Inspection on 21/04/08 for Stiperstones

This inspection was carried out on 21st April 2008.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 21 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Stiperstones 10/07/09

Stiperstones 15/04/09

Stiperstones 05/01/09

Stiperstones 23/10/08

Stiperstones 22/05/07

Stiperstones 10/01/06

Stiperstones 11/08/04

Stiperstones 26/04/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Stiperstone Stiperstone Clappers Lane Chobham Surrey GU24 8DD Lead Inspector Suzanne Magnier Unannounced Inspection 21st April 2008 10:00 Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stiperstone Address Stiperstone Clappers Lane Chobham Surrey GU24 8DD 01276 858440 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) Welmede Housing Association Ltd Mr Alistair Ian Ogilvy Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Within the category `LD` (learning disabilities), 1 (one) service user may be within the category `LD` and `PD` (learning disabilities/physical disability) The age/age range of the persons to be accommodated will be: 35-64 YEARS 22nd May 2007 Date of last inspection Brief Description of the Service: Stiperstones is a care home for eight adults with learning disabilities and provides personal care only. The property is located in Clappers Lane, Chobham, Surrey and accommodation is provided on two floors accessed by stairs. The home has eight single bedrooms and facilities include a kitchen, lounge, dining area, office, laundry, bathrooms and toilets. The property has a private drive and a large garden, which is secure and easily accessible. Private parking is available. The fees at the home are £1395.00 per week. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the care home was an unannounced ‘Key Inspection’. Some additional standards were assessed and have been included within the report. Ms S Magnier Regulation Inspector carried out the inspection and a senior care worker represented the service as the registered manager was on annual leave and the deputy manager on a day off. During the inspection it was difficult to know if the home had certain documentation as this could not be found during the inspection. As a result the commission spoke with the manager on the telephone to clarify that the home had the documentation and this was sent to the commission and has been included as evidence within the report. For the purpose of the report the individuals using the service are referred to as residents. The inspector arrived at the service at 10.00 and was in the home for seven hours. It was a thorough look at how well the home is doing. It took into account detailed information provided by the home and any information that CSCI has received about the service since the last inspection. The majority of residents living at the home have communication difficulties, so their responses were assessed by observing facial expressions, body language, listening and requesting staff to interpret the individuals own way of communicating and observing staff interactions. An easy read summary of the report has been made available to the service in order that residents and their representatives can be informed about the service using this alternative way of reporting. The Commission received responses to the Annual Quality Assurance Assesssment (AQAA) sent prior to the inspection promptly following the inspection as the registered manager was on annual leave. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. Documents sampled during the inspection included the homes Statement of Purpose and Service User Guide, care plans, person centred plans, daily Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 6 records and risk assessments, medication procedures, health and safety records, and several of the homes policies and procedures. No access to the staff training and recruitment records was possible as the files were not available. The commission have noted that two of the three requirements made during the inspection undertaken on the 22nd May 2007 have been complied with. One requirement that the quality assurance process be reviewed and updated to ensure that the views of residents and stakeholders are actively sought could not be assessed due to the absence of the managers and lack of evidence found in the home and thus has been assessed as not met. The commission have not received or been made aware of any notifications of complaints or safeguarding vulnerable adults referrals since the previous inspection. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. What the service does well: What has improved since the last inspection? What they could do better: A total of eighteen requirements and three good practice recommendations have been made as a result of this key inspection and can be viewed in detail at the end of this report. The home’s Statement of Purpose and Service User Guide must be updated. Copies must be made available to prospective individuals and residents living Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 7 in the home. Copies of both amended documents must be sent to CSCI local office. The commission has noted that there was no evidence available to support that formal reviews of the residents care plan/placement by the funding authority has been undertaken. The home must request a local authority review regarding any resident’s care and must ensure that the care plans for each resident are up to date to promote and make proper provision for the care, treatment and supervision of residents. The home must ensure that any activities in which a resident participates and any unnecessary risks to the health and welfare of residents must be identified and documented and so far as possible eliminated to ensure the safety of residents. The home must obtain written consent to use photographs of residents within any of the homes documentation in order to ensure that the resident’s rights to privacy and dignity is promoted and maintained. The home must ensure that each resident has an individual report book, which will report on the individual’s daily activities, their interactions, achievements and general demeanour throughout a 24- hour period in order to promote residents rights to individuality and confidentiality. It has been required that the home consult residents more fully about their social interests and make arrangements to enable residents to engage in local, social and community activities in a planned and consistent manner. The homes main oven must be repaired in order that residents can benefit from an oven cooked meal and the home is in compliance with providing sufficient and suitable kitchen equipment. Records of food provided by the home must be in suffcient detail to enable any person inspecting the record to determine whether the diet offered to residents is satisfactoey in relation to nutrition. Residents preferences regarding gender based care was not recorded in residents care plans and it is recommended that these preferences be clearly recorded when updating the care plans to promote residents rights to choice and dignity. The home must ensure that arrangements are in place, including training, for the safe administration of medicines and ensure that residents are protected from harm or abuse with regard to medication practices in the home. It has been recommended that the way in which individuals prefer to take their medicines for example with jam or tea are documented and that it is clear that covert use of medicines is an unacceptable practice. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 8 The home must make suitable arrangements, by training staff or by other measures to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. All parts of the home must be kept clean and reasonably decorated and free from hazards to resident’s safety whilst promoting the residents rights to privacy, dignity and having regard to their disability. The home must make arrangements to ensure that all staff receive training appropriate to the work they are to perform including a structured induction and ensure that at all times suitably qualified competent and experienced persons working at the care home in such numbers as are appropriate for the health and welfare of residents. The home must make arrangements and have available for inspection records of all persons employed at the care home as required in Schedule 2 & 4 of the Care Homes Regulations 2001 (as amended 2006). The Regulation 26 visits and protocols must be strengthened in order to promote improved management of the home and promote the best interests of the residents. All cleaning fluids/materials must be stored and kept securely in compliance with the control of substances hazardous to health (COSHH) guidance in order to ensure the health and safety of residents. The home must ensure that food must be stored in compliance with food safety regulations in order to protect residents from hazards to their health and wellbeing. It has been required that the home must forward to the CSCI an improvement plan detailing how the home intends to improve the services provided in the home to ensure the safety and well being of residents in their home. These requirements have a bearing on the safety of, and outcomes for, the residents who live at the home and the failure to comply with the regulations is an offence. 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. The summary of this inspection report can be made available in other formats on request. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4. People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Prospective residents and their representatives do not have accurate information about the home in order that they can make an informed choice about moving to the home. The homes admission and assessment procedures ensure that individual’s needs are appropriately identified and met and people can visit the home prior to residency. The home does not provide intermediate care. EVIDENCE: The homes Statement of Purpose could not initially be located by the senior care worker yet was found later in the day in the office by the inspector. The Statement of Purpose provided some evidence of the services and facilities offered to residents living in the home yet there was no indication when the document had been updated or was the final version. The Service User Guide was sampled and evidenced that the document was not accurate in informing prospective residents or their representatives about the current services provided by the home for example the document included outdated photographs of the home, referred to the National Care Standards Commission as the current contact address of the commission, did not reflect Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 11 the current fees of the home and contained a photograph of another Welmede Homes CSCI inspection report. It is required that the Statement of Purpose must detail the information in respect of the Care Homes Regulations 2001 Schedule 1 (as amended September 2006) and the Service User Guide must comply with the regulations as set out in Care Homes Regulations 2001 (as amended September 2006.) Following the inspection the manager advised the commission that the documents are being reviewed and Welmede have assigned a staff member to assist the home in redeveloping the documents to ensure that prospective individuals and their representatives have accurate information about the home and the services provided. The inspector noted that the home had an out of date copy of the Care Homes Regulations 2001 and did not have a copy of the updated Care Homes Regulations 2001 (as amended 2006). It is recommended that these be obtained in order to ensure that the home is compliant with the Regulations. Following the inspection the manager advised the commission that an order has been placed to purchase a copy of the updated Care Homes Regulations 2001 (as amended 2006). All the residents have been residing at the home for some years and their care needs assessments were developed whilst in the care of the previous care service provider. The inspector sampled three resident’ s files, which contained the initial assessment details for the resident moving into the home. There have been no admissions to the home since the previous inspection. Welmede have an admission and assessment policy and procedure, which was sampled by the inspector to ensure that all prospective residents have a care, needs assessment prior to admission to the home and to ensure that the home could be able to meet the individual’s needs. The senior care worker explained the procedure for prospective residents being admitted to the home which included visits and overnight stays and meeting the person in their own environment and getting to them prior to them moving to Stiperstones if that was their choice. The home does not offer intermediate care. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9, 10. People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The support and personal care needs that residents receive require further development within the care plans. Arrangements for resident’s care plan reviews needs to be better managed. The management of risk assessments needs to be improved to ensure the safety of residents in the home. Resident’s dignity and respect is not consistently promoted. EVIDENCE: The senior care worker explained that each resident has a care plan and the home have maintained a system whereby each resident has a member of staff allocated as their key worker. The inspector sampled three resident’ s documents related to their care plans and daily records. One care plan sampled was well documented and included up to date information about the resident and their lifestyle. Generally the sampling of the documents was complicated due to the records being kept in Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 13 different files or different sections of the files for example health care appointments were recorded within the progress charts and risk assessment documents were kept separately from the care plan to which they related. As a result each resident had a care plan, and a file, which contained other documentation and some health records. Following the inspection the manager advised the commission that he was aware of the lack of consistency in filing and had begun, before going on annual leave, a process of meeting with staff to clarify the reorganisation of the files in order that information could be made more accessible. Two residents had a person centred plan, which had been developed with the individual where able. The person centred plans were well documented and helped the reader to understand and get to know the individual and their life history, significant events in their life, their likes and dislikes, holiday memories, photographs, choices in their lives for example getting up, going to bed, some goals and aspirations, meaningful activities such as reassurance objects and people that are important to them in their lives. The home have incorporated photographs of residents within the person centred plans and the home have been advised that written consent must be obtained from the individuals or their representatives for the use of photographs of residents within any of the homes documentation in order to ensure that resident’s rights to privacy and dignity are promoted and maintained. The care plans sampled included a statement of the support by staff that the individual required for example getting into the bath, shaving, dressing and supervision at meal times. It was noted that there were no agreed working guidelines within any of the documentation that clearly informed the staff member how the resident liked or preferred to have staff support in a predicable and consistent way. There was little indication to describe the resident’s individualised personal care needs for example gender specfic care, how the individual liked to be spoken to, the level of their mobility and assistance needed with moving and handling and their sensory awareness. The person centred plan for one resident stated that he found it difficult getting in and out of the bath yet there was no written guidance on how staff supported the resident and no risk assessment was located to demonstrate that the hazard identified had been thoroughly assessed to ensure both the residents and staff safety. The care plans and other documents stated that residents were involved in daily living skills for example helping to lay the table, using the vacuum cleaner, getting the vegetables out of the kitchen cupboards, taking plates to the sink, helping the recycling programme, self help with washing and dressing, and tidying up the garden. The documents sampled did not include how the resident was achieving the goal or the stages at which the task had Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 14 been completed. For example the senior care worker described clearly how one resident was supervised by staff to wash his face yet the detail of how the resident achieved this daily living skill was not evident in any of the documentation and no progress and building upon this skill was documented. Whilst sampling another care plan it was observed that it was a copy of a care plan that had been developed in 2004 and was exactly the same in 2008. For example it was noted that one of the care plans stated that the resident enjoyed the new activity of horse riding in 2004 which had currently, according to staff, been stopped due to health and safety reasons at the local riding stables. The care plan also used medical terms describing the resident’s communication skills, which the senior support worker was not aware of what the terminology meant. It is acknowledged that residents living at the home were unable to sign their care plans due to their individual limited ability and this detail was only recorded on one of the three care plans sampled and should be recorded on each plan on behalf of the individual. It was noted that there was no evidence within some residents care plans that a formal review of their care plan/placement by the funding authority had been undertaken. This detail was discussed with the senior care worker who confirmed that the staff at the home undertook any care plan reviews rather than formal reviews held with outside agencies for example care managers or the local authority. The inspector sampled some documentation for one resident which indicated that an evaluation form dated 3/3/08 had been completed by the manager regarding the residents goals yet this detail had not been included into the current care plan. Another care plan indicated that the resident’s use of the toilet, dressing and personal activities had not been reviewed since February 2007. Due to the complexity of the documentation it was difficult to clearly ascertain if each resident has a regular review of their care plans in order to ensure that their changing needs are identified and met. It has been required that the home must request a local authority review regarding any resident’s care and must ensure that the care plans for each resident are up to date to promote and make proper provision for the care, treatment and supervision of residents. Following the inspection the manager has advised the commission on the telephone that Welmede are seeking to ensure that all residents have a local authority care management review. In addition that residents relatives, involved professionals or known advocates are invited to attend residents in house reviews. Four residents have strong links with relatives who try to attend, and if unable, will give apologies and forward comments (usually via phone) and where other professionals are involved in a residents care they will generally supply a report if they cannot attend. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 15 The manager advised that residents wishes, views, feelings, and needs are taken into account and residents are encouraged to be present at the in house care planning or review meetings. Due to some residents limited verbal communication the homes staff use photographs or objects of reference to assist individuals to understand and become involved in their care. The commission have been assured that the home holds residents meetings and copies of the meeting minutes were sent to the commission to confirm meetings are held and the use of photographs have been used to assist resident’s to choose their next holiday. Resident’s daily notes covering a twenty-four hour period are recorded using one book for all residents. It was noted that one member of staff had written ‘ as usual slapping his forehead and wandering around the kitchen area’ whilst another had written ‘sitting in the lounge playing with his toy’. The entries into the book did not reflect acknowledgement of the residents behaviour as a means of communication and the use of the word toy was considered disrespectful with regard to the age of the person it related to. It has been required that each resident has an individual report book which will report on the individual’s daily activities, their interactions, achievements and general demeanour throughout a 24- hour period. These changes will be considered as positive in promoting residents rights to individuality and confidentiality. During the inspection it was noted that there was a calm atmosphere throughout the home and individuals were observed to be comfortable moving freely around their home. Staff were observed to preserve and maintain residents dignity and privacy by knocking on their room doors prior to entry and supporting resident’s discreetly to the bathroom. Whilst sampling files the inspector noted that the home had completed some residents individual risk assessments, which documented hazards in residents daily living for example road safety, dangers in the home, falling, risk of choking, self injury and moving and handling. One care plan stated that hazards had been noted regarding the resident using a glass tumbler due to breaking the glass and inappropriate behaviour. No risk assessments could be located for these hazards. It has been required that any activities in which a resident participates and any unnecessary risks to the health and welfare of residents must be identified and documented and so far as possible eliminated. The risk assessments were as previously documented separate from the care plans and it has been suggested that when the care plans are reviewed the corresponding risk assessments are attached to the relevant care plan documentation in order that staff have a more complete understanding and availability of documentation regarding the assessment of hazards in residents lives. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Individuals are able to exercise some choice in the daily lives yet this needs to be better managed to support residents in taking part in consistent and planned social and recreational activities. Individuals are supported to maintain bonds with family and friends. Records regarding the homes menus and kitchen facilities must be improved in order that residents receive a healthy and balanced diet. EVIDENCE: Within the care plans it was evidenced that staff at intervals complete a progress chart describing the activities that a resident had participated in. Several of the progress charts were out of date and the senior carer advised that other records of activities would be documented in the daily record book. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 17 The daily record book detailed that residents had been out for a drive, in their garden, feeding the birds, had attended a disco and Bingo once a month, which one staff member voluntarily organises on their day off, going to the local Snoozelum, having an annual summer barbeque and visits to the local pub and restaurants. Two activity sheets were sampled and discussed with the senior care worker. The sheets detailed that on Mondays all residents do house hold recycling, Tuesdays any time of the day may go bowling, Wednesdays in the summer go out to local pub, Thursday Bingo Club (organised voluntarily by a staff member on their day off), Friday Swimming on a fortnightly basis due to staff shortages, Saturdays and Sunday in house activities or Rambling – weather permitting. The senior care worker advised that the activities chart was not up to date and on further sampling by the inspector it was ascertained that the activities which residents undertook depended on how many staff were on duty and if another resident had an appointment all activities for all residents would be cancelled due to lack of staff on duty to support the other residents. There was evidence in the resident’s bedrooms that leisure activities such as TV, listening to music and having objects of interest were available. One resident who had celebrated a recent birthday had greeting cards in their room from family and friends. The senior care worker advised that some residents have family members and friends who may visit the home and keep in contact. Some individuals have built up lasting friendships in the home and whilst sampling records and looking at individuals bedrooms the inspector noted that family and friends photos were in people’s bedrooms and in their person centred plans. The disco held for residents has also included residents meeting other peers with whom they lived with prior to moving to Stiperstones. The senior care worker stated that the staff felt this was important for residents to stay in touch with friends and also have the opportunity to meet new friends at the disco, which includes people using other professional resources. It was evident that the staff try to manage to offer residents opportunities for social engagement however whilst sampling the records it was evident that most residents require one to one or two to one support and the resources of the home for example one service vehicle and staffing ratios were insufficient in offering planned, consistent and predictable meaningful activities for the benefit of residents. It has been required that the home consult residents more fully about their social interests and make arrangements to enable residents to engage in local, social and community activities in a planned and consistent manner. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 18 The senior care worker advised that no individuals have shown an interest in participating in attending places of worship however the home have contact with the local vicar and staff would promote peoples spiritual and religious beliefs by providing support should an interest be shown. The pace of the day was unhurried and staff undertook individual’s daily routines in a quiet and professional manner. The inspector noted in records and also on the day of the inspection that individuals preferences for example getting up and going to bed, having snacks and getting up through the night were accommodated by staff to reinforce the individuals rights to making decisions and having choices. As previously documented where residents skills and abilities are recognised there was little or no recorded evidence found to support how the resident undertakes the task or how staff are supporting the resident to build upon the existing skill. During the course of the inspection the inspector did not observe meal times yet noted at breakfast that residents sat at a large dining table and two other residents sat at a smaller table. The large table did not have a covering over it and the setting of the table was bare of condiments. Resident’s clothes were protected from spillage using cloth protectors as required following the previous inspection that resident’s dignity be preserved and the use of plastic aprons be ceased. Staff were at hand to offer verbal support and supervision to residents during the meal time. The inspector sampled the homes menus which offered what was considered as a nutritious diet. It was found that the homes large oven had not been working for over a week and although the home had sought to have the repair rectified the oven was still not working. The staff advised that they had purchased cooked chickens at the weekend in order that the residents could have a roast dinner. A requirement has been made that the oven is repaired in order that residents can benefit from an oven cooked meal and the home is in compliance with providing sufficient and suitable kitchen equipment. The homes menu had not been updated to include the changes and it is required that records of food provided by the home must be in suffienct detail to enable any person inspecting the record to determine whether the diet offered to residents is satisfactory in relation to nutrition. The inspector observed that the home provides specialist crockery for example specialist cups to enable residents to manage their drinks independently. The homes fridges and freezers were well stocked with fresh fruit, vegetables, and dairy products. Requirements regarding the safe storage of food and chemicals have been documented in the last section of the report. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. People who use the service experience poor quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The resident’s physical, emotional and health care needs are not robustly monitored and met. Individual’s choice and dignity is not consistently promoted. Medication procedures do not ensure that medication is administered to all individuals in a safe and appropriate way. EVIDENCE: The homes system of recording health care appointments was found to be complex and after investigation it was found that documentation could be found in either the residents progress charts, the homes daily records or in the residents care plans. Records of health care appointments indicated that residents had attended medical appointments both inside and outside of the homes environment. Appointments included specialised health care professionals, general practitioners (GP), and access to chiropodists, opticians, district nurses, dentists, and other hospital specialists. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 20 The care plans contained monthly body weight charts and it was noticed that one resident’s body weight was last recorded in August 2007 and another in January 2008. There were no records found to indicate that residents had received support from the dietician or the reason for the resident body weight being measured. Several entries onto the progress reports advised that a continence referral assessment had been requested in November 2007 for one resident yet there was no indication if the resident had been assessed by the local continence advisor and if so what the outcome of the referral was. Another entry stated ‘foot care fine awaiting an appointment for check up’ yet there was no documented outcome if the resident had attended an appointment. The lack of clear documentation to evidence that resident’s health care needs were well maintained and managed was of concern and it has been required that the method of recording residents health care is more robustly managed in order to ensure that residents rights to health care are promoted. The home currently supports residents with personal care depending on the ability of each individual. The staff team consists of a multi racial mixed gender staff group yet the majority of the staff are male which supports gender based care. Residents preferences regarding gender based care was not recorded in residents care plans and it is recommended that these preferences be clearly recorded when updating the care plans. The inspector sampled the secured medication cupboard in the home. The cupboard was orderly, yet spillages had not been cleaned. The local Pharmacist supplies the home’s medication and the inspector was advised that the home is not currently supporting any residents with the administration of controlled medicines and no resident self medicates. The home’s records evidenced that the ordering, returns and stock taking of medicines were robust. During the sampling of the medication administration charts it was observed that there were no gaps in any of the medication administration sheets apart from one resident who had not received their midday medication during the inspection. The senior care worker acted promptly to refer to the Welmede medication policy and procedure and to alert the residents GP. It was brought to the senior care workers attention that his colleagues on shift had also not reminded the staff member of the time regarding the administration of the resident’s medication. The home were advised that a Regulation 37 notification must be received by the commission without delay regarding this occurrence. The medication folder had a documented list of staff signatures of staff that were deemed competent to administer medicines. Several staff members were no longer employed by the home so the list was not viewed as up to date. The file also contained a section of information, which included the resident’s Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 21 photograph, their general description, their GP, next of kin and known allergies. It was suggested that this information be placed with the resident’s medication chart for easy access and in order to assist staff when administering medication. There was no information to inform staff of what residents medication was for, the known side effects and one care plan dated February 2007 stating the residents medication did not match the current prescribed medication on the medication chart. Within the medication file were documented forms regarding the use of homely remedies. The forms detailed the medication, dosage and the purpose of the medication for example Paracetamol, Simple Linctus, Calamine Lotion, yet the forms had not been signed by the GP. Additionally there was no indication that there were clear guidelines for staff in the event of a resident requiring ‘as necessary medication’ (PRN) in order to ensure that as required medicines are administered in a manner which protects the resident from harm or abuse. The senior care worker confirmed that one resident preferred to take their medication with jam or tea yet this was not recorded on the documentation which included a photo of the resident and their known allergies. It has been recommended that the way in which individuals prefer to take their medicines for example with jam are documented and that it is clear that covert use of medicines is an unacceptable practice. Following the inspection the commission have received records of staff training details to confirm that staff last received medication training in 2005 and one staff member in 2004. It has been required that the home must ensure that arrangements, including training, are in place for the safe administration of medicines and ensure that residents are protected from harm or abuse with regard to medication practices in the home. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The complaints process and resident’s rights to protection from abuse by the homes policies and procedures need strengthening. EVIDENCE: During the inspection the Welmede complaints procedure was sampled which gave the reader information to people associated with the home how to make a complaint or raise a concern if they were dissatisfied. A pictorial complaints procedure was also sampled. The inspector requested to see the homes complaints record and was advised that this could not be located as the home had not received any complaints and it was unclear if any record of complaints received by the home were recorded. Following the inspection the commission were advised that the home had not received any complaints yet were advised that arrangements should be in place if the home receives a complaint, which clearly details the chronology of events for example the dates of the complaint, actions taken by the home, copies of correspondence with the complainant and the outcomes regarding complaints in order to ensure that there is appropriate evidence to support that peoples views, opinions and complaints are recognised and acted upon. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 23 It was evident that the majority of residents would not be able to tell of any dissatisfaction with the service provided, and would be reliant on staff recognising that they were unhappy. The senior care worker advised that staff and residents families would be aware of the residents’ ways of communicating and would understand any changes which may indicate the resident was not happy, such as changes in mood, behaviours and body language. The local authority multi agency procedures for safeguarding adults dated 2005 could not be located within the home and the senior care worker advised that as far as he was aware no safeguarding referrals had been received by the home. The inspector sampled that the home has a policy statement regarding reporting abuse which was noted to be in accordance with the local authorities multi agency procedures in order to safeguard people in their care. There were no records available to evidence that staff had undertaken safeguarding vulnerable adults training and of two staff spoken with one confirmed they had not received any training and one stated that they had had training last year. Following the inspection the commission were provided with training records which indicated that the majority of staff received safeguarding training in May 2007 yet two staff last received training in November 2005 one of whom was the senior care worker on duty during the inspection. It is required that the home must make suitable arrangements, by training staff or by other measures to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. People who use the service experience adequate quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The general décor of the home both in communal and in residents bedrooms could be improved to offer a more pleasing, safe and well-maintained homely environment. EVIDENCE: The general atmosphere in the home was calm and orderly during the inspection. During the tour of premises it was acknowledged that the home has a high incidence of wear and tear and the staff do their best to keep the home clean and tidy. The general decorative maintenance of the home was worn with some areas in the home having a dark and gloomy appearance for example the dining/lounge area and the upstairs hallways. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 25 The furnishings for example chairs and sofas in the communal areas and in some resident’s bedrooms were old and mis-matching and the inspector was advised that some of the chairs were over ten years old. As documented in the previous report following the last inspection several carpets in the home were soiled and despite a steam cleaning programme the carpets were worn and in need of replacement. One carpet on a downstairs bedroom was heavily stained and needs to either be steam cleaned or replaced. Following the previous inspection two residents have had laminated flooring provided in their rooms which was viewed as an improvement. Resident’s bedrooms were observed as spacious and one had been personalised with the individuals name on the door and the resident had also purchased matching bedroom furnishings and a new bed. The rooms were individualised and some contained individual’s own items of furniture, personal possessions, leisure items including televisions, radios, and books. Several rooms lacked framed pictures and the inspector was advised that this was the resident’s choice. In general the bedrooms were clean yet within the wardrobes it was observed that the residents clothes were either hanging up on hangers or strewn in the bottom of the wardrobe. The senior care worker advised that one resident in the home goes into other residents rooms and interferes with the residents clothing leaving clothes strewn at the bottom of the wardrobes. It was observed that the residents bedding in general was not matching for example the pillow cases did not match the duvet covers and vice versa. Some resident’s suitcases were stored on top of wardrobes and laundered clothes were left in piles for someone to put them away. Several rooms had old hospital beds and no effort had been made to make the furniture look less institutional for example with a valance. In one downstairs room by the bedroom door it was noticed that cable wiring had been left dangling and in several rooms residents curtains were not attached to the curtain rails. The homes bathrooms and toilets were clean, however the staff advised that residents are not aware of the importance of flushing the toilets after use and staff have to make time to go around the home to ensure that toilets have been flushed after use. One bathroom contained specialist equipment and specific aids to support people in their daily lives and records of safe bathing practices for example water temperature checks were well documented. The inspector observed that hand washing facilities were available throughout the home and risk assessments following the previous inspection regarding the use of liquid soap had been documented. The senior care worker advised that the home have to refer all repairs and maintenance concerns to the housing association and this is done on a regular Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 26 basis. It has been required that all parts of the home are kept clean and reasonably decorated and are free from hazards to residents safety whilst promoting the residents rights to privacy, dignity and have regard to their disability. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 27 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35. People who use the service experience poor quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. Staff in the home were not competent and in sufficient numbers to support the residents at all times. The home did not provide evidence of a robust system for the induction, training and development of staff in order to ensure the safety and protection of residents in the home. Recruitment practices were previously assessed as good. EVIDENCE: Negotiations between Welmede Housing Association and the Surrey Primary Health Care Trust have been ongoing for a length of time and the inspector was informed that all staff employment has been transferred from the Surrey Primary Health Care Trust to Welmede Housing Association. The inspector was advised that the home is currently supporting 8 residents and have some staff vacancies due to staff retirement and long term sickness. The staff team is stable with the majority of the staff having worked at the home for several years. The current staff, including bank staff are covering the Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 28 staff vacancies, sickness and annual leave in order to offer the residents stability and continuity of care. The home use the services of one agency to cover staff shortfalls. The commission were informed after the inspection that thorough profiles for agency staff are documented to ensure the safety and protection of residents. The inspector sampled the staff rotas and observed that there are usually four staff on duty at each shift with two waking night staff. The three staff on duty during the inspection were working 3 full days of thirteen hours and one was also undertaking night duty within the same week. The staff duties include providing resident’s with personal care, shopping, cooking, housekeeping and laundry, as well as assisting residents with social activities and transporting them to these using the homes vehicle. The home has assured the commission in writing that Welmede have prioritised recruitment for the home in order to meet the current staff shortage. Staff recruitment files were secured so these were not available to be inspected to ascertain robust recruitment practices however the previous inspection indicated that recruitment procedures for the home were found to be good. The staff advised that no new staff have been recruited since the last inspection. It has been required that the home must make arrangements and have available for inspection records of all persons employed at the care home as required in Schedule 2 & 4 of the Care Homes Regulations 2001 (as amended 2006). There were no accessible or available records in the home to confirm staff attendance of mandatory training and induction and these were requested following the inspection. It was noted that there were shortfalls in training, which the manager was aware of and no reference had been made of staff induction details. Staff competency due to the medication error of staff on duty during the inspection raised concern regarding their competency and numbers of staff available on the day of the inspection was considered insufficient to provide appropriate care and support to residents. It has been required that the home must make arrangements to ensure that all staff receive training appropriate to the work they are to perform including a structured induction and ensure that at all times suitably qualified competent and experienced persons working at the care home in such numbers as are appropriate for the health and welfare of residents. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 29 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. People who use the service experience poor quality outcomes in this area. This judgement has been made using a range of evidence including a visit to this service. The management and administration of the home is not robust. The home is run in the best interests of the residents yet their views and opinions and those of other associated with the home could be strengthened. Resident’s general safety and welfare is not promoted and improvements need to be made regarding some health and safety concerns in the home. EVIDENCE: As previously documented the manager was on annual leave on the day of the inspection and the deputy manager was on a day off. Following the inspection the commission were advised that there would not be the expectation that the deputy manager would be off duty at the same time as the registered manager and that the services manager should have been informed of the inspection. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 30 A requirement was made following the inspection of 22nd May 2007 that the quality assurance process in the home must be reviewed and updated to ensure that the views of residents and other stakeholders are actively sought. Following the inspection this was discussed with the manager who confirmed that through resident meetings, contact with residents relatives and friends and visitors to the home peoples views and opinions of the service were listened to and acted upon. The formal process of assuring quality for example documentation will be sampled at the next inspection. The inspector sampled some Regulation 26 notification reports, which were held in the service. Regarding the decorative maintenance of the home there were recorded outcomes of the observation that the décor was ‘a bit tired could do with brightening’ and the furniture was ‘ well worn ? when due for replacement leather type furnishing may be more practical.’ The inspector was informed that the Regulation 26 visits are generally announced and the home have been reminded that this regulation requires organisations that are not in day-to-day control of a service to appoint persons to make a monthly, unannounced visit to the home. It is the expectation that any shortfalls in the quality of the service would be noted by the organisation during the Regulation 26 visits, so that appropriate action could have been taken to rectify the shortfalls. It has been required that the Regulation 26 visits and protocols must be strengthened in order to promote improved management of the home and promote the best interests of the residents. It was noted that a cupboard in the kitchen, which contained cleaning fluids had been left unlocked and the key was sited in the lock. It has been required that all cleaning fluids/materials must be stored and kept securely in compliance with the control of substances hazardous to health (COSHH) guidance in order to ensure the health and safety of residents. Whilst sampling the homes fridge the inspector observed that a package of pate and salad condiments had not been stored in compliance with the current food safety regulations and a requirement has been made that the home must ensure that all food be stored in compliance with food safety regulations and consult with the environmental health officer in order to protect residents from hazards to their health and well-being. Records indicated that servicing of fire equipment had taken place and health and safety checks had been undertaken however it was noted that one residents bedroom door was not closing properly and a requirement has been made that the defective door is repaired without delay in order to safeguard the resident and others in the home in the event of a fire. The home have maintained records relating to water and food temperature checks to ensure residents safety and well being. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 31 The home has the required gas safety and electrical certificates available in the home and a current insurance indemnity certificate was displayed in the homes office. Records indicated that the home completes an accident and incident book which was sampled by the inspector. The inspector re affirmed the procedures that the home must report any incidences to the CSCI under Regulation 37 notifications of any event that affect the well being and welfare of residents in the home. As recorded throughout the report a large number of aspects of the home’s management are potentially putting the health, safety and welfare of residents and staff at risk. This includes the lack of a robust management of care plans and related documents pertaining to residents health and wellbeing, lack of adequate resources regarding residents rights to access meaningful activities and leisure, lack of staff training including safeguarding adults training and medication training, poor management of files and other records in the home, shortfalls in providing a homely and well decorated environment for residents and staff shortages. It has been required that the home must forward to the CSCI an improvement plan detailing how the home intends to improve the services provided in the home to ensure the safety and well being of residents in their home. These requirements have a bearing on the safety of, and outcomes for, the residents who live at the home and the failure to comply with the regulations is an offence. Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 32 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 1 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 1 33 X 34 3 35 1 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 2 X 2 1 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 X 2 X 2 X X 1 X Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 33 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA1 Regulation Schedule 1 1-18 5 (1) (a-f) (2)(2A)(ab) (3)(4) Requirement Timescale for action 21/06/08 2 YA6 3 YA9 4 YA10 The Statement of Purpose and service user Guide must detail the information in respect of the Care Homes Regulations 2001 (as amended September 2006). Both documents must be kept under review and the commission and service users notified of any revision within 28 days. 12.(1) (b) The home must request a local 21/08/08 (3) authority review regarding any resident’s care and must ensure that the care plans for each resident are up to date to promote and make proper provision for the care, treatment and supervision of residents. 13.(4)(b)(c) The home must ensure that 21/06/08 any activities in which a resident participates and any unnecessary risks to the health and welfare of residents must be identified and documented and so far as possible eliminated to ensure the safety of residents. 12 (4) (a) The home must obtain written 21/06/08 consent to use photographs of DS0000013802.V361045.R01.S.doc Version 5.2 Stiperstone Page 34 5 YA10 12.(4)(a) 6 YA12 YA14 16.(2)(m) 7 YA17 16.(2)(g) 8 YA17 Schedule 4 13. 9 YA20 13.2 13.(4c) 10 YA23 13.(6) residents within any of the homes documentation in order to ensure that the resident’s rights to privacy and dignity is promoted and maintained. The home must ensure that each resident has an individual report book, which will report on the individual’s daily activities, their interactions, achievements and general demeanour throughout a 24hour period in order to promote residents rights to individuality and confidentiality. The home must consult residents more fully about their social interests and make arrangements to enable residents to engage in local, social and community activities in a planned and consistent manner. The homes main oven must be repaired in order that residents can benefit from an oven cooked meal and the home is in compliance with providing sufficient and suitable kitchen equipment. Records of food provided by the home must be in suffienct detail to enable any person inspectiong the record to determine whether the diet offered to residents is satisfactoey in relation to nutrition. The home must ensure that arrangements, including training, are in place for the safe administration of medicines and ensure that residents are protected from harm or abuse with regard to medication practices in the home. The home must make suitable DS0000013802.V361045.R01.S.doc 21/06/08 21/06/08 21/05/08 21/06/08 21/07/08 21/07/08 Page 35 Stiperstone Version 5.2 11 YA30 YA24 23(2)(d) 13.(4)(a) 4.(a)(b) 12 YA35 18.(1c) (i)(ii) arrangements, by training staff or by other measures to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. All parts of the home must be 21/06/08 kept clean and reasonably decorated and free from hazards to resident’s safety whilst promoting the residents rights to privacy, dignity and having regard to their disability. The home must make 21/07/08 arrangements to ensure that all staff receive training appropriate to the work they are to perform including a structured induction and ensure that at all times suitably qualified competent and experienced persons working at the care home in such numbers as are appropriate for the health and welfare of residents. The home must make arrangements and have available for inspection records of all persons employed at the care home as required in Schedule 2 & 4 of the Care Homes Regulations 2001 (as amended 2006). The Regulation 26 visits and protocols must be strengthened in order to promote improved management of the home and promote the best interests of the residents. All cleaning fluids/materials must be stored and kept securely in compliance with the control of substances hazardous to health (COSHH) guidance in order to ensure the health and safety of residents. The home must ensure that all food must be stored in DS0000013802.V361045.R01.S.doc 13 YA32 YA35 17 & 19 Schedule 2&4 6 (a-g) 21/06/08 14 YA42 26 21/05/08 15 YA42 13.(4)(a) 21/05/08 16 YA42 13. (4 c ) 21/05/08 Stiperstone Version 5.2 Page 36 17 YA42 Schedule 4 .14 18 YA42 24 (A) compliance with food safety regulations and consult with the environmental health officer in order to protect residents from hazards to their health and well-being. The defective bedroom door 26/04/08 must be repaired without delay in order to safeguard the resident and others in the home in the event of a fire. An improvement plan must be 21/05/08 provided to the CSCI detailing how the home intends to improve the services provided in the home. 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 YA18 Good Practice Recommendations Residents preferences regarding gender based care was not recorded in residents care plans and it is recommended that these preferences be clearly recorded when updating the care plans to promote residents rights to choice and dignity. It has been recommended that the way in which individuals prefer to take their medicines for example with jam are documented and that it is clear that covert use of medicines is an unacceptable practice. 2 YA20 Stiperstone DS0000013802.V361045.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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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