Inspection on 23/08/05 for Willow House

This inspection was carried out on 23rd August 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Willow House 22/05/07

Willow House 04/01/06

Willow House 06/10/04

Willow House 27/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Willow House 101 Countess Road Amesbury Salisbury Wiltshire SP4 7AT Lead Inspector Roy Gregory Unannounced 23 August 2005 rd 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 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 Stationary 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. Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Willow House Address 101 Countess Road Amesbury Salisbury Wiltshire SP4 7AT 01980 622220 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Sharon Anne Arnott, Glen Arnott Sharon Anne Arnott Care Home 8 Category(ies) of LD Learning Disability (8) registration, with number LD(E) Learning Disability - over 65 of places PD Physical Disability (3) PD(E) Physical Disability - over 65 Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 8 service users with a learning disability may be accommodated at any one time. 2. No more than 3 of the 8 service users with a learning disability may also have a physical disability. Date of last inspection 6th October 2004 Brief Description of the Service: Willow House is a semi-detached, extended family home providing single bedroom accommodation for eight people over three floors, including one room with en-suite facilities. The other rooms have bathrooms and toilets nearby and some have wash hand basins. Communal space comprises a large sitting room and modern conservatory, which is used in part as the dining room. This in turn gives onto a pleasant garden that overlooks open countryside. The home is situated unobtrusively alongside similar residential properties on the northern edge of Amesbury, and is easily accessed by public or private transport. The registered manager is also the co-owner (with her husband) of the business. Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 11:10 a.m. and 8:10 p.m. on Tuesday 23rd August 2005. The inspector met with all of the residents, four individually (one of whom had recently moved in) and as a guest at the evening meal. The registered manager, Sharon Arnott, was available throughout and made documentation available. Additionally there were conversations with care staff. The inspector looked at care plans to compare observations of care and residents’ perceptions with written records. Other records consulted included those relevant to staff recruitment and training, and health and safety. All communal areas were visited and two individual rooms were seen with the consent of their occupants. The inspector also spoke with the co-provider Mr Glenn Arnott, who was at the home when the visit commenced. What the service does well: What has improved since the last inspection? Much work has been put to making the garden more accessible. A greenhouse has been provided, and one service user in particular was making use of this. In response to previous requirement, a toilet floor had been made good. Further redecoration had been carried out. The accounting system for Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 6 residents’ monies had been simplified, and checked as satisfactory by the company auditor. 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. Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 8 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 standard(s) 1 - 4 Assessment of potential service users is thorough, including visits to the home, thereby ensuring service users and their supporters can feel confident that the home can meet their needs. Information provided is of a good standard. EVIDENCE: The home has admitted one new resident since the previous inspection. For that person, assessments of the potential of Willow House to meet their needs were carried out by their care manager and staff of their then placement, which was no longer meeting their needs, in discussion with Mrs Arnott. This process was followed by the prospective service user coming to the home for a teatime visit, and then a weekend stay, before a decision on admission was made. Six weeks into the placement, a review was held, with full involvement on the part of the service user and nearest relative. A number of people, including the relative, confirmed at the review that many positive developments were already noted, and attributed to the move to Willow House. The resident concerned expressed confidence in the placement to the inspector. Since the inspection the inspector has spoken to the resident’s close relative, who confirmed their involvement in initial visits to the home and the assessment and review process. They had had sight of associated documentation. They reiterated their satisfaction with the placement and the admission process. Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 9 A resident admitted last year said the home gave him what he had needed and wanted. In both cases, pre and post admission information had been appropriately used in creation of care plans. Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 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 standard(s) 6 - 9 Individual plans direct care, and incorporate evidence of meaningful review. Residents are involved in the care planning process and thereby assisted with decision-making. There are good systems in place for consultation with residents about every-day and special events in the home, resulting in a culture of participation. On an individual level there is appropriate support to risk-taking, which enhances opportunities for maximum independence. EVIDENCE: An assessment of skills was the first element in each care plan, setting out what an individual could manage for themselves, where a little support was needed, and where there was a need for significant support. Specific guidance was then given for those areas of identified need for support. For an individual with communication needs, for example, there was clear evidence-based guidance, which fitted with staff descriptions of how they worked with this need. The plans showed evidence of monthly review and meaningful evaluation. For example, an evaluation of someone’s responses to activity provision had led to arrangement of an additional weekly attendance at a club. Residents spoken to were aware of the plans and happy with how they operated, including key worker involvement, which was greatly valued. Residents had signed their plans where possible. Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 11 The manager and deputy have attended training in ”person centred planning” (PCP). A start had been made on PCP with one resident considered most likely to benefit initially, including beginning to compile a personal book with them, which was seen. Care plans stressed key worker responsibilities in assisting decision-making, whilst minutes of monthly residents’ meetings showed these actively involved residents by informing them as a group about developments, including staff changes, and seeking ideas and wishes. Risk assessment and management were documented to a satisfactory level, and closely allied to care planning. Staff support to responsible risk taking, for example in the kitchen, was seen to be part and parcel of the delivery of care in the home. There was a policy in place for the unexplained absence of a service user, and the inspector saw evidence of a monthly check with each service user that they had up to date I.D. and knew what actions to take in the event of becoming lost. Two residents spoke of the importance to them of being able to go out, in the knowledge that they were safe when doing so. Examples were seen of risk assessments counter-signed by other professionals, e.g. care manager or psychologist. Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 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 standard(s) 11 - 17 The nature of care planning, and quality of working relationships between service users and staff, mean that residents have access to planned and spontaneous activities that fit their individual wishes and needs. These provide for personal development and access to the wider community, as well as natural homely routines within the home. EVIDENCE: Residents demonstrated active involvement in personal interests during the inspection, ranging from heavy rock music to needlepoint, from gardening to reading about science. They also attended a variety of day services and clubs, relevant to individual interest and age. Varying groups of residents had been to theatre events, locally and in London, and had taken or were planning holidays. One resident said that he had agreed to try attendance at a particular club, and had carried on as he liked it. He liked the fact also that his expressed dislikes were respected. Care plans included guidance on promoting daily skills. Staff job descriptions make specific reference to the promotion and maintenance of relationships and communication with families and friends. Family members had been invited to a recent barbecue. Mrs Arnott keeps Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 13 families in touch with significant events relating to the home by way of occasional newsletters. The inspector joined residents and staff for a substantial evening meal, at which there was spontaneous conversation, and discrete assistance to individuals as necessary. Residents expressed satisfaction with the standard of meals in the home, many playing a part in preparation, serving or clearing away. The kitchen was a supported environment, but residents had freedom of its use in order to obtain drinks as required. Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 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 standard(s) 18, 19 & 21 Staff offer personal support that matches service users’ recorded needs and preferences. Healthcare needs are clearly recorded and managed, with full use of external consultation and guidance. Factors related to ageing are recognised and planned for, and the death of a resident is handled with respect. EVIDENCE: Users’ preferences in respect of personal support were recorded in care plans. Records showed a good level of liaison between the home and the local GP practice, and staff attentiveness to indicators of possible ill health. Staff had received training specific to one resident’s primary condition, and published material was readily available for ongoing reference. Weights were monitored monthly for all residents. Care records tracked all medical appointments, and could be cross-referred to outcomes. One resident spoke of a difficult period following surgery, when he felt staff had helped him considerably to be “much better than I was.” The review summary for another resident confirmed what the inspector had been told of plans for surgical intervention, and showed the manager was consulting with medical personnel about best practice issues, including consent. There was much evidence in the home of support to maintenance of exercise regimes given by physiotherapist inputs, and to co-operation with dentists’ instructions. Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 15 Sadly, the home had experienced the death of a resident since the previous inspection. Minutes showed this event was shared within the residents’ meeting, and some residents had chosen to attend the funeral and contribute to the choice of hymns. Subsequently Mrs Arnott had arranged an externally provided training session for staff, about bereavement, linked to which was an offer of counselling in the event of future need. With hindsight, Mrs Arnott considered this valuable input to have been late in relation to the events in the home, but it was now in place for the future. The care planning process showed that age-related factors were identified and kept under review for individuals. Two residents made unprompted remarks about hopes to end their days at Willow House. Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 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 standard(s) 22 & 23 Residents feel confident in the home’s provisions for their security, and in the readiness and ability of staff and management to respond to any concerns raised. EVIDENCE: The openness of staff/service user communication, together with the regularity of residents’ meetings and invitations to families to interact with the home, means that potential areas of complaint on the part of service users or their supporters can be recognised and acted upon at an early stage. There was provision for recording formal and informal complaints, concerns, incidents and compliments. Two residents said separately they would raise any concern initially with their key workers. Both considered the residents’ meetings worked well for all residents. The manager and other staff have experience of working with the local vulnerable adult procedures. A resident who had been a victim away from the home was very pleased with support he had received from management and staff. Another considered that feeling safe at Willow House was a main reason for being there. There was a secure and transparent system for safekeeping of service users’ monies, and accounting for all transactions. The company auditor had checked two accounts at random. All service users now had bank accounts for receipt of direct payment of benefit income. For the majority, safekeeping was provided by the home for cash cards and PINs. Mrs Arnott described situations where it had been expedient for cash withdrawals to be made at the request of, but in the absence of, individual service users. She said she took responsibility for the implications of so doing. Whilst the accounting system demonstrated the integrity of practice, it would be desirable to have in place a means of recording resident wishes and satisfaction with the outcome, on each occasion that money is withdrawn by proxy. Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 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 standard(s) 24 - 28, 30 Willow House provides a homely environment where residents enjoy private and communal facilities in comfort and in line with their respective needs. Good standards of hygiene are maintained. EVIDENCE: The conservatory was now about a year old and had blended into the home, with addition of pictures and plants. A resident said she had chosen the blinds there, which together with a ceiling fan maintained a pleasant temperature. Outside, the garden had been made more accessible, and a greenhouse installed, which was used by one resident in particular. There had been some recent redecoration within the home, including of a resident’s room to their specification, and the whole of the home, including bathrooms and toilets, presented well in terms of homeliness and cleanliness. One resident thought their bedroom “better than anything I could have imagined” and said the sharing of toilets and bathrooms was not problematic. In respect of those rooms where a wash hand basin was not provided, this was acknowledged in individual service user guides. Two washing machines were in use, one for a specific use to avoid risk of cross infection. Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 - 36 Staffing is sufficient in numbers and quality to ensure service users are safely and consistently supported. Recruitment practice is safe. Staff are supported in their roles by regular supervision, appropriate training and employer support to achievement of NVQ awards. EVIDENCE: The home was fully staffed. Rotas showed day-time cover on weekdays starts at 6:30 a.m. with the member of staff who has “slept in” overnight, although it was anticipated this might move to 7:00 a.m., as a later start at a day service used by some residents was expected to be introduced. The baseline staffing level is two care staff, plus the manager or deputy manager during some part of each weekday. Staffing is reduced or increased according to residents’ needs; for example, up to 9:00 a.m. on Saturdays and 10:00 a.m. on Sundays there is only one member of staff on duty, but between 10:00 a.m. and 6:00 p.m. at weekends, 3 staff are provided to enable residents’ access to the community. The deputy manager works every other weekend, alternating with experienced care staff. The deputy manager provides on-call duties when the manager is on holiday. There was evidence of this back-up having been used when necessary. Training records for staff were easy to follow. They demonstrated achievement of mandatory training, and showed when these courses needed to be revisited. The team and individual training plans were reviewed twice yearly, and there Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 19 were brief statements of the relevance to service user needs of training courses that staff had undertaken. Copies of certificates were on file, and showed extensive use of accredited trainers. Newer staff had completed all mandatory training including in-house competency training for the administration of medication; they were also booked onto an accredited medication course in September 2005, i.e. at the first opportunity. One carer was aged under 25 years and was training under the Modern Apprenticeship Scheme. Most staff apart from the three most recently appointed had achieved or were working towards NVQ level 3 in care. The deputy manager has attained NVQ level 4 in care and management. The manager and deputy manager were working on a new induction package with the intention of it gaining LDAF accreditation. Induction records for recently appointed staff showed attention to detail and to individual need. Staff meetings generally included some training content. Supervision records confirmed priority was given to maintaining monthly supervision for full-time staff, two-monthly for part-time. These always included a focus on resident, and especially key client, issues, key workers being required to show they review care plans monthly; any proposed changes to care plans are then discussed in supervision before being finalised and communicated to the rest of the staff group. Recruitment practice was safe, but records would be enhanced by documented evidence of when receipt of CRB and POVA disclosure are initially notified by the “umbrella body” used. Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 20 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 42 & 43 There is clear leadership and direction from the registered manager. Quality assurance systems are centred around service users, producing information that is used to improve the service. There are systems in place to identify and promote the health and safety needs of residents and staff. EVIDENCE: Mrs Arnott has both a nursing qualification and management certificate. The providers show commitment to quality assurance by a combination of regular internal audits of standards, residents’ and staff meetings, information supplied to residents’ families, and the gathering of direct feedback by questionnaires. The relative of the recently admitted resident said that of several potential placements seen, Willow House presented as offering a service based on sincerity, a friendly approach and lack of institutional routines. They considered their agreement to the placement to have been vindicated. Other residents portrayed a similar appreciation of the way the home is run. One said “it’s well run, I’m proud to live here.” Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 21 Fire precautions records were up to date. External fire training was arranged for all staff to attend in September 2005. A fire alarm repeater was on order, to be installed outside the room of a resident with hearing difficulties, as had already been done for another resident. Mr Arnott was at the home during inspection, attending to a maintenance matter that had just arisen, and there were records of his continuing monthly audit of, and attention to, health and safety issues. The home was still using an outdated form of accident book, which needs replacing, but actual accident records were appropriate and crossreferred to care records. For one individual, this entailed inter-agency liaison about an identified heightened risk of falls. For another, the environmental cause of an accident had been addressed. The inspector drew attention to two staff accidents that suggested induction of new staff should include attention to safe use of the iron press. Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 4 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 4 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 4 4 4 3 4 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 4 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 3 4 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Willow House Score 3 4 x 3 Standard No 37 38 39 40 41 42 43 Score 4 4 4 x x 3 3 D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 23 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 Regulation Requirement There are no requirements from this inspection. Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 23 Good Practice Recommendations Where a residents personal money is withdrawn from a cash machine in the absence of the account holder, the circumstances of doing so should be documented on each such occasion, and signed by the resident or their representative. A signed and dated record should be kept of each notification to the home of receipt of initial CRB disclosures by the umbrella body. Accident books that conform to Health & Safety Executive requirements should be provided to replace those in use at the time of inspection. 2. 3. 34 42 Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 24 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham SN15 2BB 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 Willow House D51_D01_S44553_WILLOWHOUSE_v198341_220805_Stage4.doc Version 1.40 Page 25 - 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. 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