Inspection on 20/10/05 for April Court

This inspection was carried out on 20th October 2005.

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

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

Other inspections for this house

April Court 18/01/07

April Court 17/02/06

April Court 24/01/05

April Court 12/07/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 April Court 186 Poole Lane Kinson Bournemouth Dorset BH11 9DS Lead Inspector Heidi Banks Unannounced Inspection 11:55 20 October 2005 th April Court DS0000031997.V258974.R01.S.doc Version 5.0 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 April Court DS0000031997.V258974.R01.S.doc Version 5.0 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. April Court DS0000031997.V258974.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service April Court Address 186 Poole Lane Kinson Bournemouth Dorset BH11 9DS 01202 576110 01202 570093 lindsay.divall@bournemouth.gov.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) Bournemouth Borough Council Lindsay Ann Divall Care Home 18 Category(ies) of Learning disability (18) registration, with number of places April Court DS0000031997.V258974.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The Manager must not directly line manage the day to day activities of the day centre located in the building. Service users to be admitted to the first floor must be ambulant and able to manage stairs. The home complies with the Schedule of Requirements dated 25 July 2003 by 31 January 2004. 24th January 2005 Date of last inspection Brief Description of the Service: April Court is a Local Authority retained residential home for 18 people with learning disabilities. The home is managed on behalf of Bournemouth Borough Council by Ms Lindsay Divall. April Court is a purpose built home located in the Kinson area of Bournemouth. It is situated a residential area with shops, churches and other amenities nearby. The main bus route between Poole and Bournemouth is easily accessible. Residents’ accommodation is provided in 12 single and 3 twin bedrooms on two floors. The communal areas consist of a lounge, smaller lounge and dining room, all of which can be used for various activities. There is a training kitchen that is available to residents with support from staff. There is a separate flat facility on the first floor which can be used for the assessment of service users’ independent living skills. There is a pleasant patio area at the rear of the building which is accessible to all service users. The Registered Manager is experienced and well qualified to NVQ Level 4 standard and the home is staffed by a team comprising a Deputy Manager, 3 Assistant (Duty) Managers, Care Assistants and Night Care Staff. There is a part-time cook and domestic and clerical support. April Court DS0000031997.V258974.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over the course of 3.5 hours on a weekday. The lead inspector was accompanied by Mark Goodman, Regulation Manager. The inspection was part of the normal routine of inspecting every service twice a year. The inspectors were assisted by the Registered Manager throughout the duration of their visit. There are 14 residents living at the home at the present time. The age range of the residents is currently between 28 and 62. At the time of inspection the majority of residents were attending day services, one had been discharged from hospital earlier that morning, and therefore had stayed at home and one returned from a holiday abroad with a group of peers during the inspectors’ visit. The number of service users living in the home with a medium to high level of need has increased which means that it has become more difficult to obtain verbal feedback from residents during the inspection process. Therefore during this inspection, information was obtained mainly from the Registered Manager, a Care Assistant on duty, observation of staff interaction with the service users present, conversation with one service user, inspection of service user files and a guided tour of the premises. Prior to the inspection comment cards had been received from 13 residents, 6 relatives / visitors, 4 Care Managers, 2 GPs and 2 health care professionals. In general feedback was very positive and demonstrated that residents like living at April Court and felt well cared for. Responses from relatives also showed that they were satisfied with the overall care provided within the home and were kept informed of important matters affecting their relatives and consulted about their care. Responses from health and social care professionals demonstrated that communication between themselves and the staff is good and that they too are satisfied with support given to the residents. The Registered Manager has ensured that the requirement and good practice recommendation made at previous inspections have now been met and there is a clear commitment to providing a high quality service that meets the changing needs of residents. As a result of this there were no further requirements made at this inspection. What the service does well: The service continues to receive positive feedback from service users, relatives and health and social care professionals. It is apparent from feedback within comment cards that staff maintain positive working relationships with the multi-agency team and demonstrate a clear understanding of the needs of service users, for example ‘The quality of the care and support provided to the service users living at April Court…has enabled them to remain living within the local community. I am very appreciative of the service provided to them.’; April Court DS0000031997.V258974.R01.S.doc Version 5.0 Page 6 and ‘Staff at April Court are always helpful, they behave in a professional manner and liaise with me appropriately. I consider the support provided by the home to be of a high quality.’ It is apparent from both feedback within comment cards and inspection of service user files that staff will request support as required from the multiagency team in order to meet the health and social care needs of residents. It was also noted that staff support residents in accessing generic and specialist health care services including attendance at preventative health screening appointments which is particularly encouraging. Both the manager and staff have access to accredited and informal training opportunities and the structure of the staff team ensures that there is always a senior team member on duty who has responsibility for the running of each shift. 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. April Court DS0000031997.V258974.R01.S.doc Version 5.0 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 April Court DS0000031997.V258974.R01.S.doc Version 5.0 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): Not inspected on this occasion. EVIDENCE: April Court DS0000031997.V258974.R01.S.doc Version 5.0 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 and 8 Essential Lifestyle Planning within the home has improved service users’ awareness of how their changing needs are reflected in Individual Plans. Individual Plans are in a format that makes them inaccessible to current service users. Service users are involved in making decisions about their lives on a day-today basis. Individuals may be involved to varying degrees in the life of the home due to their differing levels of ability and motivation. EVIDENCE: April Court uses a range of documents in order to make ongoing assessment of the individual needs of service users. These were seen to include an Individual Service Plan, an Essential Lifestyle Plan and a Communication Profile. Specific assessment documents such as a Moving and Handling assessment were also available. Examination of one service user file showed that a Communication Profile was originally completed in January 2003 and updated in November 2003. It is April Court DS0000031997.V258974.R01.S.doc Version 5.0 Page 10 recommended by the inspectors that this is reviewed and updated on a regular basis, possibly alongside the review of the Individual Service Plan and Essential Lifestyle Plan to ensure that information contained in all three documents is consistent. A moving and handling assessment was available for a service user with mobility needs. However, this had been completed by an Occupational Therapist on 16th February 2005 with a review date of ‘prior to 16th May 2005’. There was no updated document available to demonstrate that a review had taken place. It is recommended that a review is undertaken at the earliest opportunity to ensure that the service user’s mobility needs are met. It was noted that on one service user’s Individual Service Plan a goal was identified as ‘improve communication’ but there was no action plan available defining what this means for the individual concerned, how this is to be achieved, who will be involved and how and when progress will be evaluated. The inspectors therefore recommend that clear action plans are agreed in response to goals set which are specific, measurable, achievable, relevant and with a clear timescale. Two Essential Lifestyle Plans were examined by the inspectors. It was noted that the Plan makes reference to individual needs and preferences throughout and covers a range of issues including health care needs, personal care needs, safety and vulnerability issues, communication and preferred activities and social contacts. The Plan offers broad guidance to staff on individual needs and likes and dislikes within their daily lives. It was evident that a number of individuals are listed as having made a contribution to the Essential Lifestyle Plan including the service user. However, the document was not signed by any of the contributors. The inspectors recommend that participants in the planning process, especially the service users themselves, are encouraged to ‘sign up’ to the plan and any action plans that arise from it. The manager confirmed that bi-monthly meetings are held at the home for service users at which full attendance is encouraged. The meetings are opportunities for service users to be involved in decision-making within the home including, for example, plans for the Christmas party and holidays. The manager confirmed that a total communication approach is used to maximise service user participation in the meetings but that it can be difficult to fully engage residents who have complex communication needs and may have limited understanding of signs and symbols. The manager reported that the use of photography has been promoted within the home as part of the total communication approach. The staff are building up a resource of photographs of people, places and meals to enhance decision making and choice. The manager reported that this is proving a helpful means of communication. It is recognised that service user participation in decision-making is an ongoing challenge for a service such as April Court who have a number of service users with medium to high level needs. April Court DS0000031997.V258974.R01.S.doc Version 5.0 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): 16 and 17 Service users’ rights in their daily lives are generally recognised. Service users are offered a choice of meals including healthy options and are reported to enjoy their mealtimes. EVIDENCE: Discussion with staff and observation of their interaction with residents during the inspection demonstrated that service users’ rights are respected in terms of how they occupy their time, making choices about what they have to eat on a daily basis and freedom to be where they choose within the home. Individual Essential Lifestyle Plans recognised service users’ preferences regarding how staff support them. The manager informed the inspectors that service users participate to varying degrees in tasks such as doing their laundry, some are keen to be involved, others require more support and encouragement from staff. April Court DS0000031997.V258974.R01.S.doc Version 5.0 Page 12 Concern was expressed by the inspectors at the presence of an electronic monitoring machine which was switched on at the console on a table at the entrance to the home. The manager informed the inspectors that the monitor was in place to promote the safety of a resident who is prone to epileptic seizures. The manager stated that the monitor is usually only switched on during the night and carried around by night staff so that, in the event of the resident having a seizure, staff can respond as a matter of urgency. This is documented in the individual’s Essential Lifestyle Plan. A risk assessment is in place regarding the use of the monitor but there did not appear to be any guidance available to staff regarding the parameters of its use or evidence that use of a monitor had been agreed by the multi-agency team. It is therefore recommended by the inspectors that guidelines are agreed around the use of the monitor and staff are made aware of the parameters of its use to minimise intrusion. A training kitchen is available to residents who wish to prepare meals and drinks with staff support. However, the manager reports that this facility is used less than previously as the needs of residents have changed. A watercooling machine is available to residents who can help themselves to a drink as they choose. A cook is employed to prepare the main meal each day. At the inspection, there was evidence of options being available to service users for their main meal which is usually taken at 5pm. Following inspection, the inspector requested a copy of the home’s four-weekly menu which was provided by the Registered Manager. The menu confirmed that there are a range of hot meals, salad and vegetarian options available for residents to choose from with fruit available at every main meal. A system is in place to promote service user choice, the manager confirming that should service users wish to have a meal that is not on the menu for that day their request can be accommodated within reason. There was also evidence within an Individual Plan to demonstrate that healthy, low-fat options are encouraged where there were valid concerns around an individual’s health as part of an overall care plan that involved the advice of a dietician. The manager confirmed that there is some flexibility around the timing of meals, and whereas the majority of residents were reported to choose to eat together at around 5pm, meals could be kept warm on a hot plate in the event of a service user wishing to eat later. April Court DS0000031997.V258974.R01.S.doc Version 5.0 Page 13 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 and 19 Individual personal care needs and preferences are central to service users’ Essential Lifestyle Plans to ensure their needs are met in a manner that engages the service user and takes account of their ability to make choices. Residents’ health care needs are met through liaison between staff at April Court and generic or specialist health care services. EVIDENCE: Individual service users’ Essential Lifestyle Plans were seen to make reference to their personal support needs and preferences, taking into account safety issues and individual ability. Examination of residents’ records demonstrated how staff at April Court are working in partnership with health care professionals to meet the health needs of individuals. Staff are responsible for supporting residents to arrange and attend health appointments and evidence of attendance at GP appointments, hospital appointments and access to specialist services through the Community Learning Disability Team, for example Physiotherapy, Occupational Therapy and Nursing were evident on file. The staff have requested advice from the Community Learning Disability Team regarding the monitoring and recording of epileptic seizures and at the time of the inspection, a Community Nurse was due to attend a forthcoming staff meeting to offer training on this issue. It April Court DS0000031997.V258974.R01.S.doc Version 5.0 Page 14 was particularly encouraging to see evidence that a service user had been supported to attend preventative health screening appointments. The manager confirmed that service users access eye checks every two years and that where service users are unable to go to the appointment the home arrange for the optician to visit them at April Court. However, it was noted that some residents refused to wear glasses that had been prescribed for them. The home might consider that if a service user declines to wear glasses that have been prescribed for them this is clearly documented on the individual’s care plan and the optician consulted. From service user records it was evident that staff had made appropriate contact with the emergency services on a number of occasions to request that paramedics attend April Court. There was also evidence that there is liaison between April Court and residents’ day services regarding issues impacting on an individual’s health. April Court DS0000031997.V258974.R01.S.doc Version 5.0 Page 15 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): Not inspected on this occasion. EVIDENCE: April Court DS0000031997.V258974.R01.S.doc Version 5.0 Page 16 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): Not inspected on this occasion. EVIDENCE: April Court DS0000031997.V258974.R01.S.doc Version 5.0 Page 17 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): 31, 32, 33 and 36 Staff roles and responsibilities have now been clarified to the benefit of service users. Staff have access to generic and specialist training relevant to the service user group which promotes the safety of service users. There are systems in place to ensure good communication between shifts and to promote continuity of care. There is a structure in place that enables the support and supervision of staff, promoting good practice within the home and consistency of approach. EVIDENCE: In response to a recommendation made at previous inspections, job descriptions for Care Assistants have now been reviewed by the service in order to accurately reflect their role and responsibilities. The member of staff interviewed confirmed that she had a copy of the revised job description. The same member of staff demonstrated through discussion that she was clear about her responsibilities in supporting residents with many aspects of their daily lives and also aware of the limitations of her role – for example, that she, as a Care Assistant, would not administer medication as this was the responsibility of the Assistant (Duty) Manager. April Court DS0000031997.V258974.R01.S.doc Version 5.0 Page 18 There is a very clear line management structure within the service at April Court which comprises the Registered Manager, a Deputy Manager, 4 Assistant (Duty) Managers and a team of care assistants. The Assistant Managers take responsibility for key working a number of residents as well as leading shifts. Care Assistants take responsibility for providing care to residents and act as co-keyworkers for service users. The Care Assistant spoken with informed the inspectors that since starting in her job in July 2004 she has had access to training opportunities including an induction programme that meets the specifications of The Sector Skills Council for Social Care, training accredited by the Learning Disability Award Framework and is due to embark on her NVQ Level 2 qualification in the near future. The manager identified that staff have access to a range of formal and informal training opportunities specific to the service user group which include total communication and epilepsy and informed the inspectors that she often invites guest speakers to staff meetings to discuss relevant topics. Staff on duty at the time of the inspection were the Registered Manager, the Deputy Manager, an Assistant Manager, two Care Assistants and the Clerk. The member of care staff interviewed during the inspection reported that she receives supervision on a monthly basis from a senior member of the team and informed the inspectors that this is an opportunity for her to discuss issues relating to service users as well as her ongoing personal development within her role. On the inspectors’ arrival, the Assistant Manager was receiving supervision from the Deputy Manager. Systems for effective communication of information between staff are in place at April Court including a log book for the recording of significant events during a shift which staff are expected to read following a period of time away from the home. Verbal handovers of information occur between shifts. As an Assistant Manager undertakes a sleep-in duty overnight there is consistency from the afternoon shift to the following morning. April Court DS0000031997.V258974.R01.S.doc Version 5.0 Page 19 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 Service users benefit from an experienced and well-qualified manager. EVIDENCE: The Registered Manager has worked at April Court for 10 years of which she has been the manager for 6 years. As recommended in previous inspections, the manager has now attained her NVQ Level 4 qualification in Care alongside her existing NVQ Level 4 in Management. The manager receives regular supervision from her line manager and is committed to undertaking further periodic training to update her knowledge and competence in her role. April Court DS0000031997.V258974.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 Score x x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 x x Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 2 17 Standard No 31 32 33 34 35 36 Score 3 3 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 April Court Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score 3 x x x x x x DS0000031997.V258974.R01.S.doc Version 5.0 Page 21 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 YA6 Good Practice Recommendations It is recommended that Individual Plans (to include Essential Lifestyle Plans, Communication Profiles and Moving and Handling assessments) are reviewed and updated on a regular basis to reflect changing needs. It is recommended that involvement of the service user, family members, friends and/or advocates and other agencies in formulating Individual Plans are indicated by them signing up to the Plan. It is recommended that clear action plans arise from those goals that have been set as part of the Individual Plan. Action plans should describe the services and facilities to be provided by the home and how goals will be achieved. It is recommended that guidelines should be put in place in relation to the use of the electronic monitor with multiagency agreement. Guidelines should be communicated to all staff. 2. YA6 3. YA6 4. YA16 April Court DS0000031997.V258974.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 April Court DS0000031997.V258974.R01.S.doc Version 5.0 Page 23 - 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!