Inspection on 19/10/05 for Rosset Holt Home

This inspection was carried out on 19th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rosset Holt Home 26/09/08

Rosset Holt Home 27/06/07

Rosset Holt Home 08/05/06

Rosset Holt Home 18/05/05

Rosset Holt Home 26/10/04

Rosset Holt Home 26/04/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Rosset Holt Home Pembury Road Tunbridge Wells Kent TN2 3RB Lead Inspector Gary Bartlett Announced 19 October 2005 09:30 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 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. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Rosset Holt Home Address Pembury Road Tunbridge Wells Kent TN2 3RB 01892 526077 01892 526077 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) Keychange Charity Mrs Marilyn Rose Luck CRH Care Home 18 Category(ies) of Old age (18) registration, with number of places Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18 May 2005 Brief Description of the Service: Rosset Holt is a large detached property on two floors and stands in its own grounds. The Home is owned by the Keychange Charity and offers accommodation to older people with Christian beliefs. It is registered for 18 service users and all rooms are currently used for single occupancy although some are large enough to be used for shared occupancy if required. Six bedrooms have en-suite facilities. There are staff call points and television points in all bedrooms. The Home is equipped with a shaft-lift.Rosset Holt is located on the outskirts of Tunbridge Wells where there are the usual facilities of a town. There is access to public transport close by and the nearest Doctors surgery is a very short walk away. Space for car parking is available and there are spacious gardens for residents to use. The Home’s senior staffing team comprises the Manager and a Deputy Manager. The Home employs care staff that work a roster that gives 24-hour cover. The Home also employs other staff for catering, domestic and maintenance tasks. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in Rosset Holt from 9.30 a.m. until 4.00 pm. During that time the Inspector spoke with some residents, a visitor and some staff. Parts of the Home and some records were inspected. Some comment cards were received prior to the inspection. Residents and their relatives responded that they liked the home and staff. Responses from health professionals also indicated good standards of care. Statements on comment cards included: • “I can not fault their care” • “An excellent care home.” • “The staff are very willing and helpful.” • “There is something special about this home” • “A lovely home, beautifully kept.” The Manager and staff gave their full co-operation throughout the inspection. What the service does well: What has improved since the last inspection? The clinical waste bin has been repaired. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 6 The water supply was in the process of being improved. Some progress had been made to provide more staff training. The Home was reporting incidents under Regulation 37 as required. What they could do better: 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. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 3, 4, 5 and 6 The Home’s Statement of Purpose and Residents Guide provided service users and prospective service users the information they need to make a decision about moving into the Home. Good pre-admission assessments and the opportunity to visit the Home prior to admission ensured residents were appropriately placed and the Home could meet their needs. The Home did not provide intermediate care. EVIDENCE: The Manager said the Statement of Purpose was accurately descriptive of the aims, objectives, philosophy of care, services and facilities and terms and conditions of Rosset Holt and copies of the Service Users Guide were provided for each service users or their representative. These were not inspected on this occasion. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 9 The Manager described how a pre-admission assessment was made of each prospective resident using an aide-memoir. Records seen indicated prospective residents, their families, advocates, and relevant health care professionals were involved in the assessment process. Specialist advice was sought from external sources where required. The Manager said prospective residents or their families were able to visit the Home before moving in. A visitor present confirmed this, saying staff had been very helpful in assisting the resident to settle in. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10 and 11 Residents’ health and welfare would be better promoted by better care planning and recording and by risk assessments being written when necessary. The Medication Administration Record sheets needed to be more consistently maintained and prompt management action was required where there were discrepancies to ensure residents’ safety. Residents’ health needs were met with good liaison with relevant health care professionals. Staff treated residents with respect and maintained their privacy and dignity. EVIDENCE: Each resident had a care plan. Two care plans were inspected in detail. One being for a person in receipt of respite care. This care plan was totally inadequate which was particularly concerning as this had been notified at the previous inspection. Daily records were not consistently detailed or informative. It was not always evident that solutions had been sought for Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 11 residents’ identified problems. Risk assessments had not been reviewed or recorded as a result of recent incidents or changes in welfare. The scope and content of risk assessments still needed to be more comprehensive, especially considering that some residents regularly left the Home independently. It was important for necessary and current information to be recorded and readily available to staff for them to be able to meet residents’ needs. The Manager understood this and was aware that the care plans were not to the standard required. The medicines storage room was inspected and medications were seen to be stored in accordance with their instructions. The Manager stated it was planned to refurbish parts of the room to maintain hygiene standards. Records were available to indicate that all staff administering medications had been trained and signed off as being competent to do so. The majority of Medication Record Administration Record (MAR) sheets that were inspected had been completed appropriately. The Manager stated they were aware of a major anomaly on one sheet and this was to be investigated. The anomaly had occurred 2 weeks prior to the inspection. Medications were seen being administered in compliance with current guidelines. The Home continued to have a good working relationship with the specialist and local health care professionals, supporting residents in their health care needs. From observation and discussion with residents it was clear that staff treated residents with respect and promoted their privacy and dignity. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Most residents had some choices about their daily lives, were able to have visitors at any reasonable time and enjoyed continued links with the local community where this was their preference. The Home did not ensure all residents with sensory impairment or physical disabilities were given the autonomy they wanted and did not become isolated. Dietary needs of resident were met with a balanced menu that met their tastes although increased choices could be offered. EVIDENCE: Residents spoken with were clear that they generally considered the activities available to be consummate with their wishes Bible studies and prayer meetings were held daily and the Manager confirmed that service users chose whether to attend the services or not. A notice board in the entrance hall was seen to include details of forthcoming activities that the Home had arranged. Residents told the Inspector they attended local centres, went shopping, on day trips, had holidays, entertainers visited and music sessions were arranged. Residents said that they were able to receive visitors at any reasonable time and there was a comfortable room in which they could receive their visitors in Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 13 private should they choose not to use their bedrooms. The Manager mentioned that residents sometimes stayed with friends and family for weekends etc. It was apparent from records and discussion that some residents with sensory impairment or physical disabilities felt isolated. Residents spoke favourably of the meals and said they had plenty to eat. Although residents’ individual preferences were known and generally met, on most days the alternative to the main meal was salad. Some residents were not aware any choice was available. There was discussion about the advantages of offering two hot meals for the residents to choose from. The meals were well presented and looked appealing. Lunch was taken in a relaxed atmosphere and staff were seen to offer assistance in a discreet and sensitive manner. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 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 standard(s) 16, 17 and 18 Residents and their relatives knew their complaints would be listened to and acted on. Residents’ legal rights were protected and there were systems to ensure residents were protected from abuse. EVIDENCE: Residents benefited from the complaints procedure being readily available. Some residents and a visitor described how they knew of the complaints procedure but had not had reason to use it. There had not been any complaints in the last year. The Manager said that records of complaints would be kept and these include details of investigation and action taken and would be used to inform future practice. The Manager described how permanent residents at Rosset Holt were enabled to be on the electoral role. The Manager confirmed that where residents lacked capacity they had access to advocacy services. There were procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The Manager demonstrated a sound understanding of adult protection procedures and stated that any allegation of abuse would be referred to the concerned agencies without delay. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 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 standard(s) 19, 22, 25 and 26 The standard of the environment within the Home was generally good providing residents with an attractive and homely place to live. The Home needed to meet the environmental needs of all residents with sensory impairment or physical disabilities. EVIDENCE: Residents said they were happy with their rooms. The bedrooms seen had been personalised with the occupants’ personal effects and reflected their individual tastes and interests. Most residents said they had access to all parts of the Home and facilities they needed. However, one resident felt restricted because of their difficulty in negotiating the steps to their bedroom. Although this problem was known at the time of the resident’s admission, it was not evident that it had been addressed as soon as had been practicable. Specialist environmental advice was needed in respect of the accommodation of a resident with a visual impairment. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 16 The long-term problematic water supply to the Home was being improved. The parts of the Home inspected were clean and free from unpleasant odours. Staff were seen to effectively maintain infection control to promote residents’ health. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Recruitment processes were robust and offered protection to people living at the Home. The Home was addressing the training of staff so they had the skills to meet the needs of the residents. EVIDENCE: Residents spoke highly of staff and thought they worked hard. A statement on a comment card included: • “..greatly appreciate the continual thoughtfulness and kindness of the Matron specially, but also of the Assistant Matron, all the Carers and all the household and Kitchen staff.” The Home had a consistant staff group. Four staff members had left since the last inspection and their hours had been taken on by existing part time staff. There was some discussion about the need to discourage complacancy and resistance to change amongst a staff group that had been in place for a long time. The Manager stated they had reviewed stafing levels and considered them adequate. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 18 Although no new staff had been recruited since the last inspection, the recruitment processes described by the Manager were robust enough to ensure only properly vetted people worked at the Home. The Manager had written a training matrix for easy monitoring of staff’ training/update requirements and had requested training for staff in some courses. It was evident further training courses were required. The Manager described how the NVQ training had been disrupted by the demise of a training organisation but alternative trainers were being sought. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 36, 37 and 38 The Home would benefit from more robust and proactive management systems. Residents’ financial interests were protected. EVIDENCE: Staff and residents said they considered the Manager to be approachable, understanding and supportive. A resident said “I take my hat off to the Manager – a very efficient person.” The Manager had just completed the Registered Manager’s award, which was waiting for external verification. Statements on comment cards included: • “Very well managed, caring residential home.” • “..very well managed and good staff” Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 20 Not all requirements notified in the last inspection report had been addressed. There was little evidence that, in some instances, the Home had adequately addressed issues regarding residents’ difficulties. There were also examples where there had been undue delay in investigating noted anomalies, for example in the completion of Medication Record Administration Records. This potentially placed residents at risk. Advice was given as to how residents and staff would benefit from the identification and implementation of good systems and practices through research and meeting with other care providers, rather than working in isolation. The staff records seen did not comply with the Regulations. This needed to be rectified to provide evidence that identity of new staff was verified to promote residents’ safety. Notified deficits in staff induction had not been addressed so it was not clear staff had the basic skills to meet residents’ needs. A system of regular staff supervision was being implemented. A residents’ meeting had been held in August and questionnaires were distributed annually. The advantages of holding residents’ meetings more frequently, improving the questionnaire and of holding relatives’ forums were discussed. The Home encouraged residents to manage their own financial affairs or to have assistance from their families / representatives. There was an adequate system of holding and recording residents’ cash, which facilitated ease of monitoring. The Manager said these more regularly audited. The amounts of monies held that were inspected, balanced with the records Residents’ and relatives did not express any concerns about the Home’s management of monies or valuables held on the residents’ behalf. Records seen indicated that most staff had recently undertaken fire safety training but there were still some gaps in this. Staff were seen to be diligent in minimising risks to residents by carefully placing equipment to avoid obstruction and in ensuring COSHH requirements were adhered to. The Manager stated that records of maintenance and safety checks were in order. These were not inspected on this occasion nor were the Home’s policies, procedures or environmental risk assessments. Plumbing works within the Home were being undertaken in such a way that residents were not at immediate risk. Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 2 x 3 2 x x 2 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 2 2 x 3 3 2 2 Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 22 Yes 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. Standard 7 Regulation 14(2)(b), 15(2), 17 Schedule 3, Schedule 4 Requirement “The registered person shall maintain records as specified in Schedules 3 and 4. The registered person shall keep the service user’s plan under review” in that service users’ individual plans and records must be kept and be up to date in that they must be consistent and specific in detail of information. This remained a requirement from previous inspection reports The registered person shall ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated in that risk assessments must be more comprehensive and recorded in response to incidents and changes in residents welfare. This remained a requirement from previous inspection reports The registered person shall ensure that the care home is conducted so as to promote and make proper provision for the health and welfare of service users in that residents with sensory impairment or physical disabilities must be enabled to Timescale for action Adequate care plans must be in place by 30/01/06, if not sooner, and thereafter maintained Adequate risk assessmen ts must be in place by 30/01/06, if not sooner, and thereafter maintained Action plan to be received by CSCI by 15/11/05 2. 7 13(4) 3. 12 14 12 Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 23 4. 9 12(1)(a), 13, 17(1), Schedule 3 5. 19 22 23(2) 6. 30 18 7. 37 17(2) 8. 38 23(4)(e) have the autonomy they want, as far as is practicable, and do not become isolated “The registered person shall make arrangements for the recording, handling, safekeeping, safe administration of medicines” in that M.A.R. sheets must be completed accurately and anomolies investigated and resolved without delay The registered person shall having regard to the number and needs of the service users ensure that the physical design and layout of the premises to be used as the care home meet the needs of the service users in that appropriate professional advice must be sought and implemented in respect of proving safe accommodation for services users with sensory disabilities. “The registered person shall having regard to the size of the care home, the statement of purpose and the number and needs of the service users ensure that the persons employed by the registered person to work at the care home receive training appropriate to the work they perform including structured induction trainingThis was a requirement in previous inspection reports. The registered person shall maintain in the care home the records specified in Schedule 4 in that a record must be made of any accident that occurs in the care home “The registered person shall ensure, by means of fire drills and practices at suitable intervals, that the persons working at the care home and, Action plan to be received by CSCI by 15/11/05 Action plan to be received by CSCI by 15/11/05 All current staff must have completed the induction programme by 30/11/05 if not sooner Action plan to be received by CSCI by 15/11/05 To be completed by 30/11/05 if not sooner Page 24 Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 9. 37 17(2) 19 so far as practicable, service users, are aware of the procedure to be followed in case of fire, including the procedure for saving life” in that fire training must be provided at regular intervals. This refers to all staff, including night staff. Staff records must comply with Schedules 2 and 4 To be completed by 30/11/05, if not asooner, and maintained thereafter 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. Refer to Standard 9 15 28 30 33 Good Practice Recommendations It is recommended the Home proceeds with the stated aim of refurbishing parts of the medicines storage room to maintain infection control It is recommended that an alternative hot meal be routinely offerd to residents. It is strongly recommended the momentum of improving staff training be maintained It is strongly recommended better quality assurance systems are used Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent 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 Rosset Holt Home H56-H06 S23998 Rosset Holt Home V243180 191005 Stage 4.doc Version 1.40 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. 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