Inspection on 23/08/05 for Alexander House

This inspection was carried out on 23rd August 2005.

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.

Other inspections for this house

Alexander House 27/11/08

Alexander House 05/02/07

Alexander House 18/07/06

Alexander House 24/05/05

Alexander House 14/01/05

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Alexander House 140/142 Folkestone Road Dover Kent CT17 9SP Lead Inspector June Davies Announced 23/08/05 at 10:00am 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 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. Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Alexander House Address 140/142 Folkestone Road, Dover, Kent CT17 9SP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01474 833696 Nicholas James Care Homes Limited Mrs Elizabeth Lindsay Registered Care Home 44 Category(ies) of Old Age registration, with number of places Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24/05/05 Brief Description of the Service: Alexander House comprises of two large detached properties interconnected at the rear by a group of three summerhouses. The property is situated in the town of Dover, and is close to all public transport services. The home is registered to provide care for 46 elderly people, this includes three intermediate care beds. The bedrooms in the home are situated on ground floor, first and second floor. The home has five communal lounges plus pleasant sitting areas in the summerhouses. There is a paved courtyard between the two properties and a small enclosed garden to the rear of the property. Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection carried out over a period of two days and 13 hours. There were 35 residents at Alexander House during the two days of inspection. The inspector was able to speak with 10 residents, and six staff. Residents were only able to give limited information, but at the same time spoke highly of the care they received in the home. Staff morale had been low at the last inspection, mainly due to a new provider taking over the home, and staff not being certain as to what changes might take place. The inspector noted that staff morale is now improving within the home. The inspection, was carried out through observation, discussion, and evidence found in document form. What the service does well: What has improved since the last inspection? What they could do better: The home needs to improve on the reporting of personal hygiene tasks carried out, and keep clearer records on each individual care plan of external health professionals visits. All staff should undertake mandatory training, and keep these certificates up to date and the registered manager should ensure that at least 50 of staff receive NVQ training prior to end of December 2005. All new staff should receive NTO related induction, and then regular staff supervision. The home also needs to produce a quality assurance system to ensure that the standard of care is of a high quality. Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 Page 6 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. Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 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 standard(s) 1, 2, 3, 4, 5, 6. The home’s statement of purpose and service user guide are well produced. They provide residents and prospective residents with the information they need to make a decision about moving into the home. Residents moving into the home know that their needs can be met and that their independence will be maximised. Residents know that their goals and aspirations will be supported by the home. EVIDENCE: The inspector was able to view both the statement of purpose and service user guide for Alexander House, both documents contained all the information as required by this standard to enable a prospective resident make an informed judgement about the home. All new residents are given a contract of residence, which clearly states the room they will occupy, and the payment structure. The inspector was able to view the pre-admission assessments, and care plans written by the care managers together with the homes own pre admission assessment. From these assessments the registered manager will judge whether the home can meet the needs of the prospective residents. Where there is information on the pre admission assessments that the prospective resident will require external professional assistance, this will be Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 Page 9 arranged prior to admission to the home. Prospective residents are encouraged to visit the home prior to moving in, and on moving in, the first four weeks of their stay is a trial period of residence. On some occasions prospective residents will spend some respite time in the home prior to making a decision to move in. Two residents spoken to on the day of the inspection stated that they had previously had respite care in the home prior to moving in. Alexander House does have three step down beds, the residents in these beds receive support from the CART team in regard to occupational therapy, as well as input from the district nurses, general practitioners and assigned care managers. Residents using step down beds will only be in residence for a period of eight weeks. If at the end of the eight weeks they are still unable to return to their own homes, respite care can be offered elsewhere in the home. Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 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 standard(s) 7, 8, 9, 10, 11. Residents know that their personal goals are reflected in their individual plans and that potential risks are managed. There is no consistent daily report to provide staff with the information they need to meet the residents’ needs. The health needs of the residents are well met, while there is some evidence of good multi disciplinary working this needs to be recorded in more detail. Personal care is offered in such a way as to protect the residents’ privacy and dignity. The medication at this home is well managed promoting good health. EVIDENCE: The inspector was able to view the care plans of four residents in the home. The company have just produced new care plan formats. These care plans showed detailed information together with appropriate risk assessments, and charts to support the health care needs of the residents. At the end of each care plan the daily report sheets can be located. The inspector had some concerns in that personal hygiene is not recorded in detail, there was no written evidence of social interaction taking place, or any written evidence in regard to residents ability to remain independent, these daily report sheets could apply to any of the residents living in the home. There was evidence that reviews had been carried out, but there was not sufficient evidence on the daily reports sheets on which to base a review. The registered manager told Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 Page 11 the inspector that when staff, have concerns in regard to a resident’s tissue viability these are then reported to the district nurses for action to supply pressure relieving equipment. The continence promotion nurse visits and reviews residents who need continence aids, but again there is no evidence of the visits being recorded. Where necessary any residents requiring input from the psychiatrists, or community psychiatric nurses, would be referred in the first place through the general practitioner. There was evidence within the care plans that residents are weighed every month. Evidence was available via the diary that the home has a regular chiropodist, optician, dental technician and audiology visit. These visits should be recorded in the residents care plans. The inspector observed the lunchtime medication round, which was administered appropriately by a senior staff member. A check was carried out of the medication trolley and cupboard, all medications corresponded with MAR sheets, and MAR sheets were correctly signed off. Evidence was also available on the MAR sheets to show that medication is properly checked in dated and signed for. Staff, were observed during the inspection, treating the residents with respect and preserving their privacy and dignity. The inspector observed staff knocking on residents’ doors before entering, and ensuring that toilet and bathroom doors were closed when carrying out personal tasks for the residents. The induction process for staff does not comply with the NTO targets and therefore a requirement has been made for the home to introduce and nationally recognised induction programme for staff. Some of the residents have personal telephone lines in their room and the home has its own mobile phone that residents can use in their own rooms. All residents are called by their preferred name, and this is recorded on each individual residents care plan. The inspector viewed letters and cards from recently deceased residents relatives, these all spoke of staff dedication, and excellent care that these residents had received during their illness. Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14, 15. Activities and community links within the home are good and support and enrich the residents social opportunities. The meals in the home are good offering both choice and variety and catering for special diets. EVIDENCE: Residents are able to take their meals when they wish to. Most residents choose to eat at a specified time, but the inspector witnessed that residents are able to take meals later if they wish to. Two activities co-ordinators are employed at Alexander House, Monday to Friday on a job share basis. A variety of activities are offered to residents, and the activity co-ordinators write a daily report sheet for each resident. This report shows what activities the residents have taken part in. There was also evidence on the activity sheets that the co-ordinators also spend time talking to those residents who do not wish to take part in activities. Activities are also displayed on the notice boards around the home to inform residents what activities are taking place. The local Church of England visits the home for communion every six weeks, and the Ark visits the home on the last Friday of each month. The inspector spoke to one resident who attends the church of her choice every Sunday. The home has an open visiting policy, and where relatives and friends have travelled some distance they are offered lunch at the home. Residents are able to and actively encouraged to maintain there own autonomy and choice in relation to their financial affairs, but most residents choose for their relatives Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 Page 13 to take control of their finances. At the time of the inspection, leaflets were available around the home to inform of local advocacy services. The inspector viewed many of the residents bedrooms, and these showed that residents are able to bring personal possessions into the home with them. The inspector was able to view four week rotating menus, these showed that residents are offered a good variety of meals over a four week period. The inspector spoke to eight residents over the lunch time period, all the residents said that the food was very good in the home, and from observation the food looked wholesome and nutritious. Two residents said ‘that if they did not like what was offered on the menu then they could have a choice of food’. One visitor to the home said that their relative spoke highly of the food they were offered in the home. Some residents have a specialised diet. One resident has liquidised meals, and each portion is liquidised separately. Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 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 standard(s) 16, 17, 18 Residents know their complaints will be listened to and acted on. Staff have a good knowledge of adult protection issues which protects the residents from abuse. EVIDENCE: The inspector was able to see a revised complaints policy and procedure, which was also on display in the building. A copy of the complaints policy and procedure has been given to all the residents and their relatives. The home has received no complaints since the last inspection. The residents in the home are able to participate in postal voting if they wish to. The inspector was also able to see the recently reviewed policies and procedures in relation to elder abuse and whistle blowing. Four members of staff stated that they were aware of the abuse policy and procedure and whistle blowing policy. Some of these staff have, attended protection of vulnerable adults training. The inspector spoke to twelve residents and all stated that the staff, are very kind to them, and nothing is too much trouble. Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 23, 24, 25, 26. Recent investment is significantly improving the appearance of this home creating a comfortable and safe environment for those living there and visiting. Cleaning of the home is carried out to a high standard. EVIDENCE: The home has a programmed of routine maintenance which is supplied by a maintenance man. At the present time the home is undergoing extensive redecoration, with new carpets, furniture and soft furnishings on order. There is a small secure garden to the rear of the property, while this area is safe for the residents, there is a build up of dead leaves on the path way which should be cleared. There is a brick paved courtyard in the centre of the property, where residents can sit, and this area was seen to be tidy. Alexander House meet with the requirements of the fire safety officer and the environmental health officer. The inspector witnessed that there are five communal sitting areas in the home, with three conservatories, which link the two buildings. All lounges are well furnished in a domestic style. Some lounges provide a quiet space for residents to sit, while two lounges have recently purchased Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 Page 16 televisions and DVD players. The inspector witnessed during a tour of the building that the home has sufficient communal toilets and bathrooms to meet the needs of the residents. Twenty-four rooms have en-suite facilities. Disability equipment is supplied throughout the home such as specialised baths, hoists, grab rails and handrails. There are no shared bedrooms in Alexander House. All single bedrooms are of a good size, and are furnished according to the standards with domestic style furniture. All the permanent residents in the home have individualised their bedrooms with personal belongings. All rooms throughout the home are naturally ventilated. The provider is in the process of changing windows in the front of the building. All bedrooms are centrally heated, and attractive radiator covers have now been provided throughout the home. While lighting in lounges and bedrooms is domestic in style, this will be replaced during the refurbishment programme. The home has emergency lighting throughout and this is checked and recorded on a monthly basis. The inspector tested some of the hot water delivery temperatures in the home, and all were found to be delivering hot water at 43 degrees. On the two days of inspection the home was clean and free from offensive odours. While some of the communal toilets and bathrooms have paper hand towels, the inspector has made a recommendation that all communal hand-washing facilities are provided with paper hand towels. All communal toilets and bathrooms should be supplied with either pedal or swing lid waste bins and a recommendation has been made. The laundry facilities are excellent with high quality industrial washing machines and tumble driers fitted in both laundry rooms in the home. Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30 Staff morale is improving, and therefore reflecting on the standard of care provided to the residents in the home. Since the last inspection the standard of vetting and recruitment practices has improved providing a higher element of safety for the residents. The arrangements for staff induction and training needs to improve to ensure that there is a good skill mix of staff in the home. EVIDENCE: At the present time the home is not full, and there are sufficient care staff hours to meet the needs of the residents. The registered manager is aware that she continuously needs to review the staffing numbers in accordance with the needs of the residents. The inspector was able to speak to six care staff, some stated that they felt frustrated, being so busy they were unable to spend much time talking to the residents, while other staff felt that there were sufficient staff on duty to meet the needs of the residents. Domestic staff are employed in sufficient numbers to ensure a high standard of cleanliness throughout the home. The inspector was able to view the staff-training matrix, and this showed that at the present time ten staff have achieved a NVQ qualification, with another five staff who at the present time are in the process of gaining NVQ. At the present time only 16 of staff have a NVQ qualification and therefore the inspector has made a requirement for NVQ training to continue. The inspector viewed three staff personnel files all files had application forms, two forms of identification, two references (one from previous employer), and CRB checks. The staff training matrix while showing that the home offers job related training to staff, the inspector noted that not all staff hand undertaken mandatory training, or had updated their mandatory Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 Page 18 training certificates and has made a requirement that all mandatory training is kept up to date. The home does not have a nationally recognised induction programme for staff and a requirement has been made to ensure that staff undergo appropriate induction training. Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 37, 38 The management of this home is satisfactory overall, but there is a need for a good quality assurance system, and a regular environment risk assessment. EVIDENCE: The registered manager does not have NVQ level 4 or RMA but she does have many years experience of managing a home. The inspector evidenced that the registered manager has recently completed I.T. training and is about to attend Dementia Care, Nutrition in the Elderly, and Food Hygiene training. The registered manager and her deputy hold staff meetings, and resident meetings and these are recorded. Both the registered manager and her staff comply with the General Social Care Council code of practice and all new staff are given a code of practice booklet. At the present time there is no evidence of an effective quality assurance system in the home and the inspector has made a requirement for the home to work towards a system that will provide them with information as to the quality of care the home provides. The Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 Page 20 inspector was able to evidence that all policies and procedures in the home have been reviewed and updated in the last six months, the induction programme does not comply with NTO and there was no evidence that regular staff supervision takes place, while a requirement has already been made for an appropriate induction programme to be used, the inspector is making a requirement that staff receive at least six supervisions per year, and these supervisions should be recorded and signed by the staff member. The inspector viewed all policies and procedures, and noted that these have recently been reviewed. Alexander House, has good health and safety policies and procedures, regular checks are carried out on the fires system and emergency lighting, the inspector did note that the last environment risk assessment was carried out in 2004, and a recommendation is being made that this is reviewed. Evidence was seen to show that maintenance certificates in regard to equipment at the home are up to date. All resident falls are recorded in the appropriate HSE book, and the registered manager is in the process of creating a falls matrix, so that she is more able to monitor falls and when they occur. Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 2 3 2 x x 2 3 3 Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 Page 22 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 8 Regulation 12, 13 Requirement Timescale for action 1/10/05 2. 28 3. 4. 5. 6. 7. 30 30 33 36 Daily report sheets need to be more informative in regard to personal care, and visits from external health care professionals. (Previous requirement timescale of 11/02/05 and 1/07/05 18 There should be a minimum of 50 NVQ trained staff in the home to ensure that the residents are in safe hands at all times. 12, 13, 18 The home should operate NTO induction package for all newly recruited staff. 12,18 All staff to receive or renew manadatory training. 24 The home to produce a quality assurance system 18 Care staff receive formal supervision at least six time per year. 31/12/05 1/10/05 1/11/05 31/12/05 1/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 Page 23 No. 1. 2. 3. Refer to Standard 26 26 38 Good Practice Recommendations Paper hand towels are provided in all communal hand washing facilities in the home. All communal hand washing facilities are provided with either pedal bins or swing top bins to prevent the risk of cross infection. Environment risk assessment to be carried out at regular intervals. Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent TN23 1HU 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 Alexander House H56-H05 S62424 Alexander House V238616 230805 Stage 4.doc Version 1.40 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. 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