Care Home: David Lewis Centre Supported Adult Living Unit

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What the care home does well There is a multi disciplinary team available to make sure that residents have all their needs met. The people who live in the home have access to a range of healthcare facilities on site so valuable medical support is available to support their health needs. The people who live in the various houses are encouraged to take part in activities on and off site. A relative said, "where my son resides puts a lot of effort into motivating and encouraging residents to become involved in activities both within the centre and in the outside community". The management of the David Lewis Centre is working hard to encourage the people who live there to take an active part in running and shaping of the services available. Question time sessions with the senior managers, comment boxes, access to senior managers, the complaints procedure and the development of the resident council ensure that the residents are listened to. What has improved since the last inspection? Requirements made by the fire officer had been responded to promptly so that the premises are safe.Further improvements have been made in the way in which residents` medication is supplied. A number of people who have lived at the David Lewis Centre for many years have had the chance of staying at the organisation`s community house in Macclesfield so they can gain experience of living nearer to town and in a more independent setting with support. The audit of the staff training across the centre is almost complete so that the manager can be sure that the staff employed in the houses have the skills to meet the residents needs. What the care home could do better: Risk assessments must be updated when individuals have changes in the circumstances. For example when they become immobile due to breaking their leg the home must agree and record the evacuation procedure so that residents and staff remain safe. CARE HOME ADULTS 18-65 David Lewis Centre Supported Adult Living Unit Mill Lane Warford Alderley Edge Cheshire SK9 7UD Lead Inspector Julie Porter with Val Flannery Unannounced Inspection 5 November 2007 12:00 David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 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 David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.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 Adults 18-65. 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. David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service David Lewis Centre Supported Adult Living Unit Address Mill Lane Warford Alderley Edge Cheshire SK9 7UD 01565 640000 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) eileen.byrne@davidlewis.org.uk David Lewis Centre Eileen Byrne Care Home 106 Category(ies) of Learning disability (61), Physical disability (106) registration, with number of places David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 106 resident to include: . Up to 61 people in the category of LD (learning disabilities) . Up to 106 people in the category of PD (physical disabilities) The registered number of places (106) are allocated to the 8 houses that make up the Supported Adult Living Unit as follows: . . . . . . . . William Mather Benn Levy Alan McDougall Winifred Comber Kenneth Faulkner Hutton House 52/53 Mill Lane 11/12 Mill Lane 25 22 16 15 9 7 7 5 5 February 2007 2. Date of last inspection Brief Description of the Service: David Lewis Centre Supported Adult Living Unit consists of eight separate houses: Hutton House (7 beds); Kenneth Faulkner Flats (11 beds); Winifred Comber House (15 beds); 11/12 Mill Lane (3 & 2 beds respectively); 52/53 Mill Lane (7 beds); Alan MacDougall (16 beds); Benn Levy (22 beds) and William Mather (25 beds). There is one registered manager for the whole unit and in addition, each house has a house manager responsible for the day-to-day running of the home. The houses are located in the grounds of the David Lewis Centre which is set in rural surroundings within travelling distance of Macclesfield and Knutsford. The extensive grounds provide opportunities for walking and recreation. Day training, college and leisure facilities are provided on site. David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit to the David Lewis Centre, including this service, took place on 5, 6, 7 and 8 November 2007. The visit was carried out by two inspectors who looked at various aspects of this home and the way the David Lewis Centre runs. The visit was just one part of the inspection. Before the visit, the manager of the Supported Adult Living Unit was asked to complete a questionnaire to provide CSCI with up to date information about the home. CSCI questionnaires were sent out for people who live in the various houses to fill in to find out what they think of the home. Other information received since the last key inspection was also reviewed. During the visit, various records were looked at; a tour of the David Lewis Centre, including this home, was carried out; and inspectors observed how residents and staff were working together. A number of residents and staff were spoken with. They gave their views and these have been included in this report. What the service does well: What has improved since the last inspection? Requirements made by the fire officer had been responded to promptly so that the premises are safe. David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 6 Further improvements have been made in the way in which residents’ medication is supplied. A number of people who have lived at the David Lewis Centre for many years have had the chance of staying at the organisation’s community house in Macclesfield so they can gain experience of living nearer to town and in a more independent setting with support. The audit of the staff training across the centre is almost complete so that the manager can be sure that the staff employed in the houses have the skills to meet the residents needs. 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. David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information is available to prospective residents and their families so that they can see if the home can meet their expectations and their needs. EVIDENCE: Information is available to prospective residents and their families regarding the services the home can offer and details of the individual houses that make up the unit One care file was inspected during the visit for someone who had recently moved to the Centre. Little or no information was available from the person’s funding authority; staff spoken with said that they did not see any information regarding the person’s needs before their initial visit. When possible visits are arranged over a short periods of time, including visits for tea and weekend stays so that the person can see if the home suits their needs. They can also get to know other people living there and the staff. The care file provided evidence that this person’s needs were being assessed as an on going process and recording was good. An assessment was available of the person’s occupation health needs, which had been undertaken by staff from the David Lewis Centre. David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good quality information is recorded in the residents’ individual plans so that the staff know the best way to support them in achieving their goals. EVIDENCE: Twenty people living in the homes were spoken with at length and care plans for seven of them were inspected during this visit. The person centred plans showed how people wished to be cared for including their daily activities and the personal care they needed. One person had declined to sign any of the documents in the care plan and had stated that they did not wish to live in the home. This matter was discussed with the house manager and the manager for the Supported Living Unit who were both aware of the situation and are looking at ways to resolve it. One person’s plan identified that they wanted to move away from the Centre and live closer to shops and facilities. This person spoke enthusiastically about the time he had spent during the summer living in a house in Macclesfield. The David Lewis Centre has a house in Macclesfield used for college students David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 10 during term time. During the summer, people who have expressed a wish to live in a more independent setting were given the opportunity to “sample” life in Macclesfield. The care plans inspected showed that they had been regularly updated and that reviews take place as a minimum once per year, although the local authority that funds the person’s placement at the Centre do not always send a representative to the review meetings. Residents at the centre are encouraged to comment on whether they think new staff looking for work at the centre are suitable to work there. The Director of Care for DLC spoke of setting up a resident council that would be responsible to all residents and reporting to the trustees. Evidence was available on one resident’s file that a recent change in his circumstances had prompted up to date information being included in his risk assessment relating to his daily living. David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff support residents with their chosen timetables so that they can develop further skills towards greater independence. EVIDENCE: Residents have various timetables, depending on what they have decided they wish to do. Timetables identify activities including college, work placements away from the centre, work placements at the centre and retirement. One resident last year stated that she did not get bank statements for the money held on site for her; this matter has now been resolved and monthly statements are now issued to her. Ten CSCI survey forms for people who live in the home were returned and all said that they could do what they wanted to do during the day, the evening and weekend. One survey form from a relative had the following comment under the section on what the care home does well; “The Alan MacDougal David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 12 house where my son resides puts a lot of effort into motivating and encouraging residents to become involved in activities both within the centre and in the outside community.” A number of residents who had been involved with the stay in the Macclesfield house asked to speak with us during the visit. The comments about the stay in Macclesfield were all positive and one said that they wished that they didn’t have to come back. One person raised some anxieties of what life would be like after living for many years on the David Lewis campus and although he was anxious he still wanted to try. A number of people also asked to speak to us as they had not had the opportunity to try living in Macclesfield but wanted the same opportunities as their friends. This information was discussed with house managers and the unit manager who are working on the next group to go to the house in Macclesfield during the next college break. Mealtimes were observed in William Mather House and Hutton House. In other houses the residents and staff were observed preparing for or just after a meal. Residents spoken with were on the whole positive about the food received from the main kitchen. The people who live in Hutton House were seen preparing their own meal with staff. Across the centre a number of people cook for themselves with varying degrees of staff support or supervision; one resident is more enthusiastic to learn cooking skills since their stay in the house in Macclesfield. The on site café also provides the opportunity for some people to have their mid day meal away from the houses. During the visit two of the people from Hutton House were seen using the café. One evening during the visit people who live in Alan MacDougal House were seen planning a take-away supper from the local fish and chip shop. David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health of the residents is monitored to ensure they get the health care and support they need. EVIDENCE: Each of the people who live in the centre has health action plan that is kept in a separate file. This plan includes pictures so that the residents can understand it better. It covers continence/mental health/lifestyle/ immunisation/health checks/seizure chart/all areas of health/well being. One health action plan of the seven sets of care records inspected was not available on the house where the person lived. The other six files provided good evidence that the person’s health was being monitored, both by the staff in the houses and the professionals on site. Information on residents’ files must be accurate, factual and/or observed and not speculative. One entry on the clinical communication sheet states, “He hasn’t fallen during seizure but his leg may not have been raised as advised.” David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 14 Since the last inspection the David Lewis Centre has made changes to the way in which medicine is prescribed for individuals. A prescription is now written for each person under review or needing a repeat prescription and these are then “filled” at the on-site pharmacy. Staff in the houses have reported occasional difficulties with charts and prescriptions being forgotten or not dealt with and returned to the house after the pharmacy has closed and this needs to be monitored more closely by the person in charge at the time. David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel that their views are listened to and processes are in place so they feel that what they think matters and makes a difference. The processes for making referrals under adult safeguarding procedures is managed via the Centre with the involvement of the staff in the houses, to make sure that people are safe from possible harm. EVIDENCE: All the residents spoken with knew who they would speak with if they were unhappy with anything about their home. Complaint logs are available in each of the houses so that staff can record complaints/concerns raised by residents before they might need to use the formal complaints procedure. The complaint logbook needs to be available to all staff to record in and not locked away when the house manager is absent. Formal complaints and the outcome are recorded and monitored by the manager of the Supported Adult Living Unit. During the visit one resident was discussing the possibility of moving on and was advised to discuss the matter with the manager. Staff were seen encouraging her to call and arrange a convenient time to talk. The manager visited her in her home the same day and discussed the process. Notices were seen around the Centre advertising the date and time of the next “question time”; most residents could say what this was about and saw it as an David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 16 opportunity to have their say directly to the Chief Executive of the David Lewis Centre. All matters of adult protection continue to be monitored by the social work department on site. Records of two recent referrals were inspected and the recording found to be of a good standard. However, some further development of the process is needed to make sure that CSCI is kept informed of progress/how the issue is to be dealt with once the matter has been taken up by the DLC’s social work department David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Maintenance and refurbishment has been carried out to make sure that the residents live in well-maintained, comfortable surroundings. EVIDENCE: During the inspection all the houses that make up the Supported Adult Living Unit were visited. The inspector took a tour of each of the houses and saw some bedrooms where appropriate or when invited. All the houses were clean and fresh throughout. There continues to be considerable expenditure across the centre to refurbish the houses as needed. Houses have had new windows, redecoration programmes, structural changes for the better with the removal of the old nurses station in Benn Levy House, new patio areas have been created, three houses have agreements for new kitchens, 52/53 has had a new kitchen, one flat in Kenneth Faulkner flats has had a new kitchen and generally furniture has been purchased for the houses which looks comfortable and homely. David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 18 A sample number of the fire officer’s reports were inspected at William Mather and 52/53 Mill Lane and the recommendations made in them had been met. David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The David Lewis Centre follows robust recruitment processes to ensure that residents are supported by people who are suitable to work with them. EVIDENCE: A sample of seven staff files was inspected; all provided evidence of thorough recruitment processes being followed. Two references and POVA 1st clearance were obtained; the date of the return and the Criminal Record Bureau (CRB) clearance number had been recorded on file. As the CRB checks are stored separately it is suggested that either the database or the personnel record should identify if the CRB is clear or not. This will also assist with monitoring possible offences whilst people are employed by the David Lewis organisation. Staff at the training centre on site are currently updating all the staff training information as this was found to be inaccurate at the last inspection. This work is yet to be finalised, as each of the house managers needs to agree their records so that a complete picture is available. However from the records already completed, a clearer picture is available to the manager to support them in the planning of the service. David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 20 The training centre continues to offer refresher training each Monday and Tuesday and this covers adult protection, food hygiene, health and safety, equal opportunities, epilepsy, head injuries, infection control, resuscitation and moving and handling. Information obtained from a staff training chart for 11 Mill Lane showed that only one member of staff had not completed all the mandatory training. Of the seven staff whose files were looked at, all had received instruction in fire safety within the last six months. During the visit fourteen people were involved with induction training. Two of these people were spoken with; they said that they were looking forward to starting work but were enjoying the classroom work/training as they felt it would give them more confidence. David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run by a competent, qualified person who oversees the managers of each of the houses to make sure the home is run in the best interests of the people who live there. EVIDENCE: The manager of the Supported Adult Living Unit is registered with the Commission for Social Care Inspection and has the relevant qualifications for the position. During the visit she was seen speaking with house managers and the residents living in the homes; people appeared confident and comfortable with her. Quality assurance is approached in a number of ways. Residents, relatives and other stakeholders are consulted on the quality of services and facilities David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 22 provided and their views are welcomed and acted upon. A questionnaire is sent annually to all adult service users to ascertain their views of the service provided. As mentioned earlier the centre is looking to develop a resident council with representatives from each house in the unit taking the views forward directly to the trustees. A sample of records was inspected in relation to fire safety equipment and emergency lighting checks and these were in order. The health and safety officer had updated the fire risk assessment document in 52/53 Mill Lane in October 2007 and November 2007 in William Mather. Due to the change in one of the resident’s mobility following a fall, the fire risk assessment needs to be updated to reflect the current risk of him being immobile. David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X X 2 X David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 24 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 Refer to Standard YA42 Good Practice Recommendations The fire risk assessment for the premises should be reviewed when there are changes in the physical health of any individual living there, particularly relating to night time evacuation, to make sure that staff have the guidance so everybody is safe if there is an emergency. David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 David Lewis Centre Supported Adult Living Unit DS0000006647.V347996.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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