CARE HOME ADULTS 18-65
Elwis House, 1 1 Elwis House 2-8 Bell Green Lane Sydenham London SE26 5TB Lead Inspector
Rossella Volpi Unannounced Inspection 22nd September 2005 2-00 Elwis House, 1 DS0000025617.V255100.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 Elwis House, 1 DS0000025617.V255100.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. Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Elwis House, 1 Address 1 Elwis House 2-8 Bell Green Lane Sydenham London SE26 5TB 0208 7789485 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) Providence Project Mr Andrew House Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. This home is registered for 4 people with learning disabilities of whom up to 3 may be over 65 years and up to 3 may also have a physical disability 1st November 2004 Date of last inspection Brief Description of the Service: Elwis House provides a residential service to a maximum of four women and men with learning disabilities with high support needs, including people with signs of dementia or who are frail or older. The overall aim is that of promoting independence, equality of opportunities and social integration. The home aims to achieve this by listening and responding to what each service user wants, valuing diversity and developing a skilled staff team. The provider is an organisation named: ‘The Providence Project’, which is a registered charity and a company limited by guarantee. It is operated by an executive committee, represented by the chairperson. It was understood that the provider was intending to merge with another organisation, subject to registration being granted by CSCI, so that in the future there would be a change of provider. The day-to-day running of the home is delegated to a care manager, who leads a team of staff and who is supported by external managers. Accommodation is provided in a purpose built ground floor flat, designed to meet the needs of people using wheelchairs. All residents have their own bedroom. The area is served by public transport and has a selection of shops and a supermarket. Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and consisted of one visit conducted during the afternoon of 22 September 2005. The inspection included mainly discussion with staff, direct observations and inspection of records. It was not possible to significantly communicate with the residents directly on this occasion and therefore this report cannot incorporate their views. Emphasis was given, however, to general observation of what was happening and of the interaction between staff and residents. What the service does well: What has improved since the last inspection? Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 6 There was evidence of continuing work having been done to improve the support to residents and the care planning. There might be other improvements that were not noted during the inspection; this was an unannounced inspection and the manager was not present, to highlight progress made. 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
Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 7 contacting your local CSCI office. Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The home was committed to a full assessment of residents’ needs and aspirations, so as to enable appropriate care and support. EVIDENCE: No new resident had come to live at the home in recent years. It was understood that the policy of the organisation in relation to any future admissions was that prospective residents would receive a full assessment, by the appropriate professionals. All admissions would be planned, so that the person’s needs could be appropriately identified. Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 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): 6, 7, 8, 9, 10 Staff endeavoured to assist residents to make choices, to consult them about the service provided and to promote independence. Therefore the residents took active part in decision-making and had some control over their life. Care plans were thorough, but more accurate recording of how individual residents were supported would give clearer evidence of the work done, of progress made and of new goals to be set. This would ensure clearer assessment of needs and support strategies. Information about residents was handled appropriately. EVIDENCE: The care plans for the four residents were looked at and discussed with staff. Each resident’s file had a care plan, describing the services and support to be provided by the home. Overall these were consistent with the identified needs, aspirations and the goals set with the residents. There was evidence of regular review by the home. Annual reviews were conducted with the placing authority and relevant external professionals if appropriate. The resident and their family or representatives were involved in the reviews. Of the four files inspected, two showed evidence of up to date annual reviews. Staff said that the other two residents’ annual reviews had been done in recent months. As also found at
Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 11 the previous inspection, the plans demonstrated involvement of the resident, or their family or advocate. However, it was not possible to ascertain this directly from the residents or their representatives on this occasion. There were clear guidelines on how each resident should be supported. Appropriate specialists from a multi-disciplinary team contributed to the guidelines. A previous requirement regarding the measuring of goals, to better identify needs in the experience of work done, had partly been complied with. There was still a need for clearer recording and evidence of how goals were achieved, of individual responsibilities of staff in working towards this, of how what was learned from supporting each resident contributed to the setting of the next goals. However this was in the context of appropriate work and progress having been made with individual residents, which staff and residents were rightly proud of. Staff at the home endeavoured to assist residents to make choices and promote independence. This continued to be evident from discussion with staff and from direct observation. As stated in previous reports, some limitations arose for individuals from their disabilities or conditions, such as dementia. None of the residents were able to manage their own finances, although each had an individual bank account into which their benefits were paid. It was very positive that staff had taken their role of advocates for the residents seriously and had liaised with banks to promote change in their procedures, so as to ensure that the residents’ disabilities would not prevent them from using current accounts. The staff also clearly saw their roles as advocates for residents in any dispute with families, although they were aware of the sensitivity of the issue and of the need to work cooperatively with families, whenever possible, in the best interest of the residents. Staff showed evidence of how residents were supported to take responsible risks and this was seen as integral part of promoting independence and choice. Residents’ participation in the running of the home had been facilitated where feasible and risk had been assessed on an individual basis. The home had a missing person procedure. Staff were aware of Providence Project’s policy on confidentiality. Residents had a right of access to their personal files, which were stored in a lockable filing cabinet in the office. Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 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): 12, 13, 14, 15, 16, 17 Residents were encouraged and supported to access local facilities, take part in appropriate leisure activities and maintain family links and relationships. This enabled residents to pursue fulfilling activities, mix with the general community and maintain the personal links important to them. Help with the funding of some meals taken out, holidays and day trips, which were paid by the residents, would enhance leisure activities. Attention was given to the provision of meals, so that residents could enjoy a healthy diet, but additional ways to find out individual preferences should be considered. EVIDENCE: There continued to be evidence, from observations, discussion and records, that residents were supported to participate in a range of activities, according to their individual preferences and these were consistent with the information on their care plans. Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 13 Residents were supported to attend adult education classes of their choice. Staff said that the possibility of taking up paid / support or volunteer jobs had been explored with one resident, who had expressed some interest in the past; however there was no evidence on the file of this. (The issue of recording is discussed above in the report). Day trips were organised and also annual holidays away from the home, which were planned with the residents. Residents were expected to fund these from their own money and it was understood, from discussion with staff, that some found it difficult. Residents did not have, as part of their basic contract price, the option of a minimum seven-day annual holiday outside the home. This was because the placing authorities did not fund it. It is recommended that the provider discusses with the placing authorities the possibility to establish the option of a minimum seven-day annual holiday outside the home, as part of the residents’ basic contract price and the funding of some day trips. Weekly meals out for staff and residents together had been introduced. It was understood that the activity was appreciated by the residents and seen as a valuable means by staff to enrich the activities on offer. Residents had to pay for their meals out of their own money; staff meals were funded by the home. However the home is expected to provide full board and should contribute towards some of the cost to residents of lunches taken out, particularly when these are essential activities contributing to the fulfilment of the care plans. This would be discussed more fully with the manager at a future occasion. In the meantime it is recommended that the home should fund such meals for the residents, as they do for staff. As commented in previous reports, contact and visits to friends and families were supported and encouraged. The home’s routines were flexible to support choice, individual preferences and to promote independence, consistently with the individual care plans. Discussion with staff continued to show that staff endeavoured to involve residents in the planning of menus and in shopping for food. At breakfast, a selection of food would be put on the table and residents, not able to help themselves, would point to their preferences. At dinnertime, a choice of food (at least two main meals) would be cooked and residents would choose the food they wanted. Staff would use their observations and knowledge to plan the menus. It is again recommended that the home explores more ways to elicit a response, also using representations of items of food, dishes or other appropriate methods, so as to increase choice and participation. Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 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): 18, 19, 20, 21 Staff endeavoured to provide sensitive and flexible personal support and had started to ascertain residents’ wishes regarding terminal care and death. This would enable care to be planned and delivered in a way that reflected respect and concern for individual and cultural preferences. Residents’ health care needs were assessed and recognised. EVIDENCE: Each resident had a key worker, to enable consistency of support, who assisted in the drawing up of individual plans. The local community team provided specialist support. Discussion with staff and records continued to indicate that the way personal support was provided respected individual preferences. The routines at the home were kept to a minimum to ensure flexibility and choice. Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 15 The home monitored the health of the residents. Residents were all registered with a general practitioner; their files detailed health care appointments and indicated that they had access to the full range of health care professionals. None of the residents administered their own medications, as none were deemed able to manage this safely. Staff therefore administered these. There were policies and procedures in place at the home covering medication administration. The record of medication, from inspection of some entries at random, was clear and accurate. At the previous inspection it was found that there was no evidence that residents’ wishes concerning terminal care and death had been discussed with them or their families. The manager was acting on the previous requirement and such matters had been discussed with one resident, during the annual review. The requirement continues as not yet fully met. Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 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): 22, 23 Residents’ views and feelings where sought where possible and acted upon, although in some cases this could mainly be done by observing behaviour. There were procedures, clear to staff, for responding to issues raised, so that residents could be protected from abuse, neglect and self-harm. EVIDENCE: Discussion with three members of staff gave evidence that they knew what to do should a complaint or an allegation of abuse be received. They were aware of the home’s whistle-blowing policy and of the adult protection procedure. The permanent staff had attended courses on adult abuse. (The procedures were not looked at). No complaint had been received for over two years. Staff were aware that the majority of residents would not able to complain, but staff were also aware of and committed to acting as advocates for the residents, should any issue of concern be noted. They discussed how to keep vigilant to prevent or detect any signs of possible abuse. They said that the complaints’ procedure had been discussed with relatives, who were consulted on how best they could be enabled to express concerns. (This was recommended at previous inspections, because of the low incidence of complaints). At the previous inspection the manager had said that he intended to make the service users’ guide more accessible, by using a pictorial form. When this is completed, it would also enhance the complaints’ procedure. As discussed above in the report, although it was not possible to elicit residents’ views directly on this occasion, some time was spent observing the interaction between residents and staff. Clearly residents appeared at ease with staff, with whom they interacted freely.
Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 17 Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 18 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, 30 The home offered single, comfortable bedrooms and shared facilities. Attempts had been made to embellish the environment, so as to create a homely feel for the residents. EVIDENCE: The premises were purpose built to meet the needs of people with physical and learning disabilities and were on the ground floor. All the bedrooms were single, but only one had en-suite toilet facilities. The premises were clean and staff said that residents found them comfortable. Efforts had been made to personalise or embellish the environment. The building formed part of a complex of flats. London and Quadrant Housing Association undertook maintenance. The area was served by public transport and had a selection of shops and a supermarket. There was a policy in place to control the spread of infection. Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 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): 31, 32, 35, 36 Residents benefited from a staff team who was clear about their roles and responsibilities and who received regular and ongoing support and training. Therefore, overall, the provider was equipping staff to appropriately support the residents’ group. EVIDENCE: Permanent staff interviewed confirmed that they had clear job descriptions, received regular supervision and took part in staff meetings. The General Social Care Council’s code of conduct had been issued to and discussed with staff. These were means to ensure that staff would be effective in supporting residents and that they would work consistently with the ethos of the home. The needs of some of the residents and the fact that one of them had very limited verbal communication, made stability of staff even more crucial. Inspection of rotas showed that the required staffing levels had been maintained. It was noticed that the levels of day staff had been increased, for parts of the day, as a response to changing needs of residents. The home had permanent vacancies and had been short of permanent staff for some time. However they were able to ensure the services of regular agency staff, (the agency staff interviewed, for example, had been working at the home for over one year). Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 20 It was understood that agency staff did not take part in staff meetings. It is recommended that they should be included. This would be both to support them in their job and also because they should be able to contribute to the discussion and reviews about the work of the home and with individual residents. The agency staff had been working at the home regularly over a long period of time. Staff considered that the team was competent and had the appropriate qualities and experience. It was understood that the organisation remained committed to staff training and had taken steps to ensure that at least 50 of care staff would achieve a National Vocational Qualification (NVQ) in care at level 2 or above by 2005, as stipulated by the national minimum standards. Staff said that they were well supported and found the supervision sessions both helpful and stimulating. The induction process was discussed with a permanent member of staff who had joined the team in the last year. There was evidence of a thorough process, from the discussion. Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 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): 37, 42 The health and safety of residents and staff was promoted, as far as it was reasonably practicable. EVIDENCE: The manager had not yet applied for registration and this meant that the home had been without a registered manager for. While no doubt about the suitability of the manager arose during this or previous inspections, the manager was not fully assessed by CSCI. This was of concern as the assessment for registration is in place to ensure that suitable people manage registered homes. As the manager was on holiday, it was not possible to follow this up with him at the time. However this was followed before the report was finalised and he assured that he would contact the CSCI London central registration team immediately to discuss what he was required to do and the urgency of his application. (This is the reason why the score under standard 37 has been given as almost met, as opposed to not met). Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 22 The home had a policy on health and safety. The kitchen was clean, tidy and well maintained. Discussion with staff assured that regular risk assessemnts were carried out, that fire drills were conducted at the required intervals, that hot water outlets were checked and that staff attended mandatory health and safety training, which included moving and handling and fire safety. There were records regarding maintenance and routine safety checks; contracts were in place for the annual servicing of the fire safety system, gas safety and the hoists. These showed that servicing had taken place during the past 12 months. Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 3 Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x x x x x 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 2 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 x x 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
Elwis House, 1 Score 3 3 3 2 Standard No 37 38 39 40 41 42 43 Score 2 x x x x 3 x DS0000025617.V255100.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? yes 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 6 Regulation 15(1)(2) Requirement The registered provider must ensure that reviews of care plans give clear evidence of monitoring, evaluation, review and update of objectives. - To this end recording must include what is learnt from supporting the resident. - The individual responsibilities of key-workers / support staff must be clearly identified - When there are communication issues, information must be kept around what the person does, what the staff think it means and when it happens. (This would be to help establish how the resident can best be supported). (Previous timescale of 1 May 2005, for similar requirement, partly met) The registered provider must ensure that residents’ wishes concerning terminal care and death are discussed with the users or their families and a record is kept. (Previous timescale of 1 May Timescale for action 30/03/06 2 21 12(2)(3) 30/03/06 Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 25 2005 partly met) 3 34 19(1)(2) (3)(4)(5) The registered provider must ensure that all statutory checks, to ensure suitability of staff, are conducted and inform the decision to appoint. In particular the registered provider must ensure that: - All previous work and education history is obtained and any gaps explored. - Appropriate references are consistently sought and received before applicants start work. - Existing files are reviewed. - Appropriate steps are taken to ensure that the checks are consistent with the requirements of the national minimum standards and regulations and the home’s own policy. (This requirement, imposed at the last inspection, could not be followed up on this occasion as the staff records were not kept at the home. The requirement is repeated with a new time scale, but no new action plan is needed). 4 YA37 8 (1) (2) The registered provider must ensure that an application is submitted to CSCI for registration of the home’s manager. 30/11/05 05/10/05 Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard 13 and 14 Good Practice Recommendations That the home contributes towards the cost of meals taken out, when these are an essential activity contributing to the fulfilment of the care plans. That the provider initiates discussion with the placing authorities to establish, as part of the basic contract price, the option of a minimum seven-day annual holiday outside the home for each resident. That management explores additional ways to elicit a response from residents regarding the food or meals they want. This should include using representations of items of food, dishes or other appropriate methods. That agency staff who have been working at the home regularly over a period of time are included in staff meetings. 2 14 3 17 4 31 Elwis House, 1 DS0000025617.V255100.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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