Inspection on 22/05/05 for Beaumanor House

This inspection was carried out on 22nd May 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Beaumanor House 15/06/09

Beaumanor House 12/07/07

Beaumanor House 10/05/06

Beaumanor House 27/10/05

Beaumanor House 25/02/05

Beaumanor House 16/12/04

Similar services:

Hillside

Applegarth

122 Scorer Street

St Marys Nursing Home

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

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

CARE HOME ADULTS 18-65 Beaumanor House 34 Robert Hall Street Leicester Leicestershire LE3 5RB Lead Inspector Rajshree Mistry Unannounced 22 May 2005 at 9.30am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Beaumanor House Address 34 Robert Hall Street Leicester Leicestershire LE3 5RB 0116 2664833 0116 2664833 None Leicester City Council Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Julian Holt Care Home 21 Category(ies) of LD - Learning Disability - 21 registration, with number PD - Physical Disability - 1 of places Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: No person falling within category physical disability (PD), may be admitted to the home unless that person also falls within the category of learning disability (LD), i.e. daul disability No person falling within category Learning Disability (LD) / Physical Disability (PD) may be admitted into the home when there is already one person of categories LD/PD already accommodated within the home. Date of last inspection 25th February 2005 Brief Description of the Service: Beaumanor House is a registered care home providing accommodation for up to twenty-one adults with learning disability. The home is owned and managed by Social Services, Leicester City Council. Beaumanor House is located in a quiet residential area, close to local shops and amenities. There is a car park to the front of the home. Public transport routes are nearby and approximately ten minutes to the city centre by car. Accommodation is on the ground floor with level entry access. Bedrooms are close to the bathrooms and toilets. All areas of the home are accessible for people using wheelchairs and walking aids. Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on Sunday 22nd May 2005, from 9.30am and lasted for 6 hours. The method of inspection consisted of a tour of the premises, examination of four service users care records, medications and health and safety records for the home. Eight service users were spoken with and observations were made in relation to how the staff interacted with service users with limited communication skills. Staff on duty over the two shifts were also spoken with. Visiting relatives of one service user shared their views and concerns about the home. Four service users’ bedrooms, communal areas, and the medication room were viewed including the areas where the building works were continuing. Key workers on duty spoke about care provided, the procedures within the home, and how the identified care needs for service users were met. What the service does well: What has improved since the last inspection? Since the last inspection building works have commenced and new fire doors placed in corridors to create safe fire zones. The male and female toilets to the front of the home are wheelchair friendly. The home has appointed a maintenance person, who is responsible for dealing with minor faults and repairs. The home now has a Registered Manager. Service users are now offered an opportunity to go on holiday from the home. Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 4 The admission process to the home is well managed providing prospective service users with clear and detailed information about the provision of care. There is a flexible and individual approach for service users to test drive the home. EVIDENCE: There is a good admission procedure which includes the assessments of individuals are carried out by the health and/or social care professionals, as part of the referral process. Four service user files were viewed. They detailed the specific care needs of service users, identifying the needs that would be met by heath and/or social care professionals. The contractual agreement for a service user on a short-stay was viewed and this detailed the terms of the short-stay. Service users that spoke with the Inspecting Officer indicated that they had opportunities to visit the home several times ranging from a day to short stays before choosing to move to the home. Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 9 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 standard(s) 6, 7, 8, Progress has been made on improving arrangements to ensure that the health care needs of service users are identified and met. Service users are supported on a day-to-day basis with decision-making and issues, which affect themselves. EVIDENCE: Only one out of the four service users’ care files examined contained individual person centred plans with a risk assessment. The three service users of which one service user has regular short respite stays had no risk assessments or a basic plan of care that was person centred. The plan of care examined contained management strategies to manage the diabetes with medication, exercise and diet. A monitoring chart has been developed for staff to record significant activities identified to manage the diabetes. Recordings were detailed and reflected the care provided and any significant events. Staff that spoke with the Inspecting Officer indicated that they use the information received from the social worker assessment and care plan to deliver the care needs identified. Staff confirmed that service users with sensory impairment require clear speech and are spoken with face to face. Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 10 Staff are vigilant of the premises, ensuring the environment is safe. Staff said work is being undertaken to develop more person centred plans. A group of service users spoke with the Inspecting Officer. Four service users were case tracked in relation to looking at how their individual care needs were identified and met by the home. In some instances the responses were limited although communicated through gestures, by pointing and through their key workers. Observations made of the interaction between the service users and staff indicated that staff were approachable and responsive to needs of the service users. In general service users are consulted, supported to make decisions on a day-to-day basis. Service users access local services such as the day centre, college and social events. Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 11 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 standard(s) 11, 12, 13, 14, 15, 16, 17, Social and leisure interests are accommodated within the home, through the local community and planned events. Service users rights and privacy is respected in the way care needs are met. Meals are varied and balanced. Culturally appropriate and dietary needs are provided. EVIDENCE: Several service users attend the day and community centres several times a week. Two service users attend college doing a range of courses such as art, cookery and woodwork. Service users’ interests and hobbies are supported, for example one service user enjoys music, listens to music in his room and has a guitar. There are several small lounges throughout the home and a large dining room. One lounge has a pool table and a stereo, which was well used. The key worker for one service user spoke about supporting and learning skills to move into sheltered or supported living schemes. The home has a selfcontained unit, a kitchen, lounge and bedroom and shower/toilet facility, which can be used by service user with staff support to experience independent living prior to making decisions about their future accommodation. Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 12 The Inspecting Officer spoke to a small group of service users whilst participating in an art and craft session in the dining room. Service users told the Inspecting Officer of social events held at the home such as the “60’s Night”. Photographs of social events and service users are displayed around the home. There are planned holidays scheduled for several service users to Ireland by an aeroplane and another service user is going to Wales for holiday in July. There is the charter of residents’ rights and rules of the home. Service users are made aware of the rights and rules of the home at the point of admission in the appropriate mode of communication such as written spoken, using pictures, symbols and sign language. Service users are encouraged to share issues, concerns or suggestions directly with the staff or at the residents meetings. Service users may receive visitors at anytime in private or in the communal areas. Staff were seen to seek the permission of service users before entering bedrooms. Service users were addressed by their preferred names. Service users were observed being treated with respect with providing support and in conversation. Meals are varied and balanced accommodating cultural and dietary requirements. Meals are prepared on the premises by staff and an agency cook in the absence of a permanent cook. One service user helps the staff in the kitchen regularly. One service user stated that they are encouraged to eat together in the dining room, however, if they choose they can eat separately and at different times if they choose. Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 13 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 standard(s) 18, 19, 20. Care is delivered in the preferred manner in consultation with the service users. Service users chose to access the local health care services. The management of medication is poor and poses significant risk. EVIDENCE: Four service users care files were viewed and detailed there was ongoing consultation with health and social care professionals. Staff use the care plans provided by the social worker for service users on respite and short stays. Only one service user file contained a detailed plan of care with risk assessment in place relating to mobility, diet and medication. Staff on duty including agency staff appear to have access to limited information about meeting individual service users’ physical and emotional health care needs in the most preferred way. Daily case recordings completed by staff, for the four service users were detailed. Staff key working with service users provide care provision tailored to the individual service users care needs. A staff member was observed speaking in the service user’s first language e.g. in Gujarati. Visitors are welcome at any time. Service users move freely around the home. The Inspecting Officer observed relatives for one service user visiting in the privacy of the smaller lounge and the service users’ bedroom. Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 14 Service users have access to the local GP surgery. One service user said he attends hospital appointments for his diabetes every quarter. Medication is stored in the medication room. Administration of medication and recording was seen and is considered to be unsafe. Immediate requirements were made in relation to serious concerns that were identified during the inspection visit. These included; • • Current medication being stored in plastic named baskets with the surplus stock; Named medication being dispensed from more than one packet, box and bottle at the same time, thus making it difficult to audit and track medication according to the recordings on the Medication Administration Record Sheets. Medication in manrex packs prepared by the Pharmacist and foil wrapped in boxes. A spray ointment in one service user’s basket did not appear on the individual MAR sheet with any administration instruction. The spray was known as “Spirlon, ointment spray”. Creams applied were not always recorded on the MAR sheet as prescribed. • • • Medication and medication administration records for service users on short stays was accurate and auditable. The procedure for ordering medication was in good order although stored together with the medication already in use. Staff who administer the medication informed the Inspecting Officer that this is a new system, which was introduced two-weeks ago. Staff told the Inspecting Officer that medication was previously stored in a medication trolley, controlled medication and surplus stock were kept in a locked cabinet per service user. Staff expressed their own concerns regarding the storage, administration and recording of medication. Comments included: “don’t feel safe giving medication out because you have to look for things in the basket”; “takes a lot longer and you can be disturbed” and “risk of forgetting because it’s not systematic”. The Inspecting Officer was unable to view the respective new procedure, as staff were unable to locate it. The emergency procedure in response to an error in administration was clearly displayed. The fridge is locked with the correct temperature for the storage of insulin. Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Service users can express their views. Any concerns are dealt with, before the situation affects the service users’ wellbeing and results in a complaint. EVIDENCE: The home’s complaints procedure is displayed on the notice board around the home. Service users spoken with said they would speak to their key worker should they have any concerns. The Inspecting Officer observed visiting relatives expressing concerns to a key worker. The complaints procedure was offered to the relative and notes made on file and in the communication book for the attention of the home’s Manager. Staff spoken with were not able to provide the service user and her relatives the contact details of the advocacy services. The Commission for Social Care Inspection has not received any complaints since the last Inspection. The Inspecting Officer was unable to view the record of complaints’ as this was not accessible to the Officer in Charge. Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 16 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 standard(s) 24, 25, 26, 27, 28, 29. The home generally provides a comfortable and safe standard of accommodation suited to service users needs. Improvements need to be considered in respect of structural defects and accommodation to be fit for purpose. EVIDENCE: Service users have a choice of lounges and a large dining room. Furniture and fittings in the lounges create a homely atmosphere. One lounge has a pool table and a stereo. Five service users bedrooms were viewed, including a service user with sensory impairment. The bedrooms were personalised, comfortable, clean and spacious. A service user with sensory impairment spoke with the Inspecting Officer stated the staff are aware where to place his laundry and toiletries. Service users were asked as to their view of their individual bedrooms and the communal areas; all expressed satisfaction with the accommodation provided. Since the last inspection new automatic fire doors are being installed. One bedroom is being re-furbished as a result of the automatic fire doors installed in the corridor. On inspection of the bedroom concerns were raised in relation Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 17 to individual space available. Consideration should be made to ensure the bedroom is fit for purpose without compromising individual safety and space. The large bedroom is not occupied at present. On viewing the bedroom there was a substantial crack along the wall near the bed along the ceiling and to the adjacent wall, measuring approximately 4 metres. Works should be undertaken to remedy and make good the defect. The home provides sufficient lavatories and bathing/shower facilities to meet the needs of service users. New disabled male and female toilets have been created. Short stay rooms are located in one area of the home close to bath/shower and toilet facilities. The home does not have access to hoist and equipment to transfer service users. Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 36 A robust staff training programme is in place to ensure staff are well trained and competent to do their jobs safely. Staffing levels fall below the recommended level therefore, on occasion the service users could be at risk. EVIDENCE: The home operates a key working system whereby each service user has at least two named key workers to meet their needs and provide support for daily living. Service users spoken with confirmed their key workers generally respond promptly. Staff rotas were examined and it was noted that agency staff are regularly used to meet the needs of the residents. Agency staff covers the following areas: designated cook, designated administrative staff and carers including night staff. Discussion with staff indicated that agency staff need supervision if service users needs are not known, which could result in staff compromising meeting the care needs of service users’ timely The Local Authority has in place a departmental training plan, the document details general areas of training and training specific to needs of residents. Staff that spoke with the Inspecting Officer confirmed that they are encouraged to identify their training needs, which has a direct impact on the provision of care. Over fifty percent of permanent staff have completed National Vocational Qualification – Level 2. Staff receive regular supervision and annual appraisals, which is recorded. Team Meeting take place monthly. The agenda items were displayed in the staff office, which included medication. Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 41, 42, Service users are consulted about living in the home. Records are secure and treated in confidence. Environmental improvements have resulted in service users and staffs’ health, safety and welfare being promoted and protected. EVIDENCE: Residents Meetings are held regularly, which residents can choose to attend. Staff with language skills supports the residents to join in with the discussion and raise issues. The observed interaction between staff and service users was relaxed, friendly, using a soft tone of voice that indicated reassurance. Communication observed included speech, using signs, gestures and symbols with face-to-face contact. Service users reviews are on going, with formal review meeting with health and social care professionals. Service users spoken with were aware of the records held at the home and securely stored in accordance with data protection. Service users were observed being consulted about the provision of care. In general the records were secure, available and up to date. The records of complaints received was Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 20 not accessible or available for inspection, refer to the section on Complaints, Concerns and Protection. During the tour of the premises fire exits were clearly marked and were not obstructed. Since the last inspection building works have commenced and a handy person appointed. Automatic fire doors have been installed, creating safe fire zones throughout the home. Fire drill records and safety equipment testing records were up to date. Regular fire testing and alarming testing is in place and recorded. The home’s fire assessment is in place and current. Water temperatures tested at the point of delivery, were within the recommended safety levels. Service users and staff that spoke to the Inspecting Officer were generally satisfied with the safety within the home. Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x 3 x Standard No 22 23 ENVIRONMENT Score 2 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 2 3 x Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Beaumanor House Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x x x 3 3 x C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 22 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15(2) Requirement The Registered Manager should develop care plans that are person centred plans in consultation with the service users. Risk management strategies detailed and instructions to staff how to deliver the identified care needs. The Registered Manager must ensure that the arrangements for receiving, storing, administration and recording of medication is improved and can be audited. The Registered Manager must ensure that surplus medication to be stored separately to avoid using more than one bottle or packet at any one time. The Registered Manager must ensure medication is labled with the name of the service user and recorded on the medication administration record sheet. The Registered Manager shall make available the summary of the complaints received for inspection. C51 S31587 Beaumanor House V227615 220505.doc Timescale for action 22/06/05 2. YA20 13(2) Immediate 3. YA20 13(2) Immediate 4. YA20 15(2) Immediate 5. YA22 22 22/06/05 Beaumanor House Version 1.30 Page 23 6. YA28 23(2)(b) 7. YA28 23(2) The Registered Manager must ensure that the large bedroom with cracks along the wall and ceiling is repaired. The Registered Manager must ensure that the bedroom currently being re-furbished is accessible and fit for purpose. 22/06/05 22/06/05 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 YA20 Good Practice Recommendations The Registered Manager should consult the Pharmacist to audit the medication and the procedures to ensure practices are safe.The Registered Manager should make available contact details for advocate services. The Registered Manager should identify and make available the contact details for advocacy services for service users and their relatives. The Registered Manager should consider recruiting permanent staff to eleviate pressures from permanent staff working with service users and supporting agency staff. 2. YA22 3. YA33 Beaumanor House C51 S31587 Beaumanor House V227615 220505.doc Version 1.30 Page 24 Commission for Social Care Inspection The Pavilions, 5 Smith Way Grove Park Enderby Leicestershire LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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