Inspection on 14/12/06 for 85 Lodge Lane

This inspection was carried out on 14th December 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 22 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

85 Lodge Lane 07/08/07

85 Lodge Lane 10/10/05

85 Lodge Lane 09/08/05

85 Lodge Lane 11/01/05

85 Lodge Lane 13/04/04

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Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 85 Lodge Lane Low Town Bridgnorth Shropshire WV15 5DF Lead Inspector Mike Moloney Key Unannounced Inspection 14th December 2006 07:00 85 Lodge Lane DS0000020724.V294703.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 85 Lodge Lane DS0000020724.V294703.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. 85 Lodge Lane DS0000020724.V294703.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 85 Lodge Lane Address Low Town Bridgnorth Shropshire WV15 5DF 01746 766832 01746 766832 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) www.macintyrecharity.org MacIntyre Care Jo-Anne Jones Care Home 5 Category(ies) of Learning disability (5) registration, with number of places 85 Lodge Lane DS0000020724.V294703.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate five (5) people with Learning Disabilities of which two (2) people may have Physical Disabilities. 10th October 2005 Date of last inspection Brief Description of the Service: 85 Lodge Lane is a semi-detached property situated on a residential estate on the outskirts of Bridgnorth, Shropshire. The property is owned by Shropshire Health Authority. MacIntyre Care is a voluntary organisation contracted to provide a care service. The home is registered with the Commission for Social Care Inspection to provide accommodation and personal care to a maximum of five adults with a learning disability and physical disability. Service users are provided with a single room. Bedrooms for individuals with mobility difficulties are situated on the ground floor. The property is situated on an estate and is in keeping with the houses surrounding it. It is close to local shops. MacIntyre have a mission statement in place, which is ‘To be recommended and respected as the best provider of services for children and adults with learning disabilities throughout the United Kingdom’. Further information is available in the home’s service user guide. The current fees for the home are £1,147 per week 85 Lodge Lane DS0000020724.V294703.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, records kept in the home, medication records, discussions with the staff team, tour of the premises, previous inspection reports and talking with as well as observing the care experienced by people using the service What the service does well: What has improved since the last inspection? What they could do better: A number of areas that require improvement were highlighted during this inspection. The service users were seen to have little activity outside of the home arranged for them and there is some doubt about whether or not some that are arranged within the home, such as looking out of the window, are stimulating enough. Not including key workers in the reviewing of these activities makes it unsurprising that this process was ineffective. Not including the information about service users’ likes and dislikes, that had already been obtained, within the written information to which the staff had access would also have made it difficult to meet their needs. The implementation of health action plans would go some way towards ensuring that service users’ medical needs are fully met. A complaints procedure that is accessible to all interested parties including members of the public would ensure that those who advocate on behalf of this vulnerable group of adults are able to do so effectively. The reporting of 85 Lodge Lane DS0000020724.V294703.R01.S.doc Version 5.2 Page 6 serious concerns and allegations of abuse to the appropriate authorities, including Commission for Social Care Inspection, is a legal requirement. Ensuring that staff undertake the mandatory safety training is also necessary to ensure that the service users are safe and this needs to be supported by regular staff supervision to enable further, more detailed, discussions to take place for the same reason. The monthly visits that are required by law to monitor the home’s ability to meet the needs of the service users must not be carried out by someone who is concerned with the day to day running of the home so that the observations are impartial. The maintaining of records showing that health and safety issues are regularly monitored needs to be improved if the home is to demonstrate that it does, in fact, monitor such things. 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. 85 Lodge Lane DS0000020724.V294703.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 85 Lodge Lane DS0000020724.V294703.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): EVIDENCE: No service users have been admitted since the last inspection. 85 Lodge Lane DS0000020724.V294703.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 adequate. Individuals are not involved in decisions about their lives and do not play an active role in planning the care and support they receive This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records of two of the service users were looked at. The key workers for both people were present during the inspection. Care plans were seen to be in place and these were seen to have recent review dates in them. Care staff were spoken to during the inspection and they indicated that they had little input into those reviews. Talking to the staff indicated that little use has been made of the Person Centred Approach to assessment of needs and wishes. There were no entries in the service user files that were consistent with this approach. The staff did say that they had carried out an exercise during the last summer that had identified the likes and dislikes of each service user. This information could not be found within the service users’ files. 85 Lodge Lane DS0000020724.V294703.R01.S.doc Version 5.2 Page 10 A variety of risk assessments were seen within the service user files that related to activities that were crucial to the lifestyles of the person concerned. However, there was evidence to show that the conclusions of the assessments were either not acted upon or based on an incomplete consideration of the factors that should have been taken into account. In one case the manual handling risk assessment stated that staff should be trained in the use of the hoist. The staff carrying out that operation on the morning of the inspection confirmed that they had not received such training. A second example was that a risk assessment had been carried out on the use of bed rails. The risk assessment seen did not consider whether or not it was necessary to use them. Staff spoken to on the day of the inspection confirmed that they had not received risk management training. 85 Lodge Lane DS0000020724.V294703.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 poor. People who use services are given few opportunities to make choices about their life style, and to develop their life skills. They have few social, educational, cultural and recreational activities available to them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records of two of the service users were looked at. The key workers for both people were present during the inspection. For one of the service users the records showed that he had been out of the building on eight occasions during November 2006. On two occasions this was to the weekly Gateway Club, three occasions to a multi-sensory room, once to a MacIntyre party, once for a curry and once to post a letter. Looking at his files it was not possible to identify any activities that he liked to take part in within the home. The inspector was informed that he liked spending time looking out of the front window. He was placed in his wheelchair looking out of the window for a large proportion of the inspection. 85 Lodge Lane DS0000020724.V294703.R01.S.doc Version 5.2 Page 12 The records for the second service user showed that she had been out of the building on one occasion in the preceding two weeks. This had been to go to the multi-sensory facility followed by shopping. Both key workers confirmed that as far as they were aware the records were accurate. The records showed that service users can and do receive regular visits from friends and families. Two vehicles are available to be used for activities away from the home. The manager confirmed that approximately 50 of the staff are permitted to drive them. The menus were looked at and these were seen to be varied and balanced. Staff stated that service users’ preferences were found by experience and they also said that if a service user rejected a meal they were always offered an alternative. Staff on duty at the time of the inspection confirmed that the service users preferences for different types of food were not contained within their records. 85 Lodge Lane DS0000020724.V294703.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 adequate. The health and personal care that people receive is based on their individual needs, however, elements of those needs are not reviewed frequently enough. The principles of respect, dignity and privacy are put into practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff were seen working with the service users and they were seen to do so in a positive, caring and sensitive manner. Time was spent chatting with the individual residents as they worked with them and the reactions of the service users confirmed that they were used to this. The records available in each of the files allowed for recording of any healthcare appointments. Looking at the home’s main diary and talking with the staff confirmed that these were accurate. Medication storage and management procedures were looked and these were seen to be appropriate. The manager stated that there had been no medication review for one of the service users for over a year. She stated that one had not been requested by the home. She also stated that were no health action plans 85 Lodge Lane DS0000020724.V294703.R01.S.doc Version 5.2 Page 14 in place for any of the service users, the purpose of which is to identify the appropriate time for such actions to take place. Staff confirmed that they had received training in the safe handling of medicines and that this training programme was ongoing. 85 Lodge Lane DS0000020724.V294703.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 poor. Due to the nature of their disabilities people who use the service are unlikely to be able to fully access the formal complaints procedures that have been made available to them. Those who may be acting on their behalf do not have such a procedure available to them and therefore the service users are not fully protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager stated that no complaints had been received by the home. She also said that the home did not have a complaints procedure for use by nonservice users. The manager reported that one allegation of abuse had been received. She stated that CSCI had been notified but in fact there was no record of this. She explained that a senior manager had investigated the matter and the service user’s social worker had been contacted.. The financial records for one of the service users was looked at. It was possible to ‘track’ the use of his money but one transaction had been wrongly recorded. A new policy for the management of service users’ finances was seen to have been developed by the proprietor. 85 Lodge Lane DS0000020724.V294703.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 and 30 Quality in this outcome area is good. The physical design and layout of the home enables people who use the service to live in a well-maintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was seen to be decorated and maintained in clean and homely manner. Access to the building is good as is access to the pleasant rear garden. The home is situated near to local shops. The laundry is appropriately equipped and sited away from food preparation and eating areas. 85 Lodge Lane DS0000020724.V294703.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 and 36 Quality in this outcome area is poor. Staff in the home are not trained to support the people who use the service and it cannot be shown that they are always available in sufficient numbers. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff were observed working with the service users on the day of the inspection and they were seen to do so in a positive, caring and sensitive manner. They spent a lot of time chatting with the individual residents as they worked with them and the reactions of the service users confirmed that they were used to this. The staff rota for December and November were looked at. These showed that 3 staff were on duty in the mornings, two in the afternoon and evenings and two overnight with one of those ‘sleeping in’. The records maintained to monitor ‘time off in lieu’ were looked at and it was seen that these were not reflected in the main staff rota and neither were the arrangements to cover those who were taking such time off making it impossible to ascertain whether or not safe staffing levels were maintained at such times. 85 Lodge Lane DS0000020724.V294703.R01.S.doc Version 5.2 Page 18 The documents that are required by law to be in place before any new starters commence working with vulnerable adults were seen to have been obtained in a visit to the provider’s office in August. The training that has been undergone by all of the staff who were available during the visit was discussed with them. It was confirmed by them that they had received or were receiving induction training. They also said and the manager confirmed that over 50 of the team had obtained NVQ2 or better in care. However, some of them also confirmed that they had not received the necessary mandatory health and safety training. The staff stated and the manager confirmed that they had only received one session of professional supervision since February 2006. 85 Lodge Lane DS0000020724.V294703.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 poor. The home does not make appropriate arrangements to ensure the safety of the service users and has an ineffective quality assurance system. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager confirmed that she is working towards the qualifications that are appropriate to the running of this type of service. The regulation 26 reports that require the provider to visit a home on a monthly basis to monitor its performance are provided to the Commission for Social Care Inspection. These visits were carried out by the registered manager’s immediate line manager. They showed no action to remedy the issues highlighted in this report. A number of these issues should have been evident at various points in recent months. 85 Lodge Lane DS0000020724.V294703.R01.S.doc Version 5.2 Page 20 Some of the records used for the monitoring a health and safety were seen to be up to date. These included the gas safety certificate and portable appliance testing records. However, the weekly fire detection and alarm equipment test records were not maintained on a regular basis suggesting that such tests had not taken place. Similarly the fire evacuation practices were not recorded and it was confirmed by staff that these had not taken place. The recent records of hot water temperature in the downstairs bathroom were seen but those for the upstairs bath were not available. None of the bath water temperature records for June and July could be found suggesting that they had not existed. The staff stated and the manager confirmed that staff training on such issues as manual handling, fire prevention, food hygiene and infection control had not been made available to the staff. There were no records of risk assessments having carried out on hazardous substances being used in the home. A bed rail fixed to the bed of one of the service users was seen to have been fitted in the wrong position. 85 Lodge Lane DS0000020724.V294703.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 x 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 2 23 2 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 3 33 2 34 3 35 1 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 x 12 1 13 1 14 x 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 x 2 x 1 x x 1 x 85 Lodge Lane DS0000020724.V294703.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 YA6 Regulation 15 (2) Requirement All care plans must be reviewed with the service user (involving significant professionals, family and advocates) at the request of the service user or at least every six months and updated to reflect changing needs; and agreed changes are recorded and actioned. This requirement is outstanding from the inspection on 10/10/05 The social needs of the service users must be reviewed so that any needs identified can be addressed. The social preferences of the service users must be reviewed to ensure that they are offered appropriate choices. Risk assessments of all elements of the service users’ care plans must be carried out by a person qualified to do so and Timescale for action 28/02/07 2 YA6 14(2) and 15(2) 28/02/07 3 YA7 14(2) and 15(2) 28/02/07 4 YA9 13(4) 28/02/07 85 Lodge Lane DS0000020724.V294703.R01.S.doc Version 5.2 Page 23 5 YA12 14(2) and 15(2) and 16(2)m 6 YA13 14(2) and 15(2) and 16(2)m 7 8 9 YA17 YA19 YA20 14(2) and 15(2) and 16(2)i 14(2) and 15(2) 14(2) and 15(2) 10 YA22 22(1) 11 YA23 37 12 YA33 17(2) actions identified within those assessments must be implemented. The social needs of the service users must be reviewed so that any educational or occupational needs identified can be addressed. The social needs of the service users must be reviewed so that any identified needs relating to access to the local community can be addressed. The dietary needs and preferences of the service users must be assessed. A health action plan for all of the service users must be developed. Referrals must be made to ensure that medication reviews are carried out on a regular basis. A procedure must be established for considering complaints made to the registered person by a person acting on the service users behalf. The registered person must give notice to the Commission without delay the occurrence of any allegation of misconduct by the registered person or any person who works at the home. This must be in writing. The registered person must maintain a duty roster of persons working at the care home containing enough detail to show who was present 28/02/07 28/02/07 28/02/07 28/02/07 28/02/07 28/02/07 31/01/07 31/01/07 85 Lodge Lane DS0000020724.V294703.R01.S.doc Version 5.2 Page 24 at any time. 13 YA35 18(1)(c)i Staff must receive the training necessary to maintain the health and safety of the service users and those working at the home. Staff must receive recorded professional supervision at least six times a year. The manager must obtain qualifications at level 4 NVQ, in both Management and Care. The person who carries out the visits required by regulation must not be directly concerned in the conduct of the care home. The inspection must include scrutiny of records relating to fire prevention, fire detection and hot water temperatures. Staff who are responsible for selecting, fitting and checking bed rails must receive appropriate training and bed rail assemblies should be included on a planned maintenance schedule. This requirement is outstanding from the inspection on 10/10/05. Records must be maintained that show that fire detection/warning systems are tested at appropriate intervals. Records must be maintained that show that hot water temperatures are monitored in order to DS0000020724.V294703.R01.S.doc 31/03/07 14 YA36 18(2) 31/01/07 15 YA37 9 30/06/07 16 YA39 26(2)c 31/01/07 17 YA39 26(4)b 31/01/07 18 YA42 13(4)(6) 31/01/07 19 YA42 23(4)c 31/01/07 20 YA42 13(4)b 31/01/07 85 Lodge Lane Version 5.2 Page 25 21 YA42 23(4)d 22 YA42 13(4)b maintain them at safe levels. Staff must undergo appropriate training on matters relating to health and safety. The use of hazardous substances must be risk assessed. 31/03/07 28/02/07 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 85 Lodge Lane DS0000020724.V294703.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 85 Lodge Lane DS0000020724.V294703.R01.S.doc Version 5.2 Page 27 - 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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