Inspection on 20/04/05 for 3-5 St Matthews Road

This inspection was carried out on 20th April 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 but made no statutory requirements on the home.

Other inspections for this house

3-5 St Matthews Road 04/03/08

3-5 St Matthews Road 03/05/06

3-5 St Matthews Road 05/10/05

3-5 St Matthews Road 07/09/04

3-5 St Matthews Road 05/04/04

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

CARE HOME ADULTS 18-65 3-5 St Matthews Road St Leonards on Sea East Sussex TN38 0TN Lead Inspector Caroline Johnson Unannounced 20 April 2005 14:30 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 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 Stationary 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. 3-5 St Matthews Road Version 1.10 Page 3 SERVICE INFORMATION Name of service 3-5 St Matthews Road Address St Leonards on Sea East Sussex TN38 0TN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01424 445924 Sussex Autistic Community Trust (Care Services) Limited Mr S J Cowley Care Home 9 Category(ies) of Learning Disability (LD) 9 registration, with number of places 3-5 St Matthews Road Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. That only service users with an autistic spectrum disorder may be admitted. 2. That the maximum number of service users to be accommodated is 9 (nine). 3. That service users are aged between 18 (eighteen) and 65 (sixty-five) years on admission. Date of last inspection 7 September 2004 Brief Description of the Service: 3-5 St Matthews Road is registered to accommodate nine adults with an autistic spectrum disorder. The home is one of four homes in East Sussex owned by the Sussex Autistic Community Trust. The registered premises consists of two semi-detached houses arranged into three separate units. House no.3 has one unit accommodating five residents whilst house No.5 has two units, one for one resident and the second for three residents. Each unit is staffed separately, whilst a manager oversees the whole service. The home is situated a short walk from the Silverhill area of St Leonards on Sea, with its local amenities and shops. Bus services run close to the home. 3-5 St Matthews Road Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, the first in the year running form April 1 2005 to March 31 2006. The inspection lasted from 2.30pm until 7.20pm. Time was spent with the deputy manager going through various records and documentation. About half an hour was spent meeting with two of the residents who talked about their home, the service provided and their day activities. In addition to meeting with the deputy manager, a member of care staff was interviewed. What the service does well: What has improved since the last inspection? What they could do better: The standard of care provided at 3-5 St Matthew’s Garden’s is good. At the time of inspection one of the resident’s healthcare needs had changed significantly and the home had recognised that they were no longer able to meet the needs of the individual. They were actively seeking support to arrange alternative accommodation for the individual concerned. Unfortunately the impact of the resident’s changed needs was evident in the home. Instead of sleep-in staff at night it will now be necessary to have a carer work through the night. A number of incidents had occurred that could potentially have compromised staff and residents’ safety and so it will now be necessary to 3-5 St Matthews Road Version 1.10 Page 6 have an emergency call system in place. The number of complaints has increased and the home are responding by putting in place temporary measures to try to improve the situation in the short term. It was evident when talking with residents that the home is going through a stressful period. The home needs to continue to work towards having 50 of the staff team trained in NVQ level 2. They also need to ensure that there is a system in place (quality assurance) whereby the views of residents and their relatives are sought about the quality of the care provided in the home. Since the inspection of St Matthews there have been further discussions with both the Registered Manager and the General Manager concerning the resident referred to above. It is clear that the measures that are currently in place are working well and some improvements have been noted in the individual’s healthcare. It has been agreed that requirements one and five will remain in this report. However, rather than achieving the timescale set, the home now needs to keep the need for alternative accommodation and the need for waking night staff under continual review. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 3-5 St Matthews Road Version 1.10 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 Standards Statutory Requirements Identified During the Inspection 3-5 St Matthews Road Version 1.10 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 standard(s) 1,3 Prospective residents are provided with detailed information, in a format which is easily understood, to assist them in making a choice about whether or not they might wish to live in the home. When residents’ needs change the home is active in pursuing specialist support to respond to the changed needs. EVIDENCE: The home has a statement of purpose and a service user guide in place, which has also been produced in pictorial form so that residents who have communication difficulties may find it easier to understand. At the time of inspection there were no vacancies at the home. Within each case file is a detailed assessment of the needs and abilities of each of the residents. From the assessment, a plan of the care to be provided is formulated. Through examination of records, discussions with staff and a couple of residents, it was evident that the home is able to meet the assessed needs of all but one resident. In respect of this individual it was evident that their healthcare needs had changed considerably in the past few months. Arrangements are being made to find a more suitable placement for this resident in a more appropriate environment. 3-5 St Matthews Road Version 1.10 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 standard(s) 6,8,9 Generally the care planning system is good and plans are reviewed and updated regularly. Some of the goal/training plans in place are essentially a guide for staff and do not involve the resident achieving a specific goal. Where this is the case the goals could be removed but the guidance retained for staff to follow. This would reduce the number of goals for each individual and greater emphasis could then be placed on assisting residents to achieve them. Goals should be very specific and easily measurable. EVIDENCE: Two care plans were inspected on this occasion. The plans included a detailed assessment of the needs and abilities of both residents. In addition there was an autistic spectrum assessment, risk assessments, behavioural guidelines, goal plans and training plans. There is a keyworker system in place and keyworkers have responsibility for updating and reviewing care plans. A staff member spoken with talked knowledgeably about the needs and abilities of the resident that he keyworks. Care plans are reviewed and updated regularly. However, in one of the plans seen, although the goals and training plans had been updated some of the risk assessments were dated 2000. There were lots of training plans in place. Some included very detailed information about the action to be taken to meet the goals identified. However, some included very broad goals. For one resident the goal was `cooking’ but no indication of a 3-5 St Matthews Road Version 1.10 Page 10 specific goal that would be achievable and where progress could be measured easily. For another resident one of the goals identified was letter writing’. The majority of the action points had been achieved and all that remained were points that staff need to be aware of. It was agreed that this information should be written up as guidelines for staff as there was no specific goal to be worked on. All of the residents are involved in the care planning process and where appropriate they are encouraged to sign their plans. In respect of one care plan, there was no information available to advise of the action to be taken should the resident have a seizure. The deputy manager advised that a new care plan format would be introduced in the coming months. Residents stated that they are included in the running of the home in that they share the household tasks and they do their own laundry. The have a weekly meeting and discuss issues relating to their home. 3-5 St Matthews Road Version 1.10 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 standard(s) 12,13,14,17 Records seen in respect of two residents’ finances were not clear and the systems in place for monitoring record keeping needs to be improved. Residents lead interesting and active lives. Individual timetables include opportunities to develop educational skills and residents have lots of opportunities to participate in recreational activities of their choice. The variety of activities provided is good and ensures that residents are well stimulated. EVIDENCE: A good practice recommendation was made at the last inspection of the home to review the system for managing service users’ finances to give residents the opportunity to participate in the process. The deputy manager advised that this has been achieved for a couple of residents. However, as there are different procedures in place for managing individual resident’s finances the specific details for each individual needs to be highlighted in each resident’s care plan. Each resident has a weekly timetable of activities. They have opportunities to attend one of the two day centres managed by the registered provider. One of day centres has only recently opened. One day centre is designed to cater for adults with autism and the other for adults with asperger’s syndrome. In addition some attend local colleges and have work placements. Residents also 3-5 St Matthews Road Version 1.10 Page 12 talked about their hobbies and interests, which include, swimming, cycling, computers, horse riding, ten-pin bowling and regular outings to pubs and restaurants. They have also been involved recently in choosing and planning their annual holidays. Menus are planned weekly and the residents stated that they are involved in this and also have opportunities to participate in the weekly shopping. 3-5 St Matthews Road Version 1.10 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 standard(s) 18,19,20 The home works hard to ensure that there is good communication within the staff team and consistency in approach to meeting the needs of the residents. Specialist support is arranged when required to meet the individual needs of the residents. EVIDENCE: A requirement was made at the last inspection of the home that staff receive training in the administration of medication and this has been achieved. Staff spoken with stated that the training received was thorough and that in addition to the formal training there is a system in-house whereby new staff are observed on a number of occasions until they are competent administering medication. When residents require specialist input to meet their healthcare needs then arrangements are made for this to happen. This is evident in respect of one particular resident where there is regular input from his psychiatrist to meet his changing healthcare needs. During the course of the inspection two residents approached the deputy manager regarding anxieties that they were experiencing. The deputy manager dealt with the concerns sympathetically and with professionalism ensuring that staff were kept informed so that if the issues were raised again during the course of the evening, the residents could receive similar reassurance and a consistent approach. 3-5 St Matthews Road Version 1.10 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 standard(s) 22,23 The complaints procedure is working in that residents, neighbours and relatives have raised concerns. The home needs to ensure that the older version of the complaint procedure is removed from the policy manual and replaced with the new version. Some of the concerns have not been resolved and temporary measures have been put in place to address the issues raised. The measures are holding measures only and can only work in the short-term. Residents and staff are living and working in a stressful environment. Action needs to be taken as a matter of urgency to find alternative accommodation for one of the residents who is clearly unhappy and whose needs can no longer be met by the home. EVIDENCE: There were two versions of the home’s complaint procedure, one in the policy and procedure manual and one in the complaint file. Since the last inspection of the home there were seven complaints recorded. The last complaint recorded included three separate complaints. Three of the complaints had been resolved and the remaining are ongoing. The complaints had been raised by residents, relatives and neighbours and relate in the main to the impact caused in the home by one resident whose healthcare needs have changed. The home is actively trying to resolve this issue and have put in place a number of temporary measures to try to reduce the stress caused to the residents. There is an adult protection procedure in place, which details the action to be taken should abuse be suspected. The deputy manager was confident that the home has information on what constitutes abuse but this could not be located. Since the last inspection of the home there was one adult protection issue relating to the resident whose healthcare needs have changed. The result of 3-5 St Matthews Road Version 1.10 Page 15 the strategy meeting held was that Social Services would seek to find an alternative placement for the resident concerned. When speaking with one resident he referred a number of times to disturbance caused within the home. The deputy manager advised that staff, whilst not raising concerns formally, have informally raised their concerns about the stress they are under. 3-5 St Matthews Road Version 1.10 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 standard(s) 24,25,26,28,30 The home was clean on the day of inspection. All areas seen were well maintained and decoration was of a good standard. Work is required to tidy the garden area and the broken furniture needs to be removed, as it is a reminder to the residents of stressful incidents in the home. EVIDENCE: A full tour of the home was not undertaken on this inspection. There are separate lounge and dining rooms in each of the three units. In addition there is an activity room in one of the units. All areas seen were well decorated to a good standard. The garden to the rear of house 5 was not viewed as part of the inspection. There is a large garden to the rear of house 3. Work is required to tidy up the garden area. There was some broken furniture lying around the patio area. This has been the result of a number of incidents involving one of the residents. Only one bedroom was seen and it was obvious that the room had been decorated to reflect the personality of the resident. All areas of the building seen were clean. A requirement was made at the last inspection of the home that staff receive training on infection control and this had been met. A good practice recommendation was also made in respect of the home’s security 3-5 St Matthews Road Version 1.10 Page 17 procedures. The deputy manager advised that arrangements have been made for the matter to be addressed in the coming week. 3-5 St Matthews Road Version 1.10 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,35,36 Staff are well supported and receive regular training to ensure that they are able to meet the needs of the residents accommodated. The home needs to ensure that there is a waking night carer in house three. The current arrangements for night staff detailed below are unsatisfactory and need to be resolved as a matter of urgency. Work needs to continue to try to ensure that there are 50 of the staff team trained to NVQ level two or above. EVIDENCE: At the time of inspection there were no staff vacancies. A staff member spoken with confirmed that he had been given a job description. Staffing levels were discussed and were generally satisfactory to meet the needs of the residents during the day. At night there is a sleep-in arrangement in each of the houses. The home has recently submitted a request for additional funding to provide a waking night carer in house three due to the disturbed sleep pattern of one of the residents. Currently staff regularly have a disturbed night and are unable to work the following day shift. This in turn has led to upset for some of the residents who do not cope well with change. To try to avoid this upset, some staff work through the day shift despite having worked the evening shift the day before as well as the night shift. Staff spoken with stated that they value the many training opportunities made available to them. One staff member stated that in addition to statutory training he had attended a number of courses designed specifically for staff 3-5 St Matthews Road Version 1.10 Page 19 working with adults with autistic spectrum disorders. The home had been on target to meet the requirement to have 50 of staff trained to NVQ level two or above but due to staff turnover this has slowed down the process. Currently there are four staff doing level three and two staff already have level three. Another three staff are due to start studying in November 2004. Staff spoken with stated that they receive regular supervision and support from the manager and his deputy. The home has recently introduced a new code of conduct for staff. 3-5 St Matthews Road Version 1.10 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,41,42,43 The home needs to introduce a system for formally seeking the views of residents and relatives in relation to the quality of the care provided in the home. There is an urgent need to provide an emergency call system in one of the units to ensure staff safety at all times. The home needs to have a copy of the National Minimum Standards and Regulations and all staff need to be familiar with the content. There are a small number of policies and procedures yet to be produced and some of the policies and procedures in place need to be reviewed. EVIDENCE: The manager is a qualified nurse and is continuing to work towards achieving NVQ level 4 in management. A staff member spoken with stated that he was well supported. He said that the supervision was ‘the best I’ve ever had had in any other employment’. He also stated that the weekly staff meetings are very useful as they provide an opportunity for everyone to be kept up to date with changes in care practices. Some of the service users have very complex needs and require consistency in approach. 3-5 St Matthews Road Version 1.10 Page 21 The home has accreditation with the National Autistic Society and with Investors in People. Views of service users and relatives are sought as part of the review processes for accreditation. However, the outcome this process is not kept in the home. A requirement was made at the last inspection to introduce questionnaires to seek the views of service users and relatives in respect of the home and the quality of the care provided. This has yet to be achieved. As required at the last inspection, all staff have received training in fire safety. The home’s insurance certificate was on display but was out of date. The deputy manager advised that the certificates are issued via their head office and will be on its way shortly. Some of the home’s policies and procedures have not been reviewed since 2002 and although a number of new policies and procedures have recently been introduced there is a need to provide additional policies and procedures. A list of those required to be in place was provided to the home. The need to ensure that the home has a copy of the standards and regulations was also discussed. Records of accidents and incidents were examined and it is evident that the severity of the incidents has increased in recent weeks. A couple of incidents occurred recently which involved staff’s safety being threatened. Both incidents were dealt with by experienced staff and potentially serious consequences were avoided. There is a need to have an emergency call system in place in one of the units so that help can be summoned quickly if required. The need to keep the Commission informed of all serious incidents was also discussed. 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. Where there is no score against a standard it has not been looked at during this inspection. 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) 3-5 St Matthews Road Version 1.10 Page 22 “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 x 2 x x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 x 3 x 3 Standard No 11 12 13 14 15 16 17 2 3 3 3 x x 3 Standard No 31 32 33 34 35 36 Score 3 2 2 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 2 3 2 2 3 2 3 3-5 St Matthews Road Version 1.10 Page 23 YES Are there any outstanding requirements from the last inspection? 3-5 St Matthews Road Version 1.10 Page 24 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 3 Regulation 14(1)(d) Requirement The home must ensure that action is taken to seek alternative accommodation for one service user that is more suited to meeting his assessed needs. In respect of the care plans seen risk assessments must be reviewed and updated regularly and in relation to one resident there must be a risk assessment detailing action to be taken should the resident have a seizure. The system for managing residents finances must be reviewed. The garden area must be tidyed and the broken furniture removed. A waking night shift must be provided in house three. A quality assurance and monitoring system that uses questionnaires to seek the views of residents and others must be introduced. (This was a requirement of the last inspection, timescale 7/12/04 not met). An emergency call system must be made available in the flat in house three. Any incident that affects the well being of a resident must be reported to the Commission without delay. Version 1.10 Timescale for action 15 June 2005 2. 9 13(4) 30 May 2005 3. 4. 5. 6. 11 24 33 39 17(2) Schedule 4 para. 9 23(2)(o) 18(1)(a) 24(1) 30 July 2005 15 May 2005 10 May 2005 30 June 2005 7. 8. 42 42 13(4) 37(1)(e) 15 May 2005 15 May 2005 3-5 St Matthews Road Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 6 Good Practice Recommendations Goals identified in care plans should be more specific in terms of what it is hoped will be achieved. Where staff need advise to ensure that a correct procedure should be followed this should be written up as guidelines rather than goals/training plans. The homes adult protection procedure should include information on what constitutes abuse. 50 of staff should be trained to NVQ level 2. The manager should continue to train to NVQ level 4 or its equivalent in management. The home should refer to the NMS to identify any policies and procedure that still need to be produced. A number of the policies and procedures already in place should be reviewed. 2. 3. 4. 5. 23 32 37 40 3-5 St Matthews Road Version 1.10 Page 26 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 3-5 St Matthews Road Version 1.10 Page 27 - 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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