Inspection on 04/05/06 for 72a Broad Street House 2

This inspection was carried out on 4th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

72a Broad Street House 2 05/05/09

72a Broad Street House 2 25/04/07

72a Broad Street House 2 19/01/06

72a Broad Street House 2 06/06/05

72a Broad Street House 2 08/02/05

72a Broad Street House 2 16/09/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 72a Broad Street House 2 Cedar And Douglas Units 72a Broad Street Clifton Shefford Bedfordshire SG17 5RP Lead Inspector Andrea James Unannounced Inspection 27th April 2006 10:00 72a Broad Street House 2 DS0000014885.V288291.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 72a Broad Street House 2 DS0000014885.V288291.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. 72a Broad Street House 2 DS0000014885.V288291.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 72a Broad Street House 2 Address 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) Cedar And Douglas Units 72a Broad Street Clifton Shefford Bedfordshire SG17 5RP 01462 813824 01462 813824 diane.humberstone@hft.org.uk www.hft.org.uk Home Farm Trust Care Home 8 Category(ies) of Learning disability (8) registration, with number of places 72a Broad Street House 2 DS0000014885.V288291.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 2006 Brief Description of the Service: Cedar and Douglas was one of two homes run by the Home Farm Trust in the small town of Clifton. The building was divided into two units to support 8 adults with learning disabilities; the units catered for 8 service users with complex needs and autism. The units were designed to accommodate four service users independently from the other unit. As a result of this, each unit had its own kitchen, lounge and bathing facilities and was linked by the laundry room on the ground floor and the staff room on the top floor. There were separate entrances to each unit and service users communally shared the garden facilities. The home was situated close to local amenities including shops and pubs. The service users were able to access other towns such as Bedford, Biggleswade and Shefford with the use of their local transport or route cars and the homes own transport facilities. 72a Broad Street House 2 DS0000014885.V288291.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried over a 5-hour period on the 4th of May 2006. The inspection process involved a partial tour of the premises and service users and staff were spoken to as a part of the inspection. The focus of the inspection undertaken by the Commission For Social Care Inspection (CSCI) was based upon the outcomes for service users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practices and focuses on aspects of service provisions that needed further development. The primary method of inspection used was “ case Tracking” which involved selecting a sample of service users and tracking the care they received through the reviewing of their records, discussion with them, the care staff and observation of care practices. The inspection was a key inspection and as a result all the key standards were inspection on this site visit. What the service does well: What has improved since the last inspection? Since the last inspection the home have been appointed a new area manager who appears to have visited the home on several occasions and have identified areas of improvement that was required to ensure the welfare and safety of the service users and areas that would enable the manager to be more effective in meeting the aims and objectives for the home. The home failed to meet several of their requirements but had addressed the issues of safer medication systems for service users. The home also ensured the wishes of the service users in the event of terminal illnesses or death was adequately recorded. 72a Broad Street House 2 DS0000014885.V288291.R01.S.doc Version 5.2 Page 6 The service had disconnected the call point systems in the toilets that were ineffective and all staff had been equipped with mobile communication units where they could be contacted where they were in the building. 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. 72a Broad Street House 2 DS0000014885.V288291.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 72a Broad Street House 2 DS0000014885.V288291.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3 and 5. Quality outcome in this area was poor. This judgement was made using available evidence including a visit to the service. Service users and their relatives were provided with sufficient information in order to make a choice if they wanted to live at the home and satisfactory contractual agreements were in place. The home was poor at assessing and ensuring the needs of the service users were met EVIDENCE: The home provided a Statement of Purpose and a Service User’s Guide for all service users prior to admission. There have been no recent admissions as the home has full occupancy but the information inspected was satisfactory to ensure service users and their relatives were aware of the facilities available in the home. The home was due to make further development to the Service User’s Guide by implementing the expected guidelines to follow when dealing with service users finances. The service users all had contractual agreements that were signed and dated. The home failed to have satisfactory assessments of needs for the majority of the service users and as a result the practice for identifying service users needs was poor. 72a Broad Street House 2 DS0000014885.V288291.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9. Quality in this outcome was poor. This judgement was made using available evidence including a visit to the service. The care plan documentation had not been developed and as a result personal needs, risk assessments and future objectives were not identified for the service users in the home. Service users were encouraged to take risks in developing their lifestyles but these were not documented as a part of the service users care intervention. EVIDENCE: No improvements were made to the care plans since the last inspection. The home failed to ensure compliance to the past requirements to develop service users care plans and as a result service users needs were not satisfactorily identified. There was no evidence that service users had been consulted about their care or that the care needs have been reviewed. The manager said service users would have annual reviews where their needs would be identified. Some service users with high and challenging needs have had various in-puts from external professionals and where possible service users health care needs have been addressed when they were identified. These were only evident 72a Broad Street House 2 DS0000014885.V288291.R01.S.doc Version 5.2 Page 10 through the daily notes and guidelines that had been implemented for some service users. There was no evidence of how the home was to meet these needs and due to staff changes it was concerning that consistency of care would be compromised. There was also a lack of risk assessments for service users who posed a risk to other users and staff. Service users were encouraged to make decisions where possible about their life styles. One service user was able to have a holiday that he requested and others were able to embark on employments and college courses of their choice. It was evident that the home supported the service users to take risk as apart of their independent lifestyle. 72a Broad Street House 2 DS0000014885.V288291.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,15,16 and 17. Quality in this outcome area was good. This judgement was made using available evidence including a visit to the service. Service users spoke about the quality lifestyle they were able to live, they were given the opportunity for personal development, to engage in age appropriate and cultural, social, and sexual activities. They were also encouraged to develop community skills, and maintain a healthy diet. EVIDENCE: The home ensured that service users were encouraged to take part in community activities. Service users spoken to said they enjoyed their lifestyles, they gave example of places they have been, and future plans for example holidays and college placements. Service users were encouraged to maintain a healthy diet and were able to assist with the purchase and preparation of meals on a daily basis. They were also encouraged to carry out domestic skills in the cleaning of their rooms and communal areas of the home. This was done on a rota basis and service users said they were happy with this arrangement. 72a Broad Street House 2 DS0000014885.V288291.R01.S.doc Version 5.2 Page 12 Service users were not discouraged from expressing their sexuality appropriately and relatives were encouraged to visit the home. Service users took part in age appropriate activities and those spoken to said they attended the gateway club on a weekly basis where they were able to meet like-minded people. Service users were given opportunities for personal development. One service user spoke of his ability to embark on a part time employment while others attended college. The manager said one service user who had deteriorated still had the opportunity to attend college on a part time basis where he could maintain his social contact with others in his peer. 72a Broad Street House 2 DS0000014885.V288291.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 and 21. Quality in this outcome area was good. This judgement was made using available evidence including a visit to the service. The personal and health care support received by the service users resulted in service users welfare being protected and they were safe. Service users received good standards of support to ensure they are able to embark on leisure activities. Good medication procedures were in place and the home was operating a zero tolerance approach to medication. EVIDENCE: Service users said they received support in the ways that they preferred. One service user said he received support in fulfilling his life long desire to travel on the Euro tunnel. He was able to spend a long weekend in Brussels. Service users received support in attending various health care practitioners and emotional support was provided through various means. Service users said they had attended their general practitioners and records seen suggested some service users received flu vaccinations. The area manager recently carried out a presentation on dealing with death and dying in order to support both relatives and service users to deal with their emotional needs. 72a Broad Street House 2 DS0000014885.V288291.R01.S.doc Version 5.2 Page 14 The home had recently implement a “end of life” book that was presented in a format that was easy to use and covered all aspects of ensuring service users wishes would be followed in the event of their death. The home had improved their polices and procedures for medication and regular audits were carried out on all medication. The manager said the trust had recently implemented a zero tolerance on medication and all staff had been trained in good administration of medication. Some service users had a medication review and better stock control measures were in place for the home. 72a Broad Street House 2 DS0000014885.V288291.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality outcome in this area was adequate. This judgement was made using available evidence including a visit to the service. The home’s complaints procedures and policies created an environment that service users and relatives felt comfortable to complain should the need arise, however some processes in the home failed to protect the service users from abuse and as a result service users could be open to abuse from a financial perspective. EVIDENCE: The home received one complaint since the last inspection about the level of noise of one service user, which was disturbing the neighbours. The home proved that they were able to address the concerns of the complaints and was trying to address the issues of concerns raised. The policies and procedures implemented for dealing with service users finances needed further development and this was recognised by the management of the home as areas to be addressed. Their were also some inhouse practices that needed to be developed, for example staff were not double signing for service users monies and receipts of purchases were not available for several transactions. 72a Broad Street House 2 DS0000014885.V288291.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,27,28 and 30. Quality outcome in this area was good. This judgement was made using available evidence including a visit to the service. The home created a safe and hygenic accommodation where service users could be comfortable and safe. EVIDENCE: The home was clean and welcoming and provided sufficient space for service users to live comfortably. The home was due to install double-glazing in one service users bedroom to reduce excessive noise. One service user had just received new furnishings that created better facilities to ensure comfort for service users. The home had a new development plan that identified areas that needed redecoration and replacement of some furnishings and flooring. Staff and service users carried out daily cleaning routines that ensured satisfactory cleaning and hygienic standards were maintained. 72a Broad Street House 2 DS0000014885.V288291.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36. Quality outcome in this area was poor. This judgement was made using available evidence including a visit to the service. The procedures in place for staff recruitment did not protect service users. Staff moral was low as the staffing ratios continue to fall and staff did not receive sufficient supervision which led to communication difficulties. EVIDENCE: The home had several vacancies that had impacted on the staffing levels and the numbers of staff available to ensure consistency for the service users. The home had 5 vacancies and as a result several hours of agency cover was being used. The manager said they had made arrangements with the agency to have the agency staff for an 8-week block where they would be able to have some consistency of care for the service users. Staff spoken to said they felt overworked and some were feeling low because they felt unappreciated. Some staff said they were not receiving the support they required through supervisions and staff meetings. The manager said she was trying to supervise all staff but admitted she was a bit behind. The staff meetings were also held on days that some staff had to be at the day centres and as a result were not able to participate in this form of communication that occurs in the home. The 72a Broad Street House 2 DS0000014885.V288291.R01.S.doc Version 5.2 Page 18 staff said as a result of not being able to attend staff meetings they were not aware of some changes in the home. Staff had received various training that would ensure they were able to meet the needs of the service users. The areas of training included behaviour management, which was identified due to service users posing challenges to the service. The home still needed to ensure a minimum of 50 of the staff team achieves their NVQ level 2 qualification in care. The problems identified in the last inspection with the staffing ratios for both units being uneven had been resolved and the ratio stood at two staff per unit. The home needed to ensure their recruitment procedures are developed to include all satisfactory standards of clearances in order to protect service users. On inspection of a sample of staff records 3 Criminal Record Bureau Checks were not available. Some staff said the manager operated an open door policy and described her as “ brilliant”” but felt that they were not always able to contact her if she was not in the home. Staff commented that there was a lack of communication between the management team and the care staff. Service users spoken to said the manager and staff were “Nice”. On observation there was a good relationship between service users, the care staff and management team. 72a Broad Street House 2 DS0000014885.V288291.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,41, 42 and 43. Quality in this outcome area was poor. This judgement was made using available evidence including a visit to the service. The leadership of the home has failed to address service development and as a result the service users needs are not met. There had been some progress on quality monitoring system but further development was needed to ensure all aspects of the services the home provides is regularly audited and improved. The home’s health and safety procedures were satisfactory and as a result service users were safe. EVIDENCE: The acting manager had still not applied for her registration with the Commission for Social Care Inspection. The service has benefited from the arrival of the new area manager who has been actively supporting the manager in the last few months. This resulted in various development in policies and procedures that will protect the service users. 72a Broad Street House 2 DS0000014885.V288291.R01.S.doc Version 5.2 Page 20 The manager appeared more confident in her ability to meet the homes aims and objectives and timescales are implemented that should result in a well run home. However the timescales for requirements continues to be unmet and is an area for concern. The poor maintenance of important aspects the required records, such as care plans, does not assist the home in evidencing that the needs of individuals are being identified and therefore met. The home had implemented a “business improvement plan” that identified quality targets for both the short term and long-term objectives. The home have made improvements to their quality monitoring systems that identified areas to be improved, this needed further development to ensure the views of the service users and staff are gained and published in accordance to the requirement of the standards. The health and safety procedures in the home were satisfactory. On the day of the inspection the fire alarm system was set off due to faulty equipment but the home carried out satisfactory evacuation procedures. There were identified First Aiders and staff received adequate training. Foods were prepared and stored satisfactorily and preventative measures were in place to prevent the spread of infection. Some risk assessments were in place for safe workings practices for service users. 72a Broad Street House 2 DS0000014885.V288291.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 3 2 1 3 3 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 2 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 x 2 x LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 1 3 2 x 1 3 2 72a Broad Street House 2 DS0000014885.V288291.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. Standard Regula Requirement tion 1. YA2 14 (1) Arrangements must be made for all service (a) users to receive a full assessment that identifies their needs to be provided by the home. Previous timescales: 30/03/05, 30/08/05 and 30.04.06 2. YA6 15 (1) (2)(a, b,c) Arrangements must be made to implement and improve all care plans in the home. These must demonstrate the identified needs of the service users and the intended plan of care. Previous timescales: 03/11/03, 30/10/04, 08/03/05, 30/08/05 and 30.04.06 Timescale for action 30/04/06 30/04/06 3. YA6 15 (2) Consultation must be sought where possible 30/06/06 for all plans of care recorded for the service users. Previous timescale: 30/08/05 and 30.04.06 Arrangements must be made to ensure all service users have adequate risk assessments in place to safe guard activities undertaken in and out of the house. Arrangements must be made to ensure correct policies and procedures are implemented in the home to safeguard the service users finances. DS0000014885.V288291.R01.S.doc Version 5.2 4 YA9 13 (4) (b) 30/06/06 5 YA23 13 (6) 30/07/06 72a Broad Street House 2 Page 23 6. YA33 18 (1) (a) Sufficient staff must be employed in the home in such numbers as to meet the needs of the service users. Previous timescales: 30/03/05 and 30/08/05. Arrangements must be made to ensure all staff recruited in the home have satisfactory clearances prior to their commencement of employment in the home. Arrangements must be made to ensure all staff receive regular supervision and support from the management team. Quality assurance system must be implemented in the home in order to monitor the service being provided. Previous timescales:01/12/04, 30/03/05, 30/08/05 and 30.04.06. The records required by regulation must be accurate and updated as changes are identified. 30/06/06 7 YA34 19 (1) 30/07/06 8 9. YA36 YA39 18 (2) 24(1) 30/07/06 30/04/06 10 YA41 17 30/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3 4. 5 Refer to Standard YA32 YA3 YA19 YA37 YA43 Good Practice Recommendations The home should provide evidence of how 50 of the care staff will obtain their NVQ level 2 in care. Arrangements should be made to review the needs of all service users to ensure the home is able to meet their needs. Arrangements should be made to ensure all health care needs identified are reflected in the service users care plans. The providers should consider offering the manager further training in management development. The manager should submit her application for registration to the Commission For Social Care Inspection as soon as possible 72a Broad Street House 2 DS0000014885.V288291.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI 72a Broad Street House 2 DS0000014885.V288291.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!