CARE HOMES FOR OLDER PEOPLE
The Sidcup Nursing And Residential Centre 2-8 Hatherley Rd Sidcup Kent DA14 4BG Lead Inspector
Maria Kinson Announced Inspection 29th November 2005 12:10 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 Sidcup Nursing And Residential Centre DS0000006769.V270260.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 Sidcup Nursing And Residential Centre DS0000006769.V270260.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Sidcup Nursing And Residential Centre Address 2-8 Hatherley Rd Sidcup Kent DA14 4BG 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) 020 8300 7711 020 8300 7799 ANS Homes Limited Mrs Jane Brock Care Home 100 Category(ies) of Old age, not falling within any other category registration, with number (90), Physical disability (10) of places The Sidcup Nursing And Residential Centre DS0000006769.V270260.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 71 beds for the general nursing care for people 60 years to include 10 beds for the physically disabled aged between 50-59 years 29 beds for the residential care of the elderly 1 place registered for named service user only under the age of 50 years. 1 place registered for named service user only under the age of 50 years for period of 6 weeks only. 12th May 2005 Date of last inspection Brief Description of the Service: The Sidcup Nursing and Residential Centre is owned by BUPA. It was purpose built as a nursing home and the ground and first floors were registered in 1997 to provide nursing care. In 1998, the second floor, which had not been in operation, was registered for residential care. The ground and first floors are for the general nursing care of 71 service users. The second floor provides residential care for 29 older people. All the bedrooms in the home have ensuite facilities and there are assisted bathrooms on each floor. There are communal sitting and dining areas and an enclosed garden. The home is very close to Sidcup High Street where there are a variety of shops and access to local buses. The Sidcup Nursing And Residential Centre DS0000006769.V270260.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 on 29.11.05 between 12.10pm and 18.40pm and on 02.12.05 between 10.15am and 12.05pm. The inspector visited all of the units but most of the time was spent on Hatherley talking with residents, visitors and staff and examining care records. On day two of the inspection the inspector visited the laundry and main kitchen. Feedback about the service was obtained from five residents and three relatives during the visit and from fourteen comment cards that were returned to the commission. There were three empty beds on the residential unit at the time of the inspection, one of which was reserved. In the period since the last inspection the registered company (ANS) was sold to BUPA. This sale included Sidcup Nursing and Residential Centre, which is now owned and managed by BUPA. The commission were informed of the new directors and responsible individual for the service. What the service does well:
Despite the recent changes staff and management have remained committed to providing a good standard of care. Feedback about the service was mostly good with the majority of residents stating that they liked living in the home, felt well cared for and safe. Resident’s made other comments about the home such as “The hands on care is good” and “This is probably the best care home I could come to”. Relatives said that they were able to visit at any time and always felt welcome. Health and social care professionals that visited the home said that staff provided a good standard of care overall and had a good understanding of residents needs. Relatives and residents were satisfied with the arrangements for obtaining medical advice and treatment and said issues such as pain were addressed promptly. A number of residents told the inspector that their health and wellbeing improved after they were admitted to the home. Comments made by relatives and records examined during the inspection supported this view. The Sidcup Nursing And Residential Centre DS0000006769.V270260.R01.S.doc Version 5.0 Page 6 The choice and quality of food provided in the home was good. Most residents were satisfied with the food provided. The cook received information from staff about resident’s dietary needs and preferred meal choices. The home was pleasantly decorated and furnished throughout providing a homely and welcoming environment for residents and their visitors. Health and safety issues were addressed promptly and equipment was serviced at regular intervals. Kitchen, laundry and domestic teams were well organised and managed and worked hard to provide a good service for residents. These teams were led by staff that were constantly striving to improve their existing standards. This home has a stable management and staff team. The manager and staff work hard to recruit and retain a full establishment of permanent staff. This provides good continuity of care for residents. Since the last inspection a new Deputy Manager, Training Coordinator, Maintenance Operative, nursing, care and support staff had been appointed. The arrangements for safeguarding resident’s money and monitoring the quality of care and services provided in the home were good. What has improved since the last inspection?
Since the last inspection the Registered Manager had updated the homes Statement of Purpose and Service Users Guide to provide clear information about the age of residents that could be admitted to the home. New equipment to assist staff and provide improved comfort for residents had been purchased. This included a new assisted bath on Granville, air conditioning in the kitchen and laundry, a new mixer, liquidiser and potato peeler and height adjustable beds. New storage cupboards had been fitted for bulky medication boxes and bottles that were too big to fit in the medication trolleys. The arrangements for administering medication had been changed to ensure that all residents received medication from their own named bottle or packet. The GP had agreed and signed the homely remedies list. The home had appointed a part- time Training Coordinator. Some aspects of training such as staff training needs were being collated and records of training
The Sidcup Nursing And Residential Centre DS0000006769.V270260.R01.S.doc Version 5.0 Page 7 had improved. A staff training programme to comply with health and safety legislation and meet staff needs was being developed. Two staff had undertaken moving and handling training for trainers and some moving and handling training updates had taken place. The number of residents requiring palliative care had increased during the past year. Staff were working with health and social care colleagues to improve end of life care and to trial new models of care for residents that were dying. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
The Sidcup Nursing And Residential Centre DS0000006769.V270260.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 Sidcup Nursing And Residential Centre DS0000006769.V270260.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): 1. The Statement of Purpose and Service User Guide provide clear information about the facilities and care provided in the home. This information assists prospective residents to make an informed choice. EVIDENCE: The Registered Manager had updated the Statement of Purpose and Service Users Guide to include clear information about the age range of residents that could be admitted to the home. Copies of the revised documents were forwarded to the commission. The Sidcup Nursing And Residential Centre DS0000006769.V270260.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 11. Some records maintained by staff did not provide adequate evidence of the action they were taking to meet residents health and welfare needs. The care provided in this home led to an improvement in some of the resident’s health and wellbeing. Action had been taken to improve the safe management of medication in the home. EVIDENCE: Two sets of care records were examined on Hatherley. One resident that was admitted to the home four days prior to this inspection did not have a care plan or general risk assessment. Although staff were still getting to know the resident, some of the residents needs and some health and safety risks were identified in the assessment and in documentation that was completed by hospital staff. The transfer letter stated that the resident attempted to get out of bed unaided and a form requesting a mattress indicated that the resident had a grade two pressure sore. The staff member said the named nurse would complete the care plan when she was next on duty. See requirement 1 and recommendation 1. The second care plan was comprehensive reflecting the concerns and personal preferences expressed by the resident. Review documents provided evidence of the improvements in health and mobility that
The Sidcup Nursing And Residential Centre DS0000006769.V270260.R01.S.doc Version 5.0 Page 11 the resident said had taken place since she was admitted to the home. Some care plans were reviewed every two to three months. Daily care records were good. Staff had established good working relationships with health and social care professionals that visited the home. Three health care professionals provided feedback about the service. All of the respondents said that staff had a clear understanding of residents needs, communicated effectively and were satisfied with the overall standard of care provided in the home. Two residents told the inspector that they had received good medical attention and problems with pain control were referred to the GP promptly. Action had been taken to address the previous requirement and recommendation relating to the administration of prescribed medication. Additional storage for bulky medication had been provided and the homes GP had agreed and signed the homely remedy list. A special kit had been purchased for denaturing controlled drugs prior to disposal. This home provides a significant amount of care for people with palliative care needs. The home was taking part in a trial to assess the effectiveness of ‘The Liverpool Care Pathway’, which provides evidence based practice guidance for staff to follow during the last days of a resident’s life. Support from the community palliative care team was provided and the home had equipment such as syringe drivers for use. See comments under standard 30. The Sidcup Nursing And Residential Centre DS0000006769.V270260.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): 13 and 15. This home provides a good choice and variety of food to meet resident’s nutritional needs and preferences. This home encourages relatives to continue to play an active role in their family members life and care. EVIDENCE: Resident’s relatives and friends were seen in the home throughout the day. Some relatives spent long periods with their family members and a number had arranged to have Christmas lunch with their relative in the home. Feedback from residents and relatives during the inspection and in the comment cards that were returned to the commission was mostly good. A number of residents said they wanted to return to their own home but said Sidcup Nursing and Residential Centre was a good alternative, “I have no complaints although I would rather be in my own home”. Residents said that staff did not impose any unnecessary restrictions, “They leave me to do what I want, this is important to me”, ”I value my independence”. Relatives said that staff were approachable and that “They seem to have residents best interests at heart”. The Cook received information from staff about resident’s dietary needs on admission to the home and often spent time with new residents establishing
The Sidcup Nursing And Residential Centre DS0000006769.V270260.R01.S.doc Version 5.0 Page 13 their preferences. The Cook attends residents meetings to obtain feedback about the menu and tries where possible to include residents favourite dishes and suggestions in new menus. Residents were able to choose their preferred food from the menu, which was displayed and some of the residents had a personal copy of the menu to refer to. Feedback about the food provided in the home was mostly good but three residents said meals were not consistently good. The four weekly menus indicated that residents were provided with a good choice and variety of food. The Sidcup Nursing And Residential Centre DS0000006769.V270260.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 manager responds promptly to concerns and complaints. The use of lap belts remains high. Staff must ensure that restraint is only used where there is no others means of securing the residents safety. EVIDENCE: The commission received one concern about the use of restraint at Sidcup Nursing and Residential Centre in October 2005. The manager was asked to investigate the concern and respond to the commission. The Manager indicated that “inappropriate” action was taken to maintain a residents safety for one day. This arrangement was undertaken with the relatives consent. The manager was aware that the action taken by staff was not suitable and had arranged training about the prevention of falls for staff. Staff had reassessed residents that use lap belts with their relatives and the GP. Copies of the review documents were sent to the commission. Staff discussed the use of lap belts with the Registered Manager prior to gaining access to this equipment. The use of lap belts on the nursing units remains high compared to other similar units. The Registered Manager agreed to discuss the use of lap belts with reviewing officers during residents annual review meetings. See recommendation 2. The Sidcup Nursing And Residential Centre DS0000006769.V270260.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, 22 and 26. This home provides a clean, comfortable and safe environment for residents to live. EVIDENCE: Since the last inspection a new parker bath had been fitted on Granville, a new potato peeler, mixer and liquidiser had been purchased for the main kitchen and thirty divan beds on the nursing units were replaced with height adjustable hospital style beds. The home has made excellent progress with the recommendation made in previous reports to provide adjustable beds for residents requiring nursing care. The building was maintained to a high standard. No maintenance issues were identified during this inspection. All areas were clean, tidy and odour free. The development plan for 2006 includes redecorating Knoll, the laundry, kitchen, dining rooms, bedroom doors and the staff room. The Manager said that several carpets would be replaced at this time. All of the nursing stations
The Sidcup Nursing And Residential Centre DS0000006769.V270260.R01.S.doc Version 5.0 Page 16 will be enclosed to provide more privacy and magnetic closures will be fitted to bedroom doors. The laundry was well laid out. Good systems were in place to ensure that risks of cross infection were minimised and that resident’s personal clothing was cared for appropriately. The laundry provides a good service for residents. The main kitchen was clean and organised. Good systems were in place to ensure the safe storage and preparation of food and staff were appropriately trained and supervised. The kitchen was awarded a Silver Clean Food Award by environmental health inspectors in 2004. There were good supplies of fresh, dried and frozen food. The cook maintained records about resident’s dietary needs and preferences. The Sidcup Nursing And Residential Centre DS0000006769.V270260.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): 28, 29 and 30. The arrangements for recruiting new staff was mostly good but some additional safeguards must be implemented to protect residents. This home works hard to maintain a stable team of permanent staff. This provides good continuity of care for residents. The arrangements for training staff were mostly satisfactory but induction and foundation training did not comply with national standards. EVIDENCE: The manager was committed to maintaining a full establishment of staff. Weekly recruitment sessions were held in the home for candidates that had completed an application form and were assessed as suitable. At the time of this inspection the home had two carer and one part- time laundry staff vacancies. The effort shown by the Manager to maintain an adequate team of permanent staff is commended. The home was using temporary staff for approximately fifteen hours each week. Two staff recruitment files were examined. Overall recruitment procedures were mostly satisfactory but some files included verbal references. This arrangement appears to have been a local agreement with the previous regulatory authority. The Manager was advised that the Care Homes Regulations states that two written references must be obtained prior to staff commencing work in the home. See requirement 2. Staff must ensure that
The Sidcup Nursing And Residential Centre DS0000006769.V270260.R01.S.doc Version 5.0 Page 18 the arrangements for supervising new staff are recorded. This is particularly important for staff that do not have a full criminal record bureau disclosure. 47. 2 of care staff working in the home had a vocational qualification in care at level two or above. Three care staff were undertaking this training. The home had recently appointed a new part-time Training Coordinator who demonstrated great commitment and enthusiasm for the role. In the short time the Training Coordinator had been in post she had started to establish staff training needs, develop a programme of training and maintain individual staff training records. The Training Coordinator was aware that the current arrangement for induction and foundation training did not comply with the national minimum standards. Two staff training records were examined. The staff members had attended various training sessions relating to wound care, diabetes, resuscitation, liquid medication and falls during the past year. The previous requirement to ensure that all staff received an annual moving and handling update had been addressed in part. Two staff members had undertaken moving and handling training for trainers and kitchen staff had attended an update. Sessions for care staff were planned. See requirement 3. This home provides a significant amount of care for people who are terminally ill. Some short training sessions about the use of equipment for pain relief had been provided for staff but none of the staff had a recognised palliative care qualification. The Registered Manager and Training Coordinator should consider this issue when analysing staff training needs. See recommendation 3. One member of staff is a trained counsellor. Residents said that most staff were kind, helpful and caring, a small minority of care staff on the ground floor unit were said to be abrupt and impatient at times. This concern was discussed with the Deputy Manager who agreed to monitor the issue and address during supervision where appropriate. The Sidcup Nursing And Residential Centre DS0000006769.V270260.R01.S.doc Version 5.0 Page 19 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, 36 and 38. This home was well managed. Prompt action was taken to ensure that resident’s health and safety was maintained. Staff received good support but formal supervision did not take place at regular intervals on all of the units. Supervision must be provided regularly to ensure that staff are fulfilling the homes aims and objectives and meeting resident’s needs. EVIDENCE: The management arrangements were unchanged. A new Deputy Manager had recently been appointed. The home had adequate systems in place for monitoring the quality of care and services provided in the home. Audits to assess the standard of care and check that staff were following company procedures were undertaken. The home obtains feedback from residents during meetings and had a comment
The Sidcup Nursing And Residential Centre DS0000006769.V270260.R01.S.doc Version 5.0 Page 20 box in the reception area. Senior staff carried out regular unannounced visits to home. Good systems were in place for safeguarding resident’s personal money. All transactions were recorded and receipts were provided. A staff and witness signature were obtained for all withdrawals. Weekly checks were undertaken to ensure records were correct and a copy of the audit was forwarded to head office. Residents or their representatives could request a statement at any time when the office staff were on duty. Receipts were kept for all purchases and payments such as newspapers and hairdressing. The Activities Coordinator was permitted to buy personal items for residents but had to provide a receipt for all purchases. Valuable items were stored securely. Supervision contracts had been completed and agreed for all staff. Discussions with staff indicated that senior staff were approachable and supportive but formal supervision was not always taking place at regular intervals on some units. See recommendation 4. Fire safety equipment was serviced at regular intervals and good records were maintained about in house fire safety checks. A fire risk assessment had been undertaken in 2000. This assessment should be reviewed and updated. A selection of health and safety records were examined and were found to be satisfactory. Accident records provided factual information about accidents and incidents that had occurred in the home and a detailed account of the observations that staff had undertaken after the event. The Sidcup Nursing And Residential Centre DS0000006769.V270260.R01.S.doc Version 5.0 Page 21 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 X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 3 X X X 3 STAFFING Standard No Score 27 X 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 The Sidcup Nursing And Residential Centre DS0000006769.V270260.R01.S.doc Version 5.0 Page 22 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 & 15 Requirement The Registered Person must ensure that care plans identify potential risks and outline the action that staff should take to meet individual’s health and welfare needs. (The previous timescale of 01/08/05 was not met) The Registered Person must obtain two written references prior to allowing a person to work at the care home. The Registered Person must ensure that all staff receive a moving and handling training update annually. (Previous timescales of 01.05.05 and 01.09.05 were not met) Timescale for action 01/03/06 2. OP29 19 01/02/06 3. OP30 13 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Sidcup Nursing And Residential Centre DS0000006769.V270260.R01.S.doc Version 5.0 Page 23 1. 2. 3. 4. OP7 OP18 OP30 OP36 The Registered Person should ensure that care plans are reviewed each month or more regularly if a resident needs change. The Registered Person should ensure that consultation takes place during annual review meetings about the use of lap belts. The Registered Person should ensure that at least one member of staff attains a recognised palliative care qualification. The Registered Person should ensure that care staff receive formal supervision at least six times a year. The Sidcup Nursing And Residential Centre DS0000006769.V270260.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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