CARE HOMES FOR OLDER PEOPLE
Portelet House Residential Care Home 22 Grand Avenue Southbourne Bournemouth Dorset BH6 3SY Lead Inspector
Jo Palmer Unannounced Inspection 10:00 9 January 2006
th 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 DS0000003973.V260929.R01.S.doc Version 5.0 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. DS0000003973.V260929.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Portelet House Residential Care Home Address 22 Grand Avenue Southbourne Bournemouth Dorset BH6 3SY 01202 422005 01202 433362 portelethouse@aol.com 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) Portelet Care Limited Mr Jean Alain Henri Moocarme Care Home 14 Category(ies) of Dementia - over 65 years of age (14), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (14) DS0000003973.V260929.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. In addition to registered places a day care service of up to 7 hours per day may be provided for one person in the categories MD(E) DE(E). 27th June 2005 Date of last inspection Brief Description of the Service: Portelet House is a care home for up to 14 older people with mental disorders who also have need of personal care. The home also offers respite care and day care. Portelet house is part of Portelet Care Ltd. The proprietors are Jean Alain Henri Moorcame and David Lallana. Mr Moorcame takes and active role in the running of Portelet house and is registered as the manager. Portelet House is a double fronted detached converted property. There is a paved area to the front of the house and off street parking is available. At the rear of the home there is an enclosed courtyard garden. Service user accommodation is over three floors with a two person passenger lift that enables access between floors. There are 10 single rooms and 2 double rooms available. Eight of the single rooms and both double rooms have en-suite facilities. The home has a comfortable lounge, adjoining dining area and conservatory, overlooking the rear garden. DS0000003973.V260929.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection on 9th January 2006 lasted for two hours and forty five minutes. Henri Moorcame, one of the joint owners and registered manager was present along with the assistant manager and other staff members who assisted throughout the inspection and provided necessary information and access to records. This was a brief inspection the purpose of which was to monitor progress in addressing a requirement and the recommendations of the last inspection and to review practices in relation to some of the National Minimum Standards. Not all standards were assessed and the reader is referred to the report of the last inspection dated 27th June 2005, which can be obtained either from the home or from www.csci.org.uk The inspector spoke with four residents, the cook, two care assistants, the manager and assistant manager, and examined relevant records. What the service does well:
For residents who have undergone comprehensive assessment, care plans provide detailed information for staff regarding how care needs are to be met. Day time medication systems adequately protect resident’s interests. Meals provided to residents are varied and well presented. Portelet House is clean and comfortable and there is sufficient space for residents in their bedrooms, communal spaces and bathrooms. There are sufficient care staff and ancillary staff on duty supported by the manager and assistant manager in the home. Several staff have undertaken NVQ training and it was confirmed that all staff have undertaken statutory health and safety training in areas such as first aid, food hygiene and moving and handling. The views of relatives representatives have been sought and returned questionnaires provide a positive and encouraging illustration of the care and service provided. DS0000003973.V260929.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better:
This inspection has identified several areas of concern where improvement is needed: Resident’s needs must be assessed prior to admission in order that the home can identify that it is the right place to meet that persons needs and in order that the resident has some assurances that the home is the right place to move to. In the event of an emergency admission, staff must obtain a baseline assessment from the referrer. From assessment, care plans must be produced that provide detail for staff on how needs are to be met, assessments must be continuously reviewed and evaluated and where a resident’s needs have changed, the care plan must reflect their current needs. For the protection of residents and staff, any resident requiring assistance with moving and handling must be properly assessed and a moving and handling plan established. Where a resident is in receipt of treatment from a district nursing service, a plan of care must be in place in order that care staff can manage the condition appropriately in the district nurses absence. Nighttime medication administration routines must be reviewed for the protection of residents and accountability of staff. Staff must receive training in issues relating to abuse and protection of vulnerable adults. A system to review the quality of care and services must be established considering the views of residents and their representatives and a development plan must be written and made available to the Commission and to residents. The record relating to the testing of the emergency lighting in the home must be available to demonstrate the viability of the system and staff must receive fire safety training at the specified intervals. This inspection has also resulted in some recommendations where practice could be improved. When assessing a resident for the purpose of admission, it is good practice to ensure that a record is held relating to the source of information obtained and to sign and date all assessment information. Care records should be complete and systems in place to ensure information is not misplaced and is available for reference. DS0000003973.V260929.R01.S.doc Version 5.0 Page 7 It has been recommended that the temperature of the medicine cupboard is monitored to ensure it remains at the recommended temperature of the medicines to be stored. A menu should be available in a format suited to the capabilities of residents identifying what meals they are to be served. A qualified person able to establish the extent of any disability equipment required or environmental adaptations should assess the premises. Health and Safety Executive advice should be followed when assessing risks associated with accidental scalding from hot surfaces. At least 50 of care staff should achieve NVQ level 2 award in care. 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. DS0000003973.V260929.R01.S.doc Version 5.0 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 DS0000003973.V260929.R01.S.doc Version 5.0 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): 1 & 3. Standard 6 is not applicable. Residents and their representatives are sometimes assured of accurate information about the care and services provided at Portelet House prior to admission although in some instances this information is lacking which could result in residents being wrongly placed in the home. EVIDENCE: Although not directly examined during this inspection, a copy of the home’s Statement of Purpose and Service User Guide are held on file with the Commission, Mr Moorcame confirmed that these are current and have not changed since the last inspection which reported that they held sufficient information to inform residents and their representatives of care and services provided at the home. Three resident care files were examined, of these, one held relevant preadmission information presented by the care manager responsible for arranging the placement. Of the other two care files it was evident that one resident was admitted under an emergency arrangement; Mr Moorcame stated that the referring agent did not provide any information about this persons care needs. A recommendation of the last inspection is now however repeated
DS0000003973.V260929.R01.S.doc Version 5.0 Page 10 as a requirement as the practice of admitting residents without prior knowledge regarding their needs is not in the best interests of the resident or the registered status of the home. Where a social worker or care manager makes an enquiry to place a resident in the home on an emergency basis, the registered persons must ensure they have sufficient detail, taken verbally over the telephone and recorded if necessary, to ensure they have the facilities and skills to care for that person’s needs and to ensure that the person falls within the category for which the home is registered. The third care file examined referred to a resident admitted to the home under a private arrangement, this file did not hold any pre-admission information, assessments or contract although Mr Moorcame confirmed that these records had been produced although could not now be found. (See standard 37) A recommendation was made following the last inspection that the source of information obtained for assessment purposes was recorded, one set of records seen during this inspection relating to a recent admission had information provided by the referring agent, the other two sets of records did not have this information available, the recommendation is repeated. DS0000003973.V260929.R01.S.doc Version 5.0 Page 11 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. Where care is planned around assessed need, records are detailed and informative and assure the resident that their needs will be appropriately met, where care needs have not been assessed and reviewed, care delivery cannot be planned accordingly leaving residents in the position of not being assured that their needs can be met. EVIDENCE: Three care files were examined. Of these, one held detailed assessment and care planning documentation evidencing that all areas of the persons health and welfare needs had been considered. There was evidence of an appropriate review process and involvement of community health care professionals as required. One care file for a person admitted to Portelet House on an emergency basis in November 2005 did not have any assessment or care planning records. There had been no pre-admission information available (see standard 3) and the admission assessment, usually completed by staff at the home was blank. Therefore, there was no indication of this persons needs or how they were to be met. The third care file examined was of a resident whose needs had recently changed due to failing health and increased frailty. This resident was receiving
DS0000003973.V260929.R01.S.doc Version 5.0 Page 12 wound care from a district nurse, was no longer mobile and was cared for in bed. There was no moving and handling assessment or plan in place to protect the resident or staff from injury, no plan for relieving pressure or for pressure area care and no wound management strategies. A requirement of the last inspection is repeated with regard to wound care as, although not registered to provide nursing care, staff at Portelet House need advice from the district nurse and a written plan of care regarding wound management should the dressing become dislodged, soiled or damaged between the nurses visits. Care staff write daily records of care provided for residents, these evidenced the residents daily lives and routines in the home including any significant events regarding their health and welfare. Systems of medication management are in place that are not recommended. A system of double dispensing is used for night staff which results in medication being taken from its original container by day staff and placed into pots marked with each residents first name. At the time of administration, night staff then take the pots with the unmarked substances to each resident and sign the record to indicate their accountability for having given the correct medication. Administration of medication by day staff is based on good practice and no double dispensing is used. Royal Pharmaceutical Guidelines state: Section 4.2 For a care home member of staff to administer a medicine it must have a printed label containing the following information: •Service users name. •Date of dispensing. •Name and strength of medicine. •Dose and frequency of medicine. Section 6.2.3 Medication should never be removed from the original container in which a pharmacist or dispensing doctor supplied it until the time of administration. The best way of administering medicines to a service user is directly from the dispensed container, medication can be placed in a small pot after removing it from the dispensed container as a way of hygienically handing it to the service user. Medication should never be secondary dispensed for someone else to administer to the service user at a later time or date. Medication stocks were satisfactory and storage secure although it has been recommended that a thermometer is used to monitor the temperature of the store cupboard used for items that must be kept below 25°C. Residents spoken with unable to engage in meaningful dialogue, records of care provided are written respectfully demonstrating an implicit respect for residents individuality and dignity. Staff interaction with residents was noted to be respectful.
DS0000003973.V260929.R01.S.doc Version 5.0 Page 13 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): 15 The last inspection reported that standards 12, 13 & 14 were met. A good, wholesome, varied diet is provided and special dietary needs are catered for. EVIDENCE: Residents were observed taking their midday meal in a pleasant, relaxed atmosphere where staff were respectfully attending to those who required assistance. Two residents spoken with confirmed that the meals were good. The cook was spoken with who confirmed the arrangements for provision of meals in the home. There is no menu or meal plan, cook stated that she cooks what is available from the supplies stating that there is always a plentiful supply and choice of dishes to make. It was confirmed also that fresh produce is used and the registered persons shop regularly from reputable suppliers. Many residents require ‘soft’ diets due to difficulty chewing or swallowing, cook confirmed that the meal of the day is put through a blender for these residents, plated meals seen demonstrated that these were presented well with each item having been separately softened. Breakfasts and evening meals are prepared and served by care staff although cook confirmed that sometimes she will prepare a dish for the evening meal for care staff to heat and serve. None of the residents had specific dietary requirements.
DS0000003973.V260929.R01.S.doc Version 5.0 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): None of these standards were assessed. The last inspection reported that standards 16 and 18 were met. (see also standard 30) EVIDENCE: DS0000003973.V260929.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20, 21, 22, 23 & 25 Residents live in a comfortable, clean environment with their own belongings around them and bedrooms, bathrooms and communal areas provide sufficient room for residents. Although hazards have been assessed, management of hot surfaces needs to be considered further using recognised guidelines from the Health and Safety executive. EVIDENCE: Several areas of the home were seen including three bedrooms, one bathroom, the lounge and conservatory and the dining area. All were clean, well maintained and reasonably decorated. Resident’s bedrooms that were seen were personalised to varying degrees and provided sufficient space. Communal areas of the home have appropriate furnishings, carpeting and decoration and the dining room provides sufficient seating. Toilets and bathrooms are conveniently sited around the home and additionally eight of the single rooms and both shared rooms have en-suite facilities. Equipment is provided to aid residents with bathing.
DS0000003973.V260929.R01.S.doc Version 5.0 Page 16 A recommendation is repeated from the last inspection, as the premises have not been assessed by a suitably competent person with regard to the extent of disability equipment required to enhance accessibility around the home. Radiators around the home are unguarded although suitable control measures are in place in most instances to ensure against accidental scalding. It has been recommended that risk assessments are reviewed however for individual residents in accordance with Health and Safety Executive guidelines. DS0000003973.V260929.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30 The home employs enough staff to meet the needs of residents although without thorough assessments of all resident’s current needs, this cannot be specifically measured. Training programmes for staff are in place although further development in this area is necessary. EVIDENCE: Mr Moorcame confirmed that there are five care staff on duty each morning, four each afternoon and two each night. The assistant manager in one duty for various shifts throughout the week in these staff numbers. The manager, Mr Moorcame is supernumerary to the shift numbers but is present in the home for various shifts in a full time capacity. Additionally, Mr Moorcame confirmed that there is a housekeeper and cook on duty daily. In terms of numbers, the ratio of staff to residents is good although in the absence of up to date assessments of residents needs (see standard 3), it is not possible to measure whether there are sufficient numbers of staff to meet all residents needs. Mr Moorcame confirmed that there are seventeen care staff employed, of these; five have attained NVQ level 2 or 3 in care. It is recommended that more staff are encouraged to achieve this award to ensure that they remain up to date with current good practice issues and that residents remain in safe hands. DS0000003973.V260929.R01.S.doc Version 5.0 Page 18 Mr Moorcame confirmed that no new staff have been employed since the last inspection, the induction programmes were therefore not examined. Other training provided had included first aid, moving and handling and food hygiene. Staff spoken with confirmed they had received this training although had not received training in adult protection or infection control. DS0000003973.V260929.R01.S.doc Version 5.0 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): 33, 37 & 38 The system of monitoring the quality of care and services in the home needs to be developed to ensure the home is run in the best interests of residents. Residents best interests need to be better protected by the home’s record keeping policies and procedures. The health and safety of residents and staff needs to be better protected by robust fire precautions. EVIDENCE: A quality audit file was examined and noted to hold questionnaires that had been sent to, and returned from relatives of residents living at the home. Responses to questions were generally positive and encouraging although where comments had been made regarding perceived improvements, there was no evidence of action taken to develop the service. There were no
DS0000003973.V260929.R01.S.doc Version 5.0 Page 20 available audits on other aspects of care or service provision. Mr Moorcame confirmed that there was no development plan for Portelet House. Of those records seen, most were up to date and accurate, however, some information was not available in respect of one residents admission assessment and contract and some care records were not up to date or accurately reflecting the resident’s current care needs. Records seen relating to testing and maintenance of fire alarms, doors, emergency lighting and fire fighting equipment by contracted engineers were accurate; records relating to visual checking and testing of the alarms, doors, and fire fighting equipment by an appointed person employed by Portelet House demonstrated these checks were carried out at the recommended intervals, the record of the internal check of the emergency lighting was not available, Mr Moorcame confirmed that this check was carried out but had not been recorded. Records relating to staff fire training evidenced that most staff have received fire safety and awareness training, including evacuation procedures although some staff had longer gaps in training than is acceptable. Guidance issued by the Commission currently states that night staff must receive training at three monthly intervals and that day staff must have this training at six monthly intervals. DS0000003973.V260929.R01.S.doc Version 5.0 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 3 X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X 3 3 2 3 3 2 X STAFFING Standard No Score 27 3 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X X 1 1 DS0000003973.V260929.R01.S.doc Version 5.0 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. Standard Regulation Requirement Where a service user is admitted to the home on an emergency basis, the registered persons must ensure that they have documented evidence from the referring agent regarding the persons immediate care needs. All service users must have an up to date care plan, available for staff reference detailing how their needs are to be met. Care plans must be based on comprehensive assessment and kept under review. For the protection of service users and staff, an up to date moving and handling care plan must be available and reviewed regularly. Where a service user is in receipt of wound care from a district nurse, the home must establish a care plan identifying the action necessary should the dressing become damaged between the nurses visits. This requirement was first made at the inspection dated 27/06/05 The safety of the procedure for
DS0000003973.V260929.R01.S.doc Timescale for action 1 OP3 14 31/03/06 2 OP7 15 31/03/06 3 OP38 13 31/03/06 4 OP8 15 31/03/06 5 OP9 13 31/03/06
Page 23 Version 5.0 6 OP30 18 7 OP33 24 8 OP38 23 9 OP38 23 the administration of medicines must be reviewed and risk assessed. For care staff to give a medicine it must be labelled with the service user’s full name, the name, form, strength, dose and frequency of the medicine. All staff must receive training by a competent trainer in issues relating to abuse and protection of vulnerable adults. The registered persons must establish and maintain a system for reviewing and improving the quality of care in the home, a report of any such review must be provided to the Commission and be available to service users. Recorded evidence must be available demonstrating that regular, monthly checks are made of the emergency lighting in the home. Until further guidance is issued, all staff on day duty must receive fire safety training at six monthly intervals and night staff at three monthly intervals. 31/03/06 31/03/06 31/03/06 31/03/06 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 OP3 Good Practice Recommendations It is recommended that when undertaking a pre-admission assessment, the source of information obtained is recorded and all assessment records should be signed and dated. The registered persons should ensure that resident care files are complete, up to date and accurate and that all information including pre-admission assessments and contracts are held securely and are available for reference.
DS0000003973.V260929.R01.S.doc Version 5.0 Page 24 1 2 OP37 3 OP9 4 OP15 5 OP22 6 7 OP25 OP28 It is recommended that a calibrated thermometer is used to monitor the temperature of the store cupboard for medicines that should be held below 25°C. It is recommended that there is a menu (changed regularly) offering a choice of meals in written or other formats that is available to, and suits the capacities of service users. It is recommended that Portelet House premises are assessed by suitably qualified persons including an occupational therapist to establish the extent of any disability equipment and environmental adaptations required. It is recommended that risk assessments are reviewed considering advice and guidance published by the Health and Safety Executive in relation to risks of accidental scalding from exposed pipe-work and radiators. It is recommended that at least 50 of staff achieve the NVQ level 2 award or equivalent. DS0000003973.V260929.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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