Inspection on 14/02/06 for Fernlea

This inspection was carried out on 14th February 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Fernlea 16/09/08

Fernlea 19/09/07

Fernlea 06/03/07

Fernlea 11/07/06

Fernlea 17/10/05

Fernlea 31/01/05

Fernlea 13/07/04

Fernlea 15/03/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

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

CARE HOME ADULTS 18-65 Fernlea 59 Fort Ann Road Soothill Batley West Yorkshire WF17 6LS Lead Inspector Alison McCabe Unannounced Inspection 14th February 2006 11:15 Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 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 Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 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. Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Fernlea Address 59 Fort Ann Road Soothill Batley West Yorkshire WF17 6LS 01924 470176 01924 470176 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) St Anne`s Community Services Mrs Sarah Grogan-Evans Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Seven service users with learning disabilities and four who also have physical disabilities. To provide accommodate and care for one named service user over 65 years 17th October 2005 Date of last inspection Brief Description of the Service: Fernlea is a care home registered to provide nursing care and accommodation for three adults with learning disabilities and four adults with learning and physical disabilities. The registration category also includes one named service user who is over 65 years of age. St. Anne’s Community Services, a charitable organisation, operate the home. The home is located in a residential area close to the centre of Batley. There are shops, a post office and community facilities within 5 minutes’ drive of the home. The property is a brick built, detached bungalow which was purpose built for use as a care home. Internally, the home is separated into two discrete units, one providing care and accommodation to adults with severe leaning disabilities and the other providing care and accommodation to adults with physical and learning disabilities. The former is referred to by the staff as the red side and the latter the blue side. All the service users have complex needs. The property has small, secure sheltered gardens on either side of the home and parking space on a drive. Internally, there is a central area where there is staff sleeping in accommodation, the laundry, macerator room and a storeroom. Accommodation on the red side comprises three single bedrooms, a lounge, kitchen/diner, bathroom, shower room and an office. Accommodation on the blue side comprises four single bedrooms with wash hand basins, kitchen/diner, lounge, conservatory that is also used as a snoezelen room, shower room and an adapted bathroom. Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by one inspector between 11.15am and 3.00pm. The inspector had the opportunity to meet with service users, staff and the acting manager. Service user and staff records were sampled as part of the inspection. Service users that were at home during the inspection were unable to give verbal feedback about their experience of living at Fernlea therefore the inspector spent time observing care practice. What the service does well: What has improved since the last inspection? What they could do better: Personal information relating to service users should be stored securely. Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 Page 6 Some service users should be given more opportunities to engage in meaningful activities. This matter has been raised with the organisation on a number of occasions. Service users need to be supported by a stable staff team. The organisation should consider employing a cleaner so that the nursing and care staff can spend more time with service users. All staff should have received training in the management of challenging behaviour and protection. 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. Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 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 Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 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): 2 Service users needs’ are assessed prior to admission. EVIDENCE: Records for three service users were examined as part of this inspection. A comprehensive assessment of need had been completed in respect of each service user prior to them moving into the home. Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9,10 Detailed care plans are in place informing staff how to meet individuals’ assessed needs. Service users are supported to make choices about their lives. Service users are supported to take reasonable risks. Most records in relation to service users are stored securely. EVIDENCE: Three service users’ individual care plans were examined as part of this inspection. All were found to contain detailed information about how assessed needs should be met. Evidence of regular reviews of care plans was also seen in the records. Daily records are kept to record whether or not individual care plans have been implemented as intended. These were clear and detailed. Concerns were raised at the last inspection that not all staff were aware of service users’ agreed care plans. The acting manager has implemented a system whereby staff are required to read the care plans and sign to say they have done so. The acting manager reported that this system had been Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 Page 10 successful in the most part. It was noted that one staff member had not signed to indicate that care plans had been read. The acting manager was aware of this and there was evidence that attempts were being made to address this. The inspector observed several examples of service users being offered choices, including where to sit, what activity to do, choice of drink/food. It was positive to note that staff were skilled at offering choices to service users using communication methods appropriate to the individual. There was evidence in daily records and individual care plans that service users are offered choices as part of their daily lives. Risk assessments have been reviewed and updated since the last inspection. Identified risks had been appropriately assessed and clear guidance about how to minimize identified risks was available to staff. Service users are supported to take reasonable risks with appropriate staff support. For example, a service user is supported in the kitchen to make drinks and snacks. Most service user records are stored securely, however it was noted that some information specific to service users was on the notice board in the kitchen on the blue side. This was discussed with the acting manager at the time of inspection in respect of confidentiality. The acting manager agreed to move the information into a file so that staff could still access this easily. The acting manager discussed this with staff on duty at the time. Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Some service users have access to daytime occupation whilst some service users have limited opportunities to take part in valued or fulfilling activities, education or training. Service users are supported to maintain contact with friends and family. Staff respect service users’ rights. Food provided is nutritious and varied. EVIDENCE: Three of the 7 service users have regular, though limited, day services and two service users have additional staff employed to provide an individual day service from the home. It was positive to note that, since the last inspection, additional staffing hours have been provided to a service user who now receives 1:1 input for two full days and three half days per week. The acting manager reported that this had had a positive impact on the service user’s quality of life. Staff at the home are responsible for the daytime occupation of the remaining service users. It was observed that, whilst staff attempt to spend time with service users who are at home during the day, this time is Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 Page 12 limited due to the number of other tasks that must be completed, for example, cooking and cleaning. Staff reported that they try to complete all household tasks in the morning so that staff have more time to spend with service users in the afternoon. Service users were observed to spend significant periods of time unsupervised when staff were busy with cleaning and housekeeping tasks. Staff on duty reported that they were in the process of developing an activities timetable for service users on the blue side to ensure that individuals were kept occupied as much as possible. This will be re-assessed at the next inspection. Service users’ opportunities to access community based activities and facilities varies. Service users living on the red side have increased opportunities since the last inspection due to additional staffing being available for two individuals. Service users living on the blue side, however, still have limited opportunities. The service users on the blue side are much more reliant on the home’s transport due to their physical disabilities. The acting manager reported that there are currently only three drivers working at the home, one of which is a part time worker. This should improve in the next few months as one of the newly recruited staff will be able to drive the transport and the registered manager, who is also a driver, is due to return from maternity leave in April 2006. It is positive that, in an attempt to address this difficulty, all the service users have been registered for a local transport scheme that can accommodate wheelchair users, although the acting manager reported that the service is fairly limited in terms of destinations and having to book a week in advance. The acting manager reported that, where possible, service users are supported to access the community on a weekly basis. Arrangements have been made for all service users to have a holiday this year. These have been planned on an individual basis with service user involvement wherever possible. Through discussion with staff, and examination of records, there was evidence that service users are supported to maintain contact with family and friends. Staff were observed to respect service users’ rights to make choices. A number of examples of this were seen, including service users being asked to choose what they would like for lunch, where they would like to sit and what they would like to do. Staff were observed to spend time interacting with service users when they had time to do so. Due the nature of service users’ disabilities, none have keys to their rooms or the front door of the home. Service users have unrestricted access to most parts of the home. It is positive that all communal areas and service user bedrooms on red side continue to be accessible and remain unlocked (these areas had previously been kept locked due to behaviours displayed by a service user who has since left Fernlea). Menus were examined and showed that service users are offered a varied and nutritionally balanced diet. Staff ensure that service users are offered the Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 Page 13 recommended five portions of fruit and vegetables every day and a record is kept of this; this is good practice. Service users participate in menu planning using photos, signs or through staff offering choices and service users pointing to the preferred option. Service users also participate in food shopping. Staff reported that meal times are flexible depending upon the wishes of service users and activities planned for the day. Guidelines about how service users prefer to be supported with their meals were available. Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 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 Staff offer personal support in the way that service users prefer and require. Service users are supported to have their healthcare needs met. Medicine management is good at this home. EVIDENCE: Service user care plans that were examined were found to contain detailed information about how service users prefer to be supported with their personal care. Care practice observed was respectful and positive. The inspector observed staff support a service user to transfer using hoisting equipment. Staff were good at explaining what was happening and ensuring that the service user’s dignity was respected. The home continues to rely on agency staff although, wherever possible, the same staff are used. This has an impact on the service in terms of continuity of care. There was evidence in the records that service users are supported to attend healthcare appointments when necessary. Service users each have a health action plan, although care needs to be taken to ensure these are signed and dated. An OK health check is completed annually and staff facilitate routine health screening. The acting manager reported that she is still exploring how Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 Page 15 an identified healthcare need for a service user can be met; this was discussed at the previous inspection. Systems in place for the storage, administration and recording of medications are good. All medication checked tallied with the records kept. It is good practice that a record has been made on all service users’ records about how they prefer to take their medication. Clear guidelines are in place advising staff as to when ‘as required’ medication should be given and this is positive. Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 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 The home has a clear complaints procedure that is available to service users and their relatives. Service users are protected by the home’s policies and procedures, though some staff need training in the areas of protection and the management of challenging behaviour. EVIDENCE: A satisfactory complaints procedure is in place. No complaints have been received at this home in the last twelve months. Systems are in place for recording complaints. Robust procedures are in place for the protection of vulnerable adults. It was unclear if all staff had been made aware of the policies and procedures and the acting manager reported that staff had not had recent training in protection. It is recommended that, where necessary, staff receive refresher training to ensure they are aware of the current policies and procedures to follow in the event of suspicion of abuse. A comprehensive physical intervention policy and procedure is available that is in line with Department of Health guidance. The manager reported that agreed physical intervention plans were in place for one service user. Staff employed by St Anne’s have received training in managing violence and aggression, although this training is not accredited by the British Institute of Learning Disabilities as recommended in the National Minimum Standards. However, St Anne’s are in the process of having senior staff within the organisation trained to become physical intervention trainers accredited by the British Institute of Learning Disabilities and this is a positive step. Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 Page 17 It was noted that agency staff employed on temporary contracts, but working on a full time basis, have not received the necessary training in managing behaviour and physical intervention. Agency staff are often working alone on red side and,therefore, it is essential that they receive training to equip them to manage any episodes of challenging behaviour safely and in line with agreed guidelines. Agency staff on duty reported that they were due to receive training in this area through the agency in the near future. The acting manager agreed to assess the risks and establish systems to protect service users and agency staff. Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 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): EVIDENCE: Not assessed on this occasion. Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 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): 33,34 The home does not have a stable staff team. Service users are protected by the home’s recruitment practice and procedures. EVIDENCE: This home continues to have difficulties in recruiting and retaining a stable staff team. Agency staff are used on a daily basis. On the day of inspection, two of three staff on the morning shift were agency staff. Some agency staff are employed on temporary contracts on a full time basis, whilst others work on an ‘as and when’ basis. Wherever possible, the same agency staff are used. A requirement made at the last inspection to fill vacant posts has not been achieved. There are currently vacancies for three nursing staff and three support workers. This is in addition to the vacancy created as one of the nursing staff has taken up the acting manager position to cover maternity leave; her post has not been filled for this period. The number of vacancies has increased since the last inspection visit completed in October 2005 where there were vacancies for three support workers and one nurse. Two support workers have recently started work at the home and are in the process of completing their induction. One of the new support staff explained that he was supernumerary for the first two weeks to give him the opportunity to observe his colleagues and get to know the service users. In addition to the vacancies, Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 Page 20 one of the nursing staff is on long-term sick leave. The organisation must consider how the ongoing difficulty of staff recruitment and retention can be addressed at this home in order to provide a stable environment for the service users. The staffing ratios are 2:3 on the red side and 2:4 on the blue side if all the service users are at home. Staff reported that they try to complete most of the domestic tasks in the morning so that afternoon staff have more time to spend with service users. Upon arrival, it was observed that both staff on the blue side were busy with cleaning and domestic duties while service users were left unsupervised with nothing to do. It is recommended that the provider considers the employment of cleaning staff so that care staff and nursing staff have more time available to spend with the service users throughout the day. Staff recruitment records are to be checked centrally by the provider relationship manager from CSCI. The home holds a checklist confirming that all the required information has been received prior to staff starting work at the home. There was evidence in records that an induction is completed. The acting manager reported that, due to the nature of service users’ disabilities, they are not involved in the interviewing process, however new staff are invited to visit the home to meet with service users prior to deciding whether or not to accept a position. Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 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): 37,39,41 An acting manager is temporarily running this home. Satisfactory quality assurance and monitoring systems are in place at this home although a system for publishing the results needs to be developed. Record keeping is satisfactory. EVIDENCE: The registered manager is a registered learning disabilities nurse with several years’ post qualification experience. The registered manager is on maternity leave, however the acting manager reported that she is due to return to the home in April 2006. The acting manager is an enrolled nurse for people with learning disabilities. She has overseen the running of the home in the registered manager’s absence with the support of the service manager. Questionnaires are sent to relatives/friends of service users seeking their views about the quality of service offered, although the results of the questionnaires are not published or made available to service users or other interested Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 Page 22 parties; a requirement has been made in respect of this. The home has an annual development plan that is available in the home. Records required by regulation that were sampled as part of this inspection were found to be current, clear and well organised. Individual service user care plans had improved in quality and clarity since the last inspection and this is positive. Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 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 1 ENVIRONMENT Standard No Score 24 X 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 1 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 2 LIFESTYLES Standard No Score 11 X 12 1 13 1 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 1 X 3 X X Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 Page 24 Yes 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 YA12 YA13 Regulation 16(2)(m)(n) 12(1)(b) Requirement The registered person must make arrangements for all service users living at the home to have regular access to community activities and recreational and daytime occupation/education opportunities consistent with their interests and wishes. Timescale of 15/4/05 and 15/12/05 unmet. Timescale for action 31/03/06 2 YA23 YA32 13(6), 18(1)(c)(i) 3. Fernlea YA33 12(1)b,18(1)a All staff must be provided 30/04/06 with training specific to challenging behaviour, by an appropriately qualified trainer. All staff expected to physically intervene with service users must have undertaken a recognised and accredited course. This must be kept up to date, follow best practice guidelines and be specific to the needs of the individual service user. The registered person 30/04/06 Version 5.1 Page 25 DS0000001081.V271242.R01.S.doc must ensure that at all times suitably qualified, competent and experienced persons are working at the home in such numbers as are appropriate for the health and welfare of service users. Staff vacancies must be filled. Timescale of 31/12/05 unmet. 4. YA39 24(2) The registered person must make the results of service user/relatives surveys, in respect of quality of care provided, available to service users. 30/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA10 YA33 Good Practice Recommendations Personal information relating to individual service users should be moved from the notice board in the kitchen. The organisation should consider employing cleaning staff. Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB 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 Fernlea DS0000001081.V271242.R01.S.doc Version 5.1 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. 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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