Inspection on 20/04/06 for Ashgale House

This inspection was carried out on 20th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 66 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashgale House 03/11/08

Ashgale House 15/10/07

Ashgale House 21/06/07

Ashgale House 19/12/06

Ashgale House 22/02/06

Ashgale House 23/11/05

Ashgale House 02/11/04

Ashgale House 04/05/04

Ashgale House 26/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Ashgale House 39-41 Hindes Road Harrow Middlesex HA1 1SQ Lead Inspector Julie Schofield Key Unannounced Inspection 20th April 2006 10:15 Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ashgale House Address 39-41 Hindes Road Harrow Middlesex HA1 1SQ 020 8863 8356 020 8863 8491 ashgalehouse@aol.com 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) Mr Aslam Dahya Mr Siyoum Beyene Care Home 14 Category(ies) of Learning disability (13), Learning disability over registration, with number 65 years of age (1) of places Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Within this Fourteen, 4 People may be residents with additional Physical disability. People with Physical Disability will reside on the ground floor of the building. Temporary variation agreed for one named individual (MB) aged 66 years for the duration of her stay. 22nd February 2006 Date of last inspection Brief Description of the Service: Ashgale House is a registered care home providing personal care and accommodation for a maximum of 14 adults aged 18-65 who have learning disabilities. The building is divided into 2 units, with the home registered to provide 8 places on the ground floor (four of these places may be occupied by service users who additionally have physical disabilities) and 6 places on the first floor. Within the 6 registered places in the first floor unit, 2 places are made available to residents (on a local authority contract basis) as respite. The Registered Provider is Allied Care, the Responsible Individual being Mr Aslam Dahya. The Registered Manager is Mr Siyoum Beyene. The home is located in a busy residential road on the outskirts of central Harrow, close to shops, leisure and other community amenities. The home was registered in May 2001 and is a two-storey building. All the home’s bedrooms are single, and none have en-suite facilities. The home has a large garden to the rear that is accessed through the ground floor unit. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 2 visits to the home. Two Inspectors, Ms Julie Schofield and Mr Andreas Schwarz carried out the first visit on the 20th April. The deputy manager assisted during this visit, which lasted for 6 hours. Ms Julie Schofield carried out the second visit on the 5th of May. The manager and deputy manager assisted during this visit, which started at 2 pm and finished at 6.10 pm. The inspectors would like to thank the manager, deputy manager, members of staff, residents and relative who gave their comments during the inspection. During the inspection a tour of the building took place, records were examined, discussions took place with managers, staff and residents and the interaction between residents and staff and the care practices were observed. Requests for information regarding the fees charged for individual placements should be made to the manager of the home. What the service does well: Staff said that the members of staff worked together as a team and that the team gained its strength through good communication and training opportunities for staff. They praised the support given by the managers in the home and said that the managers were approachable and helpful and that staff felt supported by the “open door” policy if they needed to discuss any problems. They were satisfied that staffing levels met the needs of the residents and enabled staff to work with residents, on a one to one basis if required. Comprehensive care plans are being developed for residents and staff have access to these. Staff receive training in safe working practices, medication and protection of vulnerable adults and have access to a programme of NVQ training. The manager has successfully completed his NVQ level 4 in management training. Staffing levels are sufficient to include opportunities for 1 to 1 support of residents, when required. Some residents confirmed that they are able to follow their interests and preferred activities outside the home, with support from members of staff. Within the home there are opportunities for taking part in activities and the “pottery” sessions are enjoyed by residents, and appreciated by their relatives. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: During the first visit of the inspection an immediate requirement and feedback form was issued and a letter of serious concerns sent after the visit. These were in respect of the magnetic closures on fire doors not working and compromising the safety of residents, staff and visitors to the home. The tumble drier on the ground floor was in need of repair and staff time was diverted away from residents to visiting the local launderette to dry clothes. Confirmation that an annual check of the gas supply to the home and of the appliances had been carried out was not available. A copy of the Landlord’s Gas Safety Record was required to be forwarded to the CSCI to demonstrate that the safety of residents, staff and visitors was being maintained. (It was noted on the second visit that the magnetic closures on fire doors were now maintaining contact, that the tumble drier had been repaired and that the Landlord’s Gas Safety Record check had now been carried out and a certificate had been issued). Statutory requirements were identified during previous inspection(s) and remained outstanding and statutory requirements were identified during this inspection. A record is needed of the observations of the prospective resident during their pre-admission visits to the home. Comprehensive care plans are required for each resident, including those accommodated on a respite care basis. Care plans must be reviewed at least on a 6 monthly basis. Risk assessments to be completed for self-harming and for pressure sores, as applicable and guidance provided to staff in respect of pressure areas and their care. Manual handling risk assessments need to include the support to be given by staff. Risk assessments need to be reviewed on a regular basis. Where preferred activities are listed in the care plans etc these must take place Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 7 on a regular basis. A decision not to take part in activities needs to be recorded on the care plan. A timetable for the programme of works and accompanying risk assessment needs to be forwarded to the CSCI. The programme is to include replacement of areas of laminated floor surfaces, redecoration of communal areas, replacement of areas of paving outside the home, improved ventilation in bathroom and laundry areas, redecoration of ceilings in bathroom and kitchen, adjustment of ramps to facilitate access by people using wheelchairs, replacement or cleaning of furniture, investigating cause of cracks in upper unit, making good and redecorating, securely fitting toilet seat, replacing cracked tiles, cleaning extractor fans, cleaning lampshade, replacing or installing curtains to ensure privacy, fire doors to close positively, replacing handles on kitchen units and a missing unit drawer, replacing damaged flooring in kitchen, replacing radiator cover, replace a damaged radiator thermostat, removing surplus televisions from lounge, providing seating and tables in garden, repairing or replacing damaged carpet in bedroom, removing rubbish from garden and removing building materials stored along the side of the house. The progress of a referral made by the O.T. must be checked. Staff files must contain evidence of all required checks and references. Induction records need to be complete. The home needs to have a copy of the annual review of the quality of care for reference. Supplies of disposable gloves and paper towels need to be available. Tripping hazards need to be made safe or removed from residents’ rooms. The missing fire extinguisher must be replaced. The use of wedges to hold open residents’ bedroom doors must be discussed with the fire officer. The recording of accidents must be made immediately after it has occurred. “Body maps” need to include any follow up actions taken. The response to enquiries made about accidents or incidents involving residents outside the home i.e. at day care facilities, must be kept on the resident’s case file. Monthly information regarding balance of savings for individual residents is needed. Managers must be aware of threshold of savings level, above which amount of benefits may be reduced. Amount of interest paid on savings held in an account at Head Office to be recorded and added to balance on a regular basis. Home needs to have a system of checking items listed on a receipt with items brought into the home. Menus must include choice and food records are to be completed on a consistent basis. Residents’ likes and dislikes in respect of food must be respected. The weights of residents need to be recorded and carried out according to the recommended regularity. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 8 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. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 9 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 Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 10 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): 1, 2, 4 Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents, their relatives and placing authorities are able to use information provided by the home to make an informed choice about the suitability of the home. A comprehensive assessment of the needs of the resident prior to admission to the home enables the home to determine whether a service tailored to the individual needs of the resident can be provided. A programme of pre-admission visits to the home enables the prospective resident to sample life in the home and to decide whether the service provided is acceptable. A record of these visits must be kept so that the home can demonstrate that the prospective resident was satisfied with the choice of placement. EVIDENCE: During the previous inspection a requirement had been made that the Statement of Purpose be adjusted to include additional information regarding respite care services. A copy of the revised document was forwarded to the CSCI, prior to this inspection, and it was noted that the document includes a description of the respite care service. Since the last inspection 1 resident has been admitted to the home and the case file was examined. Prior to admission to the home the placing authority had supplied the home with a core assessment and care plan. There was also Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 11 a copy of a care plan review carried out in 2005 by the placing authority. The case file contained a health needs assessment. Assessment documents sampled by the inspector were judged of good standard and very detailed, the inspector was satisfied that assessment information is included within residents care plans. The case file contained a transition plan, which included pre-admission visits to the home by the prospective resident where they would have a meal or stay overnight. The home had not recorded the observations of staff that were on duty during these visits or the reactions of the existing residents or any responses from the prospective resident. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 12 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, 9 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual care plans, which identify the complex needs of the resident and the support required of staff to meet these, provide the basis for the development of a quality service. The home needs to ensure that each resident has a care plan and that it is comprehensive in its assessment of need. Evaluating care plans on a regular basis ensures that changes in the needs of residents are identified and can be addressed and regular reviews of the placement confirm that the care home continues to be able to meet the individual needs of the resident. The home needs to ensure that the regularity of reviewing care plans is maintained for each resident. It is not apparent whether the assistance given to residents with financial matters promotes and protects their best interests. Responsible risk taking contributes towards the resident leading an independent lifestyle. However, where a risk is identified an assessment and risk management strategy need to be in place. A regular review of risk assessments is needed to meet the changing needs of residents. EVIDENCE: Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 13 Four case files were selected as part of the case tracking process. The files selected included the file of a resident on respite care, and present during the first visit. The Inspectors discussed the respite care packages currently offered to residents and the 2 respite care places are shared on a programmed basis by a small number of residents. It was noted that although the care plans for permanent residents were comprehensive, (covering personal, health and social care needs) the care plan for the respite care resident was brief. The deputy manager said that care plans had not been drawn up for 2 of the respite care residents although a statutory requirement had been identified in previous inspections that each resident must have a care plan. The comprehensive plans included a section where what the resident could do, what support the resident needed and how the service would meet the needs in this aspect of the resident’s life were recorded. Case files also contained guidelines for supporting residents and records of their preferred routines at different times of the day. Evidence of at least six monthly reviews of the care plan were not present on each file. The deputy manager said that some reviews had been carried out, where evidence was absent from the file, but that the minutes of the meeting had not been placed on the case file. She confirmed that some reviews were overdue as they were waiting for a representative of the placing authority to attend. Information about infringements on the rights of residents was included in the case file. Examples included the affect on the privacy and dignity of the resident if assistance was needed with bodily functions and the affect of a resident’s finances being kept in safe keeping for the resident. Staff gave examples of how they helped residents to make choices and how they interpreted the non-verbal communication of residents who were making their wishes known. Five residents have a member of their family that is their appointee. The home/company is responsible for supporting 7 of the residents with financial matters. The manager said that although the personal allowances were received in the home on a weekly basis the residents’ savings were kept at head office. Information is supplied to the home on a monthly basis but what is needed is a clear printout of the balance of each resident’s money held, after contributions to fees have been deducted. The last balance of savings was dated November 2005 and it was noted that 2 residents had substantial balances. The manager was unable to confirm whether this was above the savings threshold allowed before benefits were reduced. He was unable to confirm whether residents received interest on their savings held at head office. Records were kept in the home of how the money held in the home, on behalf of the residents, was managed. Records included a running total and receipts. It was noted on receipts that sometimes a large number of items were purchased e.g. 14 items and that the items did not have a description only a store number and price. The home did not have a system of checking that all the goods purchased on the receipt were brought into the home. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 14 Risk assessments were included in the case files although where there was a record of a resident’s potential to self harm the file did not contain a risk assessment in respect of this. One of the files selected was for a resident who used a wheel chair but there was no risk assessment in respect of pressure sores. Risk assessments that were on file were in respect of eating, mobilizing, swimming, moving and handling etc. Some risk assessments did not show evidence of regular reviews. Risk assessments were tailored to the individual needs of the resident rather than general ones. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 15 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents attend day care services, which provide an opportunity to develop their social skills. Taking part in activities and using community resources gives residents the opportunity to enjoy an interesting and stimulating lifestyle although the activities listed on the resident’s weekly planner must be offered on a regular basis. With staff support, residents are encouraged to maintain contact with their families and to enjoy fulfilling relationships and to observe their religious practices. Residents are encouraged to make decisions and their wishes are respected. Residents are not offered a varied diet, which promotes their right of choice, although the meals respect the religious and cultural needs of residents. EVIDENCE: Residents had a weekly day care programme and staff were able to give details of each individual resident’s day centre attendance. The home has 3 vehicles, 2 vans and a car, which can be used to transport residents. During the inspection a resident who uses a wheelchair went out in one of the vans. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 16 Residents confirmed that they used the local shops, pubs, restaurants, parks and the bingo hall. The daily recordings confirmed that staff support residents with their activities taking place outside the home, during the evenings and at weekends. Case files were examined and there were details of activities which residents enjoyed taking part in and these included going to church, going to a restaurant or to a pub or going swimming. A weekly record is kept of the activities that each individual resident takes part in. These were not always completed. Staff said that in one case family members advised the home not to do a certain activity but there was no record of this. Where it had been identified that a resident enjoyed going swimming the records did not demonstrate that this had happened on a regular basis. It was noted that a resident was particularly fond of dogs and liked the member of staff to bring their dog with them when they went with the resident to the park. The managers in the home need to monitor this to ensure that the professional boundary between the member of staff and the resident is maintained. There are “pottery sessions” held in the home and items that residents have chosen to paint are on display. Staff said that relatives enjoyed receiving these as gifts. One of the residents was engrossed in a jigsaw puzzle although pieces are put back in the box after using, even if the puzzle hasn’t been completed. Another resident spent time holding the cardboard box containing some of the puzzle pieces and the home should review whether there are any other activities, which he would enjoy. A third resident said that enjoyed doing puzzles, knitting, painting the pieces of pottery and colouring. A member of staff said that helped meet the religious and cultural needs of a resident by escorting them to the Temple. The television that was switched on in the ground floor lounge does not receive channels where the language spoken is Gujarati or Punjabi. During the second visit to the home a group of 4 residents were looking forward to going on holiday to St Leonards. One of those going on holiday has 2 birds in a cage and said that the staff would look after them while she was away. There was also a bird table in the garden and staff said that residents enjoyed watching the visitors to this. During the first visit an Inspector talked with a relative who was visiting a resident in the home. The relative confirmed that they were made welcome by the staff on duty when they visited the home. Staff said that some of the residents have regular visitors and that some of these residents enjoy visiting or staying with their families, for short periods. When the second visit took place all of the 7 parking spaces on the forecourt of the home were occupied. Parking in the street is restricted to “residents only”. The Inspector waited until a vehicle moved from the forecourt. The manager said that a skip was occupying the space reserved for visitors to the home. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 17 Residents have access to the communal areas in the home and during the second visit, when the weather was warm, some residents were enjoying sitting on the patio. Residents were able to choose whether they took part in activities or whether they wished to spend time in their rooms. Staff were able to link daily routines with the rights of residents. They identified the right to choose, the right to privacy, the right to being alone, the right to socialise, the right to take part in activities and the right to good meals etc. A statutory requirement was identified during the previous inspection that choices must be documented within the menus. The deputy manager said that work is still taking place on this and that they will use pictures to assist in offering choice. The timescale for compliance has not expired. A statutory requirement was identified during the previous inspection that residents’ weights are monitored on a monthly basis, where possible, and that a record is maintained. The deputy manager said that residents who use a wheelchair need a seated weighing scale and the home does not have this, although there are plans to purchase one. The timescale for compliance has not expired. When case files were inspected it was noted that weekly weight records were required for one of the residents. However, for this resident weight records had been carried out on a monthly basis and the last one was dated October 2005. A member of staff confirmed that a vegetarian diet is offered to a resident in order that her religious and cultural needs are met. Individual food records were examined and it was noted that they were not complete. It was also noted that although it stated several times in a resident’s case file that the resident did not like chicken a chicken meal had been recorded as consumed, for 4 days within a 6-day period (23rd to 28th March 2006). A lack of variety was also noted when on the 3rd April sausage rolls had been eaten for lunch and sausages for dinner and on the 15th April mixed vegetable curry had been eaten for lunch and for dinner. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 18 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents receive assistance with or prompting with personal care in a manner, which respects their privacy. To promote the health and safety of residents the manual handling risk assessments need to include details of the assistance to be given by the member(s) of staff. Residents’ health care needs are met through access to health care services in the community. For the use of “body maps”, to record any marks or injuries to the resident, to be effective any follow up actions need to be clearly recorded. The general well being of residents is promoted by assistance from staff in taking medication, as prescribed. EVIDENCE: The case files examined contained risk assessments in respect of manual handling but did not include what actual assistance the members of staff were required to give. This requirement was identified during the inspection that took place in February 2006 and repeated previous inspection findings. The timescale for compliance had not expired. There was information on the case files examined of the preferred morning and evening routines of residents. It was noted that the staff consisted of both male and female staff enabling residents to be assisted with personal care tasks by a member of the same Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 19 sex. Files contained extracts from the procedures manual about helping residents with their personal hygiene. It was noted that assistance with toileting was offered in a discreet manner. Files inspected contained body maps and a statutory requirement was identified in previous inspections that these should include details of the follow up work that took place. The timescale for compliance had not expired. Although some residents have restricted mobility e.g. they use a wheelchair risk assessments in respect of pressure sores were absent. A requirement was identified during the previous inspection that care plans and guidance for staff must be developed to include prevention of pressure areas. The timescale for compliance had not expired. Case files provided evidence that residents had access to health care facilities in the community e.g. the GP, the local hospitals, chiropody services, dental and optical services etc. A resident said that they were provided with an escort when they attended out patient appointments. The home is supplied with a blister pack system of administration although this month the pharmacist had not sent blister packs but had sent bottles and an explanation had not been given. The managers said that they preferred the system of blister packs. The managers agreed with a recommendation that for the remainder of the month 2 members of staff (both trained in the administration of medication) are responsible for the administration. This will enable 1 member of staff to double check the name of the resident on the bottle of tablets, the name of the drug on the bottle, the number of tablets being taken out of the bottle etc. Medication was stored in locked facilities in each unit. Records were inspected and were up to date and complete. A tube of cream opened did not have the date when it was first used, recorded on the label. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaints procedure is in place to protect the rights of the residents. An adult protection procedure and training in protection of vulnerable adults procedures help to promote and protect the welfare and safety of residents. EVIDENCE: A complaints procedure is in place in the home. It includes the stages of the process and timescales for completion. Complainants are advised of their right to contact the CSCI. The deputy manager said that no complaints have been recorded since the last inspection. A relative confirmed that if they had any concerns regarding the care of the resident they would be able to talk to one of the managers. A protection of vulnerable adults procedure is in place in the home. The deputy manager said that no allegations or incidents of abuse have been recorded since the last inspection. It was noted on a case file that a letter had been sent to the day centre that a resident attended. There had been concern about scratches, which staff noticed on the resident’s return to the home. The letter was dated February 2006 but a response from the day centre was absent from the file. When speaking with a group of 3 members of staff, each member of staff confirmed that they had received training in protection of vulnerable adults procedures. A requirement was identified during the previous inspection that the accounts of monies held on behalf of residents is regularly checked and signed. Records of this are now kept on a weekly basis. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 21 Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Overall quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents live in a home where repairs, redecoration and refurbishment are required before they can enjoy well-maintained premises. Residents live in a home where standards of cleanliness are good although supplies of goods to maintain hygienic standards need to be provided at all times. EVIDENCE: A tour of the premises took place. During the inspection in February 2006 twenty-two statutory requirements were identified in respect of the upkeep of the building. Nineteen of these requirements were repeated from previous inspections. The timescales for compliance had not yet expired although there was now compliance in respect of 5 of the requirements. It was noted that the carpet in the first floor communal areas and lounges had been cleaned and the stains removed. The handyperson was on site and had resealed the shower and baths and the flooring in these areas. The work surfaces in the first floor kitchen and ground floor kitchen have been replaced although an edging strip is required in the first floor kitchen. The hard to clean areas between kitchen cupboards and appliances are now included in the cleaning schedules for the care home. During the tour of the premises 16 additional statutory Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 23 requirements were identified. It was noted that there were tears in the carpet in Room 13, that rubbish (including old commode chairs) needed removing from the garden, that building materials were being stored along the side of the house and blocking the path, that the cracks in the walls of the first floor lounge were being covered with panels without first determining the reason why cracks had developed, that windows were without net curtains to afford privacy and in Room 9 the curtains were flimsy and did not cover all the panes in the bay window and that the ceilings in the first floor bathroom and ground floor kitchen need making good and redecorating. A resident said that they found the height of chairs too low to comfortably lower and raise themselves. There were cracked tiles in the shower room. The extractor fan in the downstairs toilet was dirty. The rug in room 7 presented a tripping hazard. An Occupational Therapy referral has been made in respect of Room 6, but no information was available regarding its progress. The lampshade in room 6 was dirty. Disused TV’s were stored in the first floor lounge. The ceiling in the first floor kitchen showed signs of water damage. The radiator thermostat in the first floor lounge was broken. The front of one of the drawers in the ground floor kitchen was missing. During the tour of the premises it was noted that the home was clean and tidy and free from offensive odours. There are laundry rooms on both floors. Clothing had been spread over the railings around the patio area and along the ramps to dry. The tumble drier in the ground floor laundry room was in need of repair and an immediate requirements and feedback form was issued. It was noted that paper towels dispensers were empty and that boxes containing disposable gloves were empty. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The rota demonstrated that there were sufficient staff on duty to support the residents and to meet their needs. Staff that have the opportunity to develop their skills and knowledge by undertaking NVQ training support residents. The home needs to ensure that recruitment practices protect the welfare and safety of residents. Comprehensive records of induction training undertaken are needed for the home to demonstrate that staff have developed the skills and understanding necessary to meet the individual needs of residents. EVIDENCE: Observations of the interactions between residents and staff confirmed that residents were relaxed and comfortable in the company of staff and that staff communicated with residents. In discussions staff demonstrated a commitment to their duties. They had completed or were undertaking NVQ training, either level 2 or 3. Staff said that they thought that staffing levels were sufficient to meet the needs of the residents and that the members of staff on duty worked together as a team, with good support from managers. The staffing rota was examined. There were 9 carers on duty in the home on the early and on the late shifts, during the day. At night there were 4 waking members of staff on duty in the Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 25 home. It was noted during both visits to the home that staffing levels were sufficient to enable residents to go out with a member of staff on a 1 to 1 basis. A requirement was made during the previous inspection that the home must obtain a satisfactory enhanced CRB check prior to a member of staff commencing employment. The deputy manager said that the requirement was in respect of a named member of staff and that no new staff have been employed since November 2005. As the home has not had an opportunity to demonstrate compliance the timescale has been extended. Four staff files were inspected. Files contained application forms, passport details and a statement of terms and conditions. Not every file contained 2 satisfactory references. One of the passport details had an expiry date for the visa/permission to work of the 31/10/04. A requirement was made during the previous inspection that a full record be maintained of he induction undertaken by new staff in the care home. As no new staff have been employed since November 2005 the home has not had an opportunity to demonstrate compliance so the timescale has been extended. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 26 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. NVQ level 4 training helps contributes towards the effectiveness of the manager and develops their awareness of the needs of residents and staff. Annual service reviews of the home monitor the quality of the service provided and enable the service to develop in such ways that meet the changing needs of the residents. For staff to adapt to necessary changes a copy of the review must be available in the home, for reference. Training in safe working practice topics enables members of staff to safeguard the health, safety and welfare of the residents and regular servicing and checking of equipment used in the home ensures that items are in working order and safe to use. Fire precautionary equipment and systems must be intact and operational. At the time of the first visit the health and safety of residents, staff and visitors to the home was compromised. EVIDENCE: Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 27 The manager had received his certificate for the successful completion of NVQ level 4 in management training and made this available for inspection. Copies of the reports of the Regulation 26 visits were available for inspection. The last was dated the 27/2/06 and it was noted that they were carried out on a monthly basis. There is now compliance with the requirement identified during the previous inspection that these monthly visits are undertaken and recorded. A statutory requirement was identified during the inspection in February 2006 that a copy of the report of the annual review of the quality of care provided is forwarded to the CSCI. The timescale for compliance had not expired. There was evidence in the case files that some residents had taken part in a satisfaction survey. Staff confirmed that they took part in an annual staff survey and that they received feedback about the results. During the tour of the premises it was noted that the magnetic door closure units were not making contact with the unit on the wall. The deputy manager said that there was a fault in this system, which had been reported to the company with the contract for servicing the system on the 15th April. An immediate requirement and feedback form was issued. It was also noted that the corner of the rug in Room 7 was “lifting” and presented a tripping hazard. A fire extinguisher was missing from the bracket near the first floor unit door. A statutory requirement had been identified during the previous inspection that a copy of the certificate for the electrical wiring installation be available for inspection. This was produced and was valid for a period of 2 years from 2005. There were valid certificates in respect of testing the portable electrical appliances, the fire alarms and emergency lighting systems and the fire extinguishers. There were records in respect of testing the fire alarm call points on a weekly basis and the last fire drill had taken place in February 2006. The home had a recorded fire risk assessment. The Landlord’s Gas Safety Record was not available for inspection and an immediate requirement and feedback form was issued. Staff on duty confirmed that they had received training in safe working practice topics including health and safety, manual handling, fire safety, first aid, food hygiene. When the accident book was inspected after 12 noon it was noted that the last recorded accident was dated the 29th September 2004. In the daily recording for the morning of the 20th April 2006 a resident had hurt their head when their wheelchair fell backwards after a wheel hit the doorframe. The deputy manager said that the accident book was completed later in the afternoon, while the inspection was taking place. A discussion took place regarding which accidents or incidents needed to be reported to the CSCI. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 28 A statutory requirement was identified during the previous inspection that the temperature in the fridges was within safe guidelines. The fridges were inspected and there was compliance. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 X 4 2 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 3 34 2 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 1 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 2 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 3 X 2 X X 1 X Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 30 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 YA4 Regulation 12.1 Requirement Timescale for action 01/08/06 2 YA6 15 3 YA6 15 That records are kept of the visits made to the home by the prospective resident during the transition plan. These records are to include the observations of managers and staff, reactions by existing residents and feedback from the prospective resident. Care plans must be available for 22/04/06 all residents living in the home. (Previous timescales of 21st January 2005, 10th May 2005 and 23rd of February 2006 not met). Comprehensive care plans, 01/07/06 which address personal, health and social care needs, must be available for all residents, accommodated permanently or on a respite care basis. That care plans are reviewed on a minimum basis of at least every 6 months, with or without a representative of the placing authority attending the meeting. Clear information to be sent to the home, on a monthly basis, about the money held at Head DS0000017514.V291103.R01.S.doc 4 YA6 15.2 01/07/06 5 YA7 17.2S4.9 01/07/06 Ashgale House Version 5.1 Page 31 6 YA7 12.1 7 YA7 17.2S4.9 8 YA7 12.4 9 YA9 13.4 10 YA9 13.4 11. YA9 13.4 12. YA14 16.2 13. 14 YA14 YA15 17.3.a 12.1 15 YA17 16.2 Office for each individual resident, after any contributions towards fees have been paid i.e. the balance of any savings held. That the home is aware of the level of savings permitted before the resident’s benefits are reduced. That the home demonstrates how each individual resident will receive any interest applicable to their individual savings. That a system is in place to check that all items listed on a receipt are items that the resident brings back with them to the home. That if there is a potential for self-harm, the resident’s case file includes a risk assessment and risk management strategies in respect of this. That when a resident has limited mobility i.e. they use a wheelchair, there is a risk assessment in respect of pressure sores. The registered manager must ensure that risk assessments are reviewed at regular intervals, with the participation of residents. That where an activity has been identified on a resident’s weekly programme of activities it takes place. That the decision not to attend activities must be recorded in service users care plans. That while a skip is occupying the space normally reserved for visitors one of the remaining 6 spaces must be designated as the visitors parking space. That a space is reserved for visitors parking at all times. Choices must be documented within the care home’s menus. DS0000017514.V291103.R01.S.doc 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 06/05/06 01/07/06 Page 32 Ashgale House Version 5.1 16 YA17 12.1 17 YA17 12.3 18 19 YA17 YA18 17.1S4.13 13.5 (Previous timescale of 22nd April 2006 not met). That residents’ weights are monitored on a monthly basis (or weekly where this is identified) where possible and a record maintained. (Previous timescale of 22nd April 2006 not met). That the likes and dislikes in respect of food, which are recorded in the resident’s case file, are respected when meals are prepared. If an alternative is served this is recorded in the resident’s individual food records. That the residents’ individual food records are complete and up to date. Ensure that Moving & Handling’ assessments include full details on how staff are to assist residents with moving and handling operations. (Previous timescale of 23/02/06 not met) Ensure that where ‘body maps’ are completed in the event of any bruises or injuries being noticed on a resident, that there clear recorded indication of what follow up had occurred subsequently, e.g. consultation with GP, investigation, reporting to the Commission for Social Care Inspection or completion of the accident book. (Previous timescale of 23/02/06 not met) Care plans and associated guidance for staff must be developed with regard to the prevention of pressure areas and advice for staff on how to work with the resident. DS0000017514.V291103.R01.S.doc 01/07/06 01/07/06 01/07/06 22/04/06 20 YA19 12.1 22/04/06 21 YA19 15 22/05/06 Ashgale House Version 5.1 Page 33 (Previous timescales of 26/04/04, 22/01/05, 10/05/05 and 23/02/06 not met) 22 YA23 13.4 That where information is requested about a possible incident or accident involving a resident a record of the response is placed on the resident’s case file. The laminated floor surfaces throughout the building are showing signs of wear and are no longer impervious surfaces. These require replacement. (Previous timescale of 23/02/06 not met) Communal areas of the building require redecoration (both walls and woodwork) in the lounges, corridors and dining areas. (Previous timescale of 23/02/06 not met) Provide seating and tables for residents to use in the garden The paving to the front and side of the building require replacement where the surfaces are cracking and potentially creating trip hazards. (Previous timescale of 23/02/06 not met) The use of wedges to prop open bedroom doors in Ashgale House must be reviewed, with consideration being given to the use of approved door opening devices, in consultation with the Fire Safety Officer. (Previous timescale of 23/02/06 not met) 01/07/06 23 YA24 16.2 22/05/06 24 YA24 23.2 22/05/06 25 YA24 23.2 23/04/06 26 YA24 23.2 22/05/06 27 YA24 23.4 22/05/06 Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 34 28 YA24 23.2 The ground floor bathroom was very warm with no opening window and an internal extractor fan. Ventilation of this area must be reviewed and improved in order to provide a comfortable environment for residents. (Previous timescale of 23/02/06 not met) Redecorate the ground floor bathroom ceiling where stained. (Previous timescale of 23/02/06 not met) The ramping to the front door requires attention where there is a steep drop that requires levelling to offer ease of access to those using wheelchairs to mobilise. (Previous timescale of 23/02/06 not met) The sofas in the first floor unit lounge require deep cleaning or (if unsuccessful) replacement as are stained and worn. The sofas in the ground floor lounge are also showing signs of wear. (Previous timescale of 23/02/06 not met) There is extensive cracking of the walls in one area of the first floor lounge. The cause of this must be eradicated if possible and the area redecorated. (Previous timescale of 23/02/06 not met) The toilet seat in the second floor toilet facility requires secure fitting as was wobbly. (Previous timescales of 02/01/05, 10/05/05 & 23/02/06 not met) 22/05/06 29 YA24 23.2 22/05/06 30 YA24 23.2 22/05/06 31 YA24 16.2 22/05/06 32 YA24 23.2 22/05/06 33 YA24 23.2 22/04/06 Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 35 34 YA24 16.2 Many curtains in the care home have shrunk and must be replaced in order to ensure resident privacy in all areas. (Previous timescale of 23/02/06 not met) 22/05/06 35 YA24 23.4 All fire doors in the building must 22/04/06 close positively. (Previous timescale of 23/02/06 not met) Ventilation in the first floor laundry must be reviewed, in order to avoid propping the door open thereby restricting the first floor fire escape route. (Previous timescale of 23/02/06 not met) The kitchen unit handles in the first floor unit require replacement where missing. (Previous timescale of 23/02/06 not met) 22/05/06 36 YA24 23.2 37 YA24 23.2 22/05/06 38 YA24 16.2 The first floor unit kitchen 22/05/06 flooring requires replacement, as has a hole in it, therefore making the surface pervious. (Previous timescale of 23/02/06 not met) Repair the damaged radiator cover in the ground floor unit hallway. To repair or replace the carpet in Room 13. That rubbish is removed from the garden. That a surveyor examines the cracks in the home and that a copy of the report is forwarded to the CSCI. That net curtains are fitted to bedroom windows and that DS0000017514.V291103.R01.S.doc 39 40 41 42 YA24 YA24 YA24 YA24 23.2 16.2 23.2 23.2 22/04/06 01/07/06 01/07/06 01/07/06 43 YA24 16.2 01/07/06 Ashgale House Version 5.1 Page 36 44 45 YA24 YA24 23.4 23.2 46 YA24 12.1 47 YA24 12.1.a 48 49 50 51 52 53 54 55 YA24 YA24 YA24 YA24 YA24 YA24 YA24 YA30 23.2.d 23.2.d 23.2.b 13.4 23.2.d 23.2.c 23.2.c 23.2 56 YA30 13.3 curtains are fitted in Room 9 which cover all panes of the bay window and which do not let the light through. That building materials are not stored at the side of the house and blocking the path. That the ceilings of the first floor bathroom and ground floor kitchen are made good and redecorated. That a timetable for the programme of works required achieving compliance is drawn up and a risk assessment is undertaken in respect of the health, safety and welfare of residents during this process. Copies of both the timetable and the risk assessment to be faxed to the CSCI. That the manager checks the progress of the referral made by the Occupational Therapist for room 6. That the lampshade in room 6 is cleaned or replaced. That the extractor fan in the downstairs toilet is cleaned. That the cracked tiles in the bathroom are replaced. The rug in room 7 must be properly secured to the floor. That the televisions stored in the first floor lounge are removed. That the radiator thermostat, which is broken, is replaced. That the missing drawer in the ground floor kitchen unit is replaced. That the tumble drier in the ground floor laundry room is repaired so that it is in working order. That the home has sufficient stocks of paper towels and disposable gloves at all times. DS0000017514.V291103.R01.S.doc 01/07/06 01/07/06 08/05/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 01/07/06 24/04/06 01/07/06 Ashgale House Version 5.1 Page 37 57 58 YA32 YA34 18.1 19.1 That 50 of carers achieve an NVQ level 2 qualification. It must be ensured that the care home is in receipt of satisfactory ‘enhanced’ CRB checks prior to a member of staff commencing employment there. (Previous timescale of 23/02/06 not met) That each file contains 2 satisfactory references and evidence of valid visa/permission to work. That the home forwards evidence of an application being made for an enhanced CRB disclosure, by the named member of staff, to the CSCI. It must be ensured that a full record is maintained of the induction undertaken by new staff in the home. Forward a copy of the report of the annual review of the quality of care that is conducted with regard to Ashgale House. (Previous timescales of 04/08/04, 02/01/05 and 23/03/06 not met) That the fault with the system of magnetic door closures is investigated and remedied so that they are in working order. That a copy of the Landlord’s Gas Safety Record is forwarded to the CSCI. Ensure that accident reports are completed where accidents and injuries occur in Ashgale House. That the missing fire extinguisher on the first floor is replaced. DS0000017514.V291103.R01.S.doc 01/10/06 01/09/06 59 YA34 19.1 01/08/06 60 YA34 19.1 01/07/06 61 YA35 18.1 01/09/06 62 YA39 24.2 23/05/06 63 YA42 23.4 21/04/06 64 65 YA42 YA42 13.3 17.2S3.3 28/04/06 23/04/06 66 YA42 23.4 15/06/06 Ashgale House Version 5.1 Page 38 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 That the home writes to the placing authorities and requests that they convene a review meeting at least on an annual basis and that a copy of the individual letters are kept on the case files. That the placing authority is invited to attend all review meetings convened by the home and if unable to a copy of the minutes of the meeting are forwarded. That minutes of review meetings are placed on the case file. That there is a system for checking that all the goods purchased on the receipt are brought into the home. That individual weekly activities record sheets are completed and are up to date. That managers ensure that staff adhere to the policies on maintaining a professional relationship with residents. That a jigsaw roll or board is used so that the puzzle can be stored when incomplete. That a review of suitable and stimulating activities for residents is carried out. That residents have access to television channels where Gujarati or Punjabi is spoken, if their family speaks Gujarati or Punjabi as a first language. That the home contacts the pharmacist and request that the system of monthly blister packs is reinstated. That for the remainder of the month where bottles of medication have been supplied, 2 members of staff working together are responsible for the administration of medication. That when a tube of cream is first used the date is recorded on the label. That where a new work surface has been fitted the edges are covered with an edging strip and not left bare. That the soap dispenser unit is reattached to the wall in the ground floor bathroom. That the home provides chairs of a suitable height so that residents can comfortably lower and raise themselves. Clothe lines for drying clothes in the garden should be DS0000017514.V291103.R01.S.doc Version 5.1 Page 39 2 3 4 5 6 7 8 9 10 11 YA6 YA6 YA7 YA14 YA14 YA14 YA14 YA14 YA20 YA20 12 13 14 15 16 YA20 YA24 YA24 YA24 YA24 Ashgale House 17 18 YA39 YA42 provided. That a copy of the Regulation 26 visit report for March 2006 is requested and kept in the home. That a copy of the guidance in respect of Regulation 37 reporting is downloaded from the CSCI website and kept in the office, for guidance. Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 40 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 Ashgale House DS0000017514.V291103.R01.S.doc Version 5.1 Page 41 - 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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