Care Home: Cherrytrees @ Abbotsbury

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What the care home does well The respite service, through the combination with the day service, provides a consistent and stimulating environment for those using the service. A warm, friendly and positive atmosphere was present throughout, with people supported to maintain their dignity, well-being and, as far as possible, their independence. Relatives spoken with following the inspection were very positive about the service. One person was unstinting in their praise of the service, not only for its direct care, but also for the support and advice it offered to cares: “care is absolutely brilliant – very helpful and considerate – supportive to me as well – an essential service, and a lifeline.” A small, consistent staff team has a good knowledge of the needs of individual users of the service, and support them in a friendly, professional and stimulating manner. What has improved since the last inspection? The service has gone through some changes in management. There is a now a full-time manager, which staff spoken with saw as giving greater opportunity for consistency and improvement. Previously identified shortcomings in pre-admission assessments, risk assessments, medication recording, and guidance for lone working have been addressed. What the care home could do better: The service has suffered in the past through a lack of continuity, or absence of, management. To maintain improvements, it needs to ensure it retains a fulltime, permanent, registered, manager. All care plans should achieve the same level of comprehensiveness, conciseness, and clarity, so that they are all a good reflection and guide to the care offered to individual users of the service. At present, there is a high reliance, in some instances, on the individual knowledge of staff to meet individual needs. Ripped wallpaper, padlocks to lock personal drawers all work against the otherwise homely and welcoming atmosphere. The service would benefit from an office that could accommodate two people. CARE HOMES FOR OLDER PEOPLE Cherrytrees @ Abbotsbury Pettiver Crescent Hillmorton Rugby CV21 4JD Lead Inspector Martin Brown Key Unannounced Inspection 17th March 2009 10:30 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 Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 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. Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherrytrees @ Abbotsbury Address Pettiver Crescent Hillmorton Rugby CV21 4JD 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) 01788 574999 01788 540163 Pinnacle Care Ltd Manager post vacant Care Home 2 Category(ies) of Dementia (2) registration, with number of places Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE) 2 The maximum number of service users who can be accommodated is: 2 11th January 2008 Date of last inspection Brief Description of the Service: Cherrytrees at Abbotsbury provides respite care and day care facilities and services for people over the age of 65 years who have been diagnosed as having dementia. The service is provided on the ground floor, at the rear of an existing local authority residential care home, with its own entrance and reception area. The home provides two single bedrooms with en-suite facilities; there is additional space, which includes a communal lounge, dining area and kitchenette, and a small laundry. The home also offers up to eight places each day for older people assessed as requiring day care services, the day care provision is not subject to regulation procedures and therefore not registered with the Commission, but there is a great deal of overlap, as many of facilities used by people on respite are used by those using the day service. People using the respite service are often also regular users of the day service. The accommodation is light and airy, and has a range of equipment and adaptations for service users who have physical disabilities. Access is available to a landscaped enclosed garden at the rear of the building. Respite placements are made via social services. Current fees are £418 person per week. Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This report has been made using information that has been gathered by the Commission for Social Care Inspection. The inspection visit was unannounced and took place on 16th March, 2009, between 10:30am and 2:30 pm. One person was using the respite service on the day of the inspection, and was spoken with briefly and observed interacting with staff and other users of the day service. Staff on duty and the manager were spoken with. A tour of the premises was made, relevant documentation was looked at, and observations of the interactions between residents, staff and their environment were made. Policies and procedures, and care records were examined, and the care of three people using the service was ‘case tracked’, that is, their experience of the service provided by the home was looked at in detail. Following the inspection, three relatives of people who have used the service were spoken with. The Annual Quality Assurance Assessment, containing information about the service, completed by the service, and returned before the inspection, also informed the inspection. Staff and people using the service were welcoming and helpful throughout. What the service does well: The respite service, through the combination with the day service, provides a consistent and stimulating environment for those using the service. A warm, friendly and positive atmosphere was present throughout, with people supported to maintain their dignity, well-being and, as far as possible, their independence. Relatives spoken with following the inspection were very positive about the service. One person was unstinting in their praise of the service, not only for its direct care, but also for the support and advice it offered to cares: “care is absolutely brilliant – very helpful and considerate – supportive to me as well – an essential service, and a lifeline.” A small, consistent staff team has a good knowledge of the needs of individual users of the service, and support them in a friendly, professional and stimulating manner. Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 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 Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Those using the service can be confident it can meet their needs, and that the service is familiar with those needs through extensive contact via the day service. EVIDENCE: People using the service tend to be people already familiar with the surroundings from using the day service, which shares the same communal facilities. Staff tend to therefore have a good knowledge of their needs and how to meet them. The service was clear on what needs it could not meet; this tended to be where mobility and physical needs could require the help of two staff. Pre-admission assessments were seen. These gave details of what a person’s needs were, and highlighted areas of specific need, and how these were managed. These assessments were completed before a person came to use the service. They are reviewed at each further period of respite. Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 9 The only problem highlighted by staff was that users of the respite service may sometimes become a little confused or even distressed when users of the day service went home and they thought that they must do the same. Staff explained the strategies they used to manage this. Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their health needs will be met, medication requirements properly managed, and that they will be treated with respect and dignity. Clearer and more concise care plans for all will better support staff in their care and support for people using the service. EVIDENCE: A sample of four care plans were looked at. The care plan of the one person currently using the service was generally very good, highlighting needs and how they are met in a clear and concise way, under the heading of ‘requirements to assist the day’. These were updated regularly, and included details of nutrition, skin care, mobility, health, and communication. Other care plans looked at were not as clear and concise as the above plan, with information being present, but in a less clear and consistent manner. The manager acknowledged that these were still in the process of being revised. All assessments, save for one concerning a manual handling assessment, were dated. Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 11 Some, but not all, the care plans contained life histories, providing staff with information that may help with identifying, stimulating, and explaining interests. Staff showed a good knowledge of individual needs and wishes. The home has a stand up weighing machine only, for when people need weighing. Currently, if a sit down one is required, one is borrowed from the adjacent care home. The manager advised that, as a respite service, they do not take prime responsibility for individual health care outside of the respite period, but have GP contact details to raise, or follow through, any health concerns. They will also arrange district nurse contacts if there are any concerns with, for example, pressure sores. The manager was able to give examples of how this had worked. Medication for those using the respite service is locked in individual rooms. Records showed that this was being dispensed accurately, and a check on current medication showed that medication remaining tallied with records of what had been given. Medication Administration Record Sheets had details of medication. The manager agreed that a brief description of what each medicine was for could be useful for staff in the event of any difficulties. Staff were aware of the purpose of most, but not all, medication. One medication, usually prescribed for epilepsy, was prescribed for one person. This person did not suffer from epilepsy, but staff were not clear on this. Some, but not all, medications were stock controlled on a daily basis. The manager agreed that these should all be checked daily, so ensure accuracy was maintained, and that any error could immediately noted and rectified. We had received one notification of a medication in the past year, which had been promptly noticed and checked out with the doctor. Observation of staff interactions with people using the service showed them being treated with dignity and their right to privacy being respected. People were supported to use the toilets in a discrete manner that supported their dignity and privacy. Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service benefit from a variety of stimulating activities and socialisation, through the contact with the day service. They enjoy nutritious meals, and are helped to maintain control and choice over their lives. EVIDENCE: Users of the respite service have spacious and quiet surroundings outside of the day service hours. During the day service hours they have the company of a dozen or so other people with dementia, and the attentions of two staff and, on occasions, entertainers who visit for an hour or two. The atmosphere was positive and stimulating during the day, with lots of chatter, and general discussions relating to people’s interests, led by staff. The person using the respite service that day appeared stimulated by going on, particularly the music session led by an outside entertainer in the morning. An activity schedule showed a variety of activities scheduled for the coming fortnight, and there were lots of items for use in stimulating activities. Large painted shamrocks were in evidence to celebrate St Patrick’s Day. A staff member advised that another artistically-minded staff had done these with people using the service previously. Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 13 There were no family or other visitors during the inspection. Three relatives were spoken with following the inspection. It is the nature of the service offered that, although welcome, family and other carers are less likely to visit. The service, by offering respite, also supports individuals remaining in the community. People using the respite service share a main midday meal with users of the day service. This was a relaxed, easy-going event, with all enjoying a choice of wholesome, nutritious food. The food is prepared by the home next door, and brought through on a heated trolley. There is a stock of food to prepare individual snacks and meals purely for the users of the respite service at other times of the day. Hot drinks were frequently offered, in accordance with guidance on this person’s care plan. The lounge dining area has an adjoining kitchenette, where snacks can be prepared. Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service can be confident that they are protected against abuse, and that any concerns or complaints raised will be fully addressed. EVIDENCE: The home has appropriate policies and procedures to safeguard residents. Staff and management were aware of appropriate actions to take in the event of any allegations or suspicions of abuse. The manager was able to give an example of how appropriate action was taken in respect of concerns regarding someone coming in to use the service. Staff have all received training in respect of safeguarding vulnerable adults. The staff member spoken with showed a good awareness of the issues and of appropriate responses. We have received no complaints regarding this service in the last twelve months. The complaints file showed a previous complaint being fully addressed. The manager advised that the service does not look after any personal monies for people using the service, and they advise that they bring no more than £10 with them for any expenditure they might need. Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Those people using the service benefit from spacious surroundings. Refurbishment of communal and bedroom areas would help to make them more welcoming. EVIDENCE: The service is provided on one level and adjoins the rear of an existing local authority residential care home. It has its own entrance and reception area but is connected by a link door. This was locked at the time of the visit. The reception area reflects its main use, that of an entrance to the day service. There are notices to staff, visitors and service users, and an assisted toilet. There is an office that is too small to house any more than one person, so that any discussions have to take place in the reception area or a bedroom. The home has a large, bright lounge, comfortably used by a dozen or so people in the day. Although furnished in a homely and comfortable manner, it is showing signs of wear, with some torn wallpaper. Bedrooms are similarly Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 16 showing signs of wear. There is a padlock in each bedroom in order to make one drawer lockable. This gives a very institutional and unwelcoming appearance to the room. The rooms were clean and fresh throughout. Bathrooms and toilets were spotless and in good repair, and welcoming in appearance. Towels, rather than paper dispensers are in use. Whilst this is more ‘homely,’ it poses an infection risk where toilets are used by a wide variety of people, as is the case where the toilets are used by those attending the day service. Towels are checked and changed two hourly, with the preparedness for this to be done more regularly if the need arose, but the potential for cross infection still remains. Laundry facilities were inspected and found to be well organised, clean and hygienic. Washing machines had the appropriate programmes to enable the disinfecting or sluicing of laundry as required. Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service benefit from the attentions of a small, consistent staff team. There is a potential risk that the staff team will be too small to fully meet needs without overstretching the existing staff team. EVIDENCE: There is a small staff team, with little turnover, resulting in staff having a good knowledge of people using the service, but also resulting in staff having to do extra shifts in the event of sickness in order to maintain staffing levels. There was one staff and the manager on duty during the inspection. Outside the day service hours, there is one member of staff on duty, for up to two respite residents. Lone worker policies and procedures, with clear arrangements for checks and support from a nearby service, were in evidence. The manager advised that there is no time allowed for handovers, so that staff tended to come in slightly earlier, or leave slightly earlier, so that any relevant information concerning the two respite users could be passed on. Training certificates and a training matrix showed details of ongoing mandatory and other relevant training, although the manager acknowledged that the matrix needed updating. Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 18 A sample of two staff files were looked at. These showed appropriate recruitment procedures. Evidence of satisfactory Criminal Records Bureau checks was seen. Staff and management were seen to be interacting with the users of the service in warm, friendly and supportive ways throughout, and engaging them in stimulating conversation, and helping to engender a comfortable and secure atmosphere throughout, so that people felt at ease. The result was a positive reaction from all users of the service. All though most of those observed were using the service on a day basis, many of them also use the respite service. Staff felt they would benefit from more staff during the day, although this related largely to the day service. Agency staff are not used. Cover for sickness and annual leave is provided from amongst existing staff. Supervision takes place, although the manager advised that this had ‘slipped’ lately, owing to staff taking annual leave, and pressures on limited management hours. Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Users of the service should be confident that a permanent full time manager will help to maintain improvements and consistency within the service. EVIDENCE: The manager advised that her post is currently that of a deputy. She is to register as manager, and advised that this is under way. She advised that she has been in post since last August, but until recently had been spending much of her time at another home run by the organisation. She says that she is now in charge full time at Cherry trees at Abbotsbury, and feels she is finally getting the opportunity to manage the service properly. One long-standing member of staff commented that ‘things are looking up now that the manager is full time’ adding ‘I’m very optimistic that things will improve now’. This staff member felt that there had been too many managers, and gaps of no manager, in recent years, for the service to function consistently, and now felt Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 20 more confident for the future of the service with a full-time and permanent manager. Relatively new in post, the manager has not yet worked on ways to gauge the performance of the respite service, by getting views of those who use the service, or the views of others involved in the service. Staff showed a ‘Thankyou’ book, full of appreciative cards and comments from past users of the service. Comments about the service from relatives spoken with were all positive. These ranged from, ‘very happy there’ to ‘an absolutely brilliant service’ The manager advised that the service does not look after any personal monies for users of the service. Relevant health and safety checks were in place, as detailed in the Annual Quality Assurance Assessment returned by the manager, and no obvious hazards were noted. Hazardous substances were safely locked away. Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x 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 x 18 3 2 3 3 x 3 x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement 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. 2. 3. 4. 5. 6. 7. Refer to Standard OP7 OP7 OP7 OP8 OP9 OP9 OP19 Good Practice Recommendations All care plans should achieve the level of clarity, comprehensiveness and conciseness witnessed in a few of them. All assessments should be dated, so it is clear how up to date they are, and when they require reviewing. Brief life histories should be in place for all users of the service, to assist in meeting their needs. A ‘sitting’ weighing machine would help the weighing of people when this was needed. The daily stock controlling of all medications should take place consistently, to ensure that any errors are picked up immediately. A brief outline of the purpose of each medication would be enable staff to be clear on the purpose of the medication they were dispensing. Individual bedrooms and communal areas would benefit from refurbishing. DS0000029373.V373996.R01.S.doc Version 5.2 Page 23 Cherrytrees @ Abbotsbury 8. 9. 10. 11. 12. OP19 OP19 OP26 OP27 OP33 Something more homely than padlocks for secure cupboard drawers would improve the appearance of bedrooms. The service would benefit from an office that could accommodate two people, so that discussions and supervision could take place with suitable confidentiality. The use of paper towels in toilets shared with the day service would reduce the risk of cross infection. The service should consider whether the existing staff team is sufficiently large to meet existing and future needs. The service should seek to get views of those using the service to see if there are areas it could improve on. A clear presentation of positive views would also help show the value of the service. Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West Midlands Office West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT National Enquiry Line: 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 © 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 Cherrytrees @ Abbotsbury DS0000029373.V373996.R01.S.doc Version 5.2 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!