Inspection on 29/06/06 for 225, London Road

This inspection was carried out on 29th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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 there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

225, London Road 14/06/07

225, London Road 16/11/06

225, London Road 26/01/06

225, London Road 20/05/05

225, London Road 02/12/04

225, London Road 30/07/04

225, London Road 16/01/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 London Road, 225 Twickenham Middlesex TW1 1ES Lead Inspector Simon Smith Unannounced Inspection 29th June 2006 1:00 London Road, 225 DS0000017380.V304620.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 London Road, 225 DS0000017380.V304620.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. London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service London Road, 225 Address Twickenham Middlesex TW1 1ES 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) 020 8892 6406 020 8892 6406 The Regard Partnership Limited Mr John Webster Patricia McKeown Care Home 6 Category(ies) of Learning disability (6) registration, with number of places London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th January 2006 Brief Description of the Service: 225 London Road is home to six young adults with learning disability. The home is owned and managed by the Regard Partnership, an established provider of accommodation and specialist support to people with learning disabilities. The Statement of Purpose describes the home as a: specialist service for young adults with learning disabilities, some complex needs and challenging behaviours. There is an emphasis on independent living and supporting individuals to develop their social and interpersonal skills. The home’s fees currently range from £1236.13 to £1975.43 per week. The home is situated within walking distance of Twickenham town centre, which provides a wide range of community facilities and good access to public transport networks. London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector used evidence from a range of sources when making judgements about the home. These included a visit to the home and discussion with residents, the deputy manager and staff. The inspector also received feedback about the home from a number of professionals, including the host authority and a placing authority. A sample of records was examined, including staff and residents’ files. The inspector was made welcome during the visit and wishes to thank residents, staff and all those who gave their views about the home. The home met 16 of 29 National Minimum Standards assessed at this visit. Two Standards were almost met and 11 Standards were not met. Thirteen Requirements were made. The home had not taken action to meet all the Requirements made following the last inspection and these are reinstated in this report. These Requirements related to care plans, risk assessments and information for staff about residents’ care, disorganised paperwork and a lack of supervision for staff, all areas which remain poor. Feedback suggests that other professionals with an involvement in the service share many of the concerns identified by the CSCI. A placing authority and the host authority told the CSCI that their concerns about the home include: • • • • • • • High turnover of staff Poor communication with other agencies Poor implementation of professional guidance Failing to maintain appropriate boundaries with residents Lack of staff support and training Disorganised paperwork Poor risk assessment As a result of these concerns the CSCI met with the area manager and Quality Assurance manager of the Regard Partnership on 11 July 2006. The Regard Partnership demonstrated a positive approach to improving the home and agreed to draw up an improvement plan. This plan will be submitted to the CSCI by 21 July 2006. The area manager advised that the registered manager will be absent from the home for at least a month and confirmed that the organisation has identified appropriate management cover for the service for this period. What the service does well: London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 6 Residents have opportunities to take part in a wide range of activities. Residents are supported to maintain relationships with their families and friends. 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. London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. Written information about the home is accurate and up to date. There is a commitment to ensuring information about the home is accessible to residents. There are concerns that the home does not meet the needs of all residents effectively. There is no evidence that the home responded appropriately to an assessment of one resident’s needs. EVIDENCE: There is a Statement of Purpose, recently reviewed, which gives details of services provided and the aims and objectives of the home. A Service User Guide is available to residents. The Service User Guide is written in plain English and makes good use of symbols to illustrate text. The area manager advised that information for residents will be available in accessible formats in the near future. London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 9 There are concerns that the home does not currently meet the needs of all residents effectively. Visiting healthcare professionals reported that the home does not implement guidance issued by them regarding the care of residents. (See also the ‘Personal and Healthcare Support’ section of this report). Written information about residents, such as care plans and risk assessments, is disorganised and out of date. (See also ‘Individual Needs and Choices’). One resident’s placing authority raised concerns about the service provided to their client as long ago as last year but there is no evidence that these issues have been addressed. These concerns include the failure to maintain appropriate boundaries, poor risk assessment and implementing changes to care plans without consultation. There is no evidence that the home has responded to an assessment of the resident commissioned by the placing authority and performed in early 2006. A further, residential, assessment planned with a specialist resource failed to take place in July 2006 due to concerns about staffing and risk assessment. See Requirement 1. London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 10 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, 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. Care plans and residents’ files need to be updated and reorganised. Residents are supported to make decisions about their lives. Risk assessments do not address all activities undertaken by residents and are not reviewed often enough. EVIDENCE: The last CSCI inspection report stated, “Much of the information held about residents was misfiled or out of date. Residents care plans and files need to be updated and reorganised to ensure that staff work with accurate, up-to-date information. Old material should be archived and formats used for recording should be standardised”. This visit found no evidence that these issues had been addressed. As a result the quality of information about residents remains an area of concern. Care London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 11 plans do not accurately reflect residents’ needs and strengths and risk assessments require review. See Requirements 2 and 3. Observation demonstrated that staff encourage residents to make decisions and informed choices in their day-to-day lives. Residents spoken to during the visit said that staff provide support with decision making when they need it. London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 12 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): 12, 13, 14, 15, 16, 17, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the home. Residents have opportunities to take part in a wide range of activities. Residents are involved in their local community. Residents are supported to maintain relationships with their families and friends. Residents are involved in planning the home’s menu. EVIDENCE: One member of staff is employed from 8am to 4pm during the week to coordinate activities for residents. Regular activities in which residents take part include horse riding, cycling, swimming, trampolining, music therapy and aromatherapy. Residents also make use of a sensory room and hydropool. One resident attends college full-time. London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 13 Residents are actively involved in their local community, using shops, cafes, pubs and other community resources. Staff reported that residents participate in food shopping and are encouraged to involve themselves in the routines of the home. One resident said that he had been out for lunch on the day of inspection and said he does this on a weekly basis. Residents receive support to maintain relationships with their families and friends. Most residents have regular contact with family members and some take holidays with their families. Interactions between staff and residents was positive during the inspection. Residents have unrestricted access to all communal areas of the home and a key to their bedroom. Residents are able to choose how they spend their time at the home. Residents’ rights and responsibilities are clearly set out in the Service User Guide. Residents spoken to during the visit said that they enjoyed the food provided by the home. Residents also reported that they have an input into the home’s menu. The advertised menu indicated that the home provides a varied and well-balanced diet. Standards of food hygiene and storage at the time of inspection were adequate. London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 14 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, 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. Written guidelines for the delivery of individual care and support are poor. The home does not communicate effectively with other relevant agencies. The home does not implement guidance from healthcare professionals about residents’ care. Appropriate professional boundaries are not consistently maintained. The recording and administration of medication must improve. EVIDENCE: The inspection identified a number of concerns about the delivery of residents’ care and liaison with other agencies involved in residents’ care. Feedback suggests that many of these concerns are shared by other professionals with an involvement in the service. London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 15 The community team for people with learning disabilities (CTPLD) of the host authority expressed concern about the high turnover of staff, lack of staff training and poor communication with other agencies. The placing authority of one resident reported that the home does not communicate effectively and that changes are made to residents’ care plans without appropriate consultation. Healthcare professionals reported that the home fails to implement guidance given by them, that paperwork is disorganised and the quality of recording and administration is poor. Professionals also said that they had observed inappropriate interaction between staff and residents at times and that appropriate boundaries were not consistently maintained. Examples provided included the use of water bombs in inappropriate settings. See Requirements 4, 5 and 6. The recording and administration of residents’ medication is another area of concern. The home had notified the CSCI of several medication errors in recent months and inspection of Medication Administration Records during the inspection identified a further error. The home must improve practice in this area to demonstrate that residents’ medication is administered safely and accurately. See Requirement 7. There is evidence that the Regard Partnership is committed to resolving this issue. The deputy manager on duty reported that her brief included a review of medication at the home, including a stock audit and improving areas such as recording and staff training. The deputy manager advised that she had recently visited residents’ general practitioners to discuss potential improvements in practice and had arranged medication training for ten staff. London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. There is an appropriate Complaints procedure. Most staff have attended training in the Protection of Vulnerable Adults. Recent allegations made by a resident received an appropriate response. EVIDENCE: The Regard Partnership has an appropriate Complaints procedure. There have been no complaints about the home in the last twelve months. The organisation has a Whistle-blowing procedure, which enables staff to report concerns about poor practice. The last inspection report made a Requirement that all staff attend training in the Protection of Vulnerable Adults. The deputy manager on duty reported that eight staff had attended this training since the last inspection. One resident made allegations about a member of staff in July 2006. The Regard Partnership responded appropriately to the allegations and informed all relevant agencies. London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 28, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The home is comfortable and safe. A positive appearance of the home and garden must be maintained at all times. EVIDENCE: The communal rooms on the ground floor of the home comprise a living room with conservatory/dining area and kitchen. Residents’ bedrooms are situated on the ground and first floors of the home. There are enough toilets and bathrooms to meet residents’ needs. There is a large rear garden, which was well used by residents during the inspection visit. Cigarette ends were strewn throughout the garden at the time of inspection. Assuming that these were discarded by staff, this displays a lack of respect for the residents’ home that is of real concern. See Requirement 8. London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 18 London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35, 36 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. There has been a high turnover of staff at the home, which has affected the continuity of care provided to residents. The home’s recruitment procedure protects residents. Staff do not receive regular, effective supervision and appraisal. New staff must receive an appropriate induction. All staff must be provided with appropriate training. EVIDENCE: As highlighted in the summary of this report, there has historically been a high turnover of staff at the home. Allied to the poor quality of written guidance for staff, this has resulted in little continuity of care or consistency of approach for residents. Whilst there was some positive feedback regarding individual staff, those returning comments expressed concern about the high turnover of staff and a London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 20 lack of appropriate training and support. The service needs to identify a strategy retain staff in order to develop a stable and consistent team. See Requirement 9. Records for three members of staff were examined. Files indicated that individual supervision and appraisal has been sporadic, and that training and the induction of new staff needs to improve. See Requirements 10, 11 12. The staff files did provide evidence of a robust recruitment procedure and confirmed that the home carries out appropriate pre-employment checks on staff, including Criminal Records Bureau disclosures. London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42, 43 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. There are concerns about the management of the service but the Regard Partnership has arranged temporary management cover for the home. The Regard Partnership has a commitment to Quality Assurance. Standards of record keeping need to improve. The health and safety of residents and staff is maintained. EVIDENCE: Evidence obtained during the inspection and feedback from other stakeholders identified a number of concerns about the current management of the home. These concerns are highlighted individually elsewhere in this report but include London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 22 staff training and support, communication with other agencies, care planning, risk assessments and recording. The Regard Partnership has advised the CSCI that the registered manager will be absent from the service for at least one month. The area manager has confirmed that the organisation have arranged management cover for the home during this period. This cover includes input from other service managers locally and weekly visits from the area manager. The Regard Partnership has demonstrated a commitment to involving residents, staff and other stakeholders in the Quality Assurance process. For example, a ‘Policy Review Forum’, comprising people from across the organisation, was established to review the organisation’s policies and procedures. As indicated in Standard 7 of this report, residents are supported to make choices about their lives and are consulted about issues that affect them in the home. The organisation has recently appointed a Quality Assurance manager to lead in this area of the business. The home was free of obvious health and safety hazards on the day of inspection. All COSHH products were stored appropriately. Standards of food storage were satisfactory. The home maintains an Accident book. The property has an appropriate fire detection system. The television licensing authority wrote to the home in May 2006 stating that there is no record of a television licence for the property. To avoid prosecution the home must obtain a valid television licence. See Requirement 13. London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 1 3 1 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 3 28 3 29 X 30 1 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 1 36 1 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 1 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 X 1 X 3 X X 3 2 London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 YA2 YA3 2 YA6 YA41 Regulation 12(1) 14(2) 12(1) 17 Requirement Ensure that the service effectively meets all residents’ needs identified through the assessment and review process. Ensure that all information held about residents is up-to-date, clear and accessible to staff. Old material should be archived and formats used for recording should be standardised. This Requirement is reinstated from the last inspection. Ensure that: • Risk assessments are performed for all areas that are relevant to residents and the activities they undertake Risk assessments are reviewed regularly to take account of changes in need Risk assessments record the date and identify the member of staff Version 5.2 Page 25 Timescale for action 30/08/06 30/08/06 3 YA9 12(1) 13(4) 30/08/06 • • London Road, 225 DS0000017380.V304620.R01.S.doc completing the assessment. This Requirement is reinstated from the last inspection. Ensure that written guidelines for the delivery of individual personal care are accurate and up-to-date. This Requirement is reinstated from the last inspection. Demonstrate that the home effectively implements guidance from healthcare professionals about residents’ care. Identify and maintain appropriate professional boundaries during interaction with residents. Ensure that all medication is accurately administered and recorded. Respect the residents’ home and maintain a clean environment at all times. Develop a strategy to retain staff in order to develop a stable and consistent team. Ensure that all staff attend training relevant to their roles. Ensure that all new staff attend a formal induction to the home. Ensure that all staff receive regular individual supervision. This Requirement is reinstated from the last inspection. Obtain a valid television licence. 4 YA18 12 30/08/06 5 YA18 12(1) 13(1) 12(4) 12(5) 13(2) 23(2) 12(5) 18(1) 18(1) 18(1) 18(1) 30/08/06 6 YA19 30/07/06 7 8 9 10 11 12 YA20 YA30 YA32 YA35 YA35 YA36 30/07/06 30/07/06 30/08/06 30/08/06 30/08/06 30/08/06 13 YA43 16(1) 30/07/06 London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 London Road, 225 DS0000017380.V304620.R01.S.doc Version 5.2 Page 28 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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