Inspection on 26/04/07 for Avenue House

This inspection was carried out on 26th April 2007.

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

The inspector 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

Avenue House 18/12/06

Avenue House 25/03/06

Avenue House 02/11/05

Avenue House 14/03/05

Avenue House 15/09/04

Avenue House 11/02/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Avenue House 5 Cotham Park North Cotham Bristol BS6 6BH Lead Inspector Savio Toson Key Unannounced Inspection 26th April 2007 09:30 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 Avenue House DS0000026495.V337913.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. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Avenue House Address 5 Cotham Park North Cotham Bristol BS6 6BH 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) 0117 9892020 0117 9892059 West of England Friends Housing Society Limited Vacancy Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th March 2006 Brief Description of the Service: The West of England Friends Housing Society Limited (FHB) which owns Avenue House, is registered with us to provide accommodation and personal care for up to thirty service users (residents), aged sixty-five and over. The Friends Housing Society has a registered responsible individual who oversees the society’s responsibility for the property, employment of all staff and the care provided. The Society has an agreement with the Methodist Homes Association (MHA) to provide sub-contracted management services for the management of the staff. This change provides a broad resource of all the professional aspects required by the Society to meet its regulatory and financial responsibilities. The Home is an older style detached property, with a recently built large extension to the side of the house. The home has several lifts and all floors are accessible for wheelchair users apart from the basement. The Home has mostly single bedrooms except for two, which enable couples to share if they wish to. All of the bedrooms are en-suite. Avenue House is situated near the centre of the city in an established residential area. Public transport is available within a short distance of the home. Local shops and community facilities are within half a mile of the Home. Weekly fees (as at April 2007) range from £452 to £547 a week. Fees include all care and accommodation costs, including meals, laundry and activities. Additional charges are made for hairdressing, chiropody and other items listed in the service user guide. People are expected to pay for their own personal items such as private telephone, toiletries and newspapers. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection on Thursday 26th April 2007 is part of our regulatory work. Caroline Cooper the recently appointed manager was in the home at the time and assisted with the inspection. Ms Cooper has now sent us an application to become the registered manager of Avenue House. The previous report and the main correspondence, since the last inspection, between the home and us were reviewed. Seven residents and three members of staff were observed, consulted with and had the opportunity to give their views on the home. A number of questionnaires, seeking the views of people involved with the home were sent out before the inspection. Three questionnaires completed by residents and one by a relative were returned. No comments from the home’s GP’s, visiting health care professionals or members of staff were returned. However the residents in this home are regularly completing questionnaires about the service and the most recent survey was distributed by the manager in April 2007. The inspection of the premise included communal areas, a sample of bedrooms, documentation and records. The records included resident plans of care, medicine sheets, fire log book and staff recruitment files. What the service does well: What has improved since the last inspection? The medicine administration for residents is now safer because of the improvements in recording onto the medicine administration sheets. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 6 The residents, who gave their views of the laundry, confirmed the observation that the home was giving an improved laundry service. Residents now have a cleaner environment to live in due to the improved domestic services arranged by the home. The residents are receiving a well-run service that is being influenced by the new manager and her team. The residents in the home will have better protection from any potential abuse because the manager showed she understood her role and responsibilities. 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. Avenue House DS0000026495.V337913.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 Avenue House DS0000026495.V337913.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): Standards 1.2.3.4.were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents or their families have all relevant information to make a decision about the nature of the home. Residents are aware of their tenancy rights because they have received an updated contract/statement of terms and conditions. EVIDENCE: People intending to move into the home are able to make choices about whether the move would be suitable for them. They and their relatives, can use the available upto date information about the home and its services. The homes Statement of Purpose document and the Service Users Guide are regularly updated and contained information about the recent staff changes and increases in fees. The fees are set out as a grid and range from £452 to £547.(10 April 2007) The additional cost for sevices like dentist, chiropodist are explained in the documents. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 9 Discussions included how the service was being accessed by people from ethnic minorities. The manager did not believe there was any reason why the home was not getting contact from people from ethnic minorities who would be interested in moving into the home. The manager could demonstrate the literature respected ethnicity and diversity, the staff were a cultural mix and the care plans showed that even though the home has Quaker connections, the religious diversity of the residents was respected. The service was not providing us with the latest copies of the Statement of Purpose and Sevice User Guide. This is a legal requirement and the home manager will now make the neccasary arrangements for copies to be sent to us. Residents have an understanding of their formal tenancy agreement which covers the home’s services and accommodation. The home had recently issued new contracts/ terms and conditions of residency. Some of the contracts were still with the resident or their relatives and the rest had been returned. Residents considering a move into the home are able to discuss their needs with the homes staff to make sure the home is the right service for the resident. Documents showed the residents needs were assessed before entering the home. Care assessments which were sampled showed that both the resident and relatives were involved in the discussions. Residents care needs were also looked at again after they had moved into the home. Residents were suported in keeping contact with specialist services by the home. The records showed that several residents were using specialist services. The home was aware of appointments, supplied staff and transport where neccesary. The residents spiritual needs were supported by the home. The homes documentation described how time, facilities and support were avaialable for residents to help meet their spiritual needs. Arrangements were made for practicing Christians in the home meet for worship on Sundays. The manager described how residents could and were being supported in building and developing personal relationships. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9,10,11 were considered. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents may be receiving care from staff who were unable to get clear instructions on how to give personalised care due some of the care records being incomplete. The residents benefited from safe systems of practice in receiving, storing, administering, and disposing of drugs. Resident’s were being cared for by staff who respected the residents privacy and dignity. EVIDENCE: Some residents were occasionally not receiving individualised person centred care, as some of the care plans did not contain sufficient instructions to the staff giving the care. Some of the care plans contained generalised instructions for staff, whilst others were incomplete. The home was introducing a care plan booklet and some of the information from the previous care plans was being written into the new ones. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 11 The potential risks to some of the resident’s health were possibly being overlooked because the relevant health screening documents had not been filled in. A lady, who had a history of falls, did have not have a completed falls risk assessment. And another lady who had a history of developing red marks on her skin had not been assessed for the potential of developing a pressure sore. There were also some risk assessments carried out (e.g. potential for aggression) which no longer appeared relevant. Resident’s needs were reviewed to ensure changes were considered and planned for. The reviews involved staff and the person or relatives with an interest in the residents care. The residents receive medicines from safe medicine administration practices by the staff. And some residents maintain their independence by administering their own medicines. Staff correctly fill in the medicine administration sheets, explaining why a medicine had not been given, recording when medicines were issued to the residents who keep their own medicines. Residents benefit from being cared by staff that respect the residents privacy and dignity. The residents spoke well of the staff and staff were observed to talk with residents in a polite and friendly way. One resident said the staff were helpful and another said, I wont have anything said against them. Residents wishes for their funeral arrangements had been discussed and their views were well documented in the care plan. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14,15 were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged and supported to live a lifestyle, which is both enjoyable, stimulating and meets individual preferences and expectations. Residents can plan their own activities. Residents maintain family contact and join in with activities and any outings. Residents are encouraged to exercise choice and control over their own finances. The residents are represented by a resident elected onto the home’s management board.This is comendable. Residents do not have the a clear equitable choice of meals at lunchtime. EVIDENCE: Residents enjoy flexible and varied activities which they have been involved in planning. Residents are regularly surveyed by the home to find out their likes and dislikes. The home runs monthly meetings for residents to plan the activities for the following month. Ten residents attended the most recent meeting. The home has an activities organiser and an activities room. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 13 The residents are supported in making choices about the activities that are available. A monthly activities list is circulated, the activities list is on display and the activities for the day are written up on the dining room notice board. The residents are supported in maintaining community contact to the level they wish. On the day of the inspection visit residents were regularly on the move. As it was a sunny day they were in and out of the home on a regular basis and using the garden located at the front of the house. One resident was gardening. Residents maintain contact with their community through relatives being free to visit. Relatives are encouraged to be involved in discussing the residents care. Residents are also supported and assisted with their social activities by volunteers, who have been checked for suitability. The volunteers run a shop inside the home and will assist in the planned outing to the local Zoo. The homes commitment to recruiting, maintaining and involving volunteers is commendable. The residents have one of their residents elected as a member onto the management board which is responsible for running the home. This practice is also commendable. The residents relatives are informally kept upto date with events and changes home. But this arrangement can exclude those who do not access the current arrangements for information sharing. The home manager is looking at more formal ways for keeping relatives informed about the home. Residents are encouraged to exercise choice and control over their own finances. The home does not get involved in managing the residents finances. Those who are unable to look after their money are put in contact with Social Servcies and an advocate is found. This is comendable. Residents do not exercise a full choice when selecting their lunchtime meal. The menus only show one main meal for lunch and then each day the alternative is describes as vegetarian alternative available, eg omelette/salad. The alternative of omellete/salad is not an equal choice to the main menu, it is not a meaningful vegetarian meal nor is it suitable for a resident who would like a meat alternative. The residents can consult the cook but this is different to selecting a meal of choice from the menu. This view was supported by several residents, one said I did not know we could have that sort of choice. Of course I would like it if it’s possible Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were considered. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Until recently, residents were not always protected from potential abuse from staff, due the lack of understanding by the home on how to look into resident’s concerns. There are good arrangements in place for staff training and awareness of protection of vulnerable adults. EVIDENCE: Until the recent appointment of the new manager, residents were not always protected from potential abuse from staff, due the lack of understanding of the complaints procedure. A letter from a previous manager to us which was responding to a complaint, of an incident which had taken place six months previous, set out the action which the manager was going to take, but not all the planned action was taken. So the staff did not get all the training which had been planned for them. One of the reports, written up after the registered owners or their representative visit the home, refered to a residents concerns about a member of staff, but there was no evidence available as to how the concerns were dealt with. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 15 The home had policies and procedures for complaints and protection of vulnerable adults. The policies were informative but rather bulky. The procedure for staff to follow could benefit from being in plain English and and located at the front of these documents. Staff have recently been on abuse awareness training. Residents lead a normal life in a home where mechanical restrictions such as bed rails are not used. This level of care practice is good. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 16 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): Standards 19,20,21,22,23,24,25,26 were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a well-maintained home which is decorated and furnished to a good standard. The residents can enjoy living in a safe, homely, peaceful environment which is clean, pleasant and hygienic. EVIDENCE: Residents live in a well-maintained environment that is clean, odour free, well furnished and in good decorative order. The home has a maintenance person who was working in the home on the day of inspection. The home’s carpets are deep cleaned on a regular basis. The Home has an external domestic cleaning service and the residents said they were pleased with the level of cleanliness in the home. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 17 The Laundry service had improved and the residents said that they had no concerns with the laundry service. On the day of inspection a representative form a company supplying laundry products was installing the parts required, along with staff training, to improve the quality of laundered clothing. There were no concerns with infection control and the manager was planning infection control training for staff. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 18 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): Standards 27,28,29,30 were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported and protected by the homes recruitment policy. The residents are cared for by staff that are trained and supported by their management team. EVIDENCE: The continuity of care for residents will improve as they are kept informed of permanent staff being recruited to fill the staff vacancies. The home has completed putting a management team in place. A few residents felt they would benefit from more staff being on duty and two said they thought there was only three staff on duty at times. The manager explained how there tends to be five on duty and how cover is arranged when staff are absent. Five on duty was suported by the staffing rotas supplied by the home. Any resident from an ethnic monority or with diverse needs will be assured to know the home has a diverse staff group. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 19 The residents will be receiving care from staff who receive regular training.The manager has nearly completed this year’s statutory training for staff and is planning further training throughtout the year. The personnel records for new staff contained their induction training manual which showed they were receiving training soon after having started working in the home. The number of staff who had completed National Vocational Qualification(NVQ) Training in care was now around the 60 level and the manager said more staff were doing their NVQ training. Residents will be receiving care form staff who have had their work supervised directly and formally. The manager could demonstrate several upto date supervision records. The residents will receive care from staff who have been recruited by a team which followed good practice and procedures. The personnel records of recently recruited staff contained the information required by law. Records included, police checks, declaration of of the individual’s health, previous employment record and references. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 20 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): Standards 31,32, 33,34,35,36,37,38, were considered. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs and best interests are central to the management approach in the home. Residents receive care from staff whose work is regularly and appropriately supervision. The health and safety of residents, staff, and visitors is protected. EVIDENCE: Residents will receive a service from a settled and permanent care management team. The team is made up of the manager, two assistant managers and two senior carers. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 21 Residents receive a service which is monitored and audited to ensure quality is maintained. The service is regularly audited and the residents are surveyed to get their views of the service. The Manager carried out the most recent survey on the 7 April 2007, which contained a range of customer satisfaction questions and positive responses. The residents can be assured that they have a care team which listens and responds to external advice. The legal requirements which the home had to action, as contained in the previous inspection report, had been done. The manager was in the next few days going to submit her application to register as manager for this service. The residents live in a safe, well maintained home. Electrical, water, heating tests are carried out. Fire risk assessments have been done. Food stored in the kitchen fridge is now being labeled, and all the firdge and freezers in the kitchen are working. The cook records the daily fridge and freezer temperatures but was unable to monitor the temperature of cooked food for the last three days because the heat probe was not working. This should have been actioned sooner. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 22 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 3 3 3 3 3 3 3 3 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 3 4 X 4 3 3 3 Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 23 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. OP7 Standard Regulation 15(1) Requirement The resident’s care plan sets out in detail the action which needs to be taken to ensure all aspects of the residents care needs are meet. The residents would then get more consistent individualised care. The residents’ needs are assessed for the risk of falling, developing pressure sores, by persons trained to do so. This means that the residents would be cared by staff who are prepared for problems and changes which could happen to the resident. The hot food-testing probe used in the kitchen needs to be in working order. This will reduce the risk to residents eating hot food which could potentially make them ill. Timescale for action 27/06/07 2. OP8 13(4)(c) 27/06/07 3. OP38 16(2)(g) 01/05/07 Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 24 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 Refer to Standard OP32 OP15 OP16 Good Practice Recommendations The manager has strategies for enabling relatives to be sufficiently informed to ensure the home creates an open, positive and inclusive atmosphere. The menu should offer a choice of lunchtime meals (of equal value). The choice of vegetarian or omelette should not be seen as good enough. The registered person ensures that there is a simple, clear and accessible complaints procedure so that residents are better protected by staff who would find to procedure easier to follow. Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Avenue House DS0000026495.V337913.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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