Inspection on 23/05/06 for Ismeer

This inspection was carried out on 23rd May 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 but made no statutory requirements on the home.

Other inspections for this house

Ismeer 17/06/08

Ismeer 03/01/08

Ismeer 17/07/07

Ismeer 12/01/06

Ismeer 10/08/05

Ismeer 09/03/05

Ismeer 24/06/04

Ismeer 01/10/03

Ismeer 19/09/02

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

CARE HOMES FOR OLDER PEOPLE Ismeer Trewollack Lane Gorran Haven St Austell Cornwall PL26 6NT Lead Inspector Alan Pitts Unannounced Inspection 23rd May 2006 10:00 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 Ismeer DS0000009040.V293151.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 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. Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ismeer Address Trewollack Lane Gorran Haven St Austell Cornwall PL26 6NT 01726 843480 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) Mrs Margaret Yvonne Wrigley Ann Elizabeth Carthew Care Home 27 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (27) of places Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. To include one named service user in the category DE(E) Total number of service users not to exceed 27 Date of last inspection 12th January 2006 Brief Description of the Service: Ismeer is a comfortable, tastefully decorated, extended detached property situated within walking distance of the village of Gorran Haven. The home is registered to provide care for 27 older people in need of personal care.Service users accommodation is currently located on three floors. Each floor is serviced by a stair lift. Although twin rooms are available all rooms are presently used for single occupancy. All bedrooms have washbasins and many have separate en-suite facilities.The property has spacious, well-tended landscaped gardens that over look the bay of St Austell and adequate parking facilities Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place on the 23rd and 24th May 2006 over approximately 7.5 hours. The inspector met with the senior staff on duty, Ann Carthew and Lisa Thomas, the registered provider, and with 5 service users. During the course of the day the inspector observed the service users being attended to by staff in a courteous and professional manner. Service users informed the inspector that their expectations of being in a care home were being fully met, and they expressed satisfaction with all aspects of the home. Various records, policies and procedures were inspected and found to be satisfactory. The inspector toured the building. What the service does well: What has improved since the last inspection? What they could do better: The registered manager must ensure that all service users have an accurate and descriptive plan of care. The registered manager must ensure that medicines are administered safely. The recording of service user’s daily quality Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 Page 6 of life at the home could be improved. The home’s complaints and Protection Of Vulnerable Adults procedures should be amended. Improvements have been made to the environment and it is hoped that this programme will continue. Staff training has improved since the last inspection, but further improvement is needed. The home must do more to protect service users by adhering to a robust employment procedure. 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. Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 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 Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 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 the following standard(s): 1, 3, 6 Service users are provided with the information they need. Prospective service users care needs are assessed prior to admission. The home does not provide intermediate care. EVIDENCE: The registered manager has amended the Statement of Terms and Conditions provided to service users to ensure that this includes the identification of the room being offered as accommodation. The Statement of Purpose and Service User Guide should be dated. The inspector is satisfied that potential service users are assessed prior to admission to the home, even though one of the two service user files inspected did not have a pre-admission assessment evident (the deputy manager did assure the inspector that the registered manager had done an assessment). The home does not provide intermediate care. Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Most, but not all service users have a plan of care. Service users have access to other healthcare professionals as appropriate. Medicines are not being administered in adherence to pharmaceutical guidelines. Service users are treated with respect and their privacy is upheld. EVIDENCE: The care documentation of five service users was inspected. One service user file inspected did not contain a care plan. The registered manager must ensure that all service users have a care plan and that, where possible, service users/representatives are involved in care plan reviews, and the entries provide clear instruction as to what the care needs and interventions necessary are (e.g. more specific than “needs assistance with dressing”). The care documentation indicated the inclusion of other healthcare professionals in the delivery of care at the home. Staff and the relevant service user confirmed this. A chiropodist visits the home every 6-weeks. A dentist is available approximately bi-monthly, and opticians visit annually. Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 Page 10 The registered manager must ensure that hand-written Medicine Administration Records are countersigned to indicate that the entry has been checked and is correct. The supplying pharmacist is providing printed Medicine Administration Records with incorrect dates and printing that is out of line with the date columns. This could cause confusion and potentially the erroneous administration of medicine. The registered manager must ensure that Medicine Administration Records provide clear information. Where tablets are not provided via the monitored dosage system staff are dispensing the medicine into ‘dosset boxes’, and then administering to the service user from these. The inspector was advised that this was because “staff forget to give them otherwise”. This constitutes secondary dispensing. The registered manager must ensure that secondary dispensing does not occur. Medicines must be administered from their original container. Approximately 25 of service users have their own telephone, and the remainder have access to the home’s telephone. Staff were seen to knock before entering service user’s rooms, and the service users spoken with confirmed that staff are respectful of their privacy. One service user did comment about other service users wandering into their room, and the deputy manager advised the inspector that arrangements for a suitable lock were in hand. The registered manager should carry out a risk-assessment and record service user’s/representative wishes in respect of the provision of bedroom door locks, and provide suitable locks as appropriate. Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 There is some evidence of social recreational activities, but evidence in the care documentation of service user’s daily lives could be improved. Service users felt that they were able to exercise choice and determine their own lifestyle, within the parameters of their care needs and capabilities. The menu could be improved with the inclusion of a choice at lunchtime. EVIDENCE: There is some recorded evidence of social/recreational activities, but this is not recorded as frequently as it could be. The registered manager advised the inspector that there are weekly outings on Wednesdays and regular activities on Mondays and Fridays, which are bolstered by videos and similar on Tuesdays and Thursdays. There is a tendency for entries in the care documentation such as “usual day”. The registered manager should ensure better recording of the service user’s daily life in the individual service user’s file. Service users confirmed that they find that they have enough to do and that they have the ability to largely determine their own lifestyle. Visitors are free to visit at any reasonable time. There is a visitor’s book in the entrance to the home. Voluntary groups (e.g. local dance group) occasionally visit the home. Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 Page 12 Personal possessions are recorded in individual service user’s files. Service user rooms showed varying degrees of personalisation. The registered manager should ensure that contact information for local agencies (such as Age Concern, Adult Social Care office) are provided to all the service users. The home does not have any involvement with service user’s benefits, merely keeping small amounts of money safe for service users. A 4-week rotating menu is in operation, which is reviewed seasonally. A record of meals provided is maintained. The kitchen was seen to be clean and well organised. An Environmental Health Officer visited in February 2006. The cook advised the inspector that an alternative would be available at lunchtime if a service user requested it. The registered manager should ensure that a lunchtime choice is offered and service user’s wishes are ascertained on a daily basis. The current menu, including choices available, should be made clearly available to service users. Service users were complimentary about the quality of the food provided. Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Service users spoken with were confident that they could raise any concerns with the staff or registered manager. A Protection Of Vulnerable Adults procedure is in place, but needs amendment. EVIDENCE: The complaints procedure in operation and displayed should be reviewed and amended to ensure that a timescale for responding to complainants is included. The complaints procedure should include contact details for the local Adult Social Care office and a statement to the effect that any concerns can be made to the local Adult Social Care office or the Commission for Social Care Inspection at any time. A record of complaints received and any action arising from them should be kept. Service users spoken with were confident that they could raise any concerns with the staff or registered manager. Approximately 7 staff have undertaken training in relation to the Protection Of Vulnerable Adults. The Protection Of Vulnerable Adults procedure in operation should be reviewed and amended to ensure clear step-by-step instruction is provided about what to do in the event of an allegation of abuse, and to ensure that the procedure is transparent and follows locally adopted Protection Of Vulnerable Adults protocols. Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Ismeer provides comfortable, clean, personalised accommodation for the service users. Service users spoken with expressed contentment with their accommodation. EVIDENCE: Service users have access to spacious dining and lounge facilities, which are comfortably and pleasantly furnished. Access to the garden/patio area is available in more clement weather. There are 2 double rooms and 23 single rooms, 12 of the latter offering en-suite accommodation. There is one staff lavatory. There are 7 communal lavatories, 3 of which are located in bathrooms. There are 4 bathrooms, one of which offers assisted bathing. The home works closely with supporting agencies and health care professionals to ensure that specialist equipment is made available to service users as necessary. Service user rooms are pleasantly decorated and furbished, and service users expressed satisfaction with their accommodation. Service user rooms are personalised to varying degrees according to the service user’s individual circumstances. Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 Page 15 An internal wall has been removed in the office, which has improved the space available. The registered manager informed the inspector that active ventilation was also due to be installed as this room currently has no natural ventilation. The home has been rewired since the last inspection, and a new fire system is being fitted in the next few weeks. New carpets have been fitted in some bedrooms and in one corridor. Some bedrooms are being redecorated, and the coach-house corridor has been redecorated. The registered manager should ensure that cleaning includes high areas such as vents in lavatories and bathrooms. The laundry area is accessed by a single step and there is a doorframe lip to negotiate. The registered provider should provide a ‘mind the step’ warning sign in this area. In the interests of infection control the registered provider should consider replacing the existing laundry machines with industrial-type machines (a washing machine with a sluice facility), which would then allow for the use of dissolving red laundry sacks for fouled linen and negate the need for staff to hand sluice laundry. Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 There is usually five care staff on duty during the day, with two on duty at night. Staff training has improved since the last inspection, but the registered manager still needs to introduce a National Training Organisation compliant induction programme. The registered manager must do more to ensure adherence to a robust employment procedure. EVIDENCE: Staff • • • hours are: 08.30-16.30 - 5 care staff 16.30-21.00 - 3 care staff 21.00-08.30 - 2 care staff The duty rota does not show the hours worked by auxiliary staff (cooks, cleaners). The registered manager should ensure that staff hours are accurately recorded on the duty rota. Service users spoken with were, without exception, complimentary about the care received and the kindness and consideration of the staff and registered manager. Staff were observed to be busy, without appearing rushed. There are 19 care staff, of which 12 have achieved NVQ Level 2 or above. The registered manager must implement a National Training Organisation compliant training programme for new staff (Skills for Care). Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 Page 17 Two staff files were inspected, which were also inspected at the last inspection. One file showed that a Criminal Records Bureau check was still outstanding. The registered manager said that this was due to the Criminal Records Bureau form being incorrectly completed and subsequently being rejected by the Criminal Records Bureau. As required at the previous inspection, the registered manager must adhere to a robust employment procedure, without exception. To assist with this the registered manager should introduce an employment checklist, that includes things such as: application received; date of interview; date reference1 sent for; date reference 1 received; date Criminal Records Bureau sent for; date Criminal Records Bureau received; Criminal Records Bureau number. Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Service user feedback about how the home was run was positive, without exception. The home has started to use quality assurance questionnaires. Service user financial interests are safeguarded, though the keeping of receipts would support this. The home has done much to improve the safety of the building, service users and staff since the last inspection. EVIDENCE: Ann Carthew is the registered manager. Ann has worked at Ismeer since 1999. She has obtained the NVQ Level 4 in care, the Registered Manager’s Award, and the A1 and A2 assessors award. Lisa Thomas assists the registered manager. Lisa is qualified to NVQ level 3 in care and NVQ level 4 in management. She also holds the A1 and A2 assessors awards. All the service users spoken with were aware of who the registered manager and registered provider was. The staff have been provided with General Social Care Council handbooks. Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 Page 19 Quality assurance questionnaires have been introduced, as confirmed by the service users. The registered manager should continue with these, including visiting healthcare professionals and relatives and publish a summary of the findings (including any action taken as a result of the responses). Appropriate insurance cover is in place. There is no reason to doubt the financial viability of the home. Weekly records of all transactions are kept. None of the home’s staff are appointees for any service user, and the home does not handle any service user’s money (benefits, pension). Some service users have a small amount of money held safe by the home. The registered manager keeps a record of payments received and made, such as for the hairdresser, but receipts do not support this record. The registered manager should ensure that receipts are obtained wherever possible where service user money is involved. Appropriate safety information, maintenance and safety certificates are in place, including: • Stair lift • Gas safety • Hoist • Appliance tests • Boilers • Fire system • Accident book • COSHH • RIDDOR • Hard wiring – installation of new wiring is almost complete, and a new certificate will be issued. As discussed at the time of the inspection, please forward a copy to the Commission for Social Care Inspection. Fire training was last provided in January 06. The registered manager should consider identifying a member of staff to undertake ‘Fire Warden’ training so that they can cascade training to other staff (3-monthly for night staff, 6monthly for day staff). The registered manager should arrange in-house training on COSHH and RIDDOR. Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement The registered manager must ensure that all service users have a care plan and that, where possible, service users/representatives are involved in care plan reviews, and the entries provide clear instruction as to what the care needs and interventions necessary are (e.g. more specific than “needs assistance with dressing”). The registered manager must ensure that hand-written Medicine Administration Records are countersigned to indicate that the entry has been checked and is correct. The registered manager must ensure that Medicine Administration Records provide clear information. The registered manager must ensure that secondary dispensing does not occur. Medicines must be administered from their original container. Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 Page 22 Timescale for action 01/07/06 2. OP9 13(2) 01/06/06 3. OP29 18, 19 As required at the previous inspection, the registered manager must adhere to a robust employment procedure, without exception. To assist with this the registered manager should introduce an employment checklist, that includes things such as: application received; date of interview; date reference1 sent for; date reference 1 received; date Criminal Records Bureau sent for; date Criminal Records Bureau received; Criminal Records Bureau number. The registered manager must implement a National Training Organisation compliant training programme for new staff (Skills for Care). 01/06/06 4. OP30 18, 19 01/07/06 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 OP1 OP7 Good Practice Recommendations The Statement of Purpose and Service User Guide should be dated. The registered manager should ensure that, where possible, service users/representatives are involved in care plan reviews, and the entries provide clear instruction as to what the care needs and interventions necessary are (e.g. more specific than needs assistance with dressing). The registered manager should carry out a riskassessment and record service user’s/representative wishes in respect of the provision of bedroom door locks, and provide suitable locks as appropriate. The registered manager should ensure better recording of DS0000009040.V293151.R01.S.doc Version 5.1 Page 23 3. OP10 4. Ismeer OP12 the service user’s daily life in the individual service user’s file. 5. 6. OP14 OP15 The registered manager should ensure that contact information for local agencies (such as Age Concern, Adult Social Care office) are provided to all the service users. The registered manager should ensure that a lunchtime choice is offered and service user’s wishes are ascertained on a daily basis. The current menu, including choices available, should be made clearly available to service users. The Protection Of Vulnerable Adults procedure in operation should be reviewed and amended to ensure clear step-bystep instruction is provided about what to do in the event of an allegation of abuse, and to ensure that the procedure is transparent and follows locally adopted Protection Of Vulnerable Adults protocols. The registered manager should ensure that cleaning includes high areas such as vents in lavatories and bathrooms. The registered provider should provide a ‘mind the step’ warning sign in the entrance to the laundry. In the interests of infection control the registered provider should consider replacing the existing laundry machines with industrial-type machines (a washing machine with a sluice facility), which would then allow for the use of dissolving red laundry sacks for fouled linen and negate the need for staff to hand sluice laundry. The registered manager should ensure that staff hours are accurately recorded on the duty rota. The registered manager should continue with quality assurance questionnaires, including visiting healthcare professionals and relatives and publish a summary of the findings (including any action taken as a result of the responses). The registered manager should ensure that receipts are obtained, wherever possible, where service user money is involved. The registered manager should consider identifying a member of staff to undertake ‘Fire Warden’ training so that they can cascade training to other staff (3-monthly for night staff, 6-monthly for day staff). The registered manager should arrange in-house training on COSHH and RIDDOR. 7. OP18 8. OP26 9. 10. OP27 OP33 11. 12. OP35 OP38 Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD 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 Ismeer DS0000009040.V293151.R01.S.doc Version 5.1 Page 25 - 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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