Inspection on 04/09/07 for Cote House

This inspection was carried out on 4th September 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cote House 31/08/06

Cote House 29/11/05

Cote House 18/07/05

Cote House 08/02/05

Cote House 05/07/04

Cote House 27/01/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Cote House Rowden Hill Chippenham Wiltshire SN15 2AG Lead Inspector Steve Cousins Key Unannounced Inspection 4 and the 25 September 2007 08:30 th th Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cote House Address Rowden Hill Chippenham Wiltshire SN15 2AG 01249 653760 01249 653888 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) milburycare.com/home.html Milbury Care Services Ltd Mrs Jennifer Boyne-Aitken Care Home 11 Category(ies) of Learning disability (2), Physical disability (11) registration, with number of places Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No more than 10 persons in receipt of day care at any one time No more than 2 persons with Learning Disabilities to be admitted to the home at any one time. 31st August 2006 Date of last inspection Brief Description of the Service: Cote House provides care with nursing for up to eleven people with physical disability. People who live at Cote House are adults between the ages of 18 and 65 years. The home offers long-term, short-term, and convalescent care. There are also up to four day-care places per day. Cote House is situated in a residential area, within easy reach of the centre of Chippenham. Accommodation is offered on the ground and first floors. All rooms have ceiling tracks for hoists. Wash hand basins are in all eleven single bedrooms and one room has an en suite bath. Bedrooms are available to accommodate wheelchair users and there is a passenger lift. Because the home is registered to provide nursing care, a qualified nurse is on duty at all times, supported by a team of carers. The service is operated by Milbury Care Services. This is a national private sector organisation, which is best known for its work in the learning disability field. Fees are negotiable but the current lowest fee is £1100 per week. Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 4th September 2007 in order to inspect all of the key minimum standards relating to care homes for adults aged 18 – 65. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the home and where possible, takes into account the views and experiences of people using the service. A number of records were inspected, including care plans, medication records and staff records. The inspector reviewed the care of four people in detail, male and female. They had varying physical and social needs. Some were new to the home and others had been there for some years. The care of other people was reviewed in less detail. Consideration was given to issues of ethnicity and diversity. Prior to this inspection, comment cards were received from four relatives of people living at the home. Their views were used to inform the inspection process and some are incorporated into this report. Other information was obtained from The Annual Quality Assurance Assessment (AQAA), which had been completed by the manager and sent to the Commission prior to the inspection. The registered manager was on leave during the day of the visit to the home therefore the inspector returned to the service on the 25th September 2007 in order to conclude the inspection. What the service does well: There are good opportunities for people to ‘test drive’ the home prior to moving in as day care and respite services are offered allowing them the opportunity to assess if the home is suitable for them. Once they have decided to move in, their needs are comprehensively assessed to ensure the home is able to give them the care and support they require. There continues to be a commitment to support people to try and maintain choice and independence in their lives, however those who are unable to do this due to their dependency and condition, are well looked after. Social activity both in and out of the home is provided and people are able to maintain links with family and friends. Relationships and communication between staff and people living in the home is good and there is a good atmosphere, with few complaints. The home is well managed and the manager and staff have worked hard to fully meet the requirements of the previous inspection. Quality assurance Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 6 systems are in place that ensures that those who live in the home and their advocates are consulted. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 7 be made available in other formats on request. Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 People’s needs are assessed before admission and they have the opportunity to make an informed choice about living at Cote House. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records of a person who was new to the home showed that the manager had undertaken a comprehensive pre admission assessment. Records of some previously admitted people also contained comprehensive assessments. In one case where assessment by a representative of the home was not possible, assessments from other suitable professionals had been obtained. People can visit the home before deciding whether to move in and Cote House also offers respite and day care services giving people the opportunity to ‘testdrive’ the home and get to know the staff and other people already living there. Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Individual plans are in place and the standard of planning and review has improved. Where able, people make decisions about their lifestyle and receive support in maintaining independence as far as is possible. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans reviewed indicated that there had been an improvement since the previous inspection. Assessments were more comprehensive and plans were reviewed more consistently. Where able, people are involved in compiling and agree to their individual plans. There were some areas that required further improvement in order to ensure best practice. One person had a care plan relating to eating and drinking, however a nutritional risk assessment had not been completed. Another person who attended for periods of respite had not had their plan fully reviewed on this admission. One person had some minimal pressure damage to their skin; Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 11 progress had been recorded in the person’s daily record, but a wound assessment tool had not been completed. Some people’s records indicated that bedrails were being used following appropriate risk assessments, however consent from either the person or their advocate had not been recorded. Not all people had their wishes recorded in relation to ‘end of life’ decisions, although the manager confirmed that progress was being made in this area. Although it is acknowledged that it was not possible for all of the people who live in the home, individualised plans indicated that some had made decisions about what support they require and how they would like to live. Sometimes this was with the aid of a relative or advocate. Examples included having staff support them to access the community for social interaction and preferences for getting up or going to bed. People who smoke are risk assessed and support is provided to ensure they can do so in safety. A person who enjoyed drawing was being supported in doing so. People are also supported accessing services and activities outside the home. One relative though the home was good at ‘Communicating and respect for the clients wishes and feelings’ Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 People are supported to engage in social activities both in and out of the home. They are able to maintain links with family and friends. There is a choice and variety of meals, although more freshly prepared food would enhance the current diet. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Due to their level of need, there are no people currently living at Cote House in employment or attending further education or training. An activity-coordinator is employed and works five days per week. An activity record is kept and a programme displayed on a notice board included in-house and external activity. Transport is provided when required. Personal home entertainment equipment was available in bedrooms and other entertainment equipment in the main lounge. Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 13 Where possible, people are supported to retain links with family and friends. One person told us that they remained in contact with their parent and another told of a friend who came to see them on a regular basis. There are no restrictions on visiting and visitors were seen in the home during the inspection. Comments from relatives included ‘ – the staff seem to go that extra mile to keep the residents happy and comfortable’ and ‘ –my brother is extremely happy here’. Staff members were observed asking people what they wanted to do and interacting with them when in communal areas. Some individual plans included information on how people wanted to live and be supported, including choices such as times for going to bed or getting up; and when to take a bath. Day and night profiles are compiled showing the usual routine preferred by each person as part of their care plans. People have keys for their rooms if they so wish. People’s opinion of the meals at Cote House was generally good. The meals are mostly of the pre-prepared, frozen variety but a good choice was available. The support assistants prepare meals. Three people spoken to by the inspector who were able to offer an opinion felt the meals were good. Records of meals served in one week were reviewed; these indicated that a choice was available. It is recommended that he home look to provide more meals prepared from fresh ingredients, which should be more nutritionally beneficial. Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 A good level of personal care and support is provided and health care needs appear to be met. Arrangements regarding medication are generally satisfactory but medication administration procedures should be audited in order to investigate discrepancies. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector visited the people whose care had been reviewed and found that equipment, aids and interventions were in place to meet their assessed needs. All appeared to have their personal hygiene needs met. One relative stated, ‘I cannot fault his care in any way’ and another felt that a positive aspect of the home was that it ‘gives continual care and medical attention’. As observed at previous inspections staff actively engaged people in conversation and explained what they were doing. Care records indicated that people had access to their General Practitioner and that staff responded promptly to any deterioration in health. A physiotherapist attends the home Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 15 weekly. Tissue viability and nutritional assessments were undertaken and people who were nutritionally at risk were being weighed regularly. The arrangements regarding medication were reviewed. There were no people who lived in the home who self-medicated. The medicine trolley was secured and other medicines stored in locked cupboards. Records of receipts and returns were kept and there was a register for controlled drugs. The medication fridge was at the right temperature and a record kept. There had been an improvement made in regard to ensuring medication sheets were signed following administration. A list of medication discrepancies indicated that some individual tablets had been recorded as found in the home. This was discussed with the manager for action, as no record as to why the discrepancy had occurred was evident. Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Complaints are minimal, but those received are dealt with promptly using the complaints procedure. As far as possible, people appear protected from abuse and neglect, but staff training in abuse issues could improve. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A complaints procedure entitled ‘Letting Us Know what You Think’ was available, along with large print and abridged versions; these were also contained in the service users guide. The home had received one complaint since the previous inspection, which had been dealt with promptly. No complaints have been received by CSCI. People who were able to comment indicated that they were well treated by the staff. One person commented ‘--- the staff are all friendly and caring to both residents and visitors –-‘. There had been no referrals to or from the local Vulnerable Adults Unit regarding Cote House. The manager reported that staff had been given information relating to the reporting of suspected abuse. As reported at the previous inspection, training records indicated that some staff had not received training in abuse issues. The manager stated that this was being addressed and further training was scheduled. The arrangements for handling people’s money were checked and found to be satisfactory. Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Improvement to the decoration and external areas has enhanced the environment for people living in the home. Response times to requests for environmental and equipment repairs have improved. Cleanliness and hygiene practice was good. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were marked improvements regarding the overall environment and staff and the manager reported that the company responded more promptly to requests for maintenance and repairs to equipment. The lounge and dining room had been redecorated along with the ground floor bathroom and nine bedrooms. The area to the rear of the home was much improved the area was tidy and the garden accessible, with some raised gardens constructed. The home is fully accessible for people who use wheelchairs. Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 18 Bedrooms were clean and tidy and the standard of cleanliness in the kitchen, bathrooms and sluice room was good. Food hygiene practice had improved. One relative commented ‘I have always found the home to be clean and comfortable ---‘. There were some improvements required. There was a slight odour in one room, which the manager was aware of and was trying to control, and one bedroom required repainting. A bath hoist in the first floor bathroom and a fire door closure required repair but the manager has since informed the Commission that this work has been completed. Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 and 35 Staff appear to be able to meet peoples needs and seem confident and effective in their roles. The skill mix is appropriate but some improvement is required with regard to the number of support assistants who have NVQ training and the provision of some mandatory training. Recruitment procedures protect the people living in the home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are currently eleven nurses and twelve support assistants employed at Cote House and the manager is actively recruiting further care staff. Two of the support workers have an NVQ and the manager reported that four are currently commencing NVQ. Throughout the inspection staff were observed to be accessible and to demonstrate an awareness of people’s needs. On the day of the inspection there were five staff on duty to support the ten people currently in the home. Duty rota’s indicated that there were normally between four to five staff on duty during the day and two at night. At least one Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 20 registered nurse was on duty at all times. Those people spoken to who were able to offer an opinion did not report any undue delays in the provision of their care and support. The recruitment documents of three staff were reviewed. These indicated that Protection of Vulnerable Adults (POVA) checks are obtained prior to commencing employment and Criminal Records Bureau (CRB) checks are requested and obtained. One staff member did not have any references on file in the home. The record indicated that these had been obtained and the manager stated that they were held at Milbury Care head office, which is current company practice. Other required documentation was in place. The training records of two staff who were new to the home indicated that they had received induction training. Individual training records are kept and the manager monitors mandatory training by use of a training matrix. Records indicated that staff had received training in mandatory subjects such as fire safety, infection control and moving and handling at regular intervals. Some required updating in food hygiene and health and safety. The manager was aware of this and further training had been planned. . Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 The manager is qualified and competent to run the home and is supported to do so. Quality assurance systems ensure that people are consulted about their views on the service. Health and safety arrangements to protect people living and working in the home have improved. Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is Mrs Jenny Boyne-Aitken. She is a first level general nurse who has the ENB 941 qualification in nursing elderly people. She is also a qualified NVQ assessor and internal verifier. Mrs Boyne –Aitken has been the manager of Cote House for over five years and has almost completed an NVQ Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 22 Level 5 in management. A deputy manager supports her and she is line managed by a Milbury Care Services senior manager. One relative commented that ‘The home fulfils all it’s duties in an exemplary manner’. Quality assurance systems consist of an annual questionnaire to people living in the home and/or their relatives, also monthly visits by a representative of the registered providers, Milbury Care Services, are carried out, during which individuals are asked their views on the home. Reports of these visits are produced and sent to the manager and to CSCI. Milbury Care has also appointed a regional quality assurance manager since the previous inspection. Residents meetings are now held and recorded. The manager reported that changes such as introducing additional activities, ensuring more staff available at peak activity times and improvements to the garden have been made following listening to the views of the people using the service. We reviewed the health and safety management arrangements in the home. Environmental risk assessments were in place and had been reviewed. Hot water temperatures were checked monthly at all outlets and radiators were covered or had low temperature surfaces. Safety checks for wheelchairs and the homes vehicle were carried out weekly, as per the homes policy. The fire log indicated that the fire safety checks were carried out at the required intervals and a fire risk assessment had been completed. Accidents are recorded and there had been none of a serious nature. The manager compiles a monthly accident return, which is sent to the Company’s regional office and then to a national health and safety director who decides if further action or investigation is required. The pre inspection questionnaire (AQAA) received from the home indicates regular maintenance of essential services and equipment. Manual handling equipment is available and rooms are fitted with ceiling hoists. Mandatory staff training includes moving and handling, infection control, food hygiene and first aid. Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 4 X X 3 X Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 24 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 YA7 Regulation 12 (2,3) Requirement The registered person is required to ensure that, where possible, consent is obtained and recorded for the use of bedrails. The registered person is required to ensure that medication discrepancies are audited. The registered person is required to ensure that staff receive training in work they are to perform in relation to: • Adult protection • Food hygiene • Health and safety Timescale for action 01/11/07 2 3 YA20 YA35 13 (2) 18 (c,i) 01/11/07 01/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA6 Good Practice Recommendations It is recommended that, where a care plan is in place with regard to nutrition, than that plan is based on a recognised nutritional assessment tool. It is recommended that when a person is frequently admitted for respite care, then their care plan be reviewed DS0000015901.V345978.R01.S.doc Version 5.2 Page 25 Cote House 3 4 5 YA6 YA17 YA23 at each admission. It is recommended that where required, a recognised wound assessment tool be used. It is recommended that he home look to provide more meals prepared from fresh ingredients, which should be more nutritionally beneficial. It is recommended that staff receive training in adult protection. Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Cote House DS0000015901.V345978.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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