Inspection on 02/09/08 for Radcliffe House

This is the latest available inspection report for this service, carried out on 2nd September 2008.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Radcliffe House 23/06/06

Radcliffe House 18/11/05

Radcliffe House 28/04/05

Radcliffe House 06/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 13/11/2008.

CARE HOME ADULTS 18-65 Radcliffe House 11 Radcliffe Road East Croydon Surrey CR0 5QG Lead Inspector Peter Stanley Key Unannounced Inspection 2nd September 2008 09:30 Radcliffe House DS0000025828.V370477.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 Radcliffe House DS0000025828.V370477.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. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Radcliffe House Address 11 Radcliffe Road East Croydon Surrey CR0 5QG 020 8680 4586 020 8680 4586 enquiries@qcclimited.com 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) Quality Care Choice Limited James Oseya Care Home 23 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (23) of places Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder, excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 23 15th October 2007 Date of last inspection Brief Description of the Service: Radcliffe House is set in a large well-maintained garden and has nineteen single and two double bedrooms, in addition to a communal lounge, smoking area and dining room. It is a large, converted period mansion, which consists of three floors, plus an attic conversion. The home is conveniently sited for local transport (buses and trams) and is within walking distance of the centre of Croydon. The nearest mainline station is East Croydon with easy access to London and the South Coast. The home provides care for up to 23 service users with long-term mental health needs. Some residents have a history of additional problems including alcohol or substance abuse. If these continue once they are admitted to the home they would be asked to leave. Whilst the home aims to rehabilitate residents so that they can live more independently, in independent or supported accommodation, most have had significantly severe mental health problems which has made rehabilitation difficult, and which has resulted in them living long-term in the home for many years. The home aims to reassess the appropriateness of each placement within a two to three year period. The fees charged for a placement at this home range from £552 to £1000 per week. Radcliffe House DS0000025828.V370477.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 stars. This means the people who use this service experience good quality outcomes. This key inspection was conducted over one day and involved discussion with the home’s registered manager, James Oseya. We also met with the deputy manager, staff and residents, and had wide-ranging discussion regarding the home. We examined both service user and staff records, and case-tracked the records of two recent admissions. Records examined included residents’ assessments, risk assessments, care plans, medication records and review minutes. Staff records examined included staff rotas, supervision, appraisal and training records. Recruitment records and criminal records checks, for three new staff recruited since the last inspection, were examined. We looked at documentation relating to the day-to-day running and management of the home. This included quality assurance questionnaires and records, policies and procedures and records relating to the logging of any accidents or incidents and complaints. Documentation relating to health and safety including the home’s risk assessments, servicing and maintenance certification, were also examined. We also referred to the home’s self audit, the Annual Quality Assurance Audit (AQAA), which has been completed by the home’s registered manager, James Oseya. This inspection follows a random inspection that took place on 24 January 2008. The reason for this inspection was to check out the progress that had been made in meeting the outstanding requirements from the previous key inspection on 15 October 2007. Of 7 requirements from the previous key inspection, 1 remained outstanding at the last (random) inspection. 3 new requirements were made. At this inspection it was evidenced that all these requirements have now been met. There are two new requirements from this inspection. The first is for a resident’s CPA Review to be evidenced, The second is the need for an up-todate (3 monthly) inspection of the home’s fire alarms and fire safety equipment. The last inspection was carried out on 21/4/08. There are also two significant concerns (which must be acted upon forthwith). These relate to the need for regular two-monthly staff supervision, and for regular two-monthly staff and residents’ meetings to be held. There are also 3 recommendations from this inspection. We spoke with both staff and residents and received generally positive feedback regarding the home and the support being provided. No complaints or allegations have been recorded. Whilst some concerns remain, the home Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 6 has built upon earlier progress in meeting previous requirements and addressing the required care standards. From all the evidence available the home is assessed as providing a generally good service and environment, and to be achieving generally good outcomes for residents. We would like to extend thanks to the manager, James Oseya for his assistance in helping to facilitate this inspection. We would also like to extend thanks to the deputy manager and to those staff and residents who spoke with the inspector What the service does well: Prospective residents are being provided with all the information they require, and the opportunity to visit, and stay overnight if they wish, before deciding whether the home is likely to meet their needs. Generally, the home is able to demonstrate that the range of needs presented by residents are being properly assessed, and appropriately met. Each resident is being provided with a contract that details the terms and conditions that apply to their residency at the home. Residents are having their health, personal and social care needs and goals set out in an individual plan of care, and are fully involved in the care planning process. Residents are enabled to participate fully in daily routines and activities, and are supported to make decisions that affect them and their day-to-day lives in the home. Residents are being assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. Residents are being encouraged to participate, and to exercise choice and control, in their daily routines and activities, and to develop their abilities and potential. Residents are being encouraged to maintain contact with their family and friends, and to develop their links and involvement with the local community. There is choice and flexibility with meal arrangements, with vegetarian options now being offered. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 7 Generally, residents are being protected by the home’s medication policy and procedures, and by the provision of accredited and updated medication training for all care staff. Clear information for raising complaints is made available, and residents and their relatives/friends are encouraged to raise any concerns they may have. The home’s policies, procedures and practice indicate that residents are being protected from abuse and are living in a safe environment. Generally, residents are living in a safe, hygienic and well-maintained environment with access to appropriate and sufficient communal facilities. Residents’ rooms are comfortable and reasonably well decorated, being suited to individual needs. The home has sufficient bathing and toilet facilities, which generally meet individual needs. The best interests of residents are being protected through the maintenance of appropriate staffing levels, and by clearly defined staff roles and responsibilities. Residents are living in a home that is being generally well managed and run in their best interests. The home is demonstrating, through the development of its quality assurance processes, that it is obtaining feedback from residents, professionals, and other stakeholders, regarding the extent to which the home is meeting its aims and objectives. Residents’ rights and best interests are being safeguarded by the home’s record-keeping policies and procedures. What has improved since the last inspection? Residents’ are being provided with a range of opportunities for leisure and social activities, efforts having been made to increase activities within the home, and to extend individuals’ involvement in community-based leisure and social activities. Residents’ rights and responsibilities are being respected and recognised in their day-to-day lives. Subject to an individual risk assessment, these have been extended so as to include the right to hold a front door key. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 8 The personal support, health care, and emotional health needs of residents are generally being well met in this home. Following a previous concern regarding a resident’s physical health care, policies and procedures have been reviewed, and relevant training has been undertaken by all staff. The home has been developing a brief health action plan summary for each resident. These plans need to be further developed so as to provide a fuller picture of the individual’s health history and health care needs, and how these can best be met in accordance with the individual’s wishes and preferences. 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. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 9 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 Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 10 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 to 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are being provided with all the information they require, and the opportunity to visit, and stay overnight if they wish, before deciding whether the home is likely to meet their needs. Generally, the home is able to demonstrate that the range of needs presented by residents are being properly assessed, and appropriately met. Each resident is being provided with a contract that details the terms and conditions that apply to their residency at the home. EVIDENCE: The home provides an up to date statement of purpose which sets out the aims, objectives, philosophy of care, services and facilities, and terms and conditions of the home. The home has also developed an excellent service user’s guide, which is written in an appropriate language and format, and Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 11 which contains all the essential information. These documents have been reviewed and updated within the last 12 months. Following referral, the needs of the prospective resident are assesed by the registered manager, who is a suitably qualified and trained person. For individuals referred through Care Managements, Care Programme assessments, risk assessments and care plans are obtained from the referring agency. Admission to the home is carefully planned. The manager or deputy manager visit the potential resident and complete an initial assessment and risk assessment of the individual. He/she is then encouraged to visit the home, with short visits being followed by overnight and weekend stays, prior to a decision being made. During these short visits and stays the prospective resident is assisted to become familiarised with the home, and with the staff and residents. Residents are initially accommodated on a trial basis for at least three months. The home only admits emergency or short-term placements if the person meets the home’s admission criteria. Following admission, an assessment meeting, involving the individual, his/her relatives/friends/representatives, and the care coordinator, is then arranged. At this meeting, a detailed assessment is undertaken and a plan of care drawn up. The assessment focuses on the individual’s needs for their mental health and well-being, medication, personal care, physical health, dietary needs, social interests and hobbies, religious/cultural needs, family involvement and social contacts. Placements are then reviewed on a regular basis, with weekly meetings taking place between the service user and his/her key worker. Placements and are not confirmed as permanent until a CPA review meeting has taken place after the first three months of placement. There have been two new admissions since the previous key inspection on 15 October 2007. The inspector completed checks and found that care programme assessments and care plans had been obtained, and that the home had completed its’ assessments and risk assessments. Each resident is provided with a statement of terms and conditions when they move into the home. This includes details of the room to be occupied, and details regarding the person’s fees and cost of tenancy, their care, accomodation and services provided. The terms and conditions state the rights and obligations of the ‘service user’ and registered provider. Whilst the home aims to assist residents to move on to lower supported or independent accommodation, so that they can live more independently, this aim is rarely being achieved. This is due, in part, to the prevalence of significantly severe long-term mental health problems amongst the resident group, and the apparent shortage of supported living options, which has made the prospect of rehabilitation difficult to achieve. The manager did, however, Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 12 state that all residents at the home are being actively reviewed, and that two residents had, within the last 12 months, been transferred into supported living accommodation. However, given that most residents have been unable to move on, and have been living long-term in the home for many years, this aim has been removed from the Statement of Purpose. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 13 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 to 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are having their health, personal and social care needs and goals set out in an individual plan of care, and are fully involved in the care planning process. Residents are enabled to participate fully in daily routines and activities, and are supported to make decisions that affect them and their day-to-day lives in the home. Residents are being assessed regarding potential risks to their health and safety, and are enabled to take responsible risks wherever possible. EVIDENCE: Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 14 The home has a comprehensive and thorough approach to care planning, with care plans being based on the Care Planning Approach. Generally, files include comprehensive service user plans, which provide detailed information evidencing how residents’ needs are being addressed, and the involvement of residents in contributing to their care plans. Risk taking plans (based on risk assessments) have been drawn up, with any restrictions being clearly identified and agreed by the resident. Contingency and crisis plans are also in place. We looked at the files for two recent admissions. These evidenced that care plans had been developed, involving the resident in a person-centred approach. Care plans are being agreed and signed by residents and are accessible to them at all times. The care plan identifies actions to be taken about the individual’s mental state, dietary needs, religious and cultural needs, personal physical health care needs and personal safety. The care plan format is clear and user-friendly, placing an emphasis on the involvement of the resident. The care plan is evaluated on a weekly or monthly basis depending on the needs of the individual, and is formally reviewed at 3 monthly intervals. There is regular monitoring of each resident’s care plan, with weekly meetings taking place between each resident and their key worker. In line with the development of a more person-centred approach, staff at the home have undertaken training in person-centred planning. There was not, however, any evidence of a CPA Review having taken place for one recently admitted resident. The manager advised that while this had, in fact, taken place, no written minutes had been received from the care coordinator. The minutes do, however, need to be evidenced, so as to evidence that the resident’s needs are being appropriately addressed. A requirement applies. Residents are being consulted in a variety of ways during their stay in the home. This includes service user meetings, key-worker meetings, care reviews and through questionnaires completed for quality assurance purposes. The inspector was, however, concerned to note that service user meetings are not taking place on a sufficiently regular basis, there having been just 4 meetings recorded within the last 12 months (on 10/10/07, 21/1/08, 29/5/08 and 29/8/08). The inspector has not made a requirement on this occasion, but will expect to see a sustained improvement over the next 12-month period. Meetings should be held at least two-monthly. Residents are encouraged to be as independent as possible in their day-to-day living and, with the support of their key workers, to be fully involved in making decisions relating to their daily recreation and activities. With the exception of two residents, who have moved on to supported living within the last year, there has been little progress in enabling residents to make the transition to more independent life-styles within the community. This Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 15 is, in part, been due to the longevity of residence for many residents, which has historically developed in this home, and to the significantly high levels of mental vulnerability which most residents present. There is evidence that residents are supported to take risks in developing independent skills and abilities. One of the stated aims of the home is to enable residents to take responsible risks wherever possible. Prior to their admission prospective residents are thoroughly assessed regarding potential risks relating to their day-to-day living inside and outside the home. We examined a sample of risk assessments and care plans. These evidenced that individuals are being encouraged and assisted to participate fully in daily routines and activities. This includes using public transport, and accessing local recreational and shopping facilities. Residents are also encouraged to look after their own monies and to collect their own benefits. We examined a sample of risk assessments that have been completed for residents living at the home. These provide a comprehensive risk assessment of each individual, with risk-taking plans and individualised care plans having been developed to detail the actions required to minimise risks and hazards. The home has a comprehensive ‘missing persons’ policy/procedure document. This clearly states the actions which staff are required to take in the event of an unplanned absence of a resident. A monitoring system maintains a check on residents’ movements in and out of the home, these being recorded. Hourly checks are completed by staff so as to ensure the safety of residents. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 16 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): 11 to 17 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents’ are being provided with a range of opportunities for leisure and social activities, efforts having been made to increase activities within the home, and to extend individuals’ involvement in community-based leisure and social activities. Residents are being encouraged to participate, and to exercise choice and control, in their daily routines and activities, and to develop their abilities and potential. Residents are being encouraged to maintain contact with their family and friends, and to develop their links and involvement with the local community. Residents’ rights and responsibilities are being respected and recognised in their day-to-day lives. Subject to an individual risk assessment, these have been extended so as to include the right to hold a front door key. There is choice and flexibility with meal arrangements, with vegetarian options now being offered. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 17 EVIDENCE: The ethos of the home, as outlined in the Statement of Purpose, is very much orientated towards promoting independence and maximising individual choice and opportunities. Staff at the home work with residents with the aim of increasing their motivation and confidence, and developing their independent living skills. Residents are encouraged to take responsibility for undertaking daily tasks such as tidying their rooms, doing their laundry, and preparing drinks, food and snacks. As evidenced in daily logs, care plans and review notes, the daily routines of the home are observed to be flexible and accommodating of individual needs and preferences. We spoke with a number of residents during the inspection and received feedback that indicated that that there is flexibility in their daily routines and that they are able to engage in a range of in-house and community-based activities. Activities and events are publicised on the home’s notice board and at service users’ meetings. Each resident has an individual daily activities programme, a copy of which is kept in his or her own room. The programme is agreed with the individual and reflects his/her interests and needs, and is monitored by the key worker and at reviews. Whenever possible, residents are encouraged to develop their learning and work-related skills. One resident has an interest in photography and attends courses in this, and computer studies, at Croydon College. While residents are encouraged to access local educational facilities including basic literacy and numeracy classes and vocational/skills-based courses, there has been little take-up of these courses. Activities within the home include regular twice-weekly art and pottery sessions, which are well attended. An art therapist visits the home each week. These sessions have aimed to develop creative self-expression, and a sense of personal fulfilment, and have proved to be very popular with residents. The inspector has previously observed one of these sessions and was impressed with the level of personal involvement and satisfaction achieved. An exhibition of their work has been held in an art gallery, within the community where members of the general public have been able to view it. Another opportunity to exhibit their work is currently being planned. There is a wide range of games and activities both within and outside of the home, including table football and pool. Some residents go swimming once a week, or play golf with their key worker, whilst others have gym equipment in their room. Activities and events are publicised on the home’s notice board Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 18 and at service users’ meetings. Since the last key inspection the home has purchased its own full-size pool table. This is situated in the main lounge and has proved to be a popular activity with the residents. The manager advised that an outdoor extension is planned where it is hoped to provide a table tennis table. Residents are helped to access resources in the community as identified in their care plans. Staff provide information on the availability of activities and facilities in the area, such as shops, libraries, cinemas, pubs, leisure centres, church and cultural centres. The manager has confirmed that the home is endeavouring to access more leisure resources with bowls and swimming, but that, as yet, there has been little interest or take-up from residents. Information on local public transport is also made available. Residents visit the shops, cafes and cinema, while some residents attend local day centres, where they are able to participate in activities and enjoy social contact. Occasional bingo sessions are organised, and staff play dominoes and board games with residents. One staff member plays the saxophone keyboard and trumpet, and occasionally plays these for the enjoyment of residents. Daily papers and magazines are available, and information is provided regarding the availability of activities in the area. The home has purchased a new mini-bus and organises day trips to seaside resorts such as Bognor Regis, Brighton or Bournemouth. These do not involve any additional cost to the residents and, from the views expressed, are very much looked forward to by both the residents and staff who accompany them. There have been recent day outings to Brighton and Hever Castle, and shorter trips out to other places of interest. Residents are enabled, if they wish, to take a holiday in this country or to go abroad. The manager said that 4 residents have been booked to go on a holiday to Greece, while another resident has recently been on a week’s holiday to France. The home actively encourages residents to maintain family links and friendships both inside and outside of the home. Residents can see visitors in their rooms and in private, and are encouraged to maintain friendships and personal relationships. Family and friends can be invited to barbecues and other events that take place at the home. Views expressed by residents have indicated that they are encouraged to maintain contact with their family and friends, and that staff are welcoming to visitors and respectful of their privacy when they receive visits. Family and friends are encouraged to be involved in care plan and CPA review meetings with the agreement of the resident concerned. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 19 The rights and responsibilities of residents are generally being well respected and recognised in their daily lives. All residents are encouraged to register on the electoral role and, if they wish, are assisted to exercise their right to vote. Following discussion at the last key inspection, residents are now being provided with their own front door key. All residents are risk assessed to ensure that the issuing of a key is not placing the individual, or other residents, at a high level of risk. Residents are encouraged to handle their own finances, and to be consulted and involved in any decision that affects their personal or collective welfare. All residents are informed of their right to access information that is kept about them if they wish to do so. Religious and cultural needs are respected, with the right of individuals to worship in their own faith being assisted to make this possible. One resident, from a Muslim religious background, is assisted to practice his religious beliefs and maintain his faith. Mealtimes are flexible and take account of individuals’ work and activity schedules. Menus evidence a wide choice of foods offering a varied and nutritional diet. Residents are consulted as to which foods they would like purchased, and are able to have an alternative dish provided if the menu options do not appeal. Following a previous recommendation, a vegetarian option is now being offered at mealtimes to all residents A detailed record is kept of the food provided, a menu book being kept in the dining room. Residents are being encouraged to shop and cook for themselves, and are able, if they wish, to assist with peeling potatoes, the clearance of dishes and washing up. The dining area is pleasantly laid out and provides a relaxed and congenial setting for taking meals. Residents are encouraged to prepare their own breakfast, and to assist with food preparation and other tasks if they choose to. Lunch and an evening meal are provided. Residents are encouraged, wherever possible to undertake day to day tasks and to develop greater independence. Tasks may include vacuum cleaning their own carpet, tidying up their room, or shopping for their own toiletries. Residents are encouraged to develop skills through leisure, training or voluntary activities, and to develop their abilities and sense of self-esteem. Comment received indicates that the food, which the home provides, is good and varied, and that it accommodates individual tastes. One resident is of the Muslim faith, and has his dietary needs respected. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 20 Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 21 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 to 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The personal support, health care, and emotional health needs of residents are generally being well met in this home. Following a previous concern regarding a resident’s physical health care, policies and procedures have been reviewed, and relevant training has been undertaken by all staff. The home has been developing a brief health action plan summary for each resident. These plans need to be further developed so as to provide a fuller picture of the individual’s health history and health care needs, and how these can best be met in accordance with the individual’s wishes and preferences. Generally, residents are being protected by the home’s medication policy and procedures, and by the provision of accredited and updated medication training for all care staff. EVIDENCE: Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 22 We examined a random sample of residents’ files and evidenced that both personal support and general health care needs are being generally well met. As detailed in assessments and care plans, the range of personal support needs presented is varied, with support being tailored according to individual needs and goals. Staff provide very flexible support with the focus being on encouraging and assisting individuals to undertake tasks such as maintaining personal hygiene, preparing their own breakfast and doing their own laundry. The inspection of residents’ files indicates that there is regular contact with health care professionals, and that personal support and healthcare needs are generally being addressed. The person’s mental and physical health needs are closely monitored, with individuals being reminded to receive visits and attend appointments as and when these are required. Residents are able to receive visits from visiting professionals in the privacy of their own rooms. Support is given to access local GP for health checks, and local dental, opticians and chiropody appointments. Support and advice are available, when required, from community psychiatric nurses and the community mental health team. All residents are supported to attend outpatients and other appointments. Following a concern from a previous key inspection, the home has reviewed and updated its’ policy regarding the physical health care needs of residents, including how these needs are addressed and monitored, and how procedures can be improved so as to promote more positive practice in this area. All staff have, within the last year, been provided with up-to-date training relating to the physical health care needs of residents, and associated good practice. Following on from these concerns, it was recommended that the home develop a health action plan for each resident, This has yet to be implemented, The home has developed a profile, which briefly summarises each resident’s health care needs, and gives brief details of how these are being addressed. However, this does not constitute a personalised health action plan for each resident. This should fully involve each resident, and be drawn up in consultation with the key professionals concerned. Each health action plan should detail his/her physical, mental and emotional health care needs, and how these can best be met in accordance with the individual’s assessed needs, wishes and preferences. The home has appropriate medication policy and procedures in place. A visiting pharmacist completes a medication audit every three months. Medication charts are maintained, together with records relating to receipts and returns of medication. The home uses the Monitored Dosage System for administering medication, with blister packs being used. All medication is kept securely in an appropriate medication cabinet. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 23 We completed some checks on residents’ medication records, including a number of MAR sheets, which were found to be satisfactory. The home received, on 20/4/08, a comprehensive audit of its’ medication procedures and practice, by a pharmacist from the Croydon Primary Care Trust. As a result of this audit, procedures were assessed as being generally satisfactory. However, a number of recommendations were made, which have been implemented. These included the need for the home to put in place a procedure for reporting medication errors, and for a record of all medications ordered to be maintained. The home was also required to undertake regular internal audits at 28-day intervals. The manager advised that, following the audit, the PCT pharmacist visited again in May 2008 to provide advice and training for staff on medication practice and procedures. He also advised that further training for staff, has been provided by a local pharmacy (Lloyds) in August 2008. All staff that administer medication have received accredited medication training. . Three residents have been risk assessed as being safe to administer their own medication, with support and training being provided. This includes showing residents how to maintain their own medication charts. These are monitored to ensure that they are being appropriately completed. The resident’s consent to medication is obtained and recorded in the individual care plan. If, following risk assessment, the person is able to self- medicate and able to manage their medication, support to enable this is provided. Residents who self-medicate are offered a lockable cupboard in their room for safe storage of medicines and only accesible by them and the key-worker or the manager who may have the need to do so. Action is taken to minimize risk by providing a self-medication record sheet which residents mark to indicate that they have taken medication. A regular weekly check is carried out to monitor progress. Residents are advised to inform staff if they become ill or if there are any side effects after taking medication. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 24 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. Clear information for raising complaints is made available, and residents and their relatives/friends are encouraged to raise any concerns they may have. The home’s policies, procedures and practice indicate that residents are being protected from abuse and are living in a safe environment. EVIDENCE: The home has an appropriate complaints policy and procedure in place. A summary is included in both the service user guide and the statement of purpose. There have been no complaints since the last inspection. Residents are able to raise any concerns or grievances with their key worker, other staff on duty, the manager or registered provider, or with their care coordinator. When complaints relating to the users’ mental health needs are made these are recorded in his/her care notes and discussed with the C.P.N. Feedback indicates that residents feel that they are being listened to, and that when problems or concerns arise, they are able to get these addressed. We spoke with a number of residents, none of whom expressed any concerns regarding the home or the support provided. One resident did, however, Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 25 express the view that he had received insufficient support from community professionals in addressing his needs. A concern was raised at the last inspection regarding the need for residents to have access to an independent advocate for assisting them to deal with any concerns or grievances. The manager advised that he had contacted the Advocacy Project in Croydon but that that it had not proved possible to provide this service. The Project has, however, offered the possibility of a volunteer befriender for establishing contact with any residents who may benefit. No allegations of abuse have been recorded since the last inspection. The home has an appropriate adult protection policy and procedure, for the protection of vulnerable adults. This is in line with local statutory procedures, with all staff being familiarised with the home’s policy and procedures. The manager has advised that all staff are provided with ongoing supervision, support and training regarding the nature of abuse and the protection of vulnerable adults. All staff have completed local statutory adult protection training. A recommendation, from the last random inspection on 24/1/08, for the registered manager or deputy manager to attend the three day ‘training for trainers’ course in adult protection, has not proved possible to implement, no courses being available or planned in Croydon at the present time. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 26 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 to 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Generally, residents are living in a safe, hygienic and well-maintained environment with access to appropriate and sufficient communal facilities. Residents’ rooms are comfortable and reasonably well decorated, being suited to individual needs. The home has sufficient bathing and toilet facilities, which generally meet individual needs. EVIDENCE: The premises were inspected and found to be homely, comfortable and safe. Fittings, adaptations and equipment are of good quality, and domestic in scale. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 27 The home has a health and safety policy, with staff receiving training in this area and being supported to maintain a safe and secure environment. The home has a large well-maintained garden with a patio area and lawn. The home does not accommodate people with significant physical disabilities and is not suitable for people who are wheelchair dependent. There are, however, a number of older residents who have some physical impairment. The home was last assessed in 2006 by an Occupational Therapist for any adaptations or aids that would assist in meeting the residents’ collective needs. We spoke to a number of residents, two of whom were in the main lounge, and others in the smoking area, dining room or in their own rooms. Residents presented as being settled and content with their environment, generally favourable views being expressed. The home is decorated to a reasonable standard throughout and presented as being comfortable, bright and warm. There is a planned programme of maintenance for the redecoration and renovation of the home, including plans to redecorate all residents’ rooms, and the communal areas. The home has several communal spaces for residents’ use, and the house has a very homely feel. There is room for all the home’s residents to sit together, or to receive visitors in private, in either of the home’s two lounges. There is also a pleasant, spacious dining room, which includes an area where residents can sit in easy chairs. Details of the menu options for the day are detailed in a diary in the dining room. The home has a small smoking area for the use of those residents who wish to smoke; this is situated well away from any of the communal areas. There is also a conservatory, adjacent to the main lounge, where residents can sit and look out across the garden. The home has 19 single rooms and 2 double bedrooms. We viewed five residents’ bedrooms and found these to be satisfactorily furnished and equipped. Generally, the rooms inspected presented as being reasonably decorated and furnished to required standards. Residents are consulted regarding their choice of colour scheme and décor, and are able to bring their own items of furniture if they wish. Residents were observed to personalise their rooms with photos, personal mementoes and possessions including personal stereos, CD players and TV sets. One resident has his own personal computer in his room. Doors to residents’ private rooms are fitted with locks suited to their capabilities and accessible to staff in emergencies. provided with the key which they can retain. Doors to rooms are fitted with locks suited to individuals’ capabilities. Each resident is provided with a key to his/her room unless their risk assessment indicates this to be unsafe. Each room has lockable storage for money and valuables. All residents’ bedrooms include a lockable drawer or facility. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 28 Following a previous requirement, the home has been undertaking a regular monthly audit of all residents’ bedrooms, an inventory of all furniture and possessions being maintained. Following a representation from the manager for this to be done on a less frequent basis, it was agreed that the audit could forthwith be undertaken on a two-monthly basis. The kitchen area is clean and domestic in scale, and residents are encouraged to make use of the facilities if they wish. There is adequate food storage, with additional storage for frozen foods in an outdoor shed. The area just outside of the kitchen is now being kept clear from a build-up of rubbish, with any loose items being properly bagged up. We met the home’s cook who has worked at the home for two years. She has completed food hygiene training and demonstrated a good knowledge and understanding of both hygiene and the culinary needs of residents. The home has a bathroom on both the ground floor and on the first floor. The existing ground floor bathroom has been renovated, with a new bath having been installed. The home also has three shower units, and seven toilets all near service user’s bedrooms and communal areas. Some bedrooms have ensuite washing and toilet facilities. The laundry room was renovated and refitted in 2006, and provides safe, hygienic and efficient laundry facilities. Both staff and residents use this. The laundry facilities are suitably positioned so as to ensure that any soiled laundry is never carried through areas where food is stored, prepared or eaten. Heating is maintained at a comfortable temperature throughout the home, with individual thermostats to regulate the temperature in all rooms. A new boiler was installed in the home, in August 2007. The home presents as being clean, hygienic and free from any offensive odours. The home complies with food hygiene and environmental health regulations, and last had an inspection, on 30 July 2007. The home’s policies and procedures manual contains various policies for the prevention and control of infection including dealing with spillages, HIV and Hepatitis B. Staff receive training in food hygiene, health and safety and infection control. A number of requirements have been met from the previous key inspection. Carpeting in Rooms 12 and 20 has been cleaned- evidenced on inspection of the home. The area just outside of the kitchen was inspected and found to be clear of any loose items of rubbish. Paper towels are now being provided for hand drying in the home’s toiletsevidenced on inspection of the home. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 29 Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 30 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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The best interests of residents are being protected through the maintenance of appropriate staffing levels, and by clearly defined staff roles and responsibilities. Whilst there is evidence of a qualified and competent staff team, their effective working is being compromised by irregular staff meetings and infrequent staff supervision. Generally, residents are being protected by an overall improvement in the home’s recruitment practices and procedures, including the obtaining of CRB certificates prior to staff appointments. However, the home is not obtaining all the necessary documentation that is required by the regulations. EVIDENCE: We examined the staff rotas. These indicated that the home is maintaining its’ staffing levels. During the day, the home has 3 care staff on duty throughout the day, from 8am to 9pm. There are two seven-hour shifts, with a half-hour Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 31 formal handover session taking place prior to each new shift. The night duty rota has two waking staff on duty at night. In addition, the home employs one full time domestic cleaner and a cook. While staff handover sessions between shifts, weekly key worker meetings with each resident, and a hands-on approach by the manager, have helped in facilitating good communication and awareness amongst the staff group, this is being offset by a falling off in two areas, supervision and staff meetings. The last key inspection report referred to the improvement in the regularity of supervision and the frequency of staff meetings. Unfortunately this progress has not been sustained, 4 staff not having had supervision within the last 3 months, and 2 others having had long gaps between supervision sessions. As detailed in Standard 36.4, all staff should receive at least six supervisions per year (2 monthly). Following discussion with the manager, James Oseya, it was decided not to make a requirement on this occasion. However, the frequency of supervision will be rigorously monitored over the next 12 months, and action taken if required. Following a recommendation from the last inspection for supervision training and some delegation of supervision, we were advised that the deputy manager is undertaking a distance learning supervision training course, and that the manager will be aiming to delegate some supervision once this training has been completed. This should help to ease the manager’s supervision workload. The manager or deputy manager chairs staff meetings. From inspection of the minutes, there has been an apparent falling off in the frequency of staff meetings over the last 12 months, just 4 having been recorded as being held over the last 12 months. These were previously being held on a regular monthly basis. As detailed in Standard 33.8, regular staff meetings should take place at least six times a year. It was decided not to make a requirement on this occasion, but we will expect to see a sustained improvement, with at least 2 monthly meetings, over the next 12-month period. The home has a comprehensive induction programme in place, with all new staff receiving induction training within six weeks of appointment. This includes training on the principles of care, safe working practice, health and safety, communication, confidentiality, and maintaining a safe environment. The induction programme is signed and dated on completion. There is an ongoing staff-training programme, with statutory training taking place in mental health, food hygiene, health and safety, medication and infection control. The home has an ongoing programme of staff training, with each staff member agreeing a personal training plan that meets their individual needs and learning objectives. All staff are assessed to identify their training and Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 32 development needs, and receive regular training to develop their skills and update their knowledge. Statutory training includes POVA, and accredited medication training. Other training over the last 12 months has included health and safety, infection control, manual handling, Emergency First Aid, Mental Health Awareness, Understanding the Mental Capacity Act, and training in Physical health care needs. The home has previously (in 2007) undertaken staff training in bereavement and loss. Staff are encouraged to study for their NVQ care qualifications. The registered manager indicated that of 13 care staff, 9 have achieved an NVQ Level 2, of whom 3 staff have obtained an NVQ Level 3. I staff member (the deputy manager) has completed his NVQ Level 4 and RMA (Registered Manager’s Award). 2 staff are currently studying for an NVQ Level 2, and 1 for an NVQ Level 3. The home has appropriate recruitment policy and procedures in place. Since the last inspection, there have been 3 new staff appointments. We checked the relevant staff files and found that CRB (Criminal Records Bureau), POVA and reference checks had been satisfactorily completed, and that the home is now complying with the regulations. However, whilst there was evidence of other checks having been completed, these did not include a recent photograph of the individual, nor a copy of the person’s birth certificate. Both of these are part of the identity checks required by Schedule 2 of the Regulations (19b). Whilst it was decided not to apply a requirement on this occasion, both a recent photograph and a copy of the applicant’s birth certificate must be evidenced for all future staff appointments. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 33 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 to 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are living in a home that is being generally well managed and run in their best interests. The home is demonstrating, through the development of its quality assurance processes, that it is obtaining feedback from residents, professionals, and other stakeholders, regarding the extent to which the home is meeting its aims and objectives. Residents’ rights and best interests are being safeguarded by the home’s record-keeping policies and procedures. Generally, the health, safety and welfare of residents and staff are being appropriately promoted and protected. Risk assessments covering Fire, and Health & Safety, have now been reviewed and updated. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 34 EVIDENCE: From 3 January 2007, the home has been managed by Mr James Oseya, the registered manager. Mr Oseya has had extensive previous experience in the mental health field and in residential care management. His appointment followed a period of nine months when the home did not have a registered manager, and which adversely impacted on the management and day-to-day running of the home. Since being in post, Mr Oseya has demonstrated his commitment to raising standards at the home by introducing a number of changes to improve practice, systems and staff working. Views expressed by both residents and staff, regarding the day-to-day running of the home, have been generally favourable. The evidence from this and previous inspections indicates that there is an open and inclusive style of management in the home, with residents being consulted and involved in decisions affecting their individual and collective welfare. Meetings for both residents and staff are being held, though these are not currently being held on a sufficiently regular basis, being 3 or 4 monthly rather than 2 monthly. These are chaired by the manager or deputy manager. The home has been developing its quality assurance processes over the last four years with questionnaires having been developed by the managing company for canvassing the views of residents, relatives, friends and visiting professionals and other interested parties. These are designed to ensure that the home is meeting its aims, objectives and statement of purpose. A service user satisfaction survey has been completed, and an audit report completed. The manager has confirmed that he has been reviewing the homes policies and procedures, this being evidenced in the AQAA and in the home’s checklist, detailing when these were last reviewed (in 2008). A policy is in place that informs residents on how to gain access to their records and any information held about them. All records are being kept securely, with confidentiality being respected. From the evidence of this inspection, residents’ and staff records are generally being well maintained. The home has a health and safety policy, and a fire safety policy, which were both last reviewed in September 2007. Following a requirement from the last inspection, up-to-date Fire Risk and Health & Safety assessments have now been evidenced, these having been reviewed and updated on 17/10/07 and 9/7/08 respectively. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 35 We checked health and safety certificates and found that all but one of the required checks have been completed within the last 12 months. Fire drills take place on a regular, weekly basis, with these being recorded in a written record. While the home has 3 monthly inspections of fire alarms and equipment, the last one was on 21/4/07, and is overdue. Fire safety training is arranged sixmonthly for all staff. Water testing for legionella is being carried out each year, together with the testing of gas and electrical appliances, boilers, heating systems and fire alarms. Environmental Health last visited on 30/7/07, completing checks on food hygiene. Water temperature checks are being completed weekly, and fridge/freezer temperatures are checked daily. The home has policies and procedures covering the control of substances hazardous to health (COSSH and RIDDOR), with the home maintaining safe storage and disposal of these substances. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 36 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 3 4 3 5 3 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 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 2 X Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 37 No Are there any outstanding requirements from the last inspection? 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. 1 Standard YA6 Regulation 15(2)(b) Requirement The CPA review minutes for AP must be obtained to evidence the discussion, at the review, of the service user’s mental and physical health and support needs, and any proposed actions or changes to the care plan. To ensure the safety of residents, an up-to-date inspection of fire alarms and fire safety equipment must be carried out. Last inspection was carried out on 21/4/08. These should be completed on a regular 3 monthly basis. Timescale for action 31/10/08 2 YA42 13(4)(a), 13(4)(c) 31/10/08 Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 38 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 YA23 Good Practice Recommendations The inspector recommends that the registered manager, or deputy manager, undertake the Croydon 3 day adult protection training for trainers course in adult protection. The manager advised that LB Croydon is unable to provide this training. Outstanding from last key inspection. 2 YA19 The home has detailed a brief health summary for each resident. A comprehensive Health Action Plan should be developed for each resident (and included in their personal file). This should provide a full picture of the individual’s health history and health care needs, and how these can best be met in accordance with the individual’s wishes and preferences. The plan should reflect a person-centred approach, fully involving the individual and his/her relatives or representatives, and should be drawn up in consultation with the GP, community psychiatric nurse and any other relevant health care professionals. 3 YA36 The inspector recommends that supervision and appraisal training should be provided for both the deputy manager and the senior care worker, so as to ensure that they have developed the requisite level of knowledge, awareness and skills required for supervising staff. Outstanding from last key inspection. The manager advised that the deputy manager is currently doing a distance-learning course in supervision and appraisal, with view to undertaking some supervision once this has been completed. Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 39 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Radcliffe House DS0000025828.V370477.R01.S.doc Version 5.2 Page 40 - 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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