Inspection on 24/04/07 for Aaron Lodge

This inspection was carried out on 24th April 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Aaron Lodge 14/04/09

Aaron Lodge 09/10/08

Aaron Lodge 25/10/06

Aaron Lodge 17/10/05

Aaron Lodge 24/05/05

Aaron Lodge 05/01/05

Aaron Lodge 20/05/04

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

CARE HOMES FOR OLDER PEOPLE Aaron Lodge Marmaduke Street Liverpool Merseyside L7 1PA Lead Inspector Debbie Corcoran Unannounced Inspection 24th April 2007 10:00 X10015.doc Version 1.40 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 Aaron Lodge DS0000025077.V340032.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 Older People. 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. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Aaron Lodge Address Marmaduke Street Liverpool Merseyside L7 1PA 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) 0151 261 0005 F/P 0151 261 0005 Aaroncare Limited Paula Marie Gamble Care Home 48 Category(ies) of Dementia - over 65 years of age (48) registration, with number of places Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home may accommodate up to 48 DE(E) Personal Care. The home may admit two persons DE Personal Care between the ages of 55 and 65 within the total of 48 beds. The Service must employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. The home may admit 5 persons under the age of 65 years. Date of last inspection 25th October 2006 Brief Description of the Service: Aaron Lodge is registered to provide personal care to 48 elderly people who have an age related mental health condition. Aaron Lodge is a purpose built home. Each resident has a single bedroom. Bathrooms and toilets are situated on both floors. Each floor has a dining area and a lounge. There is a private enclosed garden to the rear of the home with patio furniture. Parking is also available at the rear of the building. A lift and bathing aids are provided. There is access to a bus service from the home. The home is close to local shops and amenities. The city centre is approximately 10 minutes away by public transport. The range of fees for residing at the home are between £385.00 and £415 per week. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection visit was not announced beforehand. Throughout the day the inspector met with a number of residents on an individual basis and spoke with the regional director in the manager’s absence. A tour of the premises was carried out and a sample of resident’s rooms were viewed. Records were examined and these included the care plans for four of the residents, medication records, staff files, staff training records and health and safety records. What the service does well: The overall findings of this inspection were good and most some aspects of the service have been judged as such. Service users were positive about all aspects of the home. Service users comments included “I love it here “, “Paula is very kind, she’s done a lot to help me” and “staff are very good and they’re lovely”. New residents are only admitted to the home following an assessment of their needs. This is to ensure the home has sufficient information so as to determine if the person’s needs can be appropriately met. Each of the service users has a care plan which gives a sufficient level of information on how to meet the person’s needs. These include information on needs such as personal care, health, medication, emotional support, social and recreation. Service users are well supported with their health care needs and are supported to see a GP, nurse or other relevant health professionals when appropriate. The catering arrangements are well organised and most residents who were asked were satisfied with the quality of food and meals provided and with the choice of meals. The home is well presented internally and is comfortable, spacious and welcoming. Aids and adaptations are in place to promote the independence of residents and to ensure staff carry out safe practices when assisting residents with moving and transferring. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 6 Resident’s bedrooms are nicely presented and furnished with many of their personal belongings. Staff were seen to interact with the service users with warmth. Staff are provided with good training opportunities and many staff have attained or are close to completing a relevant qualification. The home appears well run and well organised. The manager wasn’t available on the day of the visit but all feedback on her skills to manage the home and on her qualities was very positive. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Resident’s needs are assessed before they move to the home to ensure that their needs can be met. Residents are provided with information on the home and have the security of a signed contract for services and facilities provided at the home. EVIDENCE: The home has a statement of purpose and service user’s guide. This provides an adequate amount of information to inform prospective residents as to the services and facilities provided at the home. The files for a number of residents were looked at in order to assess the home’s referral and admissions procedures. An assessment of needs was in place for each of the residents chosen. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 9 The assessments had been carried out by a member of staff at the home and in addition to this assessment information is attained from relevant professionals for example from care managers. A new assessment format has been introduced since the last inspection visit. This allows for detailed recording of residents needs with regard to their mental health. The new assessment was noted to have been used for one of the most recently admitted residents. Each of the residents has a signed and dated contract of residency with the home. This describes the services and facilities offered to the person. These are signed by a representative of the resident where this is appropriate. Standard 6 is a key standard to be assessed however the home provides long term care and does not provide intermediate care. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents care plans generally provide an appropriate level of information, however, some care plans need to be developed to include guidance on supporting residents who are at risk. Residents are appropriately supported with their health and medication needs. One of the routines of the home is compromising the resident’s dignity. EVIDENCE: Each of the residents has a care plan. Care plans include information on issues such as the residents needs with regards to their personal care, their psychological needs, mental health needs, maintaining safety, nutrition, behaviour, diet and fluids. The care planning was looked at for four of the residents and these generally included a good amount of information on how to meet the person’s needs. However, the care needs of two of the residents were discussed in some detail, as their needs were not fully reflected in risk assessments and in their care plan. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 11 The manager must review the risk assessment and care plan for one of these residents to ensure that there is sufficient information on supporting the person with their nutrition. Staff are supporting the resident in question with nutrition but the details of this are not recorded as part of their care plan or risk assessment. The manager should also ensure that residents are being weighed on a regular basis when their nutrition may be compromised. The risk assessment and care plan for another resident failed to identify an adequate amount of information on what the risk to their health or safety was and how to manage the risks. This related to the person’s behaviour and this could compromise the safety and well being of other residents. There was no reference to these issues in the resident’s care plan. The details of this were discussed during the visit. The manager has since addressed this issue and provided confirmation of this to the Commission. Other risk assessment information was generally good and risk assessments are reviewed and updated on a regular basis. Risk assessments cover issues such nutritional needs, moving and transferring needs and supporting residents with their behaviour. Residents are well supported with their health needs. Staff record when a resident has seen a GP, nurse or other health professional. Resident’s care plans include information on their health and a record of health related visits or appointments. Staff were observed to be warm and respectful towards residents and residents gave good feedback on the qualities of care staff. It was noted however, that the dignity of some of the residents may have been compromised by the routines of the home in that a number of male residents were sitting in the communal lounge close to lunch time in their night attire waiting for staff to support them to have a bath. This has been discussed with the manager and the manager has agreed to review the arrangements for supporting the residents with their personal care. The manager explained why this may have been the case and some of reasoning behind this relates to trying not to confuse residents by supporting them to get dressed and then later supporting them to have a bath. The manager needs to review staffing levels so as to ensure staff are working in sufficient numbers to meet the needs of the residents in a timely manner. The medication storage and adminstration was checked in general and in some detail for a number of residents. Overall the medication seems to be managed well. There were however a number of areas which need to be addressed. For one of the residnets there was duplicate information recorded on their medication administration records. Medication was then being signed for on both records. The correct dose of medication had been given but staff were signing as having administered some of the medication twice. As identified at the last inspection, staff are not double signing hand written entries on medication administration records. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 12 There were also a number of occassions when staff have not signed the medication administration records. All staff who are responsible for the administration of medication have been provided with training in this. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to be involved in activities. The quality of meals is good and residents are provided with a varied and wholesome diet. EVIDENCE: Records and discussions with residents and staff have shown that the residents are supported to be involved in activities. An activities coordinator has been employed since the last inspection visit and this person has introduce a greater variety of activities including some one to one activities and some group activities. Regular activities include sing a longs, films, music, arts and crafts, foot spas, reminiscence, weekly tea dance, bingo, karaoke, daily exercise, scents therapy and games. At the time of the visit four of the residents were having an arts and crafts session at a local community resource and the activities coordinator said that he is hoping to expand the level of community activity and participation for residents. In the afternoon an entertainer was at the home. Residents and relatives meetings are being used as an opportunity to decide on the types of activities which are being offered. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 14 The activities coordinator reported that they are trying to involve each resident in activities in some way and has arranged for some one to one activities with residents who choose to spend their time in their room. Residents are supported with their spiritual and religious needs. Religious services take place on a regular basis in line with the religious and cultural needs of the residents. Resident and relative meetings were reported to take place on a regular basis. A seasonal newsletter is made available to residents and visitors. Key pieces of information were seen to be signed as agreed by residents or their representative, such as care plans and contracts and this indicates that consultation is taking place. To assess the meals and food provided many of the residents were asked their view on the food and the catering arrangements were checked. Residents were seen to be given a choice of the main meal of the day, which was served at lunchtime, and they are also given a choice of lighter meals for their evening meal. Residents have the choice of a cooked breakfast 7 days per week. The menu was checked and this looked varied and wholesome and many of the meals are cooked from fresh ingredients. The kitchen was checked and there was a good supply of fresh food and fresh vegetables. The cook was aware of the dietary needs the residents. The majority of residents gave good feedback on the meals provided. One of the residents said that “the food is very nice“. The presentation of the dinning rooms and experience of mealtimes has been improved since the last inspection. Tables are now set with place mats and there are menus on the table. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies, procedures and practices are in place for dealing with complaints and for aiming to protect residents from abuse or neglect. EVIDENCE: The home has a complaints procedure which is time scaled appropriately and includes contact details for the Commission. A log of complaints is maintained. This indicates that complaints are appropriately investigated and responded to. The home has an Adult protection procedure. This procedure provides information on adult protection and responsibilities for contacting relevant authorities. Staff have been provided with in house training in adult protection. Staff sign confirmation that they have been provided with a copy of adult protection procedures. Appropriate checks are carried out before staff start working at the home. This is to protect residents from potential abuse. Accident records were checked. It was reported that accidents records are reviewed on a weekly basis and audited on a monthly basis and action is taken when a risk has been identified. The accident records showed that a senior member of staff had not accurately recorded a recent incident involving two residents. The manager needs to address this and ensure that accident records are completed appropriately. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a home which is well maintained, safe and comfortable. Resident’s are encouraged to bring some of their own belongings to personalise their bedrooms. EVIDENCE: A tour of home carried was out in assessing the home environment and this included all areas of the home. The home feels welcoming and it is well presented. The home has a number of lounges and there is a dinning room on each floor. All furnishings and fitting were of a good standard. Residents who have difficulty with their mobility access the first floor by using a passenger lift. Aids and adaptations are in place to enable residents to remain safe and have full use of facilities in the home. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 17 The home is purpose built and each resident is provided with a single room. Residents bedrooms were viewed and the standard of decoration and furnishings in all of the rooms was good. Residents are encouraged to bring personal belongings to keep in their rooms and the rooms are therefore personalised. The home was presented as clean and hygienic and there are sufficient domestic staff. The staff adopt safe working practices so as to safeguard residents and themselves. Regular checks are carried out on the home environment ensuring that all areas are safe and well maintained. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff numbers may not be sufficient to meet the needs of the residents at all times. Residents are supported by trained and qualified staff. Staff and residents were seen to interact with each other with warmth. EVIDENCE: Staff have been provided with a number of training opportunities since the last inspection visit including training in protection of vulnerable adults, fire safety, food hygiene and moving and handling. The manager provides in house training for an number of topics including supporting people with dementia care needs. The manager reported that there are 26 members of care staff. Of these 9 have attained a N.V.Q (National Vocational Qualification) level 2 in care and a further 9 members of staff have completed the course and are awaiting confirmation that they have passed the certificate. This means that the target of 50 of the care staff to have attained a relevant qualification should be met in the very near future. There were 6 members of care staff on duty for the duration of the inspection. Staff are divided between the 2 floors so that each floor has 3 care staff supporting 24 residents. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 19 This is a ratio of 1 member of staff to 8 residents. During the visit and certainly for the early part of the day staff were observed to be very busy on each floor and there was a period of time when there was minimal staff presence in the main lounge on the ground floor. The staff roster shows there are occasions when there are only 5 members of staff on duty and the manager is regularly included in the care staff levels. The staff rota also shows that between 8pm and 8am the staffing levels are reduced to 2 care staff. This means that from 8pm there is a staffing ratio of 1 care staff to 12 residents. Issues regarding supporting residents with their personal care in a timely manner have been identified under the ‘health and personal care’ section of the report. Given some of the findings of the inspection visit the manager is required to review the staffing levels and ensure that staff are provided in such numbers so as to ensure the residents needs can be safely and effectively met. Staff files were checked in order to assess the recruitment and selection procedures adopted at the home. These showed all pre employment checks are carried out appropriately in order to safeguard residents. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run in the best interests of the residents. Staff feel well supported but are not being provided with regular supervision meetings. Residents are surveyed on the quality of the home and regular checks are carried out on procedures and on the home environment. EVIDENCE: The manager holds a relevant qualification and has worked at the home for a number of years. Staff and residents gave positive feedback on the manager and there seems to be good working relationships across the staff team and between the manager and care staff. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 21 The home is well run in the best interests of the residents. There is a quality assurance process which includes surveying residents and their relatives on the quality of the service provided at the home. The arrangements for supporting residents with their monies was not assessed on this occasion due to the absence of the manager. Arrangements should be made to ensure that residents have access to their monies in the manager’ absence. Staff records show that staff have the opportunity of a one to one supervision meetings. However the frequency of these meetings needs to be reviewed so as to ensure that supervision is regular and up to date. Supervision meetings are referred to as ‘clinical supervision’ and sessions appear to be very focused on a specific issue. The manager should review the arrangements for supervision so as to ensure that supervision meetings cover a range of issues, areas of practice and staff development needs. Health and safety policies, procedures and practices are in place to safeguard the well being of residents, staff and visitors. Health and safety records were checked and found to be up to date. Fire safety records were not located on the day of the visit but were forwarded to the Commission by the manager following the visit. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 2 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X 3 X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 X 3 Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 13 (4) (c) Requirement Timescale for action 07/06/07 2. OP10 12 (4) (a) 3. OP9 13 (2) 4. OP27 18 (1) (a) Any risks to the health and welfare of residents must be identified and appropriate care planning must be made to manage the risks and promote the health and well being of the residents. Arrangements must be made to 24/05/07 ensure that residents are supported with their personal care in an appropriate and timely manner so as to ensure their dignity. Mediation administration records 24/05/07 must be maintained accurately at all times so as to ensure the safe administration of medication to residents. Staffing levels must be reviewed 07/06/07 to ensure that the resident’s needs are met effectively and safely at all times. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 24 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 OP35 Good Practice Recommendations The manager should make arrangements for residents to have access to their money in her absence. Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Aaron Lodge DS0000025077.V340032.R01.S.doc Version 5.2 Page 26 - 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!