CARE HOMES FOR OLDER PEOPLE
West Farm House Collingbourne Ducis Marlborough Wiltshire SN8 3DZ Lead Inspector
Malcolm Kippax Unannounced Inspection 30th January 2006 09:45 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 West Farm House DS0000028653.V282549.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. West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service West Farm House Address Collingbourne Ducis Marlborough Wiltshire SN8 3DZ 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) 01264 850224 Mrs Helen Burnett- Price Mr Barry Price Mrs Helen Burnett- Price Care Home 10 Category(ies) of Old age, not falling within any other category registration, with number (10) of places West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 13th June 2005 Brief Description of the Service: West Farm House provides board, accommodation and personal care to up to ten older people. The home is situated in a quiet village location. Village amenities, including a convenience store are within walking distance of the home. West Farm House is a two storey, period property. The decoration and furnishing of the accommodation is in keeping with the character of the building. Some adaptations have been made to meet the needs of older people. There is a large well-kept garden with a lawn and seating areas. The communal areas of the home consist of a sitting room, and a dining room with a sun lounge extension. The service users individual accommodation is on the ground and first floors. A passenger lift is available. At the time of this inspection each service user had a single room, although shared accommodation may also be available. All rooms have an en-suite facility. The registered persons, Mrs Burnett-Price and Mr Price, are both involved in the day to day running of the home. Mrs Burnett-Price overviews the care of the service users. During the day the service users receive support from a permanent staff team. There are no staff members present in the building during the night. The owners provide sleeping-in cover from their own accommodation, which is next to the home, and rely on service users contacting them by call alarm system or telephone if assistance is needed. West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection took place between 9.45 am and 5.25 pm. There were eight service users living at the home and each person was spoken with. Service users were mainly spending time in their own rooms, which were well personalised and with different outlooks. There were individual meetings in the service users’ rooms and service users were also spoken with in the dining room at lunchtime. One of the service user’s relatives was met with. Mrs Burnett-Price, was spoken with at the start of the inspection and available at certain times during the day. One staff member was met with. Comment cards had been sent to the home prior to the inspection to be given out to relatives and visitors. Four have been returned to the Commission. Records, including care and assessment, staff training and fire log book were examined. As part of this inspection, the medication arrangements were looked at on 2 February 2006 by a pharmacist inspector from the Commission. The inspection focussed on those key standards that were not looked at during the inspection in June 2005. Some of the requirements from the June inspection had been followed up on a visit to the home on 19 September 2005. New requirements had also been identified during the visit in September. What the service does well:
Service users tend to have connections in the area and often know the home before moving in. West Farm House provides the opportunity to stay within a village location and for some service users to be in surroundings that are familiar to them. One of the service users met with was settling into West Farm House and the home was living up to her expectations. The home suits service users who can maintain an independent lifestyle. Service users value the contact that they have with their relatives and the company that this provides. The service users’ visitors come and go on a regular basis and this helps to create an informal atmosphere in the home. The accommodation is clean and tidy and service users appreciate the way in which the home is kept. During the day, service users receive support from a staff team that includes experienced carers. Service users said that the carers treat them with respect and have a friendly approach. In their comment card, one respondent describes West Farm House as ‘a lovely, caring place’, with ‘excellent caring staff’. Another has written that it is ‘a very comfortable and efficiently run care home … the carers are all kind, friendly, helpful and honest … nothing is to much trouble for them’.
West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better:
The home has a policy for the provision of additional night support and facilities when needed. However, the arrangements at night have failed to ensure each service user’s safety. An incident since the last inspection, in which a service user left the home during the night was of serious concern to the Commission. The registered persons have been advised of the Commission’s view that the most appropriate way to safeguard the service users’ welfare during the night is by having staff present within the building. The Commission is having further discussion with the registered persons about the changes they are making to ensure the safety of service users. A recommendation about monitoring the service users’ activities and routines during the night as part of the assessment process has not been met. Mrs Burnett-Price assesses the service users’ needs and uses this information to produce a care plan and a service user’s plan for each person. The recording system could be simplified by the production of a single type of care plan and improved by having greater detail about how the service users’ needs are to be met. Service users may appreciate or sometimes need to have more readily available information about the home. The Service User’s guide would benefit from being in a user-friendly format and more detailed, for example about what service users can expect at night if they become more dependant or are not able to summon assistance using the current systems. The inspection report needs to be included in the guide and service users do not have a complaints procedure with the relevant contact details. These items could be contained in an information pack for service users to keep in their rooms. The need for some new safety measures has been discussed with the registered persons. This includes the fitting of hot water regulators to the baths and automatic closure mechanisms to the doors, which will enable them to be kept in an open position. Mrs Burnett-Price has regular contact with the service users and has also used the inspection process as a means of obtaining comments about the home.
West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 Page 7 This has provided useful feedback. The priority now should be given to selfassessment and a system of quality assurance which includes the production of an annual development / improvement type plan. 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. West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 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 West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 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): 3 A new service user is settling into the home and been assured that their needs will be met. Service users tend to know West Farm House before moving in and do not rely on receiving written information about the home. Inspection reports and other sources of information about the home are not widely known about. EVIDENCE: A service user who had recently come to West Farm House was pleased to have moved in and felt that the home was living up to her expectations. Mrs Burnett-Price had carried out a pre-admission assessment and sent a letter confirming the suitability of the home for meeting the service user’s current needs. Service users who were asked about the written information they had received said that they could not recall having been given anything or thought that their relatives might have this. One service user commented that she did not feel this to be necessary, as she knew the home before moving in. Some information is left out in the front hall although the inspection report is not included in this.
West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 Page 10 In response to the question in the comment cards ‘Do you have access to a copy of the inspection reports on the home?’ one person commented that they did, another was not sure and two people responded with a question mark. A requirement has been at the last inspection that ‘Information produced about the home must be accurate, up to date and reflect the range of needs that the home intends to meet’. Mrs Burnett-Price said that the brochure still stated that the home’s registration was for 13 places, but that this is corrected to 10 when given out. The home’s Statement of Purpose has been amended since the last inspection to give some further information about the needs that can be met within the home. West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9 The service users’ care plans will be improved by changing the way in which information is used and recorded. Service users are protected by the homes policies for medicine handling, however further records are required to support self-medication. EVIDENCE: Examples of three service users’ records were looked at. Each service user has a ‘Service user plan’, which they have signed and is rewritten each month by Mrs Burnett-Price. Service users also have a ‘Plan of care’, which is broadly similar to the Service user plan, but with a review section where comments have been added about the service users’ day to day care. Although described as plans, they appear to be more a record of assessed needs, rather than the action that the care staff need to take to ensure that the service users’ needs are met. Some other relevant information about service users is recorded in daily reports, including contact with outside professionals. Since the last inspection, Mrs Burnett-Price has kept a daily note of whether service users have had any needs during the night. It was reported at the last inspection that more
West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 Page 12 detailed information is needed about how a service users specialist needs are to be met in the home. A number of different forms and records are kept, however there is not a clear distinction between assessments, care plans and daily reports. Relevant information is recorded in the daily reports, although this is not being drawn upon to add detail to the care plans when they are reviewed and updated. The inspector offered to give further advice to Mrs Burnett-Price about this. Medicines are kept securely and all appropriate records are maintained. The home prepares medication administration records weekly and these are signed and dated. A homely remedy procedure has been agreed with the GP. All staff who administer medication have recently completed a training course, as a consequence of which new policies are now in place. Some residents retain control of their own medicines, the home keeping a list of their current prescription. Staff were able to discuss how this process is risk assessed and reviewed but there is no documentation to support it. West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14 Service users maintain an independent lifestyle, which is reflected in the home’s routines and a lack of organised activities. There is an informal atmosphere in the home. Contact with relatives and the outside community is important to service users. EVIDENCE: Service users were met with in their own rooms, which have a homely and individual appearance. Service users have brought with them a range of personal possessions and items of furniture when moving into the home. Service users have their own telephones. Service users had lunch together in the dining room and some service users enjoyed a sherry with others in the sun lounge before the meal. After the meal, the service users returned to their own rooms, where they spend most of their time. A sitting room is available. Some occasional social events, such as a summer garden party, are arranged but there is no regular activities programme. In their comment card, one respondent had written ‘No communal activities for the ladies’. During the inspection, some service users were occupied reading newspapers and books. Other people were watching television or just sitting. One service user continues to have the use of a car.
West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 Page 14 Some service users have regular visitors. The daughter of one service user was met with and other service users’ relatives ‘dropped in’ during the day. Service users said how much they like this contact and the company it provides. Comments received about the home have all been very positive about the visiting arrangements. One service user spent time with a visitor who was from a befriending service. This is a useful resource to have on offer for service users who may have infrequent contact with other people or become less able to occupy themselves. The home’s informal atmosphere was evident later in the afternoon, when a service user was able to use the kitchen and help out with the laying of tables for tea. The service user liked to assist and this appeared to be a regular routine without the involvement of staff. Mrs Burnett-Price has reported that the home has no involvement with the service users’ financial affairs, as these are handled by the service users personally or by their families. West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Service users know people who they can talk to about concerns, but lack information about a full complaints procedure. Formal complaints are not being made. EVIDENCE: As reported under standards 12 and 14, the service users have contact with relatives and others who they can discuss any concerns with. Mrs BurnettPrice said that the home has not received any complaints and felt that any concerns would be dealt with as part of life in the home and sorted out without needing to get to a formal stage. In their comment cards, three respondents said they were aware of the home complaints procedure and one person said that they were not. Mrs BurnettPrice said that service users did not have a complaints procedure that includes the name, address and telephone number of the Commission. West Farm House DS0000028653.V282549.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): 26 The home is clean and tidy. Service users like how the home is kept. The laundry has improved although hand-washing facilities are not well located. EVIDENCE: The accommodation looked clean. Service users said that they were satisfied with the support that they receive with their own rooms. The communal areas seen were well furnished and decorated, in a co-ordinated style. There were no unpleasant odours. An environmental health officer had last visited the home in July 2005 and Mrs Burnett-Price has reported that there are no outstanding requirements or recommendations. The laundry area is located outside the home. This has been redecorated and had a new floor fitted during the last year. Refurbishment so far has not included the installation of a hand washing facility. Staff members use the facilities in a utility room, which is next to the kitchen. The fitting of thermostatic controls to the hot water supply in the bathrooms has been discussed with the registered persons since the last inspection. A contractor visited the home on the day of the inspection about this work.
West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 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): 27, 28 and 30 The staffing arrangements at night have failed to ensure the safety of each service user. Staff members are gaining relevant qualifications and the provision of staff training is improving. Knowledge about C.R.B. disclosures is needed in order to ensure that service users are not at risk. EVIDENCE: Standard 27 was looked at in respect of the arrangements at night. The home has a policy for the provision of additional night support and facilities when this is needed by service users. This was in place at the time of the last inspection. Since the last inspection there has been further contact with the home following an incident in which a service user left the home during the night without the registered persons’ knowledge. The Commission has required the registered persons to provide additional night time support and supervision to ensure that service users are safe and their needs are met. The registered persons have increased security to the doors. The Commission has advised the registered persons that the preferred option is for a staff member to be present in the building at night. The registered persons have indicated that other measures will be taken but have not yet confirmed the details of these and a timescale. The Commission is
West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 Page 18 having further discussion with the registered persons about the changes they are making to ensure the safety of service users. Mrs Burnett-Price has completed ‘Needs at night’ assessment forms. During the inspection, one service user said that she had used the call alarm system in the night when assistance was needed. Other service users said that they were aware of the system and would use it, or would prefer to cope in their own way without ‘disturbing’ the owners. One service user said that they would prefer to have a staff member in the home during the night but understood that this was not the current arrangement. A recommendation about monitoring the service users’ activities and routines during the night as part of the assessment process has not been met. The registered persons say that they talk to service users on a daily basis about their needs. There is a matrix that gives an overview of the training undertaken by staff. The staff team have received instruction in first aid and manual handling, other than for the most recently appointed staff member. The training needs for this person will need to be prioritised and appropriate courses arranged. In 2004, a police officer from the vulnerable adults unit visited the home to talk about abuse awareness and the procedure for the protection of vulnerable adults. The staff member met with said that she had attended the above training events and had also received training in infection control and more recently a course in the safe handling of medication. A training course titled, ‘Positive Dementia Care’ has been arranged for March 2006. The staff member had completed her NVQ level 2 in care and Mrs Burnett-Price has reported that six carers, or 75 of the staff team, have now achieved this qualification. Standard 29 concerning the recruitment of staff was looked at during the previous inspection. A requirement was made concerning the carrying out of C.R.B. disclosures on existing staff, which Mrs Burnett-Price has since confirmed as being done. A check was made of a service members file, which showed evidence of the C.R.B. disclosure, although it was found and confirmed with Mrs Burnett-Price that the completion of C.R.B. had not included all people who may be asked to provide cover in the home on a relief basis. Mrs Burnett-Price also asked about the need for a gardener to have a C.R.B. disclosure. The Commission’s policy and guidance about C.R.B. disclosures and P.O.V.A. was sent to Mrs Burnett-Price after the inspection. West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 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 and 35 The manager’s achievement in gaining the registered managers award is very positive. Systems for self-assessment and quality assurance are not well developed. Service users are managing their own financial affairs with the support of their relatives. EVIDENCE: Mrs Burnett-Price was originally registered with Wiltshire County Council, when she was considered to meet the standards in respect of supervisory experience, qualifications and competence. Prior to setting up the home, Mrs Burnett-Price worked as a radiographer and has managed a large department within a psychiatric hospital. West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 Page 20 Mrs Burnett-Price has undertaken training courses in conjunction with the staff team and said that she has completed the registered managers award since the last inspection. Mrs Burnett-Price has regular contact with the service users and said that she uses the inspection process as a means of obtaining comments about the home. There is no system of quality assurance and formal self-assessment and Mrs Burnett-Price said that there was no annual development / improvement plan for the home. Mrs Burnett-Price has reported that the home has no involvement with the service users’ financial affairs, as these are handled personally by the service users or by their families. Standard 38 was looked at during the previous inspection. There was a requirement that fire doors must not be held open unless they are fitted with an appropriate device approved by the fire officer. This was discussed further during the visit on 19 September 2005, when Mrs Burnett-Price said that she was looking at the options that are available. West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 x x x x x x x x 3 STAFFING Standard No Score 27 1 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x N/A x x x West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 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 15 Requirement The care plans must give more detailed information about how a service users specialist needs are to be met in the home (met in part since last inspection). All service users who self medicate must have a thorough risk assessment and regular review recorded on their file. Service users must receive a copy of the home’s complaints procedure that includes the name, address and telephone number for the Commission. Individual thermostatic controls must be fitted to the baths. Additional night time support and supervision must be provided to ensure that service users are safe and their needs are met (this is the subject of further discussion with the registered persons). C.R.B. disclosures must be undertaken in accordance with the Commission’s policy and guidance. That a report is produced in respect of a review of the quality of care that is carried out in accordance with Regulation 24 of
DS0000028653.V282549.R01.S.doc Timescale for action 31/01/06 2 OP9OP 13(2) 03/02/06 3 OP16 22 31/03/06 4 5 OP25 OP27 13 18 31/03/06 02/02/06 6 OP29 19 02/02/06 7 OP33 24 31/03/06 West Farm House Version 5.1 Page 23 the Care Homes Regulations 2001. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP1 OP1 OP7 OP24 Good Practice Recommendations That a check is made with service users to ensure that they have received the information that is required to be given under the Care Homes Regulations 2001. That information about the home is more readily available and accessible to service users and others. That the care plans provide greater detail about the action that care staff need to take to ensure that the service users’ needs are met. That a programme is undertaken to fit automatic mechanisms to the doors, which will enable the doors to be safely kept in an open position (carried over from previous inspection). That a hand-washing facility is provided in the laundry. That regular monitoring of service users’ activities and routines during the night is part of the assessment process (carried over from previous inspection). That a policy and procedure for quality assurance is produced giving details of the system that will be implemented and the relevant timescales. 5 6 7 OP26 OP27 OP33 West Farm House DS0000028653.V282549.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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