Inspection on 12/04/06 for Ambleside

This inspection was carried out on 12th April 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ambleside 04/06/07

Ambleside 18/08/06

Ambleside 29/11/05

Ambleside 07/04/05

Ambleside 04/11/04

Ambleside 05/05/04

Similar services:

Claremont House

Coopers Mill Ltd

Sun Court Nursing Home

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

15 Bramble Close

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

CARE HOME ADULTS 18-65 Ambleside Wengeo Lane Ware Hertfordshire SG12 OEQ Lead Inspector Mrs Jan Sheppard Unannounced Inspection 12th April 2006 10:00 Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 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 Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ambleside Address Wengeo Lane Ware Hertfordshire SG12 OEQ 01920 460415 01920 466089 hilary.porter@turning-point.co.uk 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) Turning Point Southern Area Office Ms Hilary Porter Care Home 6 Category(ies) of Learning disability (6), Physical disability (1) registration, with number of places Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home may accommodate up to one person with a physical disability when associated with a learning disability. 29th November 2005 Date of last inspection Brief Description of the Service: Ambleside is a residential care home for adults with a learning and physical disability. The secluded house is large, detached and is located at the end of a private road approximately one mile from the town centre of Ware. It is owned by Hertfordshire County Council but the home is run by Turning Point Ltd, which is a voluntary organisation. The building was renovated and first registered as a Care Home in 1998. It comprises six single bedrooms, offices and a staff sleeping- in room, and has communal spaces consisting of a large hall, lounge, dining room, kitchen and activities room. The home has a well designed and accessible rear garden with a large patio accessible from the lounge. Adequate parking space is provided to the front of the building. The current fees for the residents, who are all sponsored by Hertfordshire County Council, are £511.40 per month. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of this current year and took place over one day. All the residents were communicated with using various methods best suited to each individual as none of the resident has any speech. Discussions were had with the staff on duty and with the Homes Manager. The comments in this report reflect the findings made by the inspector during that time and also take account of information gathered from the homes manager since the last inspection. Thirty two standards were examined during this inspection. The staff reported to the inspector that since the last inspection a number of improvements and changes had been made both to the fabric of the home and to its operational procedures, and confirmed that they were encouraged by these improvements which follow a long period of uncertainty due to the structural reorganisation within the Turning Point Organisation. Not all of the requirements made following the last inspection have been met. Three requirements and one recommendation are made following this inspection. What the service does well: What has improved since the last inspection? Since the last inspection many improvements have been made to the furnishings, fabric and decorations of the home and further works are in progress. These works have greatly improved the ambience of the home, which now has a light and airy appearance with attractive fresh decorative colours that contribute to the homely feel found on the day of this inspection. Staff training on NVQ level courses has now commenced and all staff now have a planned supervision meeting on a regular basis. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 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. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has polices and procedures that meet the requirements of these standards for the needs assessment of new residents and appropriate visiting arrangements for their gradual introduction to the home. EVIDENCE: These standards could not be fully inspected, as there have been no new residents admitted to the home since it opened in 1998. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6.7,8,9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The residents all have care plans but the recording of these was found not to be adequately maintained or kept up to date. EVIDENCE: The residents care plans and documentation concerning their risk assessments were found to be securely kept in the homes office where staff can access these as needed. However the care plans were found not to be well maintained with inadequate recording of changing care needs and lack of regular reviews. One plan did not appear to have been reviewed since 2003. Several plans did not contain a residents photograph. The arrangements discussed with the homes manager during the previous inspection concerning the new person centred care plan format that has been introduced by the company have not been progressed since then at Ambleside. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 10 However staff spoken with demonstrated a very good awareness of the residents care needs and spoke to the inspector of some of the recent changes in these needs for certain of the residents. Staff were also aware that their care planning records were not being maintained up to date but said that when staffing was short their priority was to give good practical care for the residents and not to spend time with written work. The home must arrange its working practices so that the staff have sufficient time to maintain care plan records on an on going basis as well as giving proper time and attention to the practical caring duties involved in meeting the residents care needs. A requirement is made that the care plans are adequately recorded with regular reviews and risk assessments updated. The arrangements for storing and accessing the residents confidential information were seen to be properly maintained in the homes office in locked cabinets. Staff were heard to consult with the residents asking them about their choices and using their knowledge of their individual communication skills to interpret their wishes. The records of the residents meetings also evidenced that the staff spend time discussing and describing plans, changes and arrangements within the home concerning its routine with the residents in an inclusive manner. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The residents all have day centre activity programmes, which offer them the opportunity for personal development alongside peers of a similar age and ability. The home frequently participates in activities and events held in their local community. A nutritious and varied menu, chosen by the residents and supervised by a dietician, is offered with fresh ingredients and home cooking being provided on a daily basis. EVIDENCE: The residents all attend day centre activities for three and a half days each week. Since the last inspection their day activity needs have been reviewed with their social services representative and some adjustments so that programmes better meet individual needs have been arranged. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 12 The manager reported that these new arrangements are now working well. She mentioned that for one resident who is wheelchair bound but who likes to be out in the open air, further changes involving the use of direct payments monies to enable him to have one to one care whilst being taken out into the community, are being planned .The problems with insufficient van drivers noted during the last inspection have now been resolved and the manager said that new staff would be required to have driving abilities for the homes transport. The inspector noted that some of the residents bedrooms contained evidence of their artwork this completed at their day centre classes. The staff discussed with the inspector arrangements that are planned for the residents holidays to be taken during July, August and September. The residents go in small groups either two or three and one prefers to holiday alone. Locations chosen include a Worcestershire farmhouse and a holiday centre in the New Forest both these locations have swimming pools, which are said to be very much appreciated by the residents. The improvement in social skills noted for one resident following her holiday last year have been maintained since then and the staff expressed their amazement at this achievement after so many years and discussed their efforts to ensure that this improvement is maintained. The home has a programme of local activities and events in their near neighbourhood where visits and outings are planned during the summer months. The home also plans their own BBQ Garden Party event with invites to relatives and near neighbours. All four residents who have relatives and friends maintain contact with them, three families being able to visit regularly .One parent was visiting from Holland on the day after this inspection and staff commented that similar visits are made by another USA based parent several times a year. The manager described the various methods that are used; written cards, telephone calls and e-mails to ensure that this regular contact is maintained with all families and friends. The homes menus evidenced that a varied nutritious diet is offered with fresh ingredients being home cooked each day. A large bowl of fresh fruit was seen in the kitchen along with low fat yoghurts and semi skimmed milk in the fridge these indicating the homes approach to following a healthy eating routine. The dietician continues to visit every three months to supervise menu planning and to monitor the residents weights. Staff spoke of the help and assistance that they had received in managing the semi-liquid diet required by one resident. Records of what food is actually consumed by the residents are maintained along with the weekly chosen menu. The records showed that the home, with the dieticians assistance, had drawn up a guideline for the fluid intake for one resident when he attends day care centre for the whole day and for who a very small change in his dietary routine can result in vastly fluctuating behaviour patterns and upset for him. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 13 A daily choice of meals is offered to accommodate the various preferences and tastes of the residents. Since the last inspection a new fridge freezer has been fitted in the kitchen. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Personal care and health care offered to the residents continues to be of a good standard. The home has a robust medication storage and administration system, which meets the requirements of this standard. EVIDENCE: Personal care was seen during this inspection to be being delivered to the residents in a kind and understanding manner by staff who clearly understood their care needs, both physical and emotional and had developed various non verbal ways of communicating with them all. Many of these staff have worked with these residents for many years and have an in-depth understanding of their care needs and of their varying moods and can interpret their wishes as to how these needs should be met on any particular day. The home benefits from having well established professional working relationships with their local GP, the community nursing teams and with various specialist consultants at the local hospitals this ensuring that any changing health needs of the residents can be quickly met. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 15 There have been no changes to the homes medication administration system since the last inspection. The local supplying pharmacist carries out regular audits to check the management of the system within the home. The homes manager carries out regular checks as to the accuracy of the medication administration records and checks made on the day of this inspection found them to be properly recorded Since the last inspection a small medication fridge has been installed and liquid medication and other medications were seen to now be being stored at the correct temperature. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home has a complaints policy and procedures and also has policies and procedures concerning Adult protection and Whistle Blowing, which follow the guidelines given in the Hertfordshire Adult Protection Joint Agency procedures. EVIDENCE: There have been neither complaints nor any incidents concerning adult protection since the last inspection. Staff were aware of their obligations concerning these areas and of the importance of them remaining diligent in keeping awareness for any non verbal signs of distress or concern that may be exhibited by the residents. Several of the staff have undertaken refresher training concerning adult protection since the last inspection. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26, 27, 28, 29 and 30 Quality in this area of outcome is adequate. This judgement has been made using available evidence including a visit to the service. The environmental standards of this home have improved since the last inspection. Further works as identified by the homes manager are in hand. On the day of this inspection the home was found to be clean and hygienic and to have a pleasant and homely appearance. EVIDENCE: On the day of this unannounced inspection the home, Ambleside, was found to be very well presented, clean tidy and to have a homely atmosphere. Paving works recently completed to the homes driveway have considerably improved the external appearance of the home and a number of tubs with flowering spring flowers have given further improvement. The manager explained that works to repair the broken perimeter fence panels, smashed in a recent gale, have been agreed. The works to complete the internal decorations of the communal rooms, the lounge, and the hallway sitting areas, the kitchen and dining room are now finished. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 18 Many of the residents bedrooms have also been redecorated and items of new furnishing, beds cupboards carpeting and soft furnishings have also been provided. The staff discussed with the inspector the plans to complete the refurbishment in two of the residents rooms where detail items remain outstanding. The residents all have single bedrooms, which are light and spacious; they contain suitable equipment to meet their needs and to promote their independence and are styled and decorated in a manner that reflects their tastes and interests. Staff said that two of the residents had family members who had given help and assistance with the refurbishment of their rooms. On the day of this unannounced inspection the home was found to be clean and tidy and to be free from any malodours. However it was noted that all the wash hand basins in the residents bedrooms required to be de-scaled to remove the build of green-blue limes scale marks and a repair is needed to the ground floor bath where rust is accumulating around the hoist joint area. Since the last inspection a new fridge freezer has been installed in the kitchen and staff told the inspector that the efficiency of the new commercial washing and dryer machine in the laundry area is greatly facilitating the constant washing process within the home. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34,35 and 36 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the home. The home continues to retain a stable core group of experienced staff who work very well together as a team and are particularly dedicated to offering the best possible care to their vulnerable residents. The home needs to recruit staff to its three vacant permanent posts. EVIDENCE: On the day of this unannounced inspection the staff numbers on duty tallied with the planned duty rota. The home continues to carry three permanent staff vacancies with this current shortfall being covered by regular agency staff, (several of whom have worked at the home for over two years, thereby giving continuity of care to the residents). No staff have left since the last inspection; Following a recent Recruitment Fair the resulting numbers of applications has been most encouraging. Several of these prospective applicants, who were visiting the home on the day of this inspection, spoke with the inspector and proved to be existing carers some with considerable work and training experience with this client group. The existing staff group were clearly very encouraged at the prospect of having additions to their ranks of permanent staff. The home has the required recruitment policies and procedures to ensure that residents are supported and protected. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 20 As no new staff have been appointed since the last inspection it was not possible to fully inspect these. The manager discussed with the inspector how to best record and file the required information for each member of staff. Since the last inspection 5 of the care staff have commenced the NVQ level 2 qualifying course. Several spoke to the inspector about these studies. A number of other training courses have been attended including Food and Hygiene, Skip training, First Aid Adult Protection and Fire Safety training. Planned supervision meetings for all staff have also been set up since the last inspection and annual appraisals have been planned. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39, 42 and 43. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the home. The manager and staff team continue to endeavour to run this home well with the best interests of the residents constantly in mind. Since the last inspection their employing organisation, Turning Point, has made improvements with their management routines but further improvements are still needed to enable them to fully meet the requirements of the Care Standards Act and to adequately support the Homes manager and staff. EVIDENCE: Since the last inspection the Homes manager has been registered on an NVQ level 4 course and is to commence these studies in September. The home is fortunate in retaining its manager and staff through these recent difficult years for this consistency gives continuity of care for the residents and has resulted in a very loyal dedicated and very close working staff team. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 22 Staff spoken with by the inspector all had a much more positive outlook than they did at the time of the previous inspection. All staff also continued to speak very positively about the help and support given to them by the homes manager, “ without her help we just could not have kept going”, one said. The requirement made at the last inspection concerning the monthly unannounced management visits as required under Section 26 of the Act has not been met. Only one such visit made in February 2006, could be evidenced. A further requirement is made. The manager said that despite this visiting deficiency, her immediate line manager is supportive to her and is readily available by telephone for consultation whenever needed. The home could not evidence that any Quality Reviews or Satisfaction Questionnaires have been sent to the residents or to their relatives. The manager thought that the company carried out such reviews centrally but no results specifically concerning Amble side were made available to them. The manager discussed with the inspector plans that she has for commencing small local quality surveys for the residents relatives and for local stakeholders in the home. A requirement is made. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 3 3 3 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 1 x x 3 1 Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15.2(a)&(b) Requirement The resident’s Care Plans must be fully recorded and maintained up to date and be subject to regular reviews. Timescale for action 30/06/06 2. YA39 24(1)(a)&(b) The home must establish routine quality checks the results of which can be evidenced in the home. 26 It is a requirement that unannounced monthly visits are made to the home by the registered provider and that a report of these visits is sent to the CSCI This requirement is out standing from the previous inspection . Further action will be taken if this standard is not met. 31/08/06 3. YA43 31/12/06 Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 25 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 YA30 Good Practice Recommendations It is recommended that renovations are made to the bedroom washbasins that are disfigured by lime scale marks and that similar repairs are made to the small area on the assisted bath that has become rusty. Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Ambleside DS0000019267.V293519.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!