Inspection on 10/03/06 for Ulcomb House

This inspection was carried out on 10th March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ulcomb House 25/06/07

Ulcomb House 15/12/05

Ulcomb House 17/03/05

Ulcomb House 29/06/04

Ulcomb House 24/03/04

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

CARE HOME ADULTS 18-65 Ulcomb House 24 London Road Sittingbourne Kent ME10 1NA Lead Inspector Lynnette Gajjar Unannounced Inspection 10th March 2006 08:05 Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 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 Ulcomb House DS0000024037.V285264.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ulcomb House Address 24 London Road Sittingbourne Kent ME10 1NA 01795 428447 01795 410877 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 Brenda Joyce Tyler Mr Robert William Tyler Mr Anthony Ian Vallis Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age of residents: Residents shall be over 16 years of age to 27 years of age on admission. 15th December 2005 Date of last inspection Brief Description of the Service: Ulcomb House is a semi-detached property with accommodation on three floors, bedrooms being on the first and second floors. All rooms are single occupancy and have television points. The home offers accommodation and support for 5 young adults with learning disabilities, with the emphasis on assisting them to move towards a more independent life style. Services are individually tailored to meet the needs of the service users, offering opportunities to develop their skills as is appropriate. The home is situated on the busy A2 leading into Sittingbourne, with shops and other local amenities within easy walking distance. It is on a bus route and there is a main line railway station approximately a quarter of a mile away. Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection, the second in the year running from April 1st 2005 to March 31st 2006, was conducted by Lynnette Gajjar, Regulatory Inspector. The inspector was in the Home from 08:05 a.m. until 14.00 pm. The home currently has five service users, aged between 21 and 35 years of age and is running no vacancies. Due to incomplete CRB disclosure checks in relation to children, the service have been advised that no admissions for 1618 years olds can be considered until full satisfactory checks on all staff are in place. During that visit all service users and staff were spoken with and parts of the Home and some records were inspected. The focus of the inspection was to inspect the Standards not assess at the last visit and to assess compliance with the notified recommendations. Documentation was on the whole in good order and recommendations from the previous inspection had been implemented. Consequently, this report should be read in conjunction with the inspection report dated 15th December 2005. As part of the inspection, the manager agreed to be assessed as part of their fit person interview with the Commission to be registered as the manager under then Care Standards Act 2000 The House Manager, staff and service users were helpful and gave their full cooperation throughout the inspection. Service users were relaxed and happy with both staff and the inspector the visit. Some comments shared by service users included: “I am going to college Tuesday I like college we are making roast chicken” “I’ve been here nearly a year, I like it here” “Everyone muck’s in together, it’s a very good atmosphere, all the staff are good, help you sort things out if you have problems” “I don’t think I would change anything, I like it here” “I like going out to lunch best” “When I have problem’s and get angry I talk to Dr (name) and that helps me” “I was going to McDonalds but because I didn’t get all stars on my chart and some sad faces I can’t go today, maybe tomorrow, I am going shopping to get my mum’s mother’s day card and other things on my list” Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Service users would benefit from very clear guidelines for all PRN medication to ensure safe and consistent administration by staff. Staff would feel more Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 7 confident in handling medication through undertaking an accredited medication training and assessment of competency. Through a thorough recruitment process with full written references received and held on file; full CRB disclosures undertaken to cover children and accurate to the position they are applying for, Cartref Homes can reassure service users and their representative appropriate checks have taken place to ensure their safety. The Statement of Purpose and Service Users Guide should be updated to include the correct name of the Commission and information specific to the Responsible Individual and House Manager. All staff must be trained in and adhere to the adult protection procedures. Further development of records held in the home can be improved. Service users and staff would benefit from regular internal audits / monitoring by the manager of records held in the home. 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. Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 Information is available to service users but requires updating to enable individuals to make an informed choice about wishing to live at Ulcomb House. EVIDENCE: The Statement of Purpose, Service User Guide and contract of terms and condition were a combined document. The House Manager stated that every service user had a copy and these were seen on files sampled. The example inspected had been issued in November 2005 but had not been updated to include the name of the Commission of Social Care Inspection. It did not include details of the room to be occupied by the service user nor had a representative of Cartref Homes signed it. The contract section had facility for it to be signed by representatives of the service user. The House Manager stated this was being done as reviews occurred with relatives. Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,9,10 Information about service users is handled appropriately and confidentiality maintained. Service users would feel better respected and independent though having the responsibility of holding their own front door key to the home when on outings. EVIDENCE: Through discussion with a service users and sharing of their current care plan, it is clear that service users are given full support and encouragement to maintain personal contact with health and social care professionals, to maintain good standards of health and social care. Daily write ups were discussed with some very good entries that really gave the reader a good understanding of how the day had gone for the service user, how they felt, what they had done and needed help with. Records seen should be signed by staff on each entry. In house reviews have taken place for service users with records seen. Through discussion the autonomy of having a front door key for individuals was raised, whilst the inspector is sympathetic to the cost implications of lost Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 11 keys, the service user is a paying tenant. The home’s ethos is to encourage independence and such a risk should be clearly assessed and where deemed the service user is unable to manage this responsibility at present recorded in individual care plans, with aspirations and goals to work towards achieving this responsibility and coping strategies for more independence. Service users had a good understanding of the key working system and their personal key workers were discussed with fondness openly. Staff expressed a good knowledge of policies and procedures for handling information. Service users did not have any concerns about how staff handled information about them and the staff spoken with were aware of the need to promote confidentiality. Records were seen to be stored securely when not in use. Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,16 Community links are good and personal relationships and activities outside of the home are encouraged and maintained at the individual’s choice. EVIDENCE: Service users are able and encouraged to follow hobbies and interests of their own choosing and the staff knows individual personal preferences. Care records reflect that a steady, though flexible routine occurs on a day - to -day basis and those in the home feel safe with this. Outings happen daily both planned structured sessions at local adult education centres, as wells as more leisure opportunities such as the snooker, darts, cinema, and music club and as a particular favourite and having ‘lunch out’. Watching personal videos, TV, various indoor games, for sole or group use are offered and are clearly enjoyed. Service users were supported out different times during this visit on 1:1 or 2:1 outings of their choice. Service user continue to have very regular contact with their direct and extended family through home visits and one was particularly excited as going to stay over night today with their family to celebrate their birthday. Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 13 Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20 Intimate and personal care needs are attended to in a dignified manner and the physical and emotional health of individuals is promoted. Safe medication practices are followed but will be further enhanced through separate PRN guidelines EVIDENCE: Staff are clearly aware as to the type and nature of the support required for individual’s personal and intimate care needs. Every effort is made to maintain privacy and dignity when people are being supported with bathing, washing and dressing. Due to behaviours being experienced additional assessments, guidance offer confidence that the care and guidance promoted is being managed appropriately. New staff have not completed N.A.P.P.I training and should not support service users alone where such techniques may be required to be implemented. A particular incident recently highlighted this and the House Manager was reviewing the support given to the individual. Service users discussed regular meetings with clinical Psychologist and their CPN. Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 15 Medication was overall managed well and will offer consistent approaches by staff in having written guidelines for all PRN medication not just Diazepam, paracetomol etc. This would ensure consistent safe administration within clear set triggers and action to be taken. Photographs should be inserted to the MAR sheet for identification. MAR sheets are audited weekly. Daily monitoring should be taken of the temperature of the small storage room for medication to ensure it does not exceed 25 degrees. Staff undertake in house training in medication and dispense medication in pairs. Staff expressed that they would feel more confident with assessed accredited training in the medication they currently handle. Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Systems are in place to enable those living and those visiting the home to raise concerns or complaints with staff and people they trust. Staff must receive training in adult protection to better promote service users’ safety. EVIDENCE: The home has a clear complaint procedure. Due to the nature of the service and those living here, using this system is limited. It is evident they would be reliant on a relative/ advocate/staff to identify concerns and raise them on their behalf. Discussion took lace to enhance current format with actual photographs to aid understanding by the current service users. Staff who have been spoken with evidence a basic understanding of how to protect and prevent abuse, including reporting under local procedures. Staff have not undertaken adult protection training as recommended in the previous report. The House Manager was unaware of proposed dates being set. The majority of staff have attended training in non-aggressive intervention recently. The House Manager is aware that those who have not should support service users who may require this intervention alone. Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,27 Service users live in a warm, safe, clean home and garden, which will be enhanced further with the removal of large heavy waste deposited after recent maintenance work and the installation of a shower to the first floor. EVIDENCE: The home continues to be presented to good standard with a homely atmosphere. Service users are encouraged to undertake daily chores and cleaning within their agreed activity plan. Staff are required to support in completing some tasks. The bathroom on the first floor is proposed for refurbishment to include a walk in shower. Currently a service user has to access the shower room of the laundry until work is completed. All bedrooms are used as single and are personalised in accordance with the occupant’s wishes. All residents can lock their bedroom doors, with a number bringing in their own furniture and possessions when they first moved in. Residents have moved bedrooms at their choice since vacancies have occurred to meet their individual needs. Rooms are redecorated and new furnishings are purchased, as they are required. Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 18 Some minor repairs were needed and the House Manager said these had been notified to the maintenance person but he was shared between all of the 5 sites operated by Cartref Homes and this sometimes took time to complete. All parts of the Home seen were commendably clean, warm and comfortable. Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,34 A committed, and motivated staff team supports Service users. Formal written recruitment processes and checks must be implemented to promote the safety and well being of residents. EVIDENCE: Staff presented as confident and approachable in their roles. Their commitment to the ensuring the safety and independence of service users was very evident in the manner, support seen during the visit. Good team working, communication and direct respect for each other was observed today. Staff confirmed continued working towards their NVQ 2 in care training. All new staff should undertake Three staff files seen contained almost all the required documentation. However a newly recruited staff member who started in November 2005 had only received verbal references, to date not written references had been received or chased, the CRB disclosure received was dated august for position of Befriender, not Residential Support Worker. CRB Disclosures are not portable or transferable and therefore an invalid document. No copies of training certificates were seen on the staff file, including N.A.P.P.I., which is required for supporting service users in this home safely. This staff member is Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 20 nearing the end of their probation period and satisfactory documentation and training has not been received to ensure service users safety. CRB certificates were seen on files assessed as suitable for adult service users, however none had undertaken checks in relation to children. Therefore no staff are covered to work with those 16-18 years old as detailed on the registration. Currently all service users are over 21 years. The House Manager was informed no new admission could be accepted for those 16-18 years of age until full satisfactory CRB children checks have been received. The House Manager was not aware of the information missing from staff files as not involved in their maintenance but office and senior management staff manage these. Auditing and monitoring systems would have identified the gaps found today. Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,42 Residents’ personal preferences support and care needs are encouraged through the House Managers open leadership and the promotion of a safe home and working environment. EVIDENCE: The registered manager has worked with this resident group since 1999 and has been House Manager since 2002. As part of this visit the manger agreed to undertake their fit person interview with the Commission to be Registered Manager. The manager has completed training in first line management and is currently working towards their Registered Managers Award Level 4. Service Users and staff expressed a satisfaction towards the management approach to the home. Service users felt the House Manager was approachable and staff feel well supported. The House Manager demonstrated through discussion, clear understanding of the needs of current service users and current issues for them. Monitoring Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 22 health and safety in the home is to a good standard, with regular health and safety walking routes taking place, and equipment serviced as required to maintain a safe home and facilities. Fire checks and drills are undertaken as required and recorded. Discussion over the recent group of regulation 37 notices took place, in relation to staff supporting the individual and staff training required ensuring their behavioural needs are fully met when in difficult situation experienced and the service users feel safe and confident with the staff supporting them. Accident incident records are well maintained but would be enhanced further through having a log of incident numbers to where filled for ease of tracking/ reference and monitoring patterns/ training needs. Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 3 34 2 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 2 X 3 3 X X X 3 X Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 24 NO Are there any outstanding requirements from the last inspection? 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 YA1 Regulation 6 Requirement The registered person shall keep under review, where appropriate, revise the statement of purpose and service user guide and notify the commission and service users of any such revision within 28 days in that 1)This be updated to include detailed information regarding the responsible individual name, experience and training and registered manager name, experience and training. 2)NCSC is replaced with Commission for Social Care Inspection. An action plan is to be received by CSCI by the given timescale. 13(2),17(1) The registered person shall 31/03/06 make arrangements for the recording, handling, safekeeping, safe administration of medicines” in that: 1. Consistent approaches by staff by having written guidelines for all PRN DS0000024037.V285264.R01.S.doc Version 5.1 Page 25 Timescale for action 31/03/06 2 YA20 Ulcomb House medication such as Diazepam, paracetomol etc. 2. The temperature of the medicines storage area must be monitored. 3. Photographs of service users to be kept with their MAR Charts. An action plan is to be received by CSCI by the given timescale. The registered person shall make arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse” in that: All staff must be trained in and adhere to the adult protection procedures. An action plan is to be received by CSCI by the given timescale The registered person shall not employ a person unless he has obtained in respect of that person information and documents required in schedule 2 in that: 1) CRB disclosures are applied for relevant to the post they are recuited for. CRB are not traferrable or portable from post to post. 2) CRB disclosures are undertaken to cover 1618 year old for all staff working in the care home, -including ancilliary staff. 3) Verbal references are supported by written refernces as soon as possible. 4) Staff files hold a current DS0000024037.V285264.R01.S.doc 3 YA23 13(6) 31/03/06 4 YA34 19 Schedule 2 31/03/06 Ulcomb House Version 5.1 Page 26 4 YA33 18(1)(c) coloured photgraph of the individual. An action plan is to be received by CSCI by the given timescale The registered person shall having regard to the size of the care home, number and needs of service users ensure that persons employed to work at the care home have appropriate training to the work they are to perform. In that all staff undertake N.A.P.P.I and behaviour management training for intervention techniques used in management behaviour guidelines. No staff untrained should be supporting service users requiring this interventions and be supported by trained colleagues at all times, until assessed as competent to work with the service users safely and correctly. An action plan is to be received by CSCI by the given timescale 31/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA6 YA9 Good Practice Recommendations It is recommended that all entries made by staff to care plans be signed. It is recommended that service users be given front door keys unless their assessment deems this inappropriate to the current care and independent living support needs. Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 27 3 4 5 6 YA22 YA24 YA24 YA42 It is recommended consideration to include photographs to current complaint procedure to assist service users understanding of the process. It is recommended that building waste stored in the back garden areas be removed as not only unsightly but also a fire and safety hazard. It is recommended consideration be given to increasing maintenance staff to meet the needs of the building maintenance of growing Cartref Services. It is recommended that records such as incidents and accidents would be enhanced further through having a log of incident numbers to where filled for ease of tracking/ reference and monitoring patterns/ training needs. Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Ulcomb House DS0000024037.V285264.R01.S.doc Version 5.1 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!