Inspection on 03/10/06 for Rosemary Cottage

This inspection was carried out on 3rd October 2006.

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 found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosemary Cottage 09/02/06

Rosemary Cottage 21/11/05

Rosemary Cottage 28/10/04

Rosemary Cottage 10/05/04

Rosemary Cottage 07/01/04

Similar services:

Thorndene

Sutton Lodge Nursing Home

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 Rosemary Cottage Canterbury Oast Trust Highland Farm Woodchurch Ashford Kent TN26 3RJ Lead Inspector Mrs Sally Gill Unannounced Inspection 3 October 2006 09:00 rd Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 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 Rosemary Cottage DS0000023516.V300728.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 Adults 18-65. 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. Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosemary Cottage Address 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) Canterbury Oast Trust Highland Farm Woodchurch Ashford Kent TN26 3RJ 01233 861510 Canterbury Oast Trust Post Vacant Care Home 6 Category(ies) of Learning disability (1), Physical disability (5) registration, with number of places Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 6 People with learning disabilities aged between 18 - 65 years of age. Date of last inspection 9th February 2006 Brief Description of the Service: Rosemary Cottage is registered to provide accommodation for up to 6 adults who have a learning disability, 5 of which also have a physical disability. The home is owned by Canterbury Oast Trust (COT), a registered charity, and is managed on a day-to-day basis by Ms Emma Stokes who is not registered with the commission. The house is a modern purpose built property with all accommodation for residents on the ground floor. All bedrooms are single occupancy. The residents have the use of a fully assisted bathroom and shower room (both with WC), and a separate WC. The kitchen is accessible to all residents with support and a large, comfortable lounge/diner has views into the garden, shared with other adjoining homes. Hallways are wide and have grab handrails where needed. The home is situated on the grounds of Highlands Farm, the home of the South of England Rare Breeds Centre, and a major tourist attraction in a rural area on the outskirts of the village of Woodchurch. A short drive will take you to the towns of Ashford and Tenterden, and approximately 3 miles away is Hamstreet train station. Within the village of Woodchurch there is the local GP’s surgery, post office, church and two pubs, the home also has transport which can be used for residents if they wish and a local bus service passes the farm. The site itself offers many opportunities for community contact, and specialist facilities such as snozelan and an art department are nearby. Current fees are £1166.59 per week. Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced site visit took place on Tuesday, 3rd October between 9.00am and 5.40pm. The manager assisted throughout the visit. Those that live at Rosemary Cottage wish to be known collectively as residents. Six people were living at the home. The inspector met and spoke to five residents and five staff on duty. Observations included interactions between residents and staff. The inspection process consisted of information collected before and during the visit to the home. Surveys were sent to residents, families, and professionals involved in the home. Surveys were received from four residents (completed with staff support), which indicated residents were happy with their care. Two relatives responded and were extremely satisfied with the care provided adding comments “X’s care under Canterbury Oast Trust at Rosemary Cottage we consider to be of the very highest order. Staffing levels are extremely good. The staff are caring and committed. X enjoys activities and outings and a good deal of one to one time. Personally and spiritually X is thriving and extremely happy. Management of the house reflects in the above. As parents we are able to rest assured that our X is safe, secure and happy. We are very thankful” and “continuing excellent care provision for X. Staff were absolutely excellent in handling a recent accident for X”. Professional feedback (four health professionals, GP surgery and a care manager) was also very positive. Comments are “Rosemary Cottage is a bright and cheerful home and the residents are happy and content there. I visit the home regularly and I always get a nice welcome and the staff are cooperative”, “I must commend the high quality of care that I have seen since providing treatment for patients there. The one to one care is very good plus outside activities and clubs geared to each client’s needs and capabilities. Exercises are carried out by staff on a daily basis with his/her clients. Very good team work”. There was one concern noted that a senior member of staff is not always available to confer with. Various records were viewed during the inspection. The inspector accessed the lounge/diner, a toilet, the medication room and the office. Rosemary Cottage DS0000023516.V300728.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: Residents would benefit from further staff training in highlighted areas and increased numbers of qualified staff. To fully protect residents some procedures/records should be improved including accident/incidents recording, medication systems, and techniques to be adopted by staff to de-escalate and deal with situations of aggression and recorded risk assessments for the use of passive restraint. The manager must submit her completed application for registration to the commission. Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 7 Resident’s agreement and involvement could be evidenced including care plans and contract terms and conditions. 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. Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 9 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 the following standard(s): 2&5 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Prospective residents can be sure that their needs will be assessed prior to admission. Each resident has a written contract with the home although these have not been signed. EVIDENCE: The inspector was advised that the statement of purpose and service user guide have been up dated to reflect changes in the home and a copy sent to the commission. There have been no new admissions to the home since 1997. The Trust has a thorough admissions procedure in place and any new resident would have their needs assessed prior to admission by the home. The home would also obtain a copy of the care manager’s assessment of needs. Contract terms and conditions were seen on resident’s files. However although it was clearly stated these had been read to the resident they were not signed by the home or resident/representative, which is recommended. Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 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 the following standard(s): 6, 7, 8 & 9 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Minor alterations are needed so that care plans fully reflect resident’s needs and that this, is the way they wish to be supported. Support to aid decision-making and participation could be further improved with increased staff training. Risk taking is well assessed with staff using creative thinking to enable activities to take place safely. EVIDENCE: Each resident has a good detailed care plan in place, which states how he or she would like to be supported. These had been reviewed within timescale. Although residents when spoken to were clearly aware and involved in the care planning process this was not evidenced. One plan outlines action to be taken should a resident become aggressive. However this is only informative if the staff member has undertaken the appropriate training (NAPPI) and not all staff have. Given the number of recent incidents it is recommended that all staff Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 11 be trained (see staff training). It was agreed by the manager to clearly record the techniques to be adopted by staff to de-escalate situations as well as the technique to be used when an incident occurs. Residents stated and observations confirmed that they are involved in the dayto-day decision making within the home. This has recently been further increased with residents now planning their menus on a weekly basis. In order that all residents can participate fully in decision-making and are not isolated it is recommended that all staff be trained in Makaton as currently only a few are. The manager advised that she is also going to review and update resident’s communication books and is building up a portfolio of menu photographs to aid communication and decision-making. Risk taking is well supported and evidenced in risk assessments. However the use of passive restraint must be recorded in a risk assessment with the multiagency agreement that has been obtained (see standard 23). Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents enjoy a variety of activities and therapies. Residents are supported to access the community and places that interest them. Friendships and family contact is well supported. Care is taken to ensure resident’s rights are recognised and respected. Residents enjoy sociable mealtimes with a healthy and varied diet. EVIDENCE: Each resident has a schedule of activities, which they have chosen. Discussions highlighted how much they enjoy these. Staff spend time really engaging with residents so they can get the best out of activities as well as maintain skills. Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 13 There are a wide variety of activities both within the home, Trust and the wider community. Many activities organised also have a therapeutic value for residents. Residents spoke of the fun they had on holiday this year. The home has recently purchased a new minibus for residents use. Family and friends are encouraged to visit and residents are supported to get see their families and friends. Daily routines are flexible around the needs of the residents. Residents know they have rights and staff work in a way, which is inclusive and enabling. Since the last inspection further improvements have been made in developing independence and decision-making. The manager agrees that further development could still be achieved. The manager intends to discuss this at the next staff meeting and use goal planning within the care plans to aid development. The main meal is now taken at lunchtime in the home, which has been beneficial to all residents. The home has a clear ethos of promoting and supporting residents in healthy living. Menus are now planned weekly with residents. Photographs and other methods are used to improve choices. The meal was observed to be hot, wholesome, appetising and certainly enjoyed by all. Staff assisted sensitively and maximise independence with the use of appropriate aids. Residents have opportunities to be involved in meal preparation. Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 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 the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Staff provide sensitive and flexible personal support making sure that residents have maximum privacy, dignity and control. Resident’s healthcare needs are met. There are shortfalls in the medication system, which could leave residents at risk. EVIDENCE: Discussions and observations confirmed that personal support is always given in the way preferred and which enhances dignity and control. Times for getting up are flexible. Residents were individually dressed reflecting their own personalities. Plenty of equipment is used to maximise independence. This is an area kept under constant review and advice and guidance is sought from professionals regularly to ensure changing health and needs is still met. Residents access annual health appointments. Health is closely monitored within the home and any problems are referred appropriately. Medication is supplied using MDS by the local doctors surgery. Individuals have now been Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 15 assessed for their ability to swallow tablets and records are maintained. The storage used for surplus stock must be properly secure. Medicines must be stored at the correct temperatures. Internal and external medicines should be stored separately. Medication must be logged in and out of the home (including home visits) in sufficient detail to enable an audit trail. Any medication prescribed PRN must have written instructions to staff as to what, why, when and any authorisation needed for administration. Thirteen staff are trained medication administration and fourteen in rectal diazepam and insulin injections. Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 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 the following standard(s): 22 & 23 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Resident’s views are listened to and acted upon. Staff know about adult protection procedures but other procedures require improvement to fully protect residents. EVIDENCE: The complaints procedure is displayed within the home in symbol form and is also discussed at each residents meeting. There have been no complaints recorded since the last inspection. Observations and discussions confirmed that resident’s views are listened to and taken seriously. Seven staff are trained in adult protection and a further eight have places booked. Staff spoken to confirmed they were aware of how to report abuse both inside and outside of the Trust. The home has obtained guidance from the DOH on physical restraint. However risk assessments agreed by professionals must be recorded for the use of passive restraints. Some staff are trained to deal with aggressive behaviour although it is recommended that all staff are trained. An incident report (which is not an isolated incident) highlighted that action could have been taken that may have de-escalate a situation before the resident became aggressive to another resident. Training will help to minimise this risk. An incident and an accident were noted in daily diaries but not followed through in report/recording procedures. All incidents/accidents must be reported and recorded in line with procedures. Residents personal allowance records and balances were in order. All staff have an enhanced disclosure in place. Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 17 Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 18 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 the following standard(s): 24 & 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents enjoy a home, which is a clean, homely, comfortable and safe environment. EVIDENCE: Rosemary Cottage is spacious, clean, safe and well maintained. Communal space is open plan with low-level windows to allow views outside when seated. Furniture is arranged to ensure it is homely but allows plenty of space for mobility aids. A cordless telephone has been purchased so residents can make and receive calls in privacy of their own rooms. Residents confirmed that they are happy with their rooms. Staff confirmed that any maintenance work required is usually carried out fairly quickly. Adaptations and equipment required by residents to enhance their independence is provided. Gardens are well maintained and it is apparent that residents enjoy them in good weather. The manager talked about the development plans for the home, which include a raised vegetable plot for resident’s just outside and improving laundry facilities. Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 19 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. Residents are supported by a caring staff team although they would benefit from higher numbers qualified and staff training in highlighted areas. Residents are protected with a robust recruitment procedure. EVIDENCE: Five staff have obtained an NVQ level 2 or above although this is considerable less than 50 . Staff were observed to be approachable, very caring and respectful to residents. In discussions they were committed and motivated to working as a team to improve outcomes for residents. Staff said they felt well supported and receive formal supervision. The home manager has a commitment to staff training and understands the importance of good training for staff. See previous comments regarding reasons for the recommendation that further staff are trained in NAPPI and Makaton. The Trust has recently reviewed their induction training with South Kent College and a new training programme will begin shortly. Files evidenced that a robust recruitment procedure is in place. Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 20 Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 21 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to this service. The home is run in the best interests of residents, the manager is experienced and committed to undertaking the relevant qualifications. Residents know that the team approach in the home is to provide an enabling, supportive and homely environment. Residents can be confident their views underpin the development of the home. The health, safety and welfare of all is promoted and protected. EVIDENCE: The manager is new in post although has worked within the home for nine years and has a further seven years experience outside of the Trust. She is currently working towards her NVQ level 4 in care and A1/A2 assessors award. She has signed up for her RMA, which will commence in January 2007. Emma Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 22 has agreed to submit her completed application for registration to the commission by 30.11.06, which is a requirement. Emma is committed and motivated in supporting and enabling her staff team to continually improve outcomes for residents. Staff said the changes in manager and seniors has been “seamless going smoothly and staff have bonded as a team”. One member said Emma “allows you to take responsibility, is supportive and aware of what’s going on but lets you use your initiative”. Another said, “She’s firm but fair”. The team provide a commendable level of support to the residents, and really understand the importance of enabling residents. The atmosphere is totally inclusive and extremely respectful. A variety of quality assurance systems are in place taking feedback from residents, families and professionals. A development plan is in place for the home. Various fire and health and safety records were checked. Fourteen staff are trained in manual handling, fifteen in fire, twelve in first aid and food hygiene and thirteen in infection control. Further places are booked for all courses. Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 23 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. 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 X 2 3 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 x LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 2 X 2 4 3 X X 3 X Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 24 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 YA20 Regulation 13(2) Requirement The home must have a safe system for medication (secure storage, ensure correct temperature for storage, separate internal/external storage, medicines to be logged in and out, written instructions for all PRN medicines) All incidents/accidents must be reported and recorded in line with procedures The manager to submit her completed application for registration to the commission Timescale for action 03/11/06 2 3 YA23 YA37 17 Schedule 3 9(1)(2) 03/11/06 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA5 YA6 YA6 Good Practice Recommendations Contract terms and conditions should be signed by the home and resident/representative Evidence the involvement of residents in care planning and that they agree this is how they wish to be supported Clearly record the techniques to be adopted by staff to deDS0000023516.V300728.R01.S.doc Version 5.2 Page 25 Rosemary Cottage 4 5 6 7 YA23 YA35 YA23 YA32 YA35 escalate situations as well as the technique to be used when an incident occurs All staff should be trained in defusing and dealing with aggressive behaviour The use of passive restraint must be recorded in a risk assessment with the multi-agency agreement Further staff to obtain an NVQ level 2 or above in care All staff be trained in Makaton Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Rosemary Cottage DS0000023516.V300728.R01.S.doc Version 5.2 Page 27 - 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!