Inspection on 23/05/06 for Ellesmere

This inspection was carried out on 23rd May 2006.

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

The inspector 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

Ellesmere 22/11/05

Ellesmere 09/06/05

Ellesmere 20/01/05

Ellesmere 03/08/04

Ellesmere 16/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Ellesmere 43 High Street Wolstanton Newcastle-under-lyme Staffordshire ST5 0ET Lead Inspector Mr Berwyn Babb Key Unannounced Inspection 23 May 2006 01:30 Ellesmere DS0000004937.V294987.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 Ellesmere DS0000004937.V294987.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. Ellesmere DS0000004937.V294987.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ellesmere Address 43 High Street Wolstanton Newcastle-under-lyme Staffordshire ST5 0ET 01782 620155 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) Choices Housing Association Limited Mrs Jill Millar Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Ellesmere DS0000004937.V294987.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 Maybe LD(E) Date of last inspection 22nd November 2005 Brief Description of the Service: Ellesmere is a residential care home that is registered to provide five places for adults with a learning disability. The home is operated by Choices organisation, a local provider with a number of small homes across North Staffordshire. The home is a mature semi detached house located on the busy High Street of Wolstanton, near to Newcastle-under-Lyme, and within easy access of all local amenities and public transport. The property is well maintained and presents a warm and welcoming atmosphere. The design and layout of the premises promotes normal daily living. The home is tastefully furnished and communal space consists of a pleasant lounge and a large kitchen/ diner. There is one en-suite bedroom situated on the ground floor. The other four bedrooms are on the first floor. These are not en-suite, but each has a washhand basin. The bedrooms are decorated to reflect each service users interests and personality. The bathroom and toilets are in close proximity to the bedrooms and communal areas. Laundry facilities are available within the home, and service users are supported to undertake their own laundry tasks. There is a patio style garden at the rear of the property with a rockery garden that the service users maintain. The home does not have space to provide car parking for visitors or staff. Cars have to be parked in the surrounding side streets. Ellesmere DS0000004937.V294987.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the key inspection for the year 2006/2007, and was carried out during the afternoon of Tuesday 23rd May 2006. The Care Manager was present together with other members of staff, and three residents. A fourth resident was out with his mother, and the fifth resident was at his luncheon club in Newcastle, and joined us later in the afternoon. There were appropriate arrangements for the occupation of the gentlemen in the house, with one going out with a member of staff, another preparing for the next day’s activities, a third resting after lunch, and all having their needs met by sensitive prompting from staff, and by adherence to their own routines. The atmosphere was friendly, with good dynamics between the residents, and members of staff who demonstrated a thorough understanding of their needs and choices. The residents interacted with the inspector in line with their abilities and personalities, some shyly, and others gregariously. All displayed clear signs of enjoying their lives, and of having a good relationship with their carers. What the service does well: What has improved since the last inspection? One gentleman was enthusiastic in showing off his room which had been redecorated. The “Cluster” worker recommended in the last report has now been appointed, and provides flexible cover when needed to this, and six other houses run by Choices. Ellesmere DS0000004937.V294987.R01.S.doc Version 5.2 Page 6 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. Ellesmere DS0000004937.V294987.R01.S.doc Version 5.2 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 Ellesmere DS0000004937.V294987.R01.S.doc Version 5.2 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): The outcome for this group of service users was good. This judgement was made using available evidence including a visit to this service, and was based on finding that no-one was admitted to the home without a comprehensive care management or care programme approach assessment. EVIDENCE: Whilst all the current gentlemen have been resident in the home for a long time, reference to one care record chosen at random showed that a very thorough assessment had been made prior to his admission. This had covered all his physical and emotional needs, as well as his known likes and dislikes, and the choices he was used to making about his life. Consideration was recorded about his previous life experience, and the contact he had with some of the other residents, in the long stay Health Authority Institutions where they had been accommodated prior to moving to Ellesmere. In the case of one gentleman who is a cyclist, he not only brought his bike to the home before being admitted, to be risk assessed, but also enlisted the help of a member of staff to help him keep it in good order. The policies and procedures of the providers require a full multi-disciplinary assessment to be made prior to admission, and this includes strategies for enabling people to take risks where ever possible, furnishing them with guidance, education and support to expand their life experiences, rather than Ellesmere DS0000004937.V294987.R01.S.doc Version 5.2 Page 9 to limit them. Where restrictions have to be imposed, this happens only after the fullest possible consultation, and with every step being taken to explain the necessity of such an action to the resident. Ellesmere DS0000004937.V294987.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The outcome for this group of service users was good. This judgement was made using available evidence including a visit to this service. A competent record was provided for each persons assessed needs and choices, and they were enabled to take reasonable risks, with their decisions being respected. EVIDENCE: Not all of the care plans were reviewed, but those that were demonstrated a personal program built upon from the original pre-admission assessment, as the individuals needs changed, and their choices matured, and as a result of input that had enabled them to do things for themselves that they had not previously been thought able to. All wording was appropriate, with the ongoing plan reflecting facts rather than opinions, and reviews had been carried out at the recommended maximum intervals, or as and when thought necessary between these times. Where the gentlemen had been able to express a view about their choice, this decision was recorded, together with any steps that needed to be introduced to assist them in getting the most out of their lives. One gentleman indicated that Ellesmere DS0000004937.V294987.R01.S.doc Version 5.2 Page 11 he likes to do his own thing by spending time in the shopping area of nearby Newcastle, where he also likes to have lunch out in a pub. Another gentleman has his own bicycle that he likes to ride, and the measures to ensure his maximum safety when doing this have been recorded. A third gentleman was a keen angler, and a member of staff enabled him to make up a threesome to fisher at a local beauty spot. They then apparently usually purchase his favourite take away meal of curry, before returning to the home. One gentleman showed off his free bus pass that gives him freedom to move around the locality, especially useful to him when he is visiting his local snooker club. Most of the gentlemen seemed to enjoy the prospect of an errand to the local shops a few doors away, though one had encountered some trouble with local children, who gather outside the convenience store. The providers had taken appropriate steps to look into this, [fully supported by the police and the shopkeeper] and the resident was given regular advice when going out, to prevent him from being a target of juvenile mischief. Importantly, what had not happened, was a curtailment of his freedom to access the local community. Ellesmere DS0000004937.V294987.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The outcome for this group of service users was good. This judgement was made using available evidence including a visit to this service. The residents were enabled to have a community presence, to be occupied and stimulated, to maintain affiliation links, and to eat nutritiously. EVIDENCE: Two of the gentlemen at Ellesmere had places on the Choices Handyman scheme, and from the way one of them spoke about it, obviously derived much personal satisfaction from having “a job”. Not only did it take him into the wider community, but also it gave him more regular contact with that community of similarly enabled residents, who inhabit Choices Homes around Newcastle and the Potteries. Many of these share histories of long periods spent in Health Authority institutions, so knew each other before moving into such homes as Ellesmere, and therefore appreciate visiting each other. Ellesmere DS0000004937.V294987.R01.S.doc Version 5.2 Page 13 As mentioned above, all the gentlemen like getting out into the local community, and those assessed as not needing a companion to do this utilise their opportunities more fully, and from talking to them, seem to gain the most benefits and enjoyment. One gentleman is enabled through creative use of staff deployment to attend football matches, whilst another likes trawling the market, car boot sales, and charity shops and events, for bargains. Some residents use public transport on their own, and in the care plan of one, there was evidence of advice and training following a risk assessment, to maximise his safety when doing this. The same gentleman was a regular attendee at a luncheon club, where he was able to associate with a different group of friends. The care plans also furnished detailed information [confirmed by the care manager] about the family links maintained by the residents, though sometimes because of distance [one gentleman’s close family live abroad] involved means that they communicate by phone and post, rather than by the regular personal visits enjoyed by others. Preparations were afoot during the afternoon for the evening meal, and some of the gentlemen contributed towards this by performing culinary or household tasks, as were detailed in their individual care plans. Quite animated discussion took place over what they should have, and the eventual outcome clearly demonstrated that the home was run for the convenience of the residents, and not that of the staff, as different choices meant that a variety of dishes had to be prepared. Discussion with the care manager revealed that some dietary advice had to be followed for different residents, and one joined in to re-iterate what things were bad for him because of a medical condition. He did not appear unduly concerned, and stated his restrictions as a matter of fact, and not of disappointment. Ellesmere DS0000004937.V294987.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The outcome for this group of service users was good. This judgement was made using available evidence including a visit to this service. The residents were receiving comprehensive social and health care support as assessed and reviewed and recorded in the Person Centred Plans. EVIDENCE: The home uses the Boots Monitored Dosage System for medication. Procedures for the safe handling of medication, including storage and records were seen and were satisfactory. The manager of the home and her deputy are qualified nurses and there was good information available for staff about all of the medication taken by the gentlemen. There were PRN (as and when) and homely remedy policies in place and medication for either of these being taken was separately recorded. In the absence of a qualified member of staff being on duty and such medication being required there is a sound procedure in place where the home must contact a qualified member of staff at another home for advice, or the qualified member of staff on call. Ellesmere DS0000004937.V294987.R01.S.doc Version 5.2 Page 15 None of the gentlemen had chosen administer their own medication. There were procedures in place for the medication for one man when he is visiting his family at the weekend. The care manager stated that the pharmacist to facilitate this supplied a separate cassette containing the appropriate medication. More generally each resident had a 24-hour plan of care in place with appropriate information available for the different areas of their health need. Protocols were in place for such things as nutrition screening, epilepsy, and diabetes management, and regular appointments were noted for such things as dentists, chiropodists, and opticians. Plans showed that the ‘OK Health Check,’ a comprehensive document that looks at all areas of both physical and mental health, were used for all the gentlemen, together with a Health Action Plan, that involved the practice nurse from the local G. P. surgery. Where prompting was required for personal health and hygiene [which was the major input in these areas, the men being generally able to do things for themselves], this was observed to be done with an easy familiarity that in no way compromised either the privacy or dignity of the resident. There was a very sensitive section in one plan reviewed of how the resident wanted to be treated when he died, and the various responsibilities for arrangements were clearly spelt out. Ellesmere DS0000004937.V294987.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The outcome for this group of service users was good. This judgement was made using available evidence including a visit to this service. Staff were well trained to recognise when residents had a grievance, and to assist them to vent it and have it addressed, and to recognise symptoms of abuse, and initiate the agreed procedure to protect vulnerable adults. EVIDENCE: Then inspector spent some time in a more formal interview situation with one of the members of staff, and from this encounter he was satisfied that the support for residents that he had heard of earlier from the care manager in relation to the gentleman targeted by children, was shared by other staff, who were the first line of advocacy for their residents. The providers have a robust complaints procedure, and train staff to assist residents in line with their ability, to be able to access this and use it to their advantage. Ellesmere DS0000004937.V294987.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The outcome for this group of service users was good. This judgement was made using available evidence including a visit to this service. The premises were maintained to a good standard that afforded residents a homely, comfortable, and clean environment, in the heart of a local community, without any stigmatising signs that it is a care home. EVIDENCE: The inspector viewed all the communal and a sample of the private areas [in the presence of their occupant] of the home, and was satisfied with the standards being kept. The bedrooms he saw were spacious and comfortably furnished, with memorabilia and photographs reflecting the lives and interests of the gentlemen living in them. One man had a new plasma screen T. V. racks for his collection of pipes [risk assessment on smoking seen in care plan], and representations of his favourite ornithological specimens. Only one room had en suite facilities [including shower] and this was on the ground floor and occupied by the oldest of the gentlemen. Ellesmere DS0000004937.V294987.R01.S.doc Version 5.2 Page 18 The other rooms [upstairs] all had their own wash-basin, and there were bathroom and toilets close at hand, as well as there being a separate W. C. on the ground floor. Ellesmere provides a spacious and comfortable home for the service users. All of the gentlemen had agreed to do jobs around the home, such as sweeping, as well as maintaining their own bedrooms and assisting with their laundry. The home was very clean and hygienic, and there was liquid soap and paper towel dispensers at all sinks. Externally the home resembled all the other houses around it, and its situation on the High Street made it very convenient for both local amenities and public transport, with a bus stop [the men have free bus passes issued to disabled people in this area] practically outside the front entrance. The front boasts a small well maintained garden, whilst the rear was paved, with garden furniture for Al Fresco eating, and the enjoyment of good weather. There was no dedicated parking, but at the time of this inspection, spaces were freely available in adjoining side streets, one of which houses the local surgery and pharmacists. Ellesmere DS0000004937.V294987.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The outcome for this group of service users was good. This judgement was made using available evidence including a visit to this service. The providers have sound recruitment and training policies, procedures, and working programmes. EVIDENCE: Ellesmere has a stable staff team led by an experienced and knowledgeable manager and deputy who are both qualified nurses. Choices organisation ensures that all of the staff have undertaken at least NVQ 2 in care within 12 months of taking up post. As noted in the introduction, this team has now been strengthened by the introduction of a member of staff to work flexibly within a cluster of seven houses run by the provider, and this reduces the need for agency staff and consequent disruption to the routine of the men knowing those people working with them. The inspector undertook a more formal interview with a member of care staff, and had protracted discussions with the care manager concerning staff deployment and training. They convinced him that new staff were appropriately recruited following the stringent procedure for protecting the safety of the residents. Basic equal opportunities standards were followed for Ellesmere DS0000004937.V294987.R01.S.doc Version 5.2 Page 20 advertisements and interviews, and potential staff had to have a clear C. R. B. check, and to provide two written reference before being considered. They were then put on an induction training program with the first week undertaken at the headquarters of Choices away from any contact with residents, before being introduced to the home under a sliding supervision program based on continuous review of their performance. Mandatory training in such things as moving and handling, First Aid, food hygiene, and health and safety were all expected to be completed before the person was considered for a permanent contract, after a six month probationary period.. Those carers on duty during the day exhibited significant skill in assisting the gentlemen to live fulfilling lives, and talked knowledgably about their various conditions, as one would expect from staff trained by an organisation that bases all it education on the principles laid down by the British Institute for Learning Disability, from whom it also directly purchases some of its specialist courses. Ellesmere DS0000004937.V294987.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The outcome for this group of service users was good. This judgement was made using available evidence including a visit to this service. EVIDENCE: The home benefits from an experienced manager who is a qualified nurse (RNMH). She holds the NVQ level 4 and Registered Managers Award, and is also a trainer in moving and handling and the management of violence and aggression. A member of various development groups that the organisation has formed to consider the quality of its performance in specific areas, she is able to demonstrate her commitment to resident participation and the improving of their quality of life. In discussion the manager was very knowledgeable about the individual needs of each gentleman, and the underlying causes of their conditions and behaviour. Ellesmere DS0000004937.V294987.R01.S.doc Version 5.2 Page 22 One of the ways she ensures continued quality for the gentlemen is though having regular house meetings and six monthly individual reviews, and a record is kept of the views of the residents expressed at these times. A sample of more recent responses was examined, and these all expressed a high level of satisfaction. The Commission for Social Care Inspection receives regular reports from Principal Officers of Choices who visit the home on a monthly basis under Regulation 26, and these always include discussion with some residents regarding their care, and satisfaction with the home. This home has not received a visit from the Fire Officer recently, so at this time there are no matters to discuss in relation to the safety of the facility for the residents and any other people in the home. Normal regular checks were being done on alarms, emergency lighting, and evacuation, and a program was in place to keep staff training up to date, with one new person awaiting their first session. Ellesmere DS0000004937.V294987.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 X 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 4 STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 3 X X 3 X Ellesmere DS0000004937.V294987.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA39 Good Practice Recommendations Provide the Commission with an update as to progress with the review of policies and procedures, and the input that has been afforded the representative service users. Consider the introduction of a cluster worker for the home. 2. YA33 Ellesmere DS0000004937.V294987.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Ellesmere DS0000004937.V294987.R01.S.doc Version 5.2 Page 26 - 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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