Inspection on 18/11/08 for Worcester Intermediate Care Unit

This inspection was carried out on 18th November 2008.

CSCI found this care home to be providing an Good service.

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

Worcester Intermediate Care Unit 12/06/07

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 30/01/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Worcester Intermediate Care Unit 229 London Road Worcester Worcestershire WR5 2JG     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Keith Jones     Date: 1 8 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 27 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 27 Information about the care home Name of care home: Address: Worcester Intermediate Care Unit 229 London Road Worcester Worcestershire WR5 2JG 01905767117 01905767449 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Shaw Healthcare (Group) Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: Date of last inspection Brief description of the care home Worcester Intermediate Care Unit is a nurse led 20 bedded specialist facility providing nursing care, physiotherapy and occupational therapy and is covered by Worcester City General Practitioners. The unit is located in a residential area on the outskirts of the city centre, within easy reach of the local amenities, shops and public services. Opened in 2001, the unit is contained within a separate area of the Red Hill Court Nursing Home. Accommodation for people who use this service is in single bedrooms with access to communal rooms. Care arrangements can be used to enable earlier discharge from hospital following an acute episode of illness; alternatively, it can provide care to prevent admission to hospital for people who have a short term episode of ill health, which does not require specialist medical intervention. All admissions have a time-limited stay, maximum being six weeks. Please refer to the homes statement of purpose & service user guide regarding the funding arrangements and additional charges. Care Homes for Older People Page 4 of 27 Over 65 20 20 0 20 Care Homes for Older People Page 5 of 27 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This was a key, unannounced inspection, that is an inspection where we looked at a wide range of areas providing a service. To help us plan the inspection we looked at pre-inspection information in the form of an Annual Quality Assurance Assessment (AQAA), requested from the Registered Provider of the service, and provided some weeks before. We conducted this unannounced inspection with the Registered Manager and senior nursing staff on duty, whose input contributed towards this report. Our inspection of the service allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 20 people in residence on the day of our inspection. Care Homes for Older People Page 6 of 27 We looked at how care is being arranged and supported for people with a wide range of personal, rehabilitation and health care needs. To do this we looked at, and tracked three peoples care, from the point of referral to the present time. We examined three staff files, checking their appointment, induction to the service, training and supervision. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of people who used this service, relatives and members of staff, who took an active role in our inspection process, their input contributed to the subsequent report. We inspected a sample review of administrative procedures, practices and records, and documents relevant to the smooth running of the unit. What the care home does well: What has improved since the last inspection? We found that those people using the service and relatives are more actively involved in the planning of care, within a reviewed care planning structure. We examined and confirmed that care files have been re-organised to provide a more Person Centred Care approach, allowing greater detail to be recorded of peoples wishes around activities and social life Care Homes for Older People Page 8 of 27 During the course of our inspection we established that there have been substantial improvements to the medicines procedures, administration and management, as required and recommended at the last inspection. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 27 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are assessed and referred solely for intermediate care to enable them to maximise their independence and return home. The management of the unit is based on openness and respect, has effective quality assurance systems developed by a qualified, competent manager. Evidence: We examined the services revised Statement of Purpose and Service User Guide, and found them to provide a very informative description of the services aims, objectives, and the way it operated. People who may be using the service are given information about the Unit by the hospital discharge liaison team, or Community Care Coordinators. Through our case tracking of three people who use the service we clearly identified that the Care Manager, or her deputy, conducted the admission assessment. We Care Homes for Older People Page 11 of 27 Evidence: confirmed that information prior to admission was presented through the Community care coordinator, who represented a Primary Care Trust (PCT). Evidence gathered from the care records and observation showed that all services had been provided, including physiotherapy and occupational therapy. We were informed that some 25 hours of Physiotherapy, and 25 hours of Occupational Therapy is provided by the PCT. Therapy services are provided in a dedicated Gym area, and a separate reablement kitchen. Information gained from the referral and admission assessment of needs, is used to formulate individual care plans based upon need, specific to each individual, with full cooperation between the person, family and the Care Manager. We noted that risk and dependency assessments are used as a standard method of identifying needs. During the course of our inspection we had the opportunity to sit and talk with people who use the service, staff and a couple of visitors. We found evidence that much care had been taken in reviewing the care planning process, and a greater involvement of people and their families in the admission and care planning process: C. is happy with his stay here and would stay indefinitely if it was possible Our case tracking confirmed that a valuable exchange between that person and the assessor took place, and the resources made available. These resources were seen to be a team with different professional skills, equipment and use of the general unit facilities. Care Homes for Older People Page 12 of 27 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The health and personal care, which people receives, is based on meeting personal needs, with clear principles of respect, dignity and privacy put into practice. Medicine administration systems are safe and secure. Evidence: We found that care records have been thoroughly revised and improved since the last Inspection, providing a clear record to help further a good quality process of care. We found that a detailed assessment on admission, reflected personal needs and preferences, with care planning organised for people using the service, involving them and their families at all stages. A profile of their health and social situation offered an individual plan of care, based upon need, that is reviewed monthly with the professional staff involved, and is supported with a thorough daily report. Risk assessments were carried out on an individual basis and frequently reviewed. We attended a review meeting with the community coordinator, senior nurse and physiotherapist, and discussed the care and treatment planning of the three people Care Homes for Older People Page 13 of 27 Evidence: being case tracked. The regular event was conducted to monitor progress, and focus attention to effective rehabilitation, and that should special health care needs be recognised, the relevant service was consulted. We confirmed that the administration of medicines adhered to procedures to protect people who use the service, with a senior nurse responsible for overseeing all matters relating to the smooth process of managing medication. Records were seen to be complete and easy to follow through, with no observed breaches in the system. We acknowledged that the service admits people direct from hospital, care homes or their own homes, with medication brought in with the resident. Medication was seen to be stored within locked cupboards in the persons own bedroom, allowing a degree of independence to participate in their own medication, following risk assessment. Several people spoken with were happy with the arrangement and actively contributed to the administration process. We confirmed that storage arrangements had been reviewed, and were satisfactory. Extra attention to oxygen cylinder security was advised to prevent any potential accidents. It is stated in the AQAA, that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of people who use the service. This was found to be true, confirmed from relatives and peoples opinions through discussion and regular surveying. We recognised the confidence within the unit between staff, people who use the service and visitors,and the mutual respect that prevailed. Care Homes for Older People Page 14 of 27 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A persons rights to live a meaningful life are central to the homes aims and objectives. People who use the service are offered opportunities to exercise choice and control over their lives. People are offered a healthy, well balanced diet according to their assessed requirements and choice. Evidence: From talking to people who use the service and staff, we confirmed a continuing daily routine that is flexible, yet focused on the rehabilitation programme, encouraging personal preferences in a wide range of activities, reflecting a homely lifestyle to promote recovery. Those people we spoke with, and the staff approached, clearly identified a relaxed and informal atmosphere, in which peoples needs were recognised. We recognised the necessity, due to the enabling nature of planned care, that there is restricted visiting times and mealtimes, to allow therapy to take place without interruption, and to allow rest in between. Care Homes for Older People Page 15 of 27 Evidence: The Annual Quality Assurance Assessment (AQAA) states that the service actively encourages people to keep themselves occupied with familiar activities, such as reading, writing, knitting and crosswords puzzles, which we found to be true. We discussed this issue with the manager who said that there are plans to seek funding for an activity coordinator, and have identified this part of care in the quality monitoring and planning of the service. Relatives are encouraged to participate in the planning of care, although the Manager had recognised the need for more effort to involve families in the actual rehabilitation process, and motivation of the individual. Comments received from those people we talked with on the day confirmed their appreciation and involvement with the progress of their health and social status: This is heaven in comparison to the hospital, I feel full of promise. A hard working practical and committed team. I am limited in what I can do, but they are opening my eyes to what I could achieve by staff encouragement. I am a bit bored but thats down to me, I feel a bit down, but the staff are wonderful in helping me to overcome it. On the day of inspection people were offered a choice of either a pork chop or a fish dish, and a choice of desserts. We acknowledged that choices had been offered at breakfast, and are offered for tea time. Those people who we spoke with on the inspection, when asked about the food stated: Really nice and tasty plenty to eat, much better than the last place. We were informed that there is a four-week menu, coping with special diets and are adaptable to meet a variety of needs. A catering company provides the meals under contract outside the control of the unit, although we were assured that the catering staff do engage with people who have special needs, and meet with the manager on a routine basis, to monitor quality of service. Staff were seen to offer discreet assistance to those who required it, with the choice of dining room or bedroom to enjoy a meal, at the discretion of people who use this service. Care Homes for Older People Page 16 of 27 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has a meaningful complaints policy. People who use the service are given opportunities to freely express any concerns, are protected from abuse, and their human rights are promoted. Evidence: Through the course of inspection we confirmed that peoples legal rights are protected by the systems in place in the home to safeguard them, including the frequent review and assessment of care planning and policies in place, including the complaints procedure. The complaints policy, and records of complaints dealt with by the service were examined, which evidenced that people and families concerns were dealt with in a meaningful and effective manner. From our discussions with people who used the service it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. One comment made to us through interviewing people on the day was: I dont have any complaints about this service, if I did I have been told to make them known to the Manager. No complaints or safeguarding issue had been received by us since our last inspection. Discussion with the Care Manager confirmed that there continues to be a satisfactory Care Homes for Older People Page 17 of 27 Evidence: way of dealing with, and response to anyone who may report any form of abuse. The Annual Quality Assurance Assessment completed by the service prior to the inspection stated that all staff employed in the last 12 months have undertaken a satisfactory Criminal Records Bureau (CRB) check, confirmed by us when examining staff files. Care Homes for Older People Page 18 of 27 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Unit provides a safe, well-maintained, clean and comfortable environment for the people who use the service, which encourages independence. Evidence: External access is satisfactory for visitors, with adequate parking. The unit is contained within a separate area of the Red Hill Court Nursing Home, with single room, en suite accommodation, with easy access to communal rooms. Internal access was made easier with ample fittings of hand and grab rails, in well-lit and airy corridors, allowing wheelchair access throughout all areas of the unit. The Care Manager confirmed to us a willingness on the part of management to meet any reasonable demand for special needs requested. Bedrooms were well maintained to meet peoples personal needs, although due to the short period of stay, personal furnishings were at a minimal level, leaving most of the bedrooms functional rather than decorative. On discussion with the Manager it was decided to look into this issue, with providing more decorative items to enhance the persons living space. Nevertheless several people, including relatives we spoke with on the day, did not find the surroundings unpleasant, with comments: To say I came in for treatment and building up, I really feel much more comfortable than I did in hospital. We were surprised at the comfortable, and very clean rooms provided for Care Homes for Older People Page 19 of 27 Evidence: dad. All communal areas are of an adequate standard, offering a small lounge area, used on the day as a meeting room, and a dining room that was functional, but well equipped, spotlessly clean and fresh smelling. A well equipped physiotherapy gymnasium was found to be of a high standard, although somewhat cluttered with equipment. There are plans for a review of baths and shower areas, with one of the bathrooms being used as an equipment store for a variety of uses, which effectively made the room unusable for its intended purpose. It was advised that alternative arrangements be made to resite storage provisions in the unit. People using the service had access to a shower, but stored equipment was a problem, which requires a clearance of the room of storage to help with health and safety standards. The domestic services in the unit were seen to be of a high standard. The people spoken to remarked that they find the environment always very clean and conducive. The kitchen and laundry services are by arrangement with the Red Hill Court care home, and was deemed by the Unit Manager to offer a good service. Meals are served from a Bain Marie heated trolley, providing a good overall standard of presentation, although most people preferred to have their meals in their own bedroom. The Annual Quality Assurance Assessment completed by the service prior to the inspection confirms that the building complies with the requirements of the local fire service, and environmental health departments, and that records are kept of their inspections. Care Homes for Older People Page 20 of 27 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the unit are trained, skilled and in sufficient numbers to fulfill the aims of the unit and meet the changing needs of people using the service. Evidence: We confirmed that the The Registered Manager, who is supernumerary, is supported by a satisfactory number of Registered Nurses and care staff. Our examination of three weeks of duty rotas showed an adequate balance between skills, qualifications and numbers to provide a foundation for a good standard of care. At the time of the inspection there were two Registered Nurses and four care staff on duty, as well as the Care Manager. We sampled three staff files, and found them to be well organised and up to date, reinforcing the policy that the thoroughness of staff selection has a major effect upon the provision of care, to ensure protection of people. We saw that all new team members receive a thorough induction, and an ongoing training and development programme. The records we examined showed that 50 of care staff are in receipt of National Vocational Qualification (NVQ) level II. Overall the evidence shows a comprehensive account of a meaningful and important schedule of training to meet internal and external demand, displaying an account of Care Homes for Older People Page 21 of 27 Evidence: training that includes all those programmes considered essential and required. Comments received on the day from people using the service indicated: Senior staff, carers and other staff are first rate, and The staff are lovely people, very kind and very helpful. The Annual Quality Assurance Assessment submission stated that they have been awarded the Investors in People award this year, and gained positive feedback from their staff about the training they receive. Our discussions with staff found this to be true. Records were available to demonstrate an on-going process of regular supervision, and showing that training sessions and staff appraisals are a routine feature of staff development. Care Homes for Older People Page 22 of 27 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be assured that the home is run in their best interests. The ethos of the service is based on openness and respect. The care team, through good working practices, promote the health, safety and welfare of people who use this service. Evidence: The Unit Manager has been in post since the unit opened in 2001. During this time she has fulfilled her managerial responsibilities, been involved in policy making and organisational decisions. In our discussion with staff we were informed of their experiences, and the degree of support and guidance offered by the Manager through staff supervision, staff meetings, and day to day contact. Our examination of records showed that appropriate risk assessments are in place for people undergoing a schedule of rehabilitation, through care assessment, planning and review, staff selection and of the general environment. These we found were up to Care Homes for Older People Page 23 of 27 Evidence: date and accurate. The services completed AQAA states that the home has quality monitoring systems in place, and they also consult the people who use the service and their relatives about the service. This process has led to the manager making changes and setting new targets, for example the need for an Activity Coordinator, and the problems associated with the Units dependency on the surrounding Red Hill care home facilities. We also established through discussions, that the units management would benefit by establishing a full risk assessment, which will draw attention to the overall needs of those people using the service, and assessing a development programme for the forthcoming years. several comments received from the units internal surveying of relatives and people using the service were: This is a very necessary and vital facility in Worcestershire. I would have the powers that be to have to see it at some time which would encourage them to see its value for all concerned. We have not met mums key worker, but all the staff make themselves available to speak to us. We feel the staff are wonderful, caring, supportive, and are extremely pleased with mums progress. Full marks. We acknowledged that the Providers, with the Care Manager have developed a formal approach to monitoring quality across a wide range of activities. An examination of administrative, monitoring, planning and care records showed an organised and professional attitude to effective record keeping. They were found to be well maintained, accurate and up to date, ensuring that peoples rights and best interests are safeguarded. We identified that people are encouraged to be independent with regard to their financial affairs, with the assistance of their relatives. Small amounts of cash were kept safe by the Care Manager and, we were informed, were regularly checked by the Registered Provider. We examined the accident records and found them to accurately reflect an event, the outcome, and the effect it may have on a person involved. This was verified by us in case tracking individual care records of people who use the service. The administration and management of the home is efficient, uncomplicated and sensitive to the needs of people. The manager ensures that all Health and safety legislation is adhered to, and that appropriate records are kept. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 25 of 27 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 9 Secure oxygen cylinders by chain attached to a secure wall, to ensure health and safety to staff and people who use the store room. That care planning involve families in the enabling process and motivation, to achieve the objectives in rehabilitation of people who use the service. Remove equipment stored in a bathroom which has made the room unusable for its intended purpose. Reduce the level of storage in the shower room to facilitate health and safety conditions for use. Consideration be given to enhance the decorative state of peoples bedrooms to enhance their stay in the unit. A full unit risk assessment to ensure that areas of activity and of storage are assessed and made safe for people using the service. 2 13 3 21 4 5 23 33 Care Homes for Older People Page 26 of 27 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. 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