Inspection on 18/09/07 for Tate House - RNIB

This inspection was carried out on 18th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Tate House - RNIB 24/08/06

Tate House - RNIB 09/02/06

Tate House - RNIB 01/12/05

Tate House - RNIB 21/03/05

Tate House - RNIB 08/02/05

Tate House - RNIB 06/02/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Tate House - RNIB Tate House 28 Wetherby Road Harrogate North Yorkshire HG2 7SA Lead Inspector Denise Rouse Unannounced Inspection 10:30 18 September 2007 th 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 Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tate House - RNIB Address Tate House 28 Wetherby Road Harrogate North Yorkshire HG2 7SA 01423 886927 01423 885192 lisa.rushton@rnib.org.uk 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) Royal National Institute for the Blind Mrs Lisa Caroline Rushton Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (10), Sensory impairment (39), Sensory of places Impairment over 65 years of age (39) Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24/08/06 Brief Description of the Service: Tate House is a care home that is run by the Royal National Institute for the Blind People. The home is registered to provide personal care for up to thirtynine people who have a visual impairment, and those requiring personal care. The home is situated on Wetherby Road, which is one of the main roads leading into Harrogate, and therefore is close to the local amenities of Harrogate town centre. Regular bus services run and there is a bus stop close to the home. Fees charged on 18/09/07 ranged from £ 426.63 for social services funding to £510.00 per week for a larger bedroom on the first floor. Additional charges are made for the barber, Hairdressing, beauty therapy, and private chiropody. A copy of the last inspection report is available in the “ Welcome Pack” which contains a summary of the services the home provides. This information is personalised for each individual and is available in different formats such as audio, Braille and Moon. Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The accumulated evidence used in this report has included: • A review of the information held on the home’s file since its last key inspection. • Information submitted by the registered provider in the Annual Quality Assurance Assessment. • Surveys received from four people residing at the home, four relatives and one general practitioner. • An unannounced visit to the home, which lasted four hours and twenty minutes. This included a full tour of the premises. • Evidence gained by direct observation during the site visit; talking with five people living at the home, the manager, and ten staff. • Inspection of records, including care profiles, medication administration records, staff files and some of the homes policies and procedures as well as the “Welcome Pack”. What the service does well: Assessment’s of peoples needs are very thorough and include details of risks which people wish to take to maintain their independence. The home provides an excellent “ Welcome pack” in the preferred format for each person, so that they know about what services the home has to offer them. A good range of activities is provided which meets the social needs of people living there. People said they received care in a way that respected their privacy and dignity. They also said “ The food is good”. The home has made excellent adaptations to the environment so that it helps the people who are visually impaired. One person said “I really like it here. There is a nice atmosphere, and it’s easy to find your way around, there are different textures on the floor, and handrails and talking tapes machines also help. Press it and it tells you exactly where you are. The grounds are excellent, Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 6 with not being able to get out on the road, and the garden track with hand rail allows exercise to be taken, and it really is excellent”. Staff induction and training is thorough and includes information about specific needs relating to poor sight, and the care that people with sight problems require, so that staff can meet these needs. A robust complaints procedure is in place to ensure that any concerns raised are investigated and dealt with thoroughly. The service is monitored in relation to the quality of service being provided to people, to ensure that the standards of service are maintained. Checks are carried out regularly to make sure the high quality of care is maintained. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 (6 not applicable) People who use this service experience excellent quality outcomes in this area. People are thoroughly assessed prior to being admitted to ensure their needs can be met. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Competent staff undertake an assessment of people’s needs. These are thorough, and include information about family, medical history, sensory impairment and social preferences. This ensures that people’s needs are known and that they can be met. Information is gained from hospitals and care management to ensure a full picture of the person’s needs is obtained. All areas of potential risk are identified in great detail and action taken to ensure people’s safety is very well documented, whilst allowing people to maintain their independence. Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 9 Assessments can be undertaken when people visit the home to spend time there to see if they like it. People are offered short and long term placements, as well as a trial period. They can experience the service, and make a decision about if it is the right place for them. A “Welcome Pack” is given to each person. This contains a photograph of the home and information about the specialist services it provides for visually impaired people. This is available in a variety of formats, such as audio, Braille, tape, compact disc, and Moon. It is individualised for each person’s special needs. The service user guide and statement of purpose is also personalised in this way. This ensures that people have all the information about the home in a format they can understand. One person stated, “I knew someone who was coming here. They spoke very highly of the home, so I came for a day. I liked the feel, informal, homely and friendly. Frankly I thought it was rather nice, so I decided to come in as a resident. I tried a trial period, and now will stay permanently”. Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 8 9 10 People who use this service experience excellent quality outcomes in this area. People’s health and personal care needs are well met and individual’s are treated with dignity and respect. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Care plans are very detailed and include information about mobility, continence, mental assessment and sensory deficit or impairment. This information is also used to create very detailed risk assessments, which are personalised and specific to each individual’s visual impairment. They detail how they can be supported to maintain their independence. People can choose to take risks and staff support them in these choices. Care plans and risk assessments are reviewed each month. People are asked to take part in these reviews, and some are able to sign the documentation, this is good practice as it allows people to say what is important to them. Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 11 Staff address people by their preferred name and all are treated with dignity and respect. People can see their General Practitioner in private. Staff are available to escort people to Hospital and optician’s appointments. One district nurse spoke highly about how people at the home are supported. Stating “ The home is so well organised. Any problems they ring me for advice over the phone. Dressings are ordered. It works like clockwork, and I enjoy coming here. They are very good at alerting me about potential problems, and anticipating problems. They provide good training in pressure area care, and I help with training when asked. If a review is to be held I am asked to attend”. Medication practices are correct and this ensures that people’s safety is promoted. People are encouraged to self medicate and are assessed to ensure they are safe to do so; this again helps people to be in charge of their own lives. Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 13 14 15 People who use this service experience good quality outcomes in this area. People are able to follow their chosen routines, and they receive a nutritious diet. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: People are happy with the activities available to them, which met their social needs. A programme of activities, which includes outings, boards games, arts and crafts is provided. Information is displayed and recorded onto people’s talking notice boards so that they are aware of what is available to them. Before lunch people are invited to take part in some gentle exercise, which helps to maintain their health and assists in the prevention of falls. The activities co-ordinator and 12 residents were out for the day at Skipton. One person said “ I went to Bridlington on a trip, two or three weeks ago. There is always something going on. If you are bored in here it’s your own fault”. Clergy visit as required, and monthly Holy Communion is held. A hairdresser and barber visit the home. A beauty therapist is available by request and provides a full range of beauty services. Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 13 Visitors are welcome, one person said, “I get a few visitors, and they can visit whenever they like”. People are able to go out for walks in the secluded attractive garden, which is suitably adapted with handrails and easy access doors to maintain peoples independence. Others go out into Harrogate either independently or with staff. The home has an activities lounge, which is well equipped, with percussion instruments and talking books. A computer room is available with a talking computer, a magnifying reading machine and a conventional computer for people to use. One person said, “ the computer room is excellent, I use it everyday”. People made beautiful pasta textured paintings for the reception walls; other paintings created by people who use the service are displayed throughout the home. The kitchen is clean and tidy. The meal looks nutritious and appetising. One person said, “ The food is good”. A variety of plates, dishes, special cups and cutlery are provided to assist people to maintain their independence at mealtimes. A talking menu is available as well as the menu being displayed in the welcome pack and on the dining room door. It is also included on each person’s talking notice board in their room these all help people to be aware of the choices available to them. The dining room is laid with coloured cloths to enhance the presentation for visually impaired people. Cloth or paper napkins are available whichever people preferred. Tip sugar dispensers allow people to sweeten their own drinks. People who require assistance with feeding are assisted discreetly. People request whatever size portion of food they require. Special diets are catered for and home made cake and biscuits are available. One person said “ I had a lovely piece of meat for lunch” others said, “The food is far too nice. I have put on half a stone. The main cook is out of this world, if you want biscuits for your room you can have them- no problem”. Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 18 People who use this service experience good quality outcomes in this area. People are protected from abuse and their complaints are listened to and dealt with properly. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The complaints procedure is available to people within the home in different formats. The manager has an open door policy and documents any issues raised as well as the outcome of action taken, to resolve any issue brought to her attention. People are encouraged to express their views. One person said “ Coming to Tate House has been a totally positive experience, I feel safe and secure here”. Another said “ I would feel comfortable speaking to the manager, or staff if I had a complaint”. There have been two complaints made since the last inspection. Issues raised are investigated properly and corrective action taken. This is well documented and people are informed of the outcome of their complaint. Staff receive training in Safeguarding Adults. Speaking with staff confirmed that they understood the importance of protecting vulnerable people from possible abuse. Pre employment checks are thorough and staff are not allowed to commence work at the home without these checks being done. This prevents staff that Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 15 may not be suitable to work in the care industry gaining employment at the home. Good recruitment practices contribute towards keeping people safe. Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 26 People who use this service experience excellent quality outcomes in this area. People live in a well maintained home, which is specially adapted to help people maintain their independence. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Access to the home is secure to prevent unauthorized people entering the home. People have their own post-box in reception, and a payphone booth is available for people to use if they did not have their own private phone in their bedroom. The home is bright, spacious and airy. A lot of thought has gone into how the home is adapted to assist visually impaired people maintain their independence. This is done by the use of textured flooring, hand rails, and textured and colour coded walls. There is tactile flooring at each corridor junction as well as a speaking guide to ensure people can find their way Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 17 around. Laundry and cleaning trolleys have“ bleepers” fitted to them. The noise alerts people that trolleys are in the corridor. A talking lift allows people to gain access to the first floor. Signage is provided for people in Braille to aid communication. Automatic door opening systems assist people to move freely through the home and gain access to the garden. Automatic door closures on bedroom doors are fitted to help protect people in the event of a fire. The service really appreciates each person’s special needs, and makes sure that adaptations are in place to ensure their health and safety. People can lock their own bedroom door if they wish to maintain their privacy. Each bedroom door has a large number, at mid height so that people can feel this to help them establish which bedroom is theirs. Also a talking notice board containing individualised information about activities, appointments and menus; to ensure people are kept fully informed. People can choose how they want their bedrooms laid out to assist them to maintain their independence and safety. A nurse call system is available throughout the home to ensure people can gain prompt attention. Accommodation is adapted for married couples to allow them to continue living their chosen lifestyle. A variety of lounges are available, including a small smoker’s lounge, and activities lounge. There are two separate dining areas. Upstairs there is a small kitchen area with a talking microwave for people to make themselves drinks and snacks. The grounds are well kept; one internal patio area has raised flowerbeds with scented colourful plants to stimulate people’s senses. A new summerhouse has been provided and is used for activities. Peoples preferred laundry days are respected. The laundry lady said, “ We provide a person centred approach to work”. Laundering systems prevent the risk of cross contamination. Hand washing facilities are available throughout the home, to help reduce the risk of the spread of infection. Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27 28 29 30 People who use this service experience good quality outcomes in this area. People are looked after by well trained, and knowledgeable staff, however staff felt under pressure at times. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: Staff provide individualised care specific to each person’s special needs. Robust recruitment procedures are in place. Interview set questions are used and candidates’ responses are documented. References are obtained and Criminal Records Bureau checks are undertaken to ensure that people are looked after by staff that are suitable to work in the care industry. People living at the home had confidence in the staff. One person said “ Staff are very friendly, there’s nothing stand offish about them. They respect my privacy and dignity. I can have a nice soak in the bath. They are there if I need them”. People said, “ I think on the whole staff are nice and are good at their jobs”. Also “ staff are very friendly, so professional, they get on with what they are doing, if you are passing they have a word with you”. Upon speaking with four members of care staff issues were raised about staff feeling under pressure by covering sickness, absence and holidays, on care as well as other departments. Staff said the manager listened to their views and was trying to resolve this by looking at the staffing levels and skill mix provided within the home. Staff expressed concerns that although they felt the Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 19 manager listened and was very supportive, staff felt under pressure due to increased client numbers and they felt there was not enough quality time to be spent with individuals. Upon inspecting the rota, extra staff were not on duty at peak times of activity. One comment received was “Staff time is often short, as so much effort is having to be put into paperwork. It would be good if there could be more opportunity to mix, chat and generally give us more mental and social stimulation”. These issues were discussed with the deputy manager. She is aware that staff fell under pressure. It has also been highlighted in the homes own survey, carried out to get peoples views. Management is looking at how key worker time can be organised in the morning and afternoon, to ensure that each person receives quality one to one time with staff. More staff are also being recruited to ease the pressure of work. Staff supervision and a yearly appraisal is undertaken to ensure staff receive the support they need, as well as any training that may help them carry out their work. Induction training is provided to all new staff and includes information about safe moving and handling techniques and abuse awareness. Information about specific issues relating to poor sight is also provided to help maintain people’s health and safety. Training is provided for all staff. Individual training records are kept, as well as a training matrix. Staff are encouraged and supported to undertake their National Vocational Qualification in Care at Level two or three. Over 50 of staff hold this qualification. This ensures that staff have knowledge, which helps them provide good care to people living at the home. Regular staff meetings are held so that the views of staff are listened to and acted upon. Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31 33 35 38 People who use this service experience good quality outcomes in this area. People can be assured that the home is well managed, and their health and safety is protected. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The manager is newly appointed but has a wealth of experience from working at Tate House for many years. An open door policy is adopted, people say she is approachable and they feel comfortable speaking with her. Quality assurance systems are in place. This includes carrying out surveys twice a year of people who live there, their relatives, health care professionals and local clergy. The results of this are made available to people and any shortfalls are acted upon. Monthly audits take place to ensure each Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 21 department is performing well. The senior management team visit the home and support the manager. Resident and relative meetings are held, however these are not always well attended and the manager is going to ask people what dates and times may be more suitable to gain better attendance. A copy of the minutes of these meetings is sent to everyone in the home, to ensure that people are kept fully informed. Personal allowance account balances are correct and receipts are kept of all transactions to ensure people are protected from financial abuse. Health and safety checks and general maintenance is routinely undertaken to ensure that people are kept safe. Monthly checks made on hot water temperatures provided in peoples bedrooms are undertaken, however adjustments required are not routinely recorded. This should be addressed. Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 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 4 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 23 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 Timescale for action 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 OP27 Good Practice Recommendations Management should review staffing levels and skill mix to ensure that staff are not placed under pressure, Management must consider how extra staff could be provided at peak times. Management must look at how key worker time could be provided. Hot water temperature adjustments undertaken should be recorded. 2 OP38 Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tate House - RNIB DS0000035128.V343652.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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