Inspection on 15/11/05 for Barnetts

This inspection was carried out on 15th November 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.

Other inspections for this house

Barnetts 10/08/07

Barnetts 05/06/06

Barnetts 27/04/05

Barnetts 09/09/04

Barnetts 13/04/04

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

CARE HOMES FOR OLDER PEOPLE Barnetts Frant Road Tunbridge Wells Kent TN2 5LR Lead Inspector Gary Bartlett Announced 15 November 2005 09:30 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 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. Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Barnetts Address Frant Road Tunbridge Wells Kent TN2 5LR 01892 542983 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) Kent Community Housing Trust Mrs Eileen Joyce Gilbertson CRH Care Home 41 Category(ies) of Dementia - over 65 (39) registration, with number Learning dis - over 65 (1) of places Old age (1) Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Care for a service user with a learning disability is restricted to one person whose date of birth is 13 August 1937. 2. Care for service users of old age, not falling within any other category (OP) is restricted to one person whose date of birth is 8 March 1926. Date of last inspection 27 April 2005 Brief Description of the Service: Barnetts is owned and operated by the Kent Community Housing Trust. It is a detached purpose built premises with accommodation on two floors. The Home is equipped with a shaft lift. There are a total of 40 bed-spaces with 34 single and 3 shared rooms. All bedrooms are fitted with a staff call point and three have telephone points.Barnetts is located on a main road on the outskirts of Tunbridge Wells where there are the usual facilities of a large town. There is easy access to public transport with a bus stop near by and a main line railway station is approximately 1 ½ miles away. Space for car parking is available at the front of the building. There are gardens to the rear of the Home for service users to use. A small day centre is run on the site. The Home’s senior staffing team comprises the Manager, an Assistant Manager, a Team Manager and some Team Leaders. The Home employs Care Services Assistants who work a roster that gives 24-hour cover. The Home also employs other staff for catering, domestic, administration and maintenance duties and Activities Coordinators. Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in Barnetts from 9.30 a.m. until 4.50 pm. During that time the Inspector spoke with some residents, visitors and some staff. Parts of the Home and some records were inspected. Due to the nature of the service provided it is difficult to reliably incorporate accurate reflections of residents’ reflections of the service in the report. Some comment cards were received prior to the inspection. Residents’ relatives generally responded that they liked the home and staff. Responses from health professionals also indicated good standards of care. Statements on comment cards included: • “I have been particularly impressed by the support and care given…” • “Very happy with all aspects of Barnetts.” • “..the care has been exceptional. The Manager and staff gave their full co-operation throughout the inspection. What the service does well: What has improved since the last inspection? Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 6 Information was more consistently collected prior to residents’ admission to be sure the Home could meet their needs. The Home’s own staff were being better trained in specialist areas such as dementia and challenging behaviour. Early morning routines had changed so there was less delay between residents getting up and being served their breakfast. Hygiene was better promoted by the redecoration and better maintenance of the laundry and improved keeping of personal toiletries. Lifting hoists and other equipment for general use were stored in appropriate parts of the building. All toilets had been clearly labelled for easy identification by residents. Residents benefited from increased staffing levels at peak times of activity. Kent Community Housing Trust had recently reviewed all its policies to ensure they complied with current legislation and good practice guidelines. 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. Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3, 4, 5 and 6 Sound systems are in place for prospective residents to decide whether Barnetts is the right home for them. EVIDENCE: The Manager said the Statement of Purpose was accurately descriptive of the aims, objectives, philosophy of care, services and facilities and terms and conditions of Barnetts and copies of the Service Users Guide were provided for each service users or their representative. These were not inspected on this occasion. Senior staff were using new documentation when they visited prospective residents prior to admission. Consequently, more comprehensive information was being recorded than previously and it was easier to make a decision whether the Home could meet the persons’ needs. Information was obtained from relevant health care professionals to assist in assessments. Residents were able to visit the Home before moving in and said staff had been helpful in assisting them to settle. Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 9 Each resident was provided with a contract between the Home and themselves. The contract clearly stated the responsibilities of the organisation and the rights of the resident. As recorded later in this report, most staff had recently received training in dementia awareness and challenging behaviour. Intermediate care was not offered at Barnetts. Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 Residents’ health and welfare would be better promoted by care plans being more directive and daily records more consistently maintained. Staff adhered to the procedures for the, storage, administration and disposal of medicines. Residents were able to take responsibility for their own medication if they wished and when it was safe to do so Residents’ health needs were met with good liaison with relevant health care professionals. EVIDENCE: Each resident had a care plan. Three were inspected in detail. A new format had been introduced and clearer information was available to staff. Not all of the plans were reflective of the residents’ needs. A staff member had been seen to struggle in assisting a resident move from a lounge to the dining area. Although a senior staff had a good knowledge of what was required, this information was not contained in the care plan. The Manager agreed that residents’ welfare and safety would be better promoted by the care plans being more directive so staff would be better informed how to meet residents’ needs. Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 11 There were some good examples of daily records of care. However, significant incidents had not always been recorded, nor was it evident that appropriate action had been taken in the immediate instance. This potentially placed residents at risk. The medical room was well maintained and medications were seen to be stored in accordance with their instructions. The senior staff member responsible for the ordering and return of medicines had a sound understanding of good practice. Records were available to indicate that all staff administering medications had been trained and signed off as being competent to do so. The Medication Record Administration Record (MAR) sheets that were inspected had been completed appropriately. Medications were seen to be administered in a safe manner. Records showed the Home continued to liaise with specialist and local health care professionals in supporting residents in their health care needs. Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 Residents had some choices about their daily lives and enjoyed personal preferences where this was practicable. Dietary needs of residents were catered for with a balanced and varied selection of food that met their tastes and choices. EVIDENCE: Since the last inspection, the Home had tried different routines at breakfast time and had arrived at a system whereby residents did not have to wait for a long between getting up and having breakfast. As a result there was less agitation at this time. Staff continued to strive to enable residents to pursue individual interests and some outings were arranged. On the day of the inspection, 6 residents went to lunch at the Lakeside café. Residents spoke favourably of the meals, said they had plenty to eat and enjoyed the choices available to them. The meals were well presented and looked appealing. Lunch was taken in a relaxed atmosphere and staff were seen to offer assistance in a discreet and sensitive manner. The menus seen were varied and alternatives were offered. Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 13 Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17 and 18 Residents and their relatives knew their complaints would be listened to and acted on. Residents’ legal rights were protected and there were systems to ensure they were protected from abuse EVIDENCE: Residents and those acting on their behalf had a complaint procedure which gave contact details and the process of investigating the complaint with timescales. A record of complaints was held which showed the nature of the complaint, subsequent investigation and any action taken. The Manager said they used complaints to improve practice where necessary. The Manager described how permanent residents admitted to Barnetts were enabled to be on the electoral role and that voting would be facilitated where requested. The Manager confirmed that where residents lacked capacity they were given access to advocacy services. There were procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The Manager and other staff spoken with demonstrated a sound understanding of adult protection procedures and stated that any allegation of abuse would be referred to the concerned agencies without delay. Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 21, 22, 23, 25 and 26 Residents enjoyed a clean and comfortable environment where they could have familiar belongings to help them feel more at home. EVIDENCE: Those parts of the Home inspected were clean and free from unpleasant odours. The laundry had been redecorated and was much better maintained than previously. At the last inspection it had been identified that the Home now had a much higher dependency group than the laundry was originally designed for. The Manager said that in view of the plans to rebuild the Home, there had not been a review as to whether current laundry facilities were adequate. The bedrooms seen were clean and personal toiletries were being kept hygienically. Wheelchairs, lifting hoists and other equipment were stored in appropriate parts of the building. Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 16 Some bedrooms were shared and fitted with privacy screening. The use of shared bedrooms should be reviewed in view of the mental frailty of the residents and the associated behaviours. Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 Recruitment processes were robust and offered protection to people living at the Home. The Home was addressing the training of its staff so they had the skills to meet the needs of the residents. The specialised care needs of the residents could not be reliably met by the Home due to it’s continued reliance on the use of agency staff and the resultant difficulty in providing a staff group with the skills required. EVIDENCE: Residents’ relatives spoke well of staff and thought they worked hard. Comment cards received prior to the inspection included the statements: • “They could not have been better or more supportive” • “I have a good relationship with the staff.” • “I am very impressed with the kindness and friendliness of the staff.” Additional staff had been employed in the mornings to ensure there was no longer an undue delay for residents to get their breakfast. The Home’s staff were required to undertake a comprehensive induction programme. There was also an induction programme for agency staff to complete on their first shift at the Home. It was suggested that this be expanded to ensure that agency staff had a clear understanding of their roles Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 18 and responsibilities. For example, that ancillary staff were not to assist residents with personal care, transferring etc. There was ongoing training for staff, which had recently included specialist areas such as dementia and challenging behaviour. Each staff file included a “staff training analysis sheet” to record training courses they had attended. Unfortunately a training matrix had not been written, as the Manager had thought, to give a clear overview of what training and updates staff required. Residents were potentially at risk through this. Records seen indicated that robust recruitment procedures were used and ensured the Home directly employed only staff that had been properly vetted. The recruitment and retention of staff continued to be very problematic for the Home. As a result the Home was still reliant on the use of agency senior, care and ancillary staff to maintain adequate staffing levels. It should be acknowledged that Kent Community Housing Trust had tried to address this in various ways. For example, the senior team structure had been augmented to offer better career progression for staff. Three staff agencies were used. The Manager explained they had requested to see the training certificates of the agency staff to confirm their competency but only one agency had agreed to this. This was especially concerning in view of the specialist needs of the residents. Particularly at weekends, some shifts were mostly agency staff, very occasionally all agency staff. Currently, there were not any Home-employed Night Team Leaders. There was a resultant lack of continuity and a clear lack of “belonging” within elements of the staff team. In parts of the Home, such as the servery, the evident lack of care in their maintenance could be attributed to this. The heavy reliance on agency staff also increased the administration workload of the office staff. This staffing situation was not conducive to residents’ well-being. Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35, 36, 37 and 38 The Home benefited from a Manager who was accessible and had high expectations of the service to be delivered. The Home regularly reviewed aspects of its performance through a programme of self-review and consultations, which included the opinions of residents and relatives. Residents’ financial interests were protected. Residents welfare would be better promoted by improved food hygiene standards within the kitchen and by keeping external fire exits clear of obstructions. EVIDENCE: Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 20 The Manager had worked for many years in a management role. They had recently undertaken the “Leadership in Dementia Care” course and had completed the Registered Manager’s award, which was waiting for external verification. Throughout the inspection, the Manager demonstrated a commendable honesty and understanding of where things needed to be improved. The Manager effectively conducted “spot-checks” of the Home to ensure the quality of the 24 hour service. One such check had resulted in the discontinued use of any agency staff member. Staff, residents and visitors said they considered the Manager to be approachable, understanding and supportive. Staff records complied with the Regulations and regular staff supervision had been implemented. The Manager explained that staff shortages had meant that supervision was not undertaken as often as was ideal. The Manager described how residents and their representatives or relatives were regularly asked for their views about the service. Most residents were unable to manage their own finances and a staff member explained that the Home encouraged residents’ families / representatives to give assistance with this. The staff member demonstrated a sound system of holding and recording residents’ cash, which facilitated ease of monitoring. Residents’ relatives did not express any concerns about the Home’s management of monies or valuables held on the residents’ behalf. Kent Community Housing Trust had recently reviewed all its policies to ensure they complied with current legislation and good practice guidelines. Records were seen to be stored in a manner that preserved confidentiality. Unfortunately, residents’ privacy was compromised by the collective recording of personal information in the “Home’s Diary”. Records seen indicated that the Home was ensuring all staff had fire training or participated in fire drills. An external fire exit had been partially obstructed by some items of garden furniture. The Manager recognised the dangers in this and arranged for them to be removed. Staff were seen to be diligent in ensuring COSHH requirements were adhered to and those spoken with had a sound understanding of emergency procedures. Parts of the fabric of the kitchen needed to be made good and areas to be kept cleaner to maintain good food hygiene standards. The refrigerators and freezers were also in need of attention, having worn and, in places, rusted casing and doors. Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 21 The Manager stated that all records of maintenance and safety checks were up to date. These were not inspected on this occasion. Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 3 COMPLAINTS AND PROTECTION x x 3 3 2 x 3 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 3 x 3 2 2 2 Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 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 OP7 OP38.7 Regulation 14(2)(b), 15(2), 17 Schedules 3&4 Requirement “The registered person shall maintain records as specified in Schedules 3 and 4. The registered person shall keep the service user’s plan under review in that: service users’ individual plans and records must be reflective of their care needs directive as to how those needs are met. Daily records must be more comprehensive and include incidents. Although being addressed, this remains a requirement from four previous inspections “The registered person shall make suitable arrangements to ensure that the care home is conducted in a manner which respects the privacy and dignity of service users”, in that personal information must be kept confidential The registered person shall make suitable arrangements to prevent infection,toxic conditions and the spread of infection in the care home in that 1. Where necessary, the fabric of the kitchen must be made good. 2. All parts of the kitchen and Timescale for action Action plan to be received by CSCI by 12/12/05 2. 37 12(4)(a) Action plan to be received by CSCI by 12/12/05 3. 38.2 13(3) Action plan to be received by CSCI by 12/12/05 Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 24 4. 38.2 23(4) kitchen equipment must be kept clean. 3. Refrigerators and freezers must be made good or replaced where necessary. The registered person shall after consultation with the fire authority make adequate arrangements for detecting, containing, and extinguishing fires. For the evacuation, in the event of fire, of all persons in the care home and safe placement of service users. in that fire exits must not be obstructed. Action plan to be received by CSCI by 12/12/05 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 OP23.7 Good Practice Recommendations The use of shared rooms should be reconsidered with service users offered a single room or sole use of the shared room unless they have made a positive informed choice to share. It is again strongly recommended that a review be undertaken to determine if the exiting laundry facilities are adequate for the Homes needs. It is strongly recommended that agency staff training certificates are seen to ensure the competency of those staff and the staff numbers and skills mix is appropriate to the assessed needs of the service users It is recommended a minimum ratio of 50 of staff are trained to NVQ level 2 or equivalent by December 2005. It is strongly recommended a training matrix is used to readily identify staff training needs It is recommended care staff receive formal supervision at least 6 times per year. It is strongly recommended the induction programme for agency staff is amended to include roles and responsibilities 2. 3. OP26 OP27.1 4. 5. 6. 7. OP28 OP30 OP36.2 OP30.2 Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection The Oast, Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Barnetts H56-H06 S23903 Barnetts V248390 151105 Stage 4.doc Version 1.40 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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