Inspection on 22/09/05 for 33a Hampstead Road

This inspection was carried out on 22nd September 2005.

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

33a Hampstead Road 05/10/06

33a Hampstead Road 13/04/05

33a Hampstead Road 24/11/04

33a Hampstead Road 28/06/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 33A Hampstead Road 33A Hampstead Road Brislington Bristol BS4 3HL Lead Inspector Andrew Pollard Announced 22 September 2005 09:45 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. 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 33a Hampstead Road Address 33a Hampstead Road Brislington Bristol BS4 3HL 0117 9077219 0117 9709301 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) Category(ies) of registration, with number of places Aspects & Milestones Mrs Hilary Frances Edwards Care Home with nursing 8 MD Mental Disorder,8 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 8 Adult patients suffering from Mental disorder excluding those detained under the Mental Health Act 1983Staffing Notice dated 28/03/2002 appliesManager must be a RN on parts 3 or 13 of the NMC register Date of last inspection 13/04/;05 Brief Description of the Service: The home is operated by Milestones a branch of the Aspects and Milestones Trust, a publicly funded charity.The home is registered to provide nursing care for 8 adults with continuing mental health needs but has limited scope for dealing with physical or age related health problems leading to physical disability.The home is located a short walk from local shops and a main bus route allows easy access to Broadmead.The aim is to create a person centred home which is relaxed and homely as well as maintaining residents life skills and providing therapeutic support where needed. 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The following methods of evidence gathering has been used In the production of this report; observation, pre-inspection questionnaire, discussion with residents and staff, relative and residents comment cards, tour of the home and sampling policies, records, care plans, meals. The emphasis of the service remains continuing care and where appropriate the long-term aim is to lead people toward a more independent lifestyle in the community. In addition staff strive to enhance the quality of life for the residents. Hampstead Rd is a person centred home is relaxed and homely and seeks to maintain residents life skills providing therapeutic support where needed. The majority of residents have little interest in the management of the home other than their attendance at the house meetings. Residents actively engage with the menu planning sessions. The staff interactions with residents witnessed by the inspector were positive and people were treated with respect and dignity. The staff team are experienced with the needs of the resident group. The skill mix and level of Registered Nurse input is appropriate for the resident group. What the service does well: The manager and staff are operating the home in an increasingly person cantered way and seek to empower and motivate the residents to engage more fully with life in and out of the home. When needed the staff have the skills and experience to identify and provide therapeutic interventions and manage the clinical care needs of the residents. There are a wide range of activities and opportunities made available to the residents. 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 6 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. 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.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 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.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) 1,2,4,5 Prospective residents have the information they require. The staff have been successful in creating a person centred home, maintaining residents life skills and providing therapeutic support based upon their assessed needs and aspirations. EVIDENCE: The statement of purpose and service user guide have been written in accord with the regulations and schedules and were unchanged since the last inspection. There is one vacancy and there have been no new admissions since the last inspection. All admissions are managed through the community mental health team and social services that carry out full assessments of peoples needs. The prospective resident and or relatives are consulted where appropriate. The manager or other RN assesses all referred clients prior to admission. People are offered a half-day visit followed by an overnight stay. The views of the existing residents are taken in to account regarding any admission. A summary of the assessed needs and a letter confirming the home’s ability to meet the needs is sent to all prospective residents. All residents have a licence agreement setting out their terms and conditions. All residents can read and most have signed the agreement. 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.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) 6,7,9 There was good evidence of needs and risk assessments being carried out and reviews of such taking place. Residents are involved with decision-making and consulted about the running of the home within the limits of their willingness or ability to take part. EVIDENCE: All residents have a person centred care plan, which they were encouraged to take an active part in developing. Some residents require staff support in this process and some play a very limited part. A thumbnail biography called “about me” is written, along with “things you need to know about me what is essential, important and what I do and don’t like”. There are six monthly multidisciplinary reviews used to generate the enhanced care plans titled “my needs, my goals and my actions.” A number of residents choose not to attend these reviews. The person centred plan and enhanced care plan have been better integrated rather than stand as two separate documents. All residents have a named Registered Nurse and Care Assistant key worker. The named Nurse and key worker evaluates each care plan element at least 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 10 every two months. The staff write daily notes at each shift change. Individualised risk assessments have been written and are held in each person’s case file along with skills assessments and competences. The main areas of risk identified are: falling, bathing, smoking, alcohol and previous mental health history and medication compliance. Any restrictions on personal freedoms were documented in care plans. The majority of residents show little interest in the management of the home other than their attendance at the residents meetings, which are generally well attended. Six residents returned comment cards none wished to speak to an inspector, two indicated an interest in being more involved in decision making in the home, this was communicated to the manager. 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 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) 11,12,13,14,17 It was evident from the range of social and occupational activities taking place that the staff strive to enhance the quality of life for the residents. Residents regularly make use of community facilities and services. From speaking to residents and reviewing records it was evident that the food provided is to peoples liking and offers a healthy diet. EVIDENCE: 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 12 The emphasis of the service remains continuing care and some rehabilitation, also to maintain the existing life skills that people have. Where appropriate the long-term aim is to lead people toward a more independent lifestyle in the community. One resident has recently moved to a supported living environment. None of the residents is able to take employment. The long -standing mental health needs of the residents often militate against the likelihood of future employment or further education. Most of the residents make use of community services and facilities. Residents attend various venues including City of Bristol College and the city farm. A number of residents also go to the social/drop in centre at St Johns each week. Three or four residents currently attend the local church from time to time. An activity organiser, Mr Jessup has been employed for 22.5hrs a week over three days engaging residents with in and out of house occupation and recreation. In the main these activities are arranged on a one to one basis based around the residents choice. Mr Jessup chairs the residents meetings the most recent this month for which notes were seen. One suggestion made by a resident was for an inter-house chess challenge. A more flexible arrangement of working hours is being introduced to support evening social activities and days set aside to take people out. Holidays or short breaks have been arranged this year including a trip to France, the Imperial War museum and planned trips to Liverpool and Butlins in Bognor Regis A number of residents have regular contact with family members or friends, however in some cases residents have lost contact with family or do not wish to have contact. Family and friends are welcome to visit the home at the invitation of the resident. There is active involvement of the residents in choice of meals and requests for individual likes are discussed at the weekly meetings or catered for on a dayby-day basis. From speaking to residents and reviewing comment cards it was evident that the food provided is to peoples liking and offers a varied diet. Records of food served are kept for a month. There are no special cultural needs at present. There is no one with special dietary needs other than a diet controlled diabetic person. Two residents do prepare snacks with varying levels of support. There are three meals a day and the times are flexible. The residents spoken to all said they enjoyed the food. 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 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 medication policy of the home is being complied with. There are effective arrangements in place to meet residents mental and physical healthcare needs. The home has all the specialist equipment required to meet the resident’s needs. EVIDENCE: Only two residents are assessed as safe to self medicate and have full custody of their drugs this is closely monitored. Competence assessments and a supporting policy for self-medication were available. Registered nurses administer all other medication. All residents have a medication profile. The home has a file containing drug alerts. The receipt and administration and disposal records were in order. Weekly stock checking takes place. Temazepam is the only the Controlled Drugs in use and is properly stored. There is a local medication policy as an adjunct to the Trust document. 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 14 All Registered Nurses are RMN apart from one EN (M). All residents remain under the care of a consultant and the SHO visits at least monthly. All residents are registered with a local GP practice that makes any referrals for any paramedical services required. Dental checks are arranged for those who wish for such as are eye tests. Three people are able to be independent in accessing medical services the others require general support. Comment cards were received from an SHO and a Social Worker both were entirely positive. All residents need some degree of prompting or support in managing personal care. Two residents have depot drugs and one person has a catheter. There are two people who have limited mobility and use a bath seat. One person uses a pressure-relieving mattress and a wheelchair for outdoor use. 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 The staff are aware of the Trusts complaints and POVA policies and are trained in putting them into practice to protect residents from abuse. The residents are aware of the complaints procedure and attend meetings to give their views on the running of the home. EVIDENCE: The complaint procedure meets CSCI requirements and is available to residents and families where appropriate. In four comment cards residents indicated they were aware of whom to complain to if they were unhappy with their care. Each resident has been given a copy of the complaint procedure and a flow chart is pinned to the notice board to raise people’s awareness. The four relative comment cards indicated they were aware of the procedure but had never had cause to complain. There is a complaint log and suggestion book in place no complaints have been made. The residents spoken with had no complaints. The Bristol “No Secrets” guidance was available as was the whistle blowing and a POVA policy. Most of the staff have attended alerter level POVA training and further updates are planned. The manager has attended training and updating in POVA through the Local Authority. Copies of the GSCC code of practice have been issued individually to the care staff. All residents have a balance sheet for any monies held for safekeeping and receipts supporting expenditure. All money is checked daily and double signed. All residents have a bank account, some of who require varying levels of staff support with managing their money. No one is able to fully manage their own finances a number handle their own personal allowance. Four residents 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 16 countersign cheques along with specific nurses. Each resident has a specific case file relating to his or her finances. An internal Trust audit has recently been carried out and an independent audit took place last autumn, no irregularities were identified. 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,27,2829,30 The house is a clean, comfortable and safe environment for the current residents. The bedrooms and communal rooms and facilities are suitable for their purpose and meet the resident’s needs. Residents have any specialist equipment they presently require to promote their independence. EVIDENCE: The home is suitable to meet the current needs of the residents who are all ambulant, however one resident is becoming increasingly frail and their placements is under review. The home was clean and in good general order. The fittings and furnishings are of a domestic nature and are in good order. The heating, lighting and ventilation are satisfactory. Appropriate arrangements are in place for maintenance and servicing of plant and equipment, for which records are kept. Bedrooms are decorated and furnished in accord with resident’s wishes. In general bedrooms are plain but this reflects to some extent the residents lack of motivation and the fact that people do not generally spend much times 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 18 in their rooms. One resident’s room is due to have the vanity unit and surround improved. Residents take some responsibility for maintaining their own rooms. Risk assessments are carried out to determine if residents are unsafe to smoke in their bedroom. Rooms are lockable and residents have access to keys if they wish. There are two bathrooms and they are suitable for the residents needs. One bathroom contains a shower. The bathroom on the ground floor has a toilet handrail and hydraulic bath seat installed. This bathroom is awaiting redecoration. A communal WC on the top floor services the two upper bedrooms. Communal areas include a dining room, lounge and smoking lounge. Laundry and kitchen facilities are of an appropriate type and scale. The food hygiene award was given by the EHO in 2004. The kitchen has been completely refurbished and refitted. A range of new garden furniture has been purchased. Department of Health guidelines on infection control are available. Proper arrangements are in place to dispose of clinical waste. 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,34,35,36 An appropriate and robust recruitment procedure is in place. The staff are experienced and trained to meet the individual and joint needs of the residents. The staff skill mix and staffing levels are conducive to maintaining and enhancing the resident’s quality of life. The manager demonstrated a clear commitment and focus on training. EVIDENCE: 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 20 Staffing levels are in accordance with the existing staffing notice. The manager works supernumerary five days per week. The staff team are experienced with the needs of the resident group and are client centred. Resident dependency is quite variable depending upon people’s mental state. The skill mix and level of RN input are appropriate for the resident group. Four new care staff have recently been appointed and there are no remaining vacancies. All prospective staff spend time with the residents who are asked for any feed back or their opinions. All proper checks are carried out and references sought. All the required staff records are now held in the home. A housekeeper works three hours five days per week and an activity organiser twenty-two hours per week. There is low usage of bank and agency staff other than regular night cover. The manager demonstrated a clear commitment and focus on training to enhance the quality of life and standards of care for residents. There is evidence from records and staff comment of learning and updating for all grades of staff in relevant areas to residents care needs. In house training topics include, schizophrenia, OCD, depression and anxiety and ECT. Breakaway training has been arranged for all staff in October. A number of care staff have NVQ level 2 or 3. All remaining care staff bar one are on NVQ programmes three of who have almost completed. Away days have been held to deepen the team commitment to person centred care and empowerment of residents. A rolling programme of updates in H&S, 1st aid, food hygine and load handling takes place. All staff will receive six to eight weekly supervision by a cascade system of which written notes are made. The annual appraisal process has commenced using documentation supplied by the Trust. 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 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) 39,42 The staff are motivated to bring about improvements in residents quality of life. The staff seek to empower the residents and safeguard them from abuse. The home is a safe and well-maintained home. EVIDENCE: 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 22 The manager and nursing staff are experienced in the care for people with mental health needs. Ms Edwards has commenced an Open University “Managing Health and Social care “ course. The Trust has a comrehensive range of policies and procedures and arrangements to review them. There are a range of local policies in place. An inhouse QA audit is carried out twice a year to review the operation and systems of the home. The standards are assessed as part of the team meetings. Whole team meetings and clinical team meetings are held regularly. Regular house meetings are held to access the views of the residents on the quality of life and services in the home. Most comment cards returned indicated that residents did not want to be more involved with decision making in the home which was bourne out in the conversations with residents. Most residents indicated in the comment cards that they felt well cared for and treated well by the staff. Four relative and two professional comment cards were submitted; all gave positive comments or praise to the staff and home. There is a comprehensive Health and Safety policy and a Trust manager with delegated responsibility for such matters and arrangements to review them. Mr Benjamin has responsibility for H&S matters within the Trust. The fire log book, records and alarm/detector maintenance arrangements were up to date and in order. Staff have attended recent fire safety training. A monthly H&S audit is carried out to ensure the safety of the residents and staff. The gas safety and electrical safety inspection certificates were in order and continuing service arrangements remain in place. The hoist has been inspected. A log of hot water temperatures is maintained. 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x Standard No 11 12 13 14 15 16 17 x x x x x x x Standard No 31 32 33 34 35 36 Score x x x x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 33A Hampstead Road Score x x x x Standard No 37 38 39 40 41 42 43 Score x x x x x x x D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 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 Regulation Requirement Timescale for action 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 Good Practice Recommendations 33A Hampstead Road D56_D05_S20228_33A Hampstead Road_V242287_010805_Stage4.doc Version 1.40 Page 25 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos. BS32 4RG 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. 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