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Inspection on 24/10/05 for 27 Highfield Road

Also see our care home review for 27 Highfield Road for more information

This inspection was carried out on 24th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 6 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

Residents appeared happy, this briefly confirmed by one resident and relative who stated they had no complaints and were satisfied with the service provided. Overall the homes documentation in respect of the residents with very few exceptions was maintained to a high standard. Highfield Road is a comfortable and homely environment that as far as possible resembles a domestic style living environment. Assessments of any risks presented to the residents and staff are well documented and clear. Observation of interaction between staff and the residents at the time of the inspection, and examination of care records indicate that the service provided is meeting the needs of the residents at the home and that staff are well supported by a committed and experienced manager. Discussion with some of the staff indicated an interest in the service and commitment to the residents.

What has improved since the last inspection?

The premises have undergone a fair degree of redecoration since the last inspection, this including the front and back lounge with new furniture in some of the rooms and the dining area. The office has also been refurbished and is now accessible to the manager. There was a noted improvement in the detail contained within residents lifestyle agreements, information on the use of physical intervention is now more explicit, documented risk assessments are better and a business plan is now available. Staff who administer medication now all have accredited medication training. There has also been development of some of the homes policies and procedures.

What the care home could do better:

There are a few areas where improvement is required this including provision of some training to staff (including NVQ level 2). It is also necessary to get the appropriate consent to medication for one resident, and signatures on lifestyle agreements from representatives or appropriate persons. There were a few areas where there were some minor inaccuracies in the records seen, as detailed within the requirements to this report. There was concern that a resident has access to the kitchen whilst staff are cooking and the current layout of the dining/kitchen area does present some risk, which whilst assessed has not been addressed.

CARE HOME ADULTS 18-65 27 Highfield Road Colley Gate Halesowen West Midlands B63 2DH Lead Inspector Mr Jon Potts Unannounced Inspection 24th October 2005 10:00 27 Highfield Road DS0000025001.V260759.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 27 Highfield Road DS0000025001.V260759.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. 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 27 Highfield Road Address Colley Gate Halesowen West Midlands B63 2DH 01384 410581 NONE 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) Inshore Support Limited Anita Webb Care Home 3 Category(ies) of Learning disability (3), Mental disorder, registration, with number excluding learning disability or dementia (3) of places 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 3 MD and up to 3 LD Date of last inspection 2/2/05 Brief Description of the Service: 27 Highfield Road is situated in a residential area of Colley Gate, Near Halesowen. The home is registered to provide care to a maximum of three service users who have been diagnosed as having a learning disability and/or mental disorder. The home is in a favourable position as it is located in a residential area yet; it is close to a main road with a bus route a number of shops and other amenities. The home is a large, traditional, domestic type dwelling, comprising of two lounges, three single bedrooms, a kitchen come dining room, a first floor bathroom and a separate shower room. The garage has been converted into usable space, which has become the office. There is also a small and pleasant private patio area to the rear. As on previous inspections, the inspector was impressed with the home regarding its internal fixtures, fittings and furniture. The home is of a generous size, is well presented, well maintained, is clean, homely and has a warm welcoming atmosphere. 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out between 10.00am and 2.36pm and involved the registered manager and discussion with staff. The inspector met all the residents and one relative. Information/evidence was drawn from case tracking, staff files; sight of documents, policies and procedures and through discussion with the manager and staff. What the service does well: What has improved since the last inspection? What they could do better: There are a few areas where improvement is required this including provision of some training to staff (including NVQ level 2). It is also necessary to get the appropriate consent to medication for one resident, and signatures on lifestyle agreements from representatives or appropriate persons. There were a few areas where there were some minor inaccuracies in the records seen, as detailed within the requirements to this report. There was concern that a resident has access to the kitchen whilst staff are cooking and the current layout of the dining/kitchen area does present some risk, which whilst assessed has not been addressed. 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 6 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. 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 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 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 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): 1,2,5 Information about the home is available in the services combined statement of purpose/service users guide. Further information, some individual to the resident is also detailed in a lifestyle agreement (terms and conditions) that is available to every resident. Resident’s needs are assessed prior to admission and on a regular and on going basis. EVIDENCE: A copy of the home’s statement of purpose/service users guide was seen during the course of the inspection, this containing a range of information about the home for prospective users. The manager stated that the company is looking at adapting this document so that it is available in other formats that would be more useable to service users that have difficultly reading. The home was seen to have detailed pre-admission assessment information in place from the purchasers of the service (local authorities), this information carried through to the homes care plans and related information, with updates obtained through regular multidisciplinary reviews. Terms and conditions (called lifestyle agreements) are available to residents these containing all the necessary details expected. The manager was advised to ensure a representative of the resident signs these documents where the residents are unable to sign themselves. 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 9 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 Resident’s needs are assessed on an on-going basis through reviews, with changes reflected in individual plans. Residents are supported to be involved in decisions about their day-to-day life. The use of a robust risk assessment process supports resident’s independence and safety. EVIDENCE: Care plans are in place for all residents, one of these examined in depth at the time of the inspection. The plan seen was detailed and information from reviews and assessments had influenced the update of these documents. Discussion with two staff indicated a working awareness of the contents of the one care plan and risk assessment documentation. Of note was the clear information seen as an addendum to the plan as to communication with one resident who used non verbal / makaton style communication techniques, this well understood by the staff spoken to. Whilst the last multidisciplinary review minutes have not to date been received at the home, these reviews are held approximately six monthly. 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 10 There is detail within the care plans and risk assessments as to where there may be limitations upon the residents although the manager was advised that an explicit statement as to exactly what these limitations are would be useful for purposes of clarity and understanding. Discussion with staff indicated that the view was that residents should have a ‘normal’ a life as possible this including access to rights as any other member of the public, this also underlined by the homes policies and procedures. The manager stated that she had discussed access to advocates with one of the better known advocacy agencies and had been instructed that unless there was dispute between the residents and their family or another agency they would not normally provide a service. Information regarding advocacy would be made available to residents if requested however. The individual risk assessments on the case file examined were found to be very detailed and were clearly informing the practices of the staff. 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 11 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): 12,13,15,16 & 17 The residents are supported to have involvement in activities and leisure appropriate to their needs and abilities, a number of these community based. Residents are supported to have relationships in accordance with their wishes and risk assessments in place at the home. Residents are able to access a healthy diet in keeping with their individual choices, this in pleasant surroundings. EVIDENCE: The care plans seen and associated documentation clearly showed that residents are involved in appropriate activities in accordance with their individual abilities, a number of these with a community orientation this assisted by the fact that the home has its own allocated transport. 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 12 The home has developed a policy on sexuality that is drawn from British Institute for learning disability documentation. Arrangements for contact with families are detailed within care documentation. Risk assessments are in place in respect of contact with others outside of the home where this is appropriate and one resident maintains regular contact with residents of other homes in the inshore group. The records of foods taken by the one resident indicate that there is an appropriate and well balanced diet made available to them. The home does have a set menu although this is subject to change based on the wishes and choices of the residents on a daily basis. Resident’s likes and dislikes in respect of food were seen to be documented with the record of foods reflecting these choices. All residents have been nutritionally assessed and outcomes from these assessments built into their care plans. The manager was advised to ensure any reference to K.B. having an allergy to apples is removed as this is now known not to be the case (after consultation with G.P. etc). The plans for the resident’s activities were seen to be structured and full records kept of the actual activities that they participate in on a day-to-day basis. The home has a charter of rights in place and staff were aware of how residents should be treated so that their rights were respected. 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 13 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 Residents receive appropriate personal support and their physical and emotional needs are met. The residents right to self-administration are limited following risk assessment, although the homes policies and procedures do protect residents in this area. EVIDENCE: Evidence showed records of choices allowed within daily routines in a number of areas, although the care plans did reflect a degree of structured intervention. Discussion with staff evidenced awareness of how they should interact with residents, both spoken to having a good working awareness of the care plan and risk assessments discussed. There was clear documented evidence of the resident’s choices having been documented in their individual case files. It was clear that all the residents are given personal space as and when they require it, the building allowing for this provision. There was clear evidence that the residents were assisted to access health services whether specialised or pertaining to routine health not associated with their learning disability. All the residents were seen by the inspector and all looked well presented and healthy. 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 14 The home was seen to have a policy on medication, this recently revised. Staff were stated to have received accredited medication training. The homes systems for the administration, storage and ordering of medication were judged to be acceptable with no gaps in medical administration records, clear information available about the medication in use and evidence of audits by the contracted pharmacist (the last one on the 23.8.05 identifying no issues). The only identified issue was that there was no signature for consent to medication for one resident, this as they were unable to sign. The manager was advised to ask an appropriate medical professional to sign this consent (i.e. G.P. / Psychiatrist). 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 15 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 Procedures are in place to support residents in expressing their views and dealing with any concerns that they may have. Appropriate adult protection training for staff would strengthen protection for residents from abuse. EVIDENCE: The home was seen to have appropriate policies in place in respect of complaints. The home has developed a pictorial complaints procedure that carries the phone number for the police, CSCI, Social Services and other managers within Inshore support. There have been no complaints received at the home or at the CSCI in the last 12 months. The home had copies of appropriate policies and procedures in addition to the local authorities ‘Safeguarding adults’ procedure this also supplemented by the pictorial version produced by Dudley MBC. The recording in case files showed that any bruising or injuries were documented on body maps, these seen to be completed and containing reference to even minor bruising/injury. The manager was advised to ensure that where appropriate incident report forms are completed where an injury maybe due to non – accidental reasons. The staff do need to have access to appropriate adult abuse/protection training. Nearly all staff have training in approaches to challenging behaviours (called positive approaches) although there are some night staff that require this input. 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 16 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 27 Highfield Rd is a comfortable and overall safe environment (see evidence) that is suitable for the residents accommodated. The house was seen to be clean and hygienic. EVIDENCE: The home is sited in a suitable position and presents as a homely environment in keeping with the provision of ‘normal’ domestic style living. There is no indication that the house is anything other that a domestic home, this ensuring that it blends into the immediate community. The home has a redecoration and refurbishment programme identifying works for the next twelve months. There was evidence of the home having received some redecoration and refurbishment since the time of the last inspection this including the lounges. All the communal living areas within the home presented as being comfortable and clean. The manager now has access to a large office area. The home is suitable for the needs and lifestyle of the residents with the exception of the following. Risk assessment has identified a need for some form of division between the dining area and the kitchen as necessary, this as there are potential dangers of one resident hurting herself or staff whilst 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 17 cooking is in progress. Appropriate action needs to be taken to address this identified hazard. The house was seen to be clean and hygienic at the time of the visit and there were no concerns in respect of the premises and the control of infection. The refurbishment of the home has being done with consideration given to providing safe and easy to clean furniture (for example: good quality plastic chairs in the dining area). . 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 18 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 Staff evidenced in discussion a good understanding of their job role. The staff seen presented as competent but the level of qualification of some of the staff team needs to be improved. Residents are supported by the homes recruitment policy and practices. There are some key areas in which some staff required training. EVIDENCE: The staffing ratios required for the resident’s were seen to be consistent with those stipulated by the purchasers and the homes assessments. Based on the evidence seen in the form of the staff available at the time of the inspection and the duty rota, the inspector judged the staffing ratios at the time of the inspection to be appropriate. There had been some issues with staffing in the recent past that the manager had addressed. Discussion with staff indicated that they had a good understanding of what were the current relevant issues for the residents (based on their care plans) and how to provide an appropriate service that respected quality of life issues. The home was seen to have a training plan that clearly identified training staff held, what was booked and what was needed. There were areas where training 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 19 is still needed for some staff in mandatory health and safety areas as well as abuse. Three staff also require positive approaches (restraint) training although the manager was clear in stating they do not work alone, this evidenced by the rota. There are currently two out of sixteen staff that have completed NVQ level two (and in one case NVQ level 3). More input into NVQ training needs to be provided to allow the home to have at least 50 of the staff team with this training. Whilst there is training input needed in some areas the home has clearly identified where and for whom this training is required and only needs to identify timescales for the provision of the same. Files for the most recently employed staff were checked in respect of recruitment practices, these evidencing that these were satisfactory. The home has employed some staff without a disclosure but has informed the CSCI on these occasions, this to discuss the risk assessment carried out. These staff have been employed so as to ensure staffing levels were not compromised. The home was seen to have a structured induction programme in place with an external training company providing input into accredited induction training. The service manager is negotiating with the company for a greater focus on the learning disability award framework. The staff employed (based on staff comments) do begin employment as supernumerary staff. The staff when spoken to did state that they felt very well supported. 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 20 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): Resident’s benefit from a well run home EVIDENCE: Based on the overall outcomes of this inspection the manager is judged to be managing the home competently. She is currently undertaking her registered managers award and is confident she will complete this by the 31.5.06. Discussion with the manager indicated that she was well supported by senior managers in running the home. 27 Highfield Road DS0000025001.V260759.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 X x 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 2 X 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 x 3 2 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 27 Highfield Road Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score 2 X X X X X X DS0000025001.V260759.R01.S.doc Version 5.0 Page 22 Yes 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 YA20 Regulation 13(2) Requirement To ensure the directions in resident K.B.s case file in regard to the action to take when constipation may be an issue is in accordance with the G.P’s current instructions. Where a resident is unable to give consent to medication, and has no representatives who can give this consent, this matter must be discussed with the G.P. or psychiatrist for agreement and consent. To ensure an incident form is completed in respect of all injuries to reflect detail on the body map charts. To inform the CSCI of what action is to be taken to reduce the risk to resident K.B due to unrestricted access to the kitchen at certain times of the day (when staff are cooking). To confirm the dates for all training necessary (as detailed within the body of this report) within the homes training plan this to include positive approaches, health and safety, infection control, adult protection DS0000025001.V260759.R01.S.doc Timescale for action 15/11/05 2 YA20 12(2) 31/12/05 3 YA23 17(1) a 15/11/05 4 YA24 13(4) c 31/12/05 5 YA32 18(1) c (i) 30/11/05 27 Highfield Road Version 5.0 Page 23 and NVQ level 2 (this to identify how there will be 50 of the staff team so trained). Elements of the above requirement are repeated from the inspection on 2.2.05. The registered provider must ensure that the manager completes her Registered Managers Award. This is a repeated requirement from the inspection on 2.2.05. 6 YA37 9(2) b (i) 31/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA5 YA7 YA17 Good Practice Recommendations To gain the signature of a representative of a resident on lifestyle agreements where the residents are unable to sign themselves. The limitations placed on residents should be documented in more explicit detail. To update K.B’s file so that it is clear there is no allergy to apples. 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 27 Highfield Road DS0000025001.V260759.R01.S.doc Version 5.0 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!