Inspection on 26/02/07 for Holmwood House

This inspection was carried out on 26th February 2007.

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 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

Holmwood House 16/10/07

Holmwood House 11/10/05

Holmwood House 09/05/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Holmwood House Austin Fields King`s Lynn Norfolk PE30 1PH Lead Inspector Mrs Geraldine Allen Unannounced Inspection 26th February 2007 09:00 X10015.doc Version 1.40 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 Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holmwood House Address Austin Fields King`s Lynn Norfolk PE30 1PH 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) 01553 773529 01553 773529 Integrated Nursing Homes Limited Mrs Pamela Jordan Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th October 2005 Brief Description of the Service: Holmwood House is a care home providing personal care and accommodation for up to 35 older people. The home is owned by Integrated Nursing Homes Ltd. The home is located in the town of King’s Lynn, close to shops, pubs, post office and other local amenities. Holmwood House is a single storey, purpose built home. 50 of the rooms are en suite. There are small gardens at the front and rear of the home. The manager, Mrs Jordan, said the current fee range was between £338.00 and £425.00. The resident or their representative is advised verbally of the rate that will apply before the resident is admitted to the home. They are also advised at this time of the additional charges that may be relevant to the resident. Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place during the day of 26th February 2007. Mrs Jordan provided information about various policies and procedures at the home some months before the inspection took place. Two relatives and 7 residents completed and returned questionnaires to the Commission. On the day of inspection, information was obtained by looking at records, touring the building, speaking with residents, visitors, staff and the manager and observing practice. A meal was also eaten with residents in the dining room. There was significant staff absence due to illness on the day of inspection. This meant that staff were working very hard to effectively meet the needs of residents. The manager was also required to undertake care duties to assist staff. Residents were very positive about their experiences of living at this home. They were complimentary about staff and the manager and felt well cared for and safe. They said they enjoyed the activities that take place and felt able to make choices around their daily living. Overall, this home is rated as adequate. A total of 5 legal requirements (one of which is repeated), and 8 recommendations about good practice have been made. The majority of the legal requirements reflect management difficulties. What the service does well: Residents receive good, timely healthcare and the home has good relations with local healthcare services. Residents are able to join in activities that they enjoy. Residents described some of the activities that take place and they were looking forward to an activity of gentle exercise on the afternoon of the inspection. Residents said they are able to make choices around their day-to-day living and were confident staff would always respect their choices and preferences. Staff receive training that is relevant to the needs of residents and helps staff to provide appropriate care. Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have a needs assessment completed before admission to the home to ensure the placement is appropriate. This home does not provide intermediate care. EVIDENCE: Mrs Jordan confirmed that the current fee rate is £338 - £425. The majority of placements are arranged through social services and the social worker is advised of the relevant rate. For privately funded placements, the relevant fee rate is advised verbally over the ‘phone or when a visit is made. Three resident’s files were looked at. Each file contained details of preadmission assessment. This assessment is supplemented by further, thorough assessments at the time of admission. This home does not provide intermediate care. Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All residents have plans of care that set out their needs and how they can be met. Care plans would benefit from the inclusion of a life history and information about significant events. Residents receive health care in a timely way. The home operates good and safe procedures in respect of medicines. These practices would be enhanced with regular assessment of staff competence in the control and administration of medicines. Staff need to be mindful of the need to protect the privacy and dignity of residents both in their practice and in how they store confidential information. Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 10 EVIDENCE: Three care plans were looked at in detail. Each care plan was well laid out to make the retrieval of information easy. Each file contained full admission details, a care plan agreement signed by the resident or their representative and a signed photograph. There were comprehensive assessments seen about all physical and healthcare needs. There was also an activity of living assessment. Each of these assessments informed the plans of care. Night and day plans of care were seen and these were reviewed monthly, with a full three monthly review taking place Evidence was seen on plan of care that the resident was involved in the review process where possible. Evidence was seen that information was cross referred appropriately, for example a medical intervention was also recorded in the daily record. An incident involving an injury to one resident was crossreferred to an accident record and this was seen. None of the plans had a life history, detailing significant information about the person’s life and important anniversaries. The plans of care were stored in a unlocked filing cabinet behind a desk at the main entrance. An open care plan was seen left on the desk at one point during the day and this was brought to the attention of Mrs Jordan as it compromised confidentiality. Good records were seen within the plans of care that detailed health care interventions and changes to regime. Residents said that staff always called the doctor when they needed them. Medication arrangements were looked at. Records were legible and up to date. Variable doses were recorded correctly. Normal practice is for refrigerator temperatures to be recorded daily and this record was seen. Medicines were stored safely and securely. Mrs Jordan stated that only trained staff dispense medicines. Good dispensing practice was described and this was observed at lunchtime. For the most part, residents felt they were treated with respect and that their privacy and dignity was respected. However, there is a tendency for most residents to have their bedroom doors open, particularly if they like to remain in their room. Whilst walking along a corridor, a resident was seen in her bedroom with the door left open by a carer. She was in some disarray with her clothing, compromising her dignity and privacy. The interaction between staff and residents was observed throughout the day and was appropriate and respectful. Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents said they were able to make choices around their daily living that reflected their preferences and expectations. Residents said their visitors were always welcomed at the home and could visit whenever they wished. There was some evidence that the specific chosen lifestyle of some residents who are vegetarians is not fully understood and appropriately catered for. Most residents said they enjoyed their meals although the standard was variable at times. Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 12 EVIDENCE: Six residents were spoken to in private and at length. Other residents were seen during the day and were spoken to briefly. Residents spoke about the activities at the home and said they were very enjoyable. They could attend if they wished. One resident said she likes to help about the home doing light chores such as dusting. One resident described enjoying going out in his electric wheelchair. There was an activity during the afternoon of inspection that was looked forward to by several residents who said they would attend. The person taking the activity was seen and spoken to briefly. She visits the home regularly to take activities such as quizzes or gentle exercise. She was disappointed with the turnout of residents on the day of inspection but was aware there was significant illness in the home. Residents said they were able to make choices around daily living that they were confident would be respected by staff. They described being able to choose how and where they spent their day. They spoke of being able to have a lie-in if they wanted. There is some suggestion that the expressed preferences of 3 residents who are vegetarians are not fully understood. Catering staff need to ensure that residents have food that is appropriate and well balanced and does not impinge on their expressed preferred lifestyles. All residents said their visitors were always made welcome at the home and could visit whenever they wished. The residents said that their visitors were offered refreshments by staff. Lunch was eaten in one of the dining rooms with residents. The experience was very enjoyable, with residents relaxed, chatty and making jokes with staff. The menu was described as boring by one resident. There was some conflict, with 1 resident saying there was no choice, whilst another said there was. The 2-week menu was seen and this noted alternatives to the main course as being either salad or omelette. The home caters for some special diets, including diabetic and vegetarian. The opportunity was taken to speak with the cook on the day of inspection. She stated that she has been at the home for 4 years and is about to commence an NVQ, having completed all relevant training such as food hygiene. It was noted that lunch is served in 2 sittings and residents were anxious to leave the dining room to allow staff to deal with the second sitting. Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure that is well known to residents and visitors. There was insufficient evidence to demonstrate that residents are protected by robust recruitment practices at this home. Not all staff have attended abuse awareness training. EVIDENCE: The home’s complaints procedure is well known to residents, who said they would speak with Mrs Jordan if they had any. Mrs Jordan confirmed that the home follows the company’s complaints procedure. The complaints records were not available at the time of inspection. Of 4 staff files looked at, only 2 (both domestic staff) had attended abuse awareness training that had been recorded. A care staff was spoken to and she confirmed that she had worked at the home for 14 months but had not attended abuse awareness training during that time although she had received this training at a previous home. Mrs Jordan confirmed that abuse awareness training last took place in December 2005 and it was agreed that abuse awareness should be updated frequently, preferably annually, to ensure staff remain fully aware. The staff records did not provide sufficient evidence to demonstrate that residents are protected by robust recruitment procedures. Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is well maintained and fit for its purpose. However, the home needs to ensure fire safety is not compromised by the use of wedges and other items to keep bedroom doors open. The home is in a good state of decoration. The lack of storage space is impinging on the appearance of some communal areas. EVIDENCE: A tour of the premises was conducted with Mrs Jordan. The home was in a good state of decoration, with many bedrooms highly individualised. Some of the bedrooms have vanity units in them. Some bedroom carpets were stained and need to be cleaned or replaced, but these will be dealt with as part of the on-going redecoration programme Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 15 It was noted during the tour that some bedroom doors are being held open by wedges or other items. The home needs to consider the use of Door Guards to hold open bedroom doors. The double doors between the kitchen and lounge were clearly marked as fire doors. Staff were using the side of the doors that should have been bolted closed. As a result, the doors were failing to close fully. All fire exit routes were clear of obstruction. The laundry was seen. The room is compact and contains industrial washers and dryer. Both washers were able to disinfect soiled laundry appropriately. The laundry person was spoken to briefly and said the machines were very reliable. All laundry is done on site, but night staff if necessary would wash only soiled laundry. New furniture was seen in the dining room. The room was attractively laid out and was clean and bright. The lounges contained appropriate furnishings and offered alternative places for residents to spend their time. There appears to be a lack of storage space, with a hoist being stored in the dining room and wheelchairs in the lounge. There were no unpleasant odours evident during the day. The home was clean but some communal areas were untidy and spoilt by the storage of equipment. Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 16 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. On the day of inspection, staff were working hard to provide good care whilst experiencing significant sickness amongst the staff group. Shifts were covered, but Mrs Jordan was required to work on care to ensure there were sufficient staff to meet needs. Staff files do not contain all the information required to demonstrate robust recruitment practices. Staff receive training to ensure they are able to meet residents needs but all staff need to attend abuse awareness training. EVIDENCE: On the day of inspection, the home was affected by significant staff sickness. The amended staff rota for the week of inspection was obtained and showed that 3 care staff were off sick who should have been on duty on the day of inspection. The normal staffing levels allow 4 care staff between 07:30 and 21:30 in addition to the manager. Three waking night staff are also employed. Additional staff are employed for catering, domestic and laundry duties. A total of 27 residents were living in the home at the time of inspection. Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 17 Four staff files were looked at in detail. Information contained within them was inconsistent and it was not possible to find evidence that the home always applies good recruitment procedures. All 4 files had details of training and development. The poor staff records were discussed with Mrs Jordan and she stated that the files had been archived and the information removed from the staff files. She went on to say that she always obtains 2 written references for all staff appointments. This could not be evidenced. Staff files showed a range of relevant training taking place that is relevant to the needs of the residents. Staff spoken to described some of the training they have done or are currently doing. The cook is about to commence an NVQ in catering/hospitality. The NVQ assessor was present in the home during the morning of inspection and was discussing the commencement of NVQ for some overseas staff, whilst also dealing with on-going NVQ’s for care staff and the registered manager. Not all staff have completed abuse awareness training and this needs to be provided to all staff. Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 18 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Mrs Jordan is an experienced manager and is currently working through NVQ4. The home’s quality assurance process is in place but now needs to be developed so that an action plan and summary is made available to all interested parties, including the Commission. Improvements need to be made to the way resident’s personal allowances are looked after. Staff do not currently receive formal supervision. There are good health & safety arrangements in place. Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 19 EVIDENCE: Throughout the inspection, telephone calls, staff, visitors, the NVQ Assessor, District Nurses, GP and delivery people frequently interrupted Mrs Jordan. She does not have a deputy manager and as a result she is unable to undertake the functions expected of a manager by the Commission. There will be no deputy appointed until after April 2007, when the new operations manager takes up their appointment. Mrs Jordan is experienced and is currently working towards NVQ4 The home’s quality assurance assessment process has included satisfaction questionnaires sent to GPs, relatives, residents and stakeholders. Audits of home functions take place in line with company policy, for example monthly pharmacy audits. The findings for the last satisfaction questionnaire were looked at. The home needs to develop an action plan and summary and ensure it is made available to all stakeholders and a copy sent to CSCI. The arrangements for looking after residents’ personal allowances were looked at. The record needs 2 signatures for all transactions. The records contained good detail of transactions and the balance held. The monies held for one resident were checked against the records and these were found to be more than the record stated. There was no evidence that regular audits of sums held against records takes place and these needs to occur to ensure errors are identified without delay. The cash was kept in a locked cash tin but stored in a cardboard box under the desk. These arrangements do not offer secure storage and alternative arrangements need to be put in place. The last supervision date recorded was 14/01/06 and the 2 files containing appraisal records show dates of 16/02/06. Mrs Jordan said she did not have the capacity to undertake supervision. Arrangements need to be put in place to ensure all staff receive formal supervision at least 6 times per year. A range of health & safety records was looked at. The accident records were up to date and well written. General risk assessments for each room in the home were seen and were thorough. Fire records were looked at. These showed that the weekly alarm test was up to date. Staff were due to have fire training presented by a fire officer shortly. As previously stated, the home needs to risk assess and install Door Guards accordingly to ensure good fire safety. Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 20 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 1 X 3 Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 21 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 OP10 Regulation 12 (4)(a) Requirement The registered persons must ensure that residents privacy and dignity is protected by the secure storage of records held about them The registered persons must ensure that staff practice does not compromise the privacy and dignity of residents. The registered persons must ensure that robust recruitment practices are followed in all circumstances. The registered persons must ensure that all monies and valuable looked after on behalf of residents is stored securely. The registered persons must ensure that staff receive formal supervision at least 6 times per year. This requirement has been outstanding since 21/11/05 Timescale for action 02/03/07 2 OP10 12 (4)(a) 02/03/07 3 OP29 19 (1) 26/03/07 4 OP35 16 (2)(i) 26/03/07 5. OP36 18,2 28/05/07 Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 22 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 4 5 Refer to Standard OP7 OP9 OP15 OP18 OP19 Good Practice Recommendations It is recommended that each care plan includes a comprehensive life history and information about significant events and anniversaries. It is recommended that all staff responsible for the administration of medicines is assessed for competence regularly. It is recommended that catering staff research and provide what constitutes a nutritious and appealing diet for residents who have food preferences such as vegetarians. It is recommended that staff receive adult abuse awareness training and that this is repeated on a regular basis. It is recommended that the home conducts risk assessments and installs door restrictors, that release if the fire alarm sounds, to all bedroom doors where the residents wish to have their door open. It is recommended that consideration is given to improving the storage arrangements of equipment so that communal areas are not used for this purpose. It is recommended the quality assurance process is developed to produce an improvement plan and summary that is made available to all residents and visitors and also the Commission. It is recommended that a deputy manager is appointed without delay. 6 7 OP19 OP33 8 OP32 Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Holmwood House DS0000062973.V331670.R01.S.doc Version 5.2 Page 24 - 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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