Inspection on 01/05/08 for 42 Twyford Gardens

This inspection was carried out on 1st May 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

42 Twyford Gardens 15/02/07

42 Twyford Gardens 29/05/06

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

CARE HOME ADULTS 18-65 42 Twyford Gardens Worthing West Sussex BN13 2NT Lead Inspector Merle Blakeley Unannounced Inspection 1st May 2008 10:15 42 Twyford Gardens DS0000066941.V363500.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 42 Twyford Gardens DS0000066941.V363500.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. 42 Twyford Gardens DS0000066941.V363500.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 42 Twyford Gardens Address Worthing West Sussex BN13 2NT 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) 020 8544 8900 www.caremanagementgroup.com Care Management Group Ltd Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 42 Twyford Gardens DS0000066941.V363500.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate on service user in the LD(E) category. Date of last inspection 15th February 2007 Brief Description of the Service: 42, Twyford Gardens is a care home registered to provide care and accommodation for up to 4 people with a learning difficulty. It is a detached bungalow and situated in a residential street on the outskirts of Worthing, West Sussex yet close to shops and other amenities. All of the residents have a single room on the ground floor, three of which are fitted with overhead hoists. Each room has en-suite facilities. Communal space consists of an open plan lounge/dining room and kitchen. There is a rear garden mostly laid to lawn with a ramp for wheelchair access to the patio. Current fees are £1,380 to £1,870 per week. 42 Twyford Gardens DS0000066941.V363500.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Quality Rating for this service is 1 star. This means the people who use this service experience Adequate quality outcomes. This unannounced key inspection was carried out on 1st May 2008. As well as this site visit information was also gained from an Annual Quality Assurance Assessment (AQAA), which was not returned by the due date requested. Two service user surveys and six staff surveys were sent to the home by CSCI. The two resident surveys were completed but no staff surveys were returned. During the visit we were able to spend a short time with all three residents and we also spoke to five staff. The acting manager facilitated the inspection. We looked at three care plans and all supporting information such as risk assessments, daily records and healthcare information and a check was carried out on how medications are being stored and administered within the home. Records of how complaints and safeguarding issues had been dealt with were discussed. We also viewed staff records, which included recruitment procedures, qualifications and the types of training courses that are offered to staff. The homes quality assurance system, how people’s finances are managed and health and safety procedures were also viewed and discussed. What the service does well: What has improved since the last inspection? During the last inspection seven requirements were made and six of them have been completed. All residents now have a contract of terms and conditions. People’s care plans are more comprehensive and written monthly reports have now been introduced. Care plans and risk assessments are reviewed on a six monthly basis or more frequently if required. 42 Twyford Gardens DS0000066941.V363500.R01.S.doc Version 5.2 Page 6 Staff have been provided with a good training programme that has included courses in person centred planning, challenging behaviours, learning disability awareness, conflict resolution, creating positive relationships with service users and families, boundaries and good practice, safeguarding adults and catheter care. Some of these training courses have addressed the issues that were raised during the last inspection regarding staff using more appropriate language with service users and improving their skills and knowledge in working with people whoa have a learning disability. The home will also be providing English language courses for some of the staff that have English as a second language. Complaints and safeguarding issues have been dealt with in a professional and timely manner. 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. 42 Twyford Gardens DS0000066941.V363500.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection 42 Twyford Gardens DS0000066941.V363500.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each person has an assessment carried out prior to moving into the home. EVIDENCE: There are currently three people living at 42 Twyford Gardens and we looked at their pre-assessment information. Care Management Group Ltd (CMG) use an induction questionnaire checklist for information which covers the areas of personal care, finances, meals, getting up and going to bed, religious and spiritual needs, social contacts, activities and likes and dislikes. All three residents were seen to have quite in-depth information about their assessed needs and preferences. There was also good individual background history, which explained current issues and any health concerns. During the last inspection a requirement was made for the home to ensure that each person had a contract of terms and conditions of residency in place. This has now been completed and the contracts were viewed. 42 Twyford Gardens DS0000066941.V363500.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 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are up to date and relevant. There was evidence to show that people are able to make their own choices. EVIDENCE: We looked at all three care plans and the information they contained was comprehensive and up to date. New care plans have been implemented and keyworker monthly reports were introduced in January 2008. Some of the keyworker reports were looked at and as they are all handwritten some of information was difficult to read. This was discussed with the acting manager who stated that it might be better if these monthly reports were typed up on the computer. The care plans were found to be very detailed and the latest reviews had been carried out in March 2008. There was evidence to show that residents and their family members are involved with their care plans and reviews. Some staff have been able to attend a training course in Person Centred Planning and this has helped to improve their understanding of the needs of people who have learning difficulties. 42 Twyford Gardens DS0000066941.V363500.R01.S.doc Version 5.2 Page 10 There was evidence to show that people are able to make their own choices and decisions within a risk assessed framework. Two of the residents were spoken to and asked if they could make choices. They said they felt they could and they can decide on what they want and do not want to do. They said they could also choose where they go, when they get up and go to bed, who they see and what they want to spend their money on. One person said that she was supported to maintain a relationship with her boyfriend. Risk assessments had been developed for various aspects of people’s lives such as attending college, clubs, going shopping, out in public places and within the home. These assessments were being reviewed on a regular basis. 42 Twyford Gardens DS0000066941.V363500.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 & 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People have access to their preferred activities. People remain in contact with friends and families and the home offers a reasonably well balanced diet. EVIDENCE: Activity plans showed that residents are involved with a number of different activities throughout the week that include IT lessons, arts & crafts and advanced cookery at a local college, outreach activities at another nearby CMG home, shopping, cinema, pub lunches and discos in the evenings. On the day of this visit all the residents were out attending activities. At the last two inspections it has been stated that a vehicle would be provided for the home, as yet this has not occurred. The acting manager was asked about this and he said he was continuing to request a vehicle, as at present adapted vehicles are being shared by several other CMG homes in the area. This can make taking people out difficult at times, as the vehicles are not 42 Twyford Gardens DS0000066941.V363500.R01.S.doc Version 5.2 Page 12 always available. The acting manager stated that taxis are often used and he felt people were not too disadvantaged as they still managed to get out. During this inspection the acting manager had to leave the home to take the vehicle back to another CMG care home. All three residents in the home are wheelchair users. All three residents have family and friends who they keep in touch with regularly. Staff support one person to go to the greater London area to visit her family on a fortnightly basis. Another person has also been assisted to attend family functions and the other has family members who visit her frequently. As well as visits, residents also stay in touch by phone and they are supported to send cards etc at birthdays and Christmas. The home has devised a menu, which they try to ensure provides people with a healthy and well balanced diet. Sometimes a resident might not want what is on the menu and they are able to choose other options. The acting manager said that residents usually eat out at least twice a week. The home is intending to provide menus in a pictorial format, which will help residents in their choices. One of the residents makes his own drinks with the help of staff and others were seen in the kitchen assisting with meal preparations. 42 Twyford Gardens DS0000066941.V363500.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 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Peoples current healthcare needs are being met. Personal care is provided in the way people prefer. Medication is being appropriately administered. EVIDENCE: All three residents have a completed ‘My Health Booklet’ and comprehensive guidelines are in place on how people should be supported with their healthcare needs. Records show that people have access to speech and language therapists, occupational therapists, community nurses, physiotherapists, neurology consultant, dentist, opticians and chiropodists. One person has a catheter in situ and concerns were raised earlier in the year as to how the care of the catheter was being managed by staff. As a result of these concerns a safeguarding referral was made. The outcome of the investigation was for the home to improve the procedures for catheter care and for staff to receive additional training. This has been carried out and to date there have been no further incidents. We spoke to the resident concerned and she stated that everything was now OK and she was also making sure that staff remembered to empty the catheter bag frequently. The acting manager also 42 Twyford Gardens DS0000066941.V363500.R01.S.doc Version 5.2 Page 14 felt that there might have been a lack of communication between the district nurse and the staff regarding procedures. Another resident is experiencing changes in her behaviours, which has caused some distress to herself and the other two residents. There are ongoing health investigations and the acting manager said that he was supporting her to attend a hospital appointment in London this week. A continuing frustration for this person is that she is still using an unsuitable wheelchair. The acting manager stated that a request for a new wheelchair had been made some time ago but unfortunately there was a long waiting list. The home has continued to contact the team for a date of when a new and more suitable chair may become available. We discussed how personal care was provided to residents. The acting manager said that residents had not shown any preference in receiving personal care by either male or female staff. However, there are two female residents and now more female staff are employed for times when people may have preferences. Each person has their own en suite facilities with assisted baths and hoists. Medication records were viewed and no errors were found. The home has experienced some medication issues in the past and one staff member was required to receive additional medication training. All staff have received medication training by the local pharmacist and accredited training through a local consortium. 42 Twyford Gardens DS0000066941.V363500.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 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There have been a number of complaints and safeguarding referrals, which the home has dealt with in a satisfactory manner. EVIDENCE: The home has produced a complaints policy and procedure, which is available in pictorial format. Four complaints and four safeguarding referrals have been made since the last inspection. Residents made four complaints. Two complaints had been made by one of the residents regarding the behaviour of another person who lived in the home. The acting manager has dealt with these issues and at present it appears the issues have been resolved. Another resident made two complaints and because of their nature they were escalated to safeguarding referrals. These issues have been investigated, however none of the claims made against staff could be substantiated. Another safeguarding referral was made when one resident pushed another over. Fortunately the person involved was not hurt but it was necessary to carry out an investigation to ascertain why this event occurred. The person involved is exhibiting some challenging behaviours at present and the acting manager stated that medical advice and neurological support is being sought. We checked the finances for all three residents and the records were found to be accurate and up to date. 42 Twyford Gardens DS0000066941.V363500.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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a comfortable environment that meets their needs. EVIDENCE: 42 Twyford Gardens has been specifically refurbished for ease of access. There are ramps to the front and rear of the property and the living areas are level and open plan. Resident’s rooms are large and airy with en suite facilities. Each room has been personally individualised with family photos and personal belongings. Residents who were spoken to said they liked their bedrooms. A new patio area is currently being built in the rear garden. On the day the home was found to be very clean and tidy throughout. 42 Twyford Gardens DS0000066941.V363500.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 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home needs to retain a more stable staff team. More staff need to obtain NVQ qualifications. Staff training and staff supervisions have improved. EVIDENCE: The home has experienced staffing issues and during last year the team had been reasonably stable but several senior care workers left. Three new staff have recently commenced working in the home. One person came from another CMG home and the other two staff members were recruited from Eastern Europe. They do not have any learning disability experience but the acting manager stated they were keen to learn. The home currently employs a very multicultural staff team and for the vast majority English is their second language. English language courses are going to be provided for some of the staff to improve their skills in both verbal and written skills. This is very important as their role involves writing daily notes, liaising with external bodies and supporting people out in the community. The staffing ratios have recently changed to reflect the increased needs of one of the residents. There are now three staff on duty in the morning and three 42 Twyford Gardens DS0000066941.V363500.R01.S.doc Version 5.2 Page 18 staff in the afternoon. Two waking staff are employed at night. Agency staff are still being employed by the home to cover five or six shifts per week, however the acting manager stated that they always use the same agency staff that are familiar with the residents. During the day staff were seen to work with the residents in a friendly and relaxed manner. During the last inspection there was clear evidence that staff lacked the experience and understanding of the skills needed for working with people who have a learning disability and challenging behaviours. Some staff were also seen to talk about residents in an inappropriate manner and use disrespectful language. Since then staff have attended training in challenging behaviours, learning disability awareness, person centred planning, conflict resolution, boundaries and good practice, epilepsy training, bowel management, fire safety, safeguarding adults, first aid, catheter care, food hygiene and creating positive relationships with service users and families. All staff are due to attend Prevention and Management of Challenging Behaviour in May 2008 and Mental Health Awareness training in June 2008. One staff member holds a National Vocational Qualification (NVQ) in Care and three more staff are working towards gaining this qualification. One senior staff member has a Masters Degree in Health Management and two others have a nursing background. At least 50 of staff should be trained to NVQ Level 2. We looked at three staff recruitment files and they contained all the required information. No staff member has commenced work without obtaining a returned CRB clearance check. Staff now receive regular supervision sessions and staff meetings are held monthly. A group of five staff were spoken to during this visit. They said that overall they were happy working in the home. Some felt that their level of salary did not reflect the work they were required to carry out. 42 Twyford Gardens DS0000066941.V363500.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 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home continues not to have a registered manager in place. A suitable quality assurance system is in place and the home is ensuring that the health and safety of residents and staff is promoted. EVIDENCE: At the last two key inspections in 2007 a requirement was made for the home to ensure that there was a registered manager in place. This requirement has not been met. The acting manager has held this role since August 2006. He stated that it was his intention to apply to become the registered manager for the home last year and all the relevant paperwork had been completed, however CMG Ltd were discussing the possibility of deregistering 42 Twyford Gardens and turning the 42 Twyford Gardens DS0000066941.V363500.R01.S.doc Version 5.2 Page 20 home into supported living accommodation. This did not take place and the home continues to be a registered care home. CMG Ltd are legally required to ensure that 42 Twyford Gardens appoints a manager who is registered with the CSCI and this requirement must now be given urgent attention. The acting manager has six years experience of working with people who have learning disabilities and he is currently completing the Registered Managers Award (RMA). The acting manager also stated that at times he is finding it difficult to complete all the necessary administration work for the home and also work with the residents. CMG Ltd need to ensure that the acting manager is provided with sufficient time to carry out all his managerial duties. Staff who were spoken to on the day stated that the acting manager was supportive and they felt he managed the home well. The home has produced a quality assurance system, which includes CMG internal audits and regular Regulation 26 visits. Copies of these reports were read on the day. Feedback from residents is sought and new pictorial format questionnaires for service users had just arrived at the home that day. Annual feedback surveys for relatives are also sent out. It will be recommended that the home also send out questionnaires to visiting professionals and stakeholders to gain their feedback on how they see the home operating. Health and safety records were viewed and discussed. A fire risk assessment of the home was carried out in November 2007. Fire drills are held three monthly and fire alarms are checked weekly. Staff have attended fire safety training. The two new staff members are due to attend this training soon. Most of the staff hold a first aid certificate and the home records all accidents that occur. There is a policy for the prevention and management of infection and four staff have received training in this subject. 42 Twyford Gardens DS0000066941.V363500.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 3 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 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 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 3 3 3 X 2 X 3 X X 3 X 42 Twyford Gardens DS0000066941.V363500.R01.S.doc Version 5.2 Page 22 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 YA37 Regulation 10 (1) Requirement An application must be submitted to CSCI for a registered manager. Outstanding from 30/03/07 and 29/05/07 2. YA32 18(1)(A) The home must ensure that a stable staff team of suitably qualified and experienced persons are employed to meet the current needs of service users. 30/08/08 Timescale for action 30/08/08 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 YA12 Good Practice Recommendations As at the last visit, consideration should be given to providing the home with it’s own transport so that people who are wheelchair users can more easily access community and educational facilities. For the Quality Assurance programme to include gaining DS0000066941.V363500.R01.S.doc Version 5.2 Page 23 2. YA39 42 Twyford Gardens feedback from visiting professionals and stakeholders. 42 Twyford Gardens DS0000066941.V363500.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 42 Twyford Gardens DS0000066941.V363500.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!