Inspection on 16/05/06 for Tree Tops Residential Care Home

This inspection was carried out on 16th May 2006.

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

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

Other inspections for this house

Tree Tops Residential Care Home 22/03/07

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Tree Tops Residential Care Home Overton Timber Hill Lyme Regis Dorset DT7 3HQ Lead Inspector Gloria Ashwell Key Unannounced Inspection 16th & 22nd May 2006 13:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 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. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Tree Tops Residential Care Home Address Overton Timber Hill Lyme Regis Dorset DT7 3HQ 01297 443821 01297 444868 richardiyavoo@btconnect.com 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) Mrs Belinda Davila Iyavoo Mr Richard Kirk Iyavoo Mrs Belinda Davila Iyavoo Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13 July 2005 Brief Description of the Service: Tree Tops is a large house set in its own grounds on Timber Hill on the outskirts of Lyme Regis with some views of the sea. There are gardens at the front and rear of the home. The home provides personal care for a maximum of 17 elderly people and also offers day and respite care and regularly accommodates 2 residents at a time for short-term care via the local Primary Care Trust. Residents’ bedrooms are on the ground, first and second floors. Stair lifts operate between all floors. The home does not have a passenger lift and is not suited to the needs of severely disabled people including wheelchair users. Communal facilities include a lounge and separate dining room, there is an additional small lounge area on the second floor of the home. Laundering of clothing and household linen is carried out at the home and arrangements can be made for chiropodists, opticians and other health and social care professionals to visit individual residents. There is a car park at the front of the home with street parking nearby. The home is close to a bus route, with a bus stop within walking distance. Fees are charged weekly; at present fees range between £350 and £420 per person. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a statutory inspection required in accordance with the Care Standards Act 2000. It was the first inspection of Tree Tops since it’s registration to Mr & Mrs Iyavoo during January 2006. Since the last inspection some concerns about the home have been made known to the Commission by members of the public; these were investigated by an additional visit and the home has consequently taken appropriate action to register a previously unregistered bedroom which had been brought into use. The inspection was unannounced; the inspector arrived at 13.15 on 16 May 2006, toured the premises and spoke to residents and staff and Mr & Mrs Iyavoo to arrange the next visit which took place at 11.00 on 22 May 2006 when documentation relating to care provision and the premises was discussed and examined. The duration of the inspection (both days combined) was 6 hours. During the inspection the inspector spoke to registered providers Mr & Mrs Iyavoo, care and household staff, 9 residents and the visiting relative of one resident. The inspector observed staff interaction with residents and the carrying out of routine tasks. Additional information used to inform the inspection process included written notifications provided to the Commission as required in accordance with Regulations. During this inspection compliance with all key standards of the National Minimum Standards was assessed. What the service does well: Mr & Mrs Iyavoo have quickly gained the support and trust of residents and staff. Some residents commented on recent improvements and one observed “It’s excellent; even more so during recent weeks”. Staff are kind and helpful to residents. Residents are treated with respect, their privacy is protected and staff understand and meet their needs. Residents feel safe and well cared for. Residents are assisted to maintain as much independence as possible and are encouraged to maintain contact with the local community. The premises are comfortable and domestically cosy, with attractive gardens and sea views from some rooms. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? 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. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 7 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 Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (The home does not provide intermediate care so Standard 6 does not apply) Quality in this outcome area is poor. This judgment has been made using available evidence including a visit to the service. Prior to admission, there is insufficient assessment of the needs of proposed residents so staff may not have enough information to properly meet and understand their needs. EVIDENCE: The inspector examined records of a pre-admission assessment written by the manager when she assessed a prospective resident, from information provided by relatives and health and social care professionals. The records indicated that the needs and circumstances of the person had been minimally assessed; there was no information regarding a number of essential aspects including dietary need, sleep, skin condition and weight, and insufficient information regarding continence, general health, mobility and mental state. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 9 To ensure that adequate information is considered when making the judgement to accept the resident into Tree Tops, and that staff have enough information to properly meet the residents needs, it is required that comprehensive assessment details are recorded in advance of all new admissions. The recently admitted resident confirmed satisfaction with the home and said “the staff are so pleasant – I was saying the other day that if I had to go anywhere for a holiday I’d come back here”. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 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 & 10 Quality in this outcome area is variable; from discussion with residents and staff there is evidence of good care provision but documentation does not support this and must be improved. This judgment has been made using available evidence including a visit to the service. For each resident there is a written plan of care but these are not based on reliable assessments and thereby fail to ensure that staff have sufficient information upon which to base their care practice. Residents health needs are fully met but periodic audit of accidents should be recorded to minimise risks of recurrence. Records of medicines prescribed by doctors must be improved to ensure the correct administration of medicines and appropriate risk assessment of residents who wish to do so managing their own medicines. Residents are treated with respect and their privacy and dignity is protected at all times. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 11 EVIDENCE: Four care plans were examined during the inspection; all were of poor standard, providing only minimal information – in particular it was noted that there was no specific description of wounds stated to be present on one of the residents, or the chest infection that daily records indicated had been experienced by another resident. The care plans were not based on the findings of reliable assessments and were not subject to adequate review; with the exception of a reference to a risk posed by unguarded radiators the care plan of one resident had been written during November 2004 and thereafter reviewed each month with the recorded outcome “no change” although there had been deterioration in the persons condition. All accidents are recorded, but subsequent actions taken to minimise the risk of recurrence are not always recorded; the home does not have a policy and procedure for accidents and does not periodically audit accidents to identify any trends or patterns (e.g. in time, place, person or activity) and subsequently to introduce measures to reduce the risks. There was no evidence that a resident managing own medicines has been assessed for safe practice in this regard, which might place this resident and others at risk of harm if prescribed medicines are wrongly administered in error. Records indicated that medicines had been accurately administered and residents said that they receive the correct medicines at correct times. But improvements must be made to the recording systems including signing and dating all handwritten instructions, recording the start and finish date of medicines prescribed for short periods and stating the dosage prescribed for each medicine. Additionally it is recommended that a list of all prescribed medicines be recorded for each resident, together with the reason for prescription, to ensure that staff can provide residents with this information upon request. Residents believe they are properly cared for; comments included “It’s a very happy place – people seem contented here…the staff are helpful” and “I think they (Mr & Mrs Iyavoo) have real love for people…”. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The quality of daily life in the home is good with residents assisted to maintain as much independence as possible. Social and leisure activities are suited to the preference and ability of each resident. Residents are encouraged to maintain contact with the local community and visits by their friends and relatives are welcomed by the home. Meals are appetising and of good quantity and quality. Most residents take meals in the dining room on the ground floor; others receive them in their bedrooms. EVIDENCE: The inspector spoke to a number of residents; all those able to express an opinion indicated satisfaction with the home, including the range of activities, meal provision, staff and premises. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 13 The home periodically arranges local excursions, visiting entertainers, one-toone and small group social and recreational activities. Residents enjoy the activities and consider them appropriate and of good variety; a visiting relative commented “they’re so patient, especially with X’s communication difficulties, and I think they’re doing a lot of activities with them”. Visitors are welcome at any time and those present during the inspection said they are always made to feel welcome and placed at ease by the staff. Residents said they were generally satisfied with the quality, choice and quantity of food provided; one resident said that ” the food is excellent “. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 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 & 18 Quality in this outcome area is good with regard to complaint management, but improvements must be made to ensure that correct action would be taken in the event of an allegation or suspicion of abuse arising. These judgments have been made using available evidence including a visit to the service. The complaints procedure provides information on the procedure to follow for persons wishing to make complaint. The home has an incorrect policy/procedure for the prevention of abuse and not all staff have received training in this subject to ensure that they remain vigilant to protect vulnerable residents from risks of abuse. EVIDENCE: Residents feel confident that if they had concerns or complaints they will be listened to and taken seriously. Since the last inspection some concerns about the home have been made known to the Commission by members of the public; these were investigated by an additional visit and the home has consequently taken appropriate action to register a previously unregistered bedroom which had been brought into use. The written policy and procedure for the protection of residents from abuse or neglect makes incorrect reference to in-house investigation taking place and must be amended to ensure that any allegation or suspicion of abuse is Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 15 immediately notified to Dorset Social Services and the Commission, in line with established guidance from the Department of Health in the document ‘No Secrets’ : www.dh.gov.uk/PublicationsAndStatistics/Publications/PublicationsPolicyAndGuidance/Publica Additionally, all staff should receive training in the understanding of abuse, and their role in protecting residents from abuse in its many forms, including neglect. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 16 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 & 26 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The premises are comfortable, clean and suited to the needs of residents who are not severely disabled and do not require use of a wheelchair. EVIDENCE: Residents bedrooms are on the ground, first and second floors of the home. A stair lift is fitted to the main staircases between the ground and first floor, and the first and second floor. A separate stair lift is also fitted to the back stairs between the ground and first floor. As there is no passenger lift, the home is not entirely suited to the needs of service users who are physically frail, including wheelchair users. Rooms are attractively decorated and appropriately furnished and the home has a cosy and relaxed atmosphere. The home is clean, well ordered and properly maintained. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 17 There is an ongoing programme of improvements; since the last inspection these have included installation of a replacement stair lift, replacement of some carpets and of the main cooker. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 18 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 & 30 Quality in this outcome area is good with regard to the number of staff and their competency but improvements must be made to employment processes to ensure the protection of residents against the employment of unsuitable staff who may place them at risk of harm. This judgment has been made using available evidence including a visit to the service. EVIDENCE: Staffing levels are provided in accordance with the assessed needs of residents to ensure that at all times sufficient staff are available to properly meet their needs. All staff spoken to during the inspection were enthusiastic about their work and felt that they provided a good standard of care to residents. Comments made by staff included “we’re a proper team…(Mr & Mrs Iyavoo) are very good bosses; from all I’ve seen in all the homes I’ve worked, they bend over backwards to get things done for the residents”. Employment records of two recently employed staff were examined; those of a care worker who had previously been employed at Treetops contained all essential information including two written references and evidence of identity but no POVA check had been recorded and the home had not obtained a new CRB disclosure, relying instead in the disclosure previously obtained. The records of the other worker were in good order and included a new CRB disclosure. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 19 For all new staff, in advance of employment, the home must obtain POVA 1st/CRB disclosure to ensure residents are not placed at risk by the employment of potentially unsuitable staff. At present 3 of the 8 care staff currently employed by the home hold a National Vocational Qualification in care; the home is thereby close to meeting the standard for at least 50 of the care staff to hold an NVQ in care. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 20 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 & 38 Quality in this outcome area is generally good; the home is well managed and suitably staffed, much liked by residents and their representatives and well maintained although records relating to residents monies, fire safety and other aspects of premises safety must be improved to ensure the continued safety of all persons in the home. This judgment has been made using available evidence including a visit to the service. EVIDENCE: Mr & Mrs Iyavoo and their staff are held in high regard by the residents. The home intends to issue a questionnaire to gain the opinions of residents and their friends and relatives to ensure the maintenance of good satisfaction levels. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 21 The home safe keeps the finances of two residents; residents unable to to personally manage their finances have nominated relatives, friends or other representatives to do this on their behalf. At present the home does not keep records of the safe keeping of the two resident’s money and must therefore develop and implement a system for this purpose, to ensure a clear audit trail for all transactions. Mr Iyavoo stated that there are regularly recorded checks and tests of fire safety equipment but the records were not available for examination during this inspection. Records of two staff were examined and eventually provided evidence that they had received fire safety training at the required frequency, although the records were muddled and hard to interpret. Records of fire safety equipment and of staff training must be improved to ensure that these aspects properly protect all service users from harm. Similarly, the most recent records of safety checks of the stair lifts could not be found at the time of inspection and the home was unable to supply evidence of the safety of the water supply with regard to risk of bacterial infection by Legionella and other potential contaminants. The home has not recorded Health & Safety risk assessment of the premises and working practices, designed to identify potential risks and introduce measures to manage/reduce them. This report contains a related requirement, to ensure that risks are systematically identified, assessed and minimised. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 2 Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 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. 1. Standard OP3 OP7 Regulation 14 15 & 13 Requirement Comprehensive assessment details must be recorded in advance of all new admissions. For each resident a care plan must be drawn up from a comprehensive assessment including reference to nutrition and skin condition. Previous timescale of 5/05/06 not met. A policy and procedure for the management of accidents must be developed and implemented, and must include reference to falls risk assessment. Handwritten entries in medication instructions must be signed and dated by the writer and countersigned by a member of care staff who has checked the entry for accuracy. The start and finish date of medicines prescribed for short periods must be recorded. The medication administration record must clearly state the total dosage prescribed for each medicine. Timescale for action 16/06/06 01/07/06 2. OP8 13 01/08/06 3. OP9 13 16/06/06 4. 5. OP9 OP9 13 13 16/06/06 16/06/06 Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 24 6. OP9 13 7. OP18 13 8. OP29 19 & Schedule 2 9. OP35 20 10. OP38 13 11. 12. OP38 OP38 13 13 13. OP38 13 Residents wishing to selfadminister prescribed medicines must be assessed for their ability to safely do so, including the ability and agreement to securely store the medicines. Records must be kept of the assessment and outcome. The home must develop and implement a suitable policy and procedure for the understanding of abuse and correct response to any allegation or suspicion of abuse. There must be evidence that the home operates a robust recruitment procedure. New staff must not commence work in the home without evidence of suitable CRB and POVA disclosure. Previous timescale of 13/08/05 not met. Systems must be introduced to ensure full records of transactions and safe keeping of residents’ money is transparent and protects residents from exploitation. Accurate records must be kept of checks/tests of fire safety equipment and staff fire safety training. The home must record a Health & Safety risk assessment of the premises and working practices. The home must supply to the Commission copies of recent records of safety checks of the stair lifts. The home must make arrangements for the safety of the water supply with regard to risk of bacterial infection by Legionella and other potential contaminants and must make records of related evidence available for inspection. DS0000066167.V293729.R01.S.doc 16/06/06 01/08/06 16/06/06 16/06/06 16/06/06 01/08/06 01/09/06 01/09/06 Tree Tops Residential Care Home Version 5.1 Page 25 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. Refer to Standard OP8 OP9 OP18 Good Practice Recommendations The home should develop and implement a policy and procedure for dealing with accidents, to include periodic audit. A list of all prescribed medicines should be recorded for each resident, together with the reason for prescription. All staff should receive training in the understanding of abuse and their role in its prevention and detection. Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Tree Tops Residential Care Home DS0000066167.V293729.R01.S.doc Version 5.1 Page 27 - 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. 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