Inspection on 26/04/05 for Granville House

This inspection was carried out on 26th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Granville House 17/09/09

Granville House 11/08/09

Granville House 18/10/07

Granville House 16/02/07

Granville House 21/11/05

Granville House 19/01/05

Granville House 01/06/04

Granville House 02/03/04

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

CARE HOMES FOR OLDER PEOPLE Granville House 40 Woodgreen Road Wednesbury West Midlands. WS10 9QS Lead Inspector Jon Potts Unannounced 26 April 2005 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 Older People. 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. Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Granville House Address 40 Woodgreen Road Wednesbury West Midlands. WS10 9QS 0121 502 2654 0121 502 2654 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) Mr. A. S. Sandhu No registered manager - Acting manager Mrs W Trainer Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The home is registered for 22 people whose primary need and reason for accomodation at the home is due to the effects of old age. The home is not regsitered to cater for any other primary need (such as dementia, physical disability, mental illness and such like) or any nursing needs (although this maybe provided through the district nursing service where applicable) Date of last inspection 19.1.05 Brief Description of the Service: The home is an adapted and extended traditional detached property that is sited within a short distance of Wednesbury Town centre with access to good transport links and the M6 motorway. Accomodation in the home includes three lounges, dining area with toilets and bathrooms on every floor. There are 14 single and 3 shared rooms, these on three floors, with only the first floor accessible via shaft lift. There is parking to the front and rear of the home and a patio and small garden area to the side and rear. There are a number of aids available including adapted baths, raised toilet seats and call system. The home is run by an acting manager who oversees 17 staff including seniors and carers. There are also some ancillary staff in place including cook, domestic and handyman. The home provides a service to older people without complex needs and whilst nursing may be provided by primary health care staff on occassions (such as district nurses) the home does not itself offer any nursing care. Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection, which was carried out over one day, was unannounced. Evidence was drawn from discussion with residents, relatives and staff, case tracking, reviewing case files, staff files, some policies/procedures, minutes of meetings, records of monies in safe keeping (against valuables kept), staff files, training records, health and safety documentation and a tour of the premises. What the service does well: What has improved since the last inspection? What they could do better: Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 6 The improvements in the care planning process need to be continued with clear identification of how the risk assessments carried out influence the actions staff are to take in caring for residents. Individual social needs could also be better recorded on care plans. The homes records in respect of monies received towards accommodation charges need to be better recorded, and easier to track. Some of the procedures need review and improvement, especially in respect of critical areas such as adult protection, medication and recruitment/selection and induction of staff. A quality assurance system that allows the home to clearly identify where it is in relation to meeting national minimum standards needs to be introduced. 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. Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,3,4 Poor pre admission practices that have compromised the safety of past residents have been identified by the acting manager and dealt with. The management are aware of the actions that they need to take to ensure that any future admissions to the home are matched to the service offered. EVIDENCE: Due to the current suspension on placements by Sandwell M.B.C the home has had no admissions this year, this meaning any comments in respect of pre admission assessments would be based on past and not current practice at the home. There have been issues however where the home has been unable to meet the needs of residents that were previously admitted outside of the homes categories of registration, this resulting in some instances where the provider decided to serve notice and advised the relatives to find more appropriate accommodation for the resident. Whilst there are now no residents not within the homes registration categories the homes admission policies need to be more robust with the admission process using all the information available (social workers assessments, care plans, staff assessments, visits to the prospective resident, trial visits to the home, trial periods of accommodation Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 9 and so on) to ensure that the home is able to fully meet the needs of any future resident. The acting manager showed a clear understanding of these issues in discussion with the inspector. The home’s statement of purpose and service guide were seen to be readily available at the home and whilst needing some minor revision (see recommendations), contained the majority of expected information. Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10 Care planning has developed since the time of the last inspection and is now incorporating the involvement of residents and relatives. Risks to residents are now better identified but are not consistently followed through into care plans, which could be more concise in the way in which they are presented. Residents are supported by staff in accessing health care services. EVIDENCE: It was evident that the care plans in use at the home, one available for every resident whose care was tracked, have developed since the time of the last inspection with evidence that residents or relatives have read and agreed them prior to signing a sheet to confirm the same. There was some degree of repetition in the information in the case file (namely in respect of the homes own assessments). There was evidence of a range of risk assessments in place covering falls, moving, tissue viability, nutrition but a clearer link to show how the outcome of the risk assessment influences the care plan in terms of the specific actions staff are to take to meet residents needs would be beneficial in making the documents clearer and more accessible to staff, and Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 11 residents/relatives. There were some instances where there were discrepancies between some of the documented information recorded and what was found in practice, one example where nutritional assessments identified the need to weigh monthly, this not seen to have been implemented. The case files carried reference to residents having access to the full range of appropriate health services, this also confirmed by residents spoken to at the time. Assessments in respect of continence (where necessary) could be improved, these to identify such as the regime for the use of aids where used as well as steps that maybe taken to promote continence (toileting regimes). The home had received a recent visit from their contracted pharmacist who identified no major concerns in respect of the way in which the home handles, stores and administers medication. The home does not however have a policy on medication refusal and ‘as directed’ medication. Discussion with the residents and relatives indicated that the home offered them dignity and privacy, some of this reflected in case files (An example been records of preferred titles – these confirmed to be accurate with residents). Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,15 The quality, quantity and choice of meals available to residents are in keeping with their preferences. The home offers a range of daily group activities although identification of individual preferences in respect of individual activities could be better. EVIDENCE: There was seen to be an activities programme on display in the home and the activities taking place on the day of the inspection reflected those documented within this. The programme was however in small print, the use of larger print advisable. There was seen to be a range of daily group activities available and residents spoken to were content with those activities available to them but there was limited information in care plans as to individual preferences and how the staff would meet their social needs. There was evidence that residents meetings have been instigated, the minutes of those seen showing discussion centred around activities and trips. The home has reviewed its menu, this now on display in the dining room. There are choices of meals available and all the residents spoken to were happy with the quality and quantity of the food available. There was also comment from one resident that drinks were freely available to them Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 13 throughout the day. The cook when spoken to did state that she was keen to keep the menu under review and was looking to develop a pictorial format for its presentation. Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,18 The home’s complaints procedure is accessible to all residents and visitors to the home, and clearly understood by some residents. Residents are not safeguarded from abuse by the homes lack of guidance on adult protection. The home’s systems for recording monies received for accommodation charges are of a poor standard and do not protect residents interests, although appropriate record keeping was in place in respect of other valuables kept at by the home. EVIDENCE: The home’s complaints procedure was on display in the foyer of the home in large print and discussion with residents and a relative indicated that they were aware of this document. The policy gives an assurance that complaints will be responded to within 28 days and carries contact details for the CSCI. Nine staff have received training in adult protection/abuse since the time of the last inspection although there was no policy in place in respect of Adult protection. When requested by the inspector it was stated that the home currently has no policy on the protection of vulnerable adults, this to be drawn up in the near future. There was seen to be a copy of Sandwell Social Services Protection of Vulnerable Adult’s procedure available however. The home safekeeps some monies for residents and some of these were checked against records, these found to balance. Records kept of these monies were seen to be appropriately recorded. Monies were seen to be kept in a safe Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 15 to which there was limited key holding access. Records in respect of those residents that paid towards their accommodation charges was however poorly recorded with a lack of clarity as to the exact fees paid and a lack of records in respect of the on-going balance of account. Discussion with two relatives that paid towards accommodation did however indicate that this was a matter of poor record keeping as opposed to any intent to overcharge, as they were quite satisfied with the amounts that they paid. Inventories of residents property was seen to be kept in all the case files examined. Residents spoken to were aware of their right to see any records written by staff at the home. Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 23, 24, 26 The implementation of a redecoration and refurbishment programme drawn up by the provider (with the assistance of the manager) should improve the facilities and ambience of the property to the benefit of the residents. EVIDENCE: A lack of past investment in the past has meant that some areas of the home have not received much attention decoratively although the management have recently supplied the CSCI with a detailed audit of the premises detailing those areas where it is intended that work should be carried out. This plan is detailed (containing timescales) and highlights an intensive redecoration and refurbishment programme for the next few months that when completed should update the property. Whilst this work had only commenced shortly before the inspection there was clear evidence of the provider’s willingness to progress the plan for the refurbishment and redecoration of the premises, this evidenced by purchase of new items of furniture and equipment. In some instances the equipment purchased has had a direct impact on the quality of individual resident’ s lives Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 17 (for example a new chair specifically purchased to meet the needs of one person, fall mats for use by beds and so on). Those residents spoken to were generally happy with their bedrooms and the furniture and equipment within them. Whilst the home is not fully meeting the standard on infection control, some of the works necessary to achieve this are programmed in to the redecoration and refurbishment programme. Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,29,30 The current staffing levels are appropriate for the current levels and numbers of residents at the home. On-going training is developing the skills and knowledge of staff. Staff recruitment procedures, whilst improved, are not fully reflected in the homes recruitment and induction procedures, which need to be developed further to ensure employment of appropriate staff. EVIDENCE: Staffing levels are currently acceptable, this based on the current low occupancy levels. There are three care staff available throughout the working day and two waking night staff. The staffing levels may however need review when occupancy levels rise, with a possible addition of ancillary staff to assist with the serving of the tea, this a task currently undertaken by one of the care staff. The home was seen to have documentation identifying what staff had received which training, although this would benefit from development into a training plan that meets national recognised standards. The home is to be complemented in achieving above the 50 ratio of NVQ trained staff with 9 out of the 17 having completed this training and others commencing the same. The majority of staff now have training in food hygiene, moving and handling, and first aid, this following recent training input. Further training, which the Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 19 management is aware of and has identified to the inspector, does need to be continued this including infection control and health and safety. There was evidence that the home has improved its recruitment practices with evidence of POVA (Protection of Vulnerable Adults) checks carried out and disclosures available for all but two staff (although POVA checks have been carried out for these individuals). These disclosures were stated to have been applied for. The homes recruitment procedure does however need review to ensure that it reflects the full range of necessary checks that the home must carry out prior to employment. There was evidence of the staff completing an induction programme to care skills council standards although the development of the initial induction period for new staff was discussed, this as the current three-day period off the rota for new staff would be insufficient for those who do not have a grounding in a care environment and who are unfamiliar with the home and residents. Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,34,36,37,38, The manager showed a good understanding of the areas where the home needs to improve with the use of forward planning improving. The support available to the manager and staff through the responsible individual has improved since the last inspection, this clearly impacting on the manager’s confidence and autonomy. EVIDENCE: The home has been through a period of instability of the last few years with the home not having a registered manager since 2002. The current manager was employed in the latter half of last year and has now applied for registration with the CSCI. Her fitness for the position of manager will be determined through this process, although her involvement in the management of the home has to date been instrumental in improving standards, with the support of the responsible individual. The provider has Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 21 recently agreed to his son taking over a controlling role in the running of the home on a day-to-day basis and initially discussions and responses from this new responsible individual indicate a wish to resolve the difficulties the home has had of late. There was evidence of staff receiving supervision from the acting manager, although this does need to be continued. The home does not yet have an operational quality assurance system, although the manager and responsible individual have discussed ways in which this could be implemented with the inspector, this based on the use of the national minimum standards as the benchmarks for quality. There are some areas where work is needed to ensure the safety of residents, these detailed within the requirements to this report, although the necessary servicing of equipment, when sampled was seen to be up to date. Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x 3 3 x 2 STAFFING Standard No Score 27 3 28 4 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 1 2 x 2 2 2 3 2 2 Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 23 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. 2. Standard 3 7 Regulation 14 & 16(2)m 12 & 15 Requirement A policy on management of emergency admissions to the home must be developed. Service user plans must be available in formats that make information within them more accessible to residents. Timescale for action 30.6.05 30.6.05. 3. 7&8 13, 14 & 15 This facility must be offered to residents with a record to show if they specifically state they do not require it. All risk assessments in respect of 30.6.05. nutrition, falls, tissue viability and such like must give rise to a clearly identified set of control measures as necessary and when a medium to high risk is identified (these to be detailed within the care plan). Continence assessments must also be developed. Care plans must carry more detail of the residents individual social needs and wishes regarding activity and stimulation. The registered provider must develop a policy and procedure on medication refusal and as 4. 7 & 12 15 30.6.05 5. 9 13(4)c 14.6.05. Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 24 directed medication. 6. 7. 8. 9. 12 18 19 22 14 13(6) 23 23(2)c There must be clear policies and procedures in respect of religious observance. A policy and procedure in respect of Adult protection must be developed. The painting of the homes exterior must be completed. Proposals must be forwarded to the CSCI identifying how the current call system can be modified so calls cannot be cancelled at the main control panel. The registered provider must replace the portable door ramp that has been removed. The initial date for meeting this requirement was the 7.4.05. The registered provider must ensure that water from all taps to sinks and baths is maintained between the temperatures of 38 - 43 degrees Celcius. Regular checks on water temepratures must be carried out and documented. The registered provider must purchase a washing machine suitable for the needs and purpose of the home. The home must ensure that bathrooms and toilets have soap and paper towels available, preferable within fixed dispensers as proposed To review and improve the homes procedure/protocol for the selection of staff, this so it covers all the areas in respect of practices that would ensure the safety of residents A)The registered provider must develop the homes staff training and development programme in 7.5.05 14.6.05 30.6.05 14.6.05. 10. 22 23(2)j 14.7.05 11. 25 23 immediate and on going 12. 26 16(2)f & 23(2)k 16 & 23 31.5.05 13. 26 31.5.05. 14. 29 19 14.6.05 15. 30 18 & 19 A) 14.7.05. B) 30.6.05. Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 25 accordance with National Training Organisation Standards. B)The homes induction process must also be developed so that new staff have sufficent time as supernummary staff, this to be reflected in the induction procedure. The registered provider must supply copies of the reports on the conduct of the home that are completed following monthly unannouced visits by him or his representative. A suitable quality assurance tool must be put into operation at the home. The target date is carried over from the previous report To produce a business and financial plan, a copy to be sent to the CSCI. This plan should take into account planned and costed changes and be reviewed annually. The initial date for meeting this requirement was the 19.3.05 There must be clear records in respect of all monies received at the home in respect of accomodation charges, these to clearly show the amount payable (including any top up fees), the amount received and the balance of the account with refrence to any receipt numbers. The two broken drawers in the kitchen freezer must be replaced or the freezer taken out of service (as suggested by the provider). The ultra violet insectocuter must be fitted with a new bulb The homes risk assessment of the premises must be reviewed 16. 32 26 To send copies to CSCI. on going 19.5.05 and ongoing 17. 33 24(1) 18. 34 32 30.6.05. 19. 35 16 & 20 14.6.05. 20. 38 23(2)c 14.6.05. 21. 22. 38 38 23(2)c 13 10.5.05. 30.6.05. Page 26 Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 23. 38 13 & 18 within the frequencies identified by the management at the home (3 monthly) and the assessment expanded to include the security of the property. All the staff must be provided with training in health and safety (as commenced by some staff) and infection control. ongoing for review at the next inspection. 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 1 Good Practice Recommendations The homes statement of purpose should include a statement as to the physical environmental standards (within the national minimum standards) met by the home. These standards are 20.1, 20.4, 21.3 - 4, 22.2, 22.5, 23.3 and 23.10. The information documented within case files should be reviewed so that there is less repetition of information within such as resident assessments. The homes activity programme should be displayed in larger print. A test of the lighting available within the home (through measurement of lux) should be carried out to verify that the home meets the standards in respect of available light. The registered provider should purchase a copy of the Residential Forums staffing tool so as to allow him to calculate staffing levels against dependency levels on an ongoing basis. 2. 3. 4. 5. 7 12 25 27 Granville House E55 S4857 Granville House V224004 260405.doc Version 1.30 Page 27 Commission for Social Care Inspection West Point Muckow Office Park Mucklow Hill Halesowen. B62 8DA 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. 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