Inspection on 29/05/07 for Ashleigh

This inspection was carried out on 29th May 2007.

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

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

Other inspections for this house

Ashleigh 19/01/06

Ashleigh 07/06/05

Ashleigh 14/09/04

Ashleigh 18/05/04

Ashleigh 04/02/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Ashleigh 27 - 33 Ash Grove Beverley Road Hull East Yorkshire HU5 1LT Lead Inspector Pam Dimishky Key Unannounced Inspection 29th May 2007 09:05 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ashleigh Address 27 - 33 Ash Grove Beverley Road Hull East Yorkshire HU5 1LT 01482 346959 F/P 01482 346959 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) Hestan Court Limited Mr Ian Crowther Care Home 37 Category(ies) of Dementia - over 65 years of age (37), Old age, registration, with number not falling within any other category (37) of places Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th January 2006 Brief Description of the Service: Ashleigh is a privately owned care home operated by Hestan Court Ltd and managed by Mr Ian Crowther, one of the company directors. Ashleigh is registered to provide care for up to 37 older people who may also suffer from dementia. The home has two floors with the first floor being accessible by a chair lift and a passenger lift. Two areas of the first floor are not accessible by either of these as they are situated on a different level and bedrooms therefore are only occupied by people who are ambulant. The home has 19 single and 9 double bedrooms, of which three offer en suite accommodation. Space available for the use of all residents includes a lounge, quiet lounge, smoking lounge and dining area. There is a garden/patio area to the rear of the home. The home is on a street, which runs off the busy Beverley Road, with easy access to local bus services. Shops, churches and public houses are all near to the home. Fees charged by the home are £340 per week with additional costs for hairdressing, chiropody, optical, dental all of which are invoiced directly to the resident. Residents, or their families, provide their own toiletries. Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection site visit took place over a period of 6 hours. The inspector spent some time in the lounge observing and talking to residents, looked around all of the building and a number of records were examined. Two members of staff, the manager, four residents, and one relative were spoken to. All the key standards have been assessed at this inspection. Prior to the inspection 116 surveys were sent to residents, relatives/visitors, staff, general practitioners and care managers; from the 23 returned some of their comments have been taken into account in this report. What the service does well: What has improved since the last inspection? Training is ongoing, ensuring staff have the opportunity for personal development and the necessary skills to meet residents individual needs. As a result of a resident survey conducted by the home, attempts will be made to provide more information to the residents. The percentage of staff qualified to NVQ level II has increased and now meets the recommended standard. Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6. People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The admission procedure includes a full assessment being made before the resident moves into the home ensuring individual needs can be met. EVIDENCE: A full needs assessment is made prior to prospective residents moving into the home, involving all relevant parties, to ensure individual needs can be met. A care plan is developed from this assessment and the local authority’s assessment. Written confirmation the home can meet the needs is sent to the prospective resident or their representative. The home does not admit to admit people for intermediate care. Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 & 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are put into practice. EVIDENCE: Four care plans were examined. These indicated personal support is provided in accordance with the care plan and in discussion with residents and staff it is evident individual needs and preferences of people using the service are being met. However, although manager notes and key worker care plan update sheets were noted in one case file, entries had not been made since 2005 and there should be evidence of the care plan being reviewed at least once a month and updated to reflect changing needs as necessary. A number of residents beds are fitted with bed rails and the manager confirmed appropriate risk assessments are being made before this action is taken and only with the signed agreement of the family or resident’s representative. Two residents have special needs and arrangements are in place with health service and social service professionals to support the home in meeting their needs. The manager confirmed training is also being arranged in the very near Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 10 future to provide staff with the particular skills necessary for meeting one person’s special needs. Health service support is provided through general practitioners, district nurse, community psychiatric nurse, psychiatrist, specialist social worker, occupational therapist, physiotherapist, dietician; optical, dental and chiropody services are arranged privately and paid directly by the resident or their representative. Residents and staff in conversation confirmed residents are treated with respect and their right to privacy upheld. Where possible residents are supported to maintain their independence as much as possible and one resident clearly chooses where to spend his time inside and outside the home. Medications and their storage were checked along with the medicine administration records and were found to be correct. Separate storage and records are being kept for controlled drugs and medication returned to the pharmacist is also being recorded and signed for correctly. All staff administering medication have had both in-house training and training provided by social services education centre. The team leader responsible at the time of the inspection spoke to the pharmacist regarding the monitored dosage system packs used by the home having the correct sequence of days on the pack and for dates and columns on the medicine administration record to match to reduce the risk of error. The manager confirmed the procedure for obtaining urgent medication as soon as possible, including the use of the late night pharmacy and faxing the prescription through to the pharmacist. The home has a policy and procedure for recognising and dealing with residents at risk of pressure sores including regular visits by the district nurse. The manager stated no residents currently have bed sores, although four are on bed rest and being visited by the district nurse. The inspector was informed that all staff have had training for pressure area care, although one member of staff spoken to said she was awaiting training. One general practitioner completing a questionnaire stated the home provides a good level of care and a care manager stated one resident is encouraged to keep up with hobbies and “residents are encouraged to regain mobility”. Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 & 15 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Daily life and social activities generally meet the expectations and choice of residents living in the home. EVIDENCE: In discussion with residents it is apparent their lifestyle generally matches their expectations and preferences. Choices are made about activities, food, how to spend time in the home and when to get up and go to bed. One resident stated she picks and chooses which activities to take part in and prefers to go out when a member of staff is available to accompany her but would like to go out more. Another resident lives a very independent lifestyle walking into town every day and choosing to spend much of the rest of the time in his room listening to CD’s and reading. A hairdresser was visiting the home at the time of the inspection and it was obvious some of the ladies look forward to having their hair done. The home no longer employs an activities co-ordinator due to reduced numbers of residents, but care staffing levels have remained the same allowing time for activities every day. A selection of activities according to resident choice are offered including reminiscence, one to one discussions, bingo, quizzes, table games, dominoes and crosswords. At the time of this inspection a group of residents were playing bingo in the dining room and Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 12 others were playing dominoes in the lounge. Entertainers visit the home and during the summer months taxis are booked for trips out, weather permitting; Bridlington, Burnby Hall and Beverley were all on the agenda last year. The manager stated representatives of the local Anglican church visit regularly and chat with residents who can also visit the church if they wish; a service is held in the home at Christmas and Easter. One resident stated they looked forward to these visits. A Catholic priest visits one resident every two to three weeks. Visitors are welcome at any reasonable time and one relative visiting at the time of this inspection, said the staff are very good and caring. Everyone agreed the food is very good. The cook visits all the residents every day to establish what they would like for lunch and tea; choices being available for both. Lunch on the day of the inspection was observed to be nicely presented and looked wholesome and nutritious. Those residents requiring assistance were aided by staff in a relaxed, unhurried manner. The home had arranged for one resident celebrating a birthday to have a special tea complete with birthday cake and glass of sherry. Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to express their concerns and have access to a robust, effective complaints procedure, and are protected from abuse. EVIDENCE: Since the last inspection during January 2006, the home has received seven complaints. These have been fully recorded, investigated and appropriate action taken. In discussion with residents they were not aware of the complaints procedure (although this forms part of the service user guide given to all residents) but did say they would talk to their key worker or the manager. The home has a policy and procedure for safeguarding adults and the member of staff interviewed was aware of the policy and has received awareness training on the subject. Questionnaires completed by staff indicated they understand the principals of safeguarding adults. Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Whilst there is an ongoing programme of maintenance, refurbishment and redecoration, there is a need for improvements to be made in the home (some of which are planned) to provide residents with an attractive, and homely place to live. EVIDENCE: The design and layout of parts of this home does not lend itself to catering for people who are not ambulant. Two upstairs areas have rooms on a different level, accessed by three steps; the manager stated assessments are made to ensure only ambulant people use these rooms. Bedrooms are highly personalised and it is clear residents and their families are encouraged to bring memorabilia and personal items into the home. The home is in need of redecoration and for most carpets to be replaced. However, they are currently awaiting approval from the Department of Health that an application for a Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 15 capital grant for improving the care home environment has been successful. Should this prove fruitful, arrangements are in place to commence work on redecoration and replacing carpets in the dining room, lounges, down stairs corridors and for providing a walk in shower in a down stairs bathroom. Some carpets are badly stained, and despite the best efforts of the staff they are unable to be cleaned. Two residents completing the last annual satisfaction survey had said they would like their room to be painted lilac, and the manager stated residents are able to choose their own colour schemes where possible. Some toilets did not have soap and towels, although the manager stated these were being replaced, and a resident had clearly had an accident in one bathroom which needed immediate action to clean it up. Apart from this and a slight odour in some areas, the home generally appeared clean. The kitchen was not inspected on this occasion but the manager stated the environmental health officer visited last year and made no requirements; the report was not available for inspection. The nurse call alarm is installed in all bedrooms and can only be cancelled at the point of activation. However, consideration should be given to installing a call alarm in communal areas which would encourage residents’ independence and benefit staff in emergency situations. Whilst touring the premises, one resident was found to be in need of assistance and although the call alarm was activated it took staff some time to answer it. The laundry, part of which is a through route to the office, is well equipped and has wall and floor finishes which are easily washable. One member of staff takes home personal washing for two residents for whom she is key worker; the manager stated all residents clothing is marked with their name. The home will become a “no smoking” home from 1st July 2007. Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Staff are trained and supported by the home’s manager ensuring residents’ needs can be met. EVIDENCE: Twenty-nine residents were living in the home at the time of this inspection. The staff duty rotas indicate five staff are employed on the early and late shift and three at night which is sufficient for the number and dependency levels of the people they are caring for. The activities co-ordinator is no longer working in the home, and care staff now spend time with the residents every afternoon undertaking some form of activity. Twelve new staff have been employed since the last inspection over a year ago, and their personal records were examined. All staff have had the necessary police and safeguarding adults checks, but the dates of employment appeared to indicate some staff had commenced prior to the results of one of these checks being known. However, the manager assured the inspector staff had not commenced prior to obtaining the result. Some application forms did not give exact dates for previous employment history, only years, and the manager was advised regarding this practice and where gaps are revealed these must be explored. A declaration was not being made that the job applicant was mentally and physically fit to undertake the Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 17 duties applied for as required by legislation, but this omission was rectified at the time of the inspection and will apply to all new job applicants. Staff training is very good and the pre-inspection questionnaire indicates eleven of the twenty care staff have NVQ level II or above and thirteen have a current first aid certificate; a plan of future training also listed includes not only mandatory training but also more specialist training to meet residents’ special needs. A member of staff confirmed she has undertaken mandatory training and regular updates, some updates are still awaited, plus specialist training and the manager is very supportive in meeting individual training needs. Although the inspector was informed all staff have received pressure care training, the member of staff interviewed was awaiting training. The manager confirmed staff are to access training for one resident recently admitted to the home with special needs. All staff have supervision at least six times a year covering care practice and training needs. Staff meetings for key workers are held monthly. Information discussed at these meetings is used in one to one discussions with other care staff, although one member of staff who completed a questionnaire stated they had not received supervision, not had work observed and did not access team meetings. Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect and there are effective quality assurance systems in place. EVIDENCE: The manager of the home is registered with the Commission for Social Care Inspection and holds the registered managers award. Residents do not have group meetings but are consulted on a one to one basis. An annual survey is made to determine residents’ satisfaction with the care and services provided; the results of the last survey indicated the fifteen residents who participated were happy with the home and their needs were being met. The home has a certificate for the local authority quality development scheme. The preinspection questionnaire completed by the home indicates all policies and Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 19 procedures are reviewed annually and the manager confirmed changes are also made as necessary. Residents and/or their families manage their own financial affairs, however, some personal monies are being kept by the home on behalf of the residents and these were all checked against the records and were found to be correct at the time of the inspection. The home promotes the health, safety and welfare of residents and staff. Mandatory training and updates are all taking place and a health and safety poster is displayed in the laundry for all staff to see. Maintenance and associated record information was supplied with the preinspection questionnaire and indicated these are up to date. Fire alarm and emergency lighting checks were examined and are recorded as taking place weekly and monthly respectively. The manager stated all staff have in-house annual fire training, however, fire training should take place twice a year for all staff. The landlords gas safety certificate was not available, although the manager confirmed this is current and should have been issued at the time the boiler was recently replaced; the contractor is being contacted again to send the document. The employers public liability certificate displayed in the entrance to the home is out of date and the manager thought the latest certificate was still being held at the head office. A Heartbeat Award certificate for the quality of the food provided in the home is displayed in the hall but dated 2000. As these awards are updated annually the certificate should now be removed as it is out of date and could be misleading; the manager stated the home has been scored as adequate by the local authority for food safety. The manager thought the home’s registration certificate may have been removed from its usual place on the notice board by a resident and therefore made arrangements for the Commission for Social Care Inspection to forward a duplicate copy. Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP19 Regulation 23 Requirement Replace carpets in the dining room, both lounges and downstairs corridors and develop a programme for carpet replacements in other areas and for redecoration throughout the home, particular attention being made to gloss paintwork. Ensure toilet areas are kept clean at all times and soap and towels are always available Ensure job applicants complete an employment history giving actual dates, not years, that gaps in employment are explained and provide evidence they are physically and mentally fit for the purposes of the work which is to be performed at the care home Ensure staff attend fire safety training twice a year Provide evidence the home has a current landlords gas safety certificate Timescale for action 31/12/07 2 3 OP26 OP29 16 19 29/05/07 29/05/07 4 5 OP38 OP38 23 23 31/12/07 30/06/07 Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 22 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 3 4 Refer to Standard OP7 OP22 OP19 OP38 Good Practice Recommendations Care plans should be reviewed monthly and updated to reflect changing needs as necessary Call alarm facilities installed in communal areas would promote residents independence and benefit staff in emergency situations Ensure that people occupying bedrooms, only accessed by steps on the first floor, are assessed as ambulant to do so The Heartbeat Award dated 2000 must be removed from the notice board as it is out of date and application needs to be made annually to the Environmental Health Department for its renewal. Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hessle Area Office First Floor 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ashleigh DS0000000834.V340725.R01.S.doc Version 5.2 Page 24 - 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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