Inspection on 01/04/08 for Andrin House

This inspection was carried out on 1st April 2008.

CSCI found this care home to be providing an Adequate service.

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

Other inspections for this house

Andrin House 22/04/09

Andrin House 02/04/07

Andrin House 19/04/06

Andrin House 05/09/05

Andrin House 18/04/05

Andrin House 27/09/04

Andrin House 05/04/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Andrin House 43 Belper Road Derby DE1 3EP Lead Inspector Brian Marks Unannounced Inspection 1st and 2nd April 2008 9.00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Andrin House Address 43 Belper Road Derby DE1 3EP 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) 01332 346812 F/P 01332 346812 enquiries@andrinhouse.fsnet.co.uk Rosecare Homes Limited Vacant Care Home with nursing 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd April 2007 Brief Description of the Service: Andrin House is a 37 bedded care home with nursing for older people, situated in a residential area close to the city centre of Derby. The property was originally a private dwelling, which has been extended and converted into a care home. Residents’ bedrooms are located on the ground floor and first floor, and are accessed by lift and staircase. Three bedrooms have en suite facilities and there are four communal rooms for the residents to use, including a room for people who smoke. Support services are in place with a choice of GPs, chiropodist, dentist and optician. Nursing services are provided as part of the care of the home and additionally Community psychiatric nurses, occupational therapists, physiotherapists and dieticians are accessed as required. Information provided by the service in April 2008 stated that the fees ranged from £309 - £426 per week. Details of previous inspection reports can be found on the Commission for Social Care Inspection’s website: www.csci.org.uk Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This was a Key unannounced inspection that took place at the home for nine hours over two days. Additionally, time was spent in preparation for the visit, looking at key documents such as previous inspection reports, records held by us and the written annual quality assurance assessment document (AQAA), which was returned before the inspection. This allowed for the preparation of a structured plan for the inspection. At the home, apart from examining documents, care files and records, time was spent with the acting manager of the home, who was in charge during the visit, and talking with two of the nurses and six of the staff working on the day shifts. The care records of four people who live at the home were examined in detail and all of these were interviewed along with four others who were living there on the day of the inspection. A number of relatives who were at the home during the inspection, and another who telephoned us before the inspection and the care manager of one of the people living at the home, were also spoken to. For administrative reasons no written survey forms were sent out to the home’s staff, its’ residents and their families before the inspection. No other inspection visits have been made to the home since the last Key unannounced inspection 2 April 2007. What the service does well: Andrin House provides a comfortable, relaxed environment for the people who live there, and people are encouraged to personalise their rooms with their own possessions and furniture. Residents’ social and recreational needs are addressed by staff, and people living at the home are encouraged to join in; the importance of maintaining links with family, friends and the community is also recognised and supported. Residents are generally positive about the meals provided at the home, and they stated that they were provided with choice and variety; they have been able to influence choices and style of food available following consultation at a recent residents’ meeting. Similarly most residents were positive about the standards of cleanliness and hygiene around the home. All residents have well prepared care records and these are looked at regularly to make sure that the care being provided is up to date and consistently Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 6 applied. They demonstrate that residents’ needs have been identified and that staff work hard to ensure their needs are being met. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People do not come to live at the home without the care they need being identified, but little information is obtained about their social world, which would help the home’s staff to support and view them more as individuals. EVIDENCE: Four resident care files were looked in detail at this inspection and all had information about the person taken at the time of admission, including an assessment of their care needs that had been undertaken by a senior member of staff from the home. For people coming to the home from hospital information was given about specific healthcare issues and additional information was sought about difficult areas such as problems with mobility, falls, continence and nutritional requirements. Although all of the care records looked at contained a completed description of the persons interests and activities and a ‘Map of Life’ describing their past history, these were very brief and contained little information about their strengths or achievements. Those relatives spoken to stated that their relatives’ needs were generally met; this Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 9 was also confirmed by the residents spoken to, although there was variation in the amount of enthusiasm expressed about the quality of care overall. The home does not offer an intermediate care service so Standard 6 does not apply. Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care arrangements are planned and generally delivered safely and consistently, but not always in ways that respect each resident’s individuality. EVIDENCE: All residents have their own file containing care records and four of these were looked at in detail during this inspection. The care plans in place focus on the specific areas where each individual needs help, and areas of healthcare need were described in detail. They are linked to the assessments made earlier, when people come to live at the home, and are further supported by assessments of risk areas and ways these are managed. All elements of the care plans documents had been looked and evaluated monthly and visits by General Practitioners and chiropodists are also recorded, as well the occurrence of hospital appointments. However the style of the care plans is very focussed on people’s needs along with the tasks staff carry out to meet them; the absence of significant content that relates to people’s abilities and their social world has resulted in a style of care that is not ‘person centred’ nor individualised. Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 11 This latter concern was borne out by the comments received from people living at the home and particularly some of the relatives spoken to. Most people were generally satisfied with the standard of care and one spoke of how happy he was to have come to live there earlier this year and how he has ‘really been made to feel at home’. Another described how ‘attentive staff had been and how mindful they are about my difficult eating problems’ and another, who had problems with movement, described how staff had worked hard to get the use of equipment right for her. However others described problems that were not in themselves major concerns but build up to present a more negative and insensitive approach to providing care: ‘The labelling on her clothes is very visible and doesn’t look very nice’. ‘She’s only been here a month and twice she’s been served with lunch that is cold’. ‘After a while the food gets to be very much the same’. ‘The commode is not emptied regularly and the room and bedding not cleaned regularly’. Before the inspection a relative described a situation where the room of her relative had been decorated with him still sitting in it, and lack of sensitivity in care methods is further demonstrated by the way baths are arranged for residents, as observed during the inspection. Very few residents look after their own medication so the medication administration record (MAR) charts for four residents were specifically examined and systems for storage, recording and administration of medicines on their behalf were satisfactory at the time of this visit. Handwritten sheets were properly signed and dated, the controlled drugs record was satisfactory and medicines with short life spans such as eye drops were labelled with date of opening and stored appropriately. Arrangements in the clinic room for managing additional equipment is satisfactory and the manager took delivery of new blood testing machines for each individual with diabetes during the inspection. The home also had its own policy on dealing with medication. Andrin House DS0000002150.V361556.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities for people living at the home to engage in leisure and social activities are organised, and generally they enjoy a life that suits them. EVIDENCE: Social activities are now organised by an Activities Coordinator and she involves herself with residents in small and large groups every day; on the day of the inspection she was on sick leave so no organised activities took place. The manager reported verbally, supported by residents, that these included movement to music, quizzes, games and bingo and musical entertainment is also provided. There were no written records available to show what had actually taken place and when, nor how these activities linked to the needs of residents. Staff were observed to be talking to residents on a one to one basis during the day but there were periods of time when no contacts were made and one relative observed that there was still little stimulation for those residents who had difficulty participating in activities or who were more frail and dependent. Most of the residents spoken to said they had their own routines, and quite a number were seen to spend time in their own rooms, choosing whether or not to join an activity. Bedrooms were personalised with residents’ individual Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 13 possessions. Staff and residents confirmed that visiting time was open and all relatives and friends were welcomed at the home and a number of visitors were observed to be calling at different times throughout the day of the visit. A brief visit to the kitchen indicated that purchasing, storage, stock managing and cooking arrangements in the kitchen are satisfactory, but also that there were no regular menus in place. Food served daily is recorded in the kitchen diary and this indicated that a reasonable variety, with options, has been served for lunch. Most residents were positive about the variety and quality of the food at the home, although one long-term resident commented that it was ‘samey and repetitive’ and another complained that her lunch had been served cold twice in the past month. There are no kitchen staff on duty for teatime arrangements and care staff serve sandwiches and cakes prepared earlier or occasionally serve a hot snack. These were described a being repetitive by one relative. Records were not clear whether a further snack meal was available during the evening. The serving of the midday meal was observed and those residents’ requiring help with eating were assisted by staff in a sensitive manner and the people needing special diets were catered for. Andrin House DS0000002150.V361556.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home responds to complaints made by residents and their representatives according to a written procedure, and aims to protect residents from harm. EVIDENCE: The complaints record was examined and showed that five complaints had been received at the home over the previous year and these had been looked at properly. Those relatives and residents spoken to said that they would contact the manager if they had any concerns and were confident of being listened to. The manager also stated that she preferred to deal with problems as they arose and the revival of regular meetings for residents and relatives had allowed for issues to be raised with her direct. There had been no formal complaints received at the office of the Commission for Social Care Inspection during the past year. Safeguarding vulnerable adults procedures are in place and the home has a copy of Derby and Derbyshire Statutory procedures. Staff records indicated that all staff had received update training during the past year and two members of staff spoken to confirmed that they had done this. Staff spoken to were aware of their responsibilities in relation to safeguarding adults and reported that there had been no incidents of use of the statutory procedures during the past 12 months. Andrin House DS0000002150.V361556.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, well-maintained environment and standards of cleanliness and hygiene are usually satisfactory. EVIDENCE: From a brief tour of the building it was seen that the home is generally well maintained and the manager reported improvements made since the last inspection: Better maintenance of the outside of the home with the installation of security lighting. Redecoration of the hall and entrance to the home. Redecoration of the communal rooms and the provision of new dining chairs and tables. Provision of new armchairs to the bedrooms where residents needed them. Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 16 A recent visit by the Environmental Health Officer had identified two items for attention in the kitchen that had been carried out. There has been no recent visit by the Fire Officer. The laundry was tidy and the washing machines have a sluice wash facility. Infection control procedures were in place and records indicated that staff have continued to receive update training in this subject. On the day of the inspection the home was clean, tidy and free from odours and most of the residents spoken to had no complaints about the laundry service; all residents observed in the home wore clean and well-presented clothing. However one relative commented on the standards of hygiene in the bedroom and another about the personal labelling of clothing. (See above). Andrin House DS0000002150.V361556.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides an adequate level of staffing which supports a safe environment in which people live, but shortfalls continue in the key areas of recruitment and training that undermine this. EVIDENCE: Staffing provision at the home has continued to the same level as at the last inspection and whilst a number of residents and relatives said that sometimes staff were very busy, they did not view the numbers of staff on duty to be lower than was required to meet the needs of the people living at the home. All of the staff spoken to said that they felt they received regular access to training and that this had increased during the past year – ‘the manager is very keen on getting us through training, we seem to be doing it all the time’. Records and notices in the staff office indicated that update training had occurred in the key subjects of safeguarding vulnerable people, safe moving and handling and fire safety but that there are shortfalls in training about managing infection and emergency first aid and not all staff who are assigned to prepare the teatime meal have had proper instruction in safe food handling and hygiene. A small number of staff have had further training in more specialist subjects such as catheter care and managing epilepsy but little has been done to make staff aware of how to properly meet the needs of people in their care with dementia. Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 18 Good achievements have been made in helping staff gain a care qualification and eight out of sixteen have the National Vocational Qualification level 2 with five more to be completed later this year. This means that the home had achieved the target of having 50 of care staff qualified to Level 2. The recruitment documentation of the two most recently appointed staff were looked at and, although a systematic approach was in evidence and documentation indicating a preliminary cheek on criminal records had been made, evidence of the full checks was not available. Additionally one file contained only one written reference and the other had none. Andrin House DS0000002150.V361556.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is without a Registered Manager at present and there have been failures in meeting the overall quality standards that people living at the home and their families can expect to be provided. EVIDENCE: The previous Registered Manager of the home left soon after the last inspection and the deputy manager has been acting to replace her for almost 12 months. No application has been received from the home’s proprietors to recruit and support an application to register a new manager. Management support has been available from an experienced manager of a sister home, and one of the proprietors is regularly at the home and was there on the day of the inspection. The acting manager described herself as very ‘hands-on’ and is on the duty roster as one of the two required nurses through the week; she has little additional (supernumerary) time to carry out administrative and Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 20 managerial duties. One of the areas that the manager agreed had been allowed to slip since the last inspection is the formal supervision and 1-to-1 meetings with staff, which have been irregular; records indicated that all staff had a meeting in November 2006 but only a small minority have had any since. Although one of the proprietors is regularly present in the home, there was no evidence that checks had been made to examine the standards of the home’s services through routine sampling of the opinions of residents, relatives and staff, and no written documentation or reports had been prepared to reflect this activity, as is required by law. An outside manager has completed an extensive ‘Quality Audit’ but there is no evidence that the findings of this activity have been analysed and acted upon. Activities in this area have been left to the manager and she has recently held meetings with groups of residents and relatives, which she said would be held regularly. The systems for the safe keeping of residents’ personal spending money have been in place for some time and these remain unchanged from the last inspection. Information received before the inspection indicated that servicing of equipment and maintenance of safety standards at the home were satisfactory and an examination of records and observations around the building further supported this. However, as noted previously, there are shortfalls in certain important areas of staff training and instruction. Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 2 Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 19 (1) (b) Schedule 2 Timescale for action Evidence that new staff have had 30/04/08 a full check by the Criminal Records Bureau (CRB) and that references have been obtained must be forwarded to the CSCI inspector so that it can be established that a proper staff selection system is being operated and only people suitable to work with vulnerable people are working at the home. 31/08/08 All staff must be given training or instruction that prepares them to work properly with the people living at the home, so that they are able to recognise and act in ways that support a more ‘person-centred’ style of caring. Additionally, the people responsible for the running of the home must make sure that all care staff are able to work safely with the people living at the home by providing regular training opportunities in all the important areas that affect people’s lives. Staff must be able to recognise unsafe or risky situations and have the knowledge to be able to act DS0000002150.V361556.R01.S.doc Version 5.2 Page 23 Requirement 2. OP30 13 (4) 18 (1)(c) 23 (4)(d) Andrin House 3. OP31 8 9 4. OP33 24 (1)(2) 26 (1-5) properly to protect the people in their care. The people responsible for the 31/08/08 running of the home must appoint a permanent manager and that person must apply to register with the CSCI in order to comply with the law and to demonstrate professional leadership. The people responsible for the 30/04/08 running of the home must be routinely responsible for making sure that the views of people living and working there are given voice, so that their opinions can properly influence how it runs. This is to ensure that the home is run in the residents’ best interests and is focussed on their strengths and needs. Additionally the named person responsible for the home must carry out their legal responsibilities to visit, inspect and report on the home’s operation and must do this every month. (Requirement from last inspection, timescale not met) 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 OP36 Good Practice Recommendations Staff supervision should take place every two months and include career development needs, and philosophy of care in the home. Andrin House DS0000002150.V361556.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Andrin House DS0000002150.V361556.R01.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. 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!