Inspection on 22/06/06 for St Claires Care Home

This inspection was carried out on 22nd June 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 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

St Claires Care Home 05/06/07

St Claires Care Home 08/11/05

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

CARE HOMES FOR OLDER PEOPLE St Claires Care Home 18-24 Claremont Road Folkestone Kent CT20 1DQ Lead Inspector Ms Patricia Green Unannounced Inspection 22nd June 2006 11:50a X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Claires Care Home Address 18-24 Claremont Road Folkestone Kent CT20 1DQ 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) Rosemere Care Home Ltd Mrs Margery Ann Martin Care Home 39 Category(ies) of Dementia - over 65 years of age (39) registration, with number of places St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 8th November 2005 Brief Description of the Service: St Claire’s provides residential care to up to 39 older people with dementia. The Home is a detached premises and is situated in a residential area near to the town centre of Folkestone, within easy walking distance of facilities such as shops, health centres, railway and bus stations and churches. There are three floors incorporating four day rooms and 37 single bedrooms, 6 of which have en suite facilities and one double bedroom. Service users and visitors have access to all parts of home via two shaft lifts. The home has established a small garden at the front of the premises, which is accessible to all service users. The current Fees range between £301-£450 per week. St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place on 22nd June 2006. During the visit the premises were toured, a range of documentation was viewed, the acting manager (deputy), staff, a relative and a number of residents were spoken to. Due to the category of residents cared for, not all residents were able to be spoken to regards their personal experience of receiving care at the home; judgements made include observation of care given by staff and interaction between staff and residents. The home is currently being jointly managed between the Proprietors and the deputy manager (in an acting manager position) following the resignation of the registered manager for the home. Evidence from this site visit demonstrated that the current temporary arrangements offer good leadership to staff and that the home is well managed during this interim period of recruiting a new manager. Survey questionnaires were sent out by the Commission as part of the Inspection process: at the time of this report 8 replies from GP’s and 2 replies from Care Management (Social Services) had been received. Replies were positive in the main; some specific comments made in one response have been discussed with the Acting manager. What the service does well: Since taking over recent ownership of the home the Proprietors have developed an action plan to improve the quality of the environment for residents; decorating/refurbishment is underway with a member of staff employed specifically for maintenance and redecoration. The management have fostered a very relaxed and yet interactive atmosphere within the home; interaction between staff and residents is very positive, with a ‘jovial’ and ‘friendly’ environment created. Support given to residents is undertaken in a respectful manner, with emphasis on maintaining dignity. Residents are encouraged to personalise their own bedroom and to be involved in choice of colour scheme when redecoration is required. Visitors are made to feel very welcome and can visit at anytime; the management keep relatives informed of any changes to health needs and other information pertaining to the wellbeing of the resident. St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 6 The staff team are well supported by management, with the Proprietors taking a very active role in the daily life of the home. What has improved since the last inspection? What they could do better: The weekly Fees charged to the resident need to be included as part of the written ‘terms and conditions’ of the resident’s stay at the home. Risk assessments need further development within the care planning records so as to clearly demonstrate daily support and protection required for the resident. It is acknowledged that staff are supported to attend a broad range of training; however it is advised due to the registration category of the home that staff training is monitored to ensure it continues to include specific training relating to Dementia. Due to the recent departure of the registered manager, there is a need to recruit to this position and for registration with the Commission to be applied for. Staff should be monitored to ensure there is full understanding of guidance and training received relating to Adult Protection. The management should review the use of ‘gates and keypads’ to stairways to risk assess if this provision suits the needs of residents. The refurbishment of the home should continue, to improve the overall environment for the residents. St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 7 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. St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 & 5 Standard 6 not relevant to this Home Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are informed of the facilities available. The Pre-assessment process safeguards residents that their needs can be met. Written details of the Fees charged at the home need to be included within the Service User Guide. EVIDENCE: A Statement of Purpose and Service User Guide have been produced which details the facilities available; the Acting Manager said that when the prospective resident arrives to view the home, they or their relative/advocate will be given a copy of these documents so as to have written information on which to make a decision. Due to the category of resident cared for within the home, relatives and Social Services will generally be very much involved with St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 10 the prospective resident in this initial visit and in the pre-assessment process before a decision is made to move into the home. Evidence was seen of the pre-assessment that is undertaken and the subsequent care plan that is set up from this assessment. The home is jointly owned and following the departure of the home’s registered manager, these initial assessments are currently being undertaken by one of the Proprietors, working closely with the Acting Manager in this process, through to admission. It was evident from discussion with management and in viewing documentation that the pre-assessment is seen as an important component in judging whether the home has the capacity to meet the resident’s needs. On moving into the home each resident or their relative/advocate is given a copy of the home’s ‘terms and conditions’; the Acting Manager said that the resident or their relative/advocate is informed of the Fees payable, however as noted this is currently not included within the written document. This was discussed with the Acting Manager during the visit and it was agreed that this would now be discussed with the Proprietors, with the aim of inclusion within the ‘terms and conditions’. St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): =--7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are supported by detailed information within individual care plans. They are not fully protected due to the need for risk assessments to be developed. Residents are safeguarded by the focus that has been given to staff training in ‘safe handling of medication’. EVIDENCE: It was evident during the visit that much attention has been given to the development of care planning documentation; care plans viewed included detailed information of assessment, identification of needs and daily support; evidence was seen that regular reviews are in place. A key-worker system has been introduced with the Key-worker having involvement in individual care planning. However as discussed with the Acting manager there is a need for risk assessments to be further developed, to contain more detailed information of assessment and reduction of risk for the resident. A situation that had St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 12 occurred with one of the residents in the previous week was discussed and highlighted the need for risk assessments to be reviewed/developed. Within the care planning documentation a written record is kept of all contact the resident has with GP’s, District Nurses and other health professionals. In viewing these records and in discussion with a relative it was evident that the health requirements of the residents are addressed with frequent and regular contact made with GP surgeries. A good response was received from GP’s as part of the Commission’s survey in regards to the home; responses were in the main positive; some specific comments that were made in one response have been discussed with the Acting manager. A focus for the Proprietors has been to identify the training needs of the staff team; as part of ongoing training a number of staff have undertaken training in ‘safe handling of medication’. The Acting manager confirmed that only staff whom have undertaken this training will be involved in giving prescribed medication to residents; it was also confirmed that this is an area that is closely monitored by the Proprietors and the Acting manager, whom take responsibility for ordering and ‘checking in’ medication, undertake regular checks on medication kept and check that ‘Mar’ charts are appropriately completed when medication is given. Hand written entries on ‘Mar’ charts arew now countersigned and evidence was seen of this practice. Medication was seen to be stored securely. On touring the home and meeting with residents and staff it was observed that staff were very respectful in their manner to the residents and acknowledged their choice of activity they wished to be involved in; the focus on training has included NVQ training, incorporating as part of the curriculum choice, dignity and privacy issues. St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in an environment which is stimulating and friendly, where choice is respected. Relatives and friends are welcomed. Residents benefit from a choice of menu each day and a choice of where to have their meals. EVIDENCE: Organising activities within the home have been given much focus and are closely monitored by the management to ensure that a stimulating environment is created and residents have opportunities to engage in enjoyable and meaningful activities; during the visit staff were observed to be closely interacting with the residents; a ‘positive’, jovial atmosphere was noted, with staff encouraging and supporting residents in a variety of ways. Staff spoken to said they try and encourage the residents to have as much choice as possible in how they spend their time and activities they are involved in; it is acknowledged that at times residents may not always find it easy to St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 14 make choices unaided due to the limitations they experience with their dementia condition, however staff demonstrated a very caring and patient approach, encouraging and assisting individual residents. During the visit a relative was spoken to who said that he always felt welcome when visiting, with no restrictions on visiting times; he confirmed that he was kept well informed of his relative’s progress with contact being made to keep him informed of any situation/health needs that may affect their general wellbeing. He said that his relative was very well looked after and he praised the staff for their attentiveness and support given, which he commented made him ‘feel reassured’. Residents are offered a choice of menu at the home; a nutritional assessment is undertaken as part of care planning, so as to ensure a wholesome and appropriate diet is offered. Residents may choose to have meals in their own room if this is assessed as ‘safe’ for the individual resident; one resident spoken to, commented how she chooses to have some of her meals within her own room and at other times she likes to go to the dining room; this resident also said that regular drinks are served throughout the day and will be brought to her within her own room by staff. St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Procedures and policies covering ‘Adult Protection’ and ‘Complaints’ provides protection for residents. EVIDENCE: The management have produced a Complaints procedure, with information included within the Service User Guide given to each resident. There was no recent evidence of complaints having been received; it was advised that a separate record be kept of any complaint/concern received in the future, for easy reference of action taken and timescales. As part of ongoing training for staff Adult Protection has been included, with a number of staff now having received this training; however due to the recent employment of new staff members, management need to ensure that there is full understanding and implementation in practice of training received. St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,24, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in an environment which is comfortable and is kept to a good standard of cleanliness. Planned upgrading work is in progress to enhance the quality of the environment for residents. EVIDENCE: Since taking over ownership of the home, the Proprietors have commenced a programme of improvement works to the environment; redecoration has taken place in parts of the home, which includes corridor areas and residents bedroom. One resident spoken to said how pleased she was with her redecorated room and how staff had helped with placing her own pictures/paintings on the walls. This resident said she was very comfortable at the home and that staff had been very helpful in making her room very ‘homely’. A Maintenance member of staff is employed, specifically for St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 17 undertaking decorating/maintenance and gardening; this member of staff was spoken to during the visit and confirmed that the improvement programme to the interior of the home is to continue and that the Proprietors are committed to improving the physical environment for the residents. On touring the home, it was noted to be kept to a good standard of cleanliness; the residents bedrooms were seen to be personalised with items of their own adding an individual feel and communal areas were comfortable and ‘homely’. Residents were noted to be mainly using the communal areas of the home, however the more independent residents were seen accessing and using their own room. As noted there are gates and ‘keypads’ fitted to top and bottom of stairways; as discussed with the Acting manager it was advised to review the use of these gates, to risk assess the necessity of these in accordance with the right to move freely around the home and yet protecting the safety of the resident. St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28,29 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The residents are safeguarded by the home’s recruitment process and the skills mix and qualifications of staff. EVIDENCE: Since the last Inspection, there has been a commitment by management to employ a more permanent staff group and therefore lessen the need to engage agency staff to cover working shifts. As the Proprietors experienced some difficulty in local recruitment, the decision was taken to recruit from much further a-field; this decision has proved successful, with a compliment of staff now employed with various qualifications and the appropriate skill mix. Both new and more established staff have demonstrated a commitment to ongoing training and development; new staff undertake an in-depth Induction training programme, with mandatory training included in the early stages of employment, with regular updating for other staff as necessary. NVQ training is encouraged; six staff members are currently studying at Level 2, four staff members at level 3. The Acting Manager and one other member of staff have now completed studying at Level 3 and a further three members of staff have completed at Level 2. Evidence was gained also during the visit of staff having undertaken further training in a range of courses relating to general care practice. Advice is given on the need to ensure that St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 19 training received does directly relate to the category of resident cared for at the home and as such that Dementia training is monitored and updated as necessary. Evidence was seen of the home’s robust recruitment procedure in practice; a selection of staff files were viewed and these were noted to contain a completed application form, identity check, written reference responses and CRB/POVA check replies. Documentation involved in recruiting staff from overseas was noted to be in place, relating to the relevant members of staff. St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 & 38 Standard 35 not assessed – no personal finance kept. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Relatives views are encouraged through the relatives meeting that are held and the Quality Assurance questionnaire. Residents are safeguarded by being supported by staff who receive regular support and supervision. There is a need for a permanent manager to be appointed to ensure consistency, direction and strong leadership within the home. EVIDENCE: Since the recent resignation of the registered manager, the home is being jointly managed by the deputy manager in an ‘acting up’ position and the St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 21 Proprietors. The Acting manager has completed NVQ training at Level 3 and is now planning to continue studying at Level 4; she is being supported in this study by the Proprietors. During this visit evidence gained demonstrated that the home is being well managed with staff feeling supported in their daily contact with residents; the Acting manager has fostered an ;open door’ approach and this was seen in practice during the visit. The Acting manager undertakes regular one to one supervision with staff and evidence was seen of this practice. Information gathered prior to this visit from the Proprietors confirmed that they are satisfied with the current management arrangements as an interim to a permanent manager being appointed. The Acting manager has worked at the home for a number of years having gained promotion to her current position; she expressed how this has been a very good ‘learning curve’ for her in taking on this additional responsibility. However there is a need to recruit to the manager’s position as soon as is practicable, so as to ensure that there is consistency in leadership and strong identified day to day management for the staff team. A relatives meeting is held at regular intervals to ensure that the residents are represented; a relative spoken to during the visit said he found these meetings helpful and a way of sharing information and being able to express views. As part of the home’s Quality Assurance system a questionnaire is sent out with the invitation to the relatives meetings, asking for the relative’s views and experience of contact with the home. The Acting manager confirmed that responses to the questionnaire are collated and findings recorded, with decisions made on any necessary action that needs to be taken. As part of the ongoing training programme staff receive guidance and have undertaken training in Health and Safety and Fire Safety awareness. Evidence was seen of the recording of accidents and incidents within the written records kept for individual residents. The home does not currently keep personal finances on behalf of residents. It is acknowledged that much attention has been given to addressing the outstanding requirements from the last Inspection report and that management have focused very much on improvements to the environment and raising standards of care in general through training and guidance for staff; the resignation of the home’s registered manager has undoubtedly had some impact on timescales in achieving the level of care that is aimed for within the home; however the Proprietors have demonstrated commitment to improving the residents quality of life and it is envisaged with this commitment standards of care within the home will continue to improve. St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x x 3 x 3 St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 23 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. 2. Standard OP2 OP7 Regulation 5(1)(b) 13,15 Requirement The weekly Fees charged to be included within the home’s ‘terms and conditions’. Risk assessments need to be developed within care planning records so as to clearly identify daily support required. Timescale for action 31/07/06 31/07/06 3. OP18 13 4. OP31 8 The home must monitor staff’s understanding of Adult Protection guidance and training received. There is a need for a permanent manager to be appointed at the home. 31/07/06 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations DS0000064519.V297393.R01.S.doc Version 5.2 Page 24 St Claires Care Home 1. Standard OP19 The home needs to continue with the refurbishment/redecoration of the premises and implement a programme of maintenance to address these issues. It is advised that there is a review of the use of gates and keypads at stairways, balancing the residents right to movement around the home and their need for protection. 2 OP19 St Claires Care Home DS0000064519.V297393.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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. 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