Inspection on 01/06/05 for Ashdene House

This inspection was carried out on 1st June 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 16 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashdene House 13/05/08

Ashdene House 21/05/07

Ashdene House 19/07/06

Ashdene House 22/11/05

Ashdene House 10/08/04

Ashdene House 02/06/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Ashdene House 50 St Mildreds Road Ramsgate Kent CT11 8EF Lead Inspector Clair Brown Unannounced 01 June 2005 12:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Ashdene House Address 50 St Mildreds Road, Ramsgate, Kent. CT11 8EF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01843 592045 Ashdene House Ltd Mrs Pauline Forest Care Home 18 Category(ies) of Learning Disability registration, with number of places Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10.08.04 Brief Description of the Service: Ashdene House, registered to provide residential care for up to eighteen adults with learning disabilities. Some of the residents have additional physical disabilities. The Home is situated in a residential area of the seaside town of Ramsgate, within walking distance of most local amenities. The Home has it’s own transport, which is regularly used to access amenities and events, both within the Ramsgate area and further a field. Ashdene is a large property, nestling neatly and discreetly into the other properties on the road, with a two storied building, referred to as ‘the Cottage’, within it’s grounds. This property accommodates three adults who can live more independently, with daily support from the care staff. There is ample on road parking to the front of the Home. The Home is owned by a private Company with the daily management of the Home being the responsibility of the Registered Manager. Staff are rostered to provide supervision and support to the residents on a twenty four hour basis, including wake and sleep-in cover at night. The health care needs of the residents are met by the local primary health care team. Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This an unannounced inspection by one inspector conducted over one day and the duration was five hours. The registered manager and a team leader assisted with the inspection. Two service users were spoken with to ascertain their views. A tour of the building was conducted and documents and records were examined. One service user file was case-tracked. The main focus of the inspection was the previously made requirements and recommendations. What the service does well: What has improved since the last inspection? What they could do better: The outstanding requirements need to be acted upon. Documentation such as the Homes statement of purpose needs reviewing. Care plans and service users files need to be more detailed and to be completed. There needs to be a formal monitoring of the quality of service the Home provides. The current medication procedures and storage facilities need bringing in line with current practices and legislation. A maintenance programme for the upkeep of the building should be produced and implemented. Fire procedures and escape routes should be monitored to prevent the occurrence identified of fire doors being locked. Chemical items (COSHH) need to be stored appropriately. Infection control procedures need to be improved with the provision of liquid soap and paper towels in all areas where personal care is provided. Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 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 standard(s) 1,3,5. The statement of purpose and service user guide does not provide up to date information about the Home. Service users needs are met but the current registration details are inaccurate. The service users terms and conditions are not produced in an appropriate format and contain impossible requirements. EVIDENCE: The statement of purpose has not been reviewed since March 2003 and does not reflect the current information about the Home. The copy of the service user guide given to the inspector contained title pages for some sections where details should be included. For example the summary of the statement of purpose, but this was not in the document. The service user terms and conditions include a tenancy agreement. This requires the service user to clean and tidy their bedroom. Some of the service users living at the Home are not able to perform such tasks. None of the above documents are produced in appropriate formats. There is a discrepancy in the Homes registration which says the Home is registered to take 18 service users with learning disabilities. The registered manager stated the Home only has the capacity to admit 15 service users. The Home also admits those who have physical disabilities, which is not included on their registration. This has been the situation for a long period of time, but the registration must be correct. Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 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 standard(s) 6,7,8 The care plans fail to identify all care needs and to provide staff with clear instructions on how to meet them. Service users are supported in making personal choices but these are not identified in the care plans. Service users are actively included in the day to day running of the Home is in early stages of development. EVIDENCE: One care plan of a service user recently admitted for respite care was case tracked. The service user had complex needs, some of these medical needs and although staff provide support and assistance with these procedures, insufficient instructions were recorded in the care plan. There were no directions for staff on what to do if the service user was no longer able to perform these procedures and staff do not have the required skills and training to carry them out. Some of the documentation was left blank and much of the records were not dated. The daily reports were vague and failed to record the actual care provided by the Home. The registered manager was able to verbally demonstrate how some service users are supported to make choices and follow personal wishes and routines. These include providing extra staff to enable service users to participate in chosen activities. These expressions of Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 10 choice and preferences must be detailed in the individual care plan. Since the last inspection the registered manager has held one service users meeting. Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 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 standard(s) 14,16 Leisure activities are appropriate and individual. Daily routines are flexible. EVIDENCE: Leisure activities included trips out to the local amenities as well as trips to London. The Home has its own day centre, which provides in house activities for those who are able-bodied. The service users terms and conditions state that “extra funding may be requested to cover the cost of residents holidays”, service users are entitled to a minimum of a seven-day holiday, the cost of which should be included in the basic contract price. The inspector did not determine if service users have had an annual holiday. Service users routines are individual and flexible, the numbers of staff provided varies to meet these preferences. Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 12 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 standard(s) 20 Medication storage facilities and procedures are not acceptable and do not protect the welfare of service users. EVIDENCE: The Home uses a built in storage cupboard to house the Homes medication. This is not a recognized medication storage facility that meets the requirements of current legislation. Although there is a hand-basin in this cupboard it is obscured by the hanging blister packs of medicines. This cupboard was also used to store cigarettes and envelopes of service users money. The Home does not have a medication fridge, but stores medicines in the food fridge, which is an unacceptable practice. There is no provision for the storage of controlled drugs. Current medication procedures include service users being lined up at the cupboard to receive their medicines and multiple services users medicines being transported at the same time to the cottage without safe methods of transporting them. Although the team leader spoken to was very knowledgeable about the actual medication used in the Home, only two of the four team leaders have received any medication training. This training was a one-day course and not sufficient for those responsible for those responsible for handling medicines. A full medication audit was not conducted but a brief assessment was and no errors were identified. Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 13 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 standard(s) 22,23 The complaints procedure is not produced in an appropriate format for the service users needs. Service users money is not stored safely. EVIDENCE: The complaints procedure is produced in written text only. The registered manager stated that staff have produced a video of the procedure, this has not been transferred to DVD or video tape, the footage was not viewed by the registered maanger and has subsequently gone missing from the locked managers office. On arrival at the Home the registered manager was not in her office and the door was locked. When entering the office the safe was open and money in plastic envelopes were out over the desk. Service users money was also held in the medicine cupboard/room. Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 14 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 standard(s) 24,25,26,27,28,29,30 The Home provides suitable accommodation for the service users. Management of the maintenance of the building is inadequate. Some areas of the Home are not accessible to those with restricted mobility. There is insufficient call for assistance systems (call bells) to ensure the safety & welfare of both staff and service users. A selection of specialist equipment and adaptations is provided. Infection control procedures do not prevent the possible spread of infections. EVIDENCE: The Home is a large building set in a resident road. It provides a variety of sized bedrooms. The upper levels and daycentre are not accessible to those who use wheelchairs. The Home benefits from a separate building used specially for activities. Some of the bedrooms and areas of the Home appear tired and would benefit from redecorating. The separate three bed-roomed cottage provides a living area which promotes independence. This years maintenance programme has not been produced and implemented. Minor maintenance work requirements are written in a book by staff but no records and dates are filled in when/if work is completed. Some rooms and bathrooms do not have call bells, staff have identified that they feel at risk using these Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 15 areas. The staff sleep-in room was not fit for use, the mattress had holes in it and there was a sheet tied across the window. There is no provision for calling the sleep-in staff for assistance without one of the waking night staff actually getting them and potentially leaving an emergency situation. There is a selection of equipment and adaptations provided, such as, hoists, wheelchair stair-lifts and assisted baths. There is insufficient infection procedures and protective equipment provided, such as: alginate bags; aprons; liquid soap and paper towels. Soiled laundry is currently sluiced by hand, soiled linen must be placed directly into alginate bags. A solution must be found for the provision of liquid soap and paper towels in all areas including bedrooms where personal care in provided. Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 Sufficient staffing numbers are provided. There is no management procedure for calculating and determining the provision of staff. EVIDENCE: There were sufficient staff on duty at the time of the inspection to meet service users needs. However, the registered manager did not have a means of assessing of each service users dependency levels to assist with calculating the required staffing levels. It is acknowledged that additional staff are provided to enable service users to fulfil their wishes such as trips to London. Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39,42 There are insufficient procedures for the self monitoring and auditing of the quality of care provided in the Home. The health & safety of service users in the cottage is not protected. EVIDENCE: The registered maanger stated that a quality assurance programme is being developed but has not been implemented. Currently there is no procedure for obtaining the service users views about “what’s it like live in the Home”. Although the two service users spoken to said they were happy and well cared for, there needs to be a more formal procedure operated by the Home to gather the information. The Regulation 26 visits are not being conducted monthly, there was no visit in May 2005. During the tour of the self-contained cottage situated in the grounds of the Home it was found that the two service users were in the building with no carer present. The carer holds the keys. In the cottage laundry room was the fire exit, which was locked and the key was missing. The inspector was Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 18 informed the carer holds the key for the door. This is an unsafe practice and was required to be rectified. The inspector was informed by the end of the inspection that the key had been placed back in the door. In the cottage laundry was a large bottle of washing detergent (COSHH item) on the floor. Earlier the inspector was shown where the service users personal toiletries had been locked away to stop them consuming the items. Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 19 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 2 x 2 x 2 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 2 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 x x x 2 x 3 x Standard No 31 32 33 34 35 36 Score x x 2 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Ashdene House Score x x 2 x Standard No 37 38 39 40 41 42 43 Score x x 1 x x 1 x H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4,5,17 schedule 1 Requirement The registered manager must review the statement of purpose and service user guide, to produce them in a ppropriate formats. Copies to be sent to the CSCI The registered manager must either provide evidence of a previous application for a variation payment and/or that this is a historical error in the Homes registration or make an application for a variation to the Homes registration. The registered manager must produce the service users terms & conditions in an appropriate format. The registered manager must ensure that all care and individual needs are identified on the care plan providing staff with clear instructions on how to meet these needs. Service users personal choices and prefernces must also be included in the care plan. Service users annual holiday must be funded from the basic contract fees. The Home shall access training Timescale for action 31.08.05 2. YA3 12,14,18 31.08.05 3. YA5 5 01.11.05 4. YA 6,7 12,13,15, 16,17 01.11.05 5. 6. YA14 YA20 4,12,14, 16,23 12,13,14, 01.11.05 01.11.05 Page 21 Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 16,17 schedule 3 7. YA20 12,13,14, 16,17 schedule 3 8. YA20 9. YA20 10. YA22 12,13,14 16,17, schedule 3 12,13,14, 16,17 schedule 3 22 on medication administration, for those staff designated responsible for administration.this is a previous requirement: timescale 1/07/2004 To send an action for medication cupboards that meet the requirements of current legislation. These medication cupboards must be provided, including a medication fridge and Controlled Drug storage. None medicine items must not be stored in the medication cupboards. Medication procedures must include methods for the safe transportation of medicines to other areas of the Home. Medication procedures must prevent service users being lined up to receive their medicines. Action plan by 31.08.05 31.08.05 31.08.05 11. YA23 12. YA24 12,17,20, 23, schedule 4 13,23 The Home shall devise and trial a 01.11.05 complaints procedure format, which is more appropriate for the use of the service users. this is a previous requirement: timescale 1/07/2004 Service users money must be 31.08.05 handled and stored to ensure it is protected from potential risk. The registered manager must produce and implement a maintenance programme. The manager shall ensure that the Home’s maintenance plan is updated and acted upon so as to address the requirements identified. this is a previous requirement: timescale 1/09/2004. Required to review the current provision of call bells and to provide them where assessed as needed. 01.11.05 Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 22 13. YA30 12,13,14, 15,16 14. YA33 18 15. YA39 10,12,15, 24,26 16. YA39 26 The staff sleep in room must be fit for its purpose and there must be a system to call the sleep-in staff for assitance without the waking staff having to leave the situation they are required for. The registered manager produce and implement an infection control procedure and provide the facilities and equipment in all areas where personal care is provided, for infection control procedures: liquid soap, paper towels, gloves, aprons and alginate bags. The practice of hand slucing of soiled linen must stop. The manager shall determine staffing ratios using service users needs assessments and other recommended guidance and ensure that acceptable staffing levels are maintained. previous requirement:timescale 1/10/2004 The manager shall establish and maintain a system for reviewing, at appropriate intervals, the quality of care at the Home, to provide qualitative data to inform further development of the service, and submit reports on the monitoring to the Commission. previous requirement: timescale 1/09/2004. There must be implement an annual quality assurance system to ascertain the views of service users, relatives, care managers and other visiting professionals in order to improve the service. The provider shall make unannounced monthly visits to the Home and prepare a report on the conduct of the Home, submitting reports to the registered manager and the 01.11.05 01.11.05 01.11.05 31.08.05 Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 23 17. YA42 12,13,16, 23 Commission. Previous requirement: timescale 1/09/2004 The registered manager must ensure the health & safety of both staff and service users. The fire door must be fitted with a device (approved by the Fire brigade) that ensures an escape route in the event of a fire and that can by easily operated when needed by service users. All COSHH items must be risk assessed and stored appropriately. 07.06.05 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. 2. Refer to Standard YA5 YA 8 Good Practice Recommendations To view the tenancy agreement and contract to ensure unachievable conditions are not included. The Home should demonstrate how it provides opportunities for the service users to contribute to the home’s practice, how the service users use the opportunities and evidence the outcomes of their involvement. The manager should establish means by which services from external agencies can be accessed promptly and efficiently for the benefit of the service users. The manager should ensure that a record is kept of views and concerns, communicated in whatever medium by service users, in order to establish what modes of communication are understood by staff and to determine staff training needs. The provider should provide access to NVQ training for care staff so that the required percentage of staff can achieve qualification by 2005. The manager should use formal staff supervision and annual appraisal to identify individual staff training needs and establish an individual training plan for implementation. The manager should access Learning Disability Award H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 24 3. 4. YA19 YA22 5. 6. YA32 YA32 7. YA32 Ashdene House 8. 9. YA33 Framework accredited training to equip staff with the specific skills to work with the service users placed within the Home. The Home should refer to the Department of Health guidance when assessing staffing levels within the Home. Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford Kent. TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashdene House H56-H05 S23721 Ashdene House V230065 010605 Stage 4.doc Version 1.30 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. 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