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Inspection on 05/09/06 for Abbeyfield St George`s House

Also see our care home review for Abbeyfield St George`s House for more information

This inspection was carried out on 5th September 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has dedicated, competent and well-trained staff that treats the residents respectfully. Residents are kept involved in all the decision-making in the home, both at their regular monthly meetings and on a daily basis. Staff and management listen and act upon residents` views. The home has a good admission process that includes family and friends in any assessments and trial visits, this enables prospective residents to gain the opinions of their family before agreeing to move in to the home. The home is nicely furnished and has a large conservatory and patio area in addition to its three lounges and dining area. The home is comfortable, clean, tidy and well maintained.

What has improved since the last inspection?

The call bell alarm system has now been extended to the entire home including the new hairdressing salon and upstairs lounge. The car park has been cleared of the old furniture that was stored in it. The staff sleeping-in room has been re-carpeted and a new shower fitted. Four bedrooms have been decorated and carpeted. Air conditioning has been fitted in the kitchen.

What the care home could do better:

The home could give more information to staff on the level of help required by each resident, this should be recorded in the individual care plan so that all staff know what they have to do. Staff must have clear instructions of why, how, when, what dose and how often prescribed as and when medication should be administered to residents. All staff must have up to date training in the Protection of Vulnerable Adults. The home must ensure that all employees have a satisfactory criminal records bureau check before commencing employment. Staff should receive regular supervision. All safety checks must be carried out at regular intervals and fire drills should take place at least twice a year.

CARE HOMES FOR OLDER PEOPLE Abbeyfield St George`s House Park Terrace Westcliff On Sea Essex SS0 7PH Lead Inspector Pauline Marshall Key Unannounced Inspection 5th September 2006 9:05 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 Abbeyfield St George`s House DS0000015412.V303912.R02.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. Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Abbeyfield St George`s House Address Park Terrace Westcliff On Sea Essex SS0 7PH 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) 01702 331512 01702 342893 The Abbeyfield Southend Society Limited Mrs Patricia Anne Linsell Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd September 2002 Brief Description of the Service: Abbeyfield St George’s care home provides care for twenty-five older people who do not fall within any other registration category. The home is decorated, furnished and maintained to a high standard. All personal accommodation is offered on a single occupancy basis. Twentyfour bedrooms have en-suite facilities. Each room has access to telephone and television points. The gardens are well maintained and attractive. There is parking available to the side of the building that can accommodate six cars. The home is situated in close proximity to Southend-on-Sea town centre, local community amenities and facilities. There is close access to local buses and the mainline train station to London. All prospective residents are provided with a Statement of Purpose and Service User Guide that supplies them with up to date information on the home. Fees range from £418.60 to £423.01 and there are additional charges for hairdressing, chiropodist, newspapers, telephone, toiletries and transport. Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that lasted for seven hours and twenty-five minutes. The process included a tour of the premises, a random selection of resident and staff files and discussions with residents, staff, a visiting relative and the Pat dog handler. As part of this inspection surveys were sent to eight residents, five relatives’ two General Practitioners, two district nurses and two social workers to obtain their views on the service the home provide. Seven residents surveys were returned and all were positive about the service they received. One positive survey form was returned from a General Practitioner and a relatives survey form said they were very satisfied with the helpfulness of all the care staff. No other survey forms were returned at the date of writing this report. Twenty-eight of the thirty-eight standards were inspected. What the service does well: What has improved since the last inspection? The call bell alarm system has now been extended to the entire home including the new hairdressing salon and upstairs lounge. The car park has been cleared of the old furniture that was stored in it. The staff sleeping-in room has been re-carpeted and a new shower fitted. Four bedrooms have been decorated and carpeted. Air conditioning has been fitted in the kitchen. Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 6 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. Abbeyfield St George`s House DS0000015412.V303912.R02.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 Abbeyfield St George`s House DS0000015412.V303912.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, 6 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. The home carries out a thorough pre-admission assessment of needs and provides prospective residents with sufficient information to enable them to make an informed choice. Each resident has a contract and has the opportunity to make trial visits to assess the quality of the service. EVIDENCE: The homes Statement of Purpose and Residents’ Guide provides full information on all aspects of the service that it provides. Each prospective resident is provided with a copy prior to admission. The three care files examined contained a contract and agreement to provide service and care. The manager said that all admissions are subject to a 28 day trial period where either the home or the resident may, by notice, end the agreement. Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 9 The home carries out a full pre-admission assessment and the three care files examined all confirmed this. The manager and a senior carer undertake this assessment prior to any admission. The manager said that trial visits were encouraged wherever possible and that prospective residents often had lunch or tea as part of the visit, residents spoken with confirmed this. Abbeyfield St George’s House do not provide intermediate care. Abbeyfield St George`s House DS0000015412.V303912.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The homes care plans do not include clear instructions to staff on the level of intervention required for each resident and some of the daily notes do not record sufficient information. Health care needs are recorded and met. Medication practice is good apart from the lack of protocols for the administration of prescribed as and when medication. Residents are treated with respect and their privacy is upheld. EVIDENCE: Three care files were examined that did not contain clear instructions to care staff on the level of intervention required. The review document that is completed monthly has a breakdown of the levels of need but does not show the level of intervention required. The home must have a written plan of care that shows how the residents’ needs are to be met. The need for staff to have clear instructions on the levels of intervention required by each individual resident was discussed with the manager and it was agreed that the care plans Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 11 would be amended to reflect this. Some of the daily notes were lacking in information. The care plans evidenced that residents health care appointments are arranged and details of visits to General Practitioners and any District Nurses intervention was recorded on each file. The home has a treatment room where medication is stored. Senior staff are responsible for ordering and administering medication and have all received medication training. The manager has a copy of The Royal Pharmaceutical Society of Great Britain “Administration of Medicines in Care Homes – 2003”, this document is shared with all staff who administer medication. Controlled drugs were stored separately from other medication and a separate record kept. The MARS (medication administration record) showed that PRN (as and when medication) is prescribed for several of the homes residents and that there are no protocols in place for these. As and when (PRN) medication must have clear guidelines of why, how, when, what dose and how often it should be administered. To ensure residents safety PRN protocols must be in place for all PRN medication that is prescribed. Residents spoken with confirmed that they have privacy at the home and that staff treat them with respect. Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents experience a lifestyle that matches their needs, they are encouraged to maintain contact with family and friends and have as much choice and control over their lives as possible. Residents receive a wholesome appealing balanced diet in spacious pleasing surroundings. EVIDENCE: Notes of residents meetings confirmed that a range of activities are offered both inside and outside the home. Residents spoken with confirmed that they have sufficient opportunities to participate in a variety of activities. Several residents commented on the recent bazaar that was held and said how they and their family and friends enjoyed it. The pat dog visited during the inspection and residents said they really looked forward to his visits and their pleasure when interacting with the dog was evident. Relatives and friends are able to visit the home when they wish and a visiting relative confirmed that they visit daily and that they are always made welcome and offered refreshments. Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 13 Residents meetings are held monthly and notes are kept of these. Various topics were discussed and included forthcoming events, pat dog visits, tea menu, bazaar, questionnaires, resident and staff communications and the fire drill. The fire drill is discussed at each meeting as a reminder. Residents are offered a glass of sherry or orange juice at the start of each meeting. Residents spoken with confirmed that they are able to make choices and decisions on all matters relating to them. The home offers a choice of two options at lunchtime and residents are involved in the menu planning. Should a resident require an alternative to the planned menu, the chef will always oblige. Residents spoken with confirmed that the food was excellent, good, plentiful and well presented. Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. Complaints are acted upon swiftly and all issues are taken seriously by the home. Staff requires up to date Protection of Vulnerable Adults training. EVIDENCE: The home has a written complaints procedure that is issued to all residents prior to admission and is displayed on the homes notice board. The home has not received any complaints this year. The complaints book entries from last year evidenced that action had been taken in response to the complaints recorded. The home has its own policy and procedure for dealing with Adult Protection issues and this works within the Southend on Sea Borough Councils procedure. Staff spoken with varied in their knowledge of the subject and the procedures. Some staff that have completed NVQ recently had more knowledge of abuse than others that had not. Two of the staff spoken with said they had not received specific abuse training. All staff must have up to date training on the Protection of Vulnerable Adults. Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24, 26 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Residents live in a safe well-maintained environment, they have any specialist equipment required to maximise their independence and rooms meet their individual needs. The home is clean, pleasant and hygienic. EVIDENCE: All repairs are reported to the property manager who arranges for them to be carried out. The manager said that the service has improved recently and work is being completed in a much tighter timescale and that most jobs are completed in two to three days. There are two handymen that work for the society throughout their six properties. The gardener was tidying the garden and the areas around the home on the day of the inspection. Most of the residents bring their own walking aids that they have been assessed for prior to admission, however the home has six house wheelchairs that are used and are serviced by the handyman, when necessary. The home Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 16 has two assisted baths downstairs and one upstairs in addition to a wet room (shower) and a further assisted bath with a hoist upstairs. The manager said that should residents needs change and they require further assistance with specialist equipment she would refer them to the District Nurse or the Occupational Therapist. All but one of the bedrooms at the home has an en-suite facility and each room is individually decorated with each individual persons own possessions. Residents spoken with confirmed that they were able to bring much of their own small items of furniture including small cupboards and tables as well as smaller more personal items. The home was clean, pleasant and hygienic. Two domestic staff work each day throughout the week and additional domestic staff work at the weekends. Residents, relatives and visitors spoken with commented on how nice and fresh the home is at all times. Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgment has been made using available evidence including a visit to the service. Staff are well trained, competent and supplied in sufficient quantities to meet residents needs. The homes recruitment practice is usually robust but on one occasion recently the correct check had not been carried out. EVIDENCE: The staff roster did not identify staff designation, who is in charge of the shift and it did not explain the various codes used. The manager said that this would be rectified immediately and has amended the current week in my presence. The roster showed sufficient staff on duty to meet the needs of the residents. Staff files examined showed evidence of training that has been undertaken and the manager said that more training is planned over the coming weeks. Lists of the training scheduled were on display in several of the areas that staff use. Thirteen care staff have achieved NVQ level 2 or above and all senior carers have this qualification. One of the senior carers has begun NVQ level 4 in care. Four staff files were examined and they all contained two written references. There was no evidence of induction on two of the staff files, however one of these commenced employment at the home in 1988 and the manager said that induction records were not kept at that time. The other staff file without Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 18 evidence of induction was for a staff member that had started work in November or December 2004 as a bank (as and when required) worker and had been given contracted hours on 1/2/06. All staff must have a thorough induction that meets National Training Organisation standards. All but one of the staff files contained a criminal records bureau check. A photocopy of the employees check from her previous employer was on file. The manager said that this was an oversight and she will be applying for the check without delay. All employees must have a satisfactory criminal records bureau check before commencing employment. All care staff have received moving and handling, medication, fire, health & safety, first aid and food hygiene training and some are scheduled for updates. Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38 Quality in this outcome area is adequate. This judgment has been made using available evidence including a visit to the service. The home is well managed and run in the best interests of the residents and their financial interests are safeguarded. The health, safety and welfare of the residents is promoted and protected, however some safety checks need to be carried out more frequently, including regular fire drills. Staff are supervised but need to receive the level of support and supervision as laid down in the National Minimum Standards. EVIDENCE: The manager is a State Registered Nurse of thirty-two years and has worked with the elderly for twenty-two years; she has obtained a City & Guilds NVQ Assessor award and regularly updates her knowledge and skills by attending training sessions on mandatory and service specific subjects. Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 20 The Abbeyfield Society carry out an annual survey of all of its stakeholders and is in the process of collating the information to enable them to compile a report and an action plan if required as a result of the consultation. The manager said that only part of the audit has been completed in draft form and that when it is finalised a copy will be made available to all the relevant people and to the CSCI. The home does not deal with residents’ incomes as residents and their families pay fees through direct debit to the company. The home holds a small amount of pocket monies for several residents; this money is given to the home by relatives and a receipt is given. Transaction records are kept of any expenditure and the file checked was correct. The manager said that she supervises most of the staff but senior carers sometimes supervise night staff. Four staff supervision records were examined and they contained evidence of an appraisal meeting and some supervision notes that were task orientated and looked at the areas around the individual task only. Supervision has not been carried out at least six times a year as required in the National Minimum Standards. The homes policy on supervision is the same as that laid out in the standards, therefore the home has not been keeping to either its own policy or the standards. Supervision should be carried out in line with the requirements set out in the homes own policy and the National Minimum Standards. All staff have been trained in health & safety and fire, residents are reminded of the fire procedure monthly at their residents meetings. Safety certificates are in place for the electricity and gas system. The portable appliance testing is overdue and the manager said that this would be arranged as soon as possible. There was no evidence of the water storage tanks being checked for the risk of Legionella. The manager said this will be arranged immediately and that the de-sludging of the three boilers for the house is due to be done shortly. The fire alarm system is checked weekly and the fire procedure is discussed regularly with the residents. No fire drills have taken place where staff have the opportunity to practice the actions they would need to take in the event of a fire. Regular fire drills should take place to minimise the risk of incorrect actions being taken by staff in the event of a fire at the home. Abbeyfield St George`s House DS0000015412.V303912.R02.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 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 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 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 2 3 X X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? no 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 15 (1) Requirement The registered person shall prepare a written plan as to how the residents’ needs in respect of his/her health and welfare are to be met. Timescale for action 30/11/06 2. OP9 13 (2) This refers to the need to identify in the care plan the level of staff intervention. The registered person shall make 30/11/06 arrangements for the safe administration of medicines in the care home. This refers to the protocols for PRN (as and when) medication. The registered person shall make 30/11/06 suitable arrangements by training staff to prevent residents being harmed or suffering abuse or being placed at risk of harm or abuse. This refers to the need for all staff to receive POVA (Protection of Vulnerable Adults) training. 3. OP18 13 (6) Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 23 4. OP29 19 (1) (i) The registered person shall not employ a person to work at the care home unless they have obtained all the information as required in schedule 2. This refers to the need to obtain a satisfactory criminal records bureau check before employment commences. 30/11/06 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. Refer to Standard OP36 OP38 OP38 Good Practice Recommendations The home should carry out supervision at least six times a year. All safety checks should be carried out at regular intervals including portable appliance testing and tests for Legionella in the water system. Fire drills should be carried out at least twice a year to ensure that staff and residents know what actions to take in event of a fire in the home. Abbeyfield St George`s House DS0000015412.V303912.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Abbeyfield St George`s House DS0000015412.V303912.R02.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. 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