Inspection on 01/08/05 for 30 to 31 Pickwick Close

This inspection was carried out on 1st August 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

30 to 31 Pickwick Close 30/09/09

30 to 31 Pickwick Close 21/06/07

30 to 31 Pickwick Close 04/12/05

30 to 31 Pickwick Close 16/02/05

30 to 31 Pickwick Close 07/09/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Pickwick Close 30/31 Pickwick Close Laindon Basildon Essex SS15 5SW Lead Inspector Bernadette Little Un-announced 1st August 2005 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. Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Pickwick Close Address 30/31 Pickwick Close Laindon Basildon Essex SS15 5SW 01268 410634 01268 410634 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) Estuary Housing Association Limited Mr George Lai-Chun CRH 8 Category(ies) of DE Dementia 1, DE (E) Dementia over 65 2, LD registration, with number Learning Disability 8, LD (E) Learning Disability of places over 65 - 8. Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16/02/05 Brief Description of the Service: Pickwick Close is situated relatively close to Basildon, Laindon and Wickford town centres. There are a good bus and train links to the area. The home provides 24-hour residential care for up to eight adults who have a learning disability. The homes registration has been varied to also allow care to be offered to three named residents who also have dementia. 30/31 Pickwick Close comprises of two interconnecting bungalows. Each bungalow offers four single bedrooms, a large lounge, a dining room, kitchen, bathroom, shower room, sluice facility and separate toilet. There is also a separate office and a sensory room. Each bungalow has its own garden/patio area to the rear of the property. Parking is available to the front of the bungalows. The home has its own transport facilities for residents. Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection that took place at Monday between 10am at 3:45pm. The registered manager was not on duty at the time, and various staff assisted with the inspection. Records and documents were looked at, as were all parts of the premises at a Pickwick Close. Time was spent sitting with the residents and staff. The help they gave with the inspection was appreciated. What the service does well: What has improved since the last inspection? What they could do better: Pickwick Close needed to have more staff that work there all the time. They also needed to have more staff on duty for longer hours during the day so that residents get all the help they need, for example at the evening meal time. The home also needed to give residents more chances to go out and do interesting things. All these things would help both residents and staff. The home should keep to what it says in the residents contract and the Service User Guide and residents should not have been charged for things like towels and bed linen. More records should have been available about residents money for the inspector to see. Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 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. Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 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 Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 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, 2, 3, 4, 5 The admission process was well managed and residents and other interested parties were given clear information about the home. EVIDENCE: The Statement of Purpose and Service User Guide had been reviewed in line with the recent variation to the homes registration. One section of the Service User Guide gave very clear information about a specific service uses needs, which did not best protect this residents confidentiality. Records showed that a detailed assessment had been undertaken prior to the recent admission. This had involved relevant professionals in relation to health and premises, and the support of the staff at the previous residential care home. Staff were provided with additional specific training. Pre-admission visits and stays took place. A pictorial format statement of terms and conditions was available. It identified the room to be occupied and the cost of the placement. It referred to the reader to the service user guide for details on fees. The documents did not identify who was responsible for the fees and any additional fees charged. It was supported by a licence to occupy agreement. Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 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, 7, 8, 9, 10 There was a clear care planning system in place that provided staff with appropriate information to meet the residents needs. EVIDENCE: The care plan for the most recently admitted resident identified clear aims and care instructions that would support consistency of care. The fourteen aims referred to the persons’ assessed needs. Supporting risk assessments were in place. The risk assessment regarding bed rails and the bed had been agreed by an appropriately qualified professional and considered the risk of entrapment. The Life Path Plan and information from the person’s previous care home identified their wishes for end of life practices. These documents also identified that the resident of liked to go to church and that they like evening activities such as clubs. These had not been carried through in the new care plan. Due to the residents’ complex needs, opportunities for their input to processes within the home, was limited. Staff spoken with confirmed appropriate actions in relation to maintaining resident confidentiality. Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13, 14, 15, 16, 17 Residents had limited opportunities for leisure activities, both at home and in the community. Relationships were encouraged and residents right to make everyday choices was respected. A good variety of meals was offered. EVIDENCE: Records indicated that residents had limited leisure activities, particularly in the evenings and at weekends, with much reliance on the use of the sensory room and drives out. The home had its own vehicles but had limited staff that were able to drive them. It appeared that the twenty hours, previously available to assist residents to access the community, is planned to be assimilated into the new increased care staffing levels, which is unacceptable. Inspection of records and discussion with staff showed that residents are encouraged to maintain their relationships with relatives, and that relatives are welcome at the home. A planned menu was available along with a record of food served. Staff were aware of specific dietary needs for residents and any associated risks of choking. Two residents confirmed that they were enjoying their lunch. Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 Page 11 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 Personal support was offered in a way that respected residents’ privacy and dignity. The health needs of residents were well met. The person registered had been slow to provide appropriate equipment for a resident within a reasonable timescale. EVIDENCE: Staff were seen to close doors when residents were being assisted with personal care. The rosters sampled indicated that there is at least one female and one male member of staff on duty each shift. Pickwick Close operated an effective key working system. Discussion with staff and inspection of records reflected that the health care needs of residents were clearly identified and managed. There was clear involvement from healthcare professionals, which was appropriately documented. Care plans identified specific aims that related to a residents Health Care Plan. Appropriate equipment was available in the main. While some grab rails had been fitted to meet the needs of a newer resident, the grab rails previously recommended following assessment for another resident, remained outstanding after almost a year. Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 Page 12 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 home had a complaints procedure that was produced in a way to be more easily understood by residents. Staff had appropriate training and knowledge to protect residents. (Please also see standard 41 regarding use of residents’ money) EVIDENCE: Staff confirmed that no complaints had been received by the home. Their view was that the home was considered highly, and as being well run, and that nobody would make a complaint about it. Staff spoken with, both permanent and agency, confirmed that they had received recent training on the Protection of Vulnerable Adults. Some staff were not aware of the whistleblowing procedure. All staff spoken with were aware of the correct procedure to take and expressed confidence that they would take this action to protect the residents. One agency staff member said, “otherwise its not fair”. Staff spoken with demonstrated understanding of aggression shown by residents and of how frustrating it is for them when staff were unable to understand their communications. Staff, and the training plan, confirmed that Positive Response Training was planned for later this month. Records sampled for permanent staff showed that some of them had previously attended similar training. Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 Page 13 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, 27, 28, 29, 30 The environment in this home was generally good and gave residents a nice place to live. Equipment and facilities were in place to meet resident need (but please also see standard 18). EVIDENCE: Pickwick Close was generally clean and well maintained. Residents’ bedrooms were individual in décor. They contained furniture/furnishings and other items of personalisation according to the residents’ ability to tolerate these. One residents bedroom retained the non-carpet flooring assessed for the previous resident of the room. This did not present as homely compared to other bedrooms, and there was no recorded reason for this to continue. The layout of the furniture in the lounges was noted to make the best use of the space and appeared homely. The removal of the tablecloths in the dining room for mealtimes did not enhance the experience. The sensory room was being used to store furniture, bedding, a suitcase etc. Some areas needed minor redecorating. The dining room and office carpets were badly stained. Both laundry rooms were seen to be clean and to have suitable equipment. Observed infection control procedures were appropriate. Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 Page 14 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, 34, 35, 36 Limited progress had been made in staff recruitment and retention, which had had some effect on staff morale. It had also had a negative effect on consistency of care and leisure opportunities for residents. At times, the staffing level/shift composition, were not adequate to meet resident needs. EVIDENCE: The last inspection identified a high level of agency staff usage at Pickwick Close. Since then one member of staff had been recruited, but two had taken early retirement and one had left. Estuary had endeavoured to use regular agency staff, with some success. The roster showed that most day shifts comprise of one permanent staff member and three agency staff, which did not support team building. It was again noted that there were shifts were only agency staff were on duty. Staff spoken with felt that morale, and on occasion communication, had been adversely affected. The only permanent member of staff in charge of the home at the time of the inspection was on their first day back after six months sick leave. The additional staffing levels noted at the last inspection as in place to meet the higher needs of a service user had been withdrawn. This reduction was in addition to that noted in standard 13. The additional staffing hours in place to Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 Page 15 meet the needs of the new resident were not considered adequate and needed to extend later in the afternoon/early evening to allow staff to meet the needs of all residents. Original Criminal Record Bureau checks were seen to be available for all the permanent staff, which was positive. Recent recruitment procedures were appropriate. Photographs were not available on all staff files sampled. Records were not available for agency staff in relation to staff details or staff training. A basic one-day induction tick sheet for agency staff was available. A record of induction training was not available for the most recently appointed member of staff or for another member of staff appointed some months ago. A mandatory training overview was available. This indicated that the majority of staff had attended mandatory training and updates within Estuary’s timescales, with the exception of fire training. Staff advised of resident specific training relating to dementia and Parkinsons disease, which is to be followed up by a two-day course in September. Training files were available for each permanent staff member that contained certificates, including other training, for example communication with people with a learning disability. Staff spoken with confirmed the displayed list of staff supervision sessions and of appropriate content. Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 Page 16 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, 41, 42 The management of the home was satisfactory overall and records and documentation were well-organised. Better supervision of the way residents’ money was spent, and of some safety issues, would better protect residents. EVIDENCE: Records were easily accessible following a clearly displayed plan of storage. Incident/accident records showed two issues in relation to medication practice that had not been reported to the Commission for Social Care Inspection. The registered manager is experienced and has attended regular and relevant training courses. Minutes were available of staff meetings and residents’ meetings. Not all staff felt valued and this could be a reflection of morale within the team. It was not possible to inspect and fully audit all records relating to resident’s money. Records were available of resident’s weekly expenditure and a group rolling float. A withdrawal of over £60 was noted from one resident account with no explanation recorded or receipt available. Receipts were sent Estuary Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 Page 17 each week and therefore could not be confirmed. Records were not available of residents bank/savings accounts. It was of concern to find that residents were still being charged for bedlinen, curtains, towels and flannels. It was also noted that residents were sharing a bill equally for wipes and toiletries with no clarification as to who uses what. This had been raised previously with Estuary who confirmed a change of practice. The observed practice did not comply with the resident Statement of Terms and Conditions and Service User Guide. Safety inspection certificates requested were readily available and displayed within the home, for example in relation to fire alarm, and emergency lighting and gas. Advice was provided on ensuring that all staff were aware of the correct procedure to take when measuring water temperatures, as they seem to be a wide variance, which had not been monitored and addressed. The Control of Substances Hazardous to Health (COSHH) cupboard was seen to be unlocked again. COSHH items were seen to be available to residents in a toilet area and staff were advised to remove them. The filing cabinet in the office was noted as a potential health and safety risk to staff. It was noted positively that risk assessments were in place for other issues, including the outward opening toilet doors. It is noted positively that magnetic door catches have been fitted in the home. It is understood from staff that the interconnecting door between the two ‘bungalows’ needed to be fitted with a ‘viewing’ panel for safety. Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 Page 18 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 2 3 3 3 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 x x 1 2 3 3 3 Standard No 31 32 33 34 35 36 Score 3 2 2 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Pickwick Close Score 3 2 x x Standard No 37 38 39 40 41 42 43 Score 2 2 x x 1 2 x I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 Page 19 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 5 Regulation 17(2) Schedule 4 (8) 16(2) Requirement A record must be kept of the care homes charges to residents including any additional amounts payable for services not covered by those charges. The registered person must ensure that a range of leisure and recreational activities are provided for all residents. This includes evenings and weekends. (Previous timescales from 17/03/03 not met). The person registered must ensure that the premises are fitted with all adaptations identified in the assessment report of the Occupational Therapist, this refers specifically to the grab rails. (Previous timescale of 31/10/04 not met). The person registered must ensure that all parts of the care home are kept clean and reasonably decorated. This refers to the stained carpets and minor areas of decorating required. The person registered must ensure staff competence in relation to ensuring consistency of care for service uses is Timescale for action 15th September 2005 15 September 2005 2. 13& 14 3. 19 23(2)n 15 September 2005 4. 24 23(2)(b) and (d) 15 September 2005 5. 32 18(1)b 15 September 2005 Page 20 Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 6. 32 18(1) 7. 34 7,9, & 19 Schedule 2 (1) 18(1)c 8. 35 9. 10. 35 37 18(1) and Schedule 2 37 11. 41 17(2) Schedule 4 (9) maintained. This refers both to the high use of agency staff and to the sole use of agency staff on shifts. (Previous timescale of 16/02/05 not met). The person registered must ensure that there are adequate staffing levels on duty in the home at all times to meet residents need in all aspects of their health and welfare. A reassessment of the homes staffing levels to be undertaken and the Commission to be informed of the increased staffing levels to be provided at the home. Evidence of the persons identity, including a photograph, must be available for all persons working at the care home. The person registered must ensure staff competence in relation to training for all staff at the home. This refers to evidence of training for agency staff which was not available at the home for inspection on request. (Previous timescale of 01/01/04 not met). The person registered must ensure that all staff are provided with induction training. The registered manager/ registered person must inform the commission of any event that could affect the well-being of a resident. This refers to the medication errors. The registered person must ensure appropriate records are available of residence finances and that appropriate policies and procedures are followed in relation to the use of residence money to prevent abuse. (Previous timescale of 16/02/05 not met) 1 September 2005 15 September 2005 15 September 2005 1 September 2005 1 September 2005 1 September 2005 Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 Page 21 12. 42 13(4) 13. 42 24 The person registered must ensure the safety of residents by safe storage of hazardous materials. (Previous timescale of 7/09/04 not met). The person registered must ensure that appropriate safety measures are in place. This refers to the interconnecting fire door. 1 August 2005 1 September 2005 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. 4. Refer to Standard 1 6 23 24 Good Practice Recommendations The detailed information in the Service User Guide about a residents individual needs should be reconsidered Leisure activities outside the home should be included in the care plan and weekly activities plan. All staff should be aware of the homes whistleblowing policy The flooring in the new residents bedroom should be assessed for their individual needs and be more homely in character unless the assessment clearly indicates otherwise. The sensory room should be available as a facility for residents and should not be used as a storage area. 50 of care staff should achieve NVQ level 2 The safety of the filing cabinet in the office should be assessed and actioned 5. 6. 7. 24 32 42 Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Address 1 Address 2 Address 3 Address 4 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 Pickwick Close I56-I06 S18073 Pickwick Close V241781 010805 Stage 4.doc Version 1.40 Page 23 - 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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