Inspection on 18/07/07 for Appleton Manor

This inspection was carried out on 18th July 2007.

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

The inspector 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

Appleton Manor 06/09/06

Appleton Manor 07/02/06

Appleton Manor 06/06/05

Appleton Manor 27/01/05

Appleton Manor 17/06/04

Appleton Manor 20/01/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Appleton Manor Lingard Lane Bredbury Stockport Cheshire SK6 2QT Lead Inspector Tracey Rasmussen Unannounced Inspection 18th July 2007 08:45 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 Appleton Manor DS0000017288.V339651.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. Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Appleton Manor Address Lingard Lane Bredbury Stockport Cheshire SK6 2QT 0161 4067261 0161 4068962 appletonmanor@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Limited 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) Mrs Pamela Greenfield Care Home 59 Category(ies) of Dementia (41), Dementia - over 65 years of age registration, with number (33), Old age, not falling within any other of places category (59), Physical disability (41), Physical disability over 65 years of age (15) Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. No more than 26 places can be used for nursing care. No service user may be received in the home who is less than 50 years old, male/female, described as Physical Disability 6th September 2006 Date of last inspection Brief Description of the Service: Appleton Manor Nursing Home is owned by Southern Cross Health Care Limited. The home shares its grounds with Appleton Lodge, which is owned by the same company. Appleton Manor is located on the borders of Brinnington and Bredbury and is close to local amenities, with convenient access to public transport and motorway networks. The home offers nursing care for up to 26 people. In addition, the home is registered to care for up to 33 people who have a physical disability and dementia. Accommodation is spread over two floors offering single en-suite bedrooms. One double room is provided for service users wishing to share. The first floor, called the Brinnington unit, accommodates service users who have dementia. The ground floor accommodates service users who require nursing and residential care and is called the Bredbury Unit. The current weekly fees range from £442.00 to £782.00 dependent on the package of care required. Further details regarding fees are available from the manager. Additional charges may also be made for hairdressing and other personal requirements. Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector undertook this unannounced key inspection site visit on the 18th July 2007. This means the home did not know an inspector was going to visit. The inspection included a review of all available information received by the Commission for Social Care Inspection (CSCI) about the service provided at the home since the last inspection. A questionnaire (AQAA) was sent out to the manager at the home about two months before this inspection visit and this provided additional information to assist the inspection process. All key inspection standards were assessed at the site visit and information was taken from various sources which included observing care practices, talking with people living in the home; talking with a visitor; talking with the manager and members of the staff team. A tour of the home was also undertaken and a sample of care, employment and health and safety records seen. Information from returned questionnaires (comment cards) has also been included in the report. Four residents were case tracked as part of this inspection visit. This means the care service provided to these residents was looked at and this included talking with the resident (where possible) to seek their opinions and looking at their records. A brief explanation of the inspection process was provided to the manager of the home at the beginning of the visit and time was spent at the end of the visit to provide verbal feedback What the service does well: Throughout the visit the home was welcoming, peaceful and relaxed. People living in the home were supported to be independent and their choices and preferences respected. Staff were courteous and friendly and went about their duties on the whole in a professional manner. Comments were sought from people in the home, relatives and staff and these were on the whole, positive about the care and staff. One relative said, ‘we are happy with the services here.” And, “I have only positive things to say. Grandma needs to feel cared for and she does” Written comments from relatives included; “There is a pleasant atmosphere of caring by the staff”; “The manager is very approachable and very helpful” and Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 6 “the staff are excellent to my mother and really helpful and friendly to me when I visit.” The home was clean and odour free and provided modern single roomed accommodation. Equipment and facilities to meet the different and varied care needs of the people was available. Visitors were welcome into the home. Complaints were treated seriously and investigated properly as the home’s procedures requires. Most staff had had training to ensure people were safeguarded as far as possible from abuse and they knew what to do if they suspected abuse. Employment recruitment practices were safe so staff who may have posed a risk to people living in the home were not employed. Staffing levels in the home were appropriate to meet the needs and dependency levels of the people living there. Staff had had general training and NVQ training so that 50 of the care staff team gained a qualification. A quality assurance system including regular relative meetings were established which means standards of service were monitored and improved when issues were identified. Personal monies were maintained safely and health and safety practices were safe. What has improved since the last inspection? What they could do better: Care planning records both on the dementia unit and on the nursing unit would benefit from more personalised information being included, so that staff would know how each person preferred their care to be delivered. Care plans for health needs on the nursing unit need improving and evaluations of the effectiveness of all the care given should be recorded. Records of resident’s participation in activities should be recorded in the care file and consideration should be given to increasing the number of activity hours provided in the home so that more social stimulation and one to one Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 7 support can be offered to all residents. One relative comment was, ‘I would like to see more stimulating activities for the residents’ Refurbishment and re-decoration should continue particularly on the Brinnington unit. 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. Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 8 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 Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 9 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. Resident’s needs were assessed before they moved into the home and the home confirmed they could meet the needs of the resident on admission. EVIDENCE: The quality of the information guides (standard 1) was not assessed at this visit. However it was noted that the reception area of the home was welcoming and information about the home was readily available. This included information guides such as the statement of purpose and service user guide. Not many residents were able to comment on the home but a group of cheerful ladies on the Brinnington unit said, ‘We are alright’. Relatives stated in returned comment cards, “There is a pleasant atmosphere of caring by the Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 10 staff; many of who have been there for some years” and “The care at Appleton Manor is second to none” Four resident care files were seen. These contained detailed information about each of the residents care needs. The pre-admission assessments were very detailed and informative and included assessment information. This enabled the manager of the home to assess and confirm whether the new resident’s care needs could be met properly by the services provided in the home Intermediate care (standard 6) is not provided at the home. Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to this service. Residents receive care and support in a respectful manner. The care planning documentation was not consistently sufficient to meet the personal and health care needs of the people in the home. Medication practices were safe. EVIDENCE: The home provides nursing care and support across a range of needs. The focus of the ground floor is general nursing care and the first floor offers a residential dementia care service. Due to the specialist care needs of people living in the home, only a couple of people were spoken with at this visit and they provided a mixture of comments. However general observations of the home environment and the wellbeing of the people living there were undertaken. Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 12 One visitor spoken with said, ‘We are happy with the services here’ and ‘Staff really look after her’. Comment cards from relatives were on the whole positive about the care provided in the home, comments included, “My mother has Alzheimer’s, she does have the support for the life she hasn’t chosen”; and, ‘the welfare of the service user comes first.’ The home was calm and peaceful. Staff were busy but did not rush with residents and appeared to have good interactions with them. Residents were presentable and dressed according to their preference. Staff spoken with were positive about working in the home. Staff said they were trained and supported to do their job and a number had achieved a NVQ 2 and others were undertaking NVQ training. Four care planning records were seen, two from each floor of the home. Records of contact with community health services such as GP, tissue viability, chiropody and optical support were available. Three of the four files had been audited by the manager and shortfalls or missing information identified. Care plans on the residential unit were detailed and comprehensive. However, some of the information should be developed further to include more person centred information. This means including personal information such as how the person likes or prefers care to be given. Routines that had proven to be effective, for example managing challenging or unique behaviours should also be included in the care plan. The nursing care plans on the ground floor were not as detailed or as comprehensive as they should be particularly in relation to wound care plans. Nursing staff need to address this More person centred information also needs to be recorded. Care plans viewed contained assessment information based on the activities of daily living, moving and handling, nutritional, falls, skin and pressure area risk assessments. Reviews of the care plans had been undertaken but evaluations about how effective care delivery had been should be developed further. Medication procedures were reviewed briefly on one floor. The home uses a monitored dosage system of medication storage and administration. Medication records seen for the receipt of medication, administration and disposal were all satisfactory and controlled drug registers were also recorded correctly. The medication procedures are monitored on a monthly basis by the home manager, which is checked by the manager’s line manager. Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14, and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities and stimulation could be better so that the diverse needs of the residents living in the home are met. Residents were offered a choice of meal at mealtimes and the quality of the food was good and nutritious. Lifestyle preferences were respected and visitors were welcome. EVIDENCE: Notice boards contained information about the activity schedule in the home. No activities were observed at this visit although staff did report that the activity person had done a session with reminiscence picture cards on the dementia care unit. The home employs one activity person who works between both Appleton Manor and Appleton Lodge. Given the size of the home and the specialist needs of residents on the dementia unit and the dependent nature of the residents living on the nursing unit this was not enough to provide stimulation and individual support to all the residents living in Appleton Manor. Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 14 One relative stated, ‘I would like to see more stimulating activities for the residents’. The activity person recorded records of the activities that each resident had joined in, but this information was limited and did not identify if the resident enjoyed or benefited from the activity. Children programmes were playing on the TVs of the dependent residents who were in bed on the ground floor and it appeared that no thought had been given to the unsuitability of these programmes for the residents. Care records contained limited information about the day to day social aspects of the care provided by staff. Care plans did state that the wishes of the resident with regards socialising and participating in an activity was to be respected. Visitor confirmed that they were welcomed into the home and were kept informed of all changes in the care of their loved one. The residents were offered a choice of main course at the lunchtime meal of either fish cakes or braised steak and onions. The dementia care unit had two dining rooms, one which enabled residents to maintain their independence with dining tables set with crockery and cutlery and pots of tea, milk and sugar bowls and the other dining room provided discreet one to one support to the more dependent residents. Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People in the home can be confident that staff are trained to respond appropriately to suspected abuse and that complaints will be treated seriously. EVIDENCE: In the last 12 months the home had received three complaints and these had been responded to according to the home’s complaints procedure. Records were available of the complaints and the actions undertaken in response to these. There had been two allegations of abuse and these were responded to in accordance with Stockport’s Safeguarding Adults policy and procedure. Staff spoken with about complaints and protecting people from abuse responded knowledgeably. Staff reported that they had received training in abuse and the protection of vulnerable adults and were able to discuss the content of their training. Records of this training were available. Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People live in a safe, well maintained home that was clean and odour free. Specialist equipment is available which means the different needs of each person could be met promptly. EVIDENCE: This purpose built care home has been open for about ten years. Appleton Manor provides a good standard of single en-suite accommodation for people living there, with dedicated communal lounges, dining and bathing facilities. The main entrance into the home had been recently decorated and was warm and welcoming. Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 17 On the dementia care units, some redecoration and refurbishment had been undertaken, however much further work was still required in both bedroom and communal areas. The manager confirmed that a budget request had been made to undertake these additional improvements and it was anticipated that refurbishment would continue on the dementia unit. Improvements to the environment that reflect therapeutic good practice in dementia care were also being undertaken on the Brinnington unit. So it is planned that bedroom doors will be painted in bright colours and tactile collages made available for stimulation and aide memoirs. Outdoors the home has enclosed garden areas with raised flowerbeds and patio furniture. The home is equipped with specialist aids and adaptations to promote people’s independence. The home was clean, tidy and no odours were noted. The home’s cleaners were thorough in undertaking their duties. The kitchen and laundry areas of the home were not seen at this visit. The maintenance person was employed in the home and their duties included attending to the day-to-day repairs and general maintenance of the home. Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment vetting practices, staffing levels, training and skill mix were appropriate to meet residents’ needs and promote their health and safety. EVIDENCE: The home had a peaceful atmosphere and all staff spoken with were pleasant. Returned comment cards from relatives of residents said, ‘some staff are very friendly’; ‘the staff are excellent’ and ‘The staff are all very good at the different aspects they do’. One comment said that the service in the home could improve if staff were friendlier with relatives. Staff were positive about working in the home. Staff said that they enjoyed working in the home; that they delivered a good quality service and they said they received a good standard of training. The staffing rotas were available and indicated that staffing levels were maintained at appropriate levels to meet resident’s care needs. One comment from a relative about the service on the nursing unit, ‘the post of nursing manager has not been filled …and I think the unit would benefit from firmer control’ and ‘Continuity is not always evident’. Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 19 Three employment files for newer staff to the home were seen and these were generally comprehensive although full working histories had not been consistently obtained. This means that the manager has ensured as far as possible that new staff working in the home does not have a history of abusing people. Records were available to indicate that the home did train staff from the start of employment with induction training to on-going training and NVQ. The home’s induction training was in line with Skills for Care requirements. Other staff members detailed various training courses they had attended and these included health and safety, food hygiene, infection control, manual handling, first aid, medication and fire awareness. The manager said that staff training in dementia care was to commence shortly. Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home promotes the health, safety and wellbeing of the people living there. Opportunities are provided for people in the home to contribute to the daily routines and have a say in how the home is run. EVIDENCE: The manager continues to be the driving force in the home, making sure high standards of care and service are provided whilst continuing to improve and develop the service. The manager was aware of the areas of development in the home and had plans to move the service forward. The manager was also the driving force in making sure staff received a full and varied training Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 21 programme. She also ensured that staff were supported with supervision and counselling. One returned comment card said, “The manager is very approachable and very helpful”. Both relatives and staff said that the manager was available to discuss concerns. Regular relatives and staff meetings are undertaken and questionnaires were sent out to relatives as part of the quality assurance systems in place in the home. A range of audits are undertaken regularly in the home, and these are closely monitored by senior managers in the organisation. Copies of the audits were available in the home. The home’s administrative support assistant maintains detailed records of all monies held on behalf of residents. Records were available and a clear audit trail was evident. The home employs a maintenance worker who undertakes routine repairs and monitors equipment to promote the health and safety of residents and staff. Records of maintenance including fire safety were available but not seen at this visit. Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 x 3 3 x 3 Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 OP7 Good Practice Recommendations The registered person should ensure care plan interventions contain person centred information about residents’ preferences and wishes. Evaluations of the effectiveness of the care plans should be recorded and detailed. This means resident receive an individual personalised service. The manager should ensure health care plans are recorded comprehensively so that resident health care needs are met appropriately The registered person should develop an activities programme that meets the needs of those with mental health and dementia type illnesses. Staff should receive appropriate training in those conditions and devise ways to provide meaningful daytime occupation. The home should increase the level of social activity and stimulation provided in the home so that each resident benefit from this, according to their preference or need DS0000017288.V339651.R01.S.doc Version 5.2 Page 24 2. 3. OP8 OP12 3 OP12 Appleton Manor 4 OP19 and individual care plan records are maintained. Further redecoration and refurbishment is required on the Brinnington unit to ensure a comfortable, safe and welcoming environment is provided for people living there. Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Appleton Manor DS0000017288.V339651.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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