, “not much to be honest, the driver has been off and a client here is very demanding. He puts himself and others at risk. That combined with no driver has made it difficult” and “at the moment its mostly shopping because the driver is off sick and this makes it awkward. Not gone swimming, garden centre, Albrighton or anywhere like that”. No staff that the inspector spoke to gave a view that they felt service users participated in sufficient off site activities. The lack of choice of activities was further reinforced when sampling records of 3 service users. For example one persons records state they went shopping, a walk in the park and watched television, another service user that they wandered around the home and garden, attended day care and went for a ride in the van and the third service user watched television, relaxed around the home, went for rides out in the van, played clapping games, dancing to music, and shopping. The inspector was also concerned with the deterioration in planned activities for service users with autism as documentation on file states, ‘because of autism his week should be planned and activity planners used and routines kept to’. No evidence of this being adhered to could be found. In addition to this staff informed the inspector that recently the service users behaviour had started to escalate, with the inspector unable to find evidence that the home had investigated the possible link between behaviour and lack of activities. Currently two service users have been on an annual holiday funded by the home. The inspector was informed that due to the needs of the remaining service users day trips were going to be arranged to the same value as an annual holiday (currently provided at a maximum cost of £300 per person). When examining records of meals taken by service users the inspector found that these do not demonstrate choices are offered. For example three service users individual records state they have all eaten the same meals despite two of the service users care plans stating they have specific dietary Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 17 requirements (being on a health eating plans, detailing not to be offered seconds and only small puddings). Record of meals shows no fish, very little fruit but items such as puddings, snacks such as crisps and cake and chips. Also the inspector could find little evidence of meals for people from differing ethnic backgrounds despite 2 service users from different ethnic groups living at the home. The inspector was unable to view menus and was informed that cook had taken them home. When asking why the inspector was informed “to write them”. The inspector questioned this practice, as it would be expected that menu planning occur in advance. It was however pleasing to find that all files sampled contained nutritional screening assessments with staff that the inspector spoke to all confirming understanding of their contents. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is poor at monitoring that referrals to outside agencies are acted upon, this has the potential to impact on the needs of people living at the home. Staff have a good understanding of supporting people with personal care based on dignity and privacy. Further improvements to some medication practices will add further protection to service users. EVIDENCE: All staff that the inspector spoke to demonstrated understanding of supporting people with their health needs. For example one person stated, “We look for physical changes in behaviour or signs on body. Inform senior and manager and document everything” and another “be observant of changes in service users, when here a while you pick up on things that are not normal to them e.g. facial gesture, body language, holding parts of body. Might just be a change in skin colour. Usually ask senior on duty to look”. The files of three service users were case tracked (two permanent and one respite). The permanent service users files contained a variety of health records including care plans for diet, management of medical appointments, health action plans, records of appointments for monitoring of dental, diet, chiropody, general practitioners and audiologists. In the main these were adequate however the inspector was concerned with the lack of action taken Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 19 by the home to ensure appointments are completed with outside agencies including dieticians, speech and language departments, continence nurses and specialist dental units once referrals have been made. Records indicate that some of these referrals were made as long as two years ago with service users still waiting appointments. The inspector also noted that some service users have not had medication reviews since 2004. No health records were found to be in place for the respite service user despite information on file indicating that this person has specific needs in this area. Medication systems were examined. The homes uses a monitored dosage system for the management of medication for permanent service users. Generally this was found to be in order, with copies of authorised signatures of staff that administer medication on file, evidence that staff have undertaken accredited medication training, correct records of all drugs received and disposed of in place and photographs of service users in place with medication administration sheets. When examining the medication administration sheets it was noted that in some instances staff have not signed to say they have administered medication. The medication records for the respite service user were also examined. These were found to require further work as staff hand write the administration sheets but do not give full details of medication as per the dispensing labels, some administration signatures are missing and no photograph is maintained with the medication records. A sample of medication policies and procedures were viewed. Some such as the administration and disposal policies were found to be adequate. Others however including the protocol for home remedies and covert practices are required to be reviewed, as this has not occurred since 2003. No policies or procedures could be found for the management of respite medication. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management of service users personal finances is good within the home safeguarding their personal assets. Improvements to corporate management of service users finances must be made to support systems in place within the home and to offer further protection to service users. Staff have a good understanding of protecting service users and supporting them to complain ensuring they are protected from abuse. EVIDENCE: No complaints have been made since the last inspection. Records were viewed and found to meet National Minimum Standards however the homes complaints policy requires reviewing as it contains the previous proprietors details and the wrong address for the commission for social care inspection. After the last inspection the bank books of service users were viewed by the commission for social care inspection, meeting a previous requirement. When assessing complaint and protection processes the inspector asked staff how they can support people with limited communication to complain. All staff demonstrated good levels of understanding in this area. Responses included, “if I thought they were unhappy with something, guidelines say to give them easiest form of communicating so they can complain, find advocates or support outside of the home. Because they can’t verbalise, it’s the key worker and everyone’s role to speak up for them. If I thought someone unhappy I would speak up”. All staff that the inspector spoke to also stated that they would report abuse using the whistle blowing procedure. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 21 A previous requirement to ensure the home does not hold more than the insured amount of £70 on behalf of each service user within the home remains unmet. On the day of inspection every service users finances held by the home exceeded this amount. The inspector was informed that since the change of ownership of the home financial systems for the management of service users finances have changed. The service co-ordinator states minister pathways have closed the corporate bank account that the previous owners of the home had used and opened a new account with a different bank where everyone’s monies go in. The service co-ordinator did not know how or if interest on monies is managed, if a system for paying unspent monies back into the account is in place and what this entailed or if copies of bank statements detailed individual service users financial transactions. This lack of information concerned the inspector when in addition to this no other records were found to be in place for service users including bank books and statements resulting in no effective monitoring systems for savings held on behalf of service users. Personal allowance sheets were found to be in place, all of which corresponded with personal finances held in the home. Inventories of personal items were found to be in place for the three service users that were case tracked. Those for the respite service user were not dated so the inspector could not audit them correctly to see if they corresponded with dates of admission. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There has been a major deterioration in the decoration and maintenance of the home resulting in a home that in some areas is not safe, well maintained or comfortable to live in. EVIDENCE: Six of the seven requirements identified in previous inspections have been met in full and one part met. These include purchasing of new bedding, replacing a chair for a named service user, addressing actions identified by the fire department and making safe the uneven flooring in the kitchen. Also since the last inspection all communal areas in the home have been painted various shades of white. The inspector felt that this has resulted in the home having a clinical feel to it. Due to the behaviours of the service users the home is unable to have effects such as ornaments, pictures ect around and previously relied on the use of colour to give a homely atmosphere. The communal areas now feel very stark and bare. The manager and staff on duty stated the decision to paint everywhere in white was made by the new owners and that they or the service users had no choice in the matter. Upon touring the building the inspector found that nearly every area requires attention. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 23 * There are stains on the walls and carpet in the office (carpet also looks worn and old. * All windows both inside and exterior are extremely dirty. The manager states that they have attempted to get cleaners before but due to the size of the work no one was prepared to undertake this task. * Room 5 – paper on the ceiling is coming away, the fire door does not close properly and the bedding is very creased. * The curtains are frayed on the upstairs landing. * Room 4 – the wall is damaged behind the bed, bedding is creased, carpet worn, door stained and doorframe paintwork is flaking. * Room 3 – door frame is damaged, the wall behind the bed is damaged, the paint on the walls is flaking, carpet is worn and stained, the paint on skirting boards is flaking, the fitted wardrobes appear worn and old and the bedside cabinet is broken. * Room 2 – the paint on door is damaged, the bedding creased and the vanity unit is damaged. * Lounge – there are no curtains, it appears very bare (contains a suite, television and an old table) – see notes above regarding decoration. * Conservatory – this appears very old and worn in appearance. The manager stated that she is not aware of it ever being decorated when asked by the inspector. Also the lighting is very poor and the ceiling is damaged. * Back garden – is overgrown and unkempt, old furniture, broken fence panels, lots of tree debris, broken and unusable barbeque area, abundance of weeds, only 2 garden chairs for 5 service users, worn garden table and no shed for storage. * All exterior paintwork at front and back of the home is very worn and flaking. * Porch – the decorative boarder is torn. * Front of building – needs to be made accessible for disabled, no markings of steps, paving is uneven, there are large pot holes at entrance of gates, the garden is overgrown and debris/rubbish is apparent. * Room 1 – the bedding is creased and sink taps are missing. * Storage room – contains old and donated wheelchairs. The inspector informed the manager that any wheelchair that has not been assessed by a suitably qualified person must be removed from the building. * Downstairs bathroom – there are stains on the walls and ceiling in toilet area, flaking paint on skirting boards and door frame and the grout is soiled around the sink. * Ground floor passageway – cupboards appear worn and damaged. * Kitchen – the cooker is damaged, the ceiling stained, the extractor broke, the strip light covers are filled with dead insects, a fly screen is missing and soiled tea towels are not suitable stored. * Laundry – this needs a new sink unit as this is rotting, broken and contains mould. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff recruitment and training is good resulting in a staff team that supports people living at the home in line with their terms and conditions. Staff supervision is poor and staffing levels are not consistently applied and do not always meet the needs of service users. EVIDENCE: Since the last inspection the manager has been on maternity leave (returning the day before the unannounced inspection), with a senior support worker covering the managers position. The senior support worker was given no supernumerary hours when covering the managers position, stating that in addition to these extra responsibilities she had to also continue with her own duties. Also at the same time as the manager being on leave the homes driver has been on long term leave and there is a vacant domestic position at the home. Staffing rotas for July and August 2006 were also examined. These demonstrate that care staffing levels have not always been maintained to the agreed assessed levels required for service users. There are currently four permanent and one respite service users accessing services at the home, all of whom are one to one at all times with additional hours for some personal care and access in the community. These assessed levels of need indicate that between four and eight care staff should be on duty at various times, however no rotas viewed demonstrated the maximum of eight staff at any time. The inspector feels that throughout this report sufficient evidence Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 25 is contained that demonstrates that the lack of management hours, driver, care staff and ancillary workers (on weekends) is having a detrimental effect on service provision. The recruitment, training and supervision records of three members of staff were sampled (all of whom are key workers of service users case tracked during the inspection). Generally the inspector found that recruitment records and training provided to staff is good. For example files contain evidence of references, enhanced CRB disclosures, medical declarations, statements of confidentiality, contracts of employment, evidence of induction and other records required by regulation. Certificates of training undertaken include those for aspects of ageing for people with learning disabilities, understanding autism, equality and diversity, adult protection, report writing, non violent crisis prevention, communication, nutrition and health and behaviour management. It was also pleasing to find on all files sampled that each person has an individual training and development plan in place, that staff have undertaken learning disability award framework accredited training and that all those sampled hold either NVQ level 2 or 3. Further work must now be undertaken to ensure staff receive appropriate and consistently applied levels of supervision. None of the files sampled contained evidence of staff receiving at least six supervision sessions a year; all those sampled contained evidence of only one or two supervisions and all appraisals require reviewing. In addition to improvements required to individual supervisions further work must be undertaken to ensure regular staff meetings occur as presently only two have taken place this year. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Quality assurance systems must continue to be introduced in order that the home can measure if the home is meeting its aims and objectives. There has been deterioration in some record keeping. This results in the home unable to evidence some outcomes for service users. General health and safety management is adequate however fire training of night staff is poor and has the potential to place people at risk. Some polices and procedures need reviewing to ensure they comply with legislation and protect people living at the home. EVIDENCE: As mentioned earlier in this report the registered manager has been on maternity leave for most part of this year. An abundance of evidence (as detailed in other areas of this report) indicates that this has had a negative affect on the management of the home. The registered manager is qualified and previous inspections have evidenced that she manages the home competently. Senior management and the responsible individual registered with the commission for social care inspection must undertake their Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 27 responsibilities and ensure the home is managed appropriately at all times when the registered manager is on leave. Since the last inspection the home has started to introduce a quality assurance system in order to monitor services and facilities on offer. The inspector viewed the new system and found it still to be in the early stages of implementation, requiring the introduction of development plans and the views of service users and other interested parties to be incorporated. Once fully operational an annual audit of the system should also be conducted with the outcomes reflected in future planning for the home. Policies and procedures were sampled throughout the inspection. Although the majority required by regulation are in place many require reviewing as contain out of date information relating to the proprietors. The home must also arrange for its certificate of registration to be amended as this currently states the previous owners address. As previously mentioned in this report there has been deterioration in the standard of record keeping. The inspector hopes to see a marked improvement now that the registered manager is back from leave. In relation to record keeping not mentioned in other areas of this report the inspector instructed that staff rotas be expanded to include evidence of service users presence in the home and hours spent by care staff undertaking domestic duties as presently nothing of this nature is in place resulting in no system for monitoring of appropriate staffing levels. The home was also instructed to ensure copies of behaviour sheets and regulation 37 notifications are maintained in the home (during the inspection these could not be found for one service user who had been administed PRN medication where the protocol for this includes the completion of behaviour charts). A sample of health and safety records was viewed. Twenty-seven maintenance requests were found to have been completed by the home, asking for repairs to the building and equipment to be undertaken from March to September 2006. Fourteen have been completed with thirteen outstanding. The inspector questioned why some had not been actioned when they were only minor repairs. Staff stated that the company that owns the home only employs one handyperson for all its establishments (five residential units and a daycentre) and that this impacts on getting work completed. Other records confirm that the fire alarm system was serviced April 2006, that the environmental health department inspected the home in November 2005 (with one issue still requiring attention) and that contractors visited the home July 2006 to ensure compliance with Legionella. Further work is required to ensure all COSHH products have the appropriate risk assessments and data sheets in place and that secondary dispensing does not occur unless appropriate labelling is in place. The home has its own transport. Maintenance records were viewed and found to have recently been incorrectly completed. This was discussed with the manager who agreed to take action to rectify this. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 28 Fire records were examined indicating that all equipment is checked appropriately. The inspector did however discuss the accuracy of recordings with the member of staff responsible for monitoring and recording fire records as several contained errors. Of the seventeen staff employed at the home eight have attended fire training and eleven a fire evacuation in the last nine months. The inspector was very concerned with the lack of fire training that night staff have undertaken, with none attending either training or evacuations. Concern was expressed due to the level of needs service users living at the home have, where all would be totally dependant on staff in the event of a fire. Other records viewed by the inspector confirm that the majority of staff hold training certificates for first aid, food hygiene, moving and handling, infection control and health and safety (some minor work is required to arrange refresher courses for some staff). In addition to this the manager and many staff have undertaken risk assessment training in order to extends their knowledge. Bealey`s Lane Residential Home DS0000020833.V310489.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 2 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 3 32 3 33 1 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 2 2 3 LIFESTYLES Standard No Score 11 2 12 N/A 13 2 14 1 15 3 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 3 3 3 2 2 2 2 2 Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 30 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 2 Standard YA1 YA2 Regulation 4,5,6 14 Timescale for action The home must produce an up to 30/12/06 date statement of purpose and service user guide. New service users must not be 18/09/06 admitted without a full assessment of needs being undertaken. The statement of purpose, 30/12/06 service user guide, assessment process and care plans must be designed to meet the specific needs of respite services. A representative of the service 30/12/06 user must sign the contract on their behalf – part met. Requirement originally made July 2002. All service users contracts of residency must be reviewed. 5 YA6 15 Person Centred Plans must be completed in detail with the involvement of service users – part met. Requirement originally made May 2005. Care plans must be completed for all service users (including respite users) that detail needs DS0000020833.V310489.R01.S.doc Requirement 3 YA3 16 4 YA5 5(1) 30/12/06 6 YA6 15 18/09/06 Bealey`s Lane Residential Home Version 5.2 Page 31 and goals. When reviewing care plans any changes in needs and circumstances must be recorded. All service users (including respite) must have a named key worker. The minutes of monthly key worker reviews must read as an overview of events from the previous month. The home must be able to demonstrate that staff follow behaviour and/or communication guidelines in place for service users as detailed in their files. Any respite service user must be offered opportunities to participate in decision making processes. Risk assessments must be completed in full and include specific review dates. The home must be able to demonstrate that service users are supported to develop independent living and social skills based on each persons capabilities. The home must support service users to become part of, and participate in the local community, in accordance with their assessed needs. The home must ensure that service users have access to, and choose from a range of appropriate leisure activities. The home must ensure service users have a choice of entertainment brought into the home. If activity planners are required Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 32 7 YA6 12 18/09/06 8 YA7 12(2) 18/09/06 9 10 YA9 YA11 13(4) 12(b) 16(n) 30/12/06 30/12/06 11 YA13 16(m) 18/09/06 12 YA14 16(m)(n) 18/09/06 due to the assessed needs of a service user, these must be adhered to. For any service user that is not having an annual holiday funded by the home, the financial equivalent must be provided in day trips. Service users must be offered a choice of suitable menus, that meet their dietary and cultural needs. The home must ensure service users health and wellbeing is promoted by supplying nutritious, varied, balanced meals. A record of all menus must be maintained in the home at all times. The home must review its procedures for monitoring of referrals to appropriate specialists. All service users must have annual medication reviews. Clear and detailed heath records must be maintained for any respite user. Staff must sign for all medication administered to service users, and if not given record why. Hand written medication administration records must contain full details of medication as per the pharmacy-dispensing label. A photograph must be maintained on file with the medication administration record for all service users. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 33 13 YA17 16(j) 18/09/06 14 YA19 12(a) 13(b) 30/12/06 15 YA20 13(2) 18/09/06 . YA20 13(2) All medication policies and procedures must be reviewed and comply with relevant legislation. Policies and procedures must be implemented for the management of respite medication. The homes complaints policy must be reviewed. The home must not hold more than the insured amount of £70 on behalf of each service user within the home – not met. Requirement originally made October 2005. All inventories of personal items must be dated when completed. The commission for social care inspection must be notified in writing of the corporate procedures for managing service users benefits/finances. This must include how interest is managed, systems for paying unspent monies back into the corporate bank account and where copies of bank statements can be viewed. The new system for corporate management of service users finances must comply with any relevant legislation and be agreed with parties including representatives of service users and the commission for social care inspection. The downstairs bathroom requires refurbishing – part met. Requirement originally made May 2005. The stains on the walls and ceiling in the toilet area of the downstairs bathroom must be 01/10/06 16 17 YA22 YA23 22 16(l) 30/12/06 18/09/06 18 YA23 20 01/10/06 19 YA24 16(1) 30/12/06 Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 34 20 YA24 23 21 YA24 23 removed, the flaking paint on the skirting boards and doorframe must be repaired and the soiled grout around the sink must be cleaned. The home must investigate the use of colour when decorating the building and be able to evidence that attempts have been made to create a homely atmosphere. The stained walls in the office must be decorated. The stained carpet in the office must be replaced. All windows (both inside and exterior) must be cleaned on a regular basis. All bed linen must ironed on a regular basis. The frayed curtains on the upstairs landing must be replaced. Curtains are required in the lounge. The porch must be decorated. Old and donated wheelchairs must be removed from the premises. The worn and damaged cupboards in the ground floor passageway must be replaced. The conservatory must be refurbished. This must include redecoration, repairing of ceiling and improved lighting. All exterior paintwork at front and back of the home must be repaired and repainted. 30/12/06 30/12/06 22 YA24 23 01/02/07 Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 35 23 YA24 23 Attention must be given to the maintenance of the back garden. This must include: Removing of old furniture. Repairing or replacing broken fence panels. Removing tree debris. Repairing and making accessible/usable the barbeque area. Removing of weeds. Replacing worn and broken garden furniture. Ensuring there is sufficient outdoor seating for all service users. 30/12/06 24 YA24 23 Providing a shed for storage. Attention must be given to the front of the building. This must include: Making accessible for disabled/wheelchair users. Visibly marking any steps. Repairing any uneven paving. Repairing the large potholes at the entrance of the gates. Removing any debris. 30/12/06 25 YA24 23 Maintaining the garden. Attention must be given to the kitchen. This must include: Repairing the oven. Redecorating the stained ceiling. 18/09/06 Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 36 Repairing the extractor fan. Removing the dead insects from the strip lights. Installing fly screens at the windows. Providing suitable storage for soiled tea towels. The rotting sink unit in the laundry requires replacing. Bedroom 1 requires appropriate taps fitting to the sink. Bedroom 2 requires the damaged door painting and the vanity unit replaced. Bedroom 3 requires the damaged wall behind the bed and doorframe repairing, the flaking paintwork on walls and skirting boards re-decorating, the worn and stained carpet replacing, the broken bedside cabinet replacing and attention to the fitted wardrobes. Bedroom 4 requires the damaged wall behind the bed repairing, the worn carpet replacing and the door and doorframe painting. Bedroom 5 requires the damaged ceiling repaired and work completed to ensure the fire door closes appropriately. Care staffing levels must be maintained to the assessed needs of service users at all times. Domestic and kitchen staff must be on duty seven days per week. Where this is not the case and Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 37 26 27 YA24 YA24 23 23 30/12/06 30/12/06 28 YA33 18(1) 01/10/06 care staff undertake these duties additional care staff must be put in place in order that the needs of service users are not jeopardised. Supernumerary management hours must be allocated to anyone covering the registered managers absences. Systems must be introduced to ensure staffing levels are maintained to cover annual leave, sickness and maternity leave. 29 YA33 18(1) 01/10/06 30 YA36 18(2) Regular staff meetings must take place. All staff (including night workers) 30/12/06 must receive at least 6 supervision sessions per year. All staff (including night workers) must have an annual appraisal. The quality assurance system 30/12/06 must be implemented in full – part met. Requirement originally made May 2005. The home must ensure all policies and procedures comply with current legislation and recognised professional standards. 30/12/06 31 YA39 24 32 YA40 24 33 YA41 17, 24 All policies and procedures must be reviewed on a regular basis and signed and dated by the manager. All records required by regulation 30/12/06 for the protection of service users and for the effective and efficient running of the home must be maintained, up to date and accurate. The home must apply to the commission for social care Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 38 inspection for its certificate of registration to be amended to have the old proprietors address removed. Staff rotas must be expanded to include evidence of service users present in the home at different times of the day and hours spent by care staff undertaking domestic duties. Behaviour/incident records must be maintained at all times in the home when service users are administered PRN medication. The commission for social care inspection must be notified in line with Regulation 37 of the Care Homes Regulations 2001 of any incident affecting the wellbeing of a service user. 13, 23, 24 The home must review its systems for managing and actioning maintenance of the building and repairs relating to the health and safety of service users and their environment. This must include setting and achieving timescales. The home must action all issues made in the Environmental Health report dated November 2005. Risk assessments and data sheets must be maintained in the home for all COSHH products. Maintenance records for the homes vehicle must be completed accurately. Fire records must be completed accurately. Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 39 34 YA42 30/12/06 35 YA42 23(d) All staff (including night workers) 01/10/06 must undertake fire training. All staff (including night workers) must undertake a fire evacuation. All staff (including night workers) 30/12/06 must hold up to date certificates for food hygiene, moving and handling, infection control and health and safety. The responsible individual 01/10/06 registered with the commission for social care inspection must ensure the home is appropriately managed at all times when the registered manager is on leave. 36 YA42 13 37 YA43 10 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 YA6 Good Practice Recommendations It is recommended that all staff undertake Person Centred Planning training Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 40 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Bealey`s Lane Residential Home DS0000020833.V310489.R01.S.doc Version 5.2 Page 41 - 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. 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