Inspection on 31/08/06 for Talbot Woods Lodge

This inspection was carried out on 31st August 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Talbot Woods Lodge 27/02/06

Talbot Woods Lodge 13/12/05

Talbot Woods Lodge 02/02/05

Talbot Woods Lodge 25/08/04

Talbot Woods Lodge 29/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Talbot Woods Lodge 64 Wimborne Road Talbot Woods Bournemouth Dorset BH3 7AR Lead Inspector Heidi Banks Key Unannounced Inspection 31st August 2006 10:10 DS0000003991.V310386.R02.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 DS0000003991.V310386.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 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. DS0000003991.V310386.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Talbot Woods Lodge Address 64 Wimborne Road Talbot Woods Bournemouth Dorset BH3 7AR 01202 293390 01202 297817 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 John Colley Mrs Nicola Gail Colley Care Home 14 Category(ies) of Learning disability (14) registration, with number of places DS0000003991.V310386.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th February 2006 Brief Description of the Service: Talbot Woods Lodge is a residential care home registered to accommodate a maximum of fourteen adults with a learning disability. The property is in keeping with the neighbourhood and there is ample space for parking at the front of the house. The home has easy access to a bus route which serves the centres of Bournemouth and Winton. Residents have access to an eight-seater vehicle for trips out in the community and are supported to attend health appointments as appropriate by staff. There are thirteen permanent residents at the home at the present time with the remaining one bedroom used to provide respite care for a number of different people with learning disabilities. All bedrooms are single occupancy. Eleven bedrooms are situated on the first and second floors of the home and three are situated downstairs. There are three bathrooms and two toilets for shared use by residents. The home also has a large lounge, dining room and a separate sun lounge / games room. The garden to the rear of the property has been thoughtfully landscaped and provides a further area for use by residents. The home also provides day care for a maximum of five non-residents each day. The basic minimum fee for residents at Talbot Woods Lodge is currently £450 per week. DS0000003991.V310386.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection of Talbot Woods Lodge which took place over seven hours on a weekday. The lead inspector was accompanied by Tracey Cockburn, Regulation Manager, for the first five hours of the inspection. There are thirteen permanent residents living at Talbot Woods Lodge at the present time with one bed available for people with learning disabilities on a respite stay. During the course of the inspection the inspector was able to meet some of the service users and five members of the care team. The inspector was also assisted by the registered provider, Nicky Colley and the home’s Housekeeper. A sample of records was examined including some policies and procedures, medication administration records, health and safety records and service user and staff files. The inspectors were also able to take a tour of the care home. Building work was taking place at the rear of the building to provide ground floor accommodation for an additional service user. Nine completed service user surveys were received in addition to eleven comment cards from relatives and visitors to the home, three from social care professionals, three from general medical practitioners and four from health care professionals who have contact with the home. A pre-inspection questionnaire completed by the registered provider was also supplied. Information obtained from these sources is reflected throughout the report. Twenty-six standards were assessed during this inspection. What the service does well: Individual support plans have good amounts of detail about the way in which service users prefer to be supported. Potential risks are also considered as part of the plan so that information is available to staff on how to keep service users safe. There was evidence of service users being consulted about things that are important to them, for example, activities, day trips, choice of clothing and what they would like to have in their lunch box each day. Service users are given opportunities to engage in activities that are tailored to their individual needs. Some service users enjoy going out and records showed that they are supported to do this. Other service users access sensory activities and individual sessions with a massage therapist to meet their needs. Service users’ contact with their families is encouraged and all relatives responding to the survey indicated that they felt welcomed in the home at all times. DS0000003991.V310386.R02.S.doc Version 5.2 Page 6 The home received very positive responses from relatives, health and social care professionals about the personal and health care support that is offered to service users. The home has established good links with health care professionals and many comments received in comment cards noted the friendly and caring attitude of staff and the home’s willingness to work in partnership with them to ensure service users’ needs are met. There are systems in place to ensure that the home is kept clean and in satisfactory repair. Building work taking place at the home during the inspection had been arranged so as to minimise disruption to service users. The registered provider, Nicky Colley, is an approachable figure in the home and it is clear from comments made by service users, their relatives and professionals that they are happy with Mrs Colley’s response to issues that affect service users. A new Team Leader has been appointed to provide more management support in the home. The registered provider demonstrates a commitment to meeting the National Minimum Standards for the benefit of service users. What has improved since the last inspection? It was clear during the inspection that the provider has taken steps to address requirements and recommendations made at previous inspections. Specialist advice has been sought for a service user with specific dietary needs and the provider is working towards improving record-keeping of the food he eats to ensure that his intake can be monitored and his needs are met. A maximum – minimum thermometer has been purchased for the refrigerator used to store medicines and there was evidence that temperatures are monitored on a daily basis to ensure appropriate storage. Service user plans and minutes from reviews have been typed up and are better presented than on previous inspections. The provider is continuing to explore ways in which service users are consulted about issues in the home, for example, obtaining feedback from service users about the way individual staff treat them which is then used in staff supervision. The provider has taken appropriate steps to ensure that the practice of locking bedroom doors has been agreed by service users and / or significant people in the service user’s life. This helps raise awareness that this practice is occurring in the home and ensures that appropriate people have been consulted. The complaints record has also been expanded to include the reporting of concerns and a telephone log has been introduced so that the provider is kept informed of all incoming calls and any issues that may be raised by relatives and other visitors in conversation with staff. This means that any issues can be dealt with promptly and effectively for the benefit of service users. DS0000003991.V310386.R02.S.doc Version 5.2 Page 7 A system of individual staff supervision has been implemented on a bi-monthly basis so that staff have the opportunity to raise issues that affect them in the workplace and talk about their development in their role with management. This ensures that staff are given appropriate support in their role of caring for service users. Individual fire training / drill records are now in place for staff so that it is easier to check that staff are participating in a sufficient number of training sessions and drills to promote their awareness of procedures. This will help ensure that service users are supported by staff who know what to do in the event of a fire. A new Team Leader has been appointed in the home who has some leadership responsibilities and will take responsibility for running the home in the providers’ absence. This will help ensure that service users and their representatives have a senior person that they can talk to when the providers are away from the home. What they could do better: As a result of this inspection, seven requirements and eleven recommendations have been made. The home’s Statement of Purpose and Service User Guide must be reviewed so that it contains specific information about the provision of respite and day services at the home. This will ensure that prospective residents are aware of the nature of the services provided at Talbot Woods Lodge and make their decision to live there based on this information. Recording of the meals eaten by service users needs to be done in greater detail so that anyone reading the record can see whether food provided meets the needs of service users. The provider should also audit the quality of meals on a regular basis to ensure service users are provided with a healthy and balanced diet with enough fruit and vegetables. It is suggested that this is done in consultation with service users and their relatives / representatives. Also, where service users have specific dietary needs, any menu plan for them should be drawn up in consultation with a dietician to ensure it is nutritionally adequate. Review of the home’s medication policy is needed to ensure that it is clear to all staff reading the policy what they need to do and that information is accurate and has been reviewed with relevant professionals. A tour of the premises indicated that the laundry room needs to be risk assessed. There is no lock on the laundry door and exposed pipe work in the laundry area means that service users need to be kept safe from potential harm. DS0000003991.V310386.R02.S.doc Version 5.2 Page 8 The provider must ensure that references obtained for new staff are robust and that any gaps in employment are explored at interview. These checks are to ensure that service users are protected by the people who work with them. Although staff are provided with formal training in first aid and moving and handling every three years, it is not clear whether staff joining the team during this three year period are able to access this formal training as part of their induction. This is important to enable staff to work with service users safely and so that they know what to do in an emergency. A programme of training is in place at the home but much of this training is delivered internally through videos and question and answer packs. At present, the home’s Housekeeper delivers this training but it is unclear that she has a suitable qualification in training that proves her competence to do so. The home needs to review the training provided to staff so that whoever is responsible for delivering training has the necessary skills and knowledge to do so. External training courses should be accessed where possible, for example in total communication and adult protection, where specialist trainers are used who have up-to-date knowledge of the subject they teach. The registered provider must ensure that they inform the Commission of any events in the home where changes to a service user’s health needs mean that an ambulance is called or they are admitted to hospital. Goal-setting processes should be reviewed so that they are person-centred and are evaluated at regular intervals. This will ensure that service users are working towards goals that are important to them and that the support they are given to do so is monitored. The home’s practice of locking bedroom doors during the day and at weekends is not supported by the Commission. Although agreement has been obtained by the registered provider from significant people in service users’ lives, the provider needs to keep this under regular review and ensure it is carefully documented. Staff should know how to take accurate readings from the thermometer in the refrigerator used to store medicines. This will ensure that medication is stored at an appropriate temperature and therefore that service users are protected by the home’s practices. Some shortfalls in the home environment were identified, for example, there are no handles on bedroom doors and the bathrooms would benefit from refurbishment. It was also noted that only two service users have put their name on their bedroom doors and it is recommended that consultation with service users takes place to check if and how they would like to personalise this space. Some issues have been identified in relation to staffing, for example the job description of the Housekeeper should be updated and the composition of the DS0000003991.V310386.R02.S.doc Version 5.2 Page 9 staff team should be subject to ongoing review to ensure service users’ needs are being adequately met. This is particularly important in terms of communication. Staff should have a good level of spoken English to be able to communicate effectively with service users and their relatives. The home’s annual development plan should be reviewed to ensure that it is based on service users’ views. Shortfalls in health and safety practices have been identified which should be addressed to ensure that staff are aware of their responsibilities and service users are kept safe. For example, fire safety training should be provided by a person who has the knowledge and skills to do so, accident records need review to ensure sufficient information is recorded in the appropriate format and water temperatures should be recorded on a regular basis. 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. DS0000003991.V310386.R02.S.doc Version 5.2 Page 10 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 DS0000003991.V310386.R02.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose and Service User Guide does not provide enough information about certain aspects of the home to ensure service users and their representatives have full information about the accommodation provided. Systems are in place to ensure that service users are only admitted to the home on the basis of an assessment of their needs to ensure that the home has sufficient information to meet their requirements. EVIDENCE: The home’s Statement of Purpose and Service User Guide were reviewed. This is in an easy-read format and therefore accessible to service users. It was noted that there was no specific mention of the fact that the home operates a day service on the premises or that the home offers respite accommodation on the first floor for one individual. There have been no permanent residents admitted to Talbot Woods Lodge since April 2002. At the last inspection of the service, the admissions procedure was discussed with the registered provider and the records of one service user examined to evidence this process. The registered provider reported that the home works closely with Care Managers regarding the DS0000003991.V310386.R02.S.doc Version 5.2 Page 12 admission of prospective residents. The home also has a pre-admission questionnaire which enables information about the service user’s daily activities, leisure interests, daily living skills, eating and drinking, main contacts, medication, mobility and general health to be gathered. There was evidence that this questionnaire had been completed for the most recent service user admitted. The registered provider stated that prospective residents are invited to the home for tea visits and overnight visits as part of the admissions process which gives them an opportunity to discuss their needs and aspirations with staff and meet other residents. DS0000003991.V310386.R02.S.doc Version 5.2 Page 13 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual plans offer a good amount of information about service users’ needs and preferences in relation to their personal care. Goal-setting processes should be reviewed, however, to ensure that they are meaningful to the individual and are evaluated on a regular basis. Information about the way individual service users communicate their needs and wishes was seen on some records to ensure care workers have the guidance they need to support service users with decision-making. Risk assessments are in place to indicate areas of particular vulnerability for individuals and the action to be taken by care workers to minimise risks. EVIDENCE: The individual plans for two service users were reviewed. These were generally comprehensive and contained information on all aspects of activities of daily living including eating and drinking, leisure activities, washing and dressing, elimination, night routine, self-help skills, links to family and DS0000003991.V310386.R02.S.doc Version 5.2 Page 14 bereavement. The individual’s level of independence, nature of assistance needed and choices and decisions that the service user can make were included in the plan. Individuals’ goals had been identified but had not been written in a person-centred way; for example ‘continue work with Essential Lifestyle Plan’ and ‘not to sit on floor’ does not indicate the benefits for the service user. Goals should be specific, measurable, achievable, relevant and time-limited in order to be meaningful and effective. There was also no evidence to show how goals were being evaluated at regular intervals between reviews to monitor progress and ensure their continued relevance to the service user. There was evidence to demonstrate that service users, their relatives and representatives are encouraged to sign up to their individual plans. Plans had been typed up since the last inspection of the service and therefore were more effectively presented and easier to read than the former documents. One service user indicated in a comment card that she always makes decisions about what she does each day; ‘Making my room nice, help to do the shopping, help to choose outings’. A relative of a service user also commented ‘X always chooses clothes etc and how to spend his private time when he returns from the day centre’. There was sufficient evidence in some service user plans to indicate the way in which service users communicate in order to make choices and decisions. There was also evidence on file that showed how service users with verbal communication had been encouraged to make choices about outings and activities using promotional leaflets. Nicky Colley reported that for service users who use non-verbal methods of communication simple Makaton is used and time is being spent looking at the service users’ history to ascertain their likes, dislikes and past interests which might inform the present. Discussion with two members of the staff team indicated that they understood one service user’s needs by the fact that she takes their hand and guides them to things she wants. A sample of risk assessments were seen for individual service users to identify their level of vulnerability and provide information on action to be taken to minimise risks. These were dated February 2006 and were due for review in September. Risk assessments covered social activities, household tasks, mobility, eating and drinking, abuse, personal care, self-neglect, aggression and community access. DS0000003991.V310386.R02.S.doc Version 5.2 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Efforts are made to provide a range of activities that are suited to the individual service user both in the home and local community that meet their needs and personal interests. Service users are supported to maintain contact with their family and develop friendships in the home so that they have a circle of support around them. Although the provider has taken steps to ensure that agreement has been obtained, the practice of keeping bedroom doors locked is not supported by the Commission and does not promote the rights of service users to access their bedroom at any time without needing to obtain their key from the office. Shortfalls have been identified with regards to the recording of individuals’ food intake which makes it difficult for the home to evidence that the meals provided meet service users’ needs. DS0000003991.V310386.R02.S.doc Version 5.2 Page 16 EVIDENCE: The service users at Talbot Woods Lodge attend different day services in the community which enable them to be with their peer group and take part in a range of activities. Daily records showed that one service user case-tracked had accessed their local community on several occasions in the previous month including a visit to the circus, a picnic in a local park, a kite festival and a visit to a local shopping centre. A programme of activities for the month is on display in the hallway of the home. The home has a vehicle which can transport up to eight service users. At present only three members of the staff team are able to drive the vehicle. Four service users had recently enjoyed a holiday to Devon. For a further nine service users whose day centre was due to close in mid-September for one week a series of day trips were being arranged. Additional staffing was being organised to facilitate these activities. Discussion with Nicky Colley evidenced that she is aware that effort needs to be made to ensure that all service users are enabled to access their community irrespective of their level of disability. To ensure this occurs, Nicky Colley reported that a rota for pub trips is in place. The home also organises visits from a massage therapist on a regular basis for seven service users who have a severe learning disability, Nicky Colley reporting that this is proving very successful and beneficial for them. One relative of a service user stated in a survey ‘The timetable is suited to X’s needs and to what she enjoys, for example, swimming, walking etc.’ All service users at Talbot Woods Lodge are reported to have contact with members of their family or foster families. Discussion with one service user indicated that she has a boyfriend. Another service user talked of a friendship she has with a fellow resident and interaction with staff demonstrated that she is offered ongoing support with this. All service users’ relatives indicated in comment cards that they feel welcomed in the home at all times. It was noted during a tour of the home that the majority of bedrooms continue to be locked by staff at the home while service users are not using them. One service user who completed a survey supported by a relative commented that they ‘cannot access bedroom as room is now locked during the day and at weekends’. The provider has stated that this is to ensure that service users’ rooms are not accessed by others and therefore that their property remains safe. This was raised at an inspection of the home in December 2005 when the registered provider was advised to ensure that the agreement of service users and their representatives / relatives is obtained regarding this practice. Since this time written agreements have been put in place with signatures of representatives of the home, service users’ Care Managers and relatives. Nicky Colley confirmed that the circumstances for each service user would be discussed at each review to ensure that significant people in the service user’s DS0000003991.V310386.R02.S.doc Version 5.2 Page 17 life continue to be aware of and are in agreement with the practice. While the provider has taken appropriate steps to ensure that agreement is obtained, the Commission for Social Care Inspection is not in agreement with the practice of locking bedroom doors in circumstances such as these because it is seen as restricting the freedom of service users to access their bedrooms at all times. It is therefore recommended that the provider keeps this issue under review. The registered provider reported that all service users are issued with a key which they store in the office for safe-keeping. Service users will take their key when they wish to gain access to their bedrooms. For those service users who, due to their level of learning disability, are unlikely to collect their key for themselves, the registered provider stated that it was generally apparent from an individual’s body language whether they wanted to go to their bedrooms and that staff would support them with this. It was not clear from records how service users communicate their wish to go to their bedrooms and it is recommended that this information is added to the service user plan. Two comment cards received from relatives of service users highlighted concerns about the food provision at the home, in particular a lack of fresh fruit and vegetables in the meals provided; ‘my…concern is the quality of the main meal of the day. Sometimes vegetables are not served with the meal and the quality of protein is poor’. It was noted during the inspection that feedback of this nature had also been received from relatives in January 2006 in response to the home’s quality assurance questionnaires. This concern was raised with the registered provider and the menu examined for evidence that it offers service users a balanced diet that meets their requirements. The menu plan was generally not sufficiently detailed to give a good indication of food eaten by service users, for example references to ‘lunch box of choice’, ‘sandwiches of choice’ and ‘as per care plan’ are too vague to inform the reader of the nutritional intake of the service users. Although some meals on the menu incorporated vegetables it was not clear from records that service users are eating a good amount of fruit and vegetables each day. It was also noted that on some weeks chips were on the menu on three occasions and it is suggested that the provider explores alternatives to ensure service users are being offered a varied and balanced diet. Also, the provider should give serious consideration to replacing tinned foods such as ravioli and meatballs with home-cooked alternatives. The home’s food stores were inspected and showed a good range of fresh fruit available to service users for inclusion in their lunch boxes. Frozen vegetables were also available and cupboards appeared well stocked to meet the needs of service users. Care staff at the home are responsible for preparing meals for service users as part of their duties. One service user stated in a service user survey ‘It would be nice if there was a cook as I like a lot of fresh vegetables’. One service user’s relative also stated in a comment card that they felt a cook should be DS0000003991.V310386.R02.S.doc Version 5.2 Page 18 employed with specific responsibility for preparing meals for service users. The registered provider stated that the home had employed a cook in the past and this had not proved successful. It is suggested that this is kept under review to ensure that service users benefit from the knowledge and skills of a cook and that time spent preparing meals does not detract from support time provided to service users by care staff. The registered provider has agreed to review the home’s menu with service users and their relatives to ensure that people have the opportunity to query what is provided and share ideas for improvement. An evening meal was observed taking place in the home. It was evident that staff were present to support service users with eating and drinking as appropriate. The menu plan for one service user with particular dietary requirements was reviewed. Again, records were not detailed enough to evidence the food or amount that is being eaten on each occasion. It was also not clear from records that where the service user was unable to eat a particular food choice, for example baked beans or peas, a suitable alternative was being offered to him to ensure the meal was balanced and his intake of fruit and vegetables was adequate. Since the inspection the provider has forwarded a revised menu plan with clearer details of meals he is to be offered on a daily basis. It is recommended that the provider ensures that a dietician is consulted with regards to his menu plan, whenever it is revised, to ensure that his needs are being met. There was evidence on the service user’s file of information related to the support needed with eating and drinking including pureeing of food to a specific consistency and the use of a plateguard and beaker to promote his independence. DS0000003991.V310386.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Personal support is delivered to service users in a way that meets their individual needs and preferences. Service users are supported to access a range of health care services to ensure their requirements are met and their health is maintained. The home’s medication policy and procedures should be reviewed for clarity and accuracy to ensure that service users are given the support they require with this aspect of their care. EVIDENCE: Support plans sampled offered sufficient detail to care staff about the individual personal care needs and routines of service users, for example, how they like to be supported with bathing and the help they need to brush their teeth. Risk assessments sampled also showed evidence that risks around personal care and self-neglect had been considered. All eleven comment cards from service users’ relatives indicated that they were satisfied with the overall care provided by the home; ‘I find the way the owner of Talbot Woods Lodge deals with the residents and any problems to be excellent. My daughter, X, has had quite a few problems of late and I have been very happy with the way DS0000003991.V310386.R02.S.doc Version 5.2 Page 20 they have been dealt with’. This was echoed by health and social care professionals in comment cards who also indicated that the home demonstrates a clear understanding of the needs of service users and that they are satisfied with the overall care provided; ‘Always a warm, caring atmosphere. Genuine interest in clients’ needs and that of carers’; ‘The home provides an excellent standard of care to my service user’. Responses from health care professionals visiting the home demonstrated satisfaction with the way in which service users’ health care needs are met and the home’s liaison with the health care team; ‘Always happy to take and seek further advice as required’; ‘The staff are always friendly and welcoming. I am always given support and all relevant information’; ‘Overall very satisfied with dealings with the home. Staff, in particular, friendly and helpful’; ‘Excellent liaison between management and GP’. Service users’ records showed evidence of liaison with generic and specialist health care services, for example general medical practitioners, community nurses, dietician, chiropody and physiotherapy. All health care professionals responding to comment cards indicated that they felt their specialist advice had been incorporated into the service user plan and was being followed by staff at the home. Following the last inspection of the service in February 2006 a requirement was made for the provider to make additions to the home’s medication policy to ensure it contains adequate information for staff. The registered provider has supplied the Commission with the additions she has made to the policy. Review of these procedures indicate that greater clarity is needed in some areas to ensure they are written in plain English and that staff understand them. It is also recommended that the provider seeks advice from a qualified pharmacist and community / diabetes specialist nurse regarding some aspects of the policy to ensure its accuracy. Most medicines in the home are administered from Monitored Dosage System (MDS) blister packs and the sample checked during the inspection agreed with the Medication Administration Record (MAR) charts. Following a requirement made at the last inspection of the service a maximum – minimum thermometer has been purchased by the home and was seen to be in place in a refrigerator used to store insulin. Temperatures are being recorded by staff on a daily basis but it was evident from records that at times the temperature had been recorded as exceeding the recommended range (2-8 degrees Centigrade). Discussion with a member of the staff team indicated that staff sometimes recorded the temperature when the door of the refrigerator had been open for some time and therefore this would give an inaccurate reading. At the time of inspection the refrigerator showed a temperature that was within the expected range. Although staff with responsibility for the administration of medication access in-house training and a short training course provided by a pharmacy, access DS0000003991.V310386.R02.S.doc Version 5.2 Page 21 to further accredited training should also be considered for all staff to ensure their competence in this area. DS0000003991.V310386.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users and their relatives are aware of the home’s complaints procedure and systems are in place to ensure that concerns raised are responded to effectively. Although an adult protection policy is in place, external training should be accessed by all staff to promote their awareness of local procedures and their responsibilities. EVIDENCE: The home has a complaints procedure which has been converted into an easyread / symbols format. A copy of the procedure is on display in the hallway of the home. All service users responding to the survey stated that they knew who to speak to if they were unhappy or wanted to make a complaint. The majority indicated that they would speak to Nicky Colley. Relatives of service users also indicated in comment cards that they were aware of the home’s complaints procedure. Nicky Colley reported that she had not received any complaints about the service in the last twelve months. The home has implemented a telephone log to record details of all incoming calls so that any issues raised by relatives or representatives of service users can be documented at the time of the call and passed to Nicky Colley for action. A new form has also been developed for recording concerns and the action taken to address them. The telephone log DS0000003991.V310386.R02.S.doc Version 5.2 Page 23 was seen but no concerns had been documented to date. It was noted that on occasions concerns may be raised via the home’s quality assurance process which should, in future, be dealt with through the home’s complaints / concerns procedure. There have been no complaints about the home received by the Commission for Social Care Inspection since the last inspection of the service. The home has an adult protection procedure which staff sign to indicate they have read and understood. A copy of the multi-agency policy ‘No Secrets’ is also available for staff reference. Staff meetings are held every two months and the schedule indicates that adult protection is discussed on a regular basis to ensure staff are aware of action they should take in the event that they suspect or witness abuse. Discussion with a member of the staff team indicated that new staff are shown two videos ‘Abuse of adults with learning disabilities’ and ‘No Secrets’. However, neither video was dated and the ‘No Secrets’ video had been produced for a local authority other than Dorset so it was unclear how this would inform staff of local procedures. On the staff files sampled there was no evidence to indicate that staff had accessed external training on abuse awareness. DS0000003991.V310386.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some shortfalls have been identified in relation to the home environment which should be reviewed and risk assessed to ensure that safety issues are addressed and potential risks to service users are reduced. Systems are in place to promote good hygiene in the home and ensure service users are protected from infection. EVIDENCE: The home currently provides accommodation for a total of fourteen service users which includes one respite bed. There is a lounge, dining room and sun lounge / activity area on the ground floor. There is a separate laundry room with a washing machine and tumble dryer. The door to the laundry room had no lock and this should be risk assessed to ensure the safety of service users due to the equipment stored in the laundry area and exposed pipes. It was noted that there is another door between the utility area and food store which was also unlocked. DS0000003991.V310386.R02.S.doc Version 5.2 Page 25 During a tour of the premises it was noted that bedroom doors do not have handles on the outside. Apart from two cases, there were no names on service users’ bedroom doors. Bathrooms were also seen to need refurbishment. The registered provider reported that plans were in place to undertake this work in the near future. The carpet in the hallway and the lounge has been re-fitted since the last inspection of the service to ensure that it provides a level surface. At the time of inspection construction work was taking place to the rear of the home as the provider is in the process of building an extension to the existing accommodation. It was evident that steps had been taken to ensure that disruption caused was kept to a minimum and did not impact adversely on existing service users. The home has an infection control policy. The registered provider stated that aprons and gloves are kept under the sinks in residents’ bedrooms and in the laundry room for use by staff when undertaking personal care tasks. Aprons for use in the kitchen are kept in the kitchen. Household substances identified as substances hazardous to health are stored securely in a locked cupboard in the laundry area. Information supplied in the pre-inspection questionnaire by the registered provider indicates that there is a contract in place for the disposal of soiled waste. The washing machine has a sluice wash facility. New staff are shown a video on infection control in the care home as part of their induction training. Formal training in infection control is delivered to staff as part of a three year cycle of training. Of the nine service users responding to the survey, the majority indicated that the home is always fresh and clean. One relative commented in a survey that in hot weather doors and windows are shut in the evenings so that ground floor living accommodation is very hot and humid. DS0000003991.V310386.R02.S.doc Version 5.2 Page 26 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The job description of the home’s Housekeeper should be reviewed so that her title accurately reflects the work she undertakes in the home and that this is clear to service users and their representatives. Staff have opportunities to access training accredited by the Learning Disability Award Framework (LDAF) and NVQ training which means that they are encouraged to develop competence in their work with residents. Ongoing review of the numbers, skill-mix and cultural composition of the staff team is needed to ensure that service users’ needs are met and that there are staff on duty at all times who can communicate with service users in their first language. Recruitment processes are not always sufficiently robust to ensure that adequate checks are carried out on care workers prior to them working with service users. The home does not currently make optimum use of external training resources or ensure that staff receive their training from suitably qualified and competent trainers. Steps have been taken by the registered provider to offer regular supervision to all staff at the home so that they are supported in their work with service users. DS0000003991.V310386.R02.S.doc Version 5.2 Page 27 EVIDENCE: During the inspection it became apparent that the individual employed as a Housekeeper within the home is undertaking a range of duties that would not usually be expected within this role. This includes facilitating induction and fire training for care staff and updating service user plans and risk assessments. Discussion with the Housekeeper confirmed that her responsibilities are varied. Job descriptions for care workers were seen to be on their individual files. Information supplied in the pre-inspection questionnaire indicates that two care staff currently hold a qualification at NVQ Level 2 or above. At the time of inspection a further four staff were due to complete their NVQ qualification in September 2006. The registered provider stated that NVQs are done through a local college of further education. Discussion with the provider indicated that all staff undertake training accredited by the Learning Disability Award Framework (LDAF) as part of their induction training at the home. This offers staff an introduction to aspects of supporting people with learning disabilities. The home’s rota indicates that there are generally four care staff on duty at the home between 0800 hrs and 2000 hrs. This excludes the registered provider and the housekeeper. From 2000 hrs there is one waking night duty and one sleep-in duty. The registered provider reported that there is one week in September when a day service attended by the majority of service users will be closed. She has made plans for this by adjusting the staff rota to provide additional day-time cover so that service users’ needs can be met. Feedback from two service users’ relatives in comment cards highlighted some concern about staffing levels in the home, one indicating that in their view there are not always sufficient numbers of staff on duty and another commenting that there are ‘just about’ sufficient numbers of staff on duty. One relative also expressed concern about the high percentage of staff in the home who are employed from overseas due to their perceived level of competency in the English language; ‘the level of competency in the English language of some staff is not very good. I’ve had to explain myself several times on occasion. Working with people with learning difficulties, a grasp of the English language is essential.’ It was also noted that a member of the staff team had also commented in a supervision session that it could be frustrating when some staff say they understand something when they do not. Three staff files were examined for evidence of recruitment documentation. All three staff had commenced in post since the last inspection of the service. One care worker was seen to have two ‘recommendation letters’ on record instead of references. These had been written in 2005 and were not specifically for the post for which they had applied at Talbot Woods Lodge. The provider stated that this individual had worked for Social Services in the United DS0000003991.V310386.R02.S.doc Version 5.2 Page 28 Kingdom prior to joining the team at Talbot Woods Lodge. There was no reference on file to evidence this. In addition there were gaps in the staff member’s employment history, as detailed on her application form. The application form for another staff member also did not show a full employment history with clear commencement and leaving dates for previous posts. One reference provided had not been signed by the referee so it was unclear who had provided it. Enhanced disclosures from the Criminal Records’ Bureau and PoVAFirst checks were on record for all staff. It was noted that the official start dates of two staff from overseas had been recorded as before PoVAFirst / CRB checks had been obtained. This was queried with the provider who confirmed that neither staff member had actually commenced working at the home until the necessary checks had been completed. The records for the third member of staff showed evidence of a PoVAFirst check and CRB check having been in place prior to commencement in post. All records sampled showed evidence of proof of identity. There was evidence on care workers’ files that the induction programme for new staff spans four working days. During this time staff undertake a tour of the premises and are given an introduction to policies, procedures and employment issues. Shadowing of more experienced care workers also takes place during this time. At induction staff are introduced to a selection of videos with accompanying workbooks to give them basic knowledge on a range of subjects about supporting people with learning disabilities. Training packs available to staff included risk assessment for moving and handling in the care home, supervision in the care home, managing challenging behaviour, effective communication, pressure ulcer prevention and dementia care. Some videos were dated as far back as 2002. There was no evidence on record to show that external training had been sought in these areas. Although the home has a total communication book produced by Dorset County Council, there was no evidence to show that staff had accessed formal training on total communication. In many cases it was evident that the Housekeeper had been responsible for signing to indicate that training had been completed. The Housekeeper does not hold a specific qualification in training. Following a recommendation made at a previous inspection of the home the registered provider has implemented bi-monthly supervision for staff. The provider reports that supervision sessions last between ten minutes and halfan-hour. Records on staff files indicated that this is a review of what the care worker is enjoying about their role and what areas of work they have found frustrating. The provider has enabled service users to participate in the staff supervision process by asking them for feedback about the performance and attitude of individual care workers. DS0000003991.V310386.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a clear management structure and the staff rota indicates that there is always a senior person on shift during day-time hours whose responsibility it is to ensure the smooth running of the shift for the benefit of service users. The home has a quality assurance process in place that promotes consultation with service users and relatives. Further review of the home’s annual development plan is needed to ensure that the development of the service is based on those issues that are most important to service users. Some shortfalls in health and safety practices have been identified that should be addressed in order for service users’ welfare to be fully protected and for the standard to be met. DS0000003991.V310386.R02.S.doc Version 5.2 Page 30 EVIDENCE: The staff structure at the home has changed since the last inspection with the provider having recently employed a full-time Team Leader. This is intended to provide greater leadership to the staff team and cover during the absence of the proprietors. The Team Leader has previous experience of working with vulnerable adults although not specifically people with learning disabilities. There are also two senior workers employed who take some responsibility for the running of their shift. It was evident during the inspection that Nicky Colley is an accessible figure to service users and they approach her to tell them about their day and for answers to queries. The provider has responded promptly to requirements made at previous inspections and has demonstrated commitment towards meeting the Regulations and National Minimum Standards. The home’s quality assurance record showed that the registered provider has sent out questionnaires to visitors to Talbot Woods Lodge on an annual basis. Responses from questionnaires sent out in January 2006 were seen. Areas looked at as part of the questionnaire included quality of care, friendliness of the staff, cleanliness of the home, response to telephone calls, the home’s décor, amenities, food provision and general impressions. In general, responses from relatives showed ratings as being ‘good’ or ‘excellent’ in all categories. The registered provider confirmed that information from the questionnaires is collated and feedback from the process is sent out to relatives of service users. The registered provider stated that she ensures that specific comments, which may be raised by individuals as part of this process, are responded to. It was discussed with the provider that people may use the quality assurance process as an opportunity to raise concerns and that in future these should be responded to following the home’s complaints / concerns procedure. This will ensure that the concern is followed up appropriately. Questionnaires are sent out to service users as part of the quality assurance process as a means of monitoring the home’s success in meeting service users’ needs and preferences. The provider reported that, to ensure their responses are as objective as possible, staff from service users’ day centres were asked to support them in completing the surveys. A sample of comments were seen and included ‘I love colouring. Staff let me colour.’ ‘I like computer games, colouring, writing and reading books…staff help me to do these things.’ Records showed evidence that issues raised in surveys had been followed up by the provider. For example, one service user had commented that she would like salad in her lunch box one day. This had been addressed with the DS0000003991.V310386.R02.S.doc Version 5.2 Page 31 service user being supported to purchase a salad box so that she can take salad with her to the day centre as and when she wants. The annual development plan seen at the time of inspection appeared to be related to maintenance issues around the home. This should be expanded to ensure that its content is based on issues that are important to service users as indicated in responses to quality assurance surveys from service users and their representatives. A sample of health and safety records were reviewed. These showed that the fire warning system in the home had been tested on 28th August 2006 with the next test due on 4th September. A quarterly service of the alarm system was also due in September 2006. Records showed that a fire training session had been carried out for thirteen staff on 14th August 2006. The home’s Housekeeper was documented as being the instructor for this session. It is not clear what training the Housekeeper has to ensure her knowledge and competence in delivering fire training to staff. Following a recommendation made at the last inspection, each member of staff now has an individual fire training record. The record sampled made references to ‘full training given’ which does not give enough information about the actual content of the training. The Housekeeper has submitted written confirmation to the Commission that she has contacted Dorset Fire and Rescue to discuss the content of fire training at the home and had been advised that they were doing enough training ‘on paper’ although provision should be made to train staff in the use of fire extinguishers. In response to this a training session in the use of fire extinguishers has been arranged for all staff with an external agency in December 2006. Training records showed that every three years an external training provider delivers training to all staff on moving and handling, infection control, food hygiene, emergency first aid, health and safety and risk assessment. It is not clear whether staff who join the team at midpoints during the three year cycle are supported to attend external training in these areas at the start of their employment to ensure their knowledge and competence. Records indicated that a check of water temperatures in the home had been carried out on 21st August 2006 but there was no evidence to show that they had been tested the following week. The home’s accident and injury log was reviewed. This provided a record of all injuries or bruises sustained by service users. Body maps had been used to indicate the area of bruising but there was no description of the bruise to give further information about its colour and size. DS0000003991.V310386.R02.S.doc Version 5.2 Page 32 It was noted that the accident book in use at the home is of the old type and needs to be updated. There was evidence in a service user’s records that in March 2006 an ambulance had been called due to concerns about his health. The registered provider had not given notice to the Commission of this occurrence as required by the Regulations. DS0000003991.V310386.R02.S.doc Version 5.2 Page 33 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 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 3 33 2 34 2 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 2 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 2 X DS0000003991.V310386.R02.S.doc Version 5.2 Page 34 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. Standard Regulation Requirement The registered provider must ensure that the home’s Statement of Purpose and Service User Guide contains information about the use of the home as a day service for nonresidents and about the respite accommodation provided in the home. Records of the food provided for all service users must be in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory in relation to nutrition and otherwise. The registered provider shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home including: A review of the medication policy to ensure clarity and accuracy of information. The registered provider must ensure that the laundry area is risk assessed in terms of safety issues for service users. DS0000003991.V310386.R02.S.doc Timescale for action 1. YA1 4 and 5 30/11/06 2. YA17 17 (2) Sch. 4 31/10/06 3. YA20 13(2) 30/11/06 4. YA24 13 31/10/06 Version 5.2 Page 35 The registered provider must ensure that appropriate written references are received for all staff prior to their commencement in post. 5. YA34 19 Evidence must also be provided that any gaps or omissions in the employment history of prospective care workers have been explored at interview. The registered provider must ensure that all staff attend formal, accredited training in moving and handling and first aid as part of their induction. The registered provider must ensure that notice is given to the Commission without delay of any occurrence in the home where there is serious injury to or illness of a service user. 13/10/06 6. YA42 13 31/10/06 7. YA42 37 13/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard YA6 Good Practice Recommendations Individual plans should contain evidence of goal-setting processes that are personal and meaningful to the service user. Documentation should demonstrate how service users are being supported to achieve their goals and how progress is being evaluated. Service users’ rights should be recognised by ensuring that restrictions such as the practice of locking bedroom doors continue to be reviewed and carefully documented for each individual. The provision of meals for service users should be regularly audited to ensure they meet the needs of service users and provide adequate portions of fresh fruit and vegetables each day. Processed foods such as tinned ravioli and tinned DS0000003991.V310386.R02.S.doc Version 5.2 Page 36 1. 2. YA16 3. YA17 meatballs should be replaced with home-cooked alternatives. Where service users have specific dietary needs, menu plans should be developed and reviewed in conjunction with a dietician. The registered provider should ensure that staff know how to take recordings of refrigerator temperatures in which medication is stored to ensure accuracy. 4. YA20 Further accredited training in the administration of medicines should be provided to all staff who have responsibility for administering medication to service users. All staff should access formal, external training in adult protection from a qualified trainer who has expertise in this field. The registered provider should take appropriate action to ensure that the bedroom doors of service users have door handles so that they can be easily opened and shut. Refurbishment of bathroom facilities should be considered to ensure that they are in good repair and good decorative order. Service users should be consulted about whether they would like their names or a symbol / picture on their bedroom doors to promote ownership of their room. The job description for the home’s Housekeeper should be reviewed and updated to ensure that it accurately reflects her role and responsibilities. Ongoing review of the numbers, skill-mix and cultural composition of the staff team is needed to ensure that service users’ needs are met and that there are staff on duty at all times who can communicate with service users in their first language. The delivery of all training in the home should be reviewed to ensure that optimum use is made of external training courses for staff (for example total communication training) and that training resources used internally are up-to-date and relevant. Staff should receive training from people who are suitably qualified and competent to undertake this role. The annual development plan for the home should be reviewed to ensure that plans for any development are based on the views of service users and their representatives. DS0000003991.V310386.R02.S.doc Version 5.2 Page 37 5. YA23 6. YA24 7. YA31 8. YA33 9. YA35 10. YA39 The registered providers should familiarise themselves with the Regulatory Reform (Fire Safety) Order 2005 which is due to be introduced on 1st October 2006. Fire safety training should be provided by a person who is suitably qualified and competent to do so. 11. YA42 Water temperature checks should be monitored and recorded on a regular basis. Incident and accident reports should contain sufficient detail so that, for example, the size and colour of bruising is recorded in addition to the site of the bruise. The registered provider should ensure that the accident book used by the home is of a type that is currently recommended by the Health and Safety Executive. DS0000003991.V310386.R02.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 DS0000003991.V310386.R02.S.doc Version 5.2 Page 39 - 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!