Inspection on 25/10/05 for Woodberry Grove

This inspection was carried out on 25th October 2005.

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

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

Other inspections for this house

Woodberry Grove 30/11/06

Woodberry Grove 22/06/06

Woodberry Grove 11/04/05

Woodberry Grove 01/09/04

Woodberry Grove 01/04/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Woodberry Grove 91 Wellington Road Bush Hill Park Enfield Middlesex EN1 2PW Lead Inspector Margaret Flaws Unannounced Inspection 25th October 2005 10:00 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 Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Woodberry Grove Address 91 Wellington Road Bush Hill Park Enfield Middlesex EN1 2PW 020 8360 2214 020 8886 9296 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) Hapee Care Ltd Mr Kathiresu Cumareshan Mrs Janet Carol McGuigan Care Home 26 Category(ies) of Dementia - over 65 years of age (26), Old age, registration, with number not falling within any other category (26) of places Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th April 2005 Brief Description of the Service: Woodberry Grove is a care home registered to provide a service for 26 older people. The service has recently been granted registration to provide dementia care services. A respite care service is also provided. The stated aim of the service is to provide a high standard of individual care, support and a pleasing environmnet for all the residents to enjoy a good quality life. Woodberry Grove is a private care home owned by Mr Cumaresham and Mr Shandakumar of SSS Care Limited. Mr Cumaresham and Mr Shandakumar own a number of other care homes in England. The service is provided in a large detatched property with rear extension, that has been converted for use as a care home. There are eighteen single bedrooms and four double bedrooms. Bedrooms are on the ground, first and second floor with a shaft lift serving all three floors. In addition, there is a chair lift linking the ground and first floors. There are bathrooms on all three floors. There are two lounge areas and a dining room on the ground floor and a room on the second floor which is used by the hairdresser and can also be used by staff and service users as a sitting area. There is a garden to the rear which includes a grassy area with trees and shrubs as well as a paved area with seating for residents. Woodberry Grove is in an quiet road in an attractive residential area of Bush Hill Park, Enfield. It is close to local shops, a railway station and bus routes. Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days. The Registered Manager Janet McGuigan assisted with the inspection. Most of the twenty three service users were spoken to, along with one relative and four staff. Care and staff records were inspected, and health and safety documentation. The CSCI pharmacist inspected the medication records and systems. A tour of the premises completed the inspection. What the service does well: What has improved since the last inspection? The home’s statement of purpose has been amended to include respite care. Some progress has been made in improving dementia care planning but there are still requirements for this. Occupational therapy assessments have been carried out for the building and for individual service users. Manual handling assessments have improved. As part of a rolling improvement programme, minor building repairs have been carried out, risk assessments for laundry handling and washing soiled linen have been done, and risks of unguarded radiators and unrestricted windows controlled. Tests have shown that the hot water system is free of legionella and all required health and safety certificates are in place. The training of staff on medication is being updated regularly to ensure that all staff, who administer medication to service users, do so safely and can identify any problems that may occur. Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 6 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. Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Clearly written information about the home and the services provided are available to services users. The assessment procedures provide a sound base on which to develop assessment and care planning information to meet the needs of people with dementia. EVIDENCE: The atmosphere at Woodberry Grove is homely and relaxed. On the day of the inspection, positive relationships were observed between service users and staff. Feedback from most service users and a relative spoken to was that the standard of care is good. There is good information for prospective service users contained in the statement of purpose and the service users’ guide. The statement of purpose contains updated information about the provision of dementia care and respite care, as required. No respite care has been provided since the last inspection. Initial assessments are on file and give sufficient information from which to Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 9 plan care. The Registered Manager also described the assessment process, which was reflected in the documentation. In response to a previous requirement, night care plans have been developed, particularly to meet the needs of service users with dementia and a mental health assessment added to the assessment process. This is an improvement but there is still more work to do in assessing the needs of service users with dementia and this is required. Service users spoken to who could describe the process, said that their needs had been assessed prior to admission. Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Service users receive respectful and sensitive care from staff who know them well and are able to provide kind and professional care. Care plans are sound and cover key areas of need but would benefit from ongoing development for those service users with dementia. Medication was found to be handled and administered by staff in a safe and secure manner on behalf of service users. The medicines policy needs to be extended to cover all possible aspects of medication administration to service users and the extra documentation needed. EVIDENCE: There were twenty three services users at the time of the inspection. Four service users’ care plans were inspected. These were clearly laid out and easy to understand and included good profiles. The service users’ care needs were well covered, although there is still some more work to do on dementia care planning documentation. The staff, however, were knowledgeable of the needs of service users with dementia and were able to describe how they worked with them to meet their needs. They have received some training in this area and the Registered Manager has completed a more in-depth course in Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 11 dementia care. The care plans set out clear goals and action to be taken to meet these goals and were regularly reviewed. The care plans now include manual handling risk assessments developed in more detail and in particular, these contain information about the use of the hoist and other mechanical equipment, as required. These were updated in July 2005. Other risk assessments cover nutrition, skin integrity and the prevention of pressure sores. District nurses come in twice a day and provide good back-up, and give insulin to two service users who require it. They also provide support when a service user is dying, along with the Enfield Palliative Care, who worked with a service user who had died recently at the home. The home was unable to get individual occupational therapy assessments done by the PCT. However, the home was fully OT assessed and all recommendations complied with. The Registered Manager has done individual OT assessments for service users in consultation with the OT service. Preventative health care visits are now recorded on a single chart, as recommended and this is much easier for staff to monitor. The home now has an alarm on the door to alert staff if a service user with dementia goes wandering out of the home. The medicines policy is short and does not cover service users taking responsibility for their own medication, the possibility of disguising medication and the documentation needed to cover these two sections. One service user is administering her own medication following an assessment, but an agreement form has not been completed. [Requirement made].The records for the receipt, administration and disposal of medication where found to be satisfactory, but the receipt of medication is being recorded in a medication book rather than on the medicine administration chart. During the inspection it was observed that tablets for a service user were being taken to her on a spoon rather than in a medicine pot. Medication is stored in locked metal cupboards in the dining room. Medication is transferred from one of the cupboards to the medication trolley for distribution to the service users. The temperature of the room where the medication is stored is being monitored and recorded and can reach a temperature of 27 oC in hot weather. There is a dedicated refrigerator for the storage of medication requiring refrigeration which is being maintained between 2 and 8 oC . The cupboard in which the medication is stored may possibly remain at 25 oC . or below. There is no Controlled Drug cupboard although currently no Controlled Drugs are being kept. Records for administration of Controlled Drugs, when kept, are being recorded on special forms. All the service users spoken to said that the staff treated them well and that their rights were respected. One staff member said that she tried to relate to the service users as she would to her grandparents, with “great respect and kindness”. Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 12 Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 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, 13, 14 and 15 Activities continue to improve, particularly those outside the home and service users’ visitors have free access to visit. Food remains pleasant and nutritious. EVIDENCE: Service users were mainly following their own interests during the inspection. Some were watching television and said they enjoyed it, while others were playing simple games with staff and having a sing along. The Registered Manager and the service users spoken to said that they used the garden frequently through the summer and until very recently. Trips outside the home have expanded since the last inspection, and service users have been involved in organising outings. They have been to the seaside, to the local theatre, to pub and restaurant lunches, and were planning big Christmas outings to the pantomime and lunch. The Registered Manager described how they are trying to develop activities to assist service users who had dementia and memory loss, for example, by using quiz books from the 1940’s. Staff said that they were enjoying outings and being able to develop new activities. One relative said that she is concerned that her mother has limited opportunity for activity because of poor mobility. Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 14 Service users said that their visitors could come at any time to see them in the home. Several service users go home regularly and many have visitors. A husband and wife and two sisters share double rooms at the home. Two service users do not have any family but have some advocacy and volunteer support from Help the Aged. Lunch was observed. The cook demonstrated a good knowledge of service users’ needs and planned healthy and nutritious meals. Some service users required assistance to eat and this was provided carefully and patiently by staff. The cook and other staff have received training in diabetes support for the six service users who are diabetic. Service users spoken to said that they liked the food and had good choices, “you just ask for it and you get it,” one said. Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 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 and 18 The arrangements to protect service users are still insufficiently robust. There is insufficient staff training and policy and procedural guidance to deal with incidents or allegations of abuse. EVIDENCE: There have been no complaints since the last inspection. The staff have not yet received adult protection training, partly because local authority courses applied for were full. Half of the staff are booked to receive the training in January 2006. The Registered Manager is booked on training in December 2005. This training remains required to protect the interests of service users. It is recommended that the Registered Manager attend a trainer the trainer course in adult protection to ensure that all staff receive updated training in these areas in the future. There is still a gap in adult protection because the home’s policy and procedure has not been updated and this is still required. The Registered Manager said that she has obtained copy of the local council’s policies and procedures but has not updated the homes. Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 There have been minor improvements since the last inspection and the environment remains pleasant and quite homely. EVIDENCE: The home has had some refurbishment since the last inspection. Two double rooms have been redone and the outside of the building has been repainted as part of a rolling maintenance and improvement programme. The kitchen is the next area of the home due for work. A cleaner works at the home five days per week, and a weekend cleaner does the weekends. Hygiene and cleaning standards were good. There is a good continence management programme for services users and the home was free from unpleasant odours. Service users’ bedrooms and the communal areas are comfortable and well furnished. Minor repairs to the ground floor toilet and the first floor bedroom Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 17 have been completed as required. The back lounge has a particularly good aspect to the garden. Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The established staff team works well to support the service users. Staff training is ongoing and there is a good basis for additional core training in the coming months. EVIDENCE: Five staff members, including the manager, were spoken. They were very positive about the home and many had worked there for a long time. The interactions observed between the team and with the service users were very relaxed, but professional. The Registered Manager works closely with the staff and the service users on a day to day basis. Staff said that morale was very good and that they were well supported, formally and informally. The staff file of one new staff member was examined and a health check form and personal identification were missing. These are required. The Registered Manager also said that all other staff need a health check form. There were twenty three service users at the home on the day of the inspection and the Registered Manager said that the current staffing level of four morning staff and three afternoon staff was adequate for the services users’ needs at present. The Registered Manager described how the current staffing mix worked when the service users were participating in activities or going on outings. It is required that the service users’ numbers and needs be closely monitored to ensure that the right staffing level is in place. There are Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 19 currently six service users with what the Registered Manager described as “moderate dementia” and she said that this was manageable. Staff also confirmed this. There has been improvement in the induction programme but there remains work to do on staff training. A timetable for staff NVQ progress is still outstanding. The assessor from Barnet College has completed a training needs assessment. A full induction programme has been drawn up for all new staff, an introductory PowerPoint presentation prepared and a worksheet designed for staff to work through. The Registered Manager has researched but been unable to find care planning training. Consequently, she has obtained a training video and is mentoring all staff in care planning on an individual basis. It remains a requirement that this training be given. Training for staff on activities has been successful and they said they are enthusiastically participating in activity development. One staff member has completed the four day First Aid Course as required, those team members who required manual handling updates have done them, and half the team has had care skills training and infection control in the past few months. A staff training profile and timetable has been drawn up. Staff are also doing medication training by distance learning through Barnet College. Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 21, 33 and 38 The home continues to benefit from the leadership of the Registered Manager. Quality assurance processes are in development. Health and safety of service users is generally well protected. EVIDENCE: The Registered Manager has commenced the Registered Manager’s Award. All the service users and staff were positive about Janet McGuigan’s management style and support. A quality assurance report is due for production in December 2005 and is still required. The Registered Manager said it includes material contributed by relatives and care professionals, as well as service users. All staff have now been shown how to do a Regulation 37 report to the CSCI. The risks associated with the unguarded radiators and unrestricted window Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 21 opening have been minimized and the infection control risk assessments have been extended. Accident and incident records inspected contained only minor falls since the last inspection. All health and safety certificates were checked and found to be in order and the home’s hot water system has been tested for legionella. Fire safety procedures and records were checked and were in order. Regular drills and checks take place. The recording of food temperatures was patchy for September and October 2005. The records were also quite messy and out of order. A requirement is made about this. Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 N/A 2 N/A N/A N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 N/A DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 N/A 18 2 3 N/A N/A N/A N/A N/A N/A 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 N/A 2 N/A N/A N/A N/A 2 Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3OP7 Regulation 4 Schedule 1 Requirement Timescale for action 01/01/06 2 OP9 13 (2) 3 OP9 12 (4) The registered person must ensure that assessments and care plans detail the needs of service users with dementia and that action is taken to meet those needs. Previous timescale of 01/08/05 not met. 01/12/05 The registered person must ensure that the home’s medication policy is extended to include self-medication and the possibility of disguising medication for service users together with standard assessment and agreement forms. The section on the disposal of medication must be rewritten to reflect the new collection procedures. The register person must ensure 01/12/05 that an agreement form is completed for the service user who is administering their own medication. It should be signed by the service user, their GP and the home manager. The ability of a service user to administer their own medication must be reassessed at least twice a year. DS0000010638.V251051.R01.S.doc Version 5.0 Woodberry Grove Page 24 4 OP9 13 (2) The registered person must 01/12/05 ensure that medication tablets are administered to service users using a medication a plastic cup and not a spoon to avoid the possibility of spillage and the medication being handled by the staff. The registered person must ensure that the temperature of the medication cupboard is maintained at 25 oC or below at all times. The registered person must ensure that the manager and all staff are provided with adult protection training. Previous timescale of 01/08/05 not met. The registered person must ensure that the adult protection policy and procedure is extended to include the action to take when responding to incidents or allegations of abuse. Reference must be made to the Department of Health’s guidance ‘No Secrets’ and the local council’s adult protection policy. Previous timescale of 01/06/05 not met. The registered person must ensure that a timetabled programme for the provision of NVQ qualifications for staff be drawn up. Previous timescale of 01/06/05 not met. The registered person must ensure that all staff have preemployment health checks. The registered person must ensure that staff are provided with training on care planning and activities. Previous timescales of 01/01/05 and 01/08/05 not met. The registered person must ensure that must ensure that a DS0000010638.V251051.R01.S.doc 5 OP9 13 (2) 01/12/05 6 OP18 13(6) 01/01/06 7 OP18 13 (6) 01/01/06 8 OP28 18 (1) c 1 01/01/06 9 10 OP29 OP30 19 (1) 18 (1) c (1) 01/12/05 01/01/06 11 OP33 24 (2) 01/01/06 Woodberry Grove Version 5.0 Page 25 12 OP38 13 (3) detailed report of the home’s quality assurance initiatives is produced at regular intervals. Previous timescale of 01/09/05 not met. The registered person must ensure that the fridge, freezer and hot food temperatures are recorded systematically every day. 01/12/05 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 OP9 Good Practice Recommendations The registered person should ensure that a Controlled Drug register for the receipt, administration and disposal of Controlled Drugs, is available for use if necessary. If Controlled Drugs are to be kept in the home the CSCI North London pharmacy inspector should be contacted for advice. The registered person should ensure the Registered Manager attend a Train the Trainer course in adult protection to ensure that all staff have access to regular training in this area. The registered person should ensure that the staff mix and staffing numbers are carefully and regularly monitored against the dependency levels and numbers of service users. 2 OP18 3 OP18 Woodberry Grove DS0000010638.V251051.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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. 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