CARE HOME ADULTS 18-65
St Laurence 33 Tower Road West St Leonards-on-sea East Sussex TN38 0RJ Lead Inspector
Jason Denny Unannounced 6 September 2005 12:35 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service St Laurence Address 33 Tower Road West St Leonards-on-sea East Sussex TN38 0RJ 01424 438262 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) Communitas Limited Miss Kelly-Jane Godden Care Home 7 Category(ies) of Learning disability (LD) 7 registration, with number of places St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Residents must be aged between eighteen (18) and sixty-five (65) years on admission 2. The maximum number of residents to be accommodated is seven (7) 3. Residents with a learning disability only to be accommodated Date of last inspection 4 May 2005 Brief Description of the Service: St Laurence is located in a residential area of St Leonards–on-Sea. The home is close to local transport and amenities. The seafront is within two miles of the home. The home is large detached property with spacious grounds. The garden has undergone redevelopment over the last year and is spacious and well equipped. The home currently provides services for four people with high dependency needs. The home is registered to provide services for seven people in line with its statement of purpose. All residents have a single bedroom some of which are double-sized, one bedroom not currently used is undersized. There is range of communal areas and sufficient bathroom and toilet facilities throughout. The home has its own mini-bus type vehicle. The Organisations day centre used by some residents for actitvities, and staff for training and interviews has closed with no plans for a replacement venue. St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an Unannounced routine inspection [second of two planned before April1st 2006], which took place between 12.35pm and 5.15pm. The Inspection found that of the 16 National Minimum Standards inspected, that 12 had been fully met and all others nearly met. One standard was exceeded in reaction to advocacy for residents. The inspector reviewed progress since the last inspection with the home manager. The focus of the inspection was again on seeing how the newest resident was settling in, along with looking at 2 other residents. The inspector spoke with 3 residents and looked at the care records for these residents. This discussion also covered the future plans for the home and staff training. The inspector toured all communal areas of the home along with bedrooms. Food stocks were examined. A record of complaints was inspected. In advance of the inspection the home organised for comment cards to be completed by all residents and their relatives. The inspector also spoke with some of these relatives during the visit along with staff. This report should be read in conjunction with the previous inspection report of May 04, 2005. What the service does well: What has improved since the last inspection?
The newest resident described as being unsettled in the last report was found to have settled down with clearer and improved guidance form the home. The formerly employed psychotherapist was described as playing a role in this
St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 6 improvement. Shortly after the last inspection another resident moved in but was promptly moved on when he became a major concern for the home. Activities and routines for all residents have improved with particular residents now better occupied and supported to develop further skills. This occurred despite the new Organisation closing their day centre. Medication changes for one resident have led to positive outcomes and more energy. The management of challenging situations is more effective. Although the quality of incident reports vary they are being promptly sent to the Commission. There have been further positive improvements to the environment with the conservatory now fit for use, new carpets on the ground floor, and continued decorating throughout the home. Bedrooms were found to be good for all residents. One visitor remarked that the home was now becoming “plush”. The manager stated that a number of staff were enrolled to shortly commence National Vocational qualifications in Care. The upkeep of the complaints file was found to have improved with a revised format. 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.
St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 8 Choice of Home
The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 2 The Home’s guide is not up to date and needs review to reflect the new owners and management of the organisation. Assessment information in relation to residents is of a good standard. Important information about a resident who had a difficult stay in the home was not known prior to the person moving in. The inspector was satisfied that the home had done everything possible to obtain a full amount of information including trial visits. The home acted quickly when it became clear that this person had needs they could not meet. Another resident was found to have now settled in, following the home making a range of changes to service provision including clearer boundaries. EVIDENCE: The inspector looked at the home’s guide, which also contains the statement of purpose. No mention was found of the new external management structure and the fact that the new owners and a management company took over the home from July 1, 2005. The rest of the guide was found to contain all other necessary information. The home was found to be acting in accordance with its own Statement of Purpose by ensuring that trial visits are undertaken by prospective new residents and that a full assessment is carried out involving all parties before a decision is made to offer a place in the home. The two most recently admitted residents [one of whom has left] was found to have full assessment information based on what was seen and gathered from social services along with their own assessment. Both were found to have
St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 9 visited the home before deciding to move in. The residents, staff, and records confirmed this. One of these residents was found to have mental health and alcohol related issues, which had not been disclosed by social services. Following a promising start the resident’s behaviour became unmanageable partly due to decisions taken about medication outside of the homes control. The home served emergency notice once the situation became dangerous. The home have since the last inspection liaised with a range of social services specialists in order to do a reassessment on another resident referred to in the last inspection report where concerns were expressed about his behaviour. By the time of the inspection the home had not confirmed the outcome of this reassessment to the Commission due to the person carrying out the report leaving the service. The inspector saw the 37-page re-assessment, which confirmed that the home was suitable following some changes. The resident confirmed to the inspector that he was now happy with the home and his records and staff comments confirmed this. His behavioural charts showed a marked decrease in challenging behaviours since the last inspection, along with other evidence showing greater cooperation. This improvement coincided with clearer boundaries and more activities. St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices
The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 & 7 Care-Plans were found to contain good information subject to regular review with all relevant people. Care-plans showed evidence of being put into action. The care-plans were found to be well organised. Staff showed a good understanding of guidelines. Residents benefit from an exceptional amount of independent advocacy, which operates effectively, and regularly, on their behalf. EVIDENCE: The Inspector examined 2 Care plans, which were found to be accessible, clear and frequently reviewed as shown in both plans, which had been reviewed in July, and the week of the inspection respectively. Both plans had a range of behavioural support and other, guidelines rewritten and revised within two months of the inspection. During the inspection a social services review was taking place in the home for a resident with him attending, along with his family and staff. Those who attended confirmed to the inspector that all but one of the annual goals had been achieved with further goals planned for the coming year. Relatives confirmed that they were pleased with how well things were going and that they hoped that the home would remain stable to continue this progress. A Computer course, communication board, and a musical instrument are being explored as part of the new goals for this person. The
St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 11 other resident was found to have had a full reassessment since the last inspection, which had assisted staff to improve how they supported this person along with providing clearer guidelines for the person. The resident and manager confirmed that improved reward systems and clearer guidelines and boundaries had helped the person to develop improved self-control as confirmed in records. All residents were found to have fortnightly visits form their designated external advocate. In addition two residents continue to benefit form weekly counselling sessions. Residents confirmed how the advocate was helping them apply for either jobs or college placements. St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 12 Lifestyle
The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 16 Meaningful Activities for all residents are now taking place with further work to develop educational opportunities. The development of more balanced range of activities is occurring with college course and work opportunities commencing along with regular leisure events. Two residents who were less active at the last inspection were found to have a fuller range of activity with plans to develop more. Structured routines for all residents were found to be in place. EVIDENCE: The weekly activity planners for two residents less occupied at the last inspection were found to show a range of activities. Both residents indicated that plans were being made to explore work opportunities. One resident confirmed that he was shortly to start a ceramics and pottery course. Both residents also had fuller routines, which included opportunities for life skills such as cooking and managing money. Records also showed a full amount of activity. One resident was found to be more motivated and active due to medication reductions. The only resident in the home during the first part of the inspection was due to having his review in the home. He was found to have a particularly active and full routine of activities with regular attendance at a day centre. Two other residents who used to visit the organisation’s day
St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 13 centre on a Friday before it closed, were found to have organised new activities on this day although they both were described as missing the day centre. These two residents were at aqua aerobics during the first half of the inspection. All residents were found to be supported to make choices about their activities and routines with support giving to them to achieve their goals. Two residents are training to enter further marathons. These two residents also choose their rewards, which occur following periods of cooperative behaviour. Staff were observed to be organised around residents routines with daily activity records showing what each person has done. St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support
The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 20 Medication arrangements were found to be soundly managed. The home regularly reviews medication with appropriate Specialists with positive outcomes. Staff are well trained in this area. EVIDENCE: The medication cabinet was examined along with all records. All aspects of storage and administration was found to meet the standard and best practice. All homely remedies were labelled and accounted for on recording sheets. Staff interviewed were found to be knowledgeable about all aspects of medication including what each drug is for. The inspector spoke to the staff person who has overall responsibility for medication who was found to be fully competent. All staff receive appropriate training before being assessed to be able to dispense medication. One resident has recently had his medication reviewed and reduced with positive effects as evidenced in greater motivation and energy levels. St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection
The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 The home has improved the level of detail and clarity in its complaint file in accordance with the standard and the home’s own policy and procedure. Staff were found to be aware of the homes complaints recording policy and procedure. The proactive, open, and sensitive way that the manager deals with concerns ensures that the rate of complaints is low. EVIDENCE: Two minor complaints made by a particular resident over the last year were previously found in the complaints file undated. The inspector has previously spoken to the resident concerned who confirmed that both issues were sorted. One of these concerns was withdrawn with the other concerning something outside the home in relation ton the unproven theory of there being Rats in a shed. Since the last inspection the home has improved the complaints recording file format. The format is now designed to record brief details of the complaint, planned action, full dates of each stage, details of any follow up, along with staff and resident signatures. No complaints or concerns have been expressed or recorded by the home since the last inspection. There have been no substantiated complaints made against the home since the present manager took over in July 2003. St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 16 Environment
The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,26,27 & 30 The home continues to explore ways of making the environment more homely and benefits from some ongoing investment. The rear garden is well maintained but not wheelchair accessible. The entrance area is the one area that is less impressive. The home has recently improved its cleaning practices. No obvious maintenance jobs were spotted with the overall home well maintained. Current Residents benefit from well-equipped and good-sized rooms. The home needs to thinks more carefully about accessibility for residents. EVIDENCE: The inspector toured all parts of the home apart from two locked bedrooms. The foyer entrance to the home was found to be clean on this inspection. The home has installed on the ground floor corridor and lounge, modern homely carpets. A New Conservatory now has a suitable floor and was found to be used with music centres, 8 seats and a television. The two lounges are large and well-equipped one had 4 leather sofas and was decorated and appointed in accordance with the needs of residents. The other lounge area was found to be in the process of redecoration with the stated possibility of becoming a bedroom as one of the unused bedrooms is undersized.
St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 17 All toilets were found to be in good order and were well-equipped including suitable drying facilities. One bathroom had a range of disabled adaptations All residents had lockable storage space in their rooms unless they expressly decline this. The home was found to be clean. One resident who chooses to assists with bathroom and toilet cleaning, now follows all infection control advice including the wearing of gloves. The kitchen door was found to be locked and had a handle only reachable by a tall person. The manager agreed to arrange to get the handle lowered as this was originally high due to a former resident who moved out of the home last year. The home is advised to review their system of locking the kitchen door to ensure that this measure is necessary and based on ongoing risk assessment. The manager stated that the new organisation Minster Pathways have given her permission to make further improvements to the environment. Visitors were impressed by the garden, which is due for further improvements to its landscaping, subject to resident’s views. The home is currently reviewing the staircase, which leads to the office areas and ways of improving natural light to the first floor. St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 18 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Staff training has been good over the last 2 years although there is current uncertainty about future plans. The number of staff with the basic NVQ is still too low. EVIDENCE: The new organisation are closing the training/Day centre and have yet to outline what their training plan is for the Communitas homes. What the budget is, who will co-ordinate this training and in what form it will take. Less than 50 of the full care staff team have at least National Vocational Qualification level 2. Although staff were unsure, the manager stated that a number of staff are due to start this course during the same month of this inspection. Staff have since the last inspection benefited from training organised by the psychotherapist who has since been relieved of his duties. This training was described as improving the overall service to residents. Staff spoken with indicated a range of basic training with the exception of NVQ’s, which had been delayed. All staff employed during the last 18 months have experienced 3 week Induction’ covering TOPSS, all mandatory training such as Moving and handling, food hygiene and First aid, and the foundational course level 2 in Care Practice, which leads to an NVQ 2. A basic introduction to the company’s philosophy of care is also included, leading to the in-house structured written induction found in each home. This type of induction where the staff person spends three weeks at the training centre before starting work
St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 19 in the home is not continuing as the centre has been closed by the new organisation. St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 20 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38,39 & 42 The lines of communication between the home and the new organisation who own and manage the home need to be clarified along with the lines of accountability and responsibility. The new organisation Minster Pathways needs to improve how it communicates with all stakeholders. The home is conducted in an open way with staff appreciating the support they receive from the manager. Quality assurance systems have improved with the Commission now receiving useful and timely monthly reports on the home by a competent person. The management of the home was again found to be competent and attentive. Reports of incidents in the home have been promptly reported since the last inspection although greater thought needs to be given to their quality. Health and safety areas were found to be in good order. EVIDENCE: Staffs interviewed were not sure how to contact the organisations new management if an issue arose that could not be resolved by their manager or area manager. The inspector could not find any evidence in the home to
St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 21 indicate the takeover of the Communitas group on July 1, 2005 with the organisation now managed by Minster Pathways. The inspector has spoken with the area/Operations manager who stated that areas of who will manage recruitment and training is still being finalised. Relatives of residents who at the home during the inspection were not aware of these changes, which occurred 2 months ago. The inspector observed residents and staff having open access to the manager. Section 26 monthly reports of inspections of the home by the organisation are now being sent to the Commission on a monthly basis within a week of the actual visit date. The reports are now more comprehensive and show what the quality of care is within the home with the area manager given the home clear direction. Some views of residents have been placed in the home’s guide The home has introduced a quality assurance system based on residents or their representative’s views. The manager ensured that all residents filled out the commissions comment cards along with relatives. All comments were positive especially about the care being provided Incidents involving residents at the home have since the last inspection been promptly reported to the Commission. The quality of some of these reports has been queried with the home manager who has identified training issues. The manager stated that she would attach her own comments to any report sent to the commission to safeguard their quality. The Inspector found all food correctly stored and labelled. The managers stated that all equipment in the home was within its servicing schedules. Risk assessments were found to be up to date and regularly reviewed. All current staff have the necessary health and safety training such as First Aid and safe Moving and Handling. St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x 3 x x Standard No 22 23
ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10
LIFESTYLES Score 3 4 x x x
Score Standard No 24 25 26 27 28 29 30
STAFFING Score 3 x 3 3 x x 3 Standard No 11 12 13 14 15 16 17 x 3 x x x 3 x Standard No 31 32 33 34 35 36 Score x x x x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21
St Laurence Score x x 3 x Standard No 37 38 39 40 41 42 43 Score x 2 3 x x 3 x H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 6 Requirement Timescale for action 06/11/05 2. 35.1,2 18[1][c] That the homes Service user guide/statement of purpose is reviewed in order to be updated to reflect the new ownership and management of the home. That the future purpose of the home is clarified along with the admittance policy. That a copy of an appropriate service user guide incorporating the statement of purpose is sent to the Commission within the timescale indicated. That the Registered provider 06/11/05 [new managing Organisation/owners] send the Commission their Staff training and development plan to show that it meets Sector Skills workforce training targets and ensures that staff fulfill the aims of the home and changing needs of service users. That this plan has a dedicated training budget and designated person with responsibility for the training and development programme. 3. St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 24 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 24 24 35 38 Good Practice Recommendations That the handle of the kitchen door is lowered so that it is reachable by service users [Residents]. That service user access to the kitchen area is reviewed to ensure that any restiction is subject to continous risk assessment. That at least 50 of Care staff are trained to National Vocational Qualification Level 2, or are working towards this by September 2005. The process of managing and running the home are open and transparent. That there are clear lines of management accountability from the home, through to the organisation who own and oversee St Laurence. St Laurence H59-H10 S21222 St Laurence V243378 060905 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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