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Inspection on 13/12/05 for 1 & 2 Hunts Lane

Also see our care home review for 1 & 2 Hunts Lane for more information

This inspection was carried out on 13th December 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Staff enable residents to have opportunities to maintain and develop social, communication and independent living skills. The staff team ensure residents are given the opportunity to attend various recreational activitities both outside of and within the home. Residents have a holiday twice a year and their physical ability does not limit the choice of holiday or activity. Residents benefit from a motivated staff team who are keen to update their knowledge through various training sessions.

What has improved since the last inspection?

This is the inspector`s first visit to the home and it was noted that the requirements and recommendations made at the last inspection had been met.

What the care home could do better:

One Care plan must include the information required to support a resident with epilepsy management. This must include emergency information regarding medication and when to call an ambulance. The manager must ensure that all staff receive the appropriate fire training within the timescales dictated by the Avon Fire Service, 6 monthly for day staff and 3 monthly for night staff. Residents will benefit from having their choices recorded detailing their wishes in the event of death in order to inform staff and appropriate others.

CARE HOME ADULTS 18-65 1 & 2 Hunts Lane Wellington Hill Horfield Bristol BS7 8UW Lead Inspector Karen Walker Unannounced Inspection 13th December 2005 09:30 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 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 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 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. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 1 & 2 Hunts Lane Address Wellington Hill Horfield Bristol BS7 8UW 0117 9354310 0117 9699000 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) The Brandon Trust Mrs Dolores May Smart Care Home 9 Category(ies) of Learning disability (9) registration, with number of places 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Staffing Notice dated 17/03/1999 applies Manager must be a RN on parts 5 or 14 of the NMC register May accommodate up to 9 persons, aged 35 years and over, requiring personal care. May accommodate 1 named person aged 65 years and over. Date of last inspection 10th May 2005 Brief Description of the Service: Hunts Lane is arranged in two separate bungalows capable of accommodating nine adults with a learning and physical disability. A small tarmac area separates the two homes. The homes have aids and adaptations to assist in the provision of personal and nursing care. The home is owned by Western Challenge and leased to the Brandon Trust who is responsible for the management of the care delivery. Set off the road and surrounded by garden, the home is close to local amenities and on the main bus routes into the city centre. It is within walking distance of pubs, churches, shops and open parkland. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector met the manager of Hunts Lane and was introduced to staff and residents. The inspector toured both homes and examined documentation relating to residents from each building. Documentation was examined relating to staffing levels and training, recruitment and health and safety. The inspector observed staff supporting residents throughout the day. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 6 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 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 7 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Prospective residents have the necessary information made available to them to ensure they are supported to make an informed choice regarding service provision. They are able to have a trial period and have their needs assessed. All residents have contracts in place detailing the terms and conditions of occupancy. EVIDENCE: The statement of purpose was examined and it was noted that it requires some minor changes and updating to ensure it contains details of the CSCI. The service user guide was also available and user friendly. This information is available to all current residents and contains adequate information to enable potential residents to make an informed choice of where to live. The manager confirmed that residents were given the opportunity to have a ‘trial stay’. Records evidence that all residents have their needs assessed and care plans put in place to meet them. Whilst case tracking the inspector noted that contracts were in place. Some were not signed by the resident but the manager explained that in this case the resident was unable to understand the content. The manager said where residents had close relatives they were sometimes asked to act as advocate and sign contracts. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Residents’ needs are assessed and met but documentation must reflect this. They are supported to make choices in their lives and are involved in many aspects of decision making in the home. Residents’ are supported to take risks as part of an independent lifestyle and can feel confident that that information about them is handled appropriately. EVIDENCE: Care plans were examined. They contained all the necessary information to enable staff members to adequately support residents with daily living skills. However one care plan lacked the information necessary to ensure effective support was given regarding the management of epilepsy. There was also no associated risk assessment. This was discussed with the manager who said there was a comprehensive assessment and plan in place but this was not available at the time. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 9 The descriptions in the care documentation prompted staff to encourage the resident to make choices on how they wish to plan their day. Staff were able to describe some of the actions they took to ensure residents’ choice was assessed, respected and acted upon. The manager gave examples of how residents with limited verbal communication were offered choice. One resident has her own ‘communication passport’ put in place to support her communication needs. It was evident that staff had a good understanding of residents communication needs and were able to understand and respond to those needs. The manager said, “The team are very good at interpreting peoples needs”. The manager said staff are in regular contact with some of the residents’ relatives to help ensure the service being provided suits the resident. Risk assessments were well written and contained the necessary information to ensure residents are supported to take risks as part of an independent lifestyle. Risk assessments were in place regarding mobility and posture and the appropriate healthcare assessments were also carried out. The Brandon Trust ensures all staff have access to the confidentiality policy. The manager said this was also covered in the new staff induction training and is covered in staff handbooks. The manager was aware of the Data Protection Act 1998 and was in the process of logging all old information relating to residents and the home ready for safe storage at the Brandon Trust HQ. Staff were observed knocking on residents’ bedroom doors and speaking to them respectfully. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11-17 Residents have as much involvement in their local community as they are able and have adequate opportunities to attend activities of their choice and various holidays. Residents’ rights are respected and independence is encouraged within a risk-assessed framework and with support from the appropriate professional. EVIDENCE: The manager explained that residents who are unable to participate in a full range of activities are still encouraged to take part by observing. An example was given where a resident is supported in the kitchen and although cannot physically help out enjoys watching and the one to one contact. Several residents regularly go to day centres providing a range of services, which vary to meet the residents’ needs. Some of the residents were out on the day of inspection and their timetable was on display in the office. The home has its own transport and the vehicle was in use on the day of inspection. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 11 Due to the physical needs of some of the residents the manager said it was sometimes difficult to support them in accessing the local community but had the opportunity whilst at their various day centres. The care plans had been updated to include a plan that ensures staff spend at least half an hour a day carrying out an activity with the resident on a one to one basis. Whilst at home residents were observed to be relaxing watching TV or listening to music. All the residents have been on holiday at different times and to different places according to interests and choice. One resident went to Longleat Centre Parks with the support of two staff whilst another two residents enjoyed a long weekend in the Isle of Wight. Once a month a musician who plays the keyboards visits the residents. All the residents enjoy a sing-along. One resident also has a private weekly music session, which the inspector was told he enjoys very much. Most of the residents’ enjoy a weekly aromatherapy session. Relatives are encouraged to visit and are supported by staff. Residents also are supported to visit relatives at home. The visitors’ policy was on display and it was noted that visiting hours were stipulated as between 8.30 and 9pm. The manager said this was because residents need an unhurried morning routine and get tired by mid-evening. From reading the induction package and care plans the inspector noted that the information contained regular references to respecting the resident’s rights. This was also confirmed by observations made of staff knocking on doors and respecting residents privacy. The menus supplied by the home offered a range of meals, which appeared nutritious and healthy. The home manager said that dieticians were regularly involved in assessing the nutritional value of the meals served. Care records showed that the dietician had assessed residents’ needs and provided a report, which informed staff of best practice techniques when supporting residents’ with feeding. One resident was observed being supported to be as independent as possible at mealtimes with a specially adapted plate and spoon. He answered favourably when asked if he liked to be supported this way. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,21 Residents’ receive personal care in a way in which they prefer and their health care needs are assessed and met with the appropriate professional support and input. Residents’ will benefit from clear guidelines and information in place relating to their wishes in the event of death and long-term illness. EVIDENCE: The care plans show that staff are guided in how to work with residents in a sensitive supportive way. The care records demonstrated that residents physical needs are met and made reference to the involvement of other healthcare professionals i.e. physiotherapists, speech and language therapists, doctors, dieticians etc. it was noted that wheelchairs are made and adjusted to suit the individual. It was noted that one resident dislikes needles and refused his daily injection necessary to maintain his health and well-being. This was discussed with the manager who explained that in consultation with the general practitioner the type of intervention was changed and the resident now has to have blood taken less frequently. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 13 Due to issues around consent to treatment and a lack of understanding as to the effects of non-treatment a multidisciplinary approach was needed to ensure that a duty of care was maintained. This included input from the house manager, the general practitioner, a relative, the appropriate social worker and the district nurse. This is good practice and ensures the best interests of the person are fully considered. There is an associated risk assessment in place. The staff were observed supporting residents with personal care at a time, which suited them and the manager, confirmed that some residents choose to have a lay-in. Residents’ were supported in an unhurried relaxed way. It was noted that some residents’ care folders did not contain ‘wishes in the event of death’. It is recommended that where relatives are available they be asked for input and where they are not key-workers and staff members well known to the person can add input, i.e. favourite music, songs etc. The inspector did not examine the medication administration sheets or the medication stored at the home however the manager said that all medication returned to the pharmacist was checked against the medication received and a record kept. Medication will be assessed at the next inspection. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Residents’ can feel confidant that they are safeguarded from abuse and that their concerns would be acted upon. EVIDENCE: The manager confirmed that quarterly house meetings take place, which incorporates a different training session each time. The staff team have just attended Protection training and produced an action plan as a result. The outcome of the training has been positive in that a ‘picture board’ is being developed to encourage and support residents to make their concerns and complaints known. A picture of all staff will be added to the board and can also be used to help with communication, i.e. informing residents’ who will be on duty etc. it will also be available to help residents’ make a choice about who they want to support them with daily living skills and personal care. The manager said that an external financial audit was recently carried out. Records show no concerns were reported but a recommendation was made regarding joint receipts. As a result of this the residents’ finances were not assessed at this inspection. The DOH ‘No Secrets’ in Bristol document was readily available and displayed in the office; this links closely with the Brandon Trust Protection of Vulnerable Adults Policy. Records show that staff carrying out their Learning And Disability Award Framework (LADAF) have to complete a comprehensive unit on protection and abuse. There were no recorded complaints or concerns. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24-30 The residents’ home is suited to their needs, comfortable and safe. Individual and shared spaces contain equipment necessary to promote independence. EVIDENCE: The homes premises are suitable for its stated purpose, accessible, safe and well maintained. The home meets residents’ individual and collective needs in a comfortable and homely way. There is a storage problem in that the hoist is stored either in the hallway or in the lounge and it has to be regularly charged. This problem should be alleviated when the environmental changes take place. There are plans to provide a covered walkway between the two houses and make some internal environmental changes. One resident gave the inspector permission to view his bedroom and see his fish. The bedrooms reflected the resident’s individual tastes and contained a range of equipment to help residents maintain their maximum physical independence. The two houses’ are surrounded by garden and separated by a drive, stairs and ramp. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 16 Bathrooms are large and contain the necessary equipment needed to maximise independence. At the time of this visit the premises were tidy and free from offensive odour throughout. There are systems in place to control the spread of infection and the appropriate services are contracted to dispose of clinical waste. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31-36 Residents’ can feel confident that a competent staff team is meeting their needs. Staff are adequately recruited and continue to be supported with regular supervision sessions and training opportunities. EVIDENCE: The staff have identified the need for a ‘staff picture board’, which will include details of the staff members role and responsibilities. The statement of purpose contains all the necessary information to inform residents of the staffing levels and their competencies. The duty rota evidences 7 ‘nurse’ qualified staff members including the home manager. The manager confirmed this is adequate to support the team and current resident group. The home is budgeted for 22 whole time equivalent staff and operates satisfactorily at this level. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 18 There was evidence in staffing records to show that staff are undertaking a National Vocation Qualification (NVQ) and all new staff undertake the LADAF induction package. The Brandon Trust have an excellent training package and records show one support worker is working towards becoming an NVQ assessor and another has completed an ‘Empowering Practice’ course at UWE. The registered nurses training records demonstrated they were attending courses, which provided the skills needed to meet the residents’ needs. There was evidence to show that staff receive regular supervision sessions and various policies and procedures are discussed. Supervision sessions are also used to ensure staff are aware of their roles and responsibilities in the home and identify training needs. Policies seen evidence that the Brandon Trust operate a robust recruitment procedure however all records relating to interview and selection, references and Criminal Record Bureau checks are held at HQ. At a later date the inspector will visit the personnel department and view a selection of staffing records. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: The manager was able to evidence that she keeps herself updated by attending various training courses. She is an NVQ assessor and is completing the Internal Verifiers (IV) course. As well as a nursing qualification in learning disabilities the manager also has a qualification in management (RMA). She supports the Brandon Trust by providing various training sessions to teams regarding ‘report writing skills’ and ‘pressure area care’. The policies and procedures in place are accessible to staff. New policies are put in the communication book for staff to read and are discussed at supervision sessions. The in-house policies reflect the needs of the residents and include the use of monitors in bedrooms, restraint and the use of bedrails and chair belts. The records seen by the inspector were detailed and respectfully written. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 20 The home uses the Organisation’s quality monitoring system and could demonstrate that monitoring was in progress. The home carries out regular Health and Safety checks and audits. There is a folder available containing data information sheets on hazardous substances used around the home (COSHH). The kitchen was found to be in good order; fridge and freezer temperatures were being recorded daily. The fire prevention information was not up to date. Fire training records did not evidence 6 monthly training for day staff and 3 monthly for night staff. This was discussed with the manager who said she thought training had taken place but had not been recorded. When asked one staff member said she could not remember when she last attended fire training. Whilst at this inspection the contractor came to test the emergency lights and fire equipment. Electrical equipment is tested on an annual basis. The certificate of liability insurance was displayed alongside the registration certificate. The manager said the homes business plan is in line with the organisational strategy plan. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 4 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 1 & 2 Hunts Lane Score 3 3 X 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 3 3 DS0000020340.V270251.R01.S.doc Version 5.0 Page 22 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 13(4)(c) Requirement Timescale for action 16/01/06 2 YA42 23(4)(d) Ensure an effective epilepsy management plan is put in place, which includes the use of PRN medication. Include a risk assessment. All staff must receive the 31/12/05 appropriate fire training within the timescales dictated by the Avon Fire Service, 6 monthly for day staff and 3 monthly for night staff. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. 1. YA21 Residents’ will benefit from clear guidelines and information in place relating to their ‘wishes in the event of death’ and long-term illness. 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 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 1 & 2 Hunts Lane DS0000020340.V270251.R01.S.doc Version 5.0 Page 24 - 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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