Inspection on 06/06/06 for Stronvar

This inspection was carried out on 6th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Stronvar 25/04/07

Stronvar 11/10/05

Stronvar 29/11/04

Stronvar 07/07/04

Stronvar 04/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Stronvar Strangers Corner Church Road Brightlingsea Essex CO7 0QT Lead Inspector Lysette Butler Unannounced Inspection 6th June 2006 08:45 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 Stronvar DS0000017945.V299353.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. Stronvar DS0000017945.V299353.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Stronvar Address Strangers Corner Church Road Brightlingsea Essex CO7 0QT 01206 304007 01206 304007 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) Mr Edward Nigel Edwards Mrs Jacqueline Dixon Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Stronvar DS0000017945.V299353.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 16 persons) To provide day care for one named service user Date of last inspection 11th October 2005 Brief Description of the Service: Stronvar is a residential care home for 16 people over the age of 65 and is situated in a residential area of Brightlingsea in the county of Essex. The home is on bus routes both to the local amenities in Brightlingsea and to the town of Colchester. The home provides single accommodation throughout with 9 rooms offering en-suite facilities and the remainder of the rooms have hand-washing facilities. There are two lifts to the first floor, one being a stair lift. Communal areas include a large dining area and a comfortable lounge. Outside there is a well maintained garden. The home has parking facilities to the front of the property. Fees for this home are £410 per week for all residents. Stronvar DS0000017945.V299353.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection started on 1st April 2006. The inspection process included: a site visit on 6th June 2006, which lasted 6 hours; review of evidence supplied by the proprietor, residents, visitors to the service and the staff; resident, visitor, healthcare professionals and staff surveys; discussions with the registered manager, senior carers, care staff, ancillary staff, residents and relatives. During the site visit the premises were inspected, including inspection of the grounds. Samples of records and residents care plans were also reviewed. The home was clean and well maintained. The overall care and well being of the residents was the focus of the inspection. Staff and residents were welcoming and happy to speak to the inspector at the site visit. This inspection covered all twenty-three key standards and eleven of the remaining standards. The manager and her staff approached the inspection in a positive and cooperative manner that was focused on achieving best practice to meet the needs of the residents. What the service does well: What has improved since the last inspection? The manager has developed and is using a new detailed assessment package, which will ensure that appropriate residents are admitted to the home. Activities have increased in number and quality; residents expressed satisfaction with the changes and feel that they can now suggest other activities that they would like to take part in. The new social preadmission assessment helps the manager to plan forthcoming activities. All staff now attend statuary training and the manager is clear that this must continue on a regular basis. The manager was in the process of being registered with the Commission for Social Care Inspection at the time of this inspection. Medication procedures have improved and documentation is now complete. Stronvar DS0000017945.V299353.R01.S.doc Version 5.2 Page 6 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. Stronvar DS0000017945.V299353.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 Stronvar DS0000017945.V299353.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): 1, 2, 3 and 6 - Quality in this outcome area is adequate; this judgement has been made from evidence gathered both during and before the visit to this service. Pre-admission assessment is detailed and ensures that new residents are suitable for the home and mix well with current residents. However the statement of purpose and service users guide need updating so that everybody is clear what the service can and cannot offer to prospective residents. EVIDENCE: The statement of purpose & service users guide has not been updated since the new manager started. The manager is going to do this once she is confirmed as the registered manager. She also told the inspector that she has been concentrating on care & staffing issues as her first responsibility since she took up post. The manager has developed and is using new assessment documentation, which is very good and contains all the information she needs to make a valid judgement about the people’s suitability for the home. The documentation is in two booklets; one contains all the factual details and the physical problems Stronvar DS0000017945.V299353.R01.S.doc Version 5.2 Page 9 experienced by the prospective resident; the second one contains the social history/needs of the prospective resident. The manager is very clear about assessment requirements of the National Minimum Standards. Intermediate care is not offered at this home. Stronvar DS0000017945.V299353.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 - Quality in this outcome area is adequate; this judgement has been made from evidence gathered both during and before the visit to this service. The health and personal care of the residents in this home is very good and ensures that the residents are safe. However the documentation to back up the care is poor and needs improving. EVIDENCE: Observation of the staff with the residents demonstrated unhurried and pleasant attitude residents. Resident surveys all mentioned the kindness and helpfulness of the care staff. The atmosphere of the home was restful & pleasant. Care plans are still very poor and need significant improvement. Most residents still do not have recognisable care plans and if they do have plans, none are reviewed monthly. They do not contain appropriate risk assessments. Some of the staff are in need of care plan updating sessions to reinforce the importance of them. The manager is intending to rewrite the layout of the care plans to ensure that all the residents’ needs are included in the new format. The manager demonstrated a commitment and enthusiasm to get the change right Stronvar DS0000017945.V299353.R01.S.doc Version 5.2 Page 11 and make the documents user friendly. All residents’ personal files contained a form detailing the residents’, or their relatives’, wishes in the event of the resident’s deteriorating condition, or death. The district nurses take blood specimens and ring the results over to the home, giving them details of any changes to treatment needed and they carry out all dressings required. The staff all stated that the district nurses were helpful and friendly; none of the staff were worried about contacting any of the local district nurses or specialist nurses for help. During this visit the inspector spoke to a district health care assistant, who was currently attending to one of the residents and she felt that she was always treated with courtesy and respected. She understood that the staff were good at notifying the district nurses about problems promptly and appropriately. She stated that it was a beautiful home and nothing is to much trouble for the staff. Diabetic care was good and testing was carried out regularly as required. At the time of this visit there were no pressure sores at the home. A hairdresser attends the home on a weekly basis, she was complimentary about the way she is welcomed, accepted by the staff and residents alike. All MAR sheets were reviewed and were correct. There is no evidence of over prescribing or overstocking of medication throughout the home. Medication storage was good in the home. Overall the practices were good ensuring that residents are safely medicated. There were no residents self-medicating at the time of this visit. Stronvar DS0000017945.V299353.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 - Quality in this outcome area is good; this judgement has been made from evidence gathered both during and before the visit to this service. Resident activities have been greatly improved since the last inspection and community input to the home ensures that the residents have a happy full life in this home. Food offered is excellent and meets the nutritional needs of the residents. EVIDENCE: Activities had improved considerably and residents spoken to said that they were enjoying the outings and entertainments offered in the home. There is not a coordinator, but the manager arranges entertainment as part of her job and care staff carry out activities within there working hours. The activities are in groups and one to one situations. The various religious needs of the residents are met and residents expressed gratitude about the time taken to ensure that they were informed about different religious needs. There was a constant flow of visitors to the home during this visit. They were welcomed and looked after whilst on the premises, being offered food and drink as appropriate if they wanted it. The home is seen as part of the local community, being included in local activities and they invite the local population to the home on a regular basis. All residents are on the electoral Stronvar DS0000017945.V299353.R01.S.doc Version 5.2 Page 13 register. Twelve have postal votes and two regularly go to the polling station to vote. The inspector arrived during breakfast; it was obvious that residents could choose when and where they had breakfast. Residents spoken to said that they could have whatever they wanted for meals, the cook was very helpful, versatile and the food was excellent. None of the residents currently need help with feeding, although two residents had liquidised meals out of choice. They also chose to have all constituents of the meal liquidised together and not in separate components. The manager was advised to document this in the care plans, but she was very clear that usually everything would be liquidised separately. The cook went to speak to all the residents on a daily basis and took their orders for lunch and supper, although she does have a daily menu choice for the meals. All vegetables are grown in the grounds of the home by the proprietor, so they have a good variety of seasonal vegetables. Stronvar DS0000017945.V299353.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 - Quality in this outcome area is good; this judgement has been made from evidence gathered both during and before the visit to this service. The residents in this home are protected by the policies & procedures the service operates, being followed at all times by the staff. EVIDENCE: There have been no complaints made to the home or the Commission for Social Care Inspection since the last inspection. Visitors spoken to felt that they could speak to the manager if they had any concerns. All staff had attended Protection of Vulnerable Adults training and those spoken to demonstrated a good understanding of the basics. There have been no Protection of Vulnerable Adults allegations since the last inspection. Stronvar DS0000017945.V299353.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26 - Quality in this outcome area is good; this judgement has been made from evidence gathered both during and before the visit to this service. The environment in this home is clean, tidy and safe for the residents. EVIDENCE: There has been no change to the fabric of the building since the last inspection. The whole home was toured during this visit, as the inspector had not been to the home before. The home was clean and tidy throughout with no unpleasant odours. The decoration throughout is pleasant and homely. There are nine rooms ensuite and seven with washing facilities. All rooms look out over the grounds and the gardens are well tended. On the day of the site visit many of the residents were sitting in their rooms, or in the lounge enjoying the wildlife that visit the grounds. The vegetable patch (see NMS 12-15) is at the bottom of the grounds and is tended by the proprietor. The proprietor also undertakes all necessary maintenance around the home and garden. The residents were chatty and all said they liked the home and felt at home in it. The radio was playing in the background with appropriate music choices. All toilets and bathrooms were clean and tidy. There is a stair lift and lift in the home, which had both been serviced in February 2006. Stronvar DS0000017945.V299353.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 - Quality in this outcome area is good; this judgement has been made from evidence gathered both during and before the visit to this service. Staffing numbers and training ensures that the residents in this home are looked after safely and appropriately. EVIDENCE: Staffing levels during the day remain the same, and were adequate for the level of dependency in the home at the time of the site visit. There is usually one night carer awake and one sleep-in night carer on duty every night. If there is a resident who needs two people to lift them a second sleep-in carer is on duty. At the time of this site visit no resident needed the help of two carers for any activity of daily living. The manager her deputy and the proprietor all live within five minutes of the home and on call in rotation, if there are any problems. The manager reviews the situation on a daily basis to ensure that safe levels of care are being offered at all times. Five of the care staff had National Vocational Qualifications at level 2 or above, which equates to 30 of the care staff. The manager was awaiting training and funding information from two different firms then she will allocate all care staff to appropriate courses. There is a key worker system in the home and residents knew who to speak to. Recruitment procedures were poor, however some of the deficiencies was because it had not been properly explained to her. Seven staff did not have Stronvar DS0000017945.V299353.R01.S.doc Version 5.2 Page 17 Criminal Records Bureau declarations and three were working based on Criminal Records Bureau declarations from other employers. The inspector explained the managers’ responsibilities in detail and the manager was going to rectify the matters immediately following the site visit. All new staff started following a PoVA first check. All personnel files needed tidying and sorting out. Many entries were not appropriately dated or signed. The files of long term members of staff contained updated contracts. Training records were good and contained within the personnel files. All staff had undertaken abuse, manual handling and fire training. At the time of the site visit three care staff had undertaken infection control training and four care staff were starting the course the following day. Stronvar DS0000017945.V299353.R01.S.doc Version 5.2 Page 18 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, 32, 33, 34, 35, 36, 37 & 38 - Quality in this outcome area is good; this judgement has been made from evidence gathered both during and before the visit to this service. Management and administration of this service is good, but quality assurance procedures are not continuing to change and improve the service for the better. EVIDENCE: The manager was in the process of being registered with the Commission for Social Care Inspection at the time of this inspection. She demonstrated a good understanding of the role and enthusiasm to take the service forward. The manager works as part of the staff team on the floor on 3-4 occasions each week, however she only works on the floor between 7 and 10 am then does office work between 10am and 1pm on these duties. Other care staff spoken to said this worked well with the workload and that she was available if needed. The manager’s further management education was discussed at length. She is Stronvar DS0000017945.V299353.R01.S.doc Version 5.2 Page 19 planning to attend a course, rather than undertaking a correspondence course, as she feels she needs the networking and stimulation of other managers. The home had a relaxed and friendly atmosphere. Visitors were observed coming & going throughout the site visit. Residents and their visitors were very happy with the home. All survey forms received following the site visit from residents were very complementary about the home and the staff. A quality assurance plan had not been undertaken and the manager knew that it needed to be done. She had good understanding of what was needed and would send a copy of the plan to the local office of the Commission for Social Care Inspection when she had completed it. Resident meetings were carried out about every three months and minutes are written, to be distributed to residents, relatives and staff who were unable to attend. Staff meetings were being carried out every six months but the manager was planning to change this to monthly, to enable her to discuss changes on a more regular basis. The previous manager had last sent out resident questionnaires over a year ago. She was going to look at the layout of the questionnaire and resend it soon, then send an evaluation of the results to the local office of the Commission for Social Care Inspection when complete. Insurances and certificates were reviewed and were at appropriate levels for the services needs. There did not appear to be any financial difficulties at the home and staff had access to all equipment needed for the care of the residents. The manager was aware of the need for all policies and procedures to be reviewed and rewritten as appropriate. Only three residents have money kept on the premises in the keeping of the home. All three accounts were checked and were correct. A separate notebook is used for each resident detailing all activity in and out of the money kept. Invoices and bills are kept individually with each notebook. The manager has started supervision with the senior care staff and was in the process of arranging sessions with the care staff at the time of the site visit. The manager was aware of the benefits of supervision and what she wished to achieve with the staff. However some staff felt that she was generally supportive and that they could talk to her at anytime so were not convinced that there needed to be a specific session set aside. All servicing and amenity certificates were up-to-date and appropriate for this service. CoSHH risk assessments were up-to-date and good. Basic fire escape risk assessments had been carried out since the last inspection, but the manager still needed to carry one out on the balcony and fire escape that is outside the room of one of the upstairs residents. Stronvar DS0000017945.V299353.R01.S.doc Version 5.2 Page 20 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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 3 3 2 2 2 Stronvar DS0000017945.V299353.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The registered manager must ensure that the statement of purpose must be current and contain all required information. The registered manager must ensure that the service users guide and residents terms & conditions must be current and contain all required information. The registered person must ensure that care plans are detailed and address all the identified needs of individual residents. (Timescale of 5/01/06 not met.) The registered person must ensure that all resident care plans are regularly reviewed. (This would normally be on a monthly basis.) The registered person must ensure that staff undertake NVQ training to ensure resident needs are met. (Timescale of 05/01/06 not met.) The registered person must ensure that all staff have current Criminal Records Bureau declarations obtained by this DS0000017945.V299353.R01.S.doc Timescale for action 31/08/06 2. OP2 4 31/08/06 3. OP7 15, 13 (4b-c), Schedule 3(1b) 15(2b-c), Schedule 3(1b) 18(1), Schedule 2(4) 19(4c), Schedule 2(7-8) 30/09/06 4. OP7 31/08/06 5. OP28 31/12/06 6. OP29 31/08/06 Stronvar Version 5.2 Page 22 7. OP29 18(4) 8. OP33 24(1-3) 9. OP36 18(2) 10. OP37 17(1-3) 11. OP38 12 service. The registered manager must not allow new staff to work unsupervised until Criminal Records Bureau declarations have been received. The registered manager must complete a quality assurance plan for the improvement of the service. The registered manager must ensure that all staff has regular supervision. (NB: See also recommendation 8 below) The registered manager must regularly review all policies & procedures. (NB: See also recommendation 9 below) The registered person must ensure that risk assessments are carried out throughout the home. 30/06/06 31/08/06 30/09/06 31/08/06 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard OP7 OP7 OP9 OP27 OP28 Good Practice Recommendations The registered manager should make sure that all staff understand and use resident care plans to direct their care. The registered manager should make sure that all individual risk assessments are contained in the care plans and reviewed regularly. The registered manager should keep a current list of the signatures of those care staff who administer medication. The registered person must ensure that night staff levels are regularly reviewed to meet the needs of the current resident group. The registered person should enable care staff to undertake National Vocational Qualification training so that 50 of care staff are trained to level 2 or above. DS0000017945.V299353.R01.S.doc Version 5.2 Page 23 Stronvar 6. 7. 8. 9. OP29 OP29 OP36 OP37 The registered manager should sort and tidy all personnel files. The registered person should review the staff application form. The manager should ensure that each member of staff has supervision on a minimum of six occasions a year. The manager should ensure that policies & procedures are reviewed at least yearly. Stronvar DS0000017945.V299353.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Stronvar DS0000017945.V299353.R01.S.doc Version 5.2 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!