CARE HOMES FOR OLDER PEOPLE
The Old Vicarage (Askam) Ireleth Road Askam In Furness Cumbria LA16 7JD Lead Inspector
Marian Whittam Unannounced Inspection 09:00 17th July 2006 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 Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Old Vicarage (Askam) Address Ireleth Road Askam In Furness Cumbria LA16 7JD 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) 01229 465189 tov.askam@btopenworld.com Vicarage Care Ltd Mr Carl Terence Raine Care Home 29 Category(ies) of Dementia - over 65 years of age (12), Learning registration, with number disability (1), Mental disorder, excluding of places learning disability or dementia (3), Old age, not falling within any other category (25) The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 29th November 2005 Date of last inspection Brief Description of the Service: The Old Vicarage, Ireleth, is a residential care home providing care for 29 people with a range of needs. The home is in a residential area on the edge of the village of Ireleth. It is within walking distance of the local shops and a public house and the small town of Askam with more shops and a post office. The home is in a large detached house and is on two floors with a single storey extension and a conservatory to one side of the house. There is by a stair lift to the first floor. There is a secure garden area at the side of the home with seating for service users. The grounds are well maintained, have seating for residents and are wheelchair accessible. There is also a sheltered inner courtyard patio area with seating close to resident’s rooms. Information is available to prospective residents in the Statement of purpose and service users guide; this is available in the home. The fees charged by the home range from £368.00 to £422.00 per week as at the date of the inspection. An additional charge is made for personal toiletries and cigarettes, newspapers, magazines, and any personal travel expenses, according to information provided by the home. The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on 17th July 2006. The inspector looked around the home and spoke with residents, visitors and staff members. Staff records, training records, medication handling and records and care plans were examined and a selection of records required by regulation. Information about the home and services, to inform the inspection, was provided in good time by the provider. Four residents returned surveys to CSCI. During the visit seven residents were happy to talk to the inspector about their experiences of living in the home. Two visitors and three staff members, in addition to the manager, were spoken with during the visit. What the service does well: What has improved since the last inspection?
Medication handling has improved to promote greater safety for residents. The home has been reviewing its medication practices and made significant improvements in practices. Records of administration are consistent and reasons for omissions and any changes are confirmed and documented and matters quickly followed up when changes occur. This improves meeting some resident’s health care needs in regard to specific medical conditions. There are better multi disciplinary discussions where medications may need to be given
The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 6 covertly. Staff who administer medication have attended training on the safe handling of medication at the local college. This improves understanding and awareness of the issues around medicines handling. Training provision and attendance is better organised, with staff having their own training files and assessments of needs and the use of a training matrix to improve planning. Adult protection training is now being provided along with a range of training relevant to the residents needs so improving resident welfare in the long term. The management is continuing to improve the environment and the completion of 4 single bedrooms, 2 with en suite will provide better facilities in single room accommodation for residents living in the home. The management team has bought in a comprehensive quality assurance and audit tool and is implementing this systematically and making changes as the reviews and implementation progresses. This has the effect of improving some of the systems and practices in the home, such as care planning practices and record keeping. This improvement should continue as the systematic quality cycle continues. Overall the standard of record keeping and organisation and clarity of information in the home is noticeably better than at the last visit. Care planning documents are clearer and more up to date and detailed than at the last inspection. Work has been done to make these more person centred and used as changing working documents improving clarity of information for staff giving care to residents. What they could do better:
By undertaking major improvements in quality assurance the home has been able to better identify areas of weakness and poor practice and take action. The home should make its development plan available to CSCI on completion and should continue the development work using the audit tools it has begun. There are some areas that would promote good practice and improve resident’s care and welfare that the home should consider. The statement of purpose and service user guide should be more easily available in the home and the home should provide the complaints procedure in alternative formats to meet individual needs. The home should continue to develop its activities programme and fully implement its plan to introduce more detailed pen pictures with residents. As good practice the cook should attend residents meetings to get feedback and suggestions on menus. The home should also continue to monitor, review and consult with residents to make sure that there is provision for smokers that does not affect the environment for other residents. The home should obtain a copy of Department of Health guidance “No Secrets” to provide information for staff and underpin its procedures. Staff should be putting residents toiletries away straight after use as some are left out in the bathroom and could pose a risk if ingested.
The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 7 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 Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 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 Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 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): 1,2, 3,4 and 5 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s Statement of Purpose, Service User Guide and terms and conditions of residency provide information for prospective residents to make informed choices about living in the home. An assessment process, care planning system and information from other agencies is in place to provide the information needed to be able meet resident’s needs when they come in. EVIDENCE: The home has a current statement of purpose and service user guide. The home should make sure these are easily available. Individual care plans show that the residents have their personal health and social needs assessed before and following admission to the home and their individual care plans have been developed from this. The home manager or senior staff do an individual assessment of needs in addition to social services care management plans to try to ensure that the home will be able meet those needs before residents come to live there. The home has an introductory period followed by a review to make sure needs are being met and the home
The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 10 suits the resident. Residents are provided with terms and conditions of residency so they are aware of their rights and responsibilities. The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 11 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): 7,8,9,10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A care planning and review system is in place and the personal, social and health needs of residents are being met and privacy respected. Significant improvements in the recording and handling of medicines have improved resident’s safety and welfare. EVIDENCE: All residents have an individual care plan, based on initial assessments and risk assessments, setting out assessed health, social and personal care needs and these are being reviewed and updated. These have improved since the last inspection to provide a clearer and easily followed plan that better reflects the individual’s needs. Staff spoken with are aware of residents care needs and their individual preferences. Psychological health and well being is being assessed and monitored as well as pressure area care, moving and handling, nutrition and continence needs. Actions for staff to take and equipment to be used are clearly stated for staff. The home has been reviewing its medication practices and made significant improvements in practices. Records of administration were satisfactory and reasons for omissions and any changes are confirmed and documented. This improves meeting some resident’s health care needs in regard to specific
The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 12 medical conditions. A resident persistently refusing a medicine had this promptly followed up with the GP. There is evidence of multi disciplinary discussions where medications may need to be given covertly. The records for medicines administration, receipt and disposal are clear, storage and stock levels are satisfactory. Staff who administer medication have attended training on the safe handling of medication at the local college. This is recorded and staff spoken with who have done this training found it a comprehensive and very useful course, especially regarding legislation. Observing staff and survey responses indicates they are polite and respect individual’s wishes and privacy. There is friendly banter during the day and positive interaction with residents by staff. Preferred terms of address are stated in care plans. Residents confirm that staff explained what they were doing when helping them and “are helpful”. Residents confirmed they saw relatives, other visitors and doctors and nurses in private and could come and go, as they wanted as long as staff knew. Visitors spoken with felt the care their relative received was “excellent” and the staff were friendly and they has never had any complaints, and the home was always clean and their relative well dressed and groomed. Training is being given on terminal care and the home has developed an information sheet for staff to support this. The home has used the hospice outreach service to provide advice and assistance in caring for those with deteriorating conditions. The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides social activities and staff support residents to maintain outside contacts and interests as they chose. Links with the community are good and promote resident’s social opportunities. Dietary needs of residents are being met with a varied menu that offered choice to residents. EVIDENCE: The home provided some regular activities, recorded resident’s hobbies and interests and organised social events from time to time. It was evident from observations during the day that staff saw spending time with residents and supporting them with their interests as a normal part of daily life in the home. A senior carer organises the activities on offer and these are displayed on the notice board depending on what residents would like to do. The home is reviewing its activities to try and develop the programme in a way that has meaning for residents. Records are not kept of what activities residents have done and this could help staff in developing those activities residents find useful and enjoyable. The manager discussed how the home was going about developing more comprehensive ‘pen pictures’ with residents. This should be fully implemented to improve understanding and support of the resident’s interests.
The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 14 Resident’s said that they could come and go as they pleased as long as they let staff know and see whom they wanted to. Some of the residents go to a local pub for a drink and a game of pool. One resident told how they enjoyed going out to get their hair done and going shopping and on holiday. One said they enjoyed the social evenings organised by staff and “it was very much appreciated”. A small number of residents handle their own financial affairs and others are supported by their families and social services with financial matters. There is also information available and displayed on using advocacy services. Residents spoken with said they enjoyed their food and that it was important to them. There is a 4 weekly menu that indicates a nutritious diet that offered a choice and catered for special diets. Records of food served and alternatives selected by residents are kept. One resident commented that particular requests are catered for. As good practice the cook should attend residents meetings to get feedback and suggestions on menus. The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints system in place and available to residents and visitors. There are procedures in place to protect vulnerable adults and for whistle blowing available for staff in the home. Training is given to staff to promote the safety of residents. EVIDENCE: The home has a satisfactory complaints procedure available to residents, on display in the foyer and within terms and conditions and service user information. For good practice the home should consider having this in other formats to meet individual needs, for example, large print or on tape for the visually impaired. Staff spoken with are aware of the home’s policies on abuse and aggression and multi agency guidelines and are due refresher training on adult protection and recognising abuse in September. The manager has completed a training course organised by social services and cascades this back to staff. This training is documented and planned for and the home has produced clear and relevant written information for staff to accompany the training. It is recommended for good practice that the home obtains a copy of Department of Health guidance” No Secrets” to accompany this. The home has a system for recording, tracking and responding to complaints. There have been no complaints logged since the last inspection and CSCI has not received any complaints about the home. Staff and management feel that because it is a small and informal home most matters that arise are dealt with
The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 16 at the time by staff and so do not escalate into a complaint. Residents say that staff listen to them and act on concerns. The home does not deal with any resident’s personal financial arrangements only small amounts of money securely stored money for safekeeping. There are procedures in place for dealing with missing residents The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 17 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, 20, 21, 23, 24,25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of decoration in the home is satisfactory with evidence of continuing maintenance and development to improve the environment for residents. The home is clean, tidy and adequately maintained for residents and had the equipment they need to promote mobility and independence. EVIDENCE: The home plans for maintenance and improvements to the premises for the long and short term. The owners have almost completed a series of improvements to increase the number of single rooms with en suite facilities available to residents. There is ongoing decoration in corridors and bedrooms elsewhere in the home. The dining and lounge areas are clean, well lit, comfortable and homely and the furnishing in bedrooms and communal areas of good quality and domestic in character. The problem of the smell of cigarettes smoke along the entrance hallway from the room used by smokers off that corridor has improved. Staff now go outside
The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 18 to smoke and in the summer residents tend to also. One resident has been successfully supported to stop smoking. The home should continue to monitor, review and consult with residents to make sure that there is provision for smokers that does not affect the environment for other residents and visitors to the home. Resident’s bedrooms seen by the inspector had satisfactory standard of furnishing and decoration. Many residents have brought in their own possessions and this made their bedrooms more personal and homely. The home is clean and tidy and there is a range of equipment and adaptations in the home to help residents make the most of their independence and to get about the home. The laundry is small but clean and tidy with care staff attend to washing. Staff were observed following appropriate infection control procedures, using gloves and appropriate protective clothing. COSHH substances are locked away. The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 19 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): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and skill mix of care staff on the rotas and on duty during the visit are adequate to be able to meet resident’s needs. Staff training is established in the home and induction and foundation training provided to promote a competent staff group to care for residents. The procedures for the recruitment of staff are satisfactory and offer protection to people living in the home. EVIDENCE: Staff rotas are satisfactory and observation and discussion with staff during the visit suggested that the home had a stable and motivated staff group providing continuity for residents. There are adequate catering and domestic staff in post. Training for NVQ Level 2 and 3 is well supported and continuing. Staff have received induction and foundation training and training records show arrange of training mandatory and as required to care for the different resident groups. Training had been given from the mental health unit on dementia awareness and depression and anxiety. Training records are now in place and being developed to provide clear records and a planning system to ensure updates are given at the correct time and that learning needs are identified and met. The staff spoken with felt they have good access to training and are encouraged and supported to take it up.
The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 20 Satisfactory recruitment and selection procedures and criminal record and POVA checks had been followed for staff working in the home. Staff have job descriptions, a staff handbook and terms and conditions of employment. The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 21 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): 31,32,33,35,36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Management is well supported by senior staff and is aware of its responsibilities towards residents and staff. Procedures and practices are in place which safeguard resident’s financial interests and promote their health, safety and welfare. EVIDENCE: There is a registered manager in post with appropriate qualifications and experience and undertakes periodic training to maintain skills. There are clear lines of accountability with the management roles and between care staff. There are staff meetings and seniors meetings and staff spoken with said their opinions are sought and considered. Staff are being given regular supervision and records show training needs are discussed and addressed. Staff spoken with felt supported in their work and development. Residents meetings are held periodically and the home uses surveys to get feedback from residents and relatives.
The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 22 There was evidence that staff supported residents in their personal interests and development and in maintaining contacts and interests outside the home. The management team has bought in, and begun to implement, a systematic quality monitoring system. The effects of this as a core management tool can be seen in improvements in systems of working following quality reviews and changes such as the care planning system. Policies and procedures are being reviewed and updated as part of the system. The standard of record keeping has improved. The home is now putting together a development plan that is developing as the reviews progress. The home should make this available to CSCI on completion and should continue the development work as they use the audit tools. The home has a suitable system in place to manage small amounts of personal monies on behalf of residents and suitable insurance is in place for the home. Records showed that fire training had been given to staff at appropriate intervals and emergency equipment is checked and appliances serviced. Risk assessments are in place for fire and recently reviewed. Water temperatures are being tested for safety and risk of Legionella and recorded. COSHH substances are safely stored, however, the home should make sure that staff put toiletries away after use as some were left out in the bathroom. The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 3 3 3 The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard OP1 OP12 OP12 OP15 OP16 OP18 OP20 Good Practice Recommendations The statement of purpose and service user guide should be more easily available in the home. A record should be kept of the activities residents take part in and how effective or enjoyable they found them. The home should continue to develop its activities programme and fully implement its plan to introduce more detailed pen pictures with residents. As good practice the cook should attend residents meetings to get feedback and suggestions on menus. The home should provide the complaints procedure in alternative formats to meet individual needs. The home should obtain a copy of Department of Health guidance “No Secrets”. The home should monitor, review and consult with residents to make sure that there is provision for smokers that does not affect the environment for other residents and visitors to the home.
DS0000048089.V291299.R02.S.doc Version 5.2 Page 25 The Old Vicarage (Askam) 8. OP33 The home should make its development plan available to CSCI on completion and should continue the development work using the audit tools. Staff should put toiletries away after use as some are left out in the bathroom. 9. OP38 The Old Vicarage (Askam) DS0000048089.V291299.R02.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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