Inspection on 13/12/06 for 4 Granville Road

This inspection was carried out on 13th December 2006.

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 no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

4 Granville Road 14/04/09

4 Granville Road 28/04/08

4 Granville Road 16/10/07

4 Granville Road 05/06/07

4 Granville Road 09/12/05

4 Granville Road 05/05/05

4 Granville Road 21/07/04

4 Granville Road 04/05/04

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

CARE HOME ADULTS 18-65 4 Granville Road Reading Berkshire RG30 3QD Lead Inspector Kerry Kingston Unannounced Inspection 13th December 2006 12.00 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 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 4 Granville Road DS0000011054.V322007.R01.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 4 Granville Road Address Reading Berkshire RG30 3QD 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) 0118 959 9370 0118 959 9370 Paramount Housing Association Limited Ms Denise Williams Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (9), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (9) 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No service users to be admitted over the age of 65 years. 9th December 2005 Date of last inspection Brief Description of the Service: 4, Granville Road is a care home providing personal care and accommodation for nine adults with mental disorders, excluding learning disability or dementia, two of whom are over sixty-five years of age. The home is owned by Paramount Housing Association Ltd. and is located on the edge of an estate approximately two miles from Reading city centre. All the service users have their own rooms. The aims and objectives of the home is to provide a secure and comfortable home; encourage and support residents to make decisions and choices in their lives; support and assist service users to make and maintain satisfying relationships; assist service users to develop their skills; and enable service users to engage in valued day time occupation and use of community facilities. The fees are £595 per week. 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit took place on the 13th December 2006 between the hours of 12.00 am and 6.00pm. The purpose of the visit was to collect information to inform the key inspection report. Information for this inspection was collected by means of a pre-inspection questionnaire, completed by the manager, service user surveys, completed by service users (all nine surveys were returned) prior to the visit. On the day of the visit the inspector toured the building, observed care practice, spoke to five service users, two staff and the manager. Service user care plans and other records were looked at. The home offers a good standard of care to some service users but although the manager and staff work very hard, it is unable to meet the assessed needs of others. What the service does well: 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. 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 7 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2. Quality in this outcome area is adequate. The assessment procedures are adequate and service users are able to make some choices about where they live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The newest service user has a full assessment, completed by the community mental health team , for a temporary placement, a full referral by the psychiatrist and a completed application form for Paramount Housing, which includes a comprehensive range of information about the service user. The assessment of living has not been fully completed by the home but there is an ‘action plan’ and the consequences if it is not carried out. A multi-disciplinary review was carried out on the 23/10/06 but there are no review notes and it is not clear what the service users’ future will be (i.e if now staying permanently). There is no daily living personal care plan as staff do not give ‘hands on’ personal care. There is no daily activities plan but the service user has been encouraged to participate in community activities. The home does monthly evaluations of work plans ,which are development plans that include activities/general health/mental health/personal hygiene/budgetting skills and daily living. The service user chose to have more support and is co-operating with work plans which has resulted in (according to a staff member) improved emotional and physical well being. 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 8 One service user who has deteriorating mental health has work plans’ for specific areas that he has difficulty with. The multi-disciplinary reviews, which are held six monthly are not specifically related to the residential placement but the home prepare a full report to inform the review process. 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good. The home makes every attempt to identify and meet the needs of service users and recognises when they are not able to. The service users are encouraged to be involved in the decision making processes of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Five care planswere examined. Care plans include assessments and ‘work plans’ that are reviewed monthly by the home. Multi-professional meetings are held every six months, the home present a full report to aid the review process. Service users attend their reviews and generaly sign the review notes and sign that they agree with the ‘work plans’ (development/maintenance goals) that arise from the review. Changing needs are reflected in individual plans but they are not always acted upon. One service user was assessed in 2002 as not being suitably placed, as the home was unable to meet her deteriorating physical needs, the service user remains in the home. The individual is aware of those needs and that the placement is unsuitable and has been unsettled many times waiting to move (see standard 18). One 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 10 service usern said he‘ has everything he needs’ (could do with a slightly larger room) and is happy to remain at Granville for sometime’. He sees the psychiatrist monthly and is fully aware of plans and evaluations and his prognosis. Two other service users said they ‘liked living at Granville road’. Service users choose activities, choose what to do on a daily basis, have service user meetings and attend reviews. Most service users complete their monthly evaluations with their key worker. Some service users sign a document to say that they do not want to be inolved in decision making in the home . All (care plans seen) have statements of terms and conditions that state what they can expect and what is expected of them. All nine of the service user surveys noted that staff listen to them and act on what they say. Risk assessments have been developed for any necessary areas and are current. The home is unable to meet personal care needs of some individuals (see standard 18), the home care service provide this support for several service users. 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17. Quality in this outcome area is good. The home supports service users to have a positive and meaningful lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users choose their activities , some are difficult to motivate because of the nature of their mental health needs. There is evidence that the most recently admitted sevice user has been encouraged to participate in external activities, the individual now goes out twice a week when admitted in July 06 they rarely left their room. One service user said he has plenty to do attends some external activities and has hobbies he does within the house. He chooses not to attend any religious services but there is a church up the road if he wants to go. Many of the service users access the community independantly. One service user goes to external activities three times a week and has a visit form a family member every weekend. The individual does not feel they spend much time in the community as it is difficult for staff to accompany them, they are reliant on a wheelchair and often there is only one staff member on duty. They also do not spend much time in communal areas and prefer to watch the 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 12 television in their bedroom. The home has difficulties because of some service users increasing physical care needs and consequent additional support needed from staff to access the community, there has been no increase of staffing to alleviate these difficulties. Service users (who are physically able) were observed to be coming in and going out of the home independantly, using the local shops,community and public transport. There is an issue about staff taking service users on holidays and this was discussed with the manager, the provider has said that it may not be appropriate for some holidays to take place, one service user said that they like to go on holiday and has missed going away this year, their perception is that they are not allowed to go on holiday anymore. The Manager will raise this issue at individual reviews. Only one of the service users has no family contact, all are encouraged to retain contact with family and friends. One service user discussed his recent bereavement and was seen preparing to go to stay with his family overnight to attend a funeral. Several residents visit families for special occasions and relatives are welcomed to the home , one service users’ relative visits weekly. One service user described how he is asisted to get train tickets to visit his mum, on occasion. Service users’ rights and responsibilities are noted in the Service User guide and staff were observed interacting with individuals’ patiently and respectfully. A staff member explained fully how he tried to ensure that ervice users were treated with respect and their rights are upheld. Three service users said they liked living in the home and are happy there. Menus were seen to be varied and nutritious, fresh ingredients are used. Staff cook for service users, some are encouraged to help as noted on their work plan. The one service user who noted on the survey that they’ve ‘never liked the food’, has difficuly in this area and this was noted on the care plan. Four service users spoken to said they liked the food were able to have an alternative if they did not want what was on the menu. One said there is alwaysloads of fresh fruit if you want it. 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20. Quality in this outcome area is poor. The home is unable to provide the best personal care support for some service users. Service users are assisted to access health services, appropriately, but daily healthcare needs are not monitored regularly. The medication administration system may not be robust. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not give personal care to service users, the provider does not expect staff to offer hands on personal care. The home began as a rehabilitation mental health service but service users physical abilities have deteriorated and they have increasing personal and physical health care needs, this does not appear to have been fully identified or adressed by the provider. One service user was assessed as being inappropriately placed in 2002 as the home could not meet their increasing pesonal support needs, these have increased steadily since then and they are still resident in the home. The individual is unable to bath or shower as there are no adequate facilities to enable this, they have not had a bath or shower for three years. The individual is supported to have a bed bath in the mornings by home care staff they are also supported to undress for bed by homecare. Homecare visit twice a day and if there are hygiene problems at other times this causes 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 14 difficulties. The service user said that they would like a proper bath but cant get up the stairs. Some attempts have been made to make the shower accessible but this has not been very sucessful.Several other service users are also supported by homecare which is not always effective as some service users need support at other times of the day and night i.e. wet beds and other personal hygiene issues. There is a minuimum of one staff member on duty which also limits the personal care support they are able to provide. The home is aware of equality and diversity issues which are referred to in the individual care plans, but are unable to meet the needs of some of the service users who have additional physical needs. Service users are assisted to access healthcare and the home works with other professionals to ensure good mental healthcare. There was no evidence of the effective internal monitoring of deteriorating physical conditions, such as weight charts for those with nutritional issues. The medication administration system has recently changed but staff dispense the medication from the blister packs into plastic containers and then into pots for consumptin by the service users. The medication administration records are signed by the staff member when the medication is dispensed into pots not when administered to the individual. The home has no controlled drugs. One service user self medicates with the appropriate risk assessments are in place, medication is stored in a lockable cupboard in the individuals’ bedroom. 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. The home listens and acts on Service users views and protects them from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The complaints book could not be located but the staff member advised that there have been no complaints received by the home since the last inspection. The Commission for Social Care Inspetion has received no information concerning complaints or Safeguarding Adults isues, since the last inspection. The staff member said that he had not received any safeguarding adults (Protection of Vulnerable Adults) or complaints training but was able to describe how he would deal with a complaint or vulnerable adults concern. One service user described how he would make a complaint, one service user said that they would ask their relative to complain on their behalf. Three service users said that they felt safe in the home.Financial records of service users were not seen. The inspector was advised that service users, generally deal with their own finances. Seven with support and guidance (this is noted on care plans) and two independantly. Six of the nine service user surveys recieved from service users said that they always knew who to talk to if they were not happy and three said they usually knew who to talk to. Some service users said that they were not sure how to make a formal complaint. A complaints procedure is displayed on the notice board. All the service users questionnaires said that staff listen to them and act on what they say. 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,29 and 30. Quality in this outcome area is adequate. The home is comfortable,safe, clean and hygienic although some areas are in need of redecoration. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The building is homely and comfortable, all areas are kept clean and tidy. Some areas looked shabby and in need of redecoration. Facilities for those with physical disabilities are not adeqate to ensure they can meet their personal care needs. (see standard 18) 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 and 35. Quality in this outcome area is adequate. The staff team are not totally effective and the manager does not have confidence in recruitment procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a small staff team of six care staff, with a minimum of one staff on duty during daytime hours. Frequent sickness and absence of some staff have caused staff shortages and some staff working additional hours. The minimum of one staff on duty can cause difficulties for staff, particularly with regard to the deteriorating mental and physical health of some service users. The manager advised that the staffing allocation has never been reviewed even though the service offered has and is continuing to change. Staff are not expected to, but do have to deal with personal care. The home was originally set up as a rehabilitation unit where all service users were independent with their personal care. The manager and staff felt that it was not clear what service the home offered as it is staffed as a rehabiliation unit for independent service users but has dependant people with increasing needs in residence. The Manager and deputy said morale is very low and felt that the staff team is not wholly effective. 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 18 Recruitment records (requirement at last inspection) are not on site and have not been seen by the manager. The manager is not confident in the recruitment processes and she does not always see the references or other paperwork. The inspector visited the providers’ offices and saw relevant paperwork and staff records. Most of the staffing records are in place although there were some ommissions in some files. The manager advised that some staff are ‘centrally’ interviewed and then allocated to a particular home without the manager being involved in the recruitment process or agreeing the appointment. Four service users said they ‘liked the staff’ and they felt ‘they’re always there to help you out’. All staff have individual training and development programmes and fifty percent of the staff team are qualified. Many Health and Safety training courses are out of date and there is no evidence of any training programmes being completed in 2006. 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42. Quality in this outcome area is adequate. The home is adequately managed and kept as safe as possible for service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been working at the home for 10 years and has a Registered Managers’ Award. She advised that there is low morale in the staff team because of long hours and some alienation /lack of support from the providers. The manager does not have enough time to fulfil all her managerial tasks as she has to cover care shifts. She is not always involved in the recruitment process and does not see the paperwork pertaining to appointments. The manager and deputy talked about disagreements with providers with regard to service user holidays and appropriate placements. There is some confusion about the function and role of the home because of the changing needs of service users. 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 20 The staff member, spoken to, felt well managed and said that he had good support. The home has a Qualiy Assurance System that consists of tennant satisfaction surveys and service user quality assessments. A monthly report on the home is completed by a care support co-ordinator (regulation 26 visits) and a quality assurance and Health and Safety monthly check list is completed by the manager. An action plan is developed from the information collected. Staff Health and Safety training is not up-to-date. The fire officer visited in April 05 and all his reccomendations have been complied with. The environmental health officer visited in June 2006 and all the recomendations have also been complied with. All health and safety maintenance records are up-to-date. 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 2 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 2 2 X 2 X 3 X X 3 X 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 22 NO 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. 2. 3. 4. Standard YA18 YA19 YA20 YA29 Regulation 14.1(d) 12.1(a) 13.2 23.2 (n) Requirement To accommodate only those service users whose needs it is able to meet. To monitor service users daily health (where necessary). To review the medication administration system to ensure its’ safety. To assess and review the provision of bathing and toileting facilities for physically disabled service users. Staff records must be available in the home and include all documents and information listed in schedule 2 of the Care Homes Regulations. (Repeated requirement 31/01/06) To ensure staff training is updated. To review the function of the home so that staffing ratios and service users suitability for placement in the home can be assessed. Timescale for action 01/03/07 01/02/07 01/02/07 01/03/07 5 YA34 19.4 (b) 01/02/07 6. 7. YA35 YA37 18.1 4.1 01/04/07 01/04/07 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 23 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 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 4 Granville Road DS0000011054.V322007.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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