Inspection on 08/06/06 for St Michael`s House

This inspection was carried out on 8th 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 Michael`s House 25/01/07

St Michael`s House 27/01/06

St Michael`s House 20/10/05

St Michael`s House 21/12/04

St Michael`s House 18/05/04

St Michael`s House 29/10/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE St Michael`s House Hewitt Street Chell Stoke on Trent Staffordshire ST6 6JX Lead Inspector Berwyn Babb Key Unannounced Inspection 8 June 2006 15:30 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 Michael`s House DS0000032516.V298822.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 Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Michael`s House Address Hewitt Street Chell Stoke on Trent Staffordshire ST6 6JX 01782 233435 F/P 01782 233436 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) Stoke on Trent City Council Mrs Lesley Kokai Care Home 44 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (44), Physical disability (5), Physical disability over 65 years of age (44) St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 5 Physical Disability (PD) - Minimum age 55 years on admission To include one named person under the age of 55 years on admission. Date of last inspection 27th January 2006 Brief Description of the Service: St Michael’s House, Chell is a purpose-built Local Authority managed home that is registered to accommodate 44 older people. The home was located within the residential area of Chell and was close to local community amenities and public transport. The home is owned by Stoke-on-Trent City Council and operated by Stoke-on-Trent Social Services Department. The home had the benefit of its own garden and patio area with distant views over the city. Pathways were appropriately ramped to provide ease of access and there was a car parking area to the front of the building. Accommodation is provided on two floors accessed by a shaft lift or staircases. There are 44 single bedrooms none of which had en-suite facilities. Eight of the beds were allocated for short-stay and rehabilitation/re-ablement where service users were admitted to promote independence in order that they may return to their own homes in the community and so avoid moving into residential care prematurely. Located on the ground floor of the home are a large lounge and a large dining room with a separate adjacent smoking room. There is a small lounge/kitchenette area for the specific use of the eight service users admitted for rehabilitation needs. On the first floor there is also a small lounge/dining/kitchenette room and a hairdressing and beauty salon. Resident’s bedrooms are located on both floors and there are four assisted bathrooms with toilets, a shower room and seven separate toilets conveniently sited around the home. St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the inspection for 2006/2007, which was carried out over the afternoon and early evening of Thursday, 8 June. The Inspector spoke with the care manager, members of her staff, some of the residents, toured the building, viewed a random selection of care plans, read through the medication administration record, did a formal interview with a member of staff, and observed the dynamic between residents and staff of the home during this afternoon. When the inspector arrived residents were sitting outside in the warm sunshine, they had been appropriately dressed with wide sun-hats to protect them and were being monitored by members of staff, who were giving them with plenty of cool drinks, and who, during the afternoon went out and got ice creams for them. They were observed not only to be meeting the residents’ needs, but also interacting with them in a friendly and supportive way. The current resident group was: Eight people in rehab, with one person waiting to come. Eight people in the intermediate care beds with one person in hospital. Ten permanent residents; making the total number in the home at the commencement of the inspection, 26. The inspector discussed with care manager the progress the requirements made by the fire officer, and these had been started, but the cross-corridor fire doors and fire-breaks still had to be fitted before the fire officer can come back and sign this work off. For this reason the home will attract requirements in this report, although all other areas assessed during the afternoon were of a satisfactory nature, and once the safety of residents can be assured should a fire occur, there is no reason why the improved status of this home should not be reflected in subsequent reports. What the service does well: St Michael’s Road Chell provides a variety of forms of care for frail elderly people in a setting that is regarded by the majority of residents as being part of their local community. St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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 Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 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 the following standard(s): 3&6 The judgement on the outcome for this group of residents was good, because the evidence showed that a proper assessment of their differing level of needs had been carried out prior to admission. EVIDENCE: Several people commented in the ‘Have your Say about’ questionnaires that were returned prior to this inspection that they had received sufficient information about the home prior to moving in, and one person had said “I received good information” and another person said “people told me about the home before I moved in.” In those care plans reviewed there were copies of full assessments that had been undertaken prior to admission, and these included input from the residents themselves, from their close family, and from relevant professionals concerned in their care. St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 Page 9 They also contained clear plans that had been made out for dealing with the needs of the resident, for each individual area where assessment showed they required help. Short term care for people leaving hospital was also provided in this home, and whilst this was in a specific area of the home with its own lounge and dining area; short stay residents were not precluded from mixing with other residents, and those who spoke with the inspector indicated not that they found this disturbing, but they very much enjoyed the variety it brought into their lives. St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 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 the following standard(s): 7, 8,9 & 10 The judgement that the outcome for this group of residents was good because discussion with them, and reference to care plans, and observation, showed that they received the personal care and support that they wanted, when they wanted it, and in the manner that they wanted it. EVIDENCE: During the afternoon the inspector was able to review several residents’ care plans, and these had been generated from a comprehensive assessment and detailed the action needed to assist the resident to overcome any problems identified. Care plans had been reviewed at appropriate intervals of at least once a month, and showed input by relevant others working in professions and visiting the home for advice and for support. All the personal information was contained on a sheet at the beginning of a file; this was followed by regular reviews of the day and night care, and a form outlining any specific choices that the resident had requested. St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 Page 11 Such things as a preference for a male or a female care were included, as were the choice or ability to manage their own medication, how or if they wanted to be monitored at night, their physical health needs, how much assistance was required by staff, details of communication that took place with their families and other contacts and some very clear detailed daily report cards which were both informative and appropriate. There were individual risk assessments on such things as; a resident’s choice to refuse having a flu jab, and another resident’s request to smoke in his bedroom. In one instance where a person wanted to have the light left on all night, an assessment re the safety of this, and whether this presented a risk to the resident, had been completed. A plan had been put in place to ensure that staff made more frequent visits to check this safety issues. Modules on health needs demonstrated where people had been assisted to keep regular appointments with such tertiary health care workers as dentists, chiropodists, and opticians. This was in addition to any appointments at hospitals, with GPs and clinics, of a regular nature, and of course, any emergent issues that required medical attention. Community nurses, GPs, and occupational therapists were attending the home as where necessary. There was appropriate staff training in continence care, the care of the elderly, moving and handling of residents, food and hygiene and infection control. The medication room was examined and records reviewed were all complete and tallied with the stock being held, and records showed that staff administering medication had received training in both the effects, and the undesired side effects. of the combination of medications administered to residents. Eye drops and other creams had been dated when first administered, so that they could be discarded one month after opening. The storage and returns procedures for medication, was assessed as being appropriate. During the afternoon personal care giving was taking place, with staff being sensitive to the privacy and dignity of the residents, when assisting them in these tasks. Each resident whose care plan was reviewed had a financial assessment completed, and where this was appropriate, Form HC2 had been completed so that residents could apply for help with any costs incurred in their healthcare. A payphone was placed in a quiet area for the use of residents, though in one of the rooms visited by the inspector the resident had her own phone installed in order to maintain contact regularly with her family. All bedrooms in this home are now for single occupation. St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14 & 15 The judgement for this group of residents is good because the daily life and social activities in the home met the requirements of those people residing there. EVIDENCE: One gentlemen spoken to had made a conscious choice which was recorded in his care plan that he did not want to partake in any form of activity, which at his advanced age of 90, he felt was inappropriate for him, and chose to spend his time in his own room watching his T. V., smoking his pipe. Appropriate risk assessments had been put in place to allow him to live this chosen lifestyle, and to monitor his mood, to ensure that they he didn’t become depressed, through being too withdrawn from company. For others who did choose to take part in the activities in the home, the services of two members of staff were dedicated to provision of in-house activities and arranging entertainment up to a maximum of eight hours per week. One of these members of staff said, “When both of us are working together, which we do every other week for a four hour period, then we are able to offer a choice of activities to residents, including taking individuals out shopping to purchase their own sundries, visits to the working man’s club and to sessions of indoor bowls.” St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 Page 13 To make this provision easier, one member has been insured to transport residents in her own car. Records and programmes showed that additionally in the home there was carpet bowls, armchair exercises, hand massaging, manicuring, grooming, quizzes, board games and 1:1 contact with the more dependent residents. The activities organiser said, “My biggest problem is fundraising, and because of the smallness of the home, we often link up with X [another elderly care home owned by Stoke on Trent City Council] to put on such things as day trips to Drayton Manor Park, London, Blackpool or Llandudno.” The care manager said; “ The majority of residents do not now manage their own affairs, mostly this is done by families, but I act as appointee for six residents and one further resident is subject to the services of a power of attorney.” A sample of menus provided in the provider data set showed a range of nutritious and appealing meals with flexible timings for breakfast between 8.30 and 10.00 A. M. Lunch being taken between 12.30 and 1.30 pm, and an evening meal between 4 and 5 pm, with a meal and biscuits, or a light snack was served between 7.30 and 8.30 pm. The inspector did not join residents for a meal on this occasion, but previous reports have indicated that sensitive assistance was given to residents who required it with kitchenette style facilities available to encourage them to maintain as much independence as they are able. The dining areas were well equipped with comfortable dining style armchairs, individual tables seating not more than five, adequate space to facilitate a wheelchair, and individual place settings at each table. The kitchens were not inspected on this occasion. Where it was appropriate, the care plans included details of special dietary considerations being met, whether these were for general health grounds of maintaining nutrition or reducing body mass, or for more particular health needs such as a liquefied diet, low sugar diet or because of vegetarian choice. St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 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 the following standard(s): 16 & 18 The judgement is that the outcome for service users was good based on the attitude and knowledge displayed by a member of staff questioned on these matters in a formal interview. EVIDENCE: A member of staff was engaged in a formal interview during which she was questioned about her knowledge concerning the protection of vulnerable adults. She was able to verify that she had been on the vulnerable adults training whilst employed in the home and pointed out that this was also included in the Level 2 of the national vocational qualification, which she had passed. She correctly identified that anybody could abuse a frail elderly person resident in St Michael’s House, and that the first thing apart from obvious signs such as bruising that might alert to her to that somebody was being abused, was a change in the known behaviour and demeanour of that resident. She correctly identified the chain of events that has to be initiated as soon as a member of staff has cause to suspect that abuse has taken place, and she was also able to detail sensible strategies in ensuring the immediate safety of that person. St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 Page 15 The City Council has a robust complaints procedure, and information on how to make a complaint was displayed in the home and also was included in the care plans seen by the inspector. Several comments were made in the questionnaires returned prior to the inspection, including one lady who said, “If I need to talk to someone I only have to go to the office and they are very welcoming and I can always talk to them”. St Michael`s House DS0000032516.V298822.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 & 26 The outcome for this group of service users has to remain poor until all outstanding work has been completed to comply with requirements recently made by the fire officer following his thorough assessment and review of the premises. However, this accepted, rooms and communal areas were very comfortably furnished, and individually personalised indicating a good outcome for residents in these areas. EVIDENCE: The Inspector undertook a tour of the internal environment of the home, visiting all communal areas and a selection of residents’ bedrooms. The inspector was very impressed with the degree of personalisation in some of the rooms that he visited, and also with the fact that some of the rooms are being taken out of use to turn them into en-suite, or activity orientated rooms, that reflect the changing nature of the care being provided in the home. St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 Page 17 The inspector was fully impressed of the homeliness of the bathrooms. These had been specifically decorated to overcome any feelings attendant upon the utilitarian nature of the space, or feelings that they might be too ‘clinical’. Colour schemes and furnishings had been creatively used to achieve this effect. As mentioned in the summary and elsewhere, much work is being undertaken to bring the home up to the modern specification of the fire officer, and therefore, much building work is taking place, together with attention decoration and refurbishment. Staff had obviously working very hard to restrict the disruption caused by this to the minimum, and to reduce any inconvenience to the residents. Within these parameters, the home was as clean and hygienic as it could be made, and no offensive odours were encountered at any point during this inspection. St Michael`s House DS0000032516.V298822.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 The judgement on the outcome for this group of residents is adequate, as the basic care needs of residents was seen to being met, with some hours being ring-fenced to promote daily life and activity. EVIDENCE: The staff rota shows that agency staff had been used to make up the numbers on 21 of the previous 168 shifts. There had been regular provision of two care staff watchful waking all night, four during the late afternoon and early evening, and six at the time of greatest need for resident to have assistance, from 8.00 am through to the post lunch period of 3.00 pm. The home continues to support ongoing training with two members of care staff planning to continue NVQ Level 2, the assistant manager - Level 3 and the domestic staff level 2 and vulnerable adults training, and currently all domestics and care staff have passed NVQ Level 1, moving and handling training which is reviewed yearly, food hygiene, infection control, care planning training and abuse training (vulnerable adults). St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 Page 19 Members of staff were observed to be sensitive to the needs of the residents in their care during the period of this inspection. The overall emphasis of the comments returned to CSCI before the inspection; was that staff were always there when they were needed, and the inspector spent a long time with the care manager discussing the two responses from residents, and one from a relative, that suggested there being too few care staff to attend to their needs in an appropriate and timely fashion. The care manager undertook to pursue this further, and to reinforce with staff the importance of clear communication with residents and their relatives. The number of agency staff having to be used to supplement the regular staff of the home is indicative of the problems being experienced by Stoke on Trent homes in recruiting, retaining, and motivating staff during this period of acute uncertainty about their future. This has not been helped by conflicting and sometimes misleading reports in the local paper, and the inspector learned that this was unsettling to residents as well as staff, when members of their family came in and told them that they had seen that the home was closing, in the local paper. St Michael`s House DS0000032516.V298822.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, 35 & 38 The judgement was that the immediate outcome for residents was poor, as the work out outlined by the Fire Officer to make the home safe for residents, was incomplete. EVIDENCE: The inspector was able to review some financial assessments that were made as part of the care plans that were examined during the afternoon. These showed where residents were not able to manage their own finances, steps had been taken to ensure that either social services, or relatives, or in one case the court of protection, had taken on that responsibility. St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 Page 21 The inspector was able to read minutes of recent residents’ meetings that had been facilitated by the activities organiser, and these show that a suitable variety of topics had been discussed, with much interest being shown in the possible destination of future outings. The care manager has all the necessary qualifications and experience to ensure that she is competent and fit to run the home. The general day-to-day servicing of equipment was documented in the records, and necessary business certificates were also seen. Unfortunately the total safety and welfare of residents cannot be adequately met, until the work outlined by the fire officer has been completed. St Michael`s House DS0000032516.V298822.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 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 3 X 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 3 X 3 X 3 X X 2 St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 Page 23 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 OP38 Regulation 23.4 Requirement The registered person shall ensure that all items and areas and identified by the fire officer as needing replacement, upgrading, new installation and any further work to ensure the protection of residents should fire break out are completed forthwith. Timescale for action 31/08/06 3 OP19 23.2 It has been agreed with the newly identified RI, Mr Alan Coe that this work will all be completed by the 31st of August. The registered person must 31/10/06 ensure that all decorative work is completed to a standard acceptable for the accommodation of elderly persons within the required timescale St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 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 Refer to Standard OP29 Good Practice Recommendations It is recommended that the registered person take all possible steps to ensure the recruitment of sufficient permanent staff to meet the needs of residents without having to resort agency staff who may be unfamiliar to them and thus cause them distress. St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 St Michael`s House DS0000032516.V298822.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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