Inspection on 20/04/05 for Raynel Drive

This inspection was carried out on 20th April 2005.

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

Raynel Drive 08/08/06

Raynel Drive 01/09/04

Raynel Drive 04/05/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Muston Road (70)

Grayling

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

CARE HOME ADULTS 18-65 Raynel Drive Raynel Drive 9 Raynel Drive Ireland Wood Leeds Ls16 6BS Lead Inspector Ann Stoner Unannounced 20th April 2005 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Raynel Drive Address 9 Raynel Drive Ireland Wood Leeds LS16 6BS Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0113 2678042 Leeds City Council Department of Social Services Care Home Only 5 Category(ies) of Learning Disability (5) registration, with number of places Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 1st September 2004 Brief Description of the Service: Raynel Drive is a detached house, with five single bedrooms, providing short term and respite care for young adults with a learning disability. In order to cater for individual need, the service can be booked either weekly or on a flexible basis for a weekend or part weeks. The home is situated in the North of Leeds near to local shops, public houses, several churches and a sports centre. The bus routes, with nearby bus stops, run to Leeds City Centre, Horsforth and Otley. The accommodation consists of a bathroom and shower room, kitchen, lounge and dining area. There is a separate laundry room. Service users are encouraged to make full use of the facilities within the house and garden, which include a television, video recorder, music system and greenhouse. Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, regulated care homes have a minimum of two inspections a year; these may be announced or unannounced visits. The last inspection was announced and took place on the 1st September 2004. There have been no further visits until this unannounced inspection. The people who live in the home use the term service user; therefore this is the term that will be used throughout this report. During the inspection records were examined, some areas of the home were seen, such as bedrooms, kitchen, lounge and dining room; care staff were observed carrying out their work, and discussions were held during the day with five members of staff, and three of the five service users. The two remaining service users were unable to communicate; therefore time was spent watching how staff made themselves understood. This inspection started at 11.00am and ended at 6.30pm. What the service does well: What has improved since the last inspection? What they could do better: To make sure that service users and their relatives understand all of the arrangements about the respite stay, a formal contract must be agreed. There are a number of things the home must do to make sure that service users get consistent care from staff. This includes carrying out an assessment to check that the home is able to provide the care needed, making certain that every service user has a plan of care that gives staff clear instructions and making sure that all risks are identified. The home must look at ways of offering a more healthy diet to people as the current approach to menu planning often means that service users choose unhealthy options. A planned timetable must be developed each week to Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 6 guarantee that every service user who is both able and willing to help and prepare meals is given the opportunity to do so. In order to keep staff and service users safe, staff must have training in moving and handling, safe use of medication, fire safety, communication skills, abuse, first aid, infection control and some of the common conditions that affect service users such as epilepsy. Safe systems must be developed to ensure service users receive the correct medication and to prevent the spread of infection, staff should follow the home’s guidelines on the correct use of gloves. Work must progress to provide all bedrooms, shower and toilet areas with a hand wash basin. Health & safety measures such as locking the cleaning cupboard, and recording all accidents and incidents must take place. A number of requirements and recommendations relating to these issues have been made. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4 & 5. Prospective service users and their carers/relatives are able to decide about respite care based on the detailed information provided and the opportunity to visit the home. The rights and responsibilities of all concerned are uncertain due to the lack of a contract. Until the home carries out its own formal assessment, both prior to admission and at regular intervals after admission, care plans will not accurately reflect need, and this along with the lack of specialised training for staff means that the specific needs of service users may be overlooked. EVIDENCE: A statement of purpose explaining the respite facility was available in the office. A prospective service user who was seen being shown around the home with her parents, was invited to visit the home for a tea visit. Staff said that this was standard practice, which was confirmed by a service user and documented within his care plan. There is still no way of informing service users and their relatives about the terms and conditions of the respite stay as a formal contract and service user guide are still outstanding. There was a social work assessment in all of the care records sampled, but there was no evidence of the home carrying out its own assessment. Staff Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 9 said that an informal assessment takes place on the introductory tea visit, but this is more of an introduction of the person to the home rather than staff identifying how the person’s needs are to be met. One service user did not have a care plan. Staff said that they referred to the social work assessment for information regarding this person’s needs; however this assessment did not reflect all of the service user’s needs. Staff have not received any specialised training on issues and conditions relating to learning disability or race equality and equal opportunities, despite this being identified at the last inspection. They were unaware that a Hindu service user did not eat beef, and explained how when working with service users they rely on their knowledge of the service user and their own experience rather than on any theory or knowledge based on current good practice. Requirements and recommendations relating to three of these standards have been made. Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 & 9 Service users are at risk of not having their needs met, as care plans are not in place for all service users. Those that do exist do not show how all care is to be given. There is no way of ensuring that staff are consistently working towards ways to minimise risk as risk assessments are not in place for all areas of risk. EVIDENCE: A good care plan is one that gives precise and detailed information on how and when care is to be delivered, both during the day and at night, paying particular attention to the likes and dislikes of the service user in all aspects of care. The care plans at the home failed to give such detail. Terms such as ‘needs checking regularly’ are used rather than the precise instructions on when the person should be checked and how this will be monitored and recorded. Instructions within the care plan are not always followed, as was evidenced with those service users whose plan indicated that they should follow a healthy diet. There were no individualised procedures seen in care plans for managing challenging behaviour and staff described an inconsistent approach when dealing with such situations. The care plans are not produced in a format that can be easily understood by service users, and within the plans seen there was no evidence of any service user and/or family Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 11 involvement and no evidence of review. There was no care plan or risk assessment in place for one service user despite the fact that he had stayed at the home on three previous occasions. There was no evidence seen of risk assessments being completed prior to admission, or of those risk assessments that were in place being reviewed. The risk assessments currently in use are lengthy documents; risks are not easily identifiable nor are the actions that staff must take to minimise the risk. Some service users, identified as being at risk when outside the home, had no individual risk assessment in place. Requirements relating to these standards have been made. Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 15 & 17 The opportunity for service users to attend day centres, whilst receiving respite care ensures continuity. Links between family and friends are encouraged, thus providing the opportunity for relationships to be maintained. The current way of service users choosing meals often results in them selecting unhealthy options, which for some service users is contrary to the instructions within the care plan. The ad-hoc way that service users participate in domestic tasks does not provide equity nor does it allow service users to follow a structured programme leading to/and building upon existing independent living skills. EVIDENCE: From the three care plans sampled all of the service users were able to help and prepare meals and snacks under supervision. There was no evidence of an individual skills programme for each service user and staff said that service users are selected at random to help prepare the evening meal. From daily records, one person’s mother had said that her son was bored at the home. During this respite stay he said the only tasks he had been involved in was setting the table for meals. Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 13 Staff explained how at the beginning of their stay service users choose their own menu and are then supported to buy food from the supermarket, which is good practice. However, from the menu records there was little evidence of service users being offered fresh vegetables, salads, low fat meat or fish on a regular basis. Two of the care plans sampled stated that the service users should, for health reasons follow a healthy diet, however it was noted that these service users ate a high proportion of burgers, chips and pizza during their stay. To maintain continuity with their normal routine, service users are encouraged to attend their usual day centres, and during this inspection all of the service users were out until approximately 4pm. One service user explained how during his respite stay he keeps in contact with his girlfriend by mobile phone and said that she visits on a weekend, accompanied by her parents. Requirements and recommendations relating to two of these standards have been made. Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 Service users are placed at risk as staff have not received any training in the handling, recording, storage, administration and disposal of medication. This risk is increased by the fact that Medication Administration Record (MAR) charts are handwritten, providing the opportunity for potential errors. EVIDENCE: The home has a policy that states two members of staff must check and sign in medication and then record this on a medication sheet. Two signatures were not always seen on these documents. One member of staff then transfers this information onto a handwritten MAR (Medication Administration Record) chart. This entry is not checked and countersigned. There have been two recent incidents regarding service users being given the wrong medication. This is unacceptable and steps must be taken to ensure this does not continue to happen. Staff were unclear about procedures for controlled medication. The home has still not obtained a bound controlled drug register, with numbered pages, and does not have a copy of The British National Formulary, despite this being a requirement in the home’s medication policy. Not all service users have lockable space in which to store medication, should the need arise. None of the staff who have responsibility for medication have received any training, despite this identified at previous inspections. Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 15 A requirement and recommendation relating to this standard has been made. Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 The complaints procedure encourages service users to complain and reassures them that their complaint will be taken seriously, as it is in a format easy to understand. Staff had a good understanding of abuse, but in order to ensure service users are protected from abuse, neglect and self harm all staff must receive training. EVIDENCE: The complaints procedure was seen within the statement of purpose. This procedure is in a format using simple language that is supported by pictures, and reassures complainants that their complaint will be thoroughly investigated. Records of all complaints and kept along with how the complaint has been investigated. One service user said that he would tell his mother if anything upset him whilst at the home. Although staff had a good understanding of abuse and were able to explain how they would deal with any suspicions of abuse, they said that they not received any training in this area. This was confirmed by examination of the training records. A requirement relating to one standard has been made. Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 30 The home provides a comfortable living environment for service users; that is clean, tidy and free from any offensive odours. Service users are at risk of cross infection due to the lack of hand washing facilities in bedrooms, shower and toilet areas, along with lack of infection control training for staff, and a hand washing policy. EVIDENCE: The home was very clean and tidy and it was noted that the laundry room now has a hand washing facility. Hand washing facilities are still not available in all bedrooms, shower and toilet areas, thus increasing the risk of cross infection, particularly when staff are handling soiled linen and continence products. Examination of training records confirmed that staff have still not received any training on infection control. The home’s policy on infection control specifies the correct use of gloves, but the home does not follow this procedure. A hand washing policy is not incorporated within the home’s infection control policy. A requirement and recommendation relating to this standard has been made. Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 The home does not provide appropriately trained staff to meet the needs of service users. EVIDENCE: By examining the training records and discussions with staff it was clear that staff have not received any recent training relating to the field of learning disability, equal opportunities or race equality. Staff raised concerns that their practice is out of date, particularly in relation to their understanding and knowledge of epilepsy, despite the fact that a number of service users have this condition. Staff were seen interacting with service users who were unable to communicate, but they said that they used their previous knowledge of the person rather than any specialised techniques from training. A requirement relating to this standard has been made. Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 Both staff and service users are placed at risk as a result of staff not receiving training on moving and handling, first aid, fire safety and infection control. This risk is further increased due to unsafe practices in relation to the storage of cleaning substances used within the home. The home does not comply with the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995, due to poor record keeping. EVIDENCE: Training records revealed that staff have not received any training in moving and handling, despite some staff suffering with back problems. Only one person within the home has received first aid training, and although fire drills are carried out at intervals of no more than 6 months, there was no record of staff having received any fire training from a suitably qualified person. Discussion with staff confirmed the lack of fire training. The cleaning cupboard that contained 5 litre containers of various substances hazardous to health was not locked. Product risk assessments were seen for Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 20 those substances obtained through the local authority’s purchasing organisation, but not for the several products obtained from the local supermarket. The daily records for one service user indicated that he had suffered a fall on the front doorstep, and on another occasion following an epileptic fit he sustained injuries to his head. The home was unable to produce an accident or incident form relating to either of these occurrences. Requirements and recommendations relating to this standard have been made. SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 2 2 3 1 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 Raynel Drive Score 1 x Standard No 24 25 26 27 28 29 Score x x x x x x Version 1.20 Page 21 J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc 8 9 10 LIFESTYLES x 1 x Score 30 STAFFING 2 Standard No 11 12 13 14 15 16 17 2 2 x x 3 x 2 Standard No 31 32 33 34 35 36 Score x x x x 1 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 1 x Standard No 37 38 39 40 41 42 43 Score x x x x x 1 x Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard 1 3, 35 Regulation 5 18 (1) Timescale for action The home must provide a service 31.8.05. user guide. Staff must access training 31.8.05. relating to the needs of service users. This must include training on: communication skills visual and hearing impairment race equality equal opportunities some of the common conditions that affect service users such as epilepsy. The previous timescale of 31.12.04 remains unmet. All service users must be issued with a contract specifying the arrangements made for respite care. All service users must have a written care plan giving clear and precise detailed instructions for staff to follow. Service users and/or their representative must agree and sign the plan. All care plans must be reviewed at intervals of no less than 6 Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 23 Requirement 3. 5 5 (3) 31.8.05. 4. 6 15 31.5.05. months. The pervious timscale of 30.11.04 remains unmet. Risk assessments for all areas of identified risk must be in place for all service users. The previous timescale of 30.11.04 remains unmet. Service users must be provided with a nutritious diet and healthy eating options encouraged. To ensure the safe recording, handling, safekeeping, safe administration and disposal of medicines those staff who have responsibility for administration of medication must receive training. A safe system must be employed to ensure service users receive the correct medication. A bound, controlled drugs register with numbered pages, must be put into use. All staff must access training in the following areas: adult abuse infection control moving and handling. All bedrooms, toilets, and shower room must be fitted with a wash hand basin. First aid training must be provided to staff. 5. 6 13 (4). 31.5.05. 6. 7. 17 20 16 (2) (i) 13 (2) 31.5.05. 30.6.05. 8. 23, 30, 35, 42 18 31.7.05. 9. 10. 30 42 13 (3) 23 (j) 13 (4) 31.10.05 31.7.05. 11. 42 23 (4) (d) (e) There must be a qualified first aider on each shift. All staff must receive fire training 31.7.05. and instruction at intervals of no more than 6 months, by a suitably qualified or appointed person Previous timescale of 31.12.04 Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 24 remains unmet. 12. 13. 42 42 17 (2) Schedule 4 13 (4) (a) The home must maintain records of all accidents and incidents relating to service users. All cleaning materials and other hazardous substances not in use must be kept in a locked cupboard. Immediate as advised. Immediate as advised. 14. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 3 11 20 20 30 Good Practice Recommendations The home should carry out a formal system of assessment prior to all respite stays. An individual skills programme should be developed to ensure that all service users have the opportunity to develop independent living skills. Service users should be provided with lockable space in which to store medication. The home should obtain a copy of the British National Formulary. The infection control nurse should be contacted for specialist advice. Policies relating to hand washing should be developed. User satisfaction questionnaires should be distributed to all stakeholders including service users, relatives, advocates, day centre staff, health care professionals, social workers and any other interested parties. Results of these surveys should be published and made available to service users, their representatives and the CSCI (Commission for Social Care Inspection) COSHH (Control of Substances Hazardous to Health) risk assessments should be in place for all cleaning products. 6. 39 7. 42 Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Raynel Drive J52 J03-S33820- Raynel Drive-V221077-200405 Stage 4.doc Version 1.20 Page 26 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!