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Inspection on 29/06/05 for Avenue The (3)

Also see our care home review for Avenue The (3) for more information

This inspection was carried out on 29th June 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

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

Communication plays a major part in maintaining choice, independence, and respecting the individual at the Avenue. The residents are fully consulted on all aspects of their care and activities. Residents spoken to said they were given opportunity to make decision for themselves with support from staff when required. The interaction observed between staff and residents is friendly, relaxed and entirely appropriate. Each year residents go on holiday at a destination of their choice. This year two residents are going abroad, four residents to Wales, and one resident who dose not like holidays is going on regular day trips. Bedrooms are personal to the individual. Independence is encouraged with support from staff to ensure the residents have a contented and fulfilled life at the Avenue.

What has improved since the last inspection?

The medication was not inspected, however the Manager said the requirement made at the last inspection had been completed.

What the care home could do better:

More information needs to be available to residents pertaining to what financial help is available to them with regards to holidays. Audits of financial records must be completed on a regular basis. There must be clear guidelines in respect of whose responsibility it is to replace or repair items of furniture if worn or broken. Health and Safety issues for the protection of residents must be reviewed on a regular basis and adequate records maintained.

CARE HOME ADULTS 18-65 Avenue, The (3) Acocks Green Birmingham B27 6NG Lead Inspector Susan Scully Announced 29 June 2005 th 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 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 Stationary 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, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Avenue, The (3) Address Acocks Green Birmingham B27 6NG Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 0121 693 0182 0121 693 0185 Kelso Care Consortium Ltd Sophie Donnelly Care Home 10 Category(ies) of Care Home registration, with number of places Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residents must be aged under 65 years. 2. That Miss Donnelly completes her Registered Managers Award by April 2005. Date of last inspection 3rd November 2004 Brief Description of the Service: 3 The Avenue is registered to provide personal care and support to 10 adults with a learning disability who have been assessed as requiring full assistance with daily living tasks. The home is staffed 24 hours a day including waking night and a sleeping in member of staff. Service users would be admitted to the home following a full assessment that would determine the level of support they require. The full range of medical services, leisure and social activities are provided for the service users. A number of adaptations have taken place within the home in order to meet the assessed needs of the service users. Service users are encouraged and supported to maintain links with their families and the local community. The care needs of the service users are monitored and reviewed and action is taken to address any concerns. The home is in a residential road close to Acocks Green shopping centre. There are a number of local bus routes. The railway station is a five-minute walk away. The Avenue is ideally placed to access Birmingham city centre and a number of smaller shopping centres. Acocks Green offers a wide choice of local community facilities and places of worship. Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. What the service does well: 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. Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 6 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 Standards Statutory Requirements Identified During the Inspection Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 7 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 standard(s) 2,4,1 Residents have sufficient information to make the decision to accept a placement or decline. Each resident is given a contract of terms and conditions when admitted. EVIDENCE: The Avenue provides each resident with a statement of purpose and service user guide prior to admission. Information contained in these document’s enable residents to make a choice weather to accept a placement or to decline. There is an amendment to be made to the service users guide. Standard 14 of the National Minimum Standard specifies as part of the basis price there is an option of a minimum seven-day holiday out side the home, which the residents help choose and plan. In the Service Users Guide this has been omitted from the contract and is seen as an additional charge. There have been no new admissions to the home since the last inspection, however the Avenue has an admission procedure that includes details of visit to the home and a settling in period. Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 8 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 standard(s) 7,8,9, Each resident make their own decisions with support from staff when required. Risks assessments are completed within the contexts of individual Plans of Care. EVIDENCE: The Manager said no decisions are made without the resident consent. All aspects of care, risk taking, and decisions are completed with full consultation of resident. Residents are given support when required and without infringement on the resident’s privacy, rights and choices. This was confirmed when speaking with residents. One resident said it was his choice to leave the decoration of his bedroom to the staff, as he knew they would make a sensible decision about the colour of his room. Risk assessment are completed and reviewed regularly. Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 9 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 standard(s) 14,16,17 Resident’s rights, choice, and decisions are respected. Flexibility and wellbalanced nutritional meals are provided. Sufficient information is not provided to residents regarding the financial contribution of the organisation. EVIDENCE: The routine at the Avenue is flexible, where choice and freedom of movement is an every day part of life. During the day staff were respectful to residents and consulted with them appropriately. Interactions between staff and residents were positive. One resident was assisted to prepare sandwiches to take with him to the day centre. The menu available showed what residents had chosen for that week, with an alternative available. This was evidenced when one resident did not like the menu available and was offered an alternative and assistance given in the preparation of the meal. One resident was observed completing his washing as part of his every day living tasks. Holidays are taken each year with support from staff. It must be determined in the contract of terms and condition that the Organisation provided a Holiday of the resident’s choice, stating the level of contributions made. Residents have un-restricted access to the home and grounds and are free to go into the garden for social activities when they choose, with staff monitoring unobtrusively. Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 10 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 standard(s) 18,19 The health care needs of residents are closely monitored and reviewed. More information in individual care plans regarding personal care and how staff support residents is required. EVIDENCE: The Avenue does not provide nursing care and this is clearly detailed in the Statement of Purpose. Staff spoken to demonstrated their knowledge with regard to the residents needs. Individual care plans need to reflect how residents are supported with personal care. For example all residents are male and the staff team is mainly female. The resident’s choice of staff must be made clear and any preference such as male workers must be sought and provision made if necessary. The health care needs of residents are recorded with the manager actively seeking the support of other professional when required. Records indicate regular health checks are made with Dentist, Doctors and Community Nurses. The health needs of residents are monitored and reviewed. Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 11 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 standard(s) 22,23 The resident are able to make complaints or raise concerns and know that they will be listened to. Full audits are not completed with regard to finances held on behalf of residents. EVIDENCE: A complaint procedure is contained in the Service Users guide and is given to residents on admission. The format viewed was in a written format. The Manger said that this is under review and Service Users guides will be available based on the assisted needs of individuals. The Service Users Guide contains the contracts of terms and condition of residency, however as sited earlier in this report amendments are required to ‘Holidays’ section. There was an incomplete audit of the resident’s finances. Those completed contained information of expenditure pertaining to the residents buying Mattress and wardrobes. On this occasion it was the choice of the resident to purchase these items and this was acknowledged. This choice must be clearly recorded on the audit. Under no circumstances should residents purchase furniture to replace worn or broken items, as this is the responsibility of the organisation. The Manager must complete an audit of any broken or worn furniture so the home can maintain an accurate record. The Manager dose not currently completed an audit of all the resident’s finances held by the home and is a requirement of this inspection. Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 12 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 standard(s) 24,25,30 EVIDENCE: Residents have a choice of two lounge areas, one of which is due for refurbishment. There are a number of seating areas in the lounges and residents are consulted about the décor. Resident’s bedrooms were individualised and personal to the resident. One resident had requested to move bedrooms to accommodate his equipment and this was arranged. One resident had requested wooded flooring however lino was used and now looks worn where mark from footwear have caused indentation. The Avenue has sufficient communal areas where residents can meet or relax. The first lounge accommodates a payphone for resident’s use, however there is no privacy in this room for personal conversations. The manager said that residents could use the portable office phone if there call was personal. The inspector requested that all communal hand towels be removed to prevent cross infection. Not all radiators are covered and this is an outstanding requirement from the previous inspection. Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 13 The manager said all water outlets temperatures were monitored monthly and recorded. However, the inspector checked the communal areas water outlet temperatures and they did not corresponded with the reading record. The manager was advised to ensure the temperature probe used was accurate. There were areas in the home where the carpets required cleaning. Each room has an en suit facility with a shower. None of the showers are temperature controlled to prevent scalding and this is a requirement of this inspection. In general the home is well maintained clean and fresh and provision in place to prevent the spread of infection. Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 14 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 Residents are supported by an effective competent staff team that meet the individual and collective needs of residents EVIDENCE: Staffing levels are maintained in accordance with condition of registration, and this was supported by the rotas. A number of staff has been at the home for some years. The Manager said the staff team were committed to the residents needs by ensuing they lead an independent life as their needs allow. Staff also support residents in the decision they make. Regular reviews are held that show residents are encouraged to make decision for themselves. When the resident has made a decision they show what support is available to them. This could be from staff or other professionals. The training records were not examined during this visit. Details of qualification and training of staff are detailed in the Statement of Purpose. Staff demonstrated their experience and knowledge during the visit. One resident said he had confidence in the staff team and felt his needs were being met. Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 15 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 40,42 Health and Safety pertaining to prevention of scalding or burns is not sufficient to ensure the Health and Safety of residents. Policies and procedure are adequate. EVIDENCE: Polices and Procedures are reviewed on a regular basis. Equipment such as Electrical Safety testing is completed. Regular testing of fire alarms and fire drill are completed. The high surface temperatures of radiators and specific needs of some service users present a risk. Protective covers must be fitted as appropriate to all radiators. Showers must be regulated to prevent scalding. Chopping bored must be replaced where worn to prevent cross infection of food products. Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 16 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 x 3 x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x x x x 3 Standard No 11 12 13 14 15 16 17 x x x 2 x 3 3 Standard No 31 32 33 34 35 36 Score x x 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Avenue, The (3) Score 3 2 x x Standard No 37 38 39 40 41 42 43 Score x x x 3 x 2 x E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 17 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5 Requirement The Service User Guide must include details about Hoildays and what contribution the organisation make. Care plans must detail the type and nature of any assistance required. These must cross reference to any other documentation such as nursing assessments. Care plans must be cross referenced to risk assessment, with read and sign sheets, indicating that staff will bring to the attention of the manager of the home any concerns, or changes to these.(Compliance not assessed at this inspection previous time scale 10/1/05. The home must ensure that daily records indicate care offered, care received and response to care. The home must also address the inappropriate language included in some entries.Compliance not assessed at this inspection previous time scale 10/1/05. Service users plans must include consideration of promoting age appropriate décor and Timescale for action 1/8/05 2. 6 15(1) 1/8/05 3. 6 15(1) 1/8/05 4. 6 15(1) 1/8/05 Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 18 5. 14 13(4)(c ) Schedule 9 13(4) 6. 15 7. 19 15(2)(b) 8. 20 13(2) 9. 20 13(2) activities/leisure opportunities. Compliance not assessed at this inspection previous time scale 10/1/05. Residents must recive information with regards to the contribution from the organisation pertaining to Holidays. The inspector noted that staff employed by an agency, which operates from the second floor of the building are accessing the home. This matter to be dealt with during registration of the agency.The inspectors were advised that this is currently being considered.Compliance not assessed at this inspection previous time scale none. Information is required in more detail in plans of care to show how the needs of residents are being met. The manager must ensure that the staff adhere to the medication policies at all times.A homely remedy policy must be written to reflect stock purchased. This must also include any cautions or warningsCompliance not assessed at this inspection previous time scale 9/11/04 Any service user wishing to selfadminister their own medication was encouraged to do so. However no evidence of risk assessments were evident, and staff had signed the Medication Administration Record (MAR) chart as administered when they had not. The staff must be clear what self-administration is.Compliance not assessed at this inspection previous time scale 9/11/04 1/8/05 1/8/05 1/8/05 1/8/05 1/8/05 Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 19 10. 20 13(2) 11. 20 13(2) 12. 20 13(2) 13. 20 13(2) 14. 20 13(2) All prescriptions must be seen prior to dispensing and a system installed to check the dispensed medication and MAR chart against the prescription. All discrepancies must be addressed. The quantities of all medicines received or any balances carried over must be recorded to enable audits to take place to demonstrate the staff are administering medication in accordance to the doctors prescription.Compliance not assessed at this inspection previous time scale 9/11/04 All dose changes must be clearly recorded on the MAR chart. Under no circumstances should original doses be crossed out. All unwanted medication or those where the dose has been changed by the prescriber must be returned to the pharmacy at the end of the cycle for destruction to avoid confusion and inappropriate administration. Compliance not assessed at this inspection previous time scale 9/11/04 Liaison with the pharmacist is required to ensure the MAR chart lists the service users current medication only.Compliance not assessed at this inspection previous time scale 9/11/04 All medication bought into the home for service users receiving respite care must be checked with the doctor for accuracy in all instances and a replacement sought when necessary.Compliance not assessed at this inspection previous time scale 9/11/04 A protocol for secondary dispensing into a “medi-dose” system for service users to take 1/8/05 1/8/05 1/8/05 1/8/05 1/8/05 Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 20 15. 20 13(2) 16. 24 23(2)a 17. 18. 19. 20. 24 24 24 26 16(2)(c ) 16(2) (c ) 16(2) ( c) 13(4) 21. 34 7,9,19 Schedule 2 away from the home during home leave must be written and staff trained to follow the policy. All medication secondary dispensed must be labelled in accordance with the Labelling Regulations 1976. All medication that is taken from the home must be fully documented on the MAR chart.Compliance not assessed at this inspection previous time scale 11/9/04 Protocols for individual service users medication prescribed for occasional use must be written. These must clearly record the exact indication when they can be administered.Compliance not assessed at this inspection previous time scale 9/11/04 Bedroom doors must be fitted with handles which allow access by service users Compliance not assessed at this inspection previous time scale 10/1/05 An audit must be complete to identify any worn or broken furniture. Carpets identified during the visit must be cleaned. Furniture that is worn must be replaced by the organisation. Additional electrical sockets are required in some bedrooms, where extensions leads are presenting a hazardCompliance not assessed at this inspection previous time scale 10/1/05 Applications for employment must include the capacity in which the applicant knows the referee. One reference must be sought from the most recent employer. Complianace not assessed at this inspection previous time scale 19/11/04 1/8/05 1/8/05 1/8/05 1/8/05 1/8/05 1/8/05 1/8/05 Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 21 22. 35 18(1) a,c 23. 35 18(1)a,c 24. 36 18(2) 25. 37 9(2)(b)(i) 26. 27. 42 42 13(4)(c ) 13(4)(c ) 28. 29. 30. 31. 32. 42 42 13(4)(c) 13(4)(c) Training records must state course, title, date, duration and content. The home must advise CSCI of date for planned epilepsy training.Compliance not assessed at this inspection previous time scale 19/11/04 The home must review the induction pro-forma to ensure it accurately reflects the content of the induction. Induction records must be consistently dated. Compliance not assessed at this inspection previous time scale 19/11/04 Staff supervision must be carried out at the required frequency. The home should review the frequency of supervision for staff undergoing induction.Compliance not assessed at this inspection previous time 10/12/04. The manager must have qualifications at level 4 NVQ in both management and care by 2005 All showers must be regulated to prevent scadling. All water outlets must be randomly checked for temperature control to prevent scalding. Chopping bored that are worn must be replaced. Protective covers must be fitted to all radiators. 1/8/05 1/8/05 1/8/05 1/8/05 1/8/05 1/8/05 1/8/05 1/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 22 No. 1. Refer to Standard Good Practice Recommendations Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Birmingham and Solihull Local Office 1st Floor, Ladywood House 45/46 Stephenson Street Birmingham, B2 4UZ 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 Avenue, The (3) E54 S16988 Avenue3 V226840 290605 - Stage 4.doc Version 1.30 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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