Inspection on 11/09/07 for Middleton Manor Care Centre

This inspection was carried out on 11th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Middleton Manor Care Centre 20/09/06

Middleton Manor Care Centre 02/02/06

Middleton Manor Care Centre 27/10/05

Middleton Manor Care Centre 14/01/05

Middleton Manor Care Centre 21/06/04

Middleton Manor Care Centre 22/01/04

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 Middleton Manor Care Centre Middleton Hall 48 Wantz Road Maldon Essex CM9 7DJ Lead Inspector A Thompson Key Unannounced Inspection 11th September 2007 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 Middleton Manor Care Centre DS0000017886.V351023.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. Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Middleton Manor Care Centre Address Middleton Hall 48 Wantz Road Maldon Essex CM9 7DJ 01621 856464 01621 851535 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) www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Susan Elizabeth Freeman Care Home 41 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (41) of places Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 41 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 16 persons) The total number of service users to be accommodated in the home must not exceed 41 persons 20th September 2006 Date of last inspection Brief Description of the Service: Middleton Manor is a large three-storey property adjoining other properties in a residential area close to the centre of Maldon. The home is owned by Ashbourne (Eton) Limited, which is a subsidiary of Southern Cross. Residents’ bedrooms are located on all three floors of the home and comprise of 31 single rooms and 5 shared rooms. On the ground floor of the home there are two communal lounge/dining rooms and two communal lounges. On the first floor there are also two small conservatory type lounges available for residents, although one of these is often used for staff training, and the position of both does not lead to general usage by residents other than those with private rooms directly adjacent. Two passenger shaft lifts provide access between all floors. The home provides 24-hour personal care and support to residents with varying dependency levels, including some places for those diagnosed with dementia. Visitor car parking is provided to the side of the property. At the rear there is a patio style garden that is fully enclosed and assessable to service users. Information from the home states that maximum weekly fees are £570 dependent on the room. Past inspection reports are available from the home, and from the CSCI internet website. Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place on Tuesday 11th September 2007. The content of this report reflects the inspector’s findings on the day of the inspection along with information provided by the service and feedback by service users, relatives, staff and other parties. Practice and procedures occurring after this inspection will be reported on in future inspection reports. Discussions took place with service users, visitors, the registered manager, care staff and other staff on duty. Random samples of records, policies and procedures were inspected and a tour of parts of the premises and grounds took place. Several service users were unable to express any views on the service owing to their diagnosed dementia. Those spoken to who did have a view confirmed they were satisfied with the care they received. Some said the food was usually good, others said it could sometimes be better. All were satisfied with their accommodation. Visitors spoken with were complimentary of the care and support provided to service users by the staff and manager. Questionnaires were also left at the home so that relatives had the opportunity to make their views on the service known to the Commission. Staff confirmed they received support from the management team. They also confirmed that they had been provided training opportunities. Twenty five standards were inspected and the outcomes for service users against nineteen of these was good, with six adequate. As a result this report includes three statutory requirements and four good practice recommendations as areas for improvement. Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Induction training for new staff must follow Skills for Care guidelines. A summary of the findings of the 2006 quality assurance surveys needs to be made available to service users and to the Commission. Some lounge and corridor areas should be re-decorated and the carpets cleaned. The provider should consider how to increase the number of communal toilets available for use by service users who use the front lounge. The provider should increase the number of bathrooms in the home. ------------------- 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. Middleton Manor Care Centre DS0000017886.V351023.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 Middleton Manor Care Centre DS0000017886.V351023.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 Quality in this outcome area is good. Admission processes ensure that service users can be confident that the home considers they can meet their needs. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Two members of staff including either the manager or deputy manager visits prospective new service users to undertake an assessment of need. Evidence of this process was seen in care plan files for service users admitted since the last inspection. Assessment headings covered included: communication, mobility, personal hygiene, nutrition, vision, continence, behaviour, manual handling, hearing, medication, foot & oral care, falls social & risks. A care plan is commenced leading up to admission, with completion as soon as possible after. Middleton Manor Care Centre DS0000017886.V351023.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 good. Care plans had been regularly reviewed and provided up to date information on the health, personal and social care needs of service users. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Three care plans were inspected. These included background information, personal details, and next of kin contacts. The service users needs/action sheet included the ‘aim of care’ taking account of the headings assessed when carrying out the initial assessment, and further sections added after admission. These were a physical & social assessment, a social profile, pressure care risks and a dependency assessment. Further risk assessments were seen covering manual handling, nutrition, falls and bowels. Risk assessments had been regularly reviewed. Care plans seen included records of service users weight, consultations, had been regularly reviewed and included review and evaluation record sheets. Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 Page 10 District Nursing services support the home in pressure sore assessment and will also supply appropriate aids and treatment. Continence issues are supported by the community continence nurse and hearing needs are provided for by GP referral to a local hospital. A chiropodist and an optician visit the home. Anyone requiring dental services must visit community practices. One GP holds a weekly surgery in the home and will visit at other times on request. The other practice visits on request. The homes medication policy and procedure covered ordering, receipt, storage, administration, homely remedies and returns of unused stocks. Staff had been trained in medication practice, some were due for update training, the manager advised this was in progress. Medication administration records were inspected no shortfalls were noted. Discussions with individual service users indicated that they were treated with respect by staff, as did observation of staff going about their duties and interactions with service users. Staff on duty were seen to be caring in their dealings with service users, and those spoken with said staff were usually helpful and considerate. Visitors spoken with were also complimentary regarding staff attitudes and the care provided. Some service users said they had their own private telephone, others use either the home’s payphone or may receive calls of the portable office phone. Middleton Manor Care Centre DS0000017886.V351023.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 good. The home provides flexible routines and a lifestyle that enables service users to make choices. However evidence should be available to confirm all service users receive an appealing diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users meetings had taken place, minutes of issues discussed and decisions made were seen displayed around the home. A meeting for relatives was planned, the date of this will be checked at the next inspection. The home still had a weekly activities programme, which was displayed, around the home. Included sessions were: reminiscence, sing-a-longs, cards, manicures facials, massage, games, puzzles, 1-1 talks, bingo, hairdresser visits and trips to the local high street shops. Activities are offered to service users on a daily basis, including weekends. These are led by a designated activities coordinator who had received training for this role. Records had been kept of activities taken part in by individual service users. Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 Page 12 A church minister visits the home fortnightly to hold a communion service. Service users spoken with confirmed they were satisfied with the choices and options made available to them regarding daily routines and leisure interests on offer. Visitors spoken with said they were always made welcome by staff. Some personal allowance monies are held for safekeeping and records of transactions and receipts are kept. Advocacy support is available locally, information was displayed on how to contact these. Inspection of private rooms confirmed that service users had been permitted to bring their own personal items with them on admission. There was also confirmation of this direct from service users, who told the inspector of the furniture and personal items they had been permitted to bring in with them. Nutrition records and menus evidenced choice and variety. The main daily meal is lunch with two choices, there is also a choice at tea. All service users spoken with said they got enough to eat and some said it was good and that there was always a choice, however others said the food was not always appealing. National Minimum Standards state that appealing meals are provided and there is a recommendation that every effort is made to ensure that service users are offered meals that are appealing, as well as wholesome and nutritious. The provider should ensure that service users are consulted regularly regarding the meals provided. This issue will be reviewed at the next inspection. Meals may be taken in private rooms or communal lounges if preferred, evidence of this practice taking place was seen. Minutes of service users meetings were seen to include discussion on meals. Middleton Manor Care Centre DS0000017886.V351023.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 good. Practices in the home safeguard service users, and ensure that concerns are listened to and addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s complaints procedure contains guidance on how to make a complaint and who to complain to. Also included were timescales for responses from the home. This had been reviewed in June 2007. Records had been kept of complaints received and of any investigation and resulting outcomes. Service users spoken with said they knew who to speak to in the home if they any concerns, and that in the past management had responded positively to any queries/issues they had raised. The manager is an in-house trainer on adult protection matters. She has provided training to staff which included clarifying types of abuse, recognising signs and required actions if abuse suspected. Five staff received this training in August 2007. The homes policy on adult protection was inspected, there was written guidance for staff on recognising and reporting abuse and action to be taken by staff and the person in charge if abuse is suspected. Also on site were the Essex Vulnerable Adults Protection Committee guidance booklets on abuse, Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 Page 14 which the care manager said are provided to all staff when they commence employment. Induction and NVQ training also includes adult protection issues. The home also had a ‘whistle blowing’ policy which provided guidance to staff on their responsibilities to report any concerns to management. Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 Page 15 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): 19,20,21,23,24,25,26 Quality in this outcome area is adequate. Furnishings in the home looked comfortable and the home appeared internally safe, but some carpets need cleaning or replacing, and some walls need redecoration. Bathing and toilet facilities could be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Individual private accommodation and facilities are all considered to be of a good standard, but some communal areas of the home needed attention. Some carpets were dirty and some walls had dirty and torn wallpaper. Redecoration of these areas should take place. Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 Page 16 Lighting in communal rooms was considered domestic in character and sufficiently bright. The furnishings of communal rooms were mainly domestic in character, of adequate quality and appropriate to the range of needs of service users. Twenty five private bedrooms benefit from en-suite facilities or designated private toilet facilities in the corridor immediately opposite the bedroom. Communal wcs are located in the bathrooms, and next to the shower room. It is understood that the only other communal wcs for service users are the two close by the main lounge/dining room on the ground floor. During discussion with service users the inspector was told that sometimes ‘queues’ build up of people waiting to use the toilet. This situation should be improved and the provider should investigate how they can increase the number of communal toilets by the main lounge. Staff call systems were located in all private rooms and communal rooms seen. The home is equipped with two shaft passenger lifts to provide access between floors. Private rooms were well decorated, comfortable and evidenced individual taste. During discussion with service users all said their rooms were comfortable. Door locks and keys are provided according to individual choice and risk assessment. All rooms seen were naturally ventilated with windows and all were centrally heated. There are only two bathrooms in the home. Since the last inspection both had been fitted with new baths with fixed hoists, this was because for some time both were out of action and service users could not be bathed. Even with the new baths the home does not meet the recommended ratio of one assisted bath to eight service users. There is an on-going recommendation in this report that the registered provider improves this ratio. All radiators in the home that were seen were guarded, and lighting in service users rooms was considered domestic in character and fully appropriate for individuals requirements/needs. The laundry room were inspected and were equipped an appropriate washing machines (with sluice cycle programme) and tumble drier. The laundry room was considered small for the size of the home. Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 Page 17 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. Staffing levels appeared to meet the needs of service users, staff had been trained but induction training needs to be evidenced for all staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s staffing rota was inspected and confirmed that staffing levels are being maintained at six care staff on duty on morning shifts until 1330 hours then three on until 1500 hours then five on until 2130. Night staffing is three on waking duties. The manager post is sumernumery. Separate and additional rostered staff were employed to undertake cooking, kitchen assistant, administrative, activities, basis maintenance and domestic duties. Discussion with staff and records confirmed that regular staff meetings are held. Staff records and discussion with staff evidenced that application forms had been completed, interviews held (with notes kept), written references obtained, written terms & conditions issued and criminal records checks Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 Page 18 undertaken. Copies of proof of ID, photographs and job descriptions were also on file. New staff undergo the home’s induction programme. Records of this were seen, and staff spoken with who had employed since the last inspection confirmed they had received induction training, however this had not been based on the Skills for Care induction standards. The home had a copy of these for inspection but the format had not yet been used. There is a statutory requirement of this point in this report. The manager was a qualified in-house trainer on: food hygiene, manual handling, health & safety, fire awareness and POVA. Training records and discussion with staff confirmed that staff had been provided training on all these subjects by the manager. Staff had been provided training on first aid by a company qualified trainer from outside the home. Again evidence of pass certificates were seen and staff confirmed they had received this training. External training provided had included NVQ, activities, continence, dementia and medication. Staff training on infection control was limited to three, this should be improved. Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,37,38 Quality in this outcome area is good. The home had been run and managed efficiently. Procedures for gaining the views of service users and relatives were in place but should include the details of any resulting actions. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager has worked at the home for several years, and had been manager for two years. An annual quality assurance questionnaire exercise takes place. The last survey had taken place this year and responses received were inspected. Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 Page 20 Questions included asked residents and relatives their views on health & wellbeing, privacy, security, daily life, complaints, physical environment and for any suggestions. The last survey was carried out in 2007, the summary of responses and of any resulting actions had not yet been formulated. This report includes a statutory requirement on this point. Some service users personal monies were kept for safekeeping, balances checked were acceptable. Records of transactions were computer stored and could not be viewed at the inspection as the administrator was on leave. These will be checked at a later date. The home had COSHH data sheets for cleaning substances used. There were premises risk assessments. Random samples of records required to be kept were inspected. These included: complaints, assessments, care plans, staff rotas, staff recruitment, accident records, visitors book, fire drills, regulation 37 notices, regulation 26 reports, menus, medication, background info’ and next of kin details, cash held for safekeeping and fire procedures. All seen were satisfactory. Discussions with staff, management and inspection of records confirmed that training is provided to staff in moving and handling, fire safety, food hygiene, and first aid, but basic training in infection control needed to be provided to all staff. Certificates and service records were available for inspection to confirm that the home’s fire equipment, passenger lift, hoists, call alarms, emergency lights, gas supply and portable electrical appliances had all been tested/serviced within recommended timescales. The inspector was advised that the electrical installation supply had been retested earlier in 2007, unfortunately records of this were not available. This report includes a statutory requirement that evidence is provided to the Commission to confirm this test had taken place. Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 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 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 2 X X 3 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 3 2 Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP30 Regulation 18 Requirement All new staff must receive structured induction training which is based on the Skills for Care common induction modules. The results of the home’s 2006 quality assurance surveys must be collated, with the results of any actions identified and/or taken made available to service users and the Commission. Evidence must be provided to the Commission to confirm that the home’s electrical installation supply is safe. Timescale for action 30/11/07 2 OP33 33 31/12/07 3 OP38 13 30/11/07 Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 Page 23 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 OP15 OP19 Good Practice Recommendations All service users should be provided a diet that is appealing. Areas of stained/dirty carpets and walls with marked/torn wallpaper should be re-decorated/cleaned to ensure that all rooms used by service users provide a clean and well maintained environment to live in. The numbers of communal toilets close to the main front lounge should be increased to reduce the time service users have to wait. The number of baths/showers should be increased from two to provide service users improved options to bathe. All staff should be given training on infection control practice. 3 OP21 4 OP30 Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Middleton Manor Care Centre DS0000017886.V351023.R01.S.doc Version 5.2 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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