CARE HOMES FOR OLDER PEOPLE
Combe House Central Drive Walney Island Barrow in Furness Cumbria LA14 3HY Lead Inspector
Ray Mowat Unannounced Inspection 2nd June 2008 09:00 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 Combe House DS0000036531.V365406.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. Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Combe House Address Central Drive Walney Island Barrow in Furness Cumbria LA14 3HY 01229 473617 01229 476336 combe.house@cumbriacc.gov.uk www.cumbriacare.org.uk Cumbria Care Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Melanie Louise Williamson Care Home 40 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (40) of places Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The registered person may provide the following category of service only: Care home only: Code PC, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Dementia over 65 years of age: Code DE(E) (maximum number of places: 12). Old age, not falling within any other category: Code OP (maximum number of places: 40). The maximum number of people who can be accommodated is: 40. Date of last inspection 29th January 2008 Brief Description of the Service: Combe House is a purpose built residential care home, which is owned by Cumbria County Council and operated by Cumbria Care, an internal business unit of the Councils Contract services group. The home is registered to accommodate forty people over sixty-five years of age, including up to ten people with dementia and a person with a mental disorder. The home is single storey and divided into four distinct living units, with all the units being fully accessible. They each contain ten bedrooms, bathrooms, toilets, a good size lounge with kitchenette and dining area. It is situated on Walney Island near the town of Barrow-in-Furness. It is in a residential area of the island and is on a main bus route and close to local amenities. The home has been designed and equipped to meet the needs of the residents. It is in its own grounds with gardens to the front and rear and off road parking is available. Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 5 The monthly fees range from £363 per week to £422 per week with additional charges for personal sundry expenses. The service user guide and statement of purpose are made available to prospective new residents and previous inspection reports are displayed on the notice board in the foyer. Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 6 SUMMARY
This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes.
During the visit we (The Commission) met with people living in the home, visitors and relatives and spent time with the manager and supervisors on duty. I also met with care staff individually and talked to them as they went about their duties. The previous manager completed a self-assessment questionnaire called an Annual Quality Assurance Assessment, which was used for this inspection. This provided us with information about how the home is run and the manager’s views on what the home does well and where they need to improve. There is also information about people living in the home and the staff. The views of people living in the home, their relatives, staff and other professionals were used to formulate the judgements made in this report. We also examined records relating to the running of the home as required by legislation, including personal care plan files. These provide staff with information about what is important to a person and how they like to live their lives. We also examined staff files and records relating to the maintenance and safety of the home. What the service does well:
The new manager is ensuring all new people who wish to move into the home are having their personal and healthcare needs assessed to ensure the home has the skills and resources to meet their needs. The home is working closely with a number of other agencies on an ongoing basis to enable them to provide appropriate care and support to people with challenging or specialist needs. Care plans have been kept under review making sure that any changes in need are recorded and a consistent service maintained. Health care needs are well documented with clear guidance in place for staff about the support people require. Strategies have also been developed with input from other professionals to support and guide good practice. Changes to the existing care plan were clearly recorded, signed and dated, which is good practice. Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 7 Medication is securely stored with good systems in place for the safe management and administration of medication in the home. People we met during the inspection were “happy” with the care they received, “we can choose when to get up and what we do”. One person when describing their experience of the home said, “no place can be perfect for everybody all the time but this place is as good as it can be”. Based on our own observations, staff were respectful and had a good knowledge and understanding of individuals and how they like to live their lives. The home is providing a good range of social events and activities for people both in the home environment and in the local community. People living in the home and staff commented about how they “enjoyed the trips and looked forward to future events”. A good choice of food is provided with special diets and requests catered for. Mealtimes were a relaxed social occasion with staff supporting people in a discreet and sensitive manner ensuring they receive sufficient nutrition. The home is safe and comfortable with the decoration and furnishings maintained to a good standard. There is good access throughout the home and grounds with suitable aids and adaptations in place to promote people’s independence. Over 60 of staff have completed their NVQ qualification and further three people are working towards the qualification. This level of training is good practice and should be continued. The new manager has settled in well and is aware of the strengths and areas for improvement within the home and is providing clear good leadership, supervision and support. Regular meetings are held with people living in the home and care staff to enable them to contribute to the running of the home and represent their views. Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 8 What has improved since the last inspection?
The assessment process has been reviewed and a new person centred assessment is being introduced that will provide a comprehensive and individual assessment of a person’s personal and healthcare needs. Based on this assessment person centred care plans will be developed with the person that will ensure the service provides a personalised package of care and support. The content of care plans are being regularly reviewed with changes and new information clearly recorded, signed and dated. Medication systems in the home including storage arrangements have been reviewed and a new monitored dosage system introduced. Staff have received training in the use of the new system and the number of errors has reduced. The tarmac paths have been treated to ensure they are free from moss and safe to use. The home has identified and infection control link person who takes a lead role in ensuring the systems and procedures within the home are in line with current good practice. The Infection Control nurse has completed an audit of the home with recommendations being implemented. A new two week staff rota has been implemented and all staff vacancies have been recruited to which will improve the staff levels in the home and the cover arrangements for staff absences. The manager is in the process of conducting staff appraisals to ensure an appropriate training programme can be developed. The manager is working closely with the supervisory team to ensure all staff receive regular formal supervision on a regular basis. Through regular monitoring the manager is aware of issues and concerns as they arise. Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 9 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. Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 10 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 Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 11 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home needs to ensure all people moving into the home are provided with suitable information about the terms of their stay and they all have their needs assessed consistently. EVIDENCE: Since the last inspection visit the new manager has reviewed and updated the home’s service user guide. This now includes up to date information about all aspects of the service. The manager is planning to provide an additional brochure to give new and prospective residents that will provide them with pertinent information about the home. The home has a contract of terms and conditions that they issue to people when they chose to move into the home. We examined the personal files of two people who had recently moved in, however although both people had a contract on file, only one of the contracts had been completed, signed and
Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 12 agreed by the person or their representative. The contract of terms and conditions should be agreed and signed when a person chooses to move into the home so that they know and understand the conditions of their stay in the home. The home is introducing a person centred assessment process that will provide suitable information for the home to develop more person centred care plans. We examined three people’s care plan files one of which included a person centred assessment. This was comprehensive and informative and gave you a real insight to what is important to a person in their life and how they prefer to be supported and cared for. They include a pen picture, which really brings the care plan to life. It is recommended that person centred care plans are introduced for all new people admitted to the home. The home is working closely with other agencies such as the community support team and community health team to support people with challenging or specialist needs. Ongoing assessments and recordings are being maintained so that information can be analysed and care plans updated, to ensure appropriate strategies are in place and a consistent approach by staff that supports people’s individual needs. On the whole people are confident their needs can be met when they move into the home. Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 13 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Improvements to the assessment and care plan process have continued with staff maintaining more detailed and consistent records that ensure all personal and healthcare needs are being appropriately recorded and responded to. EVIDENCE: With the introduction of the new person centred needs assessments and care plans relevant information about a person’s personal and healthcare needs are being recorded. The home is planning to ensure everyone living there has a person centred care plan in place, which will enable staff to provide a consistent and reliable service that meets their individual needs and promote their independence. One of the three care plans examined was in the new format and was very informative and an improvement on the current style of care plans. All the care plans examined were up to date and had been regularly reviewed and updated as changes occurred. Changes were clearly recorded, signed and dated, which is good practice.
Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 14 The staff are keeping a record of all health interventions including any specialist assessments. The home works closely with a range of health professionals to ensure people’s individual needs are being responded to appropriately. There were good examples of staff making timely referrals to other agencies when needs have been assessed, including pressure care concerns, nutritional screening and GP referrals. These interventions are being recorded in detail on care plan files to ensure all staff are aware of needs and are providing a consistent service. We checked the contents of the medication cabinet against the medical records held by the home. These were found to be up to date and in order. The home has recently changed to a new monitored dosage system. All relevant staff have received training in the use of the system. The manager felt this has been a positive move and has reduced the number of errors in the home as each medication is stored and administered individually. All prescribed medicines were securely stored with appropriate amounts of medication retained. PRN (as and when required medication) were recorded with clear protocols developed for staff, based on the advice of the person’s GP. This ensures staff administer medication consistently. Feedback from people who live in the home, who were spoken to during the inspection or returned a survey to us, was on the whole very positive. People said they were “happy in their home”, and “well looked after by lovely staff”. People know who to speak to if they are not happy and how to make a complaint. Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. The home is now providing a good range of social activities and are encouraging and supporting people to lead independent and fulfilling lifestyles both in the home environment and in the local community. EVIDENCE: Since the last inspection visit the staff hours have been reallocated to enable staff to organise and support activities both in the home and in the local community. There is a central notice board and a notice board on each unit that is used to advertise daily activities and trips. This ranges from staff providing 1-1 support so that someone can go for a walk to the local beach or it may be a group activity such as a craft group or a film club, which are proving to be popular. Also the increased number of trips to local attractions outside the home has been well received such as trips to the local theatre, a tea dance and a local museum. Other information recorded on the notice board included the daily menu, the staff on duty and the weather for the day. The manager is also producing a regular newsletter, which includes local community news and news about what is happening in the home and future events and planned activities.
Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 16 Staff maintain a record of all activities to ensure a good range of activities are provided and different people are able to participate. People spoken to were very enthusiastic about the new activities saying how much they had enjoyed them. House meetings are used to get ideas and feedback from people about what they have enjoyed and future events or activities they would like. From this one person who lives in the home has given a talk to other residents about their hobby and recently a group of people enjoyed having ‘drinks and nibbles’ while watching a football cup final. This type of consultation and flexible approach is good practice and has been beneficial to the people living in the home. I joined a group of people for a lunchtime meal, which was served from a hot trolley on the unit. There was a choice of two hot meals with alternatives provided on request. The food was well-presented and nutritional providing people with a balanced diet and suitable choice. The majority of people said the food was “good” and there was a “choice of food available”. The home has improved their monitoring of food and fluid intake and nutritional assessments were in place with weight monitored on a regular basis and appropriate referrals made for advice and support when dietary issues or concerns were raised. Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. Suitable policies, procedures and guidance are in place for staff, which ensure people’s rights are protected and they are safeguarded. Staff training in this area should be strengthened. EVIDENCE: Since the last inspection there have been no new complaints received by the home. One existing complaint is currently under investigation. The home’s policy and procedures are made available to people and are displayed in the home. People said they knew how to complain and who to complain to if they were unhappy or wanted to raise a concern. The home is operated by Cumbria Care, which is part of the County Council and therefore have adopted the Council’s safeguarding Adults practice guidelines and policy. These ensure vulnerable people are safeguarded and staff are clear what their role and responsibilities are. Training has not been taking place consistently, which has resulted in some staff not receiving appropriate training or not having their training updated. Based on discussions with the care staff and a supervisor on duty they had a sound understanding about identifying and responding to actual or suspected abuse. Three adult protection referrals have been made since the last key inspection visit, which were all appropriately referred to relevant agencies and investigated.
Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 18 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, 22, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Combe House provides a safe and comfortable home that is well maintained. EVIDENCE: During this inspection we spent time in the communal areas of the home. These were on the whole well maintained and decorated and furnished to a good standard. The home is clean and hygienic with dedicated domestic staff in place that maintain the environment. There were no obvious hazards noted during this visit with the home having their own internal system to monitor and maintain a safe and comfortable living environment. This includes a condition survey, which is an audit of the condition of the home resulting in a planned programme of maintenance. Moss was being removed from footpaths with a contract in place to maintain their safety.
Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 19 There were various aids and adaptations in place around the home to support and promote people’s independence and maintain their safety and the safety of staff. These included mobile hoists, grab rails, handrails and bath hoists. In addition photographs and pictures have been attached to the doors on people’s rooms to help them identify their own room and therefore increase their independence. Survey responses confirmed the home is “clean and fresh” and people we met were happy with the condition of the home. Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 20 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. This judgement has been made using available evidence including a visit to this service. Staffing levels are improving in the home. The recruitment process is good and ensures staff are safe and suitable. EVIDENCE: The home has recently recruited staff for all the vacant posts although not all of them are in post as they are going through the vetting process including Criminal Record Bureau checks and references. The organisation has robust recruitment procedures that ensure all staff are suitable and safe to work with people. Staff files were examined which were up to date and contained relevant information. Staff said that “staffing levels are improving, we are providing more activities and staff absences are being covered the majority of the time now”. Once all the new staff are in post this situation should be further improved. During this visit there were suitable numbers of staff on each unit resulting in their being a relaxed atmosphere in the home. People said that staff were “always willing to help and never too far away”. Over 60 of staff have completed their NVQ qualification and further three people are working towards the qualification. This level of training is good practice and should be continued.
Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 21 The manager is introducing appraisals that will identify people’s training and development needs so that they have the opportunity to maintain their skills and knowledge. At the moment staff training is inconsistent. The manager should ensure a programme of training is developed for the home that will meet the needs of the staff team. Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 22 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, 32, 33, 35, 36, 37, 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The new manger is providing sound leadership and is ensuring people are involved in the running of the home. EVIDENCE: A new manager has been appointed, Hazel Whiteoak who now needs to register with the Commission. Mrs Whiteoak is suitably experienced with 27 years nursing and management experience. She is planning to undertake the registered manager award in July 08. Both people living in the home and the care staff said the manager was “approachable”. Staff talked about getting “good support and supervision from the manager and supervisors”. Feedback from staff on the whole was they
Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 23 “felt positive about the home and that it was improving” and that the “new manager was getting to grips with the issues”. The rotation of staff around the home was ‘bone of contention’ with some staff, whilst others felt it was a positive move. The manager is monitoring the situation and will be consulting with staff at the regular team meetings. The home has an annual quality assurance questionnaire, which is issued to all people living in the home and other interested parties. In addition regular house meetings have been held which provides people living in the home with the opportunity to feedback their thoughts and feelings to the staff and manager. Key workers also meet regularly with the people they are allocated to, which is another opportunity to discuss issues or concerns. The manager has introduced a formal structure to ensure all staff receive regular supervision and annual appraisals. The manager is supervising the supervisory team who in turn provide supervision and support to the care staff. The manager meets regularly with the supervisors to monitor and review their workload and ensure good practice is followed. Staff said they “felt valued and contributed to the smooth running of the home”. Records required by regulation were examined and on the whole were up to date and accurate ensuring a safe environment is maintained. Although the fire risk assessment had been recently reviewed it should be checked to make sure it takes account of the new fire regulations. Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 24 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 3 2 2 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X 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 2 3 X X 3 X X 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 X 3 3 3 2 Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 25 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 OP31 Regulation 8 Requirement The new manager must now register with the Commission for Social Care Inspection. Timescale for action 01/09/08 Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 26 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 OP2 Good Practice Recommendations The contract of terms and conditions should be agreed and signed when a person chooses to move into the home so that they know and understand the conditions of their stay in the home. It is recommended that person centred care plans are introduced for all new people admitted to the home and existing residents. All staff should receive training relating to protection of vulnerable adults to enable them to safeguard the people in their care. The manager should ensure a programme of training is developed for the home that will meet the needs of the staff team. The fire risk assessment should be reviewed to make sure it is in line with new fire regulations. 2 OP3 3 4 OP18 OP30 5 OP38 Combe House DS0000036531.V365406.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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
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