Inspection on 25/06/08 for Bramerton

This inspection was carried out on 25th June 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Bramerton 29/06/07

Bramerton 17/10/06

Bramerton 08/02/06

Bramerton 21/11/05

Bramerton 07/10/04

Bramerton 22/07/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Bramerton Upper Bray Road Bray Maidenhead Berkshire SL6 2DB Lead Inspector Jill Chapman Unannounced Inspection 25th June 2008 10:35 Bramerton DS0000011296.V365240.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 Bramerton DS0000011296.V365240.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. Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bramerton Address Upper Bray Road Bray Maidenhead Berkshire SL6 2DB 01628 771058 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) brianb@choiceltd.co.uk Choice Ltd Mr Brian Alan Bignell Care Home 10 Category(ies) of Learning disability (0) registration, with number of places Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - LD The maximum number of service users who can be accommodated is: 10 29th June 2007 Date of last inspection Brief Description of the Service: The home is owned and run by CHOICE Ltd and provides care for people with learning disabilities. The home is a large detached house. A large garden surrounds the property and the front entrance has a secure gate. There is a separate building within the grounds that is used for various activities. The house has four floors; residents’ rooms are on the two upper floors. All of the residents have individual rooms, of varied size and shape. The ground floor has two lounges, the dining room and kitchen. The basement has three sitting areas. The Deputy Manager has confirmed that the current weekly fees charged are £1686 - £2133 for the residents living in the home. This includes the provision of day care services and is based on an individual assessment of their needs. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 10:35am and was in the service for 5 ¾ hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. The manager was not on duty on the day of the inspection. Discussion took place with the Deputy Manager, Assistant Manager and two Support staff. A tour of the buliding was carried out and some of the service users routine was seen. Staff assisted some service users to talk about activities and interests. A lunchtime meal was observed. Care and health and safety records were sampled. What the service does well: Service users are fully assessed before admission to make sure the home can meet their needs. They can try out the home before deciding to live there. Service users know that their assessed and changing needs are identified in their care plans and they are supported to make decisions about their lives. They are supported to take responsible risks as part of an independent lifestyle. Service users religious and cultural needs are identified and met. Service users are supported to lead fulfilling lifestyles in accordance with their choices and wishes. They are supported to keep in contact with family and friends and to eat healthily. Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 6 Service users receive personal care and support in the way they prefer. They are supported to access health care to meet their needs and trained staff support them to take their medication. Concerns complaints and compliments about the service are listened to and acted upon. Staff training and procedures protect service users from abuse. A thorough recruitment procedure and enough trained staff on duty provides protection to service users. The views of service users and others help develop the service. What has improved since the last inspection? What they could do better: Any restrictions on service users access to their property, accommodation or the use of monitoring devices should be documented in their care plan or risk assessment and subject to regular review to show they are still needed. Bathing risk assessments could be more detailed to show that the risks from falling, scalding and drowning have been assessed. A review of the different types of bedroom door handles would make sure they are appropriate for service users needs and improve the appearance of bedroom doors. Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 7 Clearing clutter and stored items from the basement will make it safer for service users and staff. Training for staff about individual service users mental health needs will help them fully understand and meet these. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 8 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 Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 4. Quality in this outcome area is good. Service users are fully assessed before admission to make sure the home can meet their needs. They can try out the home before deciding to live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service user guide was seen and was updated in May 2008. It is user friendly with pictures to help those with communication difficulties. A copy was seen on each file sampled. The file of a new service user was seen and showed that they received a full assessment of need, including specialist assessments prior to admission. Staff showed evidence that the service user had visited the home for pre placement visits to make sure the home was suitable before coming to live there. A transition plan made sure that the process met their needs. Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9. Quality in this outcome area is good. Service users know that their assessed and changing needs are identified in their care plans and they are supported to make decisions about their lives. They are supported to take responsible risks as part of an independent lifestyle. Service users religious and cultural needs are identified and met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Evidence was obtained from sampling the files of three service users and discussion with the deputy manager. A requirement to make sure that care and support documents provide information to staff of how the personal care needs of the service users are to be met has been carried out. Since the last inspection care files have been Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 11 reviewed and reorganised. Care plans seen were person centred, well written and give detailed information about how service users want their needs to be met. A requirement that service users care records are kept confidential has been met. Instead of a book with communal daily records of care, individual shift plans are kept for each service users and are kept in their personal file. They show what care is given, when and by whom. Night records are currently kept in a communal record but the deputy said he would extend the day shift plan to include these so they can be kept confidential. Monthly report sheets monitor care plans and reviews seen on files show that care plans are regularly reviewed. It was seen that staff routinely offer choices to service users and unless they are part of a behavioural strategy or pose a risk, they uphold the service users choice. Some restrictive practices are in place that are in response to behavioural or risk situations, for example some service users have locked cupboards or drawers, one has a monitoring device due to epilepsy, one has restricted access to his bedroom for safety reasons and TVs are protected from damage with wooden cabinets. Although in discussion with staff it is obvious that the reasons for these practices have been fully considered they are not supported by care plans or risk assessments. These should be documented and subject to regular review. The Deputy Manager confirmed this would be carried out. There are risk management strategies in place and these are well documented and supported by other professional input where relevant. These cover risks from behaviours and some environmental risks to individuals. In files sampled it was evident that these could be developed further to include other risks to the individual. For example the risk from seizures when bathing has been documented but other associated risks have not. Bathing risk assessments should be further developed to document that the risks from falling, scalding and drowning have been assessed. The Deputy manager said that this would be carried out. Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17. Quality in this outcome area is good. Service users are supported to lead fulfilling lifestyles in accordance with their choices and wishes. They are supported to keep in contact with family and friends and to eat healthily. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides day services both in house and externally. Day services timetables are prepared weekly to give service user the opportunity to do something different. Service users are given the opportunity to pursue continued learning through local colleges. Staff support service users to access the local community and use the library, churches, local shops and pubs. During the inspection service users went out Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 13 to various activities and one was talking to staff about plans to visit a pub in the evening. Holidays and day trips are organised to suit service users needs or choice. One service user likes beach holidays and a trip to Wales was arranged. Discussion with staff showed that they help service users to keep in contact with families and friends. Records of family contacts were seen on service users personal files. The arrangements for the provision of food were seen. There is a designated cook and menus are planned with service users preferences taken into account. Menus have been reviewed to increase choice and picture cards help service users see what is on offer. These show that a healthy diet is provided that includes fresh fruit, salad and vegetables. Staff confirmed that the home can cater for special diets and cultural or religious requirements if required. Records show that food is stored at the correct temperatures. Food stocks were plentiful. The cook confirmed that she has an up to date food hygiene certificate. There is ample dining space and staff were seen to offer service users help when needed. Alternatives were offered if a service user did not seem to like the meal that was served. Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20. Quality in this outcome area is good. Service users receive personal care and support in the way they prefer. They are supported to access health care to meet their needs and trained staff support them to take their medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents looked well cared for and were dressed in clean and appropriate clothing. Care plans give good written guidance for staff on how to meet service users personal care needs in the way they prefer. There are additional guidelines and monitoring records for dealing with individual behavioural needs and these are drawn up in consultation with the organisations psychology service. To avoid the need to restrain service users in potential risk situations staff are trained in intervention techniques and individual guidelines are in place for each service user. Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 15 Health needs and appointments are well documented and each service user has a health action plan. There are clear guidelines in place on the management of Epilepsy and there are monitoring sheets in place to record seizures. Records show the input of health professionals such as psychiatrists, speech therapists and psychologists involved in service users care. The medication needs for the individual are recorded in their health care plan. Staff are trained to give medication and staff confirmed that their competency is regularly reassessed. A previous requirement to make sure that medication practices are clearly documented has been carried out. Staff are trained to carry out delegated health tasks and this is clearly documented on the guidelines in individuals files and staff training records. Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. Concerns complaints and compliments about the service are listened to and acted upon. Staff training and procedures protect service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Commission has not received any information about complaints about the service. There is a complaints procedure in place and a user-friendly version is in Widget format to help service users with communications difficulties. No complaints have been received since the last inspection but past records show that the home deals with complaints appropriately. The Deputy Manager said that staff are trained in the POVA (Protection of Vulnerable Adults) and it was seen that there is an individual procedure in place to assist service users to report any kind of abuse or neglect. Staff spoken to confirmed that they had received Protection Of Vulnerable Adults training as part of their mandatory training. The home has a copy of the Interagency Procedures and has recently used this to report concerns expressed by a service user. The home has notified the Commission of any safeguarding referrals made to the Local Authority. Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30. Quality in this outcome area is good. The management of the environment has improved and better maintenance and decoration of the house have made it more homely for service users. Improvements to hygiene and health and safety procedures in the home have made the environment safer for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A previous requirement to make sure that the premises is kept in good repair and décor has been met. A lot of work has been carried out to improve the environment for service users. This includes new kitchen flooring, corridors have new carpets and Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 18 lighting and the basement has been treated for damp, new flooring and walls re-plastered and re-painted. There are new curtains in bedrooms and communal areas and tablecloths in the dining room. The Deputy Manager said that ongoing refurbishment and replacement is planned, the kitchen will be repainted and the staff office extended. A maintenance man visits the home twice weekly and a gardener once a month. The garden is secure and well kept and has leisure equipment for the service users. A wooden chalet is used for 11 sessions with service users and small meetings. At the time of the inspection a service user was in the chalet enjoying a 1-1 with staff and listening to music. It was noticed that service users bedroom door handles and locks vary, some are ball closures, others have handles that are sited high up on the door. One has a pull handle to suit the service users needs. Staff were unaware of the reason for the varying types and heights. It is recommended that bedroom door handles and locks are reviewed to suit the needs of the service users and provide a more normal and homely appearance. Any special needs or restrictions should be supported by a care plan or risk assessment. The basement floor is cluttered with storage items and it was noted that one service user accident occurred in this area. This should be made safe because they present a trip hazard for staff and service users who access this area and the deputy said that this area is in the process of being cleared. It is recommended that this as carried out without further delay. Two previous requirements regarding Fire safety have been carried out. The Fire Safety Authority has been consulted about fire safety arrangements in the home and staff said they have made some recommendations. The Assistant Manager confirmed she was present when they visited the home but the record of this visit could not be found. As a result of the visit a new fire panel has been installed and fire evacuation risk assessments for individual service users are in place. On the advice of the fire authority raised nameplates are being made for service users bedroom doors to make it easier to identify them in a smoke filled environment should a fire occur. A requirement to make sure that the home is kept clean and hygienic at all times has been met. The home was found to be very clean and there were no unpleasant odours. Infection control training is mandatory for staff. New hygiene practices such as cleaning rotas and reviewed systems for the storage and disposal of clinical waste have been introduced. A housekeeper is employed and shift records show that other staff have delegated cleaning tasks. Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, & 35. Quality in this outcome area is good. A robust recruitment procedure and enough trained staff provides protection to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA (Annual Quality Assurance Assessment) shows that the home has a programme of NVQ (National Vocational Qualification) training under way; they have achieved the target of at least 50 of staff being qualified to NVQ2 or above. In observation of staff practice at various times of the day, they were seen to relate and communicate well with service users and showed a good understanding of how to respond to their wishes and behaviours. In discussion with staff at various levels they were clear about their roles and responsibilities. Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 20 During the week staff deployment allows for 5 support staff on an early shift, four support staff on a late shift and two, day shift staff. At weekends there are 5 support staff on an early shift and 5 on a late shift but no day shift staff. At night there are 2 waking night staff. In addition to support workers a housekeeper and cook are employed. From observation and speaking with staff, deployment meets the current needs of the service users. The deputy manager confirmed that staff are recruited in line with the recruitment policies and procedures of CHOICE. It was not possible to verify recruitment records during the inspection because that manager was on sick leave, however staff interviewed confirmed that the process was fully carried out when they were employed. The manager confirmed on the AQAA that the staff have a very good training plan each year and that the training manager makes sure that each individual staff is kept up to date with their mandatory training. Staff spoken with confirmed that they had received a full induction and mandatory training and other training related to the health and learning disability needs of the service users. Staff spoken with felt that training was accessible and relevant. Some service users have additional mental health needs and although staff have some understanding of these conditions it is recommended that the manager commission training sessions about these to fully inform staff. Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42. Quality in this outcome area is good. A new and strengthened management team has improved the management of the systems that support service users. Better management and maintenance of the premises and the health and safety policies and procedures help protect service users. The views of service users and others help develop the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a new registered manager who has over 16 years experience of working in and managing residential services for adults with learning disabilities. He has completed his Registered Managers Award and NVQ 4 in Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 22 Care and other ongoing training relevant to his role. From discussion with the Deputy and Assistant Manager and staff it is clear that the manager has made positive changes to the premises, record keeping and delivery of care. The Deputy and Assistant managers presented as enthusiastic and proactive. The Deputy manager confirmed that there is a system for seeking the views of service users and others about the service. Questionnaires are sent out annually and help inform service users individual care and support programmes and the business plan for the home. Information provided on the AQAA shows that regular checks and servicing of equipment takes place. Health and safety records were sampled and show that fire, hot water temperature and accident records were up to date. Other weekly health and safety maintenance and health and safety checks are documented. Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 23 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 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 24 No 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. Standard Regulation Requirement Timescale for action 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 YA7 Good Practice Recommendations Any restrictions on service users access to their property, accommodation or use of monitoring devices should be documented in their care plan or risk assessment and subject to regular review. Bathing risk assessments could be further developed to document that the risks from falling, scalding and drowning have been assessed. That bedroom door handles and locks are reviewed to suit the needs of the service users and provide a more normal and homely appearance. Any special needs or restrictions should be supported by a care plan or risk assessment. The basement floor that is cluttered with storage items should be made safe because they present a trip hazard for staff and service users who access this area. That staff have training to meet the mental health needs of individual service users. DS0000011296.V365240.R01.S.doc Version 5.2 Page 25 2 YA9 3 YA24 4 5 YA24 YA35 Bramerton Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bramerton DS0000011296.V365240.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!