Inspection on 17/07/06 for The Avenue (44)

This inspection was carried out on 17th July 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Avenue (44) 12/07/07

The Avenue (44) 17/10/05

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 The Avenue (44) 44 The Avenue Watford Hertfordshire WD17 4NS Lead Inspector Mrs Jan Sheppard Key Unannounced Inspection 17th July 2006 10:00 The Avenue (44) DS0000065463.V303434.R01.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 The Avenue (44) DS0000065463.V303434.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 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. The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Avenue (44) Address 44 The Avenue Watford Hertfordshire WD17 4NS 01923 226946 01923 212546 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) CareTech Community Services (No.2) Ltd Care Home 8 Category(ies) of Learning disability (8) registration, with number of places The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th October 2005 Brief Description of the Service: 44 The Avenue is a large detached house, located close to the centre of Watford. The registered provider is Caretech Community Services Ltd. On the ground floor there is an entrance hall, lounge, three single bedrooms, bathroom with toilet, kitchen, dining room and a utility room. There are five single occupancy bedrooms on the first floor, a bathroom and two separate toilets. There is also a second floor that is used to provide an office, sleep-in accommodation, bathroom and kitchen. The second floor is used exclusively by staff. There is a small front garden, larger rear garden and off-road parking. The home provides care and services in a safe environment for 8 residents who all have learning disabilities. The fees which are determined according to the level of care need range from £824 per week. The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The homes new manager is Mr. Jason Cox. His application for registration is currently being made to the Commission. This was the first unannounced key inspection and took place over one day. All the staff on duty and the residents who were at home were spoken with or communicated with in whatever manner they could understand. Discussions were held with the homes manager and deputy manager who were both working in the home on the day of this inspection. The comments in this report reflect the findings made by the inspector during this visit and also take account of information and reports that are periodically sent to the Commission by the homes manager. No concerns have been raised with the Commission by relatives or other health or social care workers since the last inspection. Twenty two standards were examined during this inspection. The recommendations made during the last inspection have been met or are in the process of being met. Four requirements are made following this inspection. What the service does well: What has improved since the last inspection? What they could do better: The planned improvements to the homes environment must be fully carried out. The improvements already identified to be made to the homes recording systems must also be completed. The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 6 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 Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 7 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 The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 8 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): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has policies and procedures that meet the requirements of these standards concerning the needs assessment of new residents and appropriate visiting arrangements for their gradual introduction to the home. The home has an up to date Service Users Guide and Statement of Purpose. EVIDENCE: No new resident has been admitted to the home since the last inspection. As the last new admission to the home was in 1994 it was not possible to review any recent evidence to support these standards. However the deputy manager discussed with the inspector the admission procedures as she understood them and as she had had experience of in a previous home and thereby demonstrated her sound understanding of these standards. 44 The Avenue is registered to accommodate 8 residents but there is an agreement with the funding authority to maintain the number of residents at the current level of 7. One of the service users is over 65 years of age and this is reflected on the certificate. The homes Service Users Guide and Statement of Purpose have recently been updated so as to accurately reflect recent staff changes in the home. The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 9 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 good. This judgement has been made using available evidence including a visit to the service. The home maintains detailed individual care plans for each resident which were seen to reflect personal needs and aspirations. The key worker and care planning systems in place support the rights of the service users to be involved in making choices about their own lives. The well being and safety of the service users in the home and while out in the community are supported by risk assessments. EVIDENCE: The seven residents in this home range from 37 to 67 years of age. They have all lived together since the home opened in 1994. Previously most of them had also lived in a long term hospital setting. The care plans examined were found to be well kept with good detail as to how care needs should be met, to have a regular pattern of review and to contain risk assessments. Referrals were seen to be promptly made for special Consultant assessment to meet changing care needs or where deterioration The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 10 was noticed in a residents health. The care plans were noted to give good mention as to how staff should approach meeting the needs of the residents in a manner which encouraged them to develop and maintain their own skills and potential. The home appeared to be well focused on enabling the residents to express their needs and wishes through the recently introduced Talk-Time meetings held individually with each resident. See comments in Standard 19 for detail of this. The activities that the residents engage in both within the home and in the wider community are supported by risk assessments. These assessments cover health and behavioural related issues with supporting information for staff on triggers that may indicate when preventive measures are needed to avoid problems. The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to the service. The residents day centre and attendance at other activity programmes offer them the opportunity for personal development and recreation alongside peers of a similar age and ability. Weekend and evening events in the local community are also enjoyed. Staff offer support to service users in maintaining links with family and friends. The home offers a nutritious and varied menu chosen by the residents which offers fresh ingredients and home cooking on a daily basis. EVIDENCE: All the residents have their own planned day care activity programme devised to meet their individual needs and interests. For six of the residents this involves leaving the home to attend one of seven day or work centres whilst for the seventh resident to meet their particular needs, an in-house The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 12 programme organised by the “Life-Enhancers” organisation is provided. Several of the residents arrived home from their day activities during this inspection and they, with staff assistance where needed, told the inspector what they had been doing. It was noticeable how they quickly settled back into the home having a cool drink or requesting a shower as the day was very hot. One resident went to the kitchen to help with meal preparations this aspect being of particular interest to them. The menus are planned weekly in full consultation with the residents and some residents help the staff do the weekly shopping. On the day of this inspection various residents were heard to request particular dishes more suitable for the hot weather and an additional shop was arranged to meet these requests and to obtain extra supplies of juices to meet the extra demand for drinks caused by the prolonged very hot weather. The home receives a visit from a Dietician every four to six weeks , she supervises the menus to ensure that a healthy eating format is being followed and monitors the residents weights. All the residents are taken on a staying away holiday for which appropriate risk assessments were seen to have been completed. Four residents who recently enjoyed time staying in Wymouth did so much walking during the holiday that they lost weight. The home provides a regular weekend activity programmed in the local community with many requests for visits and outings being made by the residents for visits during the summer months including trips to London and to the coast. The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 13 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 the service. Personal care and health care is offered to the residents in an individually planned manner so as best to meet their needs. Specialist assessments are arranged for residents whose care needs change. The home has a robust medication storage and administration system. EVIDENCE: Care and assistance was seen to be being delivered in a calm and kindly manner with emphasis being given to enabling the residents to do as much for themselves as it is safely possible for them to do. Staff were seen to communicate with individual residents using a language and methods which they understood. The home operates a key worker system and it was noticeable how residents had a particular bond and confidence with their own key workers. The home has recently introduced a new individual “ TalkTime” session for each resident and records of these discussions evidenced how the residents wishes were being listened to and where possible acted upon. The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 14 The homes medication storage and administration system was found to be well maintained with accurate Medication Administration Records (MAR) sheet administration records. Staff who administer medication have received the appropriate training. The manager should establish a system of evidencing when he has carried out management checks concerning the accuracy of these records. Information concerning the residents wishes about their care during a final illness and arrangements after death, where these can be ascertained, were seen to be recorded on their care plans. The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 15 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 and including a visit to the service. The home has a robust complaints procedure and follows the Adult Protection Procedures as set out in the Hertfordshire County Council Joint Agency Guidelines. The welfare and protection of the service users is supported by CareTech policies and procedures, reporting and investigation of incidents and supervision of staff. A recommendation made at the last inspection that staff should receive refresher training concerning Adult protection has not yet been fully met. EVIDENCE: There have been no complaints nor incidents concerning Adult protection since the last inspection. The manager explained that comments made by a neighbour about noise in the garden had been promptly dealt with in a manner which maintained the homes good relations with their neighbours in this residential area. The Hertfordshire multi-agency procedures for the Protection of Vulnerable Adults were seen to be accessible for staff in the home and this subject had been discussed at a recent staff meeting. However the recommendation made at the last inspection that staff should attend a refresher training on this subject has not been fully met. A requirement is made. The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 16 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 and including a visit to the service. The home which meets the space and environment requirements of this standard was found, on the day of this unannounced inspection, to be fresh and clean and to have a planned and routine maintenance programme in place. Some identified areas needing maintenance and improvement remain outstanding and several additional requirements were noted during this inspection. The home has a good awareness of the need to prevent cross infection. There are suitable systems in place to manage residents laundry hygienically although one lapse in procedures was noted. See detail in standard 42. One additional fire safety measure is recommended to ensure full safety of the home. Overall the home provides a pleasant, comfortable, safe and homely environment for its residents. Maintenance of this environment to a good standard in all areas must be kept up. The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 17 EVIDENCE: Since the last inspection a number of measures to improve and maintain the environment to an acceptable standard have been completed and others are planned. The stairs and first floor landing areas along with one bathroom have been redecorated and a programme of regular professional carpet cleaning has commenced. The new manager shared with the inspector the list of maintenance items that he had identified and an anticipated time frame in which these works would be completed. During this inspection the following additional areas where improvements are still needed were identified. a) The bedroom of resident “C” needs to be redecorated to have improvements made to the very stained wash hand basin and to have a bedside lamp provided. b) Discussions should be had with resident “D” whose bedroom floor was covered with possessions as to whether this is because of a lack of shelving or suitable storage facilities in their room or is because they just prefers to live in such a way. c) The curtains in the main lounge which were worn and falling down need to be repaired and refitted. d) The sofas and one specialist chair in the lounge are worn and dirty giving a tired and unkempt appearance to the lounge. They should be repaired and cleaned or replaced. e) Works to complete the refitting of the kitchen, ( measurements have already been taken and the required furniture and fittings ordered), must be completed. f) To ensure adequate fore safety in all areas of the home a fire detection system should be installed in the storage cupboard in the stair well. g) The basin in the bedroom of resident “R” is badly stained and should be cleaned or replaced. h) The bedroom occupied by resident “K” requires redecoration and the wash basin needs to be de-scaled. This bedroom has no bedside lamp. The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 18 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): 32,34 and 35. Quality in this outcome area is adequate. This judgement has been made using available evidence and including a visit to the service. The home has a consistent staff group and the numbers of staff are sufficient to meet the needs of the residents. Staff are experienced and many are qualified. They are well supported by their managers. One minor omission was found in the recent staff recruitment paperwork. EVIDENCE: Staff training is given good priority in this home. All staff have a training needs profile compiled during their regular supervision and support meetings and since the last inspection courses on Epilepsy, Dementia, Report writing, Restraint Technique, Quality Assurance and Supervision and Appraisal have been attended. Staff supervision meetings are arranged monthly for full time staff and bimonthly for those who work part time. Adequate records of these meetings are kept. The manager is currently studying for the Registered Managers award, the deputy manager has NVQ at level 3 and three care workers have already attained this qualification at level 2. Two further care workers told the inspector that they were to commence this course in the autumn. The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 19 All the staff spoken with said that they were well supported by the homes managers that they attend regular supervision and support meetings and in addition, being a small home where staff work closely together there is always good opportunity to consult with colleagues when ever the need arises. Senior staff who carry out staff supervision have all undertaken the appropriate training for this role. The homes records evidenced that monthly staff meetings are held in which staff freely participate and suggest agenda items. The manager discussed with the inspector his own agenda of introducing different topics for training and clarification during these staff meetings. Recently such subjects have included the reasons for regulation 37 notices, the importance of Riddor accident reporting and a discussion of Adult Protection awareness especially with residents who have little or no speech. The home currently has one full time and one part time care worker post vacant and the records relating to the recent attempts to recruit to fill these vacancies evidenced that the home recruitment procedures followed the companies policies and with one minor exception protected the safety of the service users. References were always taken up but these had not always been validated by an official stamp from their originating company. Where agency staff are used to cover staffing shortfall these workers are all well known to the residents undertake an in house introduction training and are never expected to take on a senior role in the home. One agency staff member who spoke to the inspector explained that she had been working regularly in the home over past months and had got to know the residents and their care needs well, she explained that she was part way through her professional nursing training. The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 20 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 is based on evidence received and includes a visit to the service. The home has an experienced and well qualified manager and a stable staff group. The records are adequately maintained so that health and safety of the service users is assured. One area for improvement concerning infection control was noted. The home has a quality assurance process. EVIDENCE: Since the last inspection the homes manager was promoted to another post within the company and the deputy manager was appointed into the managers role. He is an experienced and well qualified worker who has previous experience working as a small home manager and who has the benefit of already knowing the residents at 44 The Avenue. He is currently undertaking NVQ level 4 training, the registered managers award, and has made application to the Commission for Managers Registration. On the day of this The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 21 unannounced inspection the home was calm and staff and residents appeared settled and happily going about their business despite the great heat of the day. They seemed familiar with the routines of the home which appeared to be working smoothly. The home achieved 95 at the last Quality Assurance Audit carried out by the company in June. The company regularly send out quality testing questionnaires to service users, relatives and stakeholders in the home. A number of the records were examined and were found to be well organised and adequately maintained giving better protection to the health safety and welfare of the service users. Although staff demonstrated an awareness of the required infection control measures adequate supplies of disposable gloves and aprons were seen to be freely available throughout the home, to ensure full protection red bags should be used for all foul linen when washed on a sluice cycle. The Avenue (44) DS0000065463.V303434.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 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 X 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 X 32 3 33 X 34 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 2 X The Avenue (44) DS0000065463.V303434.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. 1 2 3 Standard YA42 YA34 YA24 Regulation 13 (3) 17 (2) & 19 (1) (b) 23 (2) (b) & (d) Requirement Red bags must be used for the washing of all foul linen this to ensure full infection control. To ensure the residents protection references for new staff must be fully validated. To maintain a good standard of maintenance requirements for repair or renewal are made concerning 8 areas of the home. See the account in this standard for the detail of these requirements. To ensure full safety for the building a fire detection system must be installed in the linen storage cupboard in the stairwell. POVA training updates must be arranged for all staff in the home. Timescale for action 31/08/06 31/08/06 28/02/07 4 YA24 23 (4) (a) 23 (4) (c) (i) 13 (6) 31/08/06 5 YA23 30/12/06 The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard YA23 YA23 YA24 YA24 YA24 YA37 Good Practice Recommendations Identify frequency of POVA training updates for all staff. Manager to consider attending Hertforshire County Council training on multi-agancy policy as update. Programme flexibility into the maintnence and renewal plan for next year to enable the manager to have the bedrooms decorated while the residents are on holiday. Provide CSCI with a programme to upgrade the kitchen and replace the damaged work surface and tiling by the sink. Provide CSCI with a programe to upgrade the bathroom fixtures fittings and tiling. The manager has agreed to update CSCI on succesful completion of the final module of the Registered Managers Award. The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 The Avenue (44) DS0000065463.V303434.R01.S.doc Version 5.2 Page 26 - 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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