Inspection on 08/08/07 for Bethrey House

This inspection was carried out on 8th August 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Bethrey House 05/08/08

Bethrey House 06/02/07

Bethrey House 19/10/06

Bethrey House 15/08/05

Bethrey House 19/04/05

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Bethrey House Bethrey House 43 Goldthorn Hill Penn Wolverhampton West Midlands WV2 3HR Lead Inspector Joy Hoelzel Unannounced Inspection 8th August 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bethrey House Address Bethrey House 43 Goldthorn Hill Penn Wolverhampton West Midlands WV2 3HR 01902 338213 F/P 01902 338213 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) Quality Homes (UK) Limited Helen Kathleen Sims Care Home 18 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (18) of places Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Females aged 60 years and above and males aged 65 years and above. The home can accommodate (seven) 7 people over 65 with mild dementia (DE (E) 6th February 2007 Date of last inspection Brief Description of the Service: Bethrey House was built as a detached private dwelling around the turn of the century. It was first registered as a residential care home in 1981. Since then, the home has undergone a number of extensions and alterations. The home now provides accommodation and personal care for 18 older people. There is a car park at the front of the property and a patio and garden at the rear. The home is situated approximately two miles from Wolverhampton city centre and is on a main bus route to the city centre. There are local shops and amenities less than a quarter of a mile from the home. Weekly fees range from £327.20 - £ 385.00. Information of the home and the provision of the service are available in the statement of purpose and service user guide. Commission for Social Care Inspection reports for this service are available from the provider or can be obtained from www.csci.org.uk. Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over six and a half hours on Wednesday 8th August 2007. It was conducted by one Commission for Social Care Inspection regulation inspector and a locum inspector. Twenty three of the thirty-eight National Minimum Standards for Care Homes for Older People were inspected as they are viewed as key standards for services. Fourteen people are currently living at the home and during the inspection were observed to be accessing areas around the home. The registered manager was on the premises supported by two care staff, and ancillary personnel. A member of care staff from another home within the company arrived during the morning to fill in for sickness absences of the permanent staff. Four case files were selected for case tracking, relevant documents were inspected, discussions were held with people living at the home, visitors, members of staff and the manager. Observation was made of the various daily activities and a tour of the premises was conducted. An Annual Quality Assurance Assessment (AQAA) had been completed by the manager and submitted to CSCI prior to this inspection, offering a full overview of the home. On site surveys were distributed during the inspection and completed by people living, working and visiting the home. The comments received are included in this report. What the service does well: People living at the home are generally satisfied with the care provided with people expressing a satisfaction with their accommodation. Relatives and friends of people living in the home indicated in the on site surveys that – • • The caring is done quite well Extremely caring and kind DS0000020882.V344690.R01.S.doc Version 5.2 Page 6 Bethrey House • • Good rapport and communication with staff and relatives Looks after people 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. The summary of this inspection report can be made available in other formats on request. Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 3,6 Quality in this outcome area is good. Pre admission assessments are carried out and information is obtained from other relevant sources to ensure that the home can meet the needs of the individuals moving into Bethrey House. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The case file of the person most recently moving into the home contains an assessment of care needs from which an initial basic plan of care is developed. Other case files inspected included pre admission information from the primary care trust, social workers and previous social care placements. Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 9 The manager confirmed the information recorded in the Annual Quality Assurance Assessment and described the pre admission process and verifies that the person is visited in their place of residence prior to offering a place at the home. The home does not offer an intermediate care service. Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 7,8,9,10 Quality in this outcome area is adequate. Each individual has a care plan but practice of involving people who use the service in the development and review of the plan is variable. The plan includes basic information necessary to deliver the resident’s care but generally is not detailed or person centred. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people living at the home have a plan of care, which is developed at the point of admission to the home from the pre admission information. Four case files were selected for inspection and all included an assessment of the activities of daily living. The care plan was then based on the problem identified and the goal. Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 11 Out of the four case files only one contained evidence of the person being included in the process and all four plans had not been reviewed on a monthly basis. The personal care plan for one person identifies a hygiene problem but the goal/strategy states “continue with the encouragement of staff’. There were no specific details of how the staff should assist with maintaining standards of personal care or the person’s own preferences. Not all information recorded in the plans appears to be correct and at times appeared to be contradictory. For example in the communication section it is stated, “no problem with communication, but at times does not understand what staff are saying to him”. The manager explained that this person’s first language is not English but that they have a good command of the language. Individual risk assessments for reducing the risk of falls, nutrition, moving and handling are being carried out but need to be made far more comprehensive. Following the assessments any identified area of risk must be further assessed to include details of how the risk can be reduced. Although there has been an improvement in the content of the care plans it was discussed with the manager that further developments in detailing the specific actions for staff to follow would ensure that care needs of people would be fully met. It would appear that due to staff having cared for residents over periods of time an over reliance on personal knowledge rather than the written care plan has developed and this has the potential for inconsistencies in the way daily care routines are carried out. Staff were observed to be administering the medication during the morning and appeared to be completing the Medication Administration Record at the point of administration. A recent visit by the Primary Care Trust Community Pharmacist 21/05/07 identified the need for a larger medication trolley. One lady complained to the inspector of pain in her arm. The care staff stated this lady was not prescribed any pain relief and that the home did not have a homely remedies policy. The GP was contacted to give permission for analgesia to be administered. The homes policies and procedures for the safe administration of medication are in need of review to ensure that they meet the guidelines of the Royal Pharmaceutical Society. Some people looked a little unkempt with their appearance and appear to be reliant on staff to assist them with personal hygiene and grooming. Some Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 12 ladies hair was not washed/set, some men were unshaven, some people were wearing cardigans without buttons, and some people were wearing soiled and stained clothing. It is acknowledged that some difficulties may arise from time to time during the course of the day; nevertheless staff should be in sufficient numbers to ensure that standards of personal hygiene and grooming are maintained. Three people completed the on site survey and commented in the ‘What could be done better’ section • • Laundry, washing and ironing and putting clothes away. More time could be taken on washing of clothes Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 12,13,14,15 Quality in this outcome area is adequate. Generally staff are aware of the need to plan the routines and activities of the home in a way that meets the choice and wishes of service users, however this may be sometimes compromised because of staffing and time constraints. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager explained that the activities programme is still being developed, including both in house and in the community. A trip to the Black Country Museum is planned for September. Information recorded in the Annual Quality Assurance Assessment stated that ‘activities are arranged in house and community based with the possibility of an annual holiday. Visitors welcome – no restrictions’. Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 14 During the morning the TV and radio were both on. One person was singing along to the radio, others were watching TV but the majority of the people were sitting either asleep in their chair or watching the happenings of the day. Later in the morning two people played a board game with a member of staff; another member of staff was throwing a ball to people. During the afternoon a care staff was trying to organise a game of bingo. Many frail people with cognitive difficulties are residing in the home and it is acknowledged that they may not wish to or are unable to participate in any structured recreation, nevertheless age appropriate activities should be available at times suitable for the individual. Discussion with three people indicated a general satisfaction with the home and staff. One resident described the home as “ordinary”. There was consensus from all three that they would like more variety of activities, but no suggestions were offered. In the ‘what could be done better’ section of the on site survey completed by people living at the home comments were made of – • • More outings and shopping trips One or two more outings. Many people visited during late morning and afternoon, staff were observed to be welcoming and friendly to them. People commented in the on site survey in ‘What the home does well’ section – • • • • The caring is done quite well Extremely caring and kind. Good rapport and communication with staff and relatives. Looks after people well. During the tour of the premises most rooms contained some personal possessions. The mealtimes appeared to be very functional. The dining table had no condiments or table linen/ serviettes and was only set for eight people. Other people were assisted with their dinner in the easy chairs in the lounge area or had their meals in their bedroom. Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 15 Some people were served their dinner on plastic plates and drinks were served in plastic beakers except for one person who had a glass of beer. No one else was offered this. People were offered a choice of two main courses. One person in their bedroom stated that the – • Food is beautiful’. The on site surveys completed by three relatives indicated that the food had improved. Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): OP 16,18 Quality in this outcome area is good. The service has a complaints procedure that is clearly written and easy to understand. It is available on request in a number of formats to help anyone living at, or involved with, the service to complain or make suggestions for improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager confirmed no complaints have been raised with the home since October 2006. The complaints procedure is included in the statement of purpose and a copy is displayed at the entrance to the home. A complaints file is available for recording the complaints, the details and the action taken. Copies of Wolverhampton and Dudley Safeguarding Adults’ procedures have been obtained and available in the office for staff reference. Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 17 A lockable safe is in the office for the safe keeping of service users monies and valuables. Two people have been nominated to have the number combinations and access to the safe. Individual accounting records are maintained for each transaction with the service users signature being obtained whenever possible. Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 19,24,26 Quality in this outcome area is adequate. The home provides a physical environment that meets the specific needs of the people who live there. People say the home is comfortable, and they are generally satisfied with the accommodation. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Improvements have been made to the home since the last inspection with the flooring in the corridors, bathrooms and laundry replaced with a non-slip easily cleanable floor covering. Some items of furniture (beds and easy chairs) have been replaced with the manager confirming that more are being replaced later during the year. Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 19 The Environmental Health Officer (EHO) visited 28/06/07, a report has been received with some recommendations, and the manager states she is working through the recommendations to achieve compliance. A further visit was made by the EHO after this inspection to look at smoking in the care home, advice was given to the manager. The local fire safety officer visited in March 2006, the manager confirms the recommendations have been complied with. During the tour of the premises many of the wardrobes provided by the home have not been secured to the wall, this has the potential of the wardrobes becoming unstable and toppling over. Some bedrooms have not been provided with a lockable storage space for the safe keeping of money and/or valuables. Hand wash facilities have been placed in all communal areas and at the point of the delivery of care. Random testing of the hot water outlets was satisfactory with the water at an acceptable temperature. It is still recommended that an automatic sluice disinfector be available for the safe and effective use for dealing with bodily waste. One person living at the home expressed their satisfaction with the accommodation and said – • Staff are great, food is beautiful, couldn’t have better in a hotel. Visitors commented that they thought the service was satisfactory for their relatives needs. Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 27,28,29,30 Quality in this outcome area is adequate. People using services are generally satisfied that the care they receive to meet their needs, however there are times when staffing levels should be increased to ensure that people receive the necessary support and attention. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing rotas are maintained to show which staff are on duty at any given time of the day or night. The usual levels being 3 care staff in the morning, 2 care staff during the evening and nights. One care staff phoned in sick this morning a replacement was found from another care home and arrived about 11.00. Staff commented that they thought there were enough staff on duty usually but on this occasion when a person was off sick they were short. General observations during the day were some people looked a little unkempt with their appearance and appear to be reliant on staff to assist them with personal hygiene and grooming. It is acknowledged that some difficulties may Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 21 arise from time to time during the course of the day; nevertheless staff should be in sufficient numbers to ensure that standards are maintained. The AQAA completed by the manager indicates that 50 of care staff have achieved National Vocational Qualification level 2 with the remainder working towards it. Fifteen care staff work at the home, six have National Vocational Qualification level 2 with 5 working towards accreditation. One staff personnel file was selected and contained two written references, the date of criminal record bureau disclosure, application from and the required identity checks. Training file is being updated and new format has been printed out but to date the transfer of information has not taken place. The current format is messy and not in chronological order, making it difficult to see what has been done and which training needs refreshing. Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): OP 31,33,35,38 Quality in this outcome area is adequate. The manager is developing systems that monitor practice and compliance with the plans, policies and procedures of the home and is aware of the need to keep up to date with practice and continuously develop management skills. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Helen Simms continues to develop in her role as manager, with supervision and guidance from the area manager. Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 23 The agreed date for completion of National Vocational Qualification Level 4 in management has not been achieved. The area manager stated this is now nearing completion. Further training for the Registered Managers Award and Mental Capacity Act have been arranged for the manager. Quality assurance of the service continues with the satisfaction surveys to service users and visitors being distributed and audited. This identified some improvement areas in relation to the meals and menus. A new cook has been recruited since the last inspection, with people indicating and stating that improvements have been made. A lockable safe is in the office for the safe keeping of service users monies and valuables. Two people have been nominated to have the number combinations and access to the safe. Individual accounting records are maintained for each transaction with the service users signature being obtained whenever possible. Weekly, monthly and annual testing of the equipment and premises are conducted with records kept. The fire risk assessment was last reviewed in January 2007. Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X 3 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes 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 Regulation 15(1) Requirement The registered person must ensure all care plans set out in detail the action required to be taken by staff to ensure that the health, personal and social care needs of a person are fully met Previous requirement 30/11/06 and 31/01/07, 30/03/07 Not fully met The registered person must ensure that all assessments (Nutritional screening, tissue viability, continence and risk of falls) the findings recorded and where necessary linked to specific plan of care. Previous requirement 30/03/07 not met. The registered person must ensure that the registered manager completes the National Vocational Qualification level 4 in care and management. Previous requirement 31/01/07 Not met 30/03/07 Timescale for action 31/10/07 2 OP8 12(1)(a) (b) 31/10/07 3. OP31 9(2) 31/10/07 Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 26 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 OP9 Good Practice Recommendations It is recommended that the policies and procedures for the safe administration of medication be reviewed to ensure that they meet the guidelines of the Royal Pharmaceutical Society. It is recommended that a homely remedies policy be adopted. It is recommended that all people are assisted to maintain their own standards of personal hygiene and grooming. It is recommended that age appropriate activities are arranged at time suitable for the individual It is recommended that a complete review of the social aspects of meals and mealtimes is undertaken - its preparation, presentation and consumption It is strongly recommended that consideration be given to the complete refurbishment of the shower room. It is recommended that all wardrobes in use are securely fixed in position to reduce the risk of them becoming unstable It is recommended that all bedrooms be provided with a suitable locking facility. It is strongly recommended that a sluice disinfector be purchased to reduce the risk of cross infection and to reduce the risk to staff of splash back accidents. It is recommended that staffing levels be maintained in sufficient numbers to ensure that all care needs of people are fully met. It is recommended that a minimum ratio of 50 of care staff are trained to National Vocational Qualification Level 2 or equivalent It is recommended that the training files be reorganised for ease of reference. 2 3 4 5 6 7 8 9 10 11 12 OP9 OP10 OP12 OP15 OP21 OP24 OP24 OP26 OP27 OP28 OP29 Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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 Bethrey House DS0000020882.V344690.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!