Inspection on 31/10/07 for The Knoll

This inspection was carried out on 31st October 2007.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Knoll 31/05/07

Similar services:

Claremont House

Chesham House

Argyll House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

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

CARE HOME ADULTS 18-65 The Knoll 115 Southchurch Boulevard Thorpe Bay Essex SS2 4UR Lead Inspector Michelle Love Unannounced Inspection 31st October 2007 09:30 The Knoll DS0000067787.V353674.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 Knoll DS0000067787.V353674.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 Knoll DS0000067787.V353674.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Knoll Address 115 Southchurch Boulevard Thorpe Bay Essex SS2 4UR 01702 586684 01702 586684 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) Minster Pathways Limited Maria Baughurst Care Home 6 Category(ies) of Learning disability (6), Mental disorder, registration, with number excluding learning disability or dementia (6), of places Physical disability (6) The Knoll DS0000067787.V353674.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st May 2007 Brief Description of the Service: The Knoll is a large family house situated in a residential area. There are six bedrooms for residents within the home and it has a large lounge overlooking the front garden, a dining area and a quiet room. The home has a secluded rear garden. Southend on Sea, Thorpe Bay and Southchurch are close by and are accessible by bus. There is rail access to Southend and London from Southend East railway station. The current scale of charges for resident’s living at The Knoll is between £1,370 and £1,946.25. A copy of the homes Statement of Purpose and Service Users Guide is readily available. The Knoll DS0000067787.V353674.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection took place over 6.5 hours and was undertaken with assistance of the deputy manager and senior support worker. The inspection focused upon all of the key standards. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. A tour of the premises was undertaken throughout various times of the day. During the visit 3 residents and 3 members of staff were spoken with and their comments are used throughout the report. Following the inspection relative’s surveys were forwarded to seek peoples’ views and 10 staff surveys were left at the home for staff to complete. It was disappointing to note that only one relatives survey was returned and no staff surveys were returned to the Commission. Residents commented that they were happy living at the home and they were generally happy with the care and services provided. What the service does well: What has improved since the last inspection? What they could do better: The care planning processes require further development and should be regularly reviewed to reflect resident’s changed needs, so as to ensure that all care needs are identified and met. The Knoll DS0000067787.V353674.R01.S.doc Version 5.2 Page 6 Robust recruitment procedures, need to be adopted so as to safeguard residents. All staff who are newly employed/deployed to work at the care home must receive an induction which is in line with Skills for Care. Training for staff needs to be improved so as to enable staff to meet residents assessed needs. 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. The Knoll DS0000067787.V353674.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 Knoll DS0000067787.V353674.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. 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 this service. The home has an appropriate system for assessing the needs of prospective residents prior to admission, which helps to ensure that their needs can be met by the team at the home. EVIDENCE: Since the last inspection to The Knoll no new admissions have been undertaken at the care home, however it is recognised that the registered provider has a comprehensive assessment format for formally assessing the needs of prospective residents. At the previous inspection to the home, residents had been assessed prior to admission and additional information had been sought from individuals placing authorities. The Knoll DS0000067787.V353674.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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7,8 and 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care records need to be further developed to improve outcomes for residents and to reflect a proactive approach to care management. EVIDENCE: It was positive to note that since the last inspection a plan of care has been devised for all residents at the care home. The support plans for two residents were examined in full and these were noted to make reference to individuals’ health, social, emotional and physical care needs. Further development of the care planning processes/system needs to be undertaken to ensure that support plans are person centred and not predominately task orientated (making drinks, washing up, loading and unloading the dishwasher, making snacks, laying the table etc). For example one care plan was observed to detail the person’s personal care needs and tasks/routines within the home as detailed above. Little information was afforded to the individuals specific mental healthcare needs and how this The Knoll DS0000067787.V353674.R01.S.doc Version 5.2 Page 10 affects their daily living skills. Other issues relating to care planning are made reference to within the main text of the report. There was evidence to indicate that not all elements of support plans had been reviewed. This does not necessarily provide support staff with the most up to date information or reflect accurately individual resident’s current needs. Risk assessments were comprehensive and completed for the majority of assessed risk areas for individuals. However, where there were risks identified, records did not always evidence specific information/guidance relating to staff interventions. Additionally where restrictions are imposed on individual residents’ choice and freedom, further work is required to ensure that there is clear information depicting agreement between the home and the resident and that where appropriate other interested parties have also been consulted e.g. resident’s family and/or placing authority. The Knoll DS0000067787.V353674.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The activity programme generally meets the lifestyle needs of residents’ who live at the care home. Whilst food provided to residents is appropriate, further review is required in relation to ensuring that individual residents needs are met. EVIDENCE: Individual support plans were noted to contain an activity planner depicting individual resident’s weekly opportunities for leisure pursuits/interests and to maintain community presence. Activities recorded included listening to music, reading magazines, watching films, attending the local library, cooking, arts and crafts, lunch/pub outing, takeaway/DVD evenings, boot-sales and attendance at local Mencap sports club/Thursday club and exercise class. Information relating to the latter was displayed on a notice board in the main hallway for residents to access. The Knoll DS0000067787.V353674.R01.S.doc Version 5.2 Page 12 The senior in charge of the shift on the day of inspection advised that the opportunity for residents to attend adult education classes were not currently available as a result of insufficient places. However. it was hoped that these could be explored for the future. Of those residents spoken with, all confirmed they were given opportunities to access the local community and to participate within a range of activities that they found enjoyable. Daily care records examined, recorded that some residents find it difficult to socialise and to interact appropriately with others whilst out in the community, possibly causing other people to find their behaviours antisocial and unacceptable. Individual support plans were noted to record the above, however clear guidelines need to be devised detailing how the above manifests and provide staff with strategies as to how to deal with the above should it arise. For example one support plan was noted to record “staff to assess resident’s behaviour before taking [them] out”. Information did not include what staff would deem appropriate/inappropriate and whether or not an activity would be introduced at a later stage. Records indicated that residents are enabled and supported to maintain relationships with family and friends. Daily food records were available for individual residents and these recorded a varied range of food provided. Comments from individual residents in relation to meals, was positive. Staff must ensure that where individual support plans record that a healthy diet is required and needs monitoring, this must be carried out to ensure individual’s nutritional care needs are met. On inspection of one support plan there was evidence to suggest that one person’s diet was not carefully being monitored and this had resulted in a significant weight increase over a four-month period. The Knoll DS0000067787.V353674.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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are happy with the personal support they receive and outcomes for people to have access to healthcare provision were positive. EVIDENCE: Records evidence residents who live at The Knoll have access to a range of healthcare professionals as and when required and are supported by staff to attend appointments. Residents were noted to receive personal care and support from staff in private so as to maintain their privacy and dignity. As a result of some residents’ mental health care needs and difficulties with communication, they were unable to confirm if they were happy with the support provided by staff or if they were given choices e.g. able to get up/go to bed when they wanted, where they ate there meal etc. However daily care records made some reference to the above and demonstrated that residents are consulted and their views and wishes taken into account. The Knoll DS0000067787.V353674.R01.S.doc Version 5.2 Page 14 Medication records and storage facilities were inspected. The recording of medication administered to residents was seen as appropriate, however where handwritten MAR (Medication Administration Records) sheets are used, these were not double signed to indicate that the medication received was correct and accurate. This potentially places residents at risk as the medication received from the pharmacy could be incorrect and the prescriber’s instructions relating to the dose to be administered could be wrong. Additionally where the medication dose states 1 or 2 tablets to be administered, the specific dose was not recorded. A list of those staff deemed competent to administer medication was readily available but not all staff had recorded their signature/initials. The lack of staff training pertaining to medication for some staff is of concern and the registered provider/manager must ensure that staff, have the necessary skills and competency to administer medication to residents safely and to ensure their wellbeing. The Knoll DS0000067787.V353674.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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Whilst complaint policies and procedures in the home are good, shortfalls were noted with regard to safeguarding training for staff and staffs understanding of residents’ physical and verbal aggression. This is detrimental to individuals’ wellbeing and does not ensure that staff working at the care home can deal effectively with residents’ physical and/or verbal aggression. EVIDENCE: Each support plan contains a copy of the proprietor’s complaint procedure and this is produced in both a written and pictorial format. This needs to be reviewed to reflect that CSCI no longer investigate complaints. One resident spoken to advised, they would raise any concerns with a member of staff, but were unsure as to the name of their key worker. A complaints log is available and it was noted that no complaints or record of compliments had been received. The proprietor was observed to have safeguarding policies and procedures in place, but no local guidelines were readily available. Training records evidence the majority of staff do not have training relating to dealing with people’s aggression/inappropriate behaviours, yet several of the people who live at The Knoll exhibit varying degrees of unacceptable behaviour. This is detrimental to individuals’ wellbeing and does not ensure that staff working at the care home can deal effectively with residents’ physical and/or verbal aggression. Individual support plans make little specific reference as to how residents should be supported by staff in relation to their behaviours, yet the plans The Knoll DS0000067787.V353674.R01.S.doc Version 5.2 Page 16 record “staff to be SKIP trained” and “when staff are recruited within the home it is ensured that they have the skills and abilities to deal with such behaviours when they occur”. Several members of staff were observed to have up to date safeguarding training. Accident records for residents, evidenced restraint had been used by staff however records were limited in content and did not provide sufficient information to determine positive outcomes for residents. The Knoll DS0000067787.V353674.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ benefit from a well maintained home that meet their needs. EVIDENCE: A tour of the premises was undertaken. Residents’ bedrooms were observed to be personalised and individualised, reflecting the individuals personality. Since the last inspection the home has undergone redecoration and refurbishment and there is a contemporary feel to the home. There is a large lounge/dining room at the centre of the home and residents are actively encouraged to use these communal areas. Residents spoken with stated that they were happy with the redecoration undertaken at the home. The home was seen to be clean, tidy and no odours were noted. The home benefits from a secure and well maintained garden which residents are able to access. The Knoll DS0000067787.V353674.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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Residents are supported by adequate numbers of staff, however the recruitment of staff and training provision at the home require significant review to ensure that residents needs can be met in full and that they are safe. EVIDENCE: From discussion with the senior person in charge on the day of inspection, staffing levels were reported as 4 staff on duty between 07.30 a.m. and 22.00 p.m. and 1 waking night member of staff and 1 sleep-in person during the night. Four weeks staff rosters were examined and these indicated that over the past 2-3 weeks staffing levels have been increased from 3 to 4. Rosters indicate that the majority of staff work a long day (14.5 hours) and some staff are working between 58-66 hours per week. The staff recruitment procedures and files of new staff were examined. Some files were observed to have the majority of records as required by regulation, however it was apparent that for a few members of staff who work between The Knoll and another local ‘sister’ home, no recruitment file was available. It is unclear that residents are supported and protected by the proprietor’s The Knoll DS0000067787.V353674.R01.S.doc Version 5.2 Page 19 recruitment practices. Additionally for some newly appointed members of staff there was no evidence that they had received an induction. Of those training records available, inconsistencies were noted whereby not all staff were noted to have training relating to fire safety, manual handling, health and safety, infection control, food hygiene, basic first aid and medication. Staff do not have training related to those conditions associated with mental health care needs, learning disability or other related areas. Consideration should be given to providing appropriate staff training that ensures residents’ needs, can be met. Records also show that the home has not achieved 50 of support staff with an NVQ qualification. Shortfalls relating to staff supervision were observed whereby not all members of staff have received supervision in line with regulation. The Knoll DS0000067787.V353674.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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Management arrangements in the home are generally sound, however further development is required pertaining to safe working practices. EVIDENCE: A new manager was appointed shortly after the last inspection however they have now resigned and the home is temporarily without a manager. The registered provider has confirmed in writing to CSCI as to how the organisation will provide support to staff and residents until a new manager commences employment. The registered provider must ensure that during these interim arrangements, residents and staff benefit from a well run home. A quality assurance questionnaire was sent to all residents and to relatives. A summary and record of the outcome from these surveys was not recorded and The Knoll DS0000067787.V353674.R01.S.doc Version 5.2 Page 21 this should be considered. Generally the quality questionnaire results were positive and one recorded “we feel secure in the knowledge that our [member of family] is being well cared for at The Knoll by patient and sympathetic staff” The proprietor holds monies on behalf of residents and records were observed to be well maintained and in order, with receipts readily available. Fire records within the home were available and these included a fire plan, evidence that the home’s fire alarm system and emergency lighting were tested regularly and a copy of the home’s fire risk assessment. Consideration should be undertaken to ensure that fire drills are undertaken by staff on a more regular basis, as records suggested that since the home had been registered (January 07), only one fire drill had been undertaken. As stated previously only a limited number of staff have received training relating to fire awareness. This is not in line with the homes own fire safety policy, which states, “all employees are trained in our fire safety policy when first joining us and receive refresher training on a regular basis”. The home has a health and safety policy in place and a comprehensive number of risk assessments pertaining to the home had been devised. Accident records were examined and these were seen to be satisfactory. Records were available to indicate that regular resident meetings are undertaken and that a staff meeting had occurred following the manager’s appointment. The Knoll DS0000067787.V353674.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 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 1 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 2 X The Knoll DS0000067787.V353674.R01.S.doc Version 5.2 Page 23 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 YA6 Regulation 15 Requirement Timescale for action 01/01/08 2. 3. YA9 YA17 4. YA20 5. YA23 Care plans should be developed further so as to improve outcomes for residents, ensuring they are person centred, not task orientated and reviewed to reflect changes to residents needs. 13(4) Risk assessments should be developed so as to include staff interventions. 12(1)(a) Improvements must be made to ensure that where a healthy diet is required/is monitored for individual resident’s, all reasonable steps are taken by staff to follow and implement this. 18(1)(c)(i) Staff training in medication must be provided to all staff who administer medication to residents to ensure they are aware of current practice and are able to safeguards residents wellbeing. 13(6) Staff training in challenging behaviour must be provided to all staff to ensure they are aware of current practice and are able to safeguard residents wellbeing. 01/01/08 01/12/07 31/12/07 01/03/08 The Knoll DS0000067787.V353674.R01.S.doc Version 5.2 Page 24 6. 7. YA23 YA34 17(1)(a), Schedule 3, 3(p) 19 8. YA35 18 9. YA36 18(2) Maintain a detailed record of any physical restraint used on a resident. Robust recruitment procedures must be adopted to ensure residents are safeguarded from abuse. Training in fire safety, fire drills and other areas must be provided to all staff to ensure the safety of residents and that all their needs can be met by the staff team. Staff to receive regular supervision in line with regulatory requirements. 31/10/07 31/10/07 01/04/08 31/10/07 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. Refer to Standard YA6 YA20 YA20 YA28 Good Practice Recommendations Restrictions identified for individual residents should be reviewed to include that this has been formally agreed by the resident, their family and/or representative. Handwritten Medication Administration Records (MAR) should be double signed to ensure that information recorded is accurate and correct. Where the MAR record details that 1 or 2 tablets are to be administered, the specific dose must be recorded. 50 of staff working within the care home should attain a NVQ qualification. The Knoll DS0000067787.V353674.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 The Knoll DS0000067787.V353674.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. 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!