Inspection on 01/08/05 for Emerton Close

This inspection was carried out on 1st August 2005.

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

The inspector 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

Emerton Close 17/05/07

Emerton Close 12/12/05

Emerton Close 23/03/05

Emerton Close 21/12/04

Emerton Close 19/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Emerton Close 1 - 3 Emerton Close Bexleyheath Kent DA6 8DW Lead Inspector Elizabeth Brunton Unannounced 1 August 2005 10:30 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. Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Emerton Close Address 1 - 3 Emerton Close Bexleyheath Kent DA6 8DW 020 8303 4940 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) MCCH Society Limited Mrs Rebecca Wilde Care Home 12 Category(ies) of Learning disability (12), Physical disability (12), registration, with number Sensory impairment (4) of places Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 23 March 2005 Brief Description of the Service: Emerton Close is operated by MCCH Ltd and provides care for twelve adults with profound learning and physical disabilities, sensory impairment and complex needs. The home consists of three bungalows in close proximity to each other. Houses 2 and 3 each have two single bedrooms and a shared twin bedroom. House 1 has three single bedrooms. All three bungalows have one bathroom, a separate toilet, kitchen/diner and a lounge. Each bungalow has a small garden and there is limited parking space at the front of the buildings. An office and a sensory room are located in separate buildings. On the days of inspection, there were three service users in residence in each of houses 1 & 3 and four service users in house 2. There was one vacancy in house 3. A service user was due to move into house 3 shortly, from another unit. Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 10.30am. One inspector was in the home for seven-and- a- half hours. Much of this time was spent in houses 2 and 3. House 1 was visited briefly. All of the ten service users were met. However, it was not possible to find out the views of service users due to communication issues. The manager and other staff on duty during the day were spoken to. The communal rooms, garden and service users’ bedrooms were seen. Records were looked at, including some service users’ individual case files. An announced visit was also made to the home on 25 July 2005. On this occasion, an inspector, with nursing qualifications, spent two hours in the home inspecting peg feeding and stoma care in houses 1 and 3. Two service users were met and their rooms seen. The manager, staff on duty and the MCCH clinical nurse specialist were spoken to. Records were also inspected. What the service does well: What has improved since the last inspection? Very good care was being provided in this home at the last inspection and few requirements and recommendations were made. Bottles of medicine were now stored in clean containers and medication given out had been accurately recorded. Some rooms had been decorated and the tracking for the ceiling hoist in one service user’s room had been moved, so that there was now more room to move him from his wheelchair onto his bed. Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 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. Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 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 Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 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 & 5 Information about service users was on file but contracts for service users were still needed, in order to provide full information about the services to be provided. Preparation was being made for a new service user to move into the home. EVIDENCE: There was much information about service users on file. This included their needs, likes & dislikes. In house 2, communication passports for each service user were displayed on the notice board in the kitchen. These were most informative. An agency member of staff, who had not worked in house 2 before, was reading them. A new service user was to move into house 3 in the near future. The member of staff who was to be her keyworker said that she had gone to meet the service user in her current home. The member of staff also planned to meet with the service user’s current keyworker, in order to learn more about the service user’s needs. Comprehensive contracts for service users were still needed. Relatives and their relatives or representatives need clear information about the terms and conditions of residence in the home. (see requirement 1) Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 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 & 7 Service users had taken part in regular planning meetings, where goals had been set. Goals needed to be met within agreed timescales, unless there are clear reasons why this is not possible. Daily records needed to be more informative. Service users were encouraged to make choices and had been well supported through advocacy. EVIDENCE: Individual planning meetings had been held with service users and their relatives twice a year, at which varied and achievable goals had been set. However, the keyworker was unable to explain why three goals relating to developing interests and activities, set at one service user’s last individual planning meeting in January 2005, had not yet been met. The service user’s next individual planning meeting had been delayed, in order that his mother could attend. Daily records were maintained for each service user but some were brief, limited in content and there were gaps. Staff may need training in this area. Service users’ participation in decisions and choices was inevitably limited by the level of their learning disabilities and communication abilities. Staff spoken to were committed to giving service users choice and ascertaining their views Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 10 wherever possible and were seen to do this on the day of inspection. The manager and staff had advocated for service users, particularly in relation to health care and complaints had been made on behalf of service users. Good use had been made of the local advocacy service. (see recommendations 1 & 2) Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 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) 12 & 17 Service users participated in activities but these areas of life could be further developed for some service users. Varied and nutritious meals were served and PEG feeding practice was sound. EVIDENCE: Some service users attended day centres on a number of days each week. Staff had worked hard to support service users in taking part in activities such as going shopping, for walks, bowling, listening to music, aromatherapy and using the sensory room and the local hydropool. Staff in house 3 are to be commended for enabling service users to continue with activities, while providing intensive care to other service users with complex healthcare needs. There were weekly activity plans for each service user displayed on the notice board in house 2. However, records showed that these plans were not all being followed and that some service users were involved in few activities outside the home. Staff said that there was not sufficient staffing to take service users out regularly. However, the manager said that additional staffing hours were available for activities. The home was about to make use of the taxi card scheme, which should facilitate outings and activities outside the Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 12 home. As previously mentioned, some daily records were brief and with many gaps, so there was no reliable record of how service users had spent their time. Menus seen in house 2 showed that varied and nutritious meals had been served. Meals served each day were recorded for each service user on shift planners. A number of service users received PEG feeding. After undertaking competency based training, care staff had responsibility for administering PEG feeding, in line with comprehensive care plans and protocols. Care plans were reviewed when feeding regimes changed but regular reviews were needed, regardless of whether changes had been made. Staff spoken to were aware of the importance of mouth care but this was not included in care plans. Strategies for reducing the risks associated with PEG feeding were in place but it is suggested that risk assessments should be drawn up. Service users’ relatives/representatives should also be asked to give written consent to PEG feeding being provided by care staff. Those case files inspected showed that service users’ weight had been regularly monitored. (see requirement 2 and recommendations 3, 4 & 5) Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 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 received excellent health and personal care. Medication was safely stored and properly administered, though two items were not correctly labelled. Medication incidents had been properly dealt with. EVIDENCE: Staff were seen to provide personal care discreetly and with respect for service users’ privacy and dignity. Service users’ complex health care needs had continued to be very well met, with support from outside health care professionals. One service user in house 3 was being very closely monitored by staff, to ensure effective pain control. She was being regularly moved and a pressure relieving mattress was in place. This service user was confined to bed for most of the day. Her bed had been temporarily moved into the lounge, so that she could be closely monitored and have company. Staff said that this did not inconvenience the two other service users and that relatives of all the service users had agreed to the arrangement. Staff are to be commended for their vigilance and care of this service user. A pressure ulcer risk assessment had been completed for one service user. The manager said the MCCH nurse was designing an appropriate Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 14 format for these risk assessments. to service users, while in hospital. Excellent support had been given by staff One service user had an ileostomy. District nurses currently provided most of the stoma care. However, it was planned that care staff would be given the necessary training, so that they could undertake this work. Medication was inspected in houses 2 and 3, where it was safely stored. A sample check of medication and administration records was made and this was mostly satisfactory. A small pot of sudocreme in the bathroom of house 3 was not labelled with the owner’s name and a box of co-proximal had no pharmacist’s label. Records showed that the manager or deputy’s agreement had been sought before PRN medication had been given. The manager was again advised that MAR sheets should be secured with hole re-inforcers, to prevent them from being mislaid. Medication incidents in house 2 had been properly dealt with by the manager. (see requirements 3, 4 & 5) Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Relatives had been told how to complain and service users were protected from harm and abuse. EVIDENCE: There had been no complaints since the last inspection. A complaints procedure was in place and copies had been given to relatives. No adult protection concerns had been reported since the last inspection. Staff spoken to were aware of safe practice and committed to the protection of service users. The manager and deputy were in close touch with service users, staff and with day-to-day events in the home. Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 The home was sufficiently spacious, comfortable and generally clean and well maintained. However, some work was needed on parts of the garden and of houses 2 and 3. EVIDENCE: The building was reasonably well decorated and maintained and was sufficiently spacious for the number of service users. Gates to the property were still needed, for the safety of service users, staff and their property. There had been a further incident recently when a member of the public had urinated against the wall of house 3, below one of the service user’s bedroom windows. The paving slabs between houses 2 and 3 were uneven and could be unsafe for service users. The garden to house 3 was attractive and had been well maintained by staff. The other gardens needed attention. House 1 had been refurbished to a high standard and some rooms in the other houses had been redecorated by the deputy manager. Most bedrooms were personalised, well decorated and furnished. Carpets in some bedrooms in houses 2 and 3 needed cleaning/replacement. New furniture had been Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 17 provided in the double bedroom in house 3 but this room needed redecorating. In house 2, one service user occupied a room, which was not sufficiently spacious for safe and easy transfer. However, the hoist tracking was being changed on the day of inspection and furniture could now be re-arranged so as to provide more space. Two other service users in house 2 continued to share a room but were not considered to be sufficiently compatible with each other. In response to a letter from the inspector following the last inspection, the provider confirmed that these service users could move to the next single rooms which became available in the home. The furniture in their current room was broken and marked and the room was not very personalised. It required attention. In house 2, the toilet needed decorating and the tiling and floor covering in the bathroom required attention. The home was generally clean, apart from around the toilet and the sink in the double room in house 2. Radiators were also dirty and radiator covers needed to be regularly lifted so that radiators could be cleaned. (see requirements 6, 7, 8, 9, 10 & 11 and 2 and recommendations 6, 7, & 8) Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 The home was adequately staffed by a committed, able and well supported staff group. Staff vacancies must be recruited to. EVIDENCE: Permanent staff on duty were competent and demonstrated understanding and concern for service users and commitment to meeting their needs. Staff worked hard at communicating effectively with service users. They confirmed that they were well supported by the manager, deputy and senior staff. Staffing levels appeared to be adequate. However, additional staffing will be needed in house 3 when a fourth service user with complex needs moves in. There were four staff vacancies, including the senior post in house 2. These must be recruited to without delay. The manager said that bank staff were normally employed to cover shifts and that agency staff were rarely used. The manager also confirmed that she checked the training records for agency staff who came to work in the home. There was an agency member of staff on duty in house 2 who confirmed that she had received the necessary training. However, she was not seen to make any attempt to communicate with service users. (see requirement 12) Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 19 Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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) 37 & 42 The home was very well managed and the health and safety of service users had been protected. EVIDENCE: Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 21 The home was very well managed by an able and committed manager and deputy. The manager had detailed knowledge of the needs of service users and was strongly committed to meeting their needs. The increasing complexity of service users’ needs in this home and particularly of their healthcare needs, had added to the responsibilities of both manager and staff. It is hoped that this is acknowledged by MCCH. Consequently, the manager considered that more management time was needed in the home. It is recommended that the management time allowed for the senior support workers in charge of each house is reviewed, with a view to increasing this. The building appeared to be safe, apart from the uneven paving slabs and the need for gates, which have already been mentioned. No other hazards or risks to the safety of service users were identified. Moving and handling risk assessments were in place and staff spoken to were aware of correct practice. Food seen was correctly labelled and stored. Fire records were inspected in houses 2 and 3. Fire risk assessments and ‘stay-put’ policies were in place. Fire safety equipment had been checked and serviced by the contractor earlier this year. Fire alarms and emergency lights had been regularly tested in house 3 but not so regularly in house 2. Regular fire drills had been held but on only three occasions during the past year in house 3. It is recommended that drills are held four times each year. (see requirement 13 and recommendation 9) Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x 3 x 1 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 2 Standard No 11 12 13 14 15 16 17 x 2 x x x x 3 Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Emerton Close Score 3 4 2 x Standard No 37 38 39 40 41 42 43 Score 4 x x x x 3 x G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 5 Regulation 5(3) Requirement Each service user must be provided with a copy of their contract/statement of terms and conditions of residence in the home, which includes all the matters listed under this standard. (This has been outstanding since April 2002) Mouth care must be included in care plans for those service users receiving PEG feeding. Risk assessments and care plans for the development/prevention of pressure ulcers must be provided, where needed and as planned. All medicines must be properly labelled. MAR sheets recording the administration of medication must be secured in their folders, to prevent them being mislaid. The uneven paving slabs between houses 2 and 3 must be risk assessed and the necessary action taken. Gates to the property must be provided, in order to ensure the safety and security of service users, staff and their property. Timescale for action 1 November 2005 2. 3. 17 19 15(1) 15(1) 1 October 2005 1 October 2005 4. 5. 20 20 13(2) 13(2) 1 September 2005 1 September 2005 1 November 2005 1 December 2005 Page 24 6. 24 13(4) 7. 24 13(4) Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 (Previous timescales not met) 8. 9. 10. 24 24 24 16(2) 16(2) 23(2) The furniture in the double room in house 2 must be repaired/replaced. Bedroom carpets must be cleaned/replaced, where necessary. The two service users who currently share a bedroom in house 2 but who are not considered to be sufficiently compatible with each other, must be offered single rooms when a room becomes vacant in the home. All parts of the home must be kept clean, including the radiators Recruitment of staff to fill the vacancies in this home must be given piority. Fire alarms and emergency lighting must be regularly checked and drills regularly held. 1 November 2005 1 November 2005 When a room becomes available 11. 12. 13. 30 33 42 23(2) 18(1) 23(4) 1 September 2005 1 September 2005 1 September 2005 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. 3. Refer to Standard 6 6 12 Good Practice Recommendations Goals set at service users individual planning meetings should be met within agreed timescales, unless there are clear reasons why this is not possible. Daily records should be comprehensive, informative and regularly recorded. The necessary training should be provided for staff. The additional hours available to support service users in pursuing activities, should be made use of in house 2, so that service users can enjoy a full programme of activities, as set out in their activity plans. The signed consent of relatives to service users receiving PEG feeding from care staff, should be obtained. All care plans for PEG feeding should be regularly G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 25 4. 5. 17 17 Emerton Close 6. 7. 8. 9. 24 24 24 38 reviewed. A risk assessment of PEG feeding in the home should also be recorded. The double room in house 2 should be more personalised. House 1 and 2 gardens should be better maintained. The services of a gardener should be obtaned. The floor covering and tiling in the bathroom in house 2 should receive attention and the bathroom in this house should be re-decorated. The management time allowed for the senior care staff in charge of each house should be reviewed, with a view to increasing this. Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection River House 1 Maidstone Road Sidcup Kent, DA14 5RH 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 Emerton Close G51 G01 S38187 Emerton Close V220528 29.07.05 Stage 4.doc Version 1.40 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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