CARE HOMES FOR OLDER PEOPLE
Sunbury Lodge 1 Sunbury Street Woolwich London SE18 5NA Lead Inspector
Maria Kinson Unannounced Inspection 29th December 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sunbury Lodge DS0000006861.V316533.R02.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. Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Sunbury Lodge Address 1 Sunbury Street Woolwich London SE18 5NA 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) 020 8854 8254 020 8855 7511 www.kcht.org Kent Community Housing Trust Ms Mary O`Connor Care Home 47 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (10), Old age, not falling within any of places other category (47) Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The 10 places for Mental Disorder can be used for the provision of people with mental disorder from the age of 60 upwards. 20th December 2005 Date of last inspection Brief Description of the Service: Sunbury Lodge is a former purpose built local authority home. Accommodation is provided on two floors and built around an enclosed garden. The home is located in a quiet residential road opposite a park. It is within walking distance of Woolwich town centre and bus routes. Kent Community Housing Trust is the Registered Provider for the home. The home is registered to provide care and accommodation for 47 older people. 10 beds can be used for older people with a mental disorder. The fees charged by the home range from £414.71- £430.81 per week. This does not include additional charges such as hairdressing, toiletries, newspapers and magazines, and holidays. This information was supplied to the commission on the 21/11/06. Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place on 29th December 2006 and the 30th January 2007. The second part of the inspection was delayed due to an outbreak of a winter vomiting disease in the home. On day one of the inspection all of the communal areas and a selection of bedrooms were viewed. The inspector examined care and medication records, observed staff interacting with residents and handing information over to the staff on the evening shift. Feedback was obtained during the inspection from six residents, five members of staff, and one visitor. Comment cards were sent to residents, relatives, and health care professionals. Seven cards were returned to the commission from relatives, six from residents, and three from health care professionals. What the service does well:
The atmosphere in the home was relaxed and welcoming. Residents and relatives were satisfied with the care provided and said staff were helpful” and that “nothing is too much trouble”. Staff assessed resident’s needs before agreeing that the resident could move into the home. Residents were encouraged to arrange their rooms as they wished and bring their own furniture and belongings with them into the home. Staff respected resident’s views and promoted choice and independence. Residents said they received their medication regularly and the records maintained in the home supported this. Staff had established good working relationships with other professionals and reported changes in resident’s physical or mental health promptly. Residents said they always received good medical care. Activities and outings were provided and staff spent time talking with residents. Visiting times were flexible and relatives said they were kept informed about important matters and changes in their relative’s condition. Residents said the food provided in the home was good and confirmed that they were able to choose from the menu or request an alternative dish if they did not like the choices listed. Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 6 New staff were assessed and vetted to ensure that they were suitable for the role and did not pose a risk to residents. Staff received adult protection training and were aware of the procedure that they should follow if they witnessed or were told about an allegation of abuse. There were good training opportunities for staff Staff had a great deal of respect for the manager who they said was very approachable and “an excellent role model”. The manager had a good understanding of what was happening in the home and made herself available to residents and relatives. There were good systems in place to safeguard resident’s money and valuables. Complaints and concerns were taken seriously and addressed promptly. Equipment was serviced regularly and regular checks were carried out to identify health and safety issues. The care and services provided in the home were reviewed regularly to identify problem areas and improve the quality of care. Residents and relatives views and experiences were considered as part of this process. What has improved since the last inspection? What they could do better:
Staff should ensure that instructions for medicines that are discontinued or changed are crossed through, dated and signed. Homely remedy medicines should be checked regularly to ensure that staff are maintaining adequate records. If residents require support to take their insulin there must be an individual plan of care that states which members of staff can assist the resident and what assistance staff will provide.
Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 7 The home was clean, tidy and well maintained but some areas looked a little dull and were less welcoming. The home was using temporary staff regularly. This is likely to affect continuity of care and place additional pressure on the permanent staff. The risk of falls from windows should be assessed to see if any additional checks are required to maintain residents safety. 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. Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 (standard 6 does not apply to this home). Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Before moving into the home, a care needs assessment was carried out. This helped the manager to decide if the prospective residents needs could be met in the home. Residents received a written contract. The contact provided information about fees and stated who was responsible for payment. EVIDENCE: The company had recently introduced a new Assessor Coordinator post. The employee was responsible for assessing prospective resident’s needs and advising the manager of the service if they thought the resident’s needs could be met in the home. The manager was still responsible for assessing residents with a mental health disorder.
Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 10 All of the files seen included a copy of the multi-agency assessment and a care needs assessment undertaken by a member of staff or the assessment coordinator. On admission to the home residents were given a contract to read, agree and sign. The contract outlined information about the terms and conditions of occupancy, what the fee included, and the period of notice. Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans reflected resident’s needs but did not always include information about the action that staff should take to support residents to take their own medication. Staff worked in partnership with other professionals to meet resident’s health care needs. Good systems were in place to ensure that medication was handled and stored in a safe manner. Residents said staff were kind and caring and respected their privacy. EVIDENCE: The care records for three residents that were recently admitted to the home were examined. Resident’s strengths and needs were recorded and some plans were personalised to include specific information about residents preferred routines, likes and dislikes. Plans stated what activities the resident enjoyed, the type of activities they did not wish to take part in, what they liked
Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 12 to drink and how they liked the drink prepared. Short-term plans were developed to address issues such as an acute illness that was unlikely to form a regular part of the care required by the resident. Care plans were reviewed regularly and were usually agreed and signed by relatives or the care manager. Staff assessed residents moving and handling needs and recorded information about how the resident should be supported and what equipment was required. A GP visited the home regularly to assess and review residents that were unwell or had ongoing medical conditions. Staff also received support from the local district nursing team and community psychiatric nurses. Health and social care professionals that visited the home said that staff had a clear understanding of residents needs and informed them about “signs of relapse and significant events”. All of the respondents were satisfied with the overall standard of care provided in the home. A record was maintained in the residents file about visits from other professionals. Residents said they always received appropriate medical attention when they were unwell. The handover of information from morning to evening staff was observed. Information was provided about each resident and the oncoming shift were advised about significant events such as falls or residents that were unwell. Staff were allocated specific jobs and were asked to encourage certain residents to drink. The management of medication was good overall. Four medication charts were examined. Records of receipt, administration and disposal of unwanted medication were satisfactory. One resident was prescribed a medicine that was adjusted according to blood test results. This resulted in frequent dosage changes. To avoid confusion and reduce the risk of errors staff should ensure that old instructions are crossed through, initialled and dated. District nursing staff had pre filled some syringes for residents to self-administer at a later date. Pre filled syringes were stored and labelled correctly. Some staff had received training and were assessed by district nursing staff as competent to support residents to take their own insulin. Information about the extent of support provided and the circumstances for assisting residents should be recorded in the residents care plan. See requirement 1. Controlled drugs were stored securely and appropriate records were maintained. The supply of paracetemol in the homely remedy supply was incorrect. Regular checks should be carried out to identify errors. See recommendation 1. Staff maintained resident’s privacy and dignity when undertaking personal care. Residents were encouraged to manage their own care where possible and make decisions about how and where they spent their time in the home.
Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A flexible programme of activities was provided for those residents that wanted to take part. Relatives said they could visit the home at any time and were welcomed by staff. Staff supported residents to make personal decisions and choices. The quality and choice of food provided in the home was good. EVIDENCE: The activity co-ordinator was responsible for arranging a regular programme of activities, outings and social events. The activity programme was displayed in the activity room but the inspector was told that activities took place in all of the lounges. On the week of the inspection residents were encouraged to play darts and bingo, take short walks and undertake light exercises and take part in craft activities and reminiscence sessions. Some residents said they had enjoyed the Christmas entertainment and visits from local school children. Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 14 The company had recently introduced a new scheme to ensure that residents had access to suitable transport and were able to go out regularly. The ‘Bright Days’ bus visits the home once or twice a month. The scheme includes a driver and escort who support residents during the trip. In recent months some residents had visited local parks, restaurants and enjoyed pub lunches. This initiative is commended. Staff and residents had made a Victorian Christmas snow scene display near the entrance to the home. Residents knitted the scarves worn by the figures and the boots were borrowed from the local fire station. The display won first place and a cash prize in a competition. Relatives were satisfied with the visiting arrangements and said they were made to feel welcome. All of the relatives that returned comment cards to the commission or spoke with the inspector were satisfied with the care provided in the home. Relatives said they were kept informed about important matters and were consulted about their family members care. Relatives said their relative was “well looked after,” “staff help to keep my family members dignity intact”; “I am very happy with the care” my family member receives. Some residents looked shocked when they were asked if they were able to decide what they did each day and how they spent their time. “I can do what I want, within reason. If I want to go to bed I can, of course I can”. One resident said, “I stay in my room and sleep in my chair, through choice, staff turned the heating off because I said I didn’t like it.” Lunch was served in the main dining room. Residents were assisted to sit at their preferred table and support or encouragement was provided. The tables were nicely laid out with flowers, condiments, and juice. Food was well presented and looked appetising. Residents said, “the food is fine and there is plenty of choice”. Residents were able to choose what they ate from the menu and some residents had requested an alternative dish such as egg and chips. Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints were investigated and addressed in an open and transparent manner. Staff had access to safeguarding adults training and knew they should report allegations to senior staff. EVIDENCE: There was a supply of “Tell us what you think” cards in the reception area. The cards could be completed by anyone that lived, worked, or visited the home to provide feedback about the service. The home had received three complaints during the past year. All of the complaints received in the home were from one resident and concerned the behaviour of other residents and the arrangements at meal times. All of the concerns were thoroughly investigated and various solutions were discussed with the resident. The home had received a number of thank you cards and letters. The commission had not received any concerns or complaints about this service in the period since the last inspection. 57 of relatives said they were not aware of the homes complaints procedure. One relative said that she had not been told about the procedure but was
Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 16 “confident a procedure would be provided if requested”. Staff should consider displaying a copy of the procedure in a prominent position in the home. Most residents said they knew who to speak to if they had any concerns about the service or wanted to make a complaint. Some members of staff had recently attended adult protection and managing challenging behaviour training. Staff said they would report concerns or allegations to senior staff and felt confident the issue would be properly investigated. Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents liked their rooms and said the home was always fresh and clean. EVIDENCE: The home and grounds were clean and tidy and were maintained to a satisfactory standard. A full time maintenance technician was responsible for undertaking minor repairs, some internal re-decoration and carrying out regular health and safety checks. Some parts of the home would benefit from re-decoration, in particular some of the bathrooms and toilets looked rather clinical and the paintwork in the hairdressing room was chipped and flaking. The hallway carpet on the upper corridor and in the activities room was stained. See recommendation 2.
Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 18 Bedrooms were bright, spacious and comfortable. In the larger rooms, some residents had bought their own curtains, televisions, telephones, display cabinets, and ornaments with them into the home. These items made the rooms appear more homely and welcoming. Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Temporary staff were used regularly. Action should be taken to recruit more permanent staff and improve continuity of care for residents. Thorough checks were carried out when recruiting new staff. All grades of staff were supported to attend relevant training sessions and attain vocational qualifications. The manager was addressing the need for staff to receive training about mental health issues. EVIDENCE: The duty roster for the period 13/11/06-19/11/06 was examined. Each shift was lead by a team leader and there were six carers on an early shift, five carers on a late shift and two carers on night shifts. The manager, assistant managers or an on call person provided additional support. Agency staff were used regularly to cover staff sickness, training and absence. Where possible, staff requested agency staff that had worked in the home before to improve continuity of care. See recommendation 3. Five staff had left since the last inspection. The manager had recently carried out interviews to fill the three remaining vacant care staff posts. One member of staff was appointed and pre employment checks had been requested.
Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 20 Staff meetings were taking place regularly and staff reported that they received good support from the management team. Three staff recruitment files were examined. All of the files contained all of the necessary documentation required by legislation. 62 of care staff had a vocational qualification in care at level two or three. This exceeds the standard set by the Department of Health. Staff had access to a varied programme of training. The programme did not include specialist training about mental health issues. The manager had approached staff from the local mental health team to see if they could assist her to develop a suitable programme of training for care staff. New staff attended a four-day introduction to social care training course that covered all of the induction standards. Staff were encouraged to attend specific courses relating to their role. Since the last inspection some members of staff had undertaken abuse, stoma care, moving and handling, dementia, and challenging behaviour training. Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The balance between preserving individual rights and ensuring residents safety and security was well managed. There were systems in place to monitor and improve the quality of care provided in the home. EVIDENCE: The manager has a Certificate in Management Studies and the Registered Managers Award and is currently working towards attaining a vocational qualification in care at level four. Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 22 Staff said that the manager had an open door policy “if there are problems she will always see us, she is an excellent mentor”. The home has a comprehensive quality assurance system. The system includes regular audits of specific issues such as care planning, accidents, finances and maintenance. If staff identified issues of concern during an audit a corrective action sheet was completed to state what action would be taken to address the matter. Each year some homes were assessed by an independent company to check that they were still meeting recognised quality management standards. Feedback about the service was obtained from residents and relatives during meetings. Issues discussed during meetings were recorded and action was taken to implement suggestions. The administrator was responsible for maintaining records about residents’ money and valuables. An individual record of all transactions was maintained for each resident. Receipts were kept for all purchases made on the resident’s behalf and for any payments made for services such as hairdressing and chiropody. An individual bank account was set up for residents that did not have relatives or advocates who could assist them to manage their finances or had accrued larger sums of money. The manager checked money records regularly to ensure that staff were following company procedure and the balance was correct. The public liability and registration certificates were displayed. All fire exits were clear and regular drills and tests were carried out to ensure that the fire system was working and staff were aware of the procedure to follow in the event of a fire. Fire equipment was serviced regularly. Health and safety certificates were examined for the mains electricity installation, portable electrical appliances, gas appliances, lift, water chlorination and moving and handling equipment. All of the certificates seen were satisfactory. Hot water temperatures were tested and a visual check was undertaken of all wheelchairs. The maintenance technician said that window restrictors were checked regularly but records were not maintained. See recommendation 4. Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 24 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 OP7 Regulation 15 Requirement The Registered Person must ensure that care plans for residents that require support to take their insulin state: • What action staff should take to support a resident to take their insulin • The residents consent if care staff administer insulin • What action staff must take if the resident has a hypoglycaemic attack Timescale for action 15/05/07 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 OP9 Good Practice Recommendations The Registered Person must ensure that: • Medication changes are crossed through, dated and initialled • Homely remedy supplies are checked regularly The Registered Person should:
DS0000006861.V316533.R02.S.doc Version 5.2 Page 25 2. OP19 Sunbury Lodge 3. 4. OP27 OP38 Undertake some work to improve the appearance of the bathrooms and toilets • Repaint the hairdressing room • Remove the stains or replace the carpets in the activity room and upper corridor The Registered Person should reduce the use of agency staff to improve continuity of care for residents. The Registered Person should complete a risk assessment in respect of falls from windows. Strategies to minimise risks to residents should be recorded. • Sunbury Lodge DS0000006861.V316533.R02.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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
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