Inspection on 08/10/07 for Barlby Road

This inspection was carried out on 8th October 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Barlby Road 14/04/09

Barlby Road 21/07/08

Barlby Road 15/08/06

Barlby Road 05/12/05

Barlby Road 09/05/05

Barlby Road 25/10/04

Barlby Road 12/07/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Barlby Road 37 Barlby Road North Kensington London W10 6AN Lead Inspector Sheila Lycholit Key Unannounced Inspection 8th October 2007 11.00 Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 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 Barlby Road DS0000010843.V349664.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 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. Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Barlby Road Address 37 Barlby Road North Kensington London W10 6AN 020 8964 8543 020 8964 8156 info@yarrowhousing.org.uk 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) Yarrow Housing Limited Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th August 2006 Brief Description of the Service: 37 Barlby Road is a residential home for four people with a learning disability. The service is provided by Yarrow Housing Limited in a building owned and maintained by Kensington Housing Association. All of the service users, two men and two women, are supported by RBKC. The building is a semi-detached house in North Kensington, which has been adapted on the ground floor for wheel-chair access. The lay-out of the house provides one bedroom on the ground floor and three on the first floor. All rooms are single and of a good size. There is an office/sleep-in room in a loft extension. Service users attend day services in the Borough and are supported to pursue a range of interests. Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Monday 8th October from 11AM until 4.30PM. The four residents or housemates, as they are called, were at home supported by the Deputy Manager and 3 support staff. The Deputy Manager made herself available until the early afternoon when she had to keep an appointment with a NVQ student. The Acting Manager was at Yarrow’s head office and returned in the afternoon to speak with the Inspector. Two support staff were also at the head office undertaking part of their LDAF induction. The Acting Manager showed the Inspector around the building, with one housemate showing her his room. The previous Manager, who had just left her post, had fully completed an annual quality assurance assessment (AQAA). The Inspector also spoke with the Placement Reviewing Officer who undertakes reviews and acts as the Care Manager for the four housemates. What the service does well: What has improved since the last inspection? Staff have continued to develop the use of multi media to support housemates’ communication. A PC and printer is available for housemates in the sensory room, which has been made more welcoming. Ways of involving housemates in staff selection are being established. Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 6 A quality assurance system based on obtaining the views and concerns of housemates has become well established. 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. Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 7 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 Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. Clear information about the service is available in an accessible format. Comprehensive assessments are undertaken with the involvement of the multi professional Learning Disability Team. The admission of a new housemate since the last inspection was carefully planned, with the full involvement of the prospective resident and her family. EVIDENCE: The 3 files looked at contained copies of the service user’s guide and a contract. The guide and contract are in an accessible format and are regularly reviewed and re-issued. The first new resident for many years has moved to Barlby Road. Her assessment was taking place at the last inspection. Records show that the assessment and transition were carefully planned and undertaken, with the prospective housemate making many visits to Barlby Road, initially with her family, before deciding to move. Members of the Learning Disability Team assisted with the assessment, for example the Occupational Therapist designed ways of supporting the housemate to use the stairs, which were unfamiliar to her. It is to the credit of all involved that the new resident has settled well and has been accepted by the other longstanding housemates. Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. PCPs are of a high standard and show the involvement of housemates. Staff work hard to support housemates’ communication so that they can be involved in the running of the home and make decisions about their daily lives. Well written risk assessments are regularly reviewed and updated. EVIDENCE: PCPs for three of the housemates were looked at. Each is comprised of photos and text and is regularly reviewed. Housemates are involved in the presentation of their plans at reviews, using multi media. In addition housemates have a collage reflecting their interests and aspirations. An action plan has been developed from PCPs and reviews, with timescales. Supervision notes show that senior staff monitor action plans with key workers, ensuring that agreed deadlines are met. The communication passport of the newest housemate was seen, which had been developed with the Speech and Language Therapy Team and provided a great deal of information about ways to support her communication. Objects of reference are routinely used by staff, who commented on the improvement in Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 10 one person’s behaviour as a result of his being able to better express his needs. Comprehensive risk assessments are available, which are reviewed following any incident or identified concern. Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Housemates are supported to take part in a wide range of activities outside the home. Relationships with families and friends are well supported. An emphasis on healthy eating has been maintained, with housemates encouraged to try a wider variety of foods, including fish and fresh fruit and vegetables. EVIDENCE: Records, discussion with staff and photos displayed in the home and in files show that housemates are supported to develop their independence and to take part in activities at the home and in the wider community in line with their PCPs. Photos show one of the housemates at the office where she regularly assists. Staff are trying to find a placement for another housemate in catering where he has developed an interest. In addition to specialised day services including sessions at Scope and The Gate, housemates take part in a range of activities in the community, including using local leisure centres and going out to Richmond Park, restaurants and Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 12 pubs. Housemates’ cultural backgrounds have been celebrated, for example by visits to the Irish Centre and to Caribbean restaurants. Staff vacancies over the past 12 months have created some restrictions on trips out, especially in the evenings. Records and discussion with staff show that good relationships have been established with families who are encouraged to visit and to spend time at the home. One housemate stays with her family every other weekend. The Placement Reviewing Officer commented on the home’s good relationships with families. Holidays have been arranged as agreed at review meetings. Staff obtained funding from a charity to allow one housemate to go on holiday to Ireland, which she clearly enjoyed. The emphasis on healthy eating noted at the last inspection has been maintained, with housemates eating a wider variety of fresh foods. The kitchen is arranged to encourage individuals to choose food and drinks and to be as independent as possible, though it is kept locked unless staff are present to ensure the safety of housemates. Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Support guidelines reflect staff’s detailed knowledge of how housemates want to be assisted with personal care. Staff advocate strongly for housemates to receive good health care, in particular dental treatment. Sound medication policies and procedures are in place, though staff have not been provided with refresher training in the administration of medication. EVIDENCE: Support guidelines are well written and show that staff have a detailed understanding of housemates’ individual needs. A high priority is given to ensuring that housemates receive good health care. Up to date health action plans are available for each person and an appointment has been made with the new specialist Community Nurse to visit the home and to meet housemates and staff. Staff have established good relationships with health care colleagues, including local GPs. Staff have advocated strongly for housemates to have access to good health care and have been successful to a degree in ensuring that housemates see a Dentist regularly. Unfortunately one housemate’s anxiety became so high at Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 14 his last appointment for dental treatment that the session had to be cancelled, with a long wait for the next appointment. The use of prescribed medication, other than creams and lotions, continues to be low. A well established medication procedure is in place. MAR sheets were seen, which were up to date and fully completed. A recent error took place when an antibiotic was not given by night staff. Action has been taken to prevent a reoccurrence. Records of mandatory training show that staff have not been provided with recent training in medication. Sessions have been cancelled on a number of occasions, including the next planned session. The training is carried out by an existing member of staff who has other commitments. The Training Team should consider other ways of providing this essential training, so that it takes place as planned. Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff work creatively to elicit housemates’ concerns and to understand any unusual or difficult behaviour and takes steps to ensure that housemates’ safety and well being is a priority. EVIDENCE: Yarrow Housing has a clear complaints procedure in an accessible format. The local advocacy service is used to seek housemates’ views about the home. These findings contribute to the home’s regular quality assurance review. Information about the advocacy service is displayed in the house. No complaints have been received in the past 12 months. All staff have received training in safeguarding adults in the last 12 months. Any concerns about housemates, for example signs of distress or changes in behaviour are discussed at Team Meetings. Staff strive to understand changes in behaviour and to address the underlying issues. One housemate is asked to take time out in his room when he becomes very agitated, which has proved successful in calming him and protecting others. A ‘Best Interest’ meeting was held recently to discuss changes in a housemate’s behaviour, which were causing concern and putting her well being at risk. Incident reports are recorded in detail, with risk assessments updated where relevant. CSCI is kept informed of incidents and of any issues affecting housemates well being. Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. 37 Barlby Road is a large semi-detached house, which is indistinguishable from its neighbours. The building has been well adapted on the ground floor for one housemate who uses a wheelchair. The house is decorated in bright and cheerful colours, with objects of reference and tactile signage to support a housemates. EVIDENCE: The house is located on a bus route and is close to local shops and services in North Kensington. Bedrooms are of above average size and the building is well provided with bathrooms and lavatories, which are adapted for housemates’ use. The internal appearance of the building and the garden have continued to improve, as staff have taken steps to provide a comfortable environment, which is also safe and accessible for all housemates. Improvements have also been made to the sensory room, which contains soft seating and a PC, which has been adapted for use by housemates. Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 17 One housemate’s room was without some items of furniture, which had been removed for his safety. The Acting Manager confirmed that new heavy duty furniture had been ordered, which he would be supported to decorate to his taste. The building, including the kitchen and laundry room, was clean and tidy at this unannounced visit. A domestic assistant is employed 5 days a week and waking night staff also undertake some regular cleaning duties. Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Although some new staff have recently been recruited, the service has been operating with a number of vacancies since the end of 2006. Access to training, in particular mandatory training has improved, though the percentage of NVQ staff remains low, particularly when Bank staff are included. Staff are well supported by senior staff at the home, through supervision and Team Meetings. EVIDENCE: The staffing establishment is sufficient to allow housemates to take part in a range of activities throughout the week, including some evenings and weekends. Since the last inspection, turnover of staff at Barlby Road has been quite high, with 5 people leaving, including the Manager who moved to another post this month. Delays in recruitment earlier in the year left the home reliant on Bank staff, who are less aware of the complex needs of housemates. At the time of the inspection there were 3.5 posts vacant. Interviews were taking place shortly and the Acting Manager was hopeful that suitable staff would be appointed. Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 19 Staff are recruited by Yarrow’s HR Team with the involvement of home Managers. A number of Yarrow’s service users have been trained in recruitment and appointment interviewing and take part in interviews. Staff at Barlby Road have invited prospective applicants to meet housemates, so that they can participate in the selection process. Recruitment checks are undertaken by Yarrow’s HR staff. Yarrow Housing provides an in-house training programme and supports staff to access NVQ training. The turnover of staff has resulted in the percentage of staff having NVQ2 or above being below 50 . Five staff are currently enrolled on NVQ 2 or 3 and the Deputy Manager is studying for the NVQ Assessor’s Award. Only two of the six Bank staff regularly used have achieved NVQ2. Access to mandatory training has improved since the last inspection, with the exception of medication training discussed under standard 20. Staff meetings take place every other week and are used as an opportunity to supplement the training programme, as well as to review housemates’ needs and other business. Supervision records for two staff were looked at. Supervision notes seen were detailed and covered a range of issues including house business, key working, performance and professional development. Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 and 43 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Until the recent departure of the Manager, Barlby Road had benefited from a cohesive senior staff team, who had taken steps to develop the service, in particular housemates’ involvement in the running of the home. Staff have continued to develop quality assurance systems, based on housemates’ feedback. Visits on behalf of the provider take place at less than monthly intervals. EVIDENCE: The senior staff team of the Manager and two Deputies have provided leadership to the staff team and ensured that housemates received consistent support from a changing staff team. The Manager had left her post just before the inspection took place having given notice to Yarrow Housing and to CSCI and one of the Deputy Managers was acting up temporarily. Staff had been informed that the post would be advertised internally on an acting basis. The reasons for the delay in advertising for a permanent Manager were unclear. Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 21 Staff have continued to develop quality assurance systems for the service based on feedback from service users, whose views about the service are regularly sought. Financial records for two housemates were looked at. These were in good order with receipts kept for all purchases and a running balance noted. Senior staff sign that they have checked and reconciled housemates’ finances. Record keeping is of a high standard. Daily notes are detailed, with information noted about each aspect of housemates’ support, activities and food and drink intake noted for that day. At the time of the inspection staff were unable to print out a number of reports and documents because of a faulty printer. Staff commented that there had been difficulty in getting funding for a replacement. Health and safety is given a high priority. While risk assessments are available for all areas of the home’s operation, it is recommended that an overall risk assessment of the building is undertaken, which is reviewed annually. Waking night staff make a number of daily checks including hot water temperatures, fridge and freezer temperatures and equipment. The fire alarm is tested weekly at different points. Three fire drills have taken place this year, which are recorded. Accidents and incidents are carefully recorded and risk assessments reviewed and updated. Visits on behalf of the provider are still not taking place monthly as required. The visitors’ book indicated that five visits, rather than the nine expected, had taken place. Four reports were available on line. Barlby Road DS0000010843.V349664.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 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 3 2 4 3 3 4 4 5 3 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 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 2 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 3 3 X LIFESTYLES Standard No Score 11 3 12 4 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 X 3 3 2 Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 23 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 YA20 Regulation 13 Requirement Staff must be provided with training in the administration of medication, including refresher training. Staff vacancies, including the Manager’s post, should be advertised promptly. Staff training, including accredited training, should be given a higher priority. Staff must be provided with a working printer so that copies of documents and records are available. Visits on behalf of the provider must take place at least monthly and be recorded. Timescale for action 30/11/07 2 3 4 YA33 YA35 YA41 18 18 17 30/11/07 31/12/07 30/11/07 5 YA43 26 30/11/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA42 Good Practice Recommendations Although risk assessments are available for all aspects of the home’s operation, it is recommended that a general DS0000010843.V349664.R01.S.doc Version 5.2 Page 24 Barlby Road risk assessment is undertaken which is reviewed yearly. Barlby Road DS0000010843.V349664.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Barlby Road DS0000010843.V349664.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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