Please wait

Please note that the information on this website is now out of date. It is planned that we will update and relaunch, but for now is of historical interest only and we suggest you visit cqc.org.uk

Inspection on 12/03/07 for Thamesbrook

Also see our care home review for Thamesbrook for more information

This inspection was carried out on 12th March 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Thamesbrook is a well managed home that provides a high standard of care to older people, the majority of whom have complex needs. Staff at all levels are encouraged in their professional development, resulting in an experienced and competent team that delivers person-centred care. Feedback from relatives shows a high level of satisfaction with the service provided at Thamesbrook and confidence in the staff, with comments such as `wonderful care` and `the care that is taken of my mother could not be better`. Records are well-kept and the detailed care plans reflect staff`s in-depth knowledge of service users` needs. Attention is made to all aspects of the service including the environment, which is attractively decorated and in a good state of repair. The gardens, which are used by service users in warmer weather, were coming into flower with spring bulbs and plants at the time of the inspection. The nutritional needs of service users are given a high priority, with careful monitoring where there are concerns. All food is freshly prepared by the Chef and his team who visit the units daily. Service users are supported to maintain their interests and to take part in regular community activities, including attendance at church, day centres and clubs.

What has improved since the last inspection?

There were no requirements from the last inspection.

What the care home could do better:

While there are no requirements from this inspection, the staff team was supplemented by a higher than usual number of agency staff, as the Manager had been unable to appoint to vacancies for more than six months, while posts were held for possible redeployment from a service that was closing. Although there was no evidence that the standard of care was being compromised, staff commented on the frustration of having to constantly induct new staff. There were 10 Care Assistant vacancies at the time of the inspection.

CARE HOMES FOR OLDER PEOPLE Thamesbrook Royal Borough of Kensington & Chelsea 2 Dovehouse Street Chelsea London SW3 6LA Lead Inspector Sheila Lycholit Unannounced Inspection 12th March 2007 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Thamesbrook DS0000033393.V332445.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. Thamesbrook DS0000033393.V332445.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Thamesbrook Address Royal Borough of Kensington & Chelsea 2 Dovehouse Street Chelsea London SW3 6LA 020 7352 1004 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 Borough of Kensington & Chelsea Mr Peter Donkin Care Home 56 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (36) of places Thamesbrook DS0000033393.V332445.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Nursing beds are jointly funded with Kensington and Chelsea Primary Care Trust. 24th February 2006 Date of last inspection Brief Description of the Service: Thamesbrook is a modern nursing home located in a residential area just off the Kings Road in Chelsea, which is run by the Royal Borough of Kensington and Chelsea. The home provides accommodation for up to 56 older people in five units over three floors. Two of the units are for people with dementia who do not need nursing care. There are three units with nursing. In addition there is a 4 place rehabilitation unit. All bedrooms are single rooms, which are of a good size and have en suite shower rooms. Externally there are very well maintained and attractive gardens to the side and rear of the home and a sheltered first floor patio. Thamesbrook is close to two tube stations and to frequent bus routes on the Kings Road. Limited on-site parking is available. Thamesbrook DS0000033393.V332445.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection visit took place on Monday 12th March 2007 from 10.30AM until 5.45PM. The Manager, who had completed a pre-inspection questionnaire, made himself available throughout the visit. In addition to the Manager, the Inspector met with the Dementia Care Team Leader and two Registered Nurses/Team Leaders. A number of other staff and one visitor were spoken with during the visit. The Inspector spoke with two service users in private and observed part of the lunchtime in one of the dementia care units. The visit included a partial tour of the building. What the service does well: What has improved since the last inspection? There were no requirements from the last inspection. Thamesbrook DS0000033393.V332445.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Thamesbrook DS0000033393.V332445.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 Thamesbrook DS0000033393.V332445.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): 1, 2, 3, 4, 5 and 6 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Comprehensive information about the service is clearly presented and available in a range of formats. There is an established admissions procedure, including a trial period. The rehab. unit has been successful in helping the majority of service users referred to regain their independence and to return home. EVIDENCE: There is an up to date statement of purpose and well written service user’s guide, which contain comprehensive information about the home, including the philosophy of care and the complaints procedure. Both documents are regularly reviewed. The current fees are from £864 to £990 per week. Service users’ files looked at during the inspection contained copies of a licence agreement. Information about the terms of residence is also included in the service user’s guide. Thamesbrook DS0000033393.V332445.R01.S.doc Version 5.2 Page 9 The file of one service user who had been recently admitted contained a range of information. Records showed that staff were undertaking a comprehensive assessment using the home’s established procedure and had drawn up an interim care plan. Thamesbrook has a 4 place rehab. unit, which has a range of facilities including a gym and where service users have access to a multi-professional team. The Manager explained that the service is currently under review to ensure that there is no duplication of services in the area and that the service meets the needs of older people in the Borough. The Inspector recently met a service user at another home who had been in the rehab unit and who spoke highly of the help and support she had received. Thamesbrook DS0000033393.V332445.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): 7, 8, 9, 10 and 11 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Care plans are detailed, thorough and regularly amended and updated. Service users’ health care is given a high priority and staff work closely with health care colleagues in the community. Systems are in place to ensure the safe administration of medication, which is regularly monitored. Staff take steps to try to ensure that residents who are dying remain at the home and are cared for in accordance with their wishes. EVIDENCE: Three care plans, including one of a resident recently transferred from another home, were looked at on one of the dementia care units and four on a nursing unit. Staff use the ADL format for care planning. Care plans are detailed and comprehensive, covering all aspects of the person’s needs. Where little has been known about a service user’s background, attempts have been made to gather information from a variety of sources so that the staff team can better understand that person’s needs and find ways of supporting their communication. Each of the service users’ files contained a risk assessment Thamesbrook DS0000033393.V332445.R01.S.doc Version 5.2 Page 11 that was regularly updated and reviewed. One file did not contain a risk assessment for the use of bedside rails, though staff were clear about how these were to be positioned at night. Other files where bedside rails were used contained a detailed risk assessment. It is recommended that this assessment is included in the risk assessment form to ensure that it is not overlooked or misfiled. Senior staff regularly update care plans to reflect changes in the person’s condition. While the frequent updating of care plans is commendable, the numerous changes and additions written by hand can be difficult to follow and it is recommended that updated care plans are regularly printed off. Night staff complete the section of the care plan relating to rest and sleep. Steps are taken to minimise the disturbance to service users’ sleep by carrying out as many interventions as possible together, for example giving medication and changing pads at the same visit to the room. Service users’ wishes regarding monitoring during the night are included in the care plan. Registered Nurses are provided with opportunities to regularly update their training. Professional magazines and journals were seen on the units. Care plans and records show that staff work closely with health care colleagues to maintain service users’ heath. The Inspector was introduced to the local GP who visits weekly and more frequently if required. An excellent standard of maintaining good skin care has been achieved. Staff work with the tissue viability nurse to treat pressure sores and to prevent skin breakdown. The files of two service users who needed treatment for pressure sores and ulcers over a long period showed that sustained staff interventions and the advice of specialist health care staff had resulted in a huge improvement in their condition. Staff ensure that service users have access to health care services, including Podiatry, Physiotherapy, Dental Care, Audiology and hospital treatment where required. An Optician visits regularly. Procedures are in place to ensure the safe administration of medication. Medication is administered by the RNs on the units with nursing care and by Care staff on the dementia care units. Care staff receive training in medication as part of their induction and attend an accredited training course at Hackney College. Medication is securely stored. Discussion with the Manager and Team Leader show that the administration and recording of medication are monitored and action taken where errors occur. Two current MAR sheets on a nursing unit were looked at. There were gaps in the MAR sheet for one service user from the previous evening. The Team Leader said that he would be seeking an explanation from the RN when she came on duty that evening. During the inspection staff were observed to treat residents with respect and to take steps to protect their privacy and dignity. Particularly good staff Thamesbrook DS0000033393.V332445.R01.S.doc Version 5.2 Page 12 interventions were observed on the dementia care unit. All of the service users seen during the inspection visit were appropriately dressed in clean clothes, with attention paid to their appearance. Records show that staff regularly shop for clothes for service users where relatives are unable to do so. The Manager confirmed that the home’s policy is that residents who are dying should be cared for at Thamesbrook and not transferred to hospital. On occasions arrangements have been made for residents to be moved from hospital so that they could be cared for at Thamesbrook in their last days, by staff who know them. Detailed information about residents’ wishes regarding their spiritual needs, family and friends to be contacted and funeral arrangements are recorded on their care plans. Thamesbrook DS0000033393.V332445.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good support is provided to service users to maintain their lifestyle and interests and to retain contact with families and friends. A well managed catering service seeks to meet the nutritional needs of all service users, including the most frail. EVIDENCE: Records and discussion with service users and staff show that steps are taken to assist service users to maintain their interests. For example one service user who is a talented artist is provided with the equipment and materials to continue to paint. Several service users continue to attend day centres, including a group who go to the Pepper Pot in Notting Hill. A number of service users attend local church services, including Catholic, Anglican, Methodist and Russian Orthodox, often accompanied by staff. A multi-denominational service is regularly held in the home. Very positive feedback was received from families and friends who regularly visit the home. One visitor was spoken with during the inspection. She confirmed that she could visit at any time and was observed to be welcomed by staff and to appear at home on the unit. She commented on the high standard of care provided. Thamesbrook DS0000033393.V332445.R01.S.doc Version 5.2 Page 14 All meals are freshly prepared in the main kitchen on the ground floor. Each unit also has its own kitchen where drinks and snacks can be made. Staff confirmed that fruit and other food for snacks is collected from the kitchen daily. Care plans show that a nutritional assessment is carried out for all service users and referral made to a Dietician if necessary. Service users are regularly weighed and records show that staff have successfully maintained the weight of a number of service users whose weight loss was identified as a concern. Service users who are observed to have any difficulty in swallowing are referred promptly to the Speech and Language therapy Team for assessment. The lunchtime observed on one of the dementia care units was very well managed by the two Care Assistants on duty who, although very busy, made the meal a pleasant occasion for all the residents. A choice of dishes was available at the 3 course lunch. The Chef brought the trolley to the unit and explained what was on the menu. His Deputy returned later to check whether anything else was needed and to see whether service users were enjoying the meal. Staff supported service users to maintain their independence regarding feeding, although all required some assistance. Freshly laundered napkins and clothes protectors were in use. Staff sat down at the table and facilitated interaction between residents. The mealtime was relaxed and unhurried. Attention has been paid to purchasing china that is attractive and can also be managed by service users. Thamesbrook DS0000033393.V332445.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Thamesbrook has a well established procedure for handling complaints. Systems are in place to protect service users from abuse. EVIDENCE: Information about the complaints procedure is included in the service user’s guide, including the phone number of the RBKC complaint’s officer, whom service users and their relatives may contact directly. No complaints have been received since the last inspection. Training records show that staff receive training in safeguarding adults and copies of the multi-agency policies and procedures are available. There have been no adult protection referrals since the last inspection. Service users spoken with confirmed that they would feel free to raise any concerns with the Manager or Team leader. Thamesbrook DS0000033393.V332445.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): 19, 20, 21, 22, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The building is attractively decorated and maintained to a high standard. Bedrooms are well designed and sufficiently spacious for the specialist equipment that some service users need. A high priority is given to infection control, hygiene and cleanliness. EVIDENCE: Each unit is self-contained, consisting of single bedrooms, a sitting/dining room, kitchen, bathrooms, sluice room and office. All bedrooms are of above average size and have an en suite shower room. Bedrooms are well designed, with sufficient space for wheelchair users and specialist equipment. Additional bathrooms and lavatories are available on each unit. Bedrooms seen during the inspection were in a good state of decoration, with a range of personal Thamesbrook DS0000033393.V332445.R01.S.doc Version 5.2 Page 17 possessions. Beds, which are of adjustable height, were made up with freshly laundered good quality sheets and bedding. At this unannounced visit the home was clean, tidy and fresh smelling. A high priority is given to infection control, with steps taken to prevent cross infection. Senior staff ask for sight of lab results before admitting or re-admitting service users directly from hospital. The laundry has been rebuilt and has a range of equipment to meet the needs of the home. Thamesbrook DS0000033393.V332445.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager gives a high priority to recruiting and retaining a high quality staff team. Opportunities for professional development are made available to all staff. EVIDENCE: Rotas show that there are sufficient staff on duty, including night staff, to meet the needs of service users. A handover period between shifts is built into the rota. In discussion it was clear that the Registered Nurses value the contribution of the Care Assistants who are normally included in handovers. The Manager undertakes all recruitment checks except for CRBs, which are undertaken by the Department’s HR team. One staff file was seen that showed all checks had been made. A RN who had recently started at the home expressed his satisfaction with the induction he was receiving and commented favourably on the standards of practice that he had observed. The induction record of one of the Care Assistants was looked at, which showed that a comprehensive induction had been provided, including competency in administering medication. Action had been taken to address areas where the standard of competency had not been reached. The home has been prevented from recruiting to Care Assistant posts during the closure of another RBKC home to allow for the redeployment of staff. This has resulted in a higher use of agency staff than normal to cover the 10 Thamesbrook DS0000033393.V332445.R01.S.doc Version 5.2 Page 19 vacancies. Only 2 staff have transferred from the home that has just closed and the Manager is expecting the freeze on appointments to be lifted shortly. The files of two members of staff were looked at, which included notes of regular supervision and an annual performance appraisal. Records show that training is regularly discussed and action s taken regarding performance issues. Thamesbrook has an excellent record of staff training, with each RN having an individual training plan, which includes the opportunity to update qualifications with external training provided by King’s College Hospital. Care staff have all achieved NVQ2 or are close to completion. Several are enrolled on NVQ3. A number of staff have undertaken specialist training with the University of Bradford Centre for Dementia Care. Thamesbrook DS0000033393.V332445.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): 31, 32, 33, 34, 35, 36, 37 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Thamesbrook is a well managed home with a cohesive senior staff team. The Manager provides leadership to the team and takes steps to ensure that person centred care guides all of the home’s operations. Record keeping is of a high standard. The health and safety of service users and staff is given a high priority. EVIDENCE: The Manager, who has been in post for more than 10 years, is a Registered Nurse with extensive management experience and training. He is well regarded by colleagues working elsewhere in services for older people. He regularly up dates his knowledge and skills. He works closely with the Nurse Manager to provide leadership to the staff team. From discussion with staff it is clear that they are able to raise issues with senior staff and feel that they are kept informed about planned developments. Thamesbrook DS0000033393.V332445.R01.S.doc Version 5.2 Page 21 Staff talk confidently about their work and take pride in the person centred approach and high standards achieved by the team. A business and development plan is available for Older People’s Service’s, which includes Thamesbrook. The Service Manager visits at least monthly and completes a report on behalf of the provider. A large percentage of service users are subject to Power of Attorney. The Adult Social Care Finance Team manage the financial affairs of a number of service users. Thamesbrook’s Administrator also deals with financial transactions. Records of service users’ finances were not looked at during this visit. Recording is of a high standard. Policies and procedures are regularly updated. A variety of quality monitoring systems are in place, including management spot checks. Health and safety is given a high priority. All staff receive health and safety training, including refresher training. There is an on-site handy man who carries out minor repairs and checks the temperature of the hot water. The fire alarm is checked weekly and fire drills take place at least 4 times a year. The fire detection system is serviced quarterly. The RBKC Health and Safety Team visit regularly. The Manager receives copies from the units of all accident and incident reports, which he monitors as part of the home’s quality assurance system. Thamesbrook DS0000033393.V332445.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 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 4 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 3 3 4 3 3 Thamesbrook DS0000033393.V332445.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? 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. 7 7 Refer to Standard OP7 OP7 Good Practice Recommendations Consideration should be given to including the risk assessment for bedside rails into the service user’s main risk assessment form. While the frequent updating of care plans reflects staff’s good practice and attention to detail, it would be clearer if a new plan was regularly printed off where significant changes are made. Thamesbrook DS0000033393.V332445.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Thamesbrook DS0000033393.V332445.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!