Inspection on 12/05/05 for Douglas Jackman House

This inspection was carried out on 12th May 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Douglas Jackman House 29/10/07

Douglas Jackman House 15/06/06

Douglas Jackman House 18/01/06

Douglas Jackman House 18/03/05

Douglas Jackman House 10/08/04

Douglas Jackman House 02/02/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Douglas Jackman House 1 Weymouth Avenue Dorchester Dorset DT1 1QR Lead Inspector Sophie Barton Unannounced 12 May 2005 10:00 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 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 Stationary 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. Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Douglas Jackman House Address 1 Weymouth Avenue, Dorchester, Dorset, DT1 1QR Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01305 251598 01305 268972 Dorset County Council Gillian Caroline Joslin CRH 14 Category(ies) of LD - 14 registration, with number of places Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Staffing levels must be those determined in accordance with guidance recommended by the Department of Health. Date of last inspection 01 February 2005 Brief Description of the Service: Douglas Jackman House is registered to provide accommodation and care to 14 adults who have a learning disability. The home provides for long-term and 1 short-term placements. It is situated in the town of Dorchester, within easy walking distance of the shops, restaurants, pubs and leisure facilities. The accommodation comprises of several communal areas and has a garden to the rear of the property, which has patio seating and a summerhouse. It is a three storey house, with bedrooms on the ground, first and second floors. There is no lift. Staff is provided 24 hours a day. The majority of service users attend Day Centres during the week. Staff support service users with their personal care, social, and emotional needs. Staff have experience in communicating with adults who have a learning disability, and the home’s philosophy includes aiming to increase the service user’s independence skills and community integration. Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between the hours of 11.00am and 4.30pm and was unannounced. During this time there were five service users at home. All were seen and spoken with, two privately. The Manager, two senior support workers, and a support worker were also spoken with during the course of the inspection. A service user showed the Inspector around the house. Two care files were examined in detail, including the service users’ medication and financial records. Health and safety files were seen, complaints log, staff recruitment files, home’s diary and staff communication book, and resident meeting minutes seen. What the service does well: What has improved since the last inspection? There has only been a very short period of time between the two inspections – less than 2 months, therefore many of the recommendations and requirements have not been actioned or practice improved. However of particular note is the home’s drive to increase the independence of service users, with service users being encouraged to do more household tasks themselves. Care plans have become more user-focused with goals and aspirations being listed and reviewed each month. Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 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 standard(s) 2 and 3. Systems are in place to ensure that prospective service users’ needs are fully assessed and known to the home. Service users placed out of category do not have their needs met. EVIDENCE: As detailed at the last inspection, a service user was recently admitted to the home, who’s needs fell outside of the home’s registration category and as described in the home’s Statement of Purpose (mental health needs). The Manager did confirm that notice has been given to the Purchasing Team and a date agreed for discharge, as the home cannot meet her assessed needs. The home has developed pre-admission assessment forms for social workers to complete for any prospective service user. There was evidence that these had been completed for recently admitted service users. The home also develops its own assessment of the service user’s needs (based on the referral information, consultation with the service user and their relatives, and Community Care Assessment and Plan. Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 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 standard(s) 6, 8 and 9 The Individual Service Planning/Care Planning undertaken by the home for each service user does not sufficiently ensure that there is a detailed care plan for each service user, and therefore there is no singular documentation that informs the service user of how the home plans to meet their assessed needs. Risk, behaviour and care management in the home needs to be more individual to each service user and promote independence. Service user participation in the home is promoted by staff. EVIDENCE: The Inspector considered that the documents used for care planning do not fully address how the home is to meet the service users’ everyday needs. For example one file detailed that a service user liked going to the pub, but no detail provided about how the home is to support him with achieving this, including how often. The ‘Individual Service Plan’s’ are beneficial and thorough in recording the service users’ goals and aspirations. These are person centred, and there was evidence that the service users have been consulted in developing these, but not in the reviewing of the plans and goals. Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 Page 10 The Inspector noted that there was a lack of behaviour management guidelines for service users who can present with challenging behaviour. The risk assessments seen were not all individualised, and did not detail clearly the nature of the risk for that individual person. In relation to service user participation in the home, the manager has arranged ‘resident meetings’ where service users are able to discuss how the amenity fund is used, reach agreements on any group activities and generally air any concerns about the running of the home. However, there have only been two resident meetings in the last 7 months. Care notes read evidence that service users are involved in daily domestic tasks in the home, choosing communal furniture, and planning social events. It continues to be unfortunate that more use is not made of the upstairs kitchen facilities however, to ensure that service users are given more opportunities for independence. The home has supported service users to access Advocacy support where necessary, especially in relation to supporting them with decisions regarding future accommodation and services. Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 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 standard(s) 11, 12, 13, 14. Links with the community are good and regular, enriching service users social and leisure opportunities. The home’s routines and procedures could be more flexible to allow service users more independence, autonomy and choosing from a range of employment/training/educational activities. EVIDENCE: As stated above daily care recording evidenced that service users are regularly involved in doing household tasks such as laundry, snack cooking and cleaning. Service users were seen making snacks and drinks themselves. The main evening meals are cooked by staff, and the food for the home is obtained from wholesalers and delivered to the home, which limits service users involvement in cooking their own meals. The small domestic kitchen facility is not used regularly. Extra care hours are currently being provided for the home to support three service users in developing the necessary skills for more independent living. Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 Page 12 All of the service users attend the local Day Centre four or five days a week. The Manager has arranged for service users to have some ‘key worker’ days, where they are enabled to stay at home with staff support and undertake more individual activities. There is no evidence to show that service users have been consulted about their chosen day activities, or whether they would like to continue attending the day centre. No service users are currently involved in voluntary work, or adult education classes, however some service users are involved in working at a café linked to the Day Centre. The daily care records evidenced that service users are supported to engage in activities inside and outside of the home. In house activities included dancing, games, watching films, sewing, drawing and bingo. Outside activities included country walks, out to the pub, tourist attractions, church, and to visit local towns. Unfortunately service users have not had the opportunity to have a holiday outside of the home this year, but the staff are currently trying to organise some overnight trips to Weymouth. Service users have unrestricted access to all of the communal areas and rear garden. Unfortunately service users do not have a front door key, and have to ring the bell to gain access to the house. This is a Directorate decision, and is not based on an individual risk assessment for each service user. Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 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 standard(s) 18, 19, 20, Service users’ personal care needs are met well by the home, with the focus being on independence and autonomy. Health planning and medication procedures lack structure and detail, which could lead to some service user’s health needs being monitored or met fully. EVIDENCE: The Establishment Task Lists, detailing personal care needs, are informative and inform staff on how to support a service user. There is a lack of information however provided on the health needs of service users, especially in relation to how the health needs will be met, and monitored. The medication detailed on service users’ files did not correspond with the ‘Medication Administration Records’. The files also did not include guidelines for staff of when and how prn medication should be given. There were clear records however of service users’ health appointments and the outcome of these health appointments. The Inspector did note however that one service user required an Occupational Therapy assessment and another a Speech and Language Assessment but there was no evidence shown to say that these requests had been carried through. The Inspector also noted that service users had not routinely been for a hearing test or to the opticians. Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 Page 14 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 standard(s) 22, 23 The home has a satisfactory complaints system with some evidence that service users feel that their views are listened to and acted upon. The service users will be better protected by the home if staff have the necessary training in Protecting Vulnerable Adults and in Restraint and if the system for managing service users’ finances is better monitored. EVIDENCE: There have been no formal complaints made about the home in the last 12 months. Service users are given the opportunity to complain at resident meetings, and when spoken to they confirmed that they could raise concerns with the staff. There have been no adult protection investigations relating to any of the service users living in the home. The staff files seen indicated that a number of staff needed to attend training in the Protection of Vulnerable Adults. The staff have recently needed to restrain a service user. Staff have also not received accredited training in restraint. There must also be clear guidelines for staff available in relation to restraint and physical intervention with individual service users. The Inspector examined the financial records of two service users, to ensure that all financial records are appropriate and procedures followed to ensure that service users monies are handled appropriately. There were no discrepancies found and staff record incoming and outgoing payments on behalf of service users. However, the reason for money being withdrawn was not always clearly recorded, and there was not evidence that the bank statements had been cross referenced to the in house records made. Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 Page 15 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 standard(s) 24 and 25. The standard of the environment within this home is good providing service users with an attractive and homely place to live. Bedrooms are personalised and individual needs are met, although the continued use of the home for short-term stays does not promote privacy or consistency to the long term residents. EVIDENCE: The premises are converted from two Victorian town houses, situated in the centre of Dorchester. It has a domestic and homely feel, although the dining area would benefit from some further ‘domesticating’. All but two of the service users have a single bedroom. The bedrooms seen by the inspector were large, decorated and furnished to a high standard. They were personalised to the service users taste. The service users stated they liked their bedrooms, and that they had chosen the furnishings. Bathrooms were also homely and comfortable. There is ample communal space, with service users having a choice of lounge and dining area. The home continues to provide short-term care to some service users, although the communal space for the short term care service users cannot be separated from that used by the permanent residents. The Manager is reviewing this service. Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 and 35. The recruitment procedures and supervision of staff are not robust enough for the protection of service users. The staffing hours and staff training provided are not sufficient to ensure that the service users receive a good quality service that meets their holistic needs. The staff show commitment and interest in service users, and positive relationships have formed between staff and service users. EVIDENCE: The Manager confirmed that staff have started in post without a Criminal Record Bureau check being received. The member of staff has however not been left unsupervised with service users, but this is not evidenced on the rota or shift plan. It is also unclear from the staff files whether a POVAFirst check has been completed. Recruitment files did however evidence that other safe recruitment practices are followed. Staff supervision is taking place, although this has not been regular and does not meet the standard of six supervision sessions per year. Staff meetings take place every two weeks, and these meetings are minuted. Staff spoken with however confirmed that support is available from the senior team, and that the manager is available for guidance. Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 Page 17 The staff team (particularly the senior team) has remained consistent and relatively stable over the past few years. The rotas examined for April 2005 showed that approximately 403 care staff hours are provided each week (this includes waking night staff and 25 of senior hours). The Department of Health recommends however that the home should be providing at least 530 hours, therefore there remains a shortfall, and a breach in the home’s registration conditions. The lack of staff hours is reflected in the ability of staff to help support service users on an individual level, or to assist service users with having more choice over day and social activities. The list of training courses the staff had attended were listed in the staff personnel files. However the Inspector considered that these had not been updated and were not accurate, and therefore it was difficult to assess the training opportunities and the skills acquired by the staff team. Continuing to be outstanding is the lack of training for staff on autism, which is a main concern of the Inspector as there are several service users who have specific needs relating to autistic spectrum disorder. Staff have also not had training in epilepsy, older persons needs or personal relationships. Discussions with staff and service users evidenced that there have been many positive outcomes for service users, and that the staff team have been central to making this happen. Behaviours have reduced considerably, and new service users had settled well into Douglas Jackman House. Speaking with staff evidenced that they have developed positive relationships with service users. Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 41, 42, The health and safety systems in the home are satisfactory and ensure service users are protected from a safe environment. Service users rights would be better protected if they were involved more in the maintaining of their records. EVIDENCE: The care files and records seen contained all relevant information required by regulation, although there was no evidence that service users are involved in maintaining their personal files. Checks of fire equipment and alarms had been made regularly and appropriate staff training and drills had been carried out, although the Manager needs to consider who is competent to carry out this training. The manager confirmed that the staff have received emergency first aid, manual handling and food hygiene training. The staff record hot water temperatures regularly on the daily care reports, but there was no evidence that action was taken when these temperatures went too low. Risk assessments for the premises have been undertaken and accidents and injuries are recorded and reported as necessary. Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. 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 3 1 x x Standard No 22 23 ENVIRONMENT Score 3 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x 3 2 x x Standard No 11 12 13 14 15 Douglas Jackman House 3 1 3 2 x Standard No 31 32 33 34 35 36 Score x x 1 1 1 2 Version 1.20 Page 20 D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc 16 17 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score x x x x 2 2 x Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 Page 21 Are there any outstanding requirements from the last inspection? NO - timescale for action on three outstanding requirements has not yet passed 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 3 Regulation 14 Requirement The home must not provide a service to service users who’s needs fall outside of the home’s registration category and Statement of Purpose. There must be evidence that service users, and their represenattives, have been consulted about their programme of day activities. Staff must receive training in restraint and physical intervention. There must be a reduction in the use of agency staff within the home, to ensure that service users are given more continuity of care. Staffing levels in the home must be increased to the recommended levels set by the Department of Health Residential Forum staffing calculator. (Previous timescale of May 2004 not met). No person must start work in the care home until a satisafctory Criminal record Bureau check has been received. The home must provide training D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Timescale for action 01.07.05 2. 12 16 01.09.05 3. 4. 23 33 13 18 01.09.05 01.08.05 5. 34 19 01.07.05 6. 32 18 01.09.05 Page 22 Douglas Jackman House Version 1.20 to staff on autistic spectrum disorder, to ensure staff have the necessary understanding and skills to meet the needs of adults with this disorder. 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 6 Good Practice Recommendations 3. 4. 5. 6. 7. 9 14 16 17 19 8. 20 9. 10. 23 28 Each service user should have a clear care plan that details how the home is to meet their day to day needs. The care plan should cover the areas detailed in Standard 2.2. The six monthly reviews should include full consultation with service users and their representatives. Behaviour management plans should be developed for service users who present with challenging behaviour. Risk assessments should be individualised, clearly detail the nature of the risk and record the action to be taken to minimise the risk. Service users should have as part of the basic contract price the option of a seven day annual holiday outside of the home. Service users should be given the opportunity of having a key to the front door of the home, if they are assessed as being able to do so. The opportunities for service users to shop, prepare and cook their meals should be more regular and flexible. Health needs should be more clearly recorded on assessments and care plans. Service users should be supported to have regular hearing tests and optician appointments. There should be evidence of referrals to specialist agencies where these are deemed necessary from assessments. For service users who require prn (when required) medication, there should be clear individual guidleines drawn up detailing the crcumstances of when this should be given. There should be evidence that the bank statements for service users are checked and cross referenced with the homes records of incoming and outgoing payments. The home should not continue to offer a short term care D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 Page 23 Douglas Jackman House 11. 12. 13. 36 41 42 service as the communal areas cannot be separated from the living areas of the permanent residents. Staff should receive at least six one-to-one supervision sessions with their line manager each year. Service users should be encouraged to be invovled in maintaining their personal records. Hot water temperatures should be maintained at a temperature close to 43 degree centigrade. Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 Page 24 Commission for Social Care Inspection Unit 4, New Fields Business Park Stinsford Road Poole BH17 0NF 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 Douglas Jackman House D55 S32030 Douglas Jackman House V216290 120505 Stage 4.doc Version 1.20 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!