Inspection on 11/10/05 for The Elms

This inspection was carried out on 11th October 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Elms 11/09/07

The Elms 27/10/06

The Elms 25/05/05

The Elms 19/10/04

The Elms 18/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Elms 2 Arnolds Lane Whittlesey Cambridgeshire PE7 1QD Lead Inspector Lesley Richardson Unannounced Inspection 11th October 2005 11:15 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 The Elms DS0000024301.V253441.R01.S.doc Version 5.0 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. The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Elms Address 2 Arnolds Lane Whittlesey Cambridgeshire PE7 1QD 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) 01733 202421 01733 205584 BUPA Care Homes (CFCHomes) Ltd Care Home 37 Category(ies) of Dementia - over 65 years of age (37), Old age, registration, with number not falling within any other category (37), of places Physical disability (2), Physical disability over 65 years of age (35), Terminally ill over 65 years of age (37) The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Two named male persons under 65 years of age with physical disabilities (PD) for the duration of their residency only Thirty five persons over age of 65 years with physical disabilities (PD(E)) for the duration of Condition 1 25th May 2005 Date of last inspection Brief Description of the Service: The Elms is a large converted and extended house, situated in a residential area close to the centre of the market town of Whittlesey. It provides care and support, including nursing care, for up to 37 older people. There are 29 single and 4 double rooms; 17 of the single rooms and 2 of the double rooms have en suite facilities. Resident accommodation is on two main floors, with two further split levels from the upper floor. The upper floor is accessible by stairs or lift, the split levels are accessible by stairs with chair lifts. There are a variety of communal areas available to service users, the smaller areas being on the upper floor. In additional to the en suite facilities there are 12 toilets and 5 bathrooms. All of the areas for communal use are accessible to service users with limited mobility. An enclosed garden surrounds the home and provides a safe environment for service users to enjoy the mature garden. The town centre of Whittlesey is a 5 to 10 minute walk from the home. The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 5½ hours and was carried out as an unannounced inspection on 11th October 2005. It was the second inspection of this home for the 2005-2006 year. Three hours were spent examining records and documents and two and a half hours were spent with service users and staff. A tour of the building was also undertaken during this time. The manager was present during the inspection. Six people who were living at the home and three of the staff on duty were spoken to during the inspection. Not all service users were able to express their views. Information given in a questionnaire completed by the manager before the inspection was also used in the report. What the service does well: What has improved since the last inspection? There has been improvement in 5 of the 10 areas the home was asked to improve during the last inspection. The manager or the head of care completes assessments for people who are considering coming into the home, and assessments completed by social and health care professionals are also obtained. This means the home knows whether it can properly look after the prospective service user before they enter the home. The availability of training for staff members has also improved and a proper matrix has been drawn up to make sure everyone has the health and safety training they need to keep people living at the home safe. Recording of medication administration has got better and there are now very few missed entries in the medication forms. The recording of reasons why medication has not been given is also being done, but if there is more than one reason for this it needs to be recorded so that it is still easy to see why the medication was not given. There have been small improvements in the overall décor of the home. Action has been taken to start repairing and redecorating areas that are very scuffed The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 6 and in disrepair. The entrance to the home no longer has an offensive odour and there are fresh flowers in the foyer, which means people walking into the home get a better first impression. The manager knows about the work that needs to be done and is making arrangements for this to be completed. Importantly, people who live at the home now say the care staff are polite and feel respected. There is a better feeling in the home and it does not have the oppressive feeling it had at the last inspection. What they could do better: The home still has some work to do to meet the required standards. All information in pre-admission assessments must be included in care plans and there should be better description so that care staff can make proper judgements about how best to care for someone. Recommendations made to refer someone living at the home to a healthcare professional must be followed through and recorded in care notes. If care staff do these things it will make sure that people who live at the home are given appropriate care. Although the home has an activities co-ordinator, there is little to show that activities organised are relevant to people who live at the home. Service users said they did not know about any activities organised. This must improve and the people who live at the home must be consulted about what they would like to do. The new manager was keen to change this situation and information has been provided since the inspection to show how this has been improved. Staff were able to say what abuse is and what they would do about it in the first instance, not all staff members have had training in protection from abuse. This is vital if people who live at the home are to be safe and staff members are to know local guidelines and what they should not do. There have been improvements to the environment in some parts of the home, but there are still areas that are health and safety concerns. All exposed pipe work must be covered if it cannot be guaranteed that it will stay under 43oc. Although some radiator pipes have been covered there are others that are uncovered. Stains around toilets should be removed as it is unsightly and a potential health risk. Receptacles where sharps, such as needles and razors, are disposed of must be secure to prevent people who live at the home coming into contact with them. This places people at risk of needle stick injury, which is potentially life threatening. One receptacle was found with an insecure lid in an area that would have been accessible by service users. The home has a new manager, who had been in post for 2 weeks at the time of the inspection. An application to register a manager must be submitted to the Commission for Social Care Inspection as failure to do so is an offence under the Care Standards Act 2000. Please contact the provider for advice of actions taken in response to this The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 A pre-admission assessment of prospective service users ensures the home is able to meet service users needs. EVIDENCE: The manager or head of care completes an assessment of prospective service users to ensure they are able to meet all of their needs before that person enters the home. Assessments and reports are also obtained from health and social care professionals to give the home an overall picture of an individual’s needs. The home has an improving training programme to ensure staff members have the skills required to look after people who live at the home. Staff members undergo mandatory training in health and safety issues such as infection control, moving and handling, and fire safety. Not all staff members have had the annual updates for these health and safety topics, but the manager said she is aware of the need for this and is making arrangements for training to be given. The Elms DS0000024301.V253441.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Some progress has been made on improving arrangements to ensure that the personal and health care needs of service users are identified and met. But further improvements are needed as these shortfalls have a potential to place service users at risk. EVIDENCE: Care plans are written for needs identified from pre-admission assessments and risk assessments completed after a person has entered the home. These enable staff members to meet each service user’s needs appropriately and should be reviewed at least monthly to make sure any changes to the care needed are documented. Generally care plans in the home are well written and give good descriptions of how care should be delivered. Recording of external professionals visits was also well documented. However, there were a number of discrepancies in the service users’ records seen. One need identified in a pre-admission assessment was transferred to a care plan but did not mention a potentially significant issue that had been mentioned in the pre-admission assessment. A plan for wound care give little accurate description of the wound at each review, which means action that may have brought about faster healing could not be planned for. A risk The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 11 assessment was not available for one service user being restrained in a wheelchair, thereby giving no evidence that the service user’s rights were not being infringed. Although the use of wheelchair restraint was recommended in another service user’s falls risk assessment, the assessment did not make clear that the restraint was the only practicable means of securing the welfare of the service user, or that there were exceptional circumstances. Neither was the restraint recorded in that service user’s records. Not all plans had been reviewed every month, which means potential changes to care had not been considered. Service users records show access to a variety of healthcare professionals, including GPs, CPNs, district nurses, audiologists, dentists and dieticians. However, one service user’s records show a recommendation by one healthcare professional for a referral to be made to a falls co-ordinator or Parkinson’s specialist nurse. There was no record of this having been done, and no record of either of these healthcare professionals visiting the service user. The medication administration records were looked at to check compliance with a requirement made during the last inspection. An improvement was seen in the recording of medication given, although explanation of missed medication was not always clear as several explanations were allocated to one letter, or the explanation did not make sense, i.e. ‘switched off’. As an overall improvement has been shown there will not be a further requirement made for this standard. Service users said carers are always polite, and that they are never rude. The Elms DS0000024301.V253441.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 Social activities are not well organised and only provide limited stimulation and interest for people living in the home. EVIDENCE: The home employs an activities co-ordinator who organises events for service users. Records of events that had taken place, those that were planned and who attended was not available. Service users said they didn’t think there was much to do, although some prefer to read in a quiet area and they are able to do this. They said they are aware the home has an activities co-ordinator, but they don’t know what she does. Life maps are completed for all service users, which should give basic information about the life of each service user, and their likes and dislikes. Service users said they had been asked about their lives and their social interests, but they didn’t know if anything was done with the information. Life maps that were seen in service users files contained basic information only and didn’t give enough information for care staff to plan activities. For example, service users likes included TV, but didn’t specify which television programmes someone liked or why they liked it. Similarly, a prompt of ‘pets’ often had ‘yes’, ‘no’ or ‘dogs’, but gave little evidence that obtaining the information had been more than a form filling exercise. The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 13 People who live at the home said they were able to make choices about every day things like when to get up and go to bed and what they would like for meals. These people also said they were able to do the activities they wanted to, but as this was sitting in a quiet area to read they were unable to say if other people were able to choose whether they went out or not. They felt that going out would be difficult, as the home didn’t have enough care staff to accommodate this. The Elms DS0000024301.V253441.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home has a complaints system with evidence that service users were able to confidently raise concerns. Systems for the protection of vulnerable adults are in place, but are not adequate enough to ensure staff have appropriate guidance. EVIDENCE: Service users said they would be able to tell someone if they weren’t happy with something at the home, and would go to a carer in the instance and then possibly to the manager. Information from the manager and a pre-inspection questionnaire sent to the Commission for Social Care Inspection shows the home has received 24 complaints in the last 12 months, 10 of which have been since the last inspection. 13 of these complaints have been substantiated and 3 partially substantiated. Complaints are either investigated and responded to within 28 days or passed to the organisation’s legal department. The home has a protection from abuse policy and procedure and service users say they feel safe living there. Staff said they had not had training specifically about Protection of Vulnerable Adults (PoVA), but were able to show they understood how abuse could be manifested and what action to take if they thought abuse had occurred. In view of recent adult protection investigations at the home it is advisable for all staff to receive training that includes local authority guidelines as soon as possible. A former staff member has been referred for inclusion on the PoVA list. The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 25 and 26 Minor improvements have been made to the home, although there were a number of serious matters, which put service users at risk of serious harm and do not provide safe surroundings in which to live. EVIDENCE: There has been some improvement in the general décor of the home since the last inspection visit. An offensive smell in the foyer of the home and again at the top of one set of stairs leading to the first floor was not present at this inspection. Gouge marks on wall behind recliner chair in room 18 have been repaired and paintwork on inside window frames in room 22 has been replaced. However, there are areas identified during the inspection in October 2004 that still require attention. Specific areas of concern are: • Scuff and gouge marks on wall corners and doorframes throughout the home. • Holes in en suite or wardrobe doors in rooms 16 and 18. • Stain on the ceiling in room 29. The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 16 The requirement made at the last inspection and the inspection in November 2004 has not been fully complied with. However, as the home now has a new manager who is aware of these issues and has made inroads into resolving them no enforcement action is being taken at this time. However, failure to comply with requirements may lead to legal action being taken against the home. Exposed radiator piping in one corridor (rooms 16-19) has been covered and is now only warm to touch with the radiators turned full on. But there are radiators in lower floor bathrooms that have exposed pipe work that was too hot to hold when the heating was turned to a II rating, and this poses a risk to service users should they fall. The home has adequate toilet and bathing facilities in addition to en suite accommodation for the number of service users in the home. Facilities seen were clean and tidy except for staining around the base of one toilet located next to room 20. Sluice rooms are located on both floors and were also clean and tidy. However, the sluice on the ground floor was not locked and a sharps bin with a loose fitting lid was within easy reach, which places service users and staff members at risk of a needle stick injury. Two door wedges were found around the home during the inspection, although one was not in use at the time. If doors need to be open they can only be propped open by using a device that allows the door to shut when the fire alarm sounds. Patio doors in one service user’s room open onto the car park and were open all day on the day of inspection. This poses a serious security risk to everyone living in the home and must be addressed. The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 30 The arrangements for staff training has improved, thereby ensuring service users are cared for safely by staff with the knowledge to meet care needs. EVIDENCE: The home has an improving training programme that ensures staff members have the skills required to look after people who live at the home. Staff members undergo mandatory training in health and safety issues such as infection control, moving and handling, and fire safety. Not all staff members have had the annual updates for these health and safety topics, but the manager said she is aware of the need for this and is making arrangements for training to be given. Medication training has been arranged for qualified staff members and those senior care staff with the responsibility for medication administration. The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38 Systems are in place to ensure the health and safety and financial interests of service users are maintained. EVIDENCE: A new manager has been appointed and had been in post for 2 weeks at the time of this inspection. The manager has experience in home management and at higher organisational level with another care home provider. An application must be made to the Commission for Social Care Inspection to register a manager as it is an offence under Section 11 of the Care Standards Act 2000 to manage a care home when not registered to do so. The results of a service user satisfaction survey conducted in 2004 are available in the home. However, this did not appear to contain an action plan to show what the home needs to improve or how this is to be achieved. The The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 19 manager said there are plans for relative and stakeholder surveys to also be conducted. Service users entering the home are given written information about how the home takes care of their money and the procedures for debiting an account. Statements are sent on a monthly basis, detailing incoming and outgoing transactions, and any interest earned. Although all service users funds are placed into the same account, each service user using the system has a separate written account and record on the computer. Checks are required to ensure the health and safety of service users and these must be recorded. Records were seen for fire safety, hot water temperatures, gas safety, lift and stair lift checks. These were all recorded as acceptable. However, two door wedges were found around the home during the inspection, although one was not in use at the time. If doors need to be open they can only be propped open by using a device that allows the door to shut when the fire alarm sounds. Some equipment checks are completed, such as maintenance for hoists, but records for wheelchair and bed rail checks are not completed. The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 20 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 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 2 X 2 X X X 2 2 STAFFING Standard No Score 27 X 28 X 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 3 3 The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13(7) Requirement Timescale for action 15/10/05 2 OP7 13(8) 3 OP8 13(1)(b) 4 OP12 16(2)(n) The registered person must ensure that no service user is subject to physical restraint unless restraint of the kind employed is the only practicable means of securing the welfare of that or any other service user and there are exceptional circumstances. On any occasion on which a 15/10/05 service user is subject to physical restraint, the registered person must record the circumstances, including the nature of the restraint. The registered person must 15/10/05 make arrangements for service users to receive where necessary, treatment, advice and other services from any health care professional. Service users must be offered a 31/10/05 programme of activities and must be consulted about this. The home must provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation and fitness. (30th DS0000024301.V253441.R01.S.doc Version 5.0 The Elms Page 22 5 OP25 13(4)(a), (c) 6 OP26 16(2)(k) 7 *RQN Section 11, CSA 2000 8 OP38 23(4)(c) (i) August 2005 timeframe from previous inspection not met.) All parts of the home to which service users have access must be kept free from hazards to their safety. Unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. (25th May 2005 timeframe from previous inspection not met.) The registered person must make suitable arrangements for the disposal of general and clinical waste. An application to register a manager must be submitted to the Commission for Social Care Inspection. (31st August 2005 timeframe from previous inspection not met.) The registered person must make adequate arrangements for detecting, containing and extinguishing fires. 31/10/05 15/10/05 30/11/05 15/10/05 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 The Elms Refer to Standard OP7 OP7 OP12 OP18 OP19 Good Practice Recommendations Care plans should be reviewed at least monthly to ensure changes in care needs are met. All information given in pre-admission assessments should be included in initial care plans. Activities organised should be based on service users social interests as much as possible. All staff should have adult protection training to ensure local guidelines are known and criminal evidence is not damaged. Security of the home should be assessed for those rooms DS0000024301.V253441.R01.S.doc Version 5.0 Page 23 6 OP21 where access can be obtained from unsecured areas. Lime scale deposits around the base of toilets should be removed. The Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE 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 Elms DS0000024301.V253441.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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