Inspection on 09/10/07 for Birchwood Grove

This inspection was carried out on 9th 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 but made no statutory requirements on the home.

Other inspections for this house

Birchwood Grove 12/10/08

Birchwood Grove 12/04/07

Birchwood Grove 21/08/06

Birchwood Grove 15/11/05

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

CARE HOMES FOR OLDER PEOPLE Birchwood Grove 64 Sydney Road Haywards Heath West Sussex RH16 1QA Lead Inspector Annie Taggart Unannounced Inspection 09:30 9 October 2007 th 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 Birchwood Grove DS0000065773.V347505.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. Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Birchwood Grove Address 64 Sydney Road Haywards Heath West Sussex RH16 1QA 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) 01444 458271 01444 441 792 www.southerncrosshealthcare.co.uk Ashbourne (Eton) Limited Vacant post Care Home 24 Category(ies) of Dementia (24), Mental disorder, excluding registration, with number learning disability or dementia (24) of places Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th April 2007 Brief Description of the Service: Birchwood Grove is a care home providing personal care and nursing for elderly persons with dementia and other mental disorders. The home admits residents from the age of 50 years upwards provided they are assessed as requiring care for mental health problems. The registered providers are Ashbourne (Eaton) Limited. Birchwood Grove is a large detached house in a residential area of Haywards Heath; 5 minutes walk from the local railway station and town centre. The residents accommodation is situated on the ground and first floor accessed by a passenger lift. There are 20 single bedrooms and 2 double bedrooms, 14 of which offer en-suite facilities. There are two lounge and dining areas and a garden at the rear, which is accessible to the residents and limited parking space to the front of the property. The responsible individual on behalf of the company is Mrs Angie Knight. The post for the registered manager is vacant. Current fees are £600 to £750 per week and extra charges are made for hairdressing, chiropody and toiletries. Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. In preparation for the visit an Annual Quality Assurance Assessment (AQAA) was sent to the manager, this was returned following a reminder letter being sent by the Commission and a telephone call made to the manager. Five survey forms were sent to families and service users, five were returned and comments from these form part of the report. We read the last two inspection reports and any other relevant documentation and correspondence relating to the home. This included an improvement plan, in which the Registered Provider was required to tell us how they would meet the Requirements made at the last visit The unannounced visit was carried out at 9.30am and lasted for 5 hours. We spent time talking with service users both in their private bedrooms and in communal areas and also spoke with three family members who visit the home regularly Five care plans with any supporting documentation were tracked with any issues that needed further clarification being discussed with the relevant service user or the staff team on duty. Five staff files were seen, three were in good order but two did not contain all of the required documentation. We also spoke to five of the staff on duty during the day. We saw the main meal of the day being prepared and served and also looked at food records. Records for the running of the business were seen including fire check and staff fire training, the complaints book, accidents and incidents logs and health and safety records. The manager was present and received feedback following the visit. What the service does well: Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 6 The environment has been recently improved and Birchwood Grove now offers a comfortable and homely service for the people who live there. In order to ensure that the home can meet the specific needs of the people it supports, improved pre-admission assessments are now carried out with input from families and other professionals and a plan of care agreed. Families say that they are now much happier with the service provided and are complimentary about the manager and the staff team. What has improved since the last inspection? What they could do better: In order to provide stimulation and interest for service users a programme of activities and entertainment must be put in place and the action taken to include people recorded. Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 7 To ensure that the staff team have the skills and confidence to offer the correct support to people with dementia and complex needs, the home must provide training in the management of challenging behaviour and the home should provide safeguarding awareness as part of the induction process. To ensure the safety of people at all time, medication records should be kept up to date and the medication room kept clean and hygienic. Staff records should be kept at the home for monitoring purposes. In order to address the continuing improvement of the home, the programme of redecoration and refurbishment should be continued and a quality assurance process carried out in the near future. 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. Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 8 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 Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 9 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): 1 3 5 and 6 Outcomes for service users in this area are good. This judgement has been made using available evidence including a visit to this service. Prospective service users and their families can be confident that their needs will be assessed, that visits to the home encouraged and contracts of terms and conditions of residency agreed. EVIDENCE: The home has a Statement of Purpose and Service user Guide in place and both documents have recently been revised and updated We looked at one pre-admission assessment for a service user recently admitted to the home and this contained good information regarding a personal history and the current needs and preferences of the person. The relatives of a service user confirmed they had visited the home and commented, “ We were looking for a suitable home for our relative and came Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 10 to visit on the off chance. We were made very welcome and found the staff to be friendly and the environment homely”. A sample contract of terms and conditions of residency was seen and this contained the fees to be paid and had been signed. Birchwood Grove does not provide intermediate care Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 11 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): 7 8 9 and 10 Outcomes for service users in this area are adequate . This judgement has been made using available evidence including a visit to this service. Although there have been obvious improvements to the care planning process, further attention is needed to addressing challenging behaviour issues, the completion of records and medication management. EVIDENCE: All care plans in the home have been reviewed and updated and contain good information about the needs and preferences of each person. The plans include, personal histories, risk assessments, personal care plans, nutritional assessments and evidence that people’s weights are monitored. Seven specialist nursing beds have recently been purchased and the manager said that there is a plan in place to provide others when needed. Daily records and regular updates are completed and for some people halfhourly behaviour monitoring charts are in place. Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 12 For two people, who are being cared for in bed, records of care provided and fluids taken had not been completed since 21.30 the previous night. This was pointed out to the manager who said she would address this with the relevant night staff. There were also gaps in the completing of daily personal care records. From daily record and records of incidents occurring in the home it is clear that the staff team deal with incidents of challenging behaviour on a daily basis. For one service user, advice has been sought from the relevant professionals including a psychiatrist but to ensure the safety of both service users and the staff team further advice should be sought from experts in dementia care and the staff team should be provided with training in the management of challenging behaviour. Comments from a relative about the care currently being provided in the home included, “I did have great concerns over the home and the care being provided, I was voicing my concerns and was seriously considering moving my mother to another home but was worried about the impact this would have on her. Since the new manager has been in post and the staff/service user ratio has improved I have noticed the environment and atmosphere has improved greatly. The standard of care has increased and I am pleased with the way the home is improving. My mother seems happy and this is the most important thing for me”. Medication was stored in a locked cabinet in a medication room, but the room was very untidy with the floor and surfaces needing cleaning. There were gaps found in the signing of the Medication Recording Sheets and the medicine cabinet needed tidying. The deputy manager, who has designated responsibility for medication, was spoken to about the need to sort out the medication room and she attended to this during the visit. Birchwood Grove DS0000065773.V347505.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): 12 13 14 and 15 Outcomes for service users in this area are poor. This judgement has been made using available evidence including a visit to this service. The standard of food provided in the home has been greatly improved but the quality of life for service users would be further improved if a range of activities to provide interest and stimulation were provided. EVIDENCE: The manager tells us that a new activities co-ordinator has recently been recruited but there is still very little evidence that the home provides activities and opportunities for stimulation and interest for the people who live there. The activity records of five people were seen and no activities or outings other than with families and friends or attending the hairdresser had been recorded for several months. During the visit most people sat in their chairs or wandered around with little to stimulate them other than the televisions being on and some loud classical music being played. Comment from families regarding the lack of activities included, “ I think there needs to be more interaction and stimulation for service users and better assessments should be made of likes and dislikes before people come into the home” and “ better communication and more activities would improve the quality of life for my relative”. Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 14 Visitors to the home confirmed that they were made welcome at any time and also said that they were kept in touch with any changes or concerns the home had about their relatives. The standard of food provided in the home has been much improved by a new chef having been recruited and new menus, with choices at each mealtime having been devised with advice from a nutritional expert. We saw lunch, which was the main meal of the day being prepared and served and the meal was prepared using fresh ingredients, looked appetising and was well presented. Where service users needed assistance with eating, this was carried out in a sensitive and unhurried manner and when one service user decided they did not want the meal they had chosen another choice was offered. The manager and chef said that there was a plan in place to provide large photographic menus to assist people with verbal communication difficulties to make a choice. A family member commented, “I have noticed that service users are receiving more prompt attention at mealtimes. The staff seems to be more attentive of service users now, which is great”. The dining room is not large enough to seat all service users at one time, which means that many people are in their armchair for most of the day. This was discussed with the manager who said that as may people are very frail they prefer to have their meals in their chairs but that extra dining room facilities were being considered. Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 15 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): 16 17 and 18 Outcomes for service user in this area are adequate. This judgement has been made using available evidence including a visit to this service. Although complaints are recorded and acted upon, the safety of service users would be further improved by safeguarding training forming part of the staff induction process. EVIDENCE: There a complaints procedure in place, a copy of which is displayed in the home. The complaints book showed that complaints are now recorded and acted upon and visitors to the home said that any comments they made were taken seriously and acted upon. In the AQAA, the manager tells us that thirteen complaints have been received in the last year, all have been investigated and one was upheld. The procedure for managing service user’s monies is robust, we saw that for each person there is both a computer and paper record of all transactions made, which is regularly reviewed. Receipts are kept on file in the home and only the manager and administrator have access to the safe. The home has policies and procedures in place regarding safeguarding service users from risk of abuse. Staff training was being carried out on the afternoon of the visit using a training video and discussion. The manager and deputy had previously attended formal safeguarding training and were cascading this to the staff team. Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 16 Most of the staff team on duty were aware of their responsibilities should they suspect any abuse had occurred but one new staff member said they were not aware of the procedures to follow. As good practice, safeguarding service users should form part of the induction process prior to formal training. An Adult Protection investigation regarding the home has now been resolved. Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 17 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): 19 22 24 and 26 Outcomes for service users in this area are adequate . This judgement has been made using available evidence including a visit to this service. Improvements to the environment have been made, further improvements are planned for the near future and the home is now comfortable and homely. EVIDENCE: There is currently a plan of redecoration and refurbishment in place within the home and standards have recently been improved. Communal rooms have been redecorated and some new furniture purchased. Seven adjustable nursing beds have been purchased to aid people being cared for in bed and a bathroom, identified at the last visit as being unsafe has been completely refitted. Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 18 Automatic closures have been fitted to a number of communal and bedroom doors and the manager said that there was a plan in place to increase these for people who like to keep their bedroom doors open . The garden has been improved and is attractive and well maintained. A cleaner and a maintenance person have recently been employed and maintenance checks are recorded. The sink in one bedroom was found to be at a temperature that could scald a service user and when reported, the maintenance person immediately resolved this. There are still a number of areas of environmental improvements to be addressed and the manager said that these had already been identified and were part of the future plan for the home. The floors in some toilets, bathrooms, and the medicines room need replacing as they are very worn, some areas are broken and could be considered an infection control hazard, some bedrooms still need redecorating and the upstairs carpets in communal areas need cleaning or replacing. Some of the mugs and cups in use were badly stained and this was pointed out to a member of staff as needing to be cleaned or replaced, as they could be a potential infection risk. Consideration should also be given to updating and modernising the kitchen and some kitchen equipment such as pans, which are very worn. One bathroom is still being used for storage, which means it cannot be used for service users. Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 19 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): 27 28 29 and 30 Outcomes for service users in this area are adequate. This judgement has been made using available evidence including a visit to this service. Although staffing levels have been improved and the current staff team are kind and caring, with further specialised training they could better meet the diverse need of the people they support EVIDENCE: The manager confirmed that staffing levels have been increased and that more bank staff have been employed in order to cut the use of agency staff and offer continuity of care for service users. There was a registered nurse, two senior carers and two care assistants on the early shift supported by a cleaner, maintenance person administrator and chef. The manager’s hours are in addition to the rota. Examination of staffing rotas showed that one nurse and two carers are now on duty during the night. At the present time there are only fourteen people living in the home and the current staffing level meets their needs, the manager said that these levels would be further reviewed as other service users are admitted. Comments about the staff team were that they were kind and caring and a service user said, “Everyone here is very kind, the staff are jolly and nice and the food is good”. The staff members on duty were observed to be kind, patient and friendly in Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 20 the support they offered to service users and all of them said that staff morale had improved since the new manager had been in post. Staff training has been improved and in the AQAA the manager tells us that all of the staff team have now attended updated mandatory training. A training matrix is kept in the home and records show that staff fire training was carried out on 30/7/07, adult protection training was being carried out on the day of the visit and dementia training is booked for 15/10/07 . As previously stated, in order to ensure that the staff have the skills and confidence to care for the specific needs of the service users they support, they should receive further training in dementia care and the management of challenging behaviour. We saw five staff files, three for staff who had been employed for some time and two for recently employed staff. Current Criminal Bureau Checks had been carried out for all of the five people and three people had all of the required documentation including an application forms and two references on file. The two new staff had been employed by the head office for another home and had then been transferred to Birchwood Grove. A note on their files said that their records were held at head office. The home’s administrator telephoned the head office of the company and asked for copies be sent to the home to be kept on file for monitoring purposes. Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 21 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): 31 32 33 35 and 38 Outcomes for service users in this area are adequate. This judgement has been made using available evidence including a visit to this service. The management of the home has improved the quality of life for service users and staff morale has increased. There are still some improvements to be made and outstanding Requirements that need to be met EVIDENCE: The manager of the home is a registered nurse, is currently undertaking the Registered Manager’s Award and has made application to the Commission for registration. Both service user’s families and the staff team say that the service provided in the home has greatly improved in the time that the new manager has been in post and people described her as “approachable, solid, supportive and 100 for service users”. Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 22 A Requirment made at the last visit regarding staff fire training has now been met and risk assessments and the provision of better equipment and falls risk assessments has meant that the number of falls suffered by service users had decreased. A quality assurance process has not yet been carried out, the manager said that as she has only been in post for a short time this has not been achieved but was planned for the near future. This will be assessed at the next visit. Records show that a process of staff supervision has been put in place and the manager said that in the time she has been in post, all of the staff team have received one supervision. Regulation 26, Registered Provider’s visits had been carried out for the past two months and reports following these visits highlight areas of continuing improvement for the home. We saw records for the running of the business including incident and accident reporting and our records show us that Regulation 37 reports are now sent to the Commission as required. Maintenance checks including water temperatures and fire checks are carried out and recorded on a monthly basis. Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 2 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 2 X X 3 X 3 X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 X X 2 Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 24 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 OP12 Regulation 16(2)(n) Requirement To ensure that service users are offered stimulation and interest, a programme of leisure and recreational activities should be put into place taking into account people’s interests, wishes and capabilities and attendance should be recorded. Outstanding from 31/5/07 In order to ensure that the staff team have the skills and confidence to care for the specific needs of the people they support, the Registered Provider must ensure that they receive training in the management of challenging behaviour. In order to safeguard service users the Registered Provider must endure that Medication Recording Sheets are kept up to date and the medicines room kept clean and hygienic The Registered Provider must ensure that staff records are kept in the home for monitoring purposes. Timescale for action 30/12/07 2. OP8 12 (1) (a) 30/12/07 3. OP9 13 (2) 30/10/07 4. OP29 17 (2) 30/10/07 Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 25 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 OP18 Good Practice Recommendations To ensure that all new staff are aware of safeguarding issues, as good practice awareness training should form part of the induction process prior to formal training being received. In order to ensure that the home meets the needs of the people living there, the programme of environmental improvements should be continued and this will be monitored at the next visit. 2. OP38 Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Birchwood Grove DS0000065773.V347505.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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