Inspection on 30/05/07 for Washington Grange

This inspection was carried out on 30th May 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Washington Grange 22/05/08

Washington Grange 20/06/06

Washington Grange 27/09/05

Washington Grange 05/05/05

Washington Grange 21/12/04

Washington Grange 17/06/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Washington Grange Burnhope Road Barmston Washington NE38 8HZ Lead Inspector Eileen Hulse Unannounced Inspection 30th May 2007 09:15 X10015.doc Version 1.40 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 Washington Grange DS0000054917.V336249.R02.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 Older People. 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. Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Washington Grange Address Burnhope Road Barmston Washington NE38 8HZ 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) 0191 419 1955 0191 417 0100 washingtongrange@barchester.com Barchester Healthcare Position Vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (19) of places Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 20th June 2006 Brief Description of the Service: Washington Grange owned by Barchester Healthcare Limited is a purpose-built care home situated on the edge of the Barmston housing estate in Washington. The home is close to a local health centre, pharmacy and a social club. A short walk to the nearest bus stop provides access to the Galleries shopping centre and all its amenities, Sunderland City centre and to other parts of the surrounding areas. The home is a two-storey building offering single bedrooms with en-suite facilities that are easily reached by a passenger lift and stairways. There are 19 bedrooms for older people on the ground floor and 21 bedrooms for older people with dementia care needs on the first floor. There is a range of bathrooms and showers, WCs, lounges and dining rooms on both floors. All parts of the building are easily reached. The home cannot provide nursing care. The weekly fees are £372:00 to £478:00 per week depending upon care needs. Additional charges are made for personal items, hairdressing, and toiletries. Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection and took 10hrs 15mins to complete over a one day visit to the home in May and was carried out as part of the annual inspection programme. The Acting Manager was present for the visit and some time was spent with the Acting Manager reviewing the progress of the service. Time was also spent talking with service users, their visitors and members of staff to get their views of the service. How care staff support the service users was observed throughout the visit and a lunchtime meal was taken with service users. Information about the quality of life and care received by service users was collected using a system called ‘case tracking’. This involves following the care and experience of a group of service users by looking at care plans, talking with people, sampling records such as assessment records, staff training files, complaint records and an audit of medication medication taken by service users and the records. The requirements made in previous inspection reports were discussed with the Acting Manager and discussions took place with other staff members who were on duty at various times throughout the visit. The judgements made are based on the evidence made available during the visit to the home and from information obtained from the home before the visit was made, which included the Annual Quality Assurance Assessment record that was provided by the home’s Acting Manager. This gave up to date information about the home to include within the report. Service users and their families were complimentary about the service they receive and about the staff team, their comments included: ‘It’s a lovely home’ ‘It’s nice here and the staff will do most things for me that I cannot do’ ‘The staff do a good job’ ‘There have been times when I was not happy with the home but everything is ok now’ ‘Many changes have been made but all for the better’ What the service does well: The home have a good staff team that treat the service users with dignity and respect. Good healthcare arrangements are in place that makes sure service users can access healthcare professionals such as District Nurse, Optician, Dentist and can visit for hospital appointments. The home offers a good range of social activities that are suitable for the people living in Washington Grange. Service users can expect to have good contact within the local community. Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 6 Good medication systems are used that make sure service users are given their medication safely and systems are in place to deal with any concerns or complaints that may be made about the service. 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. The summary of this inspection report can be made available in other formats on request. Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments are included within the plans of care that help to form the basis of the service users individual care plan and to enable the home to know that they can meet all of the care needs before admission. The home does not provide intermediate care. EVIDENCE: The home accepts referrals from Care Managers and from family members and whenever a referral is made to the home, the Manager will request a care plan from the Care Manager and then arrange to visit the prospective service user in their own home or in hospital to assess that the home can meet their needs. The home has its own pre admission assessment documentation that is completed to ensure the home can meet all of the care needs and this is completed during the visit. Following this visit, the home will then ask the Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 9 service user if they would like to spend the day with them or visit to have a meal there. Once the assessment has been completed, the Manager will telephone the service user or their representative to offer a place and an admission date is then arranged. However, no formal letter is sent to the service user confirming the details or to explain to them the reasons why the home cannot offer a place at that time. All care plans that were looked at had completed needs assessment records within the care plans. Before the service user can be admitted into the home, the home Manager insists that the Care Manager must supply the home with a care plan to ensure the home care plan can be implemented based on this information. Families are invited to be present during the assessment with the service users permission. Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The care plans do not include enough information to ensure the care needs of service users are met at all times. Service users have access to all NHS facilities and services to ensure their healthcare needs are met and medication administration procedures ensure that the service users are given their medication safely. EVIDENCE: Every service user has an individual plan of care. They include good assessment details on the care required but the information is not always fully completed such as, dates when the record was completed or next of kin contact address or phone numbers. One care plan stated that (name) required the assistance of two staff to use the bath hoist, there was no guidance on the bath temperatures, why two staff were required to carry out the task or the service users preferred time of bathing. Another area of the plan stated the service user could bathe independently. The care plans are not signed by the Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 11 service user or their representative and they are not monitored or evaluated and have no way of knowing if the plan of care is working. Another care plan was incomplete with no dates or signatures and a continence care plan stated (name) is continent but may have accident through not being able to loosen clothing. There was no staff guidance and how to deal with this issue and another area of the plan stated (name) is now doubly incontinent but no new plan of care was put into place. It was recorded (name) has great difficulty feeding himself but there was no care plan in place. Although this home does not deliver nursing care the individual documents relating to this have not been removed. For example, the files still include in depth entries on tissue viability, waterlow risk assessments and BMI testing. These charts were designed to be used by nursing staff only and are causing confusion to the staff. When staff were asked to describe some of the records they were completing, they said they did not understand them. There are regular visits from local GP’s and other health care professionals including the District Nursing Service, chiropodists, opticians and dentists and these appointments are written within the care plans. Service users requiring hospital out patient appointments are escorted to these by a staff member or a family member if this is their preference. The home has a medication policy and procedure that is used by staff when dealing with medication. A monitored dosage medication system is used and an audit of the medications and controlled drugs held in the home showed no discrepancies. Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are encouraged and supported to join in activities of their choice and ability that can help to contribute to varied and fulfilling days. Service users are offered and receive a varied and nutritious diet and this helps to promote the well being of people. However, some of the dining arrangements need to be reviewed. EVIDENCE: The activity co-ordinator works in the home from 10am till 2pm Monday to Friday and offers service users a range of activities. All service users are involved in the activity programme regardless of their age, gender or abilities and new activities have been introduced for the people who have dementia and to enable more one to one activities to be implemented for everyone. Each service user has an activities sheet that records details of any activities that they have participated in but this record does not record any service users who have declined to take part. An activities sheet has been put up onto the wall so that service users know on a weekly basis what activities have been Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 13 organised, however, the format is small and not suitable for all service users to read. There are also posters at the front door and inside the lift showing any special event that are to take place and a monthly news bulletin is produced monthly so that service users are kept informed. A life skills kitchen has been installed in the home for use by the service users. They are able to use the facilities to do cooking, washing dishes and general tidying up accompanied by the activities co-ordinator. On the day of the visit, some service users were involved in a craft class and others were listening to music in one lounge and ball exercises were taking place in another lounge. Service users and relatives commented positively about the activities and said: ‘The activities have improved since (name) came’ ‘I like the social things everyday, it stops the boredom’ ‘I like the memorabilia around the home, it makes my relative talk about the items’ ‘I love to dance when it’s a music day’ Visitors are welcomed into the home at any time and one visitor spoken with said ‘I am always offered a hot drink whenever I visit’ A meal was taken with the service users and part of the time was relaxed and unhurried but there was not enough staff to help service users who needed support and assistance to eat their meal. The staff was then reduced to one person when a service user was escorted to a GP’s appointment. Tables were set with tablecloths, placemats and cloth serviettes and eating aids were available to those who needed them such as plate guards and large size condiments. The lunch consisted of chicken stew and dumplings or fishcakes and was served with green beans, turnip and mashed potatoes. There was no menu showing what was for lunch but staff showed the dinners to everyone so that they could make a choice of what they wanted to eat. Cold drinks were served with the meal with a choice of tea and a water-cooling machine is located in the dining room for those choosing water with their meal. There was no hot sweet offered, the choice was ice cream or fruit salad. During the meal, service user’s made the following comments: ‘Most of the meals are nice, occasionally I don’t like what is for tea but that’s just me’ ‘The meals are not bad but sometimes they are not very hot’ One visitor said they had seen the menus downstairs, ‘The meals are very nice it seems’ Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 14 ‘My relative is not well just now so she can have her meals in her room which is nice but I never feel there is enough staff around particularly at mealtimes’ Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Home has an appropriate complaints procedure, which is made known to service users and families, this ensures that complaints are handled effectively. The home has good adult protection procedures that will help to protect service users should an abuse situation arise or be suspected. EVIDENCE: The complaints procedure is made available to all service users and their visitors that explain to them how to make a complaint and who to should they have a concern. Service users are given a service users guide prior to admission that also contains information about what they can do if they have any concerns about the service. In discussion with some staff members it was obvious that they know how to deal with a complaint and talking with service users and visitors confirmed this. Comments they made: ‘If I have a problem I see the new manager’ ‘I haven’t had to complain but I am sure it would be sorted’ The POVA (Protection of Vulnerable Adults) procedures are in the home and accessible to the staff and all of the staff has received protection of vulnerable adults training from the Local Authority. In the last twelve months there has been one POVA investigation in the home, this is currently being dealt with and Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 16 records show it is being dealt with effectively. Staff employed in the home have received Protection of Vulnerable Adults training, two members of staff have yet to complete the training. Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean, warm and generally well maintained offering service users a homely and safe place to live. However, further refurbishment is necessary and the lack of bathing facilities needs to be addressed. All staff have received training in relation to infection control. EVIDENCE: Washington Grange is a purpose built property with accommodation provided over two floors. Service users have single bedrooms with en-suite facilities and bedrooms are accessible to meet their mobility needs. They are furnished and personalised with photographs, ornaments and other personal possessions to suit their individual choice and tastes. Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 18 During discussions with service users and their relatives, they made positive comments about the home and included the following: ‘This is my home now and staff respect the fact that I like to be in my room’ ‘It’s a nice home but its becoming worn weary’ ‘Lovely home and a very friendly home’ ‘The staff are nice and very patient’ Refurbishment and decoration in some areas of the home has been completed. All the corridors, lounge and reception areas have been redecorated including painting of handrails and doors and both dining rooms have new flooring and dining tables, chairs and curtains have been replaced. The corridor carpets are badly stained and need to be replaced and the bathing facilities do not give service users any choice in their preferences. There is no shower and insufficient assisted bathing facilities are provided. Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Well-trained and competent staff are in post, however, the staffing levels continue to be inadequate, therefore service users will not be kept safe at all times. Service users are protected by the home’s recruitment procedures that are implemented to a good standard, this ensures the right staff are employed. EVIDENCE: There were not sufficient numbers of staff on duty during the visit to the home. During the lunchtime period, there was only one member of staff available to assist with all needs of the service users. This has been an issue in the last three reports and observation showed there has been no improvement in this area. The home has a policy and procedure on staff recruitment that is used when recruiting prospective staff. The Acting Manager was able to explain in detail the process that is used from sending out an application form to the letter that tells prospective staff if they have been successful in gaining employment. Staff do not commence employment until a criminal records bureau check has been completed. Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 20 The staff training matrix showed that a large input of training has been put into place since the last inspection. Comments from staff included: ‘We have done a lot of training recently, I have completed a twelve week dementia course, some computer training and the protection of vulnerable adults training’ ‘I have worked here three years and enjoy my work’ ‘We have regular supervision and good training to help our work’ ‘I like the new management arrangements that are in place, they are good for everybody’ The staff training matrix identifies all training that staff have undertaken showing the course name and the date the training was completed. Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed by a person who is able to competently manage the home but she now needs to be registered by CSCI to ensure the home is run in the service users interests. Internal quality assurance systems are well developed and allow the views of service users, relatives and others to be sought and to monitor the quality of the service provided. Risks to the health and safety of service users, visitors and staff are minimised to a good level. Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 22 EVIDENCE: The Acting Manager has only been in post since March of this year but has worked at the home in various positions for seven years and her qualifications include Levels 2, 3 and 4 in care. She shows good leadership skills in managing a staff team but has still not made an application to CSCI to become the Registered Manager. She has updated her knowledge whilst in the post by attending several courses that include A1 Assessors course, twelve week accredited Dementia training course and all mandatory training. An application has been made to commence the Registered Managers Award and a date is to be confirmed. Observation showed that staff followed safe working practices at all times and records evidenced that Staff have received training in fire safety, moving and handling and food hygiene. Washington Grange DS0000054917.V336249.R02.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 Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 1 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 X x 3 Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 24 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 OP7 Regulation 12,13,15 Requirement The Registered Manager must monitor the use of the new care plan structure and guide her staff how to use them appropriately, making sure that all relevant information is included. (Previous timescale of 31/08/06 not met) The registered persons must ensure that the care plans set out in detail the action needed to be taken by staff. The care plans must be reviewed by care staff at least monthly and updated to reflect changing needs. (Previous timescale of 01/02/07 not met) Menus must be reviewed and there must be adequate staff on duty. The corridor carpets must be replaced. The registered persons must ensure that there are sufficient options available for the DS0000054917.V336249.R02.S.doc Timescale for action 01/08/07 2. OP7 15 01/08/07 3 OP15 16 & 18 01/08/07 4 5 OP19 OP21 13 23 01/08/07 01/08/07 Washington Grange Version 5.2 Page 25 6 OP27 18(1)(a) preferences of service users. (Previous timescale of 01/12/06 Mon 2005 not met) The registered persons must 01/08/07 ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of residents. Staffing ratios and the allocation of staff in the home must be reviewed. (Timescale of 29/07/05,30/11/05, 31/08/06, 01/12/06 not met) The Acting Manager must make 01/08/07 an application to CSCI to become the registered Manager 7 OP31 9 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 Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Washington Grange DS0000054917.V336249.R02.S.doc Version 5.2 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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