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Inspection on 15/06/06 for Castle Dene, Combe Martin

Also see our care home review for Castle Dene, Combe Martin for more information

This inspection was carried out on 15th June 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents at Castle Dene are treated as individuals, with the providers and two part time staff aiming to make their lives as independent and satisfying as they can. There is a friendly family atmosphere at the home; during the inspection the residents were observed to be at ease moving around the home and happily occupied in their chosen way. Residents spoken with praised the care they received at the home and said they were very happy living there, one said, "We get excellent care here" and "I would rate this place as the highest quality of care". The providers ensure the well being and comfort of the residents and treat them with respect and kindness. Residents` health and social care needs are well met; the home has established good working relationships with local GP surgeries and community nurses, one nurse wrote, "Standards are very high". The providers are very involved in the day-to-day care of the residents and demonstrate a clear understanding of their needs. The environment is comfortable, homely, clean and safe. Residents have various communal areas to enjoy and all took great pleasure in the lovely garden.

What has improved since the last inspection?

The providers continue to work hard to meet previous requirements and recommendations; six of the previous eight requirements have been met. Since the last inspection the providers have completed several training courses in order to ensure that skills, knowledge and competences are maintained. The management of medication at the home has been made safer with both providers completing a safe handling of medicines course. The environment continues to improve; a new shower room has been fitted on the first floor, which has been finished to a high standard with the equipment necessary to ensure residents` needs are met. Risk assessments have been completed in respect of uncovered radiators to minimise risk or harm to residents. Mr & Mrs Goddard have worked with Devon Fire & Rescue (DR&R) to ensure that the home complies with regulations and is safe for residents. A visit by DF&R in January 2006 found satisfactory standards of fire safety and all work required has been completed. A duty rota is now kept showing which staff are on duty ensuring accountability.

What the care home could do better:

When residents were asked what could be improved at the home the resounding and unanimous answer was "nothing!" The owners have been asked to improve the detail and information within care plans to better reflect the actual standard of care given. In order to ensure the continued protection of residents staff are required to undertake the appropriate training and the home needs to develop adult protection polices. Consideration should be given to ensuring that staff have the opportunity to attain a nationally recognised qualification. Residents and relatives are encouraged to voice their opinions and share ideas for improvements, but quality assurance systems must be formalised and evaluated to ensure that the home continues to be run in the best interests of the residents.

CARE HOMES FOR OLDER PEOPLE Castle Dene, Combe Martin High Street Combe Martin Ilfracombe Devon EX34 0HS Lead Inspector Dee McEvoy Key Unannounced Inspection 10:00 15 & 20th June 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Castle Dene, Combe Martin Address High Street Combe Martin Ilfracombe Devon EX34 0HS 01271 882820 01271 882820 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Kay Jean Goddard Mr Leonard Philip Goddard Mrs Kay Jean Goddard Care Home 3 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (3), Old age, of places not falling within any other category (3) Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th October 2005 Brief Description of the Service: Castle Dene is a family-run home, which provides personal care and accommodation for three older people. It is situated in the heart of Combe Martin, and therefore offers the residents easy access to the local amenities. Castle Dene is a large terraced house with well-maintained and attractive gardens to the back of the property. A conservatory has been added to the rear of the property, which residents enjoy. Single accommodation is provided for residents on first floor of the building, which is accessed via a stair lift. The providers live on the premises. On the ground floor the communal rooms are homely and spacious. The average cost of care is £326.00 per week at the time of inspection. Additional costs, not covered in the fees, include chiropody, hairdressing and personal items such as toiletries and newspapers. Current information about the service, including CSCI reports, is available to prospective residents. Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took 6 hours to complete, with the inspector visiting the home on the 15th and 20th June. The registered providers were not available for the first day of the inspection but a member of staff assisted in a friendly and professional manner. There were three residents living at the home and the inspector met and spoke with each of them. Prior to the inspection surveys were sent all residents to obtain their views of the service provided; comments were very positive with all residents confirming that they ‘always’ receive the care and support they need. Completed surveys were also received from two GPs and two community nurses; all were satisfied with the overall care provided at the home. The inspector looked around the home, which was extremely clean and comfortable. As part of the inspection a number of records were inspected, which included a pre inspection questionnaire, residents’ care notes, staff files and training records and records relating to health and safety and maintenance. What the service does well: Residents at Castle Dene are treated as individuals, with the providers and two part time staff aiming to make their lives as independent and satisfying as they can. There is a friendly family atmosphere at the home; during the inspection the residents were observed to be at ease moving around the home and happily occupied in their chosen way. Residents spoken with praised the care they received at the home and said they were very happy living there, one said, “We get excellent care here” and “I would rate this place as the highest quality of care”. The providers ensure the well being and comfort of the residents and treat them with respect and kindness. Residents’ health and social care needs are well met; the home has established good working relationships with local GP surgeries and community nurses, one nurse wrote, “Standards are very high”. The providers are very involved in the day-to-day care of the residents and demonstrate a clear understanding of their needs. The environment is comfortable, homely, clean and safe. Residents have various communal areas to enjoy and all took great pleasure in the lovely garden. Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Significant time and effort is made to ensure that admissions to the home are managed in a personal and sensitive way. Comprehensive written assessments for any new admissions will ensure accurate information is obtained prior to people moving into the home. EVIDENCE: There have been no new admissions to the home for over a year. Admissions to the home are rare but appear to be well managed ensuring that the ‘stability’ of the house is maintained, which is important with only three residents. One resident said of their admission, “I felt very welcome – couldn’t have been better.” Mrs Goddard will always visit prospective residents before admission to talk about the person’s needs and the service offered by the home. It was clear from speaking with the residents and observing the care provided that their needs were understood and met by Mr & Mrs Goddard. The providers are aware that any future admissions must have a full written assessment prior to moving into the home. Without detailed information Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 9 assurance cannot be given that care needs can be met. The provider discussed plans to improve this area, which will address the current shortfalls. Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are looked after well in respect of their health and personal care needs but care plans and risk assessments do not always reflect the high standard of care. The management of medication has improved meaning that residents are protected. Residents are treated with the up-most respect and dignity. EVIDENCE: There has been no change to the format or detail contained within care plans, which remain basic. Basic risk assessments have been completed in respect of mobility, personal care abilities, allergies and medication Nevertheless, residents needs continue to be met and the actual quality of the care given to the residents at this home is excellent. Residents’ comments included, “It is a wonderful home. I can’t speak too highly of the care and kindness” and “Every care is taken to look after my needs.” One health professional wrote, “I would gladly recommend this home. The standards are high.” Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 11 A record of significant events is kept in the diary although daily records are not routinely kept. The diary records when residents are unwell, contact with all health professionals and reflects on new treatments and outcomes. Survey responses from health professionals were positive; the home communicates clearly with GPs and community nurses and any specialist advice is followed. All responding were satisfied with the care provided to residents. Residents themselves felt well cared for and the providers take the appropriate action to ensure that all health needs are addressed. Since the last inspection both providers, responsible for the administration of medications, have completed a training course to ensure safe practice. Records were available to show which medication was coming into the home and any medication being administered to the residents. Medication was securely stored. The home has a simple medication procedure and a copy of the Royal Pharmaceutical Society’s guidelines for the administration and control of medicines in care homes to ensure safe practice is followed. Residents told the inspector that their privacy and dignity was respected at all times and that assistance with personal care is provided wherever needed, in a sensitive manner. It was evident to the inspector that the providers had a good understanding of the residents’ needs and characters. The providers and staff interacted with residents in a respectful and fond manner, one resident wrote, “we are treated as one of the family”. Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents experience a lifestyle, which meets their preference and expectations, and they are encouraged to exercise control and choice over their lives. Meals provided at the home are nutritious and balanced and offer a variety to suite individual needs and preferences. EVIDENCE: The daily routine, including getting up and going to bed and mealtimes, is flexible. One resident said, “There are no rules and regulations here!” another said, “Nobody interferes with you, we do as we want”. One resident wrote, “I consider this as my home”; and the other residents echoed this. Residents appeared completely at ease expressing their preferences. One told the inspector, “We are always asked what we would like” Residents have an active social life outside the home with family and church. Residents are supported to maintain their religious beliefs by the home. The home is often involved in local events such as carnivals and festivals and residents’ hobbies and interests are encouraged and informal activities such as local outings and trips are organised. Visitors are always welcome at the home and the atmosphere was described as “homely” and “welcoming”. Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 13 Residents spoke highly of the meals provided at the home. The inspector was told that the food was always good. Residents are involved in planning meals. Menus are not used as meals are planned on a daily basis to allow for flexibility and individual choice. Main meals are taken “en famille” around the large dining table. Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for responding to complaints are good and residents are confident that their concerns will be listened to. Staff have a good knowledge and understanding of the forms of abuse and residents can be confident that staff would act to protect them. However staff would benefit from adult protection training and policies to guide them. EVIDENCE: The complaints procedure is satisfactory and residents said they have no complaints but if they have any issue or concern would have no hesitation talking with the providers or one of the staff. Neither the home nor the Commission have received any complaints about the service. Residents feel safe and well cared for at the home; one said,” This is a happy place with caring people”. All residents manage their own financial affairs. Due to oversubscription for adult protection training a date for this training has not been confirmed yet. One staff member spoken with had a good understanding of adult protection issues and said, “We would not see those concerns here”. The home has not developed the relevant polices and procedures for adult protection including a whistle blowing policy, but does have a copy of the ‘Alerter’s Guide’ produced by the local Adult Protection Unit to ensure the correct procedures are followed in the event of an incident. Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is a safe, well-maintained environment that is comfortable for the residents; it is clean with high standards of hygiene evident throughout. EVIDENCE: A complete tour of the home was undertaken as part of the inspection, the home is well maintained, homely and comfortable. Residents’ rooms are personalised and comfortable; there is a stair lift and grab rails to assist with mobility and residents can enjoy access to all parts of the home. Since the last inspection a ‘walk-in’ shower has been fitted to meet the changing needs of the residents. The home has a large sitting room and family style dining room. The home has a lovely conservatory and well-planted and maintained garden; all residents were happy with the accommodation. Radiators in the home are not covered or guarded but the temperature of radiators is controlled individually. Since the last inspection the provider has Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 16 undertaken a risk assessment of each radiator and has judged the risk of injury to be low for the current residents. The standard of cleanliness throughout the home was high and residents said it was always like this. There is a domestic laundry area, which suits the requirements of the home. The inspector was told that soiled linen was rarely dealt with at the home; if it was necessary to deal with soiled linen it would be bagged and sluiced appropriately. Residents spoken with were happy with the laundry service; one said, “The laundry is very good. All care is taken.” The last visit by an Environmental Health Officer (2005) found that the home maintained satisfactory standards. Infection control training is booked. Policies and procedures for the control of infection are to be developed. The providers were advised to obtain local guidelines in respect of infection control and to liaise with the Infection Control team regarding any issues of concern. Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 28 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Competent, knowledgeable and friendly people care for the residents and ensure their individual needs are met. EVIDENCE: The three residents are like part of the family and as such are cared for by the providers, their daughter and one part time member of staff. Mr & Mrs Goddard live on the premises and provide 24-hour cover. The present staffing arrangements appear to meet the needs of the existing residents, certainly residents were happy with the current arrangements. Since the last inspection a rota is kept in order to show who is on duty at any given time. The providers employ two part time staff, including their daughter, who have worked at the home for nearly ten years. Enhanced CRB checks had been completed. The providers are considering employing one other member of staff to assist with holiday cover; they were reminded that robust recruitment procedures must be followed in order to protect residents. Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 18 Since the last inspection the providers have attended several training days to ensure safe practice is maintained at the home. Similar training days have been organised for both part time staff. Access to NVQ was discussed and the owners are aware of the National Minimum Standard. Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and residents are involved in the development of the service. However formal quality assurance is less well addressed. Residents’ finances are safeguarded. The homes arrangements for ensuring the health, safety and welfare of residents are in the main good. EVIDENCE: Residents and health professionals expressed complete confidence in the management of the home. The registered owners have many years experience of working with older people and managing a home however neither have formal qualifications for example NVQ 4 or the Registered Managers Award. Since the last inspection the providers have undertaking training in order to update knowledge, skills and competencies. Mr & Mrs Goddard continue to familiarise themselves with the National Minimum Standards for older people Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 20 and have worked hard to meet the previous requirements and discharge their responsibilities. The home does not have a formal quality assurance system in place but all residents confirmed that they were consulted on a daily basis regarding their preferences and always kept informed of changes. The providers told the inspector that ‘feedback’ was actively sought from residents and the daily routine of the home was centred on the residents’ needs and preferences. This was evident during the inspection. The owners are not involved with any financial matters on behalf of the residents. Since the last inspection the providers have completed various mandatory training including food hygiene, moving and handling and first aid. Training dates for the providers and staff have also been confirmed and will include infection control. A visit by Devon Fire & Rescue (DF&R) earlier this year found satisfactory standards of fire safety. The providers plan to fit automatic closing mechanisms on fire doors to further improve fire safety. Service & maintenance certificates were looked for the stair lift and fire alarm, which were satisfactory. The home has a current periodic electrical inspection certificate. Window restrictors and thermostatic valves have been fitted to reduce risks for the residents. Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X 3 2 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP18 Regulation 13 (6) Requirement The registered provider shall make arrangements, by training staff or other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. This relates to staff training. (Previous timescale of 26/5/05, 2/9/05 & 24/02/06 extended due to over subscription for this training.) The registered person shall establish and maintain a system for reviewing at appropriate intervals and improving the quality of care provided at the care home. The home must develop quality assurance systems (Previous timescale of 26/5/05, 1/7/05 & 24/02/06not met). Timescale for action 21/11/06 2. OP33 24 (1) (a) (b) 21/11/06 Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP7 Good Practice Recommendations It is recommended that any resident admitted to the home in the future has a comprehensive written assessment completed prior to moving in. It is recommended that care plans and risk assessments contain more detail to reflect the current high levels of care given. It is recommended that policies and procedures for the protection of vulnerable adults be developed and training undertaken by the registered providers and staff. Policies and procedures for the control of infection are to be developed. Consideration needs to be given to ensuring that staff have access to NVQ training. The appropriate ID needs to be obtained for staff files. 3. OP18 4. 5. 6. OP26 OP28 OP29 Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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 Castle Dene, Combe Martin DS0000022132.V292511.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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