Inspection on 18/10/07 for Churchfield Court

This inspection was carried out on 18th October 2007.

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.

Other inspections for this house

Churchfield Court 02/08/06

Churchfield Court 12/10/05

Churchfield Court 09/05/05

Churchfield Court 10/11/04

Churchfield Court 15/06/04

Churchfield Court 11/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Churchfield Court All Saints Way West Bromwich West Midlands B71 1RR Lead Inspector Mrs Jean Edwards Key Unannounced Inspection 18th October 2007 08:00 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 Churchfield Court DS0000004842.V345489.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 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. Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Churchfield Court Address All Saints Way West Bromwich West Midlands B71 1RR 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) 0121 588 5450 F/P0121 588 5450 Mr Anand Gunputh Mrs Amrita Gunputh Patricia Yvonne Dunkley Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 02/08/06 Brief Description of the Service: Churchfield Court is a residential care home registered to provide 24-hour care for 37 people over the age of 65. It is located on the A4031 (All Saints Way) at the junction of Newton Road and Heath Lane, opposite All Saints Church. West Bromwich town centre, Sandwell General Hospital and Sandwell Valley Park are nearby and there is easy access to public transport networks. The home was purpose built for the care of the elderly and has twice been extended. There is a small patio area and gardens at the rear of the property with a raised shrub border. Paths extend round to the front where ample parking is available. Accommodation is provided over two floors with access to the first floor via the main staircase and passenger lift. There are 31 single and 3 twin bedrooms all of which have en-suite toilets and washbasins. Communal space includes 3 lounges and 2 dining rooms. A statement of purpose and service user guide is available to inform residents of their entitlements. Though the documents do not include the level of fees and information regarding fee levels has not been provided to the Commission for Social Care Inspection. Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the key inspection visit for 2007 - 8, undertaken by an inspector from the Commission for Social Care Inspection (CSCI). The inspector has spent eleven hours on a weekday at the home. All Key National Minimum Standards have been assessed at this visit. The range of inspection methods to obtain evidence and make judgements includes: discussions with the deputy manager and acting deputy manager and staff on duty during the visit, discussions with residents and examination of a number of records. Other information was gathered before this inspection visit from the AQAA (Annual Quality Assurance Assessment, notification of incidents, accidents and events submitted from the home. Service user surveys, relatives and healthcare professional surveys were sent to the home by the CSCI. An analysis of the survey forms from service users, relatives and health care professionals responses is contained throughout this report. Responses are generally positive. There are currently 33 residents living at the home. During the visit the inspector spoke to the majority of residents. Longer discussions have taken place with the residents whose care was looked at in depth. The inspection has included a tour of the premises, including the grounds, communal areas of the home, the bathrooms, toilets, laundry, kitchen areas, and residents’ bedrooms, with their permission. What the service does well: The home provides comprehensive information for prospective residents and their representatives, assisting people to make decisions, which are right for them. The residents are very complimentary about the care and support they receive with comment such as: All responses from relatives surveys state they have sufficient information, including the comments, I visited many care homes before I selected one for my mother. This one was clean and cheerful and very helpful. Seems to offer better value for money, and they have regular meetings to which relatives and friends are always invited. There is a wide range of organised and spontaneous activities and outings for residents advertised on notice boards in the communal areas. The home has a supply of games, puzzles and quizzes, which are enjoyed by residents. Residents’ are supported to go out regularly on trips and outings for example to church, West Bromwich, the Cotswolds and Walsall Lights. There are also people who come to the home to provide crafts, exercises and entertainments. Residents spiritual needs are met with visits from church groups to the home, Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 6 with services, and arrangements are made to support any resident who wishes to go to church. Comments from the CSCI relatives survey include, better than expected. They respect my mom and her wishes. She has always been very insular and has never mixed well with other people. They have encouraged her to mix but also her leave her to have time for herself. A really good balance has been reached. The home is clean, comfortable, homely, and maintained to good standards comments from residents and relatives include, very clean and tidy home, all staff work very well together, very clean facilities, very compassionate carers, good food, and the care home is very clean and bright. Residents all look clean and comfortable. The staff are caring, knowledgeable about the residents needs and they are welcoming and friendly. Comments from the relatives survey about what the home does well are, my mom has been ill with a severe chest infection for 12 weeks, the home kept in regular touch. As I am in the process of moving the way it is not always possible for me to visit regularly. Sally has been an absolute star and really helpful. The management of this home show a strong commitment to training and developing staff, which means that the residents benefit from their skills and knowledge. The registered person and acting deputy managers have put in place quality and monitoring systems, which actively involve residents, relatives and staff across a number of areas of the home, including how care is provided, menus, activities, and the environment. This inspection was conducted with full co-operation of the proprietor, registered manager, staff and residents. The atmosphere through out the inspection was relaxed and friendly. The Inspector would like to thank staff, and residents for their hospitality during this inspection visit. What has improved since the last inspection? The registered persons have met 5 of the previous 9 requirements and two of the remaining requirements are partly met. In addition 1 of the 3 previous good practice recommendations has been met. The way the home plans each persons care is improving with more detailed and specific written information providing staff with clear guidance about each persons needs and preferences. At this visit additional areas needing fuller detail have been discussed. Health care assessments are generally good, with measures in place to minimise risks of falls and risks involved in moving and Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 7 handling people. There are also records on each persons file, showing that there is good access to specialist medical, chiropody and dental care. The homes system for the management and administration of residents medication has been improved in a number of areas, though as a result of this visit there are additional minor improvements needed, so that residents are safeguarded as far as possible. The registered person, acting management and staff have created an environment, where comments and concerns are welcomed as an opportunity for the home to improve. The staff are also receiving additional training to improve the ways they can safeguard the residents. Comments from the relatives survey state, the home is my moms home, thats how she feels. They are open to suggestions and are willing to accept them. We suggested fruit out so residents could choose to eat it if they wanted to. My mom likes to eat fruit. They now display fruit so residents can choose what they want, and look after the residents, despite very trying circumstances on occasions, some of the residents can be very awkward, and verbally abusive to staff and others. On an occasion I witnessed they kept very calm but firm with the person and isolated her from the situation until everything calmed down and they did this whilst under duress and with a lot of patience. The home has a maintenance, redecoration and renewal programme, and a new assisted bath has been provided, with redecoration of bedrooms and carpet replacements as needed. What they could do better: The home is putting in place new care records, which need to be completed with accurate and up to date information. A small number of health care assessments need to be improved. Minor improvements are needed to make the homes system of medication administration as safe as possible. Health care screening records should accurately reflect the current needs of residents, and be updated when the residents needs change. The registered person has provided a new assisted bath on the first floor for the use of residents whose bedrooms are on the first floor. However mattresses, Zimmer frames and other equipment in currently not in use are stored in this bathroom, which must be cleared of such items and be cleaned appropriately so that it is accessible and in a suitable condition for residents to use. Staffing levels have been assessed during this inspection visit and are not always satisfactory to respond to the residents needs in a timely way. Therefore the registered person must make sure that there are adequate acting management arrangements, with sufficient managerial time to supervise and support staff. In addition to the person managing the home there must be a minimum of 5 care staff on duty during all daytime shifts. The registered person must make sure that the acting managers formally and regularly assess Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 8 the number of residents living at the home, together with their levels of dependency and adjust staffing levels to meet all residents needs. The home must submit weekly staffing rotas to the CSCI until further notice, as evidence that the staffing levels are adequate. Comments from the CSCI relatives survey include, additional staff to make more individual attention available and it could do with more staff. At times, those in situ are very busy which does lead to a delay in calls for assistance from residents being answered. However if there is an emergency situation, there is a good and fast response The homes Annual Quality Assurance Assessments (AQAA) submitted to the CSCI should contain fuller information and better detail of the supporting evidence of what the home does well and how the improvements have been made. The registered persons and manager should make additional improvements to the homes staff training programme, for example to include equality and diversity training. As noted in the previous inspection report, although the Registered Person visits the home regularly, he must also provide the persons running the home and the CSCI with a detailed monthly report on the conduct of the home. Only one report is available at this inspection visit. Regulation 26 visits and written reports with the findings must be provided on a consist basis. At the previous inspection visit a requirement was made that the home must ensure that fire doors are not wedged open and if a resident wishes their door to be kept open, an automatic closure device must be fitted. During this inspection a residents bedroom door has been propped open without a device linked to the fire alarm system. Action must be taken to provide appropriate devices, approved by the West Midland Fire Service, as a priority, to safeguard residents. There are also a small number of additional areas relating to health and safety, which need improvement. 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. Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 9 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 Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Standard 6 is not applicable. Quality in this outcome area is good The home has a statement of purpose and service user guide. This has the effect that residents and their advocates generally have good information regarding their rights and entitlements, any agreed restrictions and how care will be provided. The home uses comprehensive assessment tools, which means that residents’ needs are thoroughly assessed to ensure that care needs will be met. The home actively encourages introductory visits and there is evidence to demonstrate that people have been given the opportunity and time to make decisions, which are right for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a statement of purpose and service user guide, providing good clear information about the home. The service user guide includes a copy of the contract/terms and conditions of residence, however it does not contain Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 11 actual details of the level of fees charged, which would be good practice. Copies of the statement of purpose and service user guide, the complaints procedure and recent CSCI inspection Reports, together with information about visiting times and advocacy services are located in the reception area. Examination of residents case files and discussions with residents and relatives confirm that they have been given copies of the homes statement of purpose, service user guide and complaints procedure. There is evidence from the CSCI service user and relatives surveys and from a sample of case files that each resident is provided with a contract / statement of terms and conditions. From discussions and observations there is evidence that all prospective residents and families have an invitation to visit before coming to live at the home. The acting deputy manager states that all care records are currently being revised and updated and not all of the sample of 4 residents case files contained records to demonstrate decisions and outcomes of visits, or reasons why a visit has been declined or was not able to take place. There are currently 33 residents accommodated. Discussions with acting deputy manager and assessment of the AQQA information supplied by the home, indicates an awareness that if and when residents deteriorate and they may need care, which the home is not able and not registered to provide, they are supported to access a more appropriate placement. The examination of a sample of residents records and discussions with relatives and staff confirm that the assessment is conducted professionally and sensitively and has involved the family or representative of the resident. Though the assessment information on two of the four residents case files examined have not been signed by the resident / or relative. Individual preferences are recorded such as rising, retiring, likes and dislikes, preferred gender of staff to give assistance with personal care. Although the deputy manager states each resident and / or their family has written confirmation to confirm the persons admission to the home and the home can meet all assessed needs, a copy of this correspondence is missing from the newest residents file. The staff show that they are aware of residents needs, and there are generally good records of each residents preferences such as rising, retiring, likes and dislikes, which reduces risks posed by reliance on verbal communication between staff. Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is good The care planning, risk assessments and monitoring generally provides staff with the information they need to satisfactorily meet residents needs. There is generally good multi disciplinary working taking place on a regular basis, which results in the health needs of residents being well met. The home has good arrangements for administration of medication, which safeguards residents health and well being. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The deputy manager and acting deputy managers are in the process of introducing improved care plans. All residents have a plan for their care needs, with some evidence of the involvement of the person and their family where appropriate, in the development and review of the plan, which demonstrates good practice. However two out of the sample of four care plans assessed have not been signed. The acting deputy states that the transfer of information from the existing care plans to the new format is not yet complete on any of the files. One person has complex needs, with diabetes, a skin condition and MRSA Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 13 and these are not included in the care plan. The plans must demonstrate how all needs are being met and provide detailed guidance for staff, for example there needs to be fuller details of foot, oral care, nutrition, and medication regimes, especially for people with diabetes. The care plans generally include beliefs, contact with relatives, physical abilities, healthcare & personal care needs, mental health and communication. Two care plans examined did not contain photographs of the residents, even though one was admitted in June 2007 and the other July 2007. The plans do give good information about each persons preferred daily routine. There are monthly checklists of personal care provided, however records have some gaps, for example there is no indication of what care was given to a resident, who was unwell in September, on several days during the month. Another residents personal care checklist has large numbers of gaps, which the acting deputy manager explained could be because this person sometimes refuses the care offered or undertakes part of their own personal care. The residents choices and decisions should be recorded as such. There are a range of risk assessments in place, though the tissue viability assessments do not indicate what preventative measures are in place, such as pressure relieving mattresses, turn charts etc., for residents deemed to be at high risk. There are residents noted to display aggressive behaviour in records examined and currently there are no written risk assessments or documented strategies to monitor and manage incidents. One resident has a nutritional screening assessment in place, which indicates at risk and has been weighed monthly showing a weight loss of 12lbs (from 9 stone to 8 stone 2lbs) in 4 months. There is no clarity about a referral to the GP and community dietician, for investigation, support and advice. Food choice records at the home are not sufficiently detailed to indicate whether this residents food intake is adequate for her needs, especially as she has diabetes. There is little documented information to demonstrate changing actions in care plans. Although the acting deputy manager and staff can verbally describe how short term care needs are met, for example one person has recently had a chest infection and has needed more care in bed and in her own room, with a course of antibiotics and needed extra fluids, however none of the actual information or practice is documented, as part of this persons care. During discussions some residents and relatives have confirmed their involvement in developing the plan and feel they receive feedback on decisions made during reviews. All care plans sampled contain evidence that they are audited monthly, signed & dated by the persons key worker. However notes are brief and basic, such as no problems and no change. There are, however, changes to two of the residents. One has increasing care needs, the other person has improved, the catheter removed the resident is now fully continent. Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 14 There is evidence that generally the acting deputy managers and staff are proactive in seeking professional advice on health care issues, acting upon it and generally able to access the aids and equipment recommended. The comments from the health care professional surveys and from visiting district nurses are generally positive about relationships with staff at this home. A district nurse visiting the home to give residents their Flu vaccinations, has stated that, staff are very friendly, helpful and knowledgeable about the residents, the home is always clean and residents look well cared for, there are good communications at the home. She states that the home tends to keep residents at the home when they are ill and deteriorate, which is positive, but however not necessarily increase staffing accordingly and sometimes the home appears to be short staffed. District nurses have also noted increased requests for visits to attend clusters of skin tear injuries to residents lower limbs. Examination of accident records and nursing notes substantiate the concern. During the tour of the home a care assistant has used a wheelchair to transport a resident from one room to another, without making sure the footplates are in place, which poses risks to the residents lower limbs. These issues have been discussed with the acting deputy managers. There is documentary evidence that all residents have appropriate access to dentists, opticians, chiropodists and other community services. The healthcare survey from the dentist contains the very positive comment, This home is well organised. I always fill out a dentists visits folder. The carers are very helpful, always to hand. The home has a medication policy, accessible for staff guidance. Staff involved in medication administration have received medication training from and demonstrate a good awareness of the use and effects of medications in the home. Medication records are generally up to date for each resident and medicines received, administered and disposed of are recorded. Any residents who wish to administer some or all of their own medication are supported to do so, with systems in place so that this can happen safely, including risk assessments. Where medication systems are in need of improvement action, there is confidence that the registered person is working to achieve the improvements. Minor improvements are required as a result of this inspection, for example, there are 3 gaps on the records of medication administered, which need to be fully recorded on MAR sheets, whether it has been given or not with a code to denote the reason and as directed dosages need to be clarified in a small number of records. From observations and discussions there is evidence that staff are aware of the need to treat residents with respect and they consider personal dignity when delivering personal care. The home arranges for residents to enjoy the privacy of their own rooms any time they wish. The residents say that are happy with Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 15 the way that the staff deliver their care and show them respect. Comments from the relatives survey include, they take good care of the people in their care and treat them kindly and they encourage my mother to do what she can manage herself and help her with everything else. Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. There are planned and spontaneous activities available on a which give residents opportunities to take advantage of and stimulating activities. Residents cultural and spiritual needs majority of residents are able to maintain good contact with regular basis, develop socially are well met. The family and friends. Dietary needs of residents are generally well catered for with a balanced and varied selection of food that meets residents tastes and choices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is evidence that the residents and relatives are able to discuss what makes them happy and make comments if they feel improvements can be made. Evidence from the CSCI residents and relatives survey forms and from discussions during the inspection visit indicates that staff listen and make genuine efforts to enable residents to enjoy a good quality of life. There are residents meetings at the home every 3 months, with notes to show that a range of topics is discussed and ideas shared. Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 17 The home has a key worker system, which enables closer relationships between residents and staff, where likes, dislikes and needs are understood. There is evidence that Key workers use information to plan activities, which residents will enjoy. There is a good level of activities, especially relating to residents with sensory difficulties. The activities and events are well advertised on the homes notice boards. A number of residents enjoy outings, including visits with members of their families. The acting deputy manager states that residents are supported to go shopping for Christmas presents, and a trip had taken place the evening prior to this inspection visit to go to see the Walsall Illuminations. There are activities arranged at the home, such as someone who comes to do crafts. The residents also enjoy exercise sessions and entertainers are regularly booked to provide entertainment at the home. During this inspection visit there has been some interaction between residents, however a large number of residents need assistance or support from staff to move around the home. During discussions some people say that they prefer to spend their time on their own in their own bedrooms, with individual interests. The staff team are well aware of individual residents decisions, which are respected and supported. A response from the CSCI relatives surveys comments, communal TV aerial reception can be poor, if possible can this be boosted? For many of the residents, this is their only entertainment for most of the day. The home needs to investigate and take action this matter. There are two residents who are active members of the local church and take themselves to the early morning Sunday service. These residents also go out from the home unescorted, for walks and local outings. The home also has visits from the local Bethel Chapel, which the residents enjoy. There is evidence that family and friends of the residents feel welcome and know they can visit the home at any time. The visiting policy and visitors book is located in the reception area. All visitors are greeted and requested to sign in and out of the home for safety and security reasons. It has been indicated that staff always make time to talk to visitors and share information with the agreement of the resident. There have been a number of visitors to the home during this visit. Those spoken to have spoken positively about the care and attention, stating the management and staff are always friendly and ready to listen and help. During the tour of the premises it is evident that residents are able to have personal possessions in their room, though there may be some restrictions, for example larger items of furniture, which may be due to space restrictions or health and safety considerations relating to the residents bedroom. There are inventories of residents personal possessions on the sample of files examined, however two inventories examined have not been signed or witnessed. Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 18 The home has a 4-week programme of menus offering meal choices, and residents are asked daily which food they want for each meal. Breakfast generally comprises: porridge, assorted cereals, toast, marmalade or jam. Residents are asked for their choice of main meals for the following day. On the day of this inspection visit lunch comprises: mixed grill or sausage casserole, followed by apple pie with cream or custard or fruit or yogurt. The cook is experienced, consults with residents and tries to meet the preferences and suggested dishes when preparing the menu. Resident surveys indicate that all residents say they are happy with the food provided and this is confirmed in discussions during this inspection visit. A resident has commented, the food is very nice. Residents are able to enjoy the flexibility of meal arrangements and can eat in their own room, or at a small table in one of the sitting rooms, if they wish. Though most residents are encouraged to have their meals at the tables in one of the dining rooms. There is evidence that staff willingly make drinks for residents at any time. The food is good quality, well presented and generally meets the dietary needs of most residents. The staff do their work well and are sensitive in their approach to help those residents who need help when eating. However it has been noticed that during this visit staff are rushed to attend to the differing needs of residents in this large home and during tea-time care staff have several times been called from the kitchen and dining rooms to help with residents needing to use the toilets. This potentially compromises infection control guidance. In addition the acting deputy manager also needed to help in the dinning rooms because the staffing levels are insufficient to allow meals to be provided in a calm, unhurried environment. Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. Complaints are listened to and action is taken to look into them, and there are systems to record investigations and outcomes. Arrangements for protecting residents are generally satisfactory. Policies, procedures, guidance and staff training are being implemented, which safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has complaints procedure displayed in the reception area and contained in the service user guide. Information supplied as part of the homes Annual Quality Assurance Assessment (AQAA) indicates that the home has not received any complaints since the last inspection in August 2006. From the results of the service users survey, all respondents indicated that they are aware of how to raise concerns and use the homes complaints procedure. The acting deputy managers indicate that they use residents meetings to discuss the homes complaints procedure. The home has not received any allegations relating to abuse of vulnerable residents. There is a copy of the multi-agency procedures to safeguard adults, Dudley MBCs Safeguard and Protect and Sandwell MBCs updated procedures to safeguard adults, at the home. There is currently no documentary evidence Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 20 to demonstrate that staff have been given time to read and make themselves aware of the safeguarding procedures. It is strongly recommended that staff signatures be obtained to show that they are aware of the up to date versions of safeguarding procedures and good practice guidance. The homes policies and procedures regarding protection of residents are generally satisfactory. Progress is being made to provide all staff with appropriate training to respond to the need to safeguard residents at the home and most staff spoken to are able to discuss what action to take in the event of any allegation or disclosure. Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,24,26 Quality in this outcome area is good. The positive changes to the décor and furnishings are continuing. The incremental improvements contribute to creating a pleasing and pleasant environment for residents to live in. The grounds are generally well maintained to provide a safe, pleasant and stimulating outdoor environment for residents to enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Churchill Court is a large bright and cheerful home and efforts have been made to make it homely and domestic in style. There are attractive gardens and garden furniture for the residents comfort and enjoyment. There is a maintenance programme, which provides assurance that there are plans to maintain the high standards for the environment. The gardens are generally well laid out and are well maintained, with tress, shrubs and plants. Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 22 During the tour of the entire building, a sample of bedrooms has been viewed, with the residents permission. Residents bedrooms, all with en-suite facilities, are well maintained and individually decorated providing pleasant personal living space. Several residents have small amounts of medication in their bedrooms; mainly creams and these are not currently stored securely and may pose risks, especially to residents with impaired capabilities. The home has communal bathing facilities, comprise 3 communal bathrooms and 1 communal shower room in the home. The home has a new assisted bath on the first floor, however the acting deputy manager states that this not well used. It is cluttered with extraneous items, such as 3 used mattresses, 1 wedge, and 2 Zimmer frames. It is evident that this bathroom cannot be adequately cleaned, whilst being used as storage for such items and is not accessible or pleasing for residents use. The kitchen is generally in good order and there are a wide variety of nutritious food supplies. There are records of the fridge and freezer temperatures and cooked food temperatures. However as at the previous inspection visit there are dried foods, such as cereals and flour, which are de-canted, not in appropriately sealed, pest proof containers and without the “best before” date and of the date of opening. In addition there are opened containers of sauces, not refrigerated or labelled with date of opening. Frozen food is disorganised, not stored correctly, with pastries, cooked foods and raw meats in same compartments. The large chest freezer in the kitchen has a broken hinge on the lid, rendering it unsafe. The acting deputy manager has taken action with catering staff to rectify the all food safety concerns during this inspection visit; and the registered provider has provided evidence that a new chest freezer has been ordered and will be delivered within 5 working days. There are records of residents’ likes and dislikes and the food chosen by each person, though these are not sufficiently detailed to demonstrate a nutritious daily food intake, as noted at the Health & Social Care section of this report. The laundry is well organised and it is sited on the ground floor away from food serving or preparation areas. There are hand-washing facilities, sluicing functions within industrial washing machines and guidelines for effective infection control. The laundry procedure clearly states disolvo sacks must be used for soiled or infected linen, and though there are infectious conditions at the home at present, the home does not currently have a supply of disolvo sacks available on site to effectively contain any outbreak or other acquired infection. The registered person has stated that a supply will be sourced and be available as a priority. The residents surveys all indicate that the home is “always” fresh and clean. During the tour of the home no malodours have been detected apart from the bedroom, where a resident has the MRSA infection in a wound, which is being Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 23 attended by the district nurses. During discussions residents indicate that they are comfortable, the home is clean, warm, well ventilated, and well lit. There are three spacious communal rooms and two dining rooms and residents are able to generally sit where they wish, though some people are protective of what they consider to be their space. The following is an additional summary, though not an exhaustive list of improvements needed resulting from the tour of the home: To provide the resident in bedroom 33 with a key for his room To run through any hot water outlets not frequently used, on a weekly basis, with documentation in compliance with Legionella risk assessment To renovate the badly scuffed side of bath in ground floor bathroom 1 To renovate the badly scuffed side of bath in large ground floor bathroom where hoist causes damage To rectify the corrosion on underside of bath hoist in large ground floor bathroom To provide over bed light cover and pull cord in bedroom 33 To replace the light in the main stairwell, which is not working To repair or replace the loose door handle on the large freezer in the store room To replace the yellow storage container, with the broken lid in the food store room To ensure the microwave interior is maintained in a clean condition To clean and renovate the wall mounted store cupboards to maintain their integrity for food safety Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. Staffing levels have been increased; despite more care staff residents are not always receiving timely and consistent care. The staff morale in this home is generally good, though staff appear rushed at times. Recruitment practices are generally robust, with appropriate vetting and checks completed, providing adequate safeguards for vulnerable residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are currently 33 residents accommodated, with a variety of dependency levels and diverse needs. Assessment of staffing rotas show that though there are staffing levels of 4 care staff on each day shift, supplemented with support from the deputy manager and acting deputy manager, at times there is evidence to show that at times some residents are having to wait for attention and staff are having to rush from one task to another. Examples are highlighted in the Health & Social Care and Daily Life sections of this report. The registered proprietor and deputy managers must regularly take action to identify residents dependencies and occupancy levels and regularly review staffing levels, making appropriate adjustments, especially with the use of additional staff if any resident needs extra care. Assessment of the AQAA submitted, staff files and staffing rotas during the visit show that 10 staff have left the homes employ since the last inspection Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 25 visit in August 2006 and although some new staff have been recruited, the home does not have accurate information about how many vacancies remain unfilled. The home is actively recruiting to fill vacancies, evidenced by the number of phone calls received at the home during the inspection visit by prospective applicants. The AQAA information indicates that 17 of the 19 care staff have achieved an NVQ level 2 care award. The deputy manager states that there are an additional 2 staff undertaking NVQ 2; 2 senior staff undertaking NVQ 3 and 2 deputies undertaking NVQ 4 and the Registered Managers Award (RMA). This means that the home is able to demonstrate that it exceeds the ratio of 50 of care staff with an NVQ 2 (or equivalent) award. The sample of 4 new staff personnel files examined is generally satisfactory, with application forms, an interview questionnaire, 2 written references and confirmation of satisfactory CRB and POVA checks. The home’s application form has been revised to require a full employment history, however this has not yet been implemented. Therefore one candidate has not provided a full employment history, and it is unclear as to whether there are any gaps in this persons employment history. The proprietor / deputy managers continue to demonstrate strong commitment to staff training and development. They participate in training initiatives and provide support measures such as supervision and staff appraisals. There is documentary evidence of a thorough induction to meet the Skills for Care common standards and staff receive at least 3 days paid training each year. The home has a training needs analysis and training plan and individual staff training profiles in place. During discussions it is evident that staff are knowledgeable about what residents needs are and how to meet them and there is a warm rapport with both residents and visitors. Staff spoken to generally feel that morale is good, that they are valued and that they are know what their responsibilities are, and what is expected of them, though there are times when they are stretched. Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 26 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,25,37,38 Quality in this outcome area is good. The registered provider and acting management arrangements strive to provide good leadership, and there are generally good communication systems, with staffing feeling well supported. There is continuing progress to regularly review aspects of the homes performance through a good programme of self-review and consultations, which include seeking the views of residents and relatives, staff and other professionals. Residents can generally be assured their financial interests are safeguarded and the standards of records are generally improving, which reduces risks to residents. This judgement has been made using available evidence including a visit to this service. Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 27 EVIDENCE: The Registered Manager, who has worked at the home since 2000 is currently away on extended, planned, leave of absence. She was appointed as registered manager in May 2005 and has relevant qualifications. The registered proprietor has put in place arrangements for her leave to be covered jointly by the deputy manager; Sharon Higgins and acting deputy manager; Sally Starkey. They are job-sharing the responsibility for the running of the home, roles, which they evidently take very seriously. They are currently undertaking training to achieve the NVQ level 4 and Registered Managers Award (RMA). There is evidence that there is mutual respect and clear understanding each persons role, responsibility and accountability. It is evident that the arrangement is working well and people work well with each other. The home has a quality assurance-monitoring package, which includes tools for obtaining feedback about the homes performance from residents, families and other stakeholders in the wider community, which is being successfully implemented. The home has a documented annual development plan and has collated responses from resident surveys undertaken in 2007, with results, which are positive available in the reception area of the home. There is evidence that that staff and residents meetings take place regularly, with minutes available. These show a record of views and decisions reached. The Registered Person visits the home regularly, and he has been present for short periods during this inspection visit. Regulation 26 reports have not been submitted to the CSCI as previously required; one report dated October 2007 is available at the home at this inspection visit. The registered provider must provide the persons running the home and the CSCI with a detailed monthly report on the conduct of the home on a consistent basis. Discussions have taken place relating to the new Regulation 24, requiring the home to submit an annual AQAA on request by the CSCI and it is recommended that the registered manager proactively use this as an additional quality assurance tool. In addition the evidence to support statements made in the AQAA need to be more detailed, as the evidence will be tested and verified during future inspection visits. Residents have the opportunity to manage their own money if they wish, though most have families who manage financial affaires for them. The Home has secure facilities for the small amounts of residents cash held in temporary safekeeping. A sample of balances and financial records examined is satisfactory. There are improvements to records keeping, which include generally very comprehensive pre-admission information, including Sandwells Single Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 28 assessment, where applicable, new care plans, and daily records, though there are still records requiring minor improvement such as risk assessments, medication records, residents photographs and staff records. However the general office diary is being used to record personal and sensitive information such as X is verbally aggressive ............. nephew wants doctor to him and Dr re X depressed and confused and Y has had cream applied and Z has had bath. This information must be recorded and held on personal files in compliance with the Data Protection Act. The random assessment of a sample of health and safety and service maintenance records examined shows that they are generally satisfactory. A small number of records are not available, for example the home must have Legionella and Asbestos risk assessments in place. There is evidence that mandatory training is being sourced and provided for all staff on an on-going basis. At the previous inspection visit in August 2006 a requirement was made that fire doors must not be wedged open, if, for the convenience of the service user, the door is to be kept open, an automatic closure device must be fitted. However during a tour of the premises the bedroom door of a resident being cared for in her room on the first floor is propped open. This outstanding requirement must be actioned as a priority. One resident now uses compressed oxygen and also uses an oxygen concentrator in her bedroom, which is appropriately stored. However authorised signage must be obtained and this must be included in the homes fire risk assessment, and there must be evidence advising the West Midland Fire Service of oxygen on the premises. There have been 70 recorded accidents involving residents in the past 12 months. The registered person must expand the system for auditing, analysing and evaluating accidents involving residents, so that this shows effective measures, such as the review / revision of risk assessments and involvement of other health professionals, as necessary. Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 3 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 3 X X 3 X 2 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 2 2 Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 30 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 OP7 Regulation 15(1) Requirement The registered persons must ensure that the process of transferring to the new care planning formats is completed with accurate information, with plans signed by the resident and / or their representative. It is the home’s responsibility to notify the CSCI when this requirement is met. 2 OP7 15(1) 1) The registered persons and manager must ensure that care plans are expanded and developed to provide more specific guidance for conditions such as diabetes, hypertension, and Parkinsons disease. 2) To devise and implement short-term care plans for shortterm care needs such as infections and need for antibiotics It is the home’s responsibility to notify the CSCI when these requirements are met. Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 31 Timescale for action 01/01/08 01/01/08 3 OP8 12(1) 13(1) 1) To ensure that the resident discussed during the inspection visit is referred to the community dietician, diabetic nurse specialist and specialist health promotion nurse for advice and monitoring 2) To ensure food intake charts are put in place and monitored for this resident 3) To ensure there are weekly weight records to monitor weight loss / gain 4) To devise and implement written risk assessments and documented strategies to monitor and manage incidents of residents aggressive or violent behaviour It is the home’s responsibility to notify the CSCI when this requirement is met. 01/12/07 4 OP9 13(2) 1) To ensure that any medication, including creams kept in residents bedrooms is stored securely al all times 2) To ensure the administration of all medication is recorded on MAR sheets or other approved alternative records such as for creams and so on kept in residents bedrooms 3) To clarify as directed dosages on MAR sheets with the prescriber and / or pharmacy provider 4) To ensure all medication is given in accordance with manufacturers instructions, for example Mebeverine to be given 01/12/07 Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 32 20 minutes before meals 5) To ensure that any handwritten entries on MAR sheets are dated, signed and witnessed by 2 appropriately trained staff 6) To obtain and display approved signs for oxygen storage and use, warning inflammable gases It is the home’s responsibility to notify the CSCI when these requirements are met. 5. OP19 23(4) Fire doors must not be wedged open. If, for the convenience of the service user, the door is to be kept open, an automatic closure device must be fitted. (Timescale of 30/09/06 is Not Met) It is the home’s responsibility to notify the CSCI when this requirement is met. 6. OP21 23(2)(j) The fist floor bathroom with the new assisted bath must be cleared of extraneous items (3 mattresses, 1 wedge, 2 Zimmer frames) and be maintained in a state of cleanliness fit for residents to use. It is the home’s responsibility to notify the CSCI when this requirement is met. 7. OP27 18(1)(a) The registered persons must 01/12/07 ensure that there are at all times suitably qualified, competent and experienced staff working at the care home in such numbers as are appropriate for the health and welfare of service users DS0000004842.V345489.R01.S.doc Version 5.2 Page 33 01/11/07 01/12/07 Churchfield Court (Timescale of 30/08/06 is Not Fully Met) It is the home’s responsibility to notify the CSCI when this requirement is met. 8 OP27 18(1)(a) 1) The registered persons must increase the care staff on duty throughout the day to a minimum of 5 suitably qualified, competent and experienced staff, including a designated senior carer, with immediate effect 2) The registered persons must ensure that there are sufficient ancillary staff on duty during each day, including weekends, so that catering and cleaning duties do not detract from care hours provided, with immediate effect 3) The registered persons must ensure that residents dependency levels are formally assessed and documented and demonstrate on the staff rotas that staffing levels are being maintained at adequate levels to meet residents needs 4) The registered persons must submit weekly staff rotas to the CSCI for consideration until further notice It is the home’s responsibility to notify the CSCI when this requirement is met. 9 OP29 19(1) Application forms must contain a full employment history. (Timescale of 30/09/06 is Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 34 01/12/07 01/11/07 Not Fully Met) It is the home’s responsibility to notify the CSCI when this requirement is met. 10 OP33 26 The Registered Person must visit the home at least once a month and prepare a report on the conduct of the home. A copy of this report must be forwarded to the Commission. (Timescale of 30/09/06 is Not Fully Met) It is the home’s responsibility to notify the CSCI when this requirement is met. 11 OP37 17(1) To cease to use the general diary 01/11/07 to record personal and sensitive information about residents or staff; all information must be recorded, held, stored and disposed in compliance with the Data Protection Act 1998 It is the home’s responsibility to notify the CSCI when this requirement is met. 12 OP38 13(4)(5) 1) To ensure that the use of oxygen is recorded on the homes fire risk assessment and notified to the West Midlands Fire Service 2) To ensure that there is an up to date - Legionella Risk Assessments - Bacteriological Test - Asbestos Risk Assessments Documentary evidence to be submitted to the CSCI 3) To ensure all wheelchairs are fitted with footplates, to be used Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 35 01/12/07 01/12/07 at all times (any resident declining their use must have a documented risk assessment in place) It is the home’s responsibility to notify the CSCI when this requirement is met. 13 OP38 13(4) To undertake a documented audit of residents sustaining skin tears with details of incident, treatment and risk assessment - to be submitted to CSCI until further notice To ensure footplates on wheelchairs are used at all times when transporting residents It is the home’s responsibility to notify the CSCI when this requirement is met. 01/12/07 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 OP3 Good Practice Recommendations That the pre-admission information is signed by the resident/relative as well as the manager to demonstrate their involvement and agreement That the monthly reviews and reassessments accurately reflect the residents needs, avoiding terms such as no change where clear changes have occurred That a copy of the written confirmation to the resident that home can meet their assessed needs is held on their case file 2 OP4 3 OP4 Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 36 4 5 OP7 OP7 That all residents care plan / case file contains their photograph That personal care checklists are fully completed and where residents refuse offers of baths / showers or undertake part of their own personal care this should also be indicated on the record to avoid unexplained gaps It is recommended that the home produce a brief Pen Picture of each service user, which gives details of their personal history as well as information of the contact and support they can anticipate from family and friends when they move to the home. Not fully Met It is recommended that Care Plans contain more detail on the process of care, i.e. how the service user likes the particular intervention to be carried out. Not fully Met It is further recommended that following the monthly review; the care plan is signed and dated by the reviewer to confirm that the review has taken place. 6 OP8 7 OP8 8 9 OP8 OP8 That tissue viability assessments and care plans identify pressure relieving equipment for residents at high risk That there is clear documentary evidence of actions taken to refer any resident with significant weight loss or poor appetite to the GP and community dietician for advice and support 1) That the homes document for the residents consent to medication administration be fully completed on the residents case file 2) That a list an up to date of the residents medication is maintained as part of their care plan 10 OP9 11 OP14 That inventories of residents personal possessions, including furniture and valuables are maintained up-todate and signed by the home, resident and / or their representative It is recommended that the home’s kitchen be provided with a mincer or liquidiser. Not Met It is recommended that when dried foods are de-canted, the date of opening and the best before date be noted on the container. - Not Fully Met 12 OP15 Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 37 13 14 15 OP18 OP24 OP26 That staff signatures are obtained to demonstrate that they have read and are aware of the Sandwell multiagency safeguarding procedures for adults That the resident in bedroom 33 be given a key for his room That all kitchen equipment and appliances are maintained in clean, working order and food safety regulations are diligently followed That all staff are provided with equality and diversity training, from a recognised training provider That the homes Annual Quality Assurance Assessments (AQAA) submitted to the CSCI should contain accurate, verified information and fuller details of the supporting evidence of what the home does well and the improvements made and to how needs for equality and diversity are met 1) That the home has an up to date copy of the DoH Infection Control Guidelines for Care Homes 2) That decanting chemical products should be avoided wherever possible; all decanted products must be labelled with the same level of data in compliance with COSHH REGS 1999 3) That the home has a supply of disolvo sacks available in the laundry, examples: red for soiled linen, white for infected linen 4) That mop heads are laundered daily at thermal disinfection temperatures 5) That the small area of exposed plaster around sink in laundry is renovated as an infection control measure 16 17 OP30 OP33 18 OP38 Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Halesowen Local Office West Point Mucklow Office Park Mucklow Hill Halesowen B62 8DA 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 Churchfield Court DS0000004842.V345489.R01.S.doc Version 5.2 Page 39 - 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!