Care Home: Rosamar

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What the care home does well Residents live in a supportive homely environment for their needs, and the staff team are cheerful respectful and caring. Residents are provided with a satisfactorily well balanced diet, and a range of social activities according to their choice. What has improved since the last inspection? Care plans have been developed and in concert with the resident, family or representative in relation to all identified needs on admission and in accordance with Social Services care plan. The shower room on the first floor was in good order. Generic risk assessment of all areas that the service users have access to have largely been completed other than those detailed below. Staff receive regular supervision. The home meets the required standards in terms of training all new staff must receive training appropriate to the work they are to perform. The Statement of Purpose contains all required information for the benefit of current and prospective residents. What the care home could do better: conduct risk assessment relating to hot water temperatures and hot surfaces for the protection of residents. Make formal written risk assessments of disclosures identified on CRB`s if any. carry out annual re-assessments of residents needs and re-write the care plan. Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Rosamar 81 Locking Road Weston Super Mare North Somerset BS23 3DW     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Andrew Pollard     Date: 2 9 1 2 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 29 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 29 Information about the care home Name of care home: Address: Rosamar 81 Locking Road Weston Super Mare North Somerset BS23 3DW 01934633397 F/P01934633397 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mrs Belinda Jane Dachtler,Mrs Geraldine Ann Coles care home 12 Number of places (if applicable): Under 65 Over 65 12 learning disability Additional conditions: Date of last inspection Brief description of the care home 12 Rosamar is registered to provide personal care to up to 10 people with a learning disability. At present 11 service users live in the home. Most are nearing or have reached retirement age. All are over the age of 40. Some residents continue to attend local day centres or colleges but those who have retired can participate in the good schedule of activities laid on by the home. Four of the bedrooms are registered as doubles and four as singles. There is a pleasant lounge on the ground floor at the front of the house and a dining room with seating area at the rear. The home is situated close to the town centre, within easy reach of local amenities and the sea front. Care Homes for Adults (18-65 years) Page 4 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The inspection was conducted with the registered manager and the inspector met with the residents living at the Home. Surveys were collected from all nine resident who were supported by staff in completing them where need be. Two staff surveys were received. Staff were observed caring for and supporting the residents with their needs. A selection of records relating to the care of residents, running and management of the Home were inspected. A tour of the home was undertaken Care Homes for Adults (18-65 years) Page 5 of 29 The Home was operating within the required conditions of registration set down by the Commission. The conditions of registration reflected the needs of residents, and numbers of residents who may stay at the Home. What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 7 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The statement of purpose and service user guides provides helpful information.Full prospective residents needs assessments are carried out.Residents are issued with living agreements and the terms and conditions of their residence at Rosamar Evidence: There have been no admissions to the home since the last inspection and the resident group remain stable. There is currently one vacancy. The statement of purpose and accompanying service user guide are being reviewed and updated. The documents had been written in a straightforward way and were easy to understand. A picture and symbol version is being developed. All residents are admitted via Social Services through the placement team and the learning disability team. The manager carries out a needs assessment and gathers relevant information from other agencies to determine the homes ability to meet prospective residents needs. Prospective residents are given a number of opportunities to visit the home, meet the people that live there and have meals in the home prior to admission, this was Care Homes for Adults (18-65 years) Page 9 of 29 Evidence: confirmed in two resident surveys. Advocacy services are facilitated if need be. A three month either way trial period follows admission. In future the manager will formally write up her assessment and store it in the case file. Contracts were seen and where possible they are signed by the resident or their representative. Care Homes for Adults (18-65 years) Page 10 of 29 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Care plans are detailed and clearly written for the benefit of residents.Residents would benefit from frequent re assessments of their care plans annually. Risks are identified and action taken to support residents.Residents are able to make their own decisions relating to everyday life. Evidence: A key worker system is not yet established in the home but is under consideration by the manager. The format of care plans is being improved, the plans in place aimed to address the physical, mental, and social needs of the residents using a person centred approach. Residents likes and dislikes and things that make them anxious are recorded. It was agreed with the manager that as well as the monthly evaluation of the care plans an annual full reassessment of peoples wishes and needs will be carried out involving the resident key worker and other people invited to the review. The care Care Homes for Adults (18-65 years) Page 11 of 29 Evidence: plans would be rewritten following this re-assessment. All residents have individual risk assessments in their files. There was information included about any potential risks and risk behaviours that may be exhibited and the management of such. Any restrictions of liberty or choice are supported by a risk assessment and care plan. Further development of this aspect of the care regime will follow booked training on the new Deprivation of Liberty legislation which will take place in the near future. Risk assessments are reassessed on a regular basis. The value of daily records was discussed and it was agreed that each person will have key events or matters outside of the regular care plan recorded in their files, however a daily statement need not be made. Social activity records are kept in a separate folder. Residents confirmed through comment and via the surveys that they can make their own decisions and choices within their everyday live. Some residents that are less able to communicate are advocated for by relatives or key workers in the decision-making processes. Records of residents meetings show that some residents have very clear ideas and concerns and suggestions about home matters. All residents records are properly maintained and safely stored. Care Homes for Adults (18-65 years) Page 12 of 29 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have the opportunity to partake in a variety of activities. The residents have a choice of the food they eat and have a varied diet. Evidence: Four residents attend day centres for a variety of days each week, the remainder have no funding for external day care services. A varied range of activities and social events take place in or out of the home, which is very important for residents particularly those without external day care. A quick view sheet has been put in place to record all activities undertaken and to ensure an adequate range of leisure and social activity is offered to all residents. The residents also benefit from having a minibus for trips and outings on a regular basis. Recent events include visits to the Playhouse, cinema, pub lunches and walks. Care Homes for Adults (18-65 years) Page 13 of 29 Evidence: A number of residents have family contact to varying degrees and the staff welcome any input or feedback from relatives. Some residents makes home visits to maintain contact with family. In the survey seven residents say they are always able to make choices about what they do each day/night and two said sometimes. There are no residents with particular cultural or faith needs. No one requires a special diet other than a diabetic. The residents are involved with menu planning and the records show that food is varied and reflects residents choices. In surveys one staff member made a particular point of praising the quality of food and one person said it would be good if the residents had a wider choice. Care Homes for Adults (18-65 years) Page 14 of 29 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive support in a way that suits them and referrals are made to health care professionals to ensure health care needs are met. Residents are protected by a medication policies and procedures and PRN medication is administered appropriately. The staff team supports the residents health care needs well. Evidence: All the residents are registered with local GPs. One person is under the care of a consultant psychiatrist who visits periodically during the year and conducts medication reviews. The GPs make referrals as required for para-medical and specialist services. Residents are able to access dental, audiology and optical services in the community. At present all residents are escorted to attend appointments. A chiropodist makes regular visits to the home. A learning disability specialist nurse and diabetic nurse support individual residents. Residents have health care information and records in their files. At present no one has health action plans and this will be reviewed at the next inspection. Care Homes for Adults (18-65 years) Page 15 of 29 Evidence: Storage of drugs is satisfactory. Medication administration record sheets, receipts and disposal records were examined and found to be in order. PREN medication was noted to be used appropriately in line with specific plans of care and not often used due to good management of challenges presented by some residents. Incident reports are properly completed as required. The PREN medication should have a maximum doses that can be given in hours recorded on the prescription sheet. At present no residents are assessed as being safe to self medicate. All the staff complete medication awareness and administration training facilitated by the supplying pharmacist. Care Homes for Adults (18-65 years) Page 16 of 29 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has good arrangements in place that facilitate individuals to make complaints and have them dealt with. The residents are protected and the staff team are regularly trained in the implementation of adult protection procedures. Evidence: Policies and procedures were seen to be in place in relation to complaints including a simplified pictorial format for residents. A copy of the procedure was on display and is included in the service user guide. There have been no complaints about care since the last inspection. No complaints were made through surveys or on the day of the visit. in surveys all nine residents said they knew how to complain and all named at least one person they would speak to if unhappy including people who were not members of staff. Residents also in conversation and through surveys indicated that the staff listened to them and acted on what they said. There was evidence that staff have training in relation to adult protection procedures at induction and thereafter, the manager arranged for all staff to attend half day updates with the Local Authority and ongoing training to be facilitated this year. The home had the Local Authority No secrets procedures and there is an in house whistle blowing and protection from abuse policy on display. Care Homes for Adults (18-65 years) Page 17 of 29 Evidence: The records in relation to residents accounts and the safe keeping of personal allowances were not assessed at this inspection. Care Homes for Adults (18-65 years) Page 18 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. All areas of the home meet the needs of the current resident group.The garden is easily accessible to all residents.The home is clean and tidy. Evidence: No major changes have taken place since the last inspection. The home remains suitable for its stated purpose. The Home was found clean tidy in generally good decorative order and free from offencive odour. The residents rooms were well decorated and personalised with their personal belongings. The standard of furnishing was good. In the survey all nine of the residents said the home is always fresh and clean. people spoken to liked their rooms. The communal areas include dinning and lounge areas. The standard of furnishing is good. There are three showers which meet the needs of the individuals living in the home, however this provision needs to be kept under review as the residents age and the potential of reducing mobility arises. A cleaner is employed three days per week but residents are encouraged to take some Care Homes for Adults (18-65 years) Page 19 of 29 Evidence: responsibility for cleaning their own rooms where able. The laundry facilities are satisfactory. The home has a policy on infection control to ensure that people living at the home are protected. the kitchen was in good order and when last inspected by the Environmental Health |Officer was given a 4 star rating. There is currently no formal record kept of hot water outlet temperatures, the manager has now instigated this practice. Care Homes for Adults (18-65 years) Page 20 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is adequately staffed with experienced staff who are well trained. Staff work hard to meet residents complex needs. The staff are supervised, appraisals need to be formerly recorded. There is a recruitment procedure in place that protects vulnerable adults. CRB risk assessments need to be written. Evidence: The home has a recruitment procedure in place to protects vulnerable adults. All personal files are held at the home, which include completed application forms, two references and criminal records (CRB) checks for all recent staff. One longstanding member of staff had no record of a CRB check having been carried out and one person had a disclosure from a former employer. The manager was to make enquiries with the umbrella body which carries out the checks to determine whether disclosures had been received in the past as she is confident they were sent. All CRBs seen were signed and dated by the inspector so the disclosure element can now be confidentially destroyed. Where information is contained in a disclosure an informal risk assessment was conducted, the manager is going to formalise this process and make a written record if the situation arises in future. Care Homes for Adults (18-65 years) Page 21 of 29 Evidence: The three staff who responded to the survey said that the recruitment procedure was properly carried out and all necessary checks completed. All staff are issued with the General Social Care Council code of practice as well as information about adult protection and mental capacity. All new staff completes an induction programme and in the survey they all said that the training they received was relevant and kept them up to date. All confirmed they had been given training on equality and diversity issues. The majority of care staff have attained at least a level 2 National Vocational Qualification award other staff are training toward the level 2 or 3 award. There was evidence that the current staff team had completed training in the last twelve months. The intention is that all staff to remain updated in the following areas; food hygiene, first aid, health and safety, fire safety and adult protection. The manager considers these staff do have the skills and experience needed to work in the home. The consistency of staffing is important to the well being of the residents and maintaining the strategies of care that prevent challenging incidents and tensions in the home. Staffing levels in the home are adequate to meet the needs of residents, however both the manager and staff considered that they would like to do more with residents if the funding allowed for it. An additional member of staff has recently been recruited for daytime shifts which has enhanced opportunities for resident activities to take place. There has been little staff turnover in the home. No agency staff are used. The manager considers these staff do have the skills and experience needed to work in the home. In the survey all staff confirmed they receive supervision and support. The manager intends to hold more structured appraisals in future and develop learning and development plans for all staff. The manager considers that the staff work well as a team and supported one another. In the survey all nine of the residents said the staff treated them well and listened to them and acted on what they said. one person said I like living at Rosamar. There are staff meetings periodically through the year, one survey respondent said they would like more meetings. Care Homes for Adults (18-65 years) Page 22 of 29 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have benefited from a consistent management approach to the home. Staff endeavour to run the home for the benefit and well being of the residents. There are appropriate arrangements in place to service and repair plant and equipment. The health and safety of residents is promoted and there are adequate policies and procedures in place. Evidence: Mrs Belinda Dachtler, the Registered Manager has NVQ level 4 in Care Management and has been at the home since it opened. Mrs Dachtler stated that she had attended various courses and undertaken relevant training to keep her skills up to date. Regulation 37 notices have been submitted as required. Only one Reg 26 report has been written recently, in future one of the partners will ensure this is completed each month, at present there is no need to submit copies to the Commission. The manager stated that there is a well-established team of staff at the home who are Care Homes for Adults (18-65 years) Page 23 of 29 Evidence: very supportive of each other. Most of the staff have been working at the home for many years. Statements in the staff survey included comments such as,This is a safe friendly and caring environment, We are experienced, long term staff and the home has a friendly warm atmosphere, the residents are well cared for and listened to, and Staff are always looking at ways to improve care... we try to give our service users choice and independence. On the day of inspection, there was evidence of positive and friendly resident and staff interactions, staff were observed to be courteous and respectful. Residents looked well cared for. The fire logbook was up to date and in order. The inspection of fire fighting equipment and fire alarms systems had taken place. Fire safety training and drills for staff has been completed. There is a Health and Safety policy in the home that contains information about Control of Substances Hazardous to Health (COSHH) and such products are safely stored. It was noted that the home has undertaken a generic risk assessment to ensure that the people living in the home, staff and visitors are protected from potential injuries with the exception of risk assessing hot surfaces such as radiators and exposed pipework. Accident records were reviewed and were found to be completed satisfactorily. Electrical and gas safety inspections have taken place, however the Landlords gas safety certificate could not be found and will be forwarded in due course. Water temperatures are monitored and in future a written record will be made. The homes certificate of insurance was displayed, as was the registration certificate. Records of a confidential nature were kept in a locked and secure. Quality assurance programmes or outcomes were not reviewed on this occasion. Care Homes for Adults (18-65 years) Page 24 of 29 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 1 4 Ensure that the Statement of 31/01/2008 Purpose has all required information for prospective and existing service users. Ensure all care plans are in 31/01/2008 place for identified individual. 2 18 15 3 20 13(2) All medication must be administered as per instruction from the pharmacy and must correspond with the MARS. 31/01/2008 4 30 13(2)(c) Ensure the shower noted on 31/01/2008 the second floor is kept clean at all times Ensure that staff undertake 31/01/2008 regular supervision to enable them to perform their duties effectively.? Ensure risk assessment is reviewed in respect of one individual following accidents. 18/01/2008 5 36 18 6 42 13 7 42 13 Undertake a generic risk 18/01/2008 assessment of all areas that service users have access to in order to protect them from Page 25 of 29 Care Homes for Adults (18-65 years) hazards. 8 42 13 Fridge and freezer temperatures must be regularly recorded 31/01/2008 Care Homes for Adults (18-65 years) Page 26 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 41 26 Regulation 26.(2) (3) & (4) prepare a monthly written report on the conduct of the home in accord with Reg 26. (4) 30/01/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 3 4 6 10 20 34 That annual re-assessments and care plan re-writes take place for each resident. That each person will have key events or matters outside of the regular care plan recorded in their files. Ensure that all as required medication (PRN) has the maximum dose to be administered in 24 hours recorded. The manager should ensure that a written record is made of any risk assessments carried out where a disclosures contains information about convictions or cautions. Put in place an annual formal appraisal process that identifies areas of personal and practice development for staff. The manager will forward a copy of the most recent landlords Gas Safety certificate to the Commission as soon Page 27 of 29 5 36 6 42 Care Homes for Adults (18-65 years) as possible. 7 42 Keep a written record of hot water outlet temperatures and risk assess hot surfaces to ensure they do not pose a risk to residents. Care Homes for Adults (18-65 years) Page 28 of 29 Helpline: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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