CARE HOMES FOR OLDER PEOPLE
Kilsby House Rugby Road Kilsby Rugby Warks CV23 8XX Lead Inspector
Mrs Judith Sansom Unannounced Inspection 12th January 2006 11:45 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 Kilsby House DS0000012830.V277475.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. Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Kilsby House Address Rugby Road Kilsby Rugby Warks CV23 8XX 01788 822276 01788 824713 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) Advent Estates Limited Mrs Gillian Ann Saxton Care Home 39 Category(ies) of Dementia - over 65 years of age (39) registration, with number of places Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. The home limits its services to the following service user categories. No person falling within the category DE (E) can be admitted where there are 39 persons of category DE (E) already in the home. As part of the total number the home may accommodate a maximum of two people in the category of OP who have a relationship with a service user in the category DE (E). Total number of service users in the home must not exceed 39. 4. Date of last inspection 28th September 2005 Brief Description of the Service: Kilsby House is situated in Kilsby, a village location on the border between Warwickshire and Northamptonshire. The home offers care to older people who suffer from dementia related conditions and utilises the person-centred approach to dementia care. The home offers care for up to 39 older people in single and shared rooms. The house is organised into three units for 15,14 and 10 people, each with its own lounge and a dining room with kitchenette facilities. Residents tend to be grouped into the units according to their individually assessed needs. There are two passenger lifts, one in the original house and one in the new extension. The home has a raised patio area, accessible to the residents. There is an enclosed garden, mainly laid to lawn, which is uneven and therefore not accessible to older people with mobility problems. Kilsby is a small village with limited public transport to local towns. Visitors to the home will therefore, require transport arrangements. Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission of Social Care Inspection is upon the outcomes for residents and their views of the service provided. The methodology of case tracking is used to find out if the care being provided to the residents is of an acceptable standard and meets their individual needs. ‘Case tracking’ involves the review of resident’s records, meeting with them and talking with the care staff who provide the personal care to the selected residents. The inspection also includes a review of the homes’ procedures and processes to ensure that all practices carried out by the staff protect the residents. The inspection process includes the collation of information from residents, relatives and visitors to the home. The manager submits a completed preinspection questionnaire. From these information sources an inspection plan is developed. The inspection in the home was carried out on an unannounced basis during the late morning and afternoon. The inspection process that included the preparation and inspection took approximately six and a half hours. Compliance by the manager to action previous requirements placed at the inspection of September 28th 2005 was reviewed as part of the inspection process. The primary method of inspection used was ‘case tracking’ which involved selecting 3 residents and tracking the care they receive through review of their records, discussion with the residents, the care staff and observation of care practices. What the service does well:
One resident stated that she was very happy in the home and that the staff are wonderful and do everything she needs. One relative stated that the care on the whole was very good. The atmosphere in the home was relaxed and friendly. The staff and residents were interacting and communicating with each other in a manner that evidenced the staff knew and understood the needs of the residents. The manager and her deputy continue to aim to provide person centred care to the residents in the home. Each person is viewed as unique and staff aim to
Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 6 ensure that each resident is happy in the home. The well being of the residents was in evidence. Residents demonstrated a social confidence with each other and were relaxed with each other. In one unit one resident had befriended another and looked after her. Residents were given the opportunity of making choices and to creatively express themselves. Staff were able to demonstrate a detailed knowledge of each of the residents that they provided care to and cared for. What has improved since the last inspection? What they could do better:
More emphasis must be placed upon improving the current care plans. Care plans must contain the actions that staff are expected to undertake in the delivery of each individuals’ care. The home boasts a person-centred philosophy however a number of shortfalls were identified during the inspection. For example because previous lifestyles, hobbies and interests are not being sufficiently explored meaningful individual activities that are ‘tailor made’ for each resident that reflects their past life are not being offered. The information recorded on the residents’ daily notes is inadequate and as a result does not guide and inform the reader about each resident on any given day. This lack of communication could potentially leave residents at risk of their personal needs not being met. A review of staffing levels in the home would be of benefit to ensure that staff are deployed where they are most needed and at recognised busy times. The way in which the home is divided, and the inaccessibility to the external areas of the home severely restricts the residents’ freedom of movement. The garden does not offer a secure area and residents are not freely able to wander in and out of the units and/or the home, unless always accompanied by a staff member. Residents are not empowered to find ’personal space’ within the home that enables them to spend time on their own.
Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 7 The home did not offer a homely atmosphere. Rooms had minimal personalisation, privacy screens were not offered in the double rooms, bedside lamps if available were often not beside the resident’s bed. Facilities to store personal toiletries, or lockable cupboards were not in evidence. Personal toiletries were left on the floor in the communal bathrooms, and in one ensuite facility resident’s personal toiletries were in a wash-bag placed on the floor as there was no alternative method of storage available. There is minimal storage space in the home resulting in the inappropriate storage of bags for soiled linen and clinical waste bags and a hoist. These were stored in the main corridors of the home. The medication cabinet in unit one was being used as a general store cupboard and contained items such as polish, cigarettes and lighter, wage slips and three bottles of alcohol. Immediate requirements were left at the conclusion of the inspection to ensure that the identified health and safety shortfalls were addressed. 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. Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 8 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 Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 9 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): Standard 6 does not apply to this home. EVIDENCE: These standards were not assessed at this inspection. Relevant information can be accessed from the previous report. Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 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 the following standard(s): 7,8,9,10&11 Although the care plans contained minimal information that confirmed that the philosophy of person-centred care is being provided the records did show that the health care needs of each resident are being met. EVIDENCE: Each resident has a care file. Information stored in this file is accessible for each staff member to use for reference and guidance. However, this information is fragmented and at times contains insufficient detail. Care plans do not record the actions or give sufficient guidance to inform staff how to provide the individual care that takes into consideration personal life styles and preferences. Life style risk assessments that are associated with the resident’s personal activities are not developed. One relative commented that the care on the whole was good but staff did not always seem to know what the resident liked and disliked. Each resident has, as part of his or her care file, a daily records log. The purpose of this log is to keep all members of staff up to date with the life of
Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 11 the residents on a daily basis. However the information was insufficient and the details recorded were general in nature and did not give an accurate holistic overview of the person that could be used to identify any specific need of the resident. Records identified that health care professionals are involved in providing the essential support and guidance that is necessary in the care for people with dementia related illnesses. These specific records contain detailed information to ensure that staff are aware of any current changes to the resident’s health needs. The registered manager has responded to the requirement placed at the last inspection to improve upon the completion of the medication records. Since the last inspection the registered manager has changed pharmacy and has entered into a new contract with an alternative pharmacy. As a result staff have received a greater level of support and input through training and advice. Medications are stored in a locked cabinet in each of the three units. The medication cupboard in unit one contained a number of sundry items. For example: a spray can of furniture polish, wage slips, 3 bottles of alcohol. An immediate requirement was left at the conclusion of the inspection to ensure that the medication cupboard is used solely for its purpose. Three un-named syringes were stored loose in the cupboard. Staff generally were respectful towards the residents and gave the opportunity for the residents to chose whether they wanted a snack in the form of a piece of fruit or a biscuit and what meal they wanted at tea-time. However, all staff must be encouraged to retain the resident’s dignity at all times, especially in communal areas and when using the homes internal communication system. Staff must always talk with the resident and explain what they are doing. This is especially important when a resident has dementia related illnesses and therefore may not recognise the member of staff. Recently the staff and residents at the home have experienced the death of one of the residents where, in consultation with the family, the decision had been made for the resident to spend their last days in the home. Through the records and from conversations the manager and care staff clearly handled this situation in a very sensitive manner. Information recorded in the care plans identifies the wishes to be considered for each resident when the resident is dying or at the time of their death. Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 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 the following standard(s): 12, 13 &14 Group social activities are managed well and provide variation and interest for people living in the home. However individual life styles and routines are not being retained to ensure that person-centred care is being provided. EVIDENCE: Group activities are offered to the residents, who have a choice of attending. A member of staff frequently takes out one resident to the local village post office. The resident takes a lot of pleasure from this experience, and tries to bring back to the home a large quantity of crisps and chocolates. All staff are encouraged to be involved in this aspect of care, and it is not dependent on being a carer. Recently a Christmas show was put on for the residents, family and friends. The residents really enjoyed this experience. However without the help of a dedicated activities organiser all staff are expected to find time in their busy schedules to plan activities for the residents. The result of this is that meaningful individual activities are not being offered on a daily basis. Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 13 The philosophy of the home is to provide person-centred care. However without the collation of necessary information that identifies life style routines, and individual choices staff are unable to ensure that each resident is treated as an individual. Due to the lack of detailed information the amount of choice and control the resident has over their own life is minimal. Residents can make choices about the basics of the life in the home including when, where and what they want to eat, go to bed or get up. Consideration must be made to reviewing the layout of the home as currently the individual choice of any resident who may want to experience being out of the home in the garden or walking in the grounds is not able to be promoted. Residents were very relaxed and peaceful in all three units. Staff were enabling residents to be involved in household tasks and to express their individualism. One resident who was busy repeatedly wiping the table explained to the Inspector what she was doing. Residents are encouraged to respond appropriately to each other. One resident has befriended another resident and enjoys looking after her and helps her with her personal care. A number of appropriate items are available in all three units for residents to relate to, for example a sewing machine, dolls, ‘touchy feely’ items and wartime memorabilia. One resident has specific religious interests and needs. Although this resident has lost her own Holy Bible, rosary and prayer book staff have undertaken steps to replace these items. Her religious needs are being met by the frequent visits of the local clergy. Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 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 the following standard(s): 16, & 18 The written complaints procedures and protection of vulnerable adults procedures do not give clear instruction and guidance for staff to take in the event of a suspicion or allegation of abuse being made. These shortfalls do not afford protection to the residents. EVIDENCE: Since the last inspection the commission has received a complaint about the way in which the registered manager managed a breakout of sickness and diarrhoea in the home that affected staff and residents. The complaint was not upheld. One relative advised the Inspector that she had made a complaint about the heating in the home, and that the manager had responded appropriately and had rectified the matter satisfactorily. There is in place a homes’ policy and procedure that informs the reader the action to take if they wish to make a complaint. Through discussions with the staff and taking into consideration the understanding of the residents, due to dementia related illnesses, this document is in need of being reviewed and amended to ensure that the reader is able to understand the steps to take with ease. Available for the staff is the Northamptonshire’s guidance on the Protection of Vulnerable Adults. The home has a written abuse policy, however the content of this policy outlines the types of abuse and does not instruct staff of the
Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 15 steps to take if they have been made aware of an abusive situation. An internal policy and procedure should be developed that takes staff through the steps that are necessary in the event of an allegation of abuse being made, this is especially important if the allegation is made against one of the senior team. Through the training that staff have already received they were able to demonstrate that they are aware of the actions which could be identified as abusive. The answers given by the staff in response to the scenarios discussed were positive. Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 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 the following standard(s): 19, 20, 24 & 25 Although the environment provides safe comfortable surroundings that are maintained to an acceptable standard due to the layout of the home and grounds being insecure residents’ freedom to move around easily is restricted. EVIDENCE: The home employs a person specifically to ensure that the ‘fabric’ of the home is maintained and to take care of the external areas and gardens. The home was warm and appropriately lit. Residents’ individual rooms are identified by their name and appropriate signage was displayed around the home identifying the location of the toilets and the fire exits. The furniture in the communal areas was suitable with a mixture of different styles of chairs including settees in the lounges. Consideration should be taken to revise the current method used when residents choose to eat their meals from their armchairs. Currently there are no occasional tables close to their chairs to enable Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 17 them to put down a drink or plate of food. For a few residents they were experiencing difficulty in keeping their food plate from slipping onto the floor. A number of shortfalls were identified during the selected tour of the premises. Resident’s rooms were viewed alongside communal areas in each of the three units. Residents privacy is not being promoted due to the lack of privacy curtains in the double rooms and by the way in which incontinence pads were stored in the bedrooms; bedside lights, if available, were frequently placed away from the bed so that residents could not benefit form the light. There is insufficient storage provided for residents to store their personal toiletries. Some residents are expected to store their personal toiletries in a wash bag that is then left on the floor of their en-suite, or alternatively personal toiletries were stored in the communal bathrooms, also on the floor. A number of resident’s rooms were not homely or personalised. Where the resident does not have any of his or her own property to bring into the home, the manager must take on this area of responsibility to ensure that all areas of the home are homely. A number of areas in the home would benefit from a more vigorous method of cleaning that includes under and behind furniture. As a part of the daily routines any bedding that is stained should be removed. All bedding should be of a homely style; on one resident’s bed a named hospital sheet was being used. Due to the current layout of the home with each unit being maintained independently, with a key lock system in place, the residents’ freedom of movement is greatly restricted. Further residents are unable to access the external grounds and gardens of the home independently due to these areas being insecure. The registered persons are strongly recommended to reconsider the layout of the home so that resident are empowered to make individual choices, that is not dependent on staff being available to be in attendance with them. Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 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 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): EVIDENCE: These standards were not assessed at this inspection. For further information please refer to the inspection report of 28th September 2005. Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 19 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, 32 & 38 There is strong leadership, guidance and direction to staff from the Registered Manager that ensures the residents receive consistent quality care. EVIDENCE: An experienced and qualified registered manager maintains the ongoing management of the home. The staff benefit from a stable management style and advise that they are able to easily talk with her. Residents reacted very warmly towards the manager and were at ease with her as she walked the premises with the inspector. The manager was able to demonstrate that she had a sound knowledge of each of the residents and was able to plainly explain their needs and which member of the health care professionals were involved in their care. The manager does have problems being able to, at times, find sufficient time to undertake her delegated tasks as a manager due to ongoing staffing issues.
Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 20 The Inspector has had detailed discussions with the registered person regarding the recruitment of overseas staff, and the impact that this method of recruiting has on maintaining a consistent level of care. The registered manager has little input into the decision making process of employing these overseas carers, a number of which have little understanding of English and have difficulty in speaking and reading documentation that is written in English. This method of recruiting is potentially putting the residents in Kilsby House at risk of their care needs not being met and of mistakes being made. The manager has to spend extra time with these newly recruited staff to ensure that they have a sufficient level of understanding so that they can fulfil their tasks as a carer. All these issues have an impact on the time that the registered manager has of ensuring that the home is running properly. Currently the manager’s office is situated away from the care home and is located in the grounds of the home. Through an internal communications system, the manager is able to be in easy contact with the staff in the home, and can be called to attend any emergency situation. The location of this office does raise a few concerns due to the manager not being able to easily fulfil some of her expected tasks as the manager. The maintenance man has the responsibility of undertaking the specific tests on the systems around the home, this includes the Legionella that have recently been undertaken. Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 21 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 X X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 2 X X X 2 2 X STAFFING Standard No Score 27 X 28 X 29 X 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 X X X X x 2 Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 22 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 12 Requirement A detailed care plan must be developed that gives sufficient instruction and guidance for staff in the actions they are to take in the delivery of care to the resident. The medications cupboard must not contain non-related medical items. Meaningful activities must be provided. Alternative storage must be found for the storage of soiled linen, clinical waste and the hoist. All residents’ personal toiletries must be stored appropriately Timescale for action 31/03/06 2 3. 4 OP9 OP12 OP38 13 16 13 13/01/06 01/11/05 13/01/06 5 Op38 13 13/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 23 1. 2. 3 4 5. OP10 OP14 OP18 OP19 OP24 Residents dignity and privacy must be preserved at all times Residents must be empowered to exercise choice and control over their lives An internal policy and procedure must be developed that instructs staff in the steps to be taken in the event of an allegation of abuse. Consideration should be given to creating a garden that is suitable, and safe for the residents to use. Arrangements should be made to ensure the privacy of the residents living in the downstairs room that is overlooked by the raised decking area. Arrangements must be made to ensure that all areas of the home are homely and bedrooms personalised. All areas of the home should be maintained to an acceptable level of cleanliness. Staffing levels should be reviewed in each of the areas to assess the sufficiency of the numbers of staff in relation to residents assessed needs. 6 7 8 OP24 OP26 OP27 Kilsby House DS0000012830.V277475.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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