Care Home: Lakeview

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What the care home does well The manager has been in post for five months and has made many positive changes within the home. The staff are all trained to meet the statutory training requirements, there is further training planned to ensure that staff competence is such to meet the needs of the people who use the service. The manager has an `open door` policy, which the relatives have appreciated and the people who use the service are fully aware, of whom the manager is. The home offers well-balanced choice of meals and refreshments throughout the day. What has improved since the last inspection? What the care home could do better: We did not make any requirements following this inspection. The manager has many improvements listed, that she wishes to put in place within a certain timescale. She is very enthusiastic and must ensure her staff are all aware of the future plans and possible changes. CARE HOMES FOR OLDER PEOPLE Lakeview Stafford Road Great Wyrley Nr Walsall West Midlands WS6 6BA Lead Inspector Joanna Wooller Key Unannounced Inspection 14th October 2008 09:15 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 DS0000022331.V372740.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. DS0000022331.V372740.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lakeview Address Stafford Road Great Wyrley Nr Walsall West Midlands WS6 6BA 01922 409898 01922 403434 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) www.alphacarehomes.com Alpha Health Care Ltd Manager post vacant Care Home 151 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (68), Learning disability (1), Mental Disorder, of places excluding learning disability or dementia - over 65 years of age (10), Old age, not falling within any other category (25), Physical disability (123), Physical disability over 65 years of age (123) DS0000022331.V372740.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Physical Disability (PD) minimum age 60 years on admission Physical Disability (PD) minimum age 49 years on admission - 2 persons 1 DE - Named Resident minimum age 59 years on admission To provide a maximum of three day care places. Date of last inspection 17th October 2007 Brief Description of the Service: Lakeview is situated on the main A34 trunk road midway between Walsall and Cannock with a regular bus service stopping directly outside the home. The services offered by the home are: - Dementia, Mental disorder, Old age, Physical disability, Physical disability over 65 years of age. Lakeview has 151 beds and is divided on two floors served by three passenger lifts. People who use the service are accommodated in single rooms with ensuite facilities. There are a limited number of double rooms, which would be ideal for married couples. The nursing and personal care areas are divided into separate corridors each with its own team of nurses and care staff. The units were recently renamed to represent one of the lakes in the Lake District. The 53-bedded mental health unit is located on the second floor and this is now divided into two units. Fees Highest £ 668 (incl £24 top up) Lowest £ 350.69 The fee information given applied at the time of the inspection; persons may wish to obtain more up to date information from the service. DS0000022331.V372740.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 that that people who use this service experience good quality outcomes. This unannounced inspection was carried out by two inspectors. The Manager was in the home and participated in our inspection process. The inspection included the following elements; Observations of the premises, Observation and inspection of records relating to provision of care, Discussions with people who use the service, Case tracking this is a process whereby we select several people who use the service, chat to them and look at their care plans and lifestyle in the home to get a picture of what it is like for them living within the service. Discussions with several of the staff members on duty. Observation and sampling of other services provided such as catering and laundry, and an inspection of the managerial aspects such as staffing issues, training, recruitment and health & safety. We were made welcome in the home and all assistance was given to gain the evidence required for the report. We had dealt with no complaints since the last inspection. Previously reported safeguarding issues had been addressed and reviewed at several multi-disciplinary meetings with recommendations being made with regards to placements and provision of care for people with special needs. People who use the service were complimentary about the care they were given, the staff and recent improvements that had been made in the home. The home manager sent us their Annual Quality Assurance Assessment (AQAA) when we asked for it. This document was completed to a good standard and gave us all the information we asked for. DS0000022331.V372740.R01.S.doc Version 5.2 Page 6 What the service does well: 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. DS0000022331.V372740.R01.S.doc Version 5.2 Page 7 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. DS0000022331.V372740.R01.S.doc Version 5.2 Page 8 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 DS0000022331.V372740.R01.S.doc Version 5.2 Page 9 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): Standard 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have their needs fully assessed to ensure that their individual needs can be met. EVIDENCE: The Annual Quality Assurance Assessment tells us “We encourage all potential residents the opportunity to come with the next of kins for lunch in order to experience what our home is like and to meet staff and other residents. All residents are assessed before admission into the home and again post admission care plans are done on a one to one basis and family are involved where ever possible. The manager and deputy meet with new residents on day of admission introducing them into our home and again a week later to discuss any concerns or comments. All residents who are admitted are given a DS0000022331.V372740.R01.S.doc Version 5.2 Page 10 service users guide, statement of purpose, complaints procedure and newsletter. An open and upfront approach is applied to all residents. During relatives meetings all felt the personal approach/touch was comforting and appreciated. Our evidence is relatives meeting minutes, pre assesments,care plans, action plans in regards to reviews and risk assesments are completed on an individual basis.” The people who use the service confirmed that they were assessed prior to admission and their details were recorded in care plans. One lady said that the manager had been to see her in hospital and she met her on arrival at the home. One relative told us that the manager and her staff were always available to discuss any concerns, which may arise following admission to the home. There was evidence in the care records that pre-admission assessments were completed and were there to formulate the initial care plan. The home does not provide intermediate care. DS0000022331.V372740.R01.S.doc Version 5.2 Page 11 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): Standards 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service each have an individual care plan which sets out their health, personal and social needs. Peoples’ health care needs are met and they are protected by the homes medication policies and procedures. Individuals living at the home are treated with respect and their right to privacy is upheld. EVIDENCE: The Annual Quality Assurance Assessment tells us “On admission all service users care is planned to a high standard we now have person centred care. We have contra indication care plans for illnesses such as Epilepsy and DS0000022331.V372740.R01.S.doc Version 5.2 Page 12 diabeties. Our care plans are developed to aid those reading them to understand why and how a resident came to be in the home. All residents relatives are encourages to read the care plans and to inform us of any changes or add ons they would like us to do. The mental capacity act is now being introduced into care plans and staff have had and are having mental capacity training. We have introduced residents to the IMCA service when they were required on our dementia unit. Care within Lakeview has dramatically changed for the better, care plans are easy to read and understand and carers are encouraged to partake in care planning. Mars charts are checked daily and photos are updated on a regular basis. We have numerous priests that will come in at short notice if required and care plans reflect this. We now have a defibrilator on site now and staff are trained to use it. DNR forms are resigned by families or residents on a monthly basis. “ The care records showed good evidence that care plans were formulated form personal information and these were suitably updated. The care records were updated and signed by the named nurse. The key workers names were identified on the care plans and they had made some entries within the plan with regards to social activities or family interaction. Some people who use the service had signed their own care plans and their next of kin signed some. Professional relationships with local doctors and other multi-disciplinary teams have been improved and this has benefited the people who use the service by ensuring close observation of their health and early intervention if treatment is required. Medication audits were evidenced to be effective throughout the home. Medication administration checked on the day of the inspection was found to be in order. One lady spoken to said “The staff are very respectful and kind. They take time to let me do things but will assist me if I ask them to. The call buzzer is useful as the staff come when I press it – I never have to wait long at all.” A relative spoken to during our visit said she felt her aunt’s health was much better than when she was admitted and the staff monitor her really well. She went on to say the staff is always visible and seem interested in all the people, including relatives and friends that visit. DS0000022331.V372740.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who use the service experience the lifestyle, which matches their individual expectations. They have contact with relatives and friends as they wish. People who use the service exercise choice and control over their lives and they receive a balance and wholesome diet. EVIDENCE: The Annual Quality Assurance Assessment tells us “We have five activity co ordinators who provide extensive and indepth activities. The dementia units do sessions such as remember the days, picture bingo, touch and feel sessions and they go out on trips on a monthly basis. The activity girls also aid with the monthly news letter and envolve families whenever possible.” Files we saw provided some information about people’ social needs and in some cases there was a social history giving information about the person and DS0000022331.V372740.R01.S.doc Version 5.2 Page 14 their previous lifestyle. We did feel that there was scope for this to be developed so that information was provided about everyone’s lifestyle. The service had developed a games room available to everyone. This contained a small snooker table and the opportunity to play a range of games. Each unit had an activity staff member responsible for working with people to develop activities. We saw that activities were being provided in each unit and people were provided with information about what was happening. People told us that activities included for example sing-a-longs, bingo, card games, gently physical activities, as well as having outside entertainers and trips out. One person told us about trips which included; going to the pub, on a barge, to tea dances, to the theatre and to a garden centre. Some people had also visited another care home. One unit had a singing group that went to perform for other people. A trip to Walsall illuminations was being planned. Within the dementia units we saw that regular activities were taking place including both group and individual activities. People had been enjoying a ‘hook a duck game’ and on the morning of our visit people had been going a gently ball throwing exercise. During the afternoon we saw the activity staff member spending time with people on an individual basis. The service offers a hairdressing service to people. Religious services are provided for those that wish to attend. We felt that the service was starting to adopt a more person centred approach to activities for example; we were told one person enjoyed football and staff made sure that he was given the opportunity to watch it. Other people were supported to go shopping and one person went out most days. With one person when a friend visited they played snooker together in the games room. Throughout the day we saw visitors visiting the service. They told us that they felt welcomed and could visit whenever they wanted. We saw that the service was promoting people’s independence and choice. One person we spoke to told us she got up when she wanted and sometimes during the night when she could not sleep would go to the kitchenette in the unit and make herself a cup of tea. We also saw that another person liked to provide some of her own food and kept food in a fridge in her room. This person also told us that she and other people were involved in deciding what activities and trips they wanted to take part in. We also saw in the bedrooms we looked at that people had lots of their own possessions. One person said she had brought her own bed and chair. Since we visited last time the service has brought in a catering firm to provide the meals. We saw that a menu was displayed. When we spoke to people they told us that they were happy with the food and one relative told us that they DS0000022331.V372740.R01.S.doc Version 5.2 Page 15 thought it had improved. We observed lunch being served and this showed that there was a choice of meals including sausage and mashed potatoes, pasta bake, egg and chips and jacket potato and cheese. Staff told us that they asked people what they wanted for their meals but there was always enough for them to change their mind when the meals arrived if they wanted to. One person told us that if they did not like something the staff would always arrange an alternative. People also told us that there were drinks throughout the day and snacks and drinks at suppertime. We saw that the service was providing for specialist diets including diabetes and gluten-free. Meals were also provided in a soft or pureed form. DS0000022331.V372740.R01.S.doc Version 5.2 Page 16 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): Standards 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are confident that their complaints will be listened to and acted upon. People who use the service are protected from abuse. EVIDENCE: The Annual Quality Assurance Assessment tells us “All complaints no matter how small are dealt within 20 days (written) and 3 days (verbal) the person making the complaint are invited into speak to the manager post response. All complaints no matter how small are dealt with very seriously and the personal touch is never lost. All staff are POVA trained and are aware of the whisleblowing policy (which is also displayed on the units) We have an updated complaints policy which is on dispaly and adherd to at all times. The training Matrix is updated on a monthly basis by the manager. The complaints folder is updated on a regular basis and includes all responses.” The service had procedures in place to listen to peoples’ views and to act on any complaints. The service was holding relative meetings. We saw that in bedrooms there was information about how people could make a complaint DS0000022331.V372740.R01.S.doc Version 5.2 Page 17 and also people told us that they knew how to raise issues they were concerned about. The service keeps records of any complaints made and we saw that these were being addressed and responses provided. The service had a safeguarding procedure in place and the staff was provided with safeguarding training. Staff we spoke to could tell us about symptoms of abuse and knew who to inform if they had any concerns. Since our last key inspection there have been a number of safeguarding incidents that revolved around people being suitably placed. We, the local Social Services deptartment and the home have now resolved this. Staff training to assist certain individuals has been completed. DS0000022331.V372740.R01.S.doc Version 5.2 Page 18 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): Standards 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a safe, well-maintained environment that is clean, pleasant and hygienic. EVIDENCE: The Annual Quality Assurance Assessment tells us “We ensure the environment is clean and tidy bedrooms are person centred. All linen is replaced when required and there is a homely atmosphere within the home. Residents and relatives are encouraged to arrange bedrooms as they wish. We are at present going through an 18 month refurbishment plan. Friendly environment and atmosphere, individualized bedrooms, improved environment, happy residents, redecorated areas, new chairs including profile and reclining, profile beds and high low beds and new dining room furniture. DS0000022331.V372740.R01.S.doc Version 5.2 Page 19 The environment had improved since our last inspection. Many bedrooms had been repainted and some refurbished. The bedrooms seen were well personalised, clean and clutter-free.” New large signage has been placed on the dementia unit to assist the people who use the service in familiarising themselves with the unit. No malodours were present throughout the home. Relatives spoken to said they have noticed a big improvement with regards to the cleanliness of the home. They went on to say the decorators were in the home every day and the overall appearance of the home was improving. We were aware that the local health protection agency nurse had visited the home and set up a group of staff with an interest in infection control that will monitor through auditing the standards of hygiene in the home. Staff were knowledgeable about infection control and hygiene, however one carer was seen toileting an individual without gloves or an apron. The manager addressed this at the time of the inspection. We were informed that the Environmental Health Officer has recently inspected the kitchen and the star rating is awaited. Several requirements were made but these are now met. DS0000022331.V372740.R01.S.doc Version 5.2 Page 20 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): Standards 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service are in safe hands and have their needs met by the numbers and skill mix of staff. People who use the service are supported and protected by the homes recruitment policy and procedure. The staff are trained and competent to do their jobs. EVIDENCE: From our observations during our inspection and by speaking from people we found that staff are provided in adequate numbers. We looked at five staff files to check recruitment processes these we fould to be in order which is good as it means that people who use the service are not placed at risk by staff being employed without proper checks being caried out. The Annual Quality Assurance Assessment tells us that “All staff are POVA trained and CRB trained and checked. Lakeview prides itself in the large amount of staff who are NVQ trained and we motivate those staff to carry on their education to do levels 3 and 4. We have our head nurses waiting to DS0000022331.V372740.R01.S.doc Version 5.2 Page 21 commence NVQ4. The staff have regular supervisions which is documented on the supervisions list and distributed to all units again this is updated by manager and deputy. We at Lakeview see training as a priority for all regardless of grade. There is regular training within the home on a weekly basis and we are the first nursing home to have done defibrillator training in the West midlands We have a 6 month training plan which is a guide to the basic training which is completed within the home. It does not however other training provided by reps, agencys and outside organisations. NVQs are encouraged by management for self improvement of all, training is seen as a priority to all by all.” We saw the training plan. This was a computerised document that highlighted when individual training was due or out of date. The staff spoke about all the training they had completed and how it had improved the staff morale and working environment. One relative spoken to said that most of the staff she had dealt with were knowledgeable and professional. She said that the staff seemed interested in the people who live at the home and compassionate toward them. We saw that Nurse specialists for infection control, wound care and continence have all recently visited the home and planned future training and update for the staff. DS0000022331.V372740.R01.S.doc Version 5.2 Page 22 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): Standards 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service live in a home, which is well managed by a responsible manager. The home is run in the best interests of the people who live in it. People who use the service have their finances safeguarded by the homes procedures. The health, safety and welfare of people who use the service and the staff are promoted and protected. EVIDENCE: DS0000022331.V372740.R01.S.doc Version 5.2 Page 23 The Annual Quality Assurance Assessment tells us “All staff now have yearly appraisals and bi monthly supervisions, a matrix of the above is kept in the managers office and distributed around units. All audits are carried out in a timely manner. All maintenence certificates are kept in the maintenence folder and are checked on a regular basis.” The new manager who is currently going through the registration process has been in post for five months. She has made many positive changes to the home and is prioritising manner more. Her ‘open door’ management style has been welcomed at the home. The people who use the service, their relatives and the staff commented on the positive atmosphere in the home and the environmental improvements. The manager is planning to complete a Quality Assurance Audit over the next few months to monitor the general progress of the home. Feedback so far was very positive and encouraging. We looked at financial issues within the home and peoples money’s were checked and found to be in order. We saw that a Health and Safety inspection took place in the home on 9th September 2008 and a further two visits have been made since to ensure compliance in met. The maintenance person has been retrained to ensure that the Health and Safety checks are correctly made and recorded and reported as necessary. DS0000022331.V372740.R01.S.doc Version 5.2 Page 24 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 X X X X 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 DS0000022331.V372740.R01.S.doc Version 5.2 Page 25 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 Refer to Standard OP7 OP8 OP38 Good Practice Recommendations People who use the service – individual care plan - should be further developed to evidence person centred care practices within the home. People who use the service – health care needs should be documented with great detail within the care plan including communication needs and preferences. The manager should introduce more robust timescales for her staff to ensure that tasks and improvements are completed within a suitable timescale. E.g. The memory boxes and picture books. DS0000022331.V372740.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection West Midlands 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 DS0000022331.V372740.R01.S.doc Version 5.2 Page 27 - 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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