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Inspection on 21/03/06 for Audley Court Remedial Treatment Centre

Also see our care home review for Audley Court Remedial Treatment Centre for more information

This inspection was carried out on 21st March 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home has a group of staff who have worked in the home for some considerable time, and there is little staff turn over indicating good working practises. They are keen to maintain the excellent reputation the home has in caring for the client group. The Service Users spoken to felt that they had a good relationship with the staff during their admissions to the home and they work hard to improve their quality of life.

What has improved since the last inspection?

The refurbishment programme in the home has proceeded as to the working plan which commenced in 2004. Since the last inspection quality laminate flooring has been fitted in the dining room and administrative areas of the home, and several pieces of furniture replaced. The `new` purpose built activities centre and training facility was occupied in November 2005. There is a very comprehensive IT Service User Data Base in place.

What the care home could do better:

No requirements were made at the inspection, and the home continues to provide an excellent standard of individualised personal care.

CARE HOME ADULTS 18-65 Audley Court Remedial Treatment Centre Audley Avenue Newport Shropshire TF10 7DR Lead Inspector Mike Highfield Announced Inspection 21st March 2006 10:00 Audley Court Remedial Treatment Centre DS0000022236.V281239.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 Audley Court Remedial Treatment Centre DS0000022236.V281239.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. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Audley Court Remedial Treatment Centre Address Audley Avenue Newport Shropshire TF10 7DR 01952 825684 01952 811539 cmac@combatstress.org.uk www.combatstress.org.uk Combat Stress 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) Mrs Morag Lamond Heggie Care Home 27 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (27) of places Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Staffing levels in the home must meet the minimum required throughout the 24 hr day including weekends. These minimum levels are for direct nursing and personal care only. They do not include ancillary staff. The following is the minimum staffing requirement in respect of Audley Court: 08:00-14:00 20:00-08:00 RMN 2 Care Assistants 4 Sliding Scale No of Patients Assistants 27-21 20-15 RMN 2 1 Care 4 4 2 4 2 3 1 2 14:00-17:00 17:00-20:00 This staffing notice takes into account that the senior nursing officer is supernumerary to these figures and is normally on duty from 9am 5pm 5 days a week. Date of last inspection 3rd October 2005 Brief Description of the Service: Audley Court is registered with the Commission for Social Care Inspection to provide personal care and accommodation for 27 people with a Mental Disorder. Audley Court is situated in Newport, Shropshire. The Society was founded in the immediate aftermath of the First World War. For over 80 years, it has been the only ex-Service organisation specialising in the assessment and treatment of men and women of all ranks of the three Armed Services and the Merchant Navy who are suffering from psychological difficulties attributable to their service. The Society has two closely linked main activities: welfare and treatment. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 5 The age range of the client group is between 19 and 90 years of age. At the time of the inspection there were 21 people in residence. The Registered Manager is Ms Morag Heggie. She is line managed by Mr Leigh Skelton, the Clinical Director and Responsible Individual. In the near future Ms Heggie is to become a Nurse Consultant within the Organisation. The home has been audited by the Health and Social Care Advisory Service with a view to becoming a centre of excellence for the treatment of Post Traumatic Illness. In November 2005 a purpose built activities centre with training and education facilities was completed and now is the central focus for treatment at the centre. The age of the Service Users at Audley Court is reducing annually due to the recent conflicts in Eastern Europe, Afghanistan, and the Arabia Gulf and since the last inspection referral rates to the home have increased by one third. Audley Court continues to give an excellent standard of service and all Social Care Inspectorate Standards were met. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 5 hours it was announced, a tour of the ‘new’ activities centre took place, and service users were spoken to. A ‘new’ IT Data Base of Service Users was viewed, with access by administration and nursing staff, it allows for admissions to be better coordinated, key workers to be allocated, care plans to be produced following interviews with clients and discharge summaries to be generated. What the service does well: What has improved since the last inspection? The refurbishment programme in the home has proceeded as to the working plan which commenced in 2004. Since the last inspection quality laminate flooring has been fitted in the dining room and administrative areas of the home, and several pieces of furniture replaced. The ‘new’ purpose built activities centre and training facility was occupied in November 2005. There is a very comprehensive IT Service User Data Base in place. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 7 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. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 8 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 Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 9 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 to 4. The information provided to current and prospective Service Users is presented in an exemplary manner enabling them to make a properly informed choices about the home, to cater for their needs. The homes statement of purpose has be revised since the last inspection, to include the services offered in the activities centre. The Service Users spoken to were confident that their feelings and views were “listened to” by the staff and they are encouraged to take an active part in the focussed service user processes. EVIDENCE: Service Users access Audley Court for short stay treatment for two weeks at a time, three times a year. A comprehensive Statement of Purpose was available to each service user and contained all the elements required by the registering authority. The Service Users are also provided with a welcome folder located in their bedroom. The folder contains detailed information regarding the service offered, and complaints procedure. There have been no changes in the admission procedure since the last inspection. A Regional Welfare Officer visits the Service Users at home and produces a report of up to date welfare issues. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 10 Admission to the service are arranged with the consent of the Service Users General Practitioner and any other health care professional involved in the care of the individual. Audley Court does not accept emergency admissions. People with a criminal history are only admitted to the service following careful risk assessment carried out prior to admission. If the risk is too high then admission to the service is refused. Service Users admitted to Audley Court are assessed by a team of nursing staff using a recognised psychological assessment tool. There is now a ‘new’ IT data base for Service User information installed in the home. Each Service User is allocated a lead worker for the duration of their stay. Discussions held with the Service Users and feedback gained from comment cards in the notes of Service Users who had been discharged were extremely complimentary and demonstrated the centres capacity to meet their individual needs. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 11 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 to 10 It was evident that the staff highly respect the Service Users rights and there is constant monitoring and reviewing to ensure that their identified needs are being met and individualised care given. The Service Users Care Plans are comprehensive and updated at appropriate intervals insuring that their needs are met. Service Users lead a full and active life during their stay in the home while receiving the support they need EVIDENCE: Treatment plans are drawn up with each Service User following a number of assessments. Appropriate therapeutic interventions based on assessments are offered to each individual for the duration of their stay. Consistency of care is provided by a lead worker, who takes the lead role in preparing and facilitating group work. Risks involving the Service Users treatment are identified and discussed and entered into their care plan, signed and agreed. Signed records are undertaken regarding outings, and the centre has a missing persons policy. All Service Users sign in and out of the centre. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 12 The very detailed information held on each Service User is held securely by the staff, and only accessed by those members of the care team who have permission to view it. All files are held secure in locked cabinets inside a locked office. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 13 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): 11 to 17. The lifestyle of the Service Users in the home is good, through a frame work of activities, independence, personal and social skills they are encouraged to develop. The home has good links with the community that enriches the Service Users social opportunities. EVIDENCE: Audley Court continues to offer a wide programme of occupation and activity. All Service Users are encouraged to attend a meeting each morning to discuss their choices from the programme. Individual and group sessions currently offered include: anxiety management, cognitive behaviour therapy, one to one counselling, anger management, grief work and peer support. Service Users are expected to comply with their individual treatment programme, which is given priority over other activities. A Consultant Psychiatrist, Dr Keron Fletcher, visits the centre weekly. All new Service Users are given the opportunity to be reviewed during their initial stay. Existing Service Users are reviewed annually or by request. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 14 The Service Users are provided with opportunities to access the local community. Sufferers of Post Traumatic Stress Disorder may have clinical distress and impairment in social and occupational functioning. Therefore participation in community activities is closely linked to their care plan. The community facilities accessed include: The British Legion Club, Navy Club, Bowling Club, Gym and local swimming pool. Local Transport or the centre’s transport is available. Staff are flexible in order to accompany service users on trips. On the day of the inspection many Service Users were on a visit to Shrewsbury to the Military Museum. One of the lounges is equipped with a loop system, a satellite TV is available and the centre also provides a library, gym equipment and computers. A “new” facility offered since November 2005 is the purpose built activities centre, which will includes an IT training room. Service Users can also access the large landscaped garden at the rear of the property. This offers a variety of seating areas, putting green, and greenhouses. Facilities are available to Service Users to maintain contact with their families by telephone, a quiet room for writing letters and E Mail in the IT Centre. Through discussions held and observations made it was evident that the daily routines promote independence and choice. Service users spoken to had a clear understanding of the aims of the service and reason for admission. Contracts are in place in relation to alcohol and drugs, and a smoking area is provided within the centre at present. Due to the nature of the service and the psychological injury suffered as a result of military service, Service Users are not offered a key to their room. Many users request that their room door is left ajar at night, this also assists staff with monitoring checks. Service Users are provided with a choice of meal and special diets are catered for. Observations made indicated that mealtimes are unhurried and people are given sufficient time to eat. The meals are presented to a very high standard, appealing and nutritious. The Service Users were very complimentary of the meals provided. The centre has achieved a healthy eating award. It was considered that the standards continue to exceed the requirements. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 15 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 to 20 The personal and health needs of the Service Users are very well met, with evidence of regular review and of good multi disciplinary working. Audley Court has a safe system for self administration of medication. EVIDENCE: Service Users admitted to Audley Court may have very complex needs. Observation, discussion and records seen demonstrated that Service Users are enabled to cope with, take control of and be responsible for their own lives. Through one to one allocation the staff work in partnership with the Service User in their assessment, plan, treatment and evaluation of care. Discussions held with Service Users indicated their appreciation of the care they were receiving and the support they have from the staff. Audley Court has developed a good working relationship with the General Practitioner in the local area. Should any physical illness occur during the period of respite he provides a service on a temporary basis. It is not the aim of the centre to review or change medication unless an emergency arises. Clinical Policies and Procedures are in place to follow. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 16 Service Users are enabled to self-administer their medication, with the exception of controlled drugs, which are retained by the centre for the safety of all Service Users. Metal storage cabinets fixed to exterior walls are used to store personal medication. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 17 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 and 23. Audley Court has a satisfactory complaints procedure and system in place, which has been developed in an appropriate format for the Service Users who use the home. EVIDENCE: The complaints procedure is clearly outlined in the welcome file located in each bedroom. All written complaints are forwarded to the Head Office for attention, resolution and audit. The home has a copy of the Multi-Agency Adult Protection Policy and Procedure. There is zero tolerance to physical violence and the police would be called if there were an incident. A no restraint policy is in place. Service users take responsibility for their own financial affairs. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 18 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 to 30. The home has been purposely designed to support the needs of the category of the Service Users. Thus it offers a high standard of accommodation and is a comfortable place to live in. EVIDENCE: The accommodation provided is to a very high standard, accessible, safe and well maintained. There is an on going refurbishment programme in the home in the home. The premises are comfortable, bright, cheerful and airy and provide sufficient light, heat and ventilation. Furnishings and fittings are of good quality and domestic in style. All Service Users are offered a single room. Double rooms are only used during extremely busy periods, providing Service Users are willing to share accommodation. Discussions held with Service Users indicated that they are happy with the facilities provided. There are adequate toilet and bathing facilities within the home for the number of Service Users all being domestic in design but can be adapted for the severely disabled. All the facilities are fitted with privacy locks. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 19 Communal facilities are spacious and include a choice of three lounges, a dining room, and library/quite room. Quality furnishing and fittings are provided throughout. Service Users can also access a large landscaped garden at the rear of the rear of the property. This offers a variety of seating areas, putting green, and greenhouses. A purpose built recreation and activities centre was opened in November 2005. On the day of the inspection the home was extremely clean, the domestic staff must be commended for their efforts in maintaining such high standards of cleanliness given the number of Service Users that access this service throughout the year. Throughout a tour of the environment, it was considered that this service continues to exceed this standard. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 to 36. Staffing at Audley Court is arranged flexibly to meet the individual care needs of the Service Users in sensitive and professional manner. EVIDENCE: All care staff have clearly defined job descriptions and appear to fully understand their roles and responsibilities. Consistency of care is provided through a lead worker who takes a lead role in preparing and facilitating group work. Staffing levels at the time of the inspection, were enough to meet the individual needs of the Service Users accessing the service at that time. In the light of increasing trend in admissions with complex problems following recent conflict the Nursing Establishment has been increased. In addition to this appointment two staff have been appointed to the activities centre. All care staff receive specialist training appropriate to their role. Audley Court has a separate team of domestic, laundry, kitchen and gardening staff. This provision allows nursing and care staff to work directly with the Service Users. Staffing is normally above that is required by the staffing notice. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 21 The Manager, Morag Heggie has been supernumerary and was line managed by the Director of Clinical Services, he is responsible for clinical standards at the centre. The centre also has a Facilities Manager. The team is to be commended for the support they provide to service users with such complex needs that utilise this unique and very specialist service. A very through recruitment procedure is adopted by the home. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 22 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 to 43. The home is managed effectively by a competent manager. The staff team are lead with confidence, creating an open and positive atmosphere from which the Service Users benefit. The management information systems developed by the company are to be commended. EVIDENCE: Ms Heggie is the Registered Manager at Audley Court, she has worked at the home for the last eight years and has a lot of clinical experience. In addition to being a Registered Mental Nurse she has the experience of being a community Psychiatric Nurse. Ms Heggie completed the Registered Managers Award in 2003, and is an NVQ Assessor. Evidence gained on the day of the inspection once again demonstrated an ‘open’ style of management, and that all staff are involved in consultation and discussion. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 23 All records seen by the inspector were well presented and audited at regular intervals. Audley Court has a Health and Safety Working Group that meet three times a year. At the time of the inspection no hazards were identified. The home has a no lift policy in place, and regular manual handling training is conducted by the Facilities Manager. COSHH Regulations are adhered to and all service records for moving handling and lifting, electrical, gas, fire, and water treatment were in order and available for inspection. Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 24 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 4 2 4 3 4 4 4 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 3 26 3 27 3 28 4 29 4 30 4 STAFFING Standard No Score 31 3 32 4 33 4 34 3 35 4 36 4 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 4 4 4 LIFESTYLES Standard No Score 11 4 12 N/A 13 4 14 4 15 4 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 4 x 4 4 4 4 4 3 4 Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 25 Are there any outstanding requirements from the last inspection? None. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Audley Court Remedial Treatment Centre DS0000022236.V281239.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!