Inspection on 30/04/07 for Charlton Road

This inspection was carried out on 30th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Charlton Road 05/05/06

Charlton Road 04/11/05

Charlton Road 26/04/05

Charlton Road 01/10/04

Charlton Road 21/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Charlton Road 30a Charlton Road Blackheath London SE3 8TY Lead Inspector Ms Pauline Lambe Unannounced Inspection 30th April 2007 09:40 Charlton Road DS0000006756.V335056.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 Charlton Road DS0000006756.V335056.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. Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Charlton Road Address 30a Charlton Road Blackheath London SE3 8TY 020 8305 2425 020 8858 5039 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) milburycare.com/home.html Milbury Care Services Limited Mr Paul Augustine Doyle Care Home 5 Category(ies) of Learning disability (4), Learning disability over registration, with number 65 years of age (1) of places Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 place registered for LD(E) in respect of named service user only. Date of last inspection 5th May 2006 Brief Description of the Service: 30a Charlton Road is a registered care home providing accommodation and nursing care for four adults with a learning disability. It is situated near to Blackheath Standard a local shopping centre and has access to good public transport links. The home is one of a group of six homes for adults with learning disabilities situated in the London Borough of Greenwich and managed by Milbury Community Services Ltd. The property is a detached bungalow which provides four single bedrooms, a lounge/dining room, kitchen, laundry room, toilet and bathing facilities. The property has small gardens to the front and rear. The home has links with the Greenwich Community Learning Disabilities Team (CLDT) to provide a multidisciplinary service. Members of the CLDT are involved in placements in the home, monitoring resident care and progress and provide day care services and links to specialist health care. The manager confirmed that the current fees were £1438.22 per week. Residents paid privately for personal clothing and toiletries, holidays and some leisure outings. Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit for this unannounced inspection was undertaken on 30th April 2007. The manager was on duty and he and the staff assisted with the inspection. One resident was in the home with a second returning from the day centre at lunchtime. The other residents were attending day centres. No relatives were seen during the visit. The service was last inspected on the 5th May 2006. The inspection included a review of information held by the Commission since the last inspection, viewing the premises, an inspection of care records and records that must be maintained to comply with regulation, talking to and observing residents and staff and contacting relatives and other professionals to get their views of the service. The overall view was that the home was well managed. A committed staff team with the relevant qualifications, skills, training and support provided care to the residents. Residents benefited from good working relationships between staff and relatives who worked together to ensure they had a lifestyle that suited them. What the service does well: What has improved since the last inspection? Improvements had been made to medicine management and records were kept for all medicines including homely remedies. A medicine error review committee had been set up and their role was to review all medicine errors and make recommendations to prevent a reoccurrence. Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 Page 6 Care plans included meeting resident social needs. Staff recruitment files seen included all the information required by regulation. The kitchen had been repainted, retiled and had new units fitted. The manager had completed a fire marshal course and provided fire safety training for staff. 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. The summary of this inspection report can be made available in other formats on request. Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management were aware of their responsibility regarding the admission of new residents. EVIDENCE: No residents had been admitted to the home since the last inspection and only one since the introduction of the National Minimum Standards. The manager was aware of his responsibility to only admit residents following access to relevant information about the resident, completion of a full assessment of need and confirmation that based on this the home could meet the resident’s needs. Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans were prepared to show how residents care needs were to be met and how risks were managed. As far as practical care plans were prepared with residents. EVIDENCE: Care records for one resident were inspected. These included assessments and the care plans showed how assessed needs were to be met. Most of the residents in the home were unable to participate with preparing care plans however relatives and residents were invited to participate in the preparation of life plans. A number of record entries seen had been corrected using correction fluid. All of the relatives contacted following the inspection said they were very satisfied with the care and support the residents received. They said that staff kept them informed about the resident’s health and welfare. Comments made included ‘staff are on the ball’, ‘I do not have to worry about my relative’ and ‘the home is well managed, homely and residents are happy and well cared for’. Feedback from staff with the Community Learning Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 Page 10 Disability Team (CLDT) contacted was very positive. They said that during visits staff were always observed interacting respectfully with residents, followed guidance they provided and used services appropriately for the benefit of residents. Recommendation 1. Resident records included risk assessments. The risk assessment in relation to the use of bedrails was not considered adequate. This was discussed with the manager and suggestions made on how to improve these. The high dependency of the residents meant that staff had to assist them with all aspects of their lives. Where risks were identified procedures and risk assessments showed how these were being managed. Where it was assessed that residents required additional one to one care this was provided. Recommendation 2. Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents had the opportunity to enjoy leisure activities of their choice both in and out of the home, were treated respectfully and had their dietary needs met. EVIDENCE: Based on assessment none of the residents were involved in further education. All residents attended day centres where they were involved in hobbies and leisure interests of choice such as arts and crafts, pottery and computers. All residents had one day off a week. On their day off they had a lie in and spent the day doing activities they enjoyed supported by staff. For example having a leisurely bath, late breakfast, going shopping, having a meal out, going to the cinema or cooking. On the day of the inspection the resident at home got up late and had the opportunity to enjoy a lot of one to one attention from staff. Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 Page 12 The resident seemed to enjoy the personal attention and was encouraged to make choose breakfast and lunch. The resident said they enjoyed ‘lazy days’ and indicated that staff were good and that they were happy in the home. A holiday to Euro-Disney was planned for all residents later in the year. A social care plan was included in the care records inspected and showed what interests the resident enjoyed and how these were met. The manager said that the mini-bus was being changed this year for a smaller more usable vehicle. As residents required a lot of support when taken on social outings the plans was to take two residents out at a time. For group outings the manager said he could access a mini-bus from one of the other homes in the Organisations. Relatives contacted were satisfied that residents had a lifestyle that suited them. One resident returned home during the inspection and seemed very relaxed and comfortable with the staff and in the home. Relatives contacted said they were made feel welcome when visiting and many knew all the residents and joined in social events in the home such as celebrating resident’s birthdays. Staff interacted appropriately with residents and spoke knowledgably about their needs. Relatives contacted said that currently the home had a very good staff team and they kept them informed about resident’s health and welfare. Since the last inspection the kitchen had been refurbished. New units had been fitted, the walls retiled and the room repainted. Management had agreed to fit new flooring but there was not date fixed for this to be done. The kitchen was clean and tidy. Records were kept of fridge, freezer and temperatures. As far as possible menus were prepared with the residents and staff used pictures to help them to make choices. Menus seen indicated a varied diet was provided. Adequate supplies of fresh, dry and frozen foods were seen. Two residents ate a normal diet and two were artificially fed. Residents being fed artificially had their dietary needs assessed by the community dietician and staff were kept up to date with equipment cleaning and maintenance. Suitable crockery and cutlery was provided for residents to enable them to maintain independence. Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s personal and healthcare needs were met and medicines were safely managed. EVIDENCE: All bedrooms in the home were for single occupancy, which provided privacy for the residents. Care plans seen showed how personal hygiene needs were to be met. It was not possible for all residents to comment on whether this suited them or not. However residents seen were well presented and one resident indicated they had enjoyed their bath and morning care that day. Feedback from relatives indicated satisfaction with how care was provided. Most of the residents in the home were unable to give feedback about any aspect of the service. Daily records were kept to show the care provided and activities the residents were involved with. All residents were registered with a GP and staff supported them to access other medical services such as dental and optical care. Residents paid Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 Page 14 privately for chiropody treatment. Links were maintained with the community learning disability team to support staff with meeting resident needs. The care records inspected had evidence to show that the resident had received relevant care from other professionals such as a dentist, chiropodist, mental health review and physiotherapist. The resident’s life plan was up to date. Staff said that residents enjoyed treatment the received from an aroma therapist who visited the home on a private basis. Medicines were well managed and records and medicines checked for two residents were found to be correct. The medicine policy and procedure had not been updated as required at the last inspection to reflect changes to medicine disposal. The manager said that the Organisations policies and procedures were all due for review in the near future. In view of this the inspector sent a copy of the British Pharmaceutical Guideline to the manager. Medicines were no longer being returned to the pharmacy for disposal but were disposed of under contract by a waste disposal company. The home had a stock of homely remedies, which was agreed with the GP. Records were kept for receipt and administration of these. The recording system for these medicines had been improved so that an audit trail could be completed. One error was noted in relation to one homely remedy. Since the last inspection the Organisation had set up a ‘medication error review committee’. The function of this group was to review all the evidence and circumstances round a medication error and recommend actions needed to prevent a recurrence. Requirement 1. Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Satisfactory procedures were in place to manage complaints and to ensure resident protection and safety. EVIDENCE: Policies and procedures were provided in relation to complaint management. A system was in place to record complaints made a bout the service. No complaints had been made to the provider or the Commission since the last inspection. Only one resident had some ability to raise concerns and said if they had any concerns they would talk to the manager or staff. Relatives contacted said they were aware of the complaints procedure and added that if they had any concerns they would see the manager or a member of staff to resolve the issue. Policies and procedures in relation to safeguarding adults were provided. No allegations of abuse had been made to the provider or the Commission since the last inspection. The home had copies of Greenwich adult protection procedures, a whistle-blowing policy and a copy of the Department of Health document ‘No Secrets’. Staff who spoke to the inspector indicated a good understanding of safeguarding adult’s adult protection and how they would manage such a situation. All staff received training on this topic. Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, 27 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment was suited to meeting the needs of the residents and bedrooms were pleasant and personal. The garden required attention. EVIDENCE: All areas of the home seen were clean, tidy and free of unpleasant odours. Bedrooms were clean, tidy and personalised to reflect the interest of the resident. Personal clothing was neatly arranged and laundered. All bedrooms and the bathroom had ceiling hoists provided which were serviced in March 2007. Staff worked with residents and relatives to purchase personal items and equipment to improve their quality of life. For example one resident had ordered a new and more suitable armchair and another had purchased a personal computer. Relatives said they found the home comfortable and could see their resident in private if they wished. Two residents had their own armchairs to ensure they were comfortable and properly supported. The property was satisfactorily maintained but the garden area to the back was Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 Page 17 unkempt. A portion of the fence to the side of the property had fallen down some time ago and had not been repaired. This left the garden open to the neighbours and could pose a risk to resident’s privacy and safety. The maintenance of the garden has been on ongoing issue and should be addressed by management. Currently the area had no seating, was very unkempt and was not inviting for either residents or relatives. In view of the location of the property the home got a lot of heavy traffic noise especially when the windows were open or when sitting in the garden. One shower and one assisted bath were provided. Residents were supported to make a choice as to which they preferred to use. Staff said residents had to ability to make a choice as to which they preferred and most of them enjoyed a relaxing bath on their days off. Hand washing facilities were provided where waste was handled and staff were provided with adequate supplies of protective clothing. The staff had access to policies and procedures on infection control. Requirement 2 and recommendation 3. Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 33, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were cared for by a committed, appropriately trained and supervised staff team. EVIDENCE: The staff team comprised of a full time manager, trained nurses and support workers. Currently the home had three permanent care staff and used regular bank staff to cover shifts. 50 of care staff had achieved NVQ level 2 or above. From the rotas inspected adequate staffing levels were maintained. One to one care was provided to one resident and was funded by social services. Relatives contacted did not raise any concerns about the staffing levels. Feedback from relatives and visiting professionals was complimentary in relation to the staff team. Comments made included ‘the home has a good staff team at the moment’, ‘the staff keep me informed about my relatives welfare’ and ‘ staff follow care guidance provided and are good to work with’. Policies and procedures were provided on staff recruitment. Two staff files were inspected. These were well maintained and contained all the information Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 Page 19 required by regulation. Records seen also included evidence of induction, training and supervision Staff who spoke to the inspector said they had access to training and support to ensure they fulfilled their role. The manager received notification of forthcoming training and identified staff to attend. Individual training records were kept and since the last inspection staff had access to training such as moving & handling, advanced medicine management, mentorship, fire safety, mental health and learning disability and infection control. The manager had attended relevant and update training as needed. Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 Page 20 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): Standards 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home was well managed with attention given to providing a safe environment for residents and others. EVIDENCE: The home manager had completed the registered managers award and had the care skills needed to manage the service. He was registered with the Commission and ensured he attended training relevant to this role. As mentioned only one resident in the home was able to voice some opinion on the service and indicated satisfaction with the service. Feedback from relatives and visiting professionals indicated satisfaction with how the service was managed. Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 Page 21 The provider completed an annual audit of the service and sent a copy of this to the Commission. The last audit received for the service in August 2006 indicated that there was an overall satisfaction with the service. Regulation 26 reports were sent to the Commission regularly. Staff meetings were held and minutes kept showed that staff had input to the meetings. A number of safety records were inspected. These included fire safety, gas, hot water temperature checks and electricity. Hot water temperatures were satisfactory but the shower temperatures were not monitored. The manager agreed to review this. Fire drills were practiced and at times to include night staff. The home manager had completed the fire marshal training and provided fire safety training for staff. The manager was advised to update the premises fire risk assessment and had received guidance on this from the fire safety department. A report of a satisfactory environment health inspection completed by Bexley Council dated July 2007 was seen. Records were up to date and showed attention was given to providing a safe environment for residents and others. Two members of staff were trained to provide first aid and all staff received basic first aid training. Recommendation 4. Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 Page 22 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 X 2 3 3 X 4 X 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 4 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 3 34 X 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 X 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 3 X 3 X X 3 x Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 YA20 Regulation 13 Requirement Timescale for action 29/06/07 2 YA28 23 The medicine policy and procedure must be updated to reflect current practice in the home. The procedure must be updated to reflect how the disposal of medicines is managed. The premises must be well 22/06/07 maintained internally and externally. The garden fence must be repaired and the Commission informed in writing when this has been done. The garden area must be kept tidy and provide a pleasant area for residents. 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 YA6 YA9 Good Practice Recommendations Correction fluid should not be used on any records. The risk assessment process in relation to the use of bed DS0000006756.V335056.R01.S.doc Version 5.2 Page 24 Charlton Road 3 4 YA24 YA42 rails should be improved to ensure resident safety. A garden maintenance programme should be in place and seating provided to ensure residents have access to pleasant external surroundings. The hot water temperature of the shower should be monitored in the same way as other hot water outlets. Charlton Road DS0000006756.V335056.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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. 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