Inspection on 14/12/05 for Desmond House Ltd

This inspection was carried out on 14th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 12 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Desmond House Ltd 18/12/06

Desmond House Ltd 06/06/06

Desmond House Ltd 19/07/05

Desmond House Ltd 01/03/05

Desmond House Ltd 19/07/04

Similar services:

Whiteley House

Tyndale Avenue

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Residential Home

Sign Health

Springwood

Fairburn Mews

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

CARE HOME ADULTS 18-65 Desmond House Ltd 16-18 Desmond Avenue Hull East Yorkshire HU6 7JZ Lead Inspector Angela Sizer Unannounced Inspection 09:30 14 December 2005 th Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 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 Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 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. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Desmond House Ltd Address 16-18 Desmond Avenue Hull East Yorkshire HU6 7JZ 01482 448865 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) Desmond House Ltd Mr Colin Achmed, Mrs Sharon Achmed Mr Graham Achmed Care Home 19 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (19), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (19) Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registration category MD(E) is to enable service users already resident in the home to remain there upon reaching pensionable age (as long as the The registration category MD(E) is to enable service users already resident in the home to remain there upon reaching pensionable age (as long as the home can continue to meet their needs). 19th July 2005 Date of last inspection Brief Description of the Service: Desmond House is a care home providing accommodation and personal care for 19 persons who are subject to enduring mental health disorders. The category for older people is to allow individuals to make the accommodation their permanent home. The care home is privately owned. The accommodation consists of two adjacent semi-detached houses. It is situated close to Beverley Rd a main thoroughfare into the centre of Hull. The home has 13 single and three double rooms, two of the single rooms and one double room have ensuite facilities. There are two lounges and a dining room. There is a garden to the rear and a small parking area. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over 7.5 hours. Prior to the visit 2 hours preparatory work was carried out. Sharon Achmed, Senior Carer and Co-Owner and Graham Achmed, Registered Manager/Co Owner helped with the inspection. A tour of the premises was undertaken and a number of records were looked at including residents’ and staff files. All of the service users and two of the staff were spoken to find out what people thought of the home and their comments have been included in this report. The inspector would like to thank the residents, manager and staff for welcoming her into the home and contributing to the content of this report. During the inspection it was noted that the home had not had a recent inspection of the electrical wiring and this was out of date. An official letter was left at the home to tell the registered manager and registered provider that these must be put right straightaway. Once the work is completed and the electrical systems confirmed that they are safe, a copy of the certificate issued must be sent to the CSCI. What the service does well: What has improved since the last inspection? Some of the paperwork has improved and is better organised. Some improvements have been made to the general décor of the home. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 6 Staff have received training in relation to mental health issues and the training programme is currently being further developed. 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. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 4&5 Prospective residents have the opportunity to visit the home prior to making a decision about moving in. Residents receive a contract or statement of terms and conditions, this does not fully inform them of the services offered. EVIDENCE: Several of the residents were spoken to during the inspection with regard to what happened when they moved in. All of who confirmed that they visited Desmond House and spent some time with the other residents and staff before they made the decision whether or not to move in. One person stated, “I visited and stayed overnight, I had my meals and got to know the other people who lived here”. Each resident is given a contract/statement of terms and conditions from the home, this does not fully inform them of what services and support are included within the fee. The contract under point 8 also states that; Wilful and deliberate damage caused by a resident to Desmond House, service users and staff’s property, the service user responsible must compensate for said damage. One resident has been made to compensate for damage to the home, the registered manager and co-owner stated that this occurs on a regular basis, but the resident has only being charged for one incident. There was no written record of a multi-disciplinary agreement and the resident’s capacity to understand this contract is limited and this compromises the protection of the resident from abuse. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 & 10 The residents’ files did not contain sufficient detail in either the care plans nor the risk assessments in order to meet the assessed needs. Individuals’ needs and choices are not supported fully, none the less the residents’ felt that their needs were being met. EVIDENCE: Three of the residents’ files were looked at and the content within the care plans and risk assessments remained minimal, as stated in the last inspection report. These would benefit from the inclusion of more detail relating to the assessed needs and how the care plan is implemented with specific direction to the care staff. Residents were able to confirm their knowledge of the care plan and risk assessment documentation and some had signed these. Risk assessments either referred to their being no risks or to specific risks associated with the service users medical condition. Service users were able to describe living a independent life style with risks that were not addressed in the assessment. It is recommended that the written documentation contain a full assessment of their risks in the daily processes of living. During this inspection and two previous visits one of the residents had spoken to the inspector about wishing to move to a single room, he had explicitly Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 10 expressed this and the registered manager stated that when a single room became available that this would be offered to that person, this has not happened. The registered manager stated that there have been no vacancies, but the home has admitted a resident into a single room during the last twelve months, there was no documentation available for inspection that would confirm that the resident had been offered this room. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 13 & 17 Residents are encouraged to lead an independent lifestyle. Outings and social events occur on a regular basis. EVIDENCE: Throughout the inspection the residents were spoken to confirming that staff and management encourage them to go out and take part in appropriate activities. Several of the residents go out on a regular basis, attending various places including community centres, community groups, college. Some comments made were; “Graham likes us to go out it helps our confidence”, “I go to the college every Friday and meet people”. Other less able residents do remain in the home day and night, residents stated that sometimes activities occur in the home such as bingo and parties on special occasions, but they also confirmed that this is how they like it. On the day of the inspection one of the co-owners visited the home and offered to take some of the residents to a local pub for a soft drink or coffee, around three residents took up this offer and upon their return stated that they had enjoyed this outing. Residents confirmed that they felt part of the local community, one person stated that they went to the local shops every day and everyone knows them. One resident said, “ I am really happy here and I know the area and feel safe”. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 12 The home offers a varied and nutritious menu, the week’s menu is displayed on the notice board in the dining room. Residents confirmed that they “really liked the food” and that they “get lots”. Staff spoken to also stated that they know what the residents like and dislike and who requires larger portions etc. None of the current residents required any assistance with feeding. Lunch on the day of the visit consisted of soup and sandwiches and tea was cottage pie, vegetables and dessert. It was presented well and was appealing to the eye, the registered manager confirmed that fresh produce is used. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 & 21 Resident’s physical and emotional needs are not fully met. The medication procedures protect residents and staff are trained with regard to administration. EVIDENCE: On the whole the physical and emotional needs of residents are met, evidence of dental, optical, chiropody appointments are on file. Residents also confirmed that they do see their GP and Psychiatrist on a regular basis and if necessary staff assist them to go. During a tour of the building it was identified that one person has MRSA, the staff member informed the inspector that all staff had received infection control training and were aware that when dealing with any personal care they must wear plastic aprons and gloves. The home did not provide any alcohol gel for staff to use in or near to the resident’s bedroom, staff said that they put clinical waste into a waste bin that had carrier bags in it, this is then transferred outside to a yellow clinical waste bag. The resident’s laundry is kept in an open laundry basket and transferred to the laundry room without using sealed bags. The home must contact the Environmental Health Department and seek further advice as to the correct procedures for storing and transporting soiled clothes and laundry. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 14 Since the last inspection the medication procedure has been adhered to and staff are now signing at the point of administration. All staff have received accredited medication training from the pharmacist. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23 The residents’ protection is not always safeguarded. EVIDENCE: From speaking to two staff members it was clear that they understand what constitutes abuse and the need to deal with this in accordance with the home’s procedure. They stated that they had received some basic training in relation to the Protection of Vulnerable Adults and this was cascaded to them by the Registered Manager. As stated in Standard 5, the contract issued to the residents’ requires them to pay for any damage they may cause to the home, regardless of their capacity to consent or capacity to understand their behaviour, there was no multidisciplinary agreement in place. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27 & 30 Some improvements to the décor have been made. Some of the service users individual accommodation does not fully meet their needs. There were areas within the home that were not clean and hygienic. EVIDENCE: Over the past twelve months some improvements to the décor within the home have been made. Although the general condition of the home remains fair, there are some areas in need of urgent attention. The flooring to the main lounge, dining area and No 16’s hallway and landing requires replacing. The toilet (13) floor was in poor condition and the walls in need of freshening up. Some of the resident’s bedrooms have been decorated to a good standard and personalised by the individuals. When speaking to residents they confirmed that they had everything that they needed in their room, one resident said, “I like my room, I have a wireless and comfortable bed that is all I need”. Another resident had bought a computer and music system and was proud to show these off. It was noted that the majority of the beds did not have a valance sheet fitted and this could be considered institutional. When discussed with some of the residents they confirmed that it would be homely to have the beds covered fully. The registered manager stated that he did not feel this area to be important. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 17 Most of the home was clean and tidy, but in bedroom 11 and bedroom 16 there were offensive smells. The bed sheets in room 16 were pulled back and found to be smeared with faeces; there was also a very strong smell of urine. As stated earlier in the report the procedure for dealing with infectious diseases requires attention. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 & 36 The home does not have a staffing level, which would support all the needs of the service users. The service provider’s recruitment practices and records do not protect service users and are unsafe. EVIDENCE: These standards relating to staffing remain the same as stated in the previous inspection report. Each member of staff is issued with a contract detailing hours worked, tasks performed and responsibilities. The home operates on the basis of two care staff per shift with the manager being included in the rota, the actual care hours is 391.50. Residents confirmed that there was insufficient staff time to give residents individual time and attention. The residents also commented that matters are very stretched if any of the residents are exhibiting difficult behaviour. The staffing level is that agreed by the previous regulating authority and under current protocols the home is not required to meet the current standard, under the new guidance from the Residential Forum the home would have to provide a minimum of 488.90 care hours. A recommendation is made that the staffing level be reviewed with a view to making the manager’s hour’s supernumery. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 19 Since the last inspection some basic mental health training has been undertaken by most of the staff. From speaking to them they confirmed that they felt more confident when dealing with individuals and felt they understood more about the residents’ problems. Four of the homes staff have an NVQ qualification. It is currently recommended that 50 of staff become qualified by the end of December 2005. The files of three staff were examined including those of two staff recently starting work in the home. Two of the staff did not have a completed application form. Only one staff had two references, but these were addressed to a children’s home and not to Desmond House, the others no references. All the staff had a CRB check but two were from previous employers and need to be repeated for this employment. None of the staff had made a health declaration. The current recruitment process is unsafe and a requirement is made that the matter be put right within a short timescale. Residents declared belief that the service provider’s recruitment practices protected them was misplaced. From speaking to two staff members it was confirmed that support is offered from management on an informal and formal basis. Formally this is not always on a regular basis and is required to take place at least 6 times per year. The recording observed was of a good standard and included issues relating to key worker roles/responsibilities and training areas required. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38 & 42 Residents do not always benefit from how the home is run, although they confirm that they are happy with the conduct of the management and staff. There are some outstanding issues with regard to health and safety and therefore currently does not provide a safe place to live. EVIDENCE: In general it was observed that staff and management speak to and treat resident’s with some respect, listening to their wishes and providing a good standard of care. In relation to the management of the home both residents and staff stated that the manager and co-owners were available at any time and also that they were “approachable with any problems”. The registered manager stated that he has commenced the NVQ level 4, but has made a decision not to continue. The company have decided to support the deputy manager to achieve NVQ level 4 in Care and then progress onto the Registered Manager’s Award, after which an application will be made for her to become the new Registered Manager. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 21 From inspection of the maintenance records it was identified that the home’s electrical wiring certificate was out of date and therefore the residents’ safety could be compromised. An immediate requirement was issued giving the home 7 days to respond. A telephone call was received on 20.12.05 in relation to an electrician having visited the home, but further work is required in the New Year in order to make the system safe. Once the electrical work is completed a copy of the electrical wiring certificate must be forwarded to the CSCI. The home does not have much written paperwork in relation to health and safety the documentation is basic, it is recommended that the home seeks further advice and direction from the Health and Safety Department. Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X 3 2 Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 1 X 2 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X 3 X X 1 LIFESTYLES Standard No Score 11 3 12 X 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 2 2 1 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Desmond House Ltd Score X 2 3 3 Standard No 37 38 39 40 41 42 43 Score 2 3 X X X 1 X DS0000044243.V263720.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? 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 YA5 Regulation 12,13,17 Requirement The registered person must ensure that the contract/statement of terms and conditions states what services are included or not included in the fee. The registered person must ensure that the care plans give detail of all needs and direction to care staff on how to implement these. The registered person must ensure that all residents sharing double rooms be offered available single rooms if required, documentation of this to be kept. The registered person to further develop the existing risk assessment in order to include all aspects contained within the assessment of need. The registered person must seek advice and direction from the Environmental Health Department or Infection Control with regard to the procedures for dealing with MRSA. DS0000044243.V263720.R01.S.doc Timescale for action 14/03/06 2 YA6 15,17 14/03/06 3 YA7 12,13,17 14/03/06 4 YA9 12,13,17 14/03/06 5 YA19 12,13,16 14/03/06 Desmond House Ltd Version 5.0 Page 24 6 YA23 7 YA24 8 YA30 9 YA34 10 YA36 11 YA42 12,13,16,17,37 The registered person must ensure that if a resident is to be charged for damages, then a multi-disciplinary agreement is in place and where possible the resident or advocate to consent. 23 The registered person must ensure that the home is maintained in a comfortable and homely way, the carpets in the main lounge, small lounge, dining room, hallway and landing (No 16) require replacing. Toilet 13 requires redecoration and the flooring replacing. 12,13,16,23 The registered person must ensure that the home is free from offensive odour, clean and hygienic. 19, Sch 2 The registered person must obtain all the following information in respect of person working in the home. -An Application form -Evidence of identity -Two written references -A current CRB check -A statement by the person as to their Physical and mental health (Previous timescale 11/02/04 – not met) 12,13,17,18 The registered person must ensure that supervision with staff is undertaken at least 6 times per year and is recorded. 12,13,16,17,23 The registered person must ensure that the electrical wiring is checked and a copy of the electrical wiring certificate to be forwarded to CSCI. An immediate requirement was issued in relation to this timescale to achieve 7 days. DS0000044243.V263720.R01.S.doc 14/03/06 14/06/06 14/03/06 14/03/06 14/03/06 21/12/06 Desmond House Ltd Version 5.0 Page 25 12 YA42 12,13,16,17,23 The registered person must 14/03/06 seek advice and direction from the Health and Safety Department with regard to having a professional check on the water system, work practice risk assessments and COSSH assessments. 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 YA24 YA33 Good Practice Recommendations The registered person should ensure that the residents’ bedrooms are homely and provide valance sheets to all beds. The registered person should review the homes staffing level in the light of the changing needs of service users and also with a view to the manager’s hours becoming supernumery. The registered person should ensure that 50 of care staff are trained to NVQ level 2 by the end of December 2005. The registered manager should have achieved NVQ level 4 in both Care and Management by the end of December 2005. 3 4 YA35 YA37 Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Desmond House Ltd DS0000044243.V263720.R01.S.doc Version 5.0 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. 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