Inspection on 14/10/05 for Ashling House

This inspection was carried out on 14th October 2005.

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

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

Other inspections for this house

Ashling House 10/11/08

Ashling House 20/02/07

Ashling House 26/04/05

Ashling House 10/12/04

Ashling House 01/09/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Ashling House 119 Elmhurst Drive Hornchurch Essex RM11 1NZ Lead Inspector Mr Roger Farrell Unannounced Inspection 14 October 2005 08:00 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 Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ashling House Address 119 Elmhurst Drive Hornchurch Essex RM11 1NZ 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) 01708 443709 Ms Beverley Holmes Ms Beverley Holmes Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th April 2005 Brief Description of the Service: Ashling House is a privately owned care home for up to 14 older persons. It is in a pleasant residential area in Hornchurch, about half a mile away from shops and public transport links. First opened as a care home in 1981, Beverley Holmes became the owner in March 2001. She is the manager in day-to-day charge, and takes great pride in providing high quality facilities, including thorough attention to cleanliness. Considerable improvements have been carried out over the past year. This has included a new wood-panelled dining room, creating new single bedrooms, and giving the garden a major makeover. The lounge is a large conservatory. The assistant manager spends his time maintaining the home, carrying out building improvements, and overseeing the contractors doing the conversion works. This has included making sure disruption to residents was kept to a minimum, and safety maintained during the recent improvements to bedrooms. Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place between 8am and 1pm on Friday 14 October 2005. The manager and assistant manager were away for the week. The last inspection was also an unannounced visit. Most of the core standards were covered at that time. Copies of that report are available at the home, or can be found on the Commission’s website on www.csci.org.uk. The inspector spent most of the time at this visit with residents, and observing the daily routines. He is grateful to the main shift-leader for the calm and helpful way she dealt with his enquiries, including finding and explaining records. Other staff also responded in a friendly and cooperative way. The inspector chatted with a group of residents over a meal, spoke to others individually, and was shown around the building including seeing bedrooms. He appreciates the time taken by visitors who spoke with him. The manager was on call, and was available when the shift-leader called her at lunchtime about a minor change to the rota. The assistant manager called back soon after to offer help if access was needed to other records as the main office is kept locked when the managers are not there. What the service does well: This is an efficiently run home. It retains many of the characteristics of a traditional quality care home. Nearly all residents are private fee payers who lived locally. This means that most continue to have regular contact with their family, who in general helped choose this home. The close attention to detail found in how the building is arranged is also apparent in the routines. The manager promotes an ordered way of doing things, and this can be seen in how staff and residents adhere to the expectations that shape the day. This structured approach is reflected in the way instructions are posted around the building, such as one saying that hot drinks are only served in the diningroom. Yet, this systematic attention to detail is equally evident in positive practical ways, such as how bedrooms are prepared and laid out each day in a quality hotel style. One resident summed this up by saying – “Beverley is strict but fair. You will find that we like things well-arranged…..we like it to be very clean and it is kept that way. Like anywhere, you have to fit in otherwise staff would never get their job done.” Another person added – “It suits us. It would annoy me if things were not right. Like I told you before, you have to fall in with the rules and ways, but it would worry me if things were not smooth and I think I’d sit there and worry.“ A staff member with experience of working in other care homes said – “I’d say the good things are the safe arrangements, it’s very clean. I’d also include the resident care. It is all so well arranged. Staff know what they need to do.” Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 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 Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5. At this visit the inspector spoke with the most recent resident, who had moved in three weeks earlier. He had lived in other care homes. He said he was very satisfied with the arrangements, adding – “I am settling very well. I have been messed around in the past. Staff in the last place wanted to do everything for me. The staff here are okay, they give me time to get up myself as I don’t need help. My room is very nice. So far so good, everything’s okay.” EVIDENCE: The manager deals with all enquiries when there is a vacancy, and carries out the assessments to see if the home can meet the needs of prospective residents. Nearly all the residents who move into this home pay their own fees. As private residents, social workers are not usually involved in making the arrangements. Normally it is a prospective resident’s family who visit first, having made an appointment to see the manager. She then visits the person, who is usually waiting to leave hospital, and carries out an assessment. A further meeting with relatives to gather background information is often needed where there is not a background report from a social worker. The files seen at the last announced visit had adequate assessment information, Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 9 including a ‘kardex’ profile sheet with photo, an assessment form and a onepage tick and comment sheet. The manager is aware that assessments need to cover all areas listed in Standard 3.3 of Care Homes for Older People National Minimum Standards. Over recent months admissions have been limited as it has been necessary to keep some places empty due to the building work that is now largely finished. The sample of personal files seen at the announced visit also had a copy of the signed contract. Through her trade association the manager keeps up-to-date with the type of contracts used by local authorities. One relative wrote to the inspector last year saying he had checked inspection reports before his relative moved in, but ‘hadn’t felt the need to do so since’ given the resident and family’s level of satisfaction. Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 and 10. The last two inspections have been unannounced, and the manager who acts as ‘keyworker’ for all residents has not been there. However, those on duty are able to give a good account of personal care and medical needs. All residents who gave a view said they are happy with the personal support they receive. At this visit a community nurse said – “Residents are always nicely presented. Staff always meet and greet me. I would normally see Beverley, but like today I would be confident that anything important would be passed on…and know that any advice or instructions would be followed.. Yes, I always see residents in private and it is always clean. Again I would say it is one of the best homes I visit.” EVIDENCE: At the last announced visit the inspector looked in detail at a sample range of practice documentation, including for the person who had developed high dependency needs. The ‘personal files’ and daily records are set out in a methodical manner. In addition to the assessment material, these include a three page ‘care profile’ under a range of useful headings; two page ‘care plan sheets’ covering practical and social needs, and how these can be met; and minutes of reviews. Where there are specific needs, such as diet or continence management, there was evidence of involvement from health care workers. Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 11 At that time the inspector gave some advice on minor improvements. The manager acts as the ‘keyworker’ for all residents, and the inspector said he would follow these up next time he visits and the manager is at the home. At this visit the shift-leader gave a general overview of dependency needs, such as mobility, contacts with medical staff, and a recent admission to hospital. The inspector looked at the main ‘Report Book’ file’. This includes each person’s ‘care plan’ grids, the review schedule, a clear photo of each resident, and the day-to-day notes. Initially the inspector was told that nobody had a pressure sore. Having met a visiting nurse, the shift-leader was able to confirm that one person had developed an ulcer whilst in hospital. She was able to show the care plan entries covering this matter. The nurse also said he was confident on the monitoring of this condition, adding that he normally deals with the manager. The ‘Report Book’ had advice on dealing with wounds and preventing infection spreading. Staff said that they had received guidance on this area. There is a general ‘medical appointments’ sheet. Part of the previous advice was to have a ‘medical tracking sheet’ for each person. This advice is repeated. As most residents lived locally they tend to stay with their own GP’s. A local pharmacist supplies medication in blister packs with printed recording sheets. Supplies are kept in a locked cupboard in the dining room, that has a handy pull-out section. The Commission’s pharmacy inspector last examined the home’s medication arrangements on 20 January 2004, and a report was provided. The inspector had followed this up with the manager – and she was able to demonstrate how she has taken suitable action on all points, including improving security for the medication cupboard keys, having the most up-todate guidance; and having available the required range of policies and procedures. Staff training includes covering the NVQ medication module, and using the test paper. At this visit the checks included watching staff administer the morning and lunchtime medication. Staff made sure each person had a fresh drink of water. When residents are in the lounge, the shift-leader dispenses the drugs from the blister pack into a dose cup and checks it, and then another staff member takes it to the resident. Strictly speaking, the person who signs for the medication should be the person who has actually seen it being taken. Nevertheless, the shift-leader could see the resident from the dining room, only one resident was dealt with at a time, and the person giving the drugs was confirming each time with the shift-leader. The shift-leader said that she had never known an error to occur in the four years she had been at the home. Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. In looking at these standards, the inspector has paid particular attention to the comments made by residents, and his observations over the five hours of the visit. In general, residents say they recognise the benefits of having ordered daily routines, one person commenting – “You have to fall in with the way things are done, or nothing will get done, especially for those how need a bit more help. Beverley makes sure what needs dong is attended to.” The most recent resident said – “It suits me just fine. All the staff are alright, and I’ve already found out that they like a laugh and a joke “ EVIDENCE: The inspector welcomed the chance to spend time with residents and to listen to their comments on how the home is run. He asked for views on the choices available, such as if there were any restrictions on going to bed and getting up, selecting meals, and how they spend their time. Over half the current residents made comments on these matters. The general consensus showed the same views as those in the earlier quotes above – that the benefits of such an ordered regime were appreciated, the cleanliness of the home being mentioned frequently. For instance, when the inspector arrived soon after 8am all residents bar one were up, dressed and had finished breakfast. The two staff on the early shift said it was for the night staff to help people with their morning routine – that the main breakfast time was between 6 and 7.30am. Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 13 No resident raised issues with this early start. One person said – “I wake up because someone puts their hand in and turns the light on. This is okay as I want to get up then.” Another said – “Breakfast is there for you when you arrive. There’s toast, porridge, cereal and grapefruit.” The most recent resident did get up later, saying that there was no restrictions as far he was aware, adding that he was still served with breakfast once his paper arrived. All four residents who sat with the inspector for the meal said they went to bed when they wished, all confirming that this matched their preference, one adding – “It is suggested to those who need assistance, but I still think they have a say if that is what they want.” These four residents, and all others who offered a view said they were satisfied with the meals. There is a four-week cycle of menus, displayed in large print. In addition to the two main meal options, there is ‘standing list’ of alternatives such omelettes or sausages. But this is the one area where things did not work according to plan. At the morning tea sitting staff seemed to be asking residents about their choice, yet the main alternative to fish in sauce was not referred to. One person did say that they were not keen on this, and were told that they could have the fish without the sauce. This may have been a passing lapse in attention, but others did subsequently say that they felt the alternatives could be made clearer. One vocal resident did say that he has asked about alternatives, and got what he asked for. This is an area that the manager should check, as attention to detail is apparent in so many other ways such as the special dietary considerations on display in the kitchen. Minutes of meetings held by the manager with residents show a consistent consensus of satisfaction with domestic arrangements, such as the timing of mealtimes and not being allowed to have hot drinks in the lounge. Staff also did the rounds asking residents if they were happy with the ‘memory lane’ activity session planned for that afternoon – though residents didn’t seem keen to then sign a book saying they agreed with the choice. Those who gave a view said that card games were still the most popular choice of activity. Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Sufficient steps have been taken to let people know what to do if they have a complaint, including contact details for the Commission. The necessary guidance covering adult abuse is also available, with staff saying what they need to do if they hear of or suspect possible abuse. EVIDENCE: Both the ‘service users’ guide’ and the statement of purpose make reference to the procedure for making a complaint and for contacting the Commission. Residents spoken to are aware that they could make a complaint to the manager, should they need to do so. The minutes of the residents’ meetings include reminders about how to make a complaint. Details on using an advocacy services are on display and are included in the ‘service users’ guide’, but have been no known contacts over the last twelve months. On the one occasion in the past when there was contact with Havering Age Concern and Elder Abuse on behalf of a resident this was described as helpful. However, at this visit, the only record asked for by the inspector that the shift leader could not find was the complaints book. There is a satisfactory adult protection policy in place, which incorporates a whistle blowing procedure. It is comprehensive in telling staff about the action to be taken if abuse is suspected or disclosed. Staff have confirmed that inhouse training is provided on awareness of what constitutes abuse, there being a training video available on this matter which all staff have seen. The shift leader gave a good answer when asked to explain what ‘whistle blowing’ meant. Copies of ‘No Secrets’ and the local protection guidelines are available. Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, 25 and 26. Comments made by residents again highlighted their appreciation of the quality of the facilities. Some said that they were happy that building work was now nearly completed, as this had caused some restriction such as access to the garden. Inspections by environmental health officers, independent hygiene consultants, and the Commission continue to confirm the excellent standards of cleanliness and household safety. EVIDENCE: Prominent in the feed back at the end of this visit was the inspector’s praise for the excellent standard of cleanliness and household management. This apparent even at 8am, before the day shift had started their general tasks. As stated above, the manager takes great pride in providing an ordered living environment. The assistant manager ensures that all upgrading work is completed to an exacting standard, such as with the new bedrooms and improved bath that has an electric swivel chair. Further steps have been taken to make sure there is appropriate temperature control in the main conservatory lounge by fitting screening panels. Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 16 The inspector looked at all but one bedroom. These all show the high standards of attention apparent in the communal areas, and reflected the tastes of individuals including personal items. The top ‘commendable’ rating has again been given for the standard covering hygiene. Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Staff were seen to interact with residents in a friendly and caring way. All comments made by residents were appreciative of the help they receive. EVIDENCE: Staff cover at this unannounced visit was according to the clear rota on display. The inspector noted that all staff reporting for the day shift arrived ahead of time and immediately began helping residents. The rota has a code showing who is leading the shift, and which staff are responsible for what sequence of tasks. This was seen to run smoothly over the five hours the inspector was present. The staff complement is – manager; assistant manager; seven full-time and three part-time care assistants (at present totalling 373 care hours, excluding manager hours.) The normal pattern of cover is two staff on the early shift (8am to 2pm); two on the late shift (2pm to 8pm) – both excluding the two managers; night cover being one waking person, and one on sleep-in cover between 8pm and 8am. At this visit there was a third person supervising the day shift from 9am as the manager was away. In the absence of the manager, staff files were not checked at this visit. However, at the last announced inspection the sample seen had the correct range of vetting documentation, including taking up references; having copies of documents that confirm identity; and obtaining CRB certificates. They also had copies of an induction programme based on the ‘Topps’ guidance. At the next visit progress on achieving the expected qualification target and training will be covered. Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 and 38. These standards will be more fully covered at the next inspection, as the manager was not present at this visit. EVIDENCE: Beverley Holmes has many years’ experience in a senior positions working with older persons in care homes, home care, and hospitals environments. She is involved in some ‘hands-on’ care, as well as undertaking most of the administrative functions; assessing prospective residents; drawing up and reviewing care plans and undertaking the supervision of all staff. The improvement plan covering the upgrading of the building is close to completion. Minutes of residents meetings record discussion with all residents about changes, such as the time of meals. Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 19 Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 3 3 3 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 3 3 X 3 3 3 4 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X X X X 3 Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 21 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 OP14 Regulation 12(4) Requirement Maintain a record of activities, but review whether residents want to carry on with the current signing system. Make sure that staff are offering a residents a choice at mealtimes from the options on the main menu and alternatives list. Make sure the complaints book available. Timescale for action 31/03/06 2. OP15 16(2)(n) 31/03/06 3. OP16 22(8) 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Consider introducing individual tracking sheets fore each type of health care professionals such as GP, optician, dental care and so on. Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Ashling House DS0000027834.V260162.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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