Inspection on 28/04/05 for Booth Road 82

This inspection was carried out on 28th April 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Booth Road 82 18/08/08

Booth Road 82 11/04/07

Booth Road 82 26/07/06

Booth Road 82 04/10/05

Booth Road 82 07/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 82 BOOTH ROAD Colindale London NW9 5JY Lead Inspector Tola Akinde-Hummel Announced 28 April 2005 at 9.45am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. 82 BOOTH ROAD Version 1.10 Page 3 SERVICE INFORMATION Name of service 82-84 Booth Road Address 82-84 Booth Road, Colindale, London NW9 5JY 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) 020 8200 8504 020 8200 8504 cbalachandre@pentahact.org.uk Cedric Frederick for PentaHact Christine Balachandre Care Home with Nursing 8 Category(ies) of LD Learing Disability (4) registration, with number PD Physical Disability (4) of places 82 BOOTH ROAD Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. Limited to 4 adults who have a learning disability (LD) and who may also have physical disabilities (PD) and have associated nursing needs. 2. One specific service user who is currently resident in the home and is over 65 years of age can reside in this home. This condition will need to be reviewed when s/he vacates the home. Date of last inspection 6th September 2004 Brief Description of the Service: 82 and 84 Booth Road were previously two homes which have now been amalgamated and operate as one home with a manager and two deputy managers. 82 Booth Road is no longer registered as a care home providing nursing care. The stated aim of the home is to provide twenty four hour care and support for people with profound learning disabilities to enable them to live as independently as possible within the community. The home consists of two adjoining semi detached houses. On the ground floor of each house is a lounge, kitchen diner, toilet and laundry room. On the first floor, there are walk in showers, an assisted bath with a toilet and four bedrooms. On the second floor there is an office shared by both houses, a storage room and a meeting room. There is a small parking area at the front of the home and a garden at the back. The garden is partly paved and shaded and is acceasible to service users. The home is situated close to Colindale station on the Northern line. It is a short walk to Colindale hospital and approximatey a mile away from Edgware Hospital. It is close to shops, restuarants and public transport facilities located along the Edgware Road. 82 BOOTH ROAD Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 8 hours. There were six service users at home over the course of the day. The inspector was able to speak to three service users briefly. Three service users have limited communication. The inspector also spoke to staff, the visiting district nurse, and the music therapist. In the two houses, six staff, the manager and the deputy manager were present. The inspector received ten comment cards from relatives care managers and visiting professionals. The manager, Mrs Christine Balanchandre was available throughout the inspection. There is currently one vacancy in the home. The inspector would like to thank all service users, staff and professionals who took part in this inspection. What the service does well: What has improved since the last inspection? The previous inspection generated ten requirements. All these requirements have been met. Service users have signed the terms and conditions of tenancy and where relevant their representatives. Service users and their representatives are now being consulted regarding the management of the home. The guidance on soiled linen is now available to staff in the infection control policy and on the laundry room door in the home. Staff files include all the relevant documentation. Service users plans are now reviewed at intervals no longer than six months. The fire alarms are now tested and recorded regularly. The garden is well maintained and service users have access to this. 82 BOOTH ROAD Version 1.10 Page 6 Staff are clear about their role and the support offered to service users should remain seamless. Service users also have access to chiropodist. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 82 BOOTH ROAD Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection 82 BOOTH ROAD Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 4, 5 Service users can expect that their needs will be assessed in sufficient detail and that they will be encouraged to have overnight stays in the home prior to moving in on a permanent basis. Service users or their representatives will be made aware of, and sign all documentation relating to their tenancy, rights and responsibilities whilst living in the home. EVIDENCE: The Inspector was able to speak briefly to three service users in relation to their experiences in the home. Two service users had moved into the home since the last inspection. The two service user plans of the recently admitted service users contained a detailed pre admission assessment which included the health needs of the service user and the support provided by health professionals in the community. All service users visit and stay overnight prior to admission to the home. Following a requirement from the previous inspection, all service users now have their contract/statement of terms and conditions signed by service users or their representatives as appropriate. These contracts are pictorially designed in order to assist service users to understand the content. 82 BOOTH ROAD Version 1.10 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9 Service users benefit from a comprehensive plan and improved programme of review. Service users are assisted to make decisions that affect their life in the home. Service users or their representatives are now being consulted about matters relating to the management of the home although this still needs developing. EVIDENCE: The inspector was able to inspect six service user plans in detail, talk briefly to service users, and witness a staff handover. The service users plans all had photographs of service users. The information was comprehensive and included methods of communication, and contributions from community health services as appropriate. All service users have recently had a review from Social Services care managers. Service users wide ranging likes and dislikes are recorded, and the areas of their lives that they wish to maintain or increase their independence such as going shopping and undertaking some aspects of their personal care are also recorded. The plans are now reviewed at least six monthly following a requirement from the previous inspection. Two service users accompanied staff to a shopping trip at their request and made decisions about what they wanted to purchase. One service user told the inspector that 82 BOOTH ROAD Version 1.10 Page 10 she goes out to dine on fish and chips regularly. The service user also told the inspector that she likes to have her singing sessions with an outside therapist and enjoys her regular aromatherapy. The service user was very much in control of her timetable and made it clear that she does not like any disruption to her routine. The service user did not wish to speak to the inspector whilst she was waiting for the aroma therapist to arrive. On arrival the service user made it clear to the therapist that she was late and asked for an explanation. Staff did not intervene in this interaction. A requirement from the previous inspection to provide evidence that service users and representatives are consulted about the management of the home is being met and consultations have begun although this has not been without difficulty. Some service users do not have any family and advocacy services have a long waiting list . The manager deputy and inspector discussed ways in which representation for some service users could be addressed and a renewed effort will be made to include all service users in this process. 82 BOOTH ROAD Version 1.10 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13 14, 16 Staff at Booth Road promote the independence of service users and assist them to increase independent living skills. A less able service users was not assisted properly whilst being fed. EVIDENCE: A new service user invited the inspector into her room. The service user told the inspector that she enjoyed music and demonstrated how to operate her new record player. The service user said that she attends college and has regular contact with her family. The service user said that she likes her room and the space has been made very personal. The service user then told the inspector that it was her “ day off” from college and went shopping with two members of staff. The service user was in a very good mood and appeared relaxed. The comment card completed by the service users relatives confirms that she is “really happy since joining Booth Road”. Service users plans make clear the hobbies of service users and the activities they undertake. Theses include going to local restaurants, swimming and attending social clubs for people with disabilities. Service users are encouraged to take on domestic tasks in the home if they are able to. One service user likes to do her own 82 BOOTH ROAD Version 1.10 Page 12 washing but due to her epilepsy must be supervised. Two service users assist with some meal preparation and setting the dinner table. Service users are asked on a daily basis what they would like to eat and offered a choice of balanced meals, which are then prepared with service users or for them. The inspector observed one service user unable to feed himself, being fed inappropriately by a member of staff. Staff must sit next to service users when feeding them to promote service user comfort and dignity. A requirement is made in respect of this. The food storage and cleanliness of some areas of the kitchens will be addressed in Standard 30 and 42 of this report. A requirement was made at the last inspection to ensure that service users have access to the garden. The inspector asked service users if they had access to the garden and was told that they do. One service user said that she intends to have her birthday party in the garden. 82 BOOTH ROAD Version 1.10 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20,21 Booth Road ensure that detailed information is recorded in relation to service users health and personal care. The medication procedure is effective but the recording of returned medicines requires minor improvement. EVIDENCE: The service user plans, reviews, comments cards from relatives and care managers confirm that service users receive appropriate personal support. The service user plans specify the gender of staff permitted to carry out personal care, and includes service users preferences in relation to baths and showers, and the choosing of clothes. Service users weight loss and gain is recorded and all risks associated with this is monitored. The size of incontinence pads required is recorded; the size and make of slings are also noted. These are reviewed to ensure they remain appropriate. The health needs of the six service user plans inspected are comprehensive. All GP visits are recorded, as are the district nurse input, the dentist and the chiropodists. One service user plan had high need and the plan detailed how to assist him in pictures and with very clear instruction. The inspector was able to speak to the district nurse whose team visits two service users 2-3 times per week. The district nurse believes that the staff team communicate the needs of the service users well. The nurse said that the service users are “always immaculate and their hygiene needs are always met and their hair and nails are always done” The district nurse said that the staff make contact if they 82 BOOTH ROAD Version 1.10 Page 14 have any health concerns regarding the service users. The district nurse said she has given advice on Diabetes and confirmed that the staff had been trained to do blood sugars by another district nurse in the team. A requirement from the last inspection recommended that all service users had chiropody treatment. All service users had the services of a chiropodist with the exception of one service user with MRSA. This service user has now had two clear swabs indicating that he is MRSA free and will have a third in the near future to confirm this. Staff were vigilant and worked rigorously to the care plan to ensure the service user became free from MRSA and that other service users were not affected. The service user plans make clear how to support service users who are showing signs of distress or are displaying challenging behaviour. There are extensive risk assessments on all service users files. These assessments cover all aspects of service users life from travelling on public transport to using the bath/shower followed by actions needed to minimise risks. The inspector looked at the medication records of service users. The system used is simple and was in order. However, the record of medication returned to the pharmacy must clearly state which service user it belonged to. All service users plans have details about whom they wish to be informed in the event of their death and what kind of arrangements they wish to be made. 82 BOOTH ROAD Version 1.10 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) Service users and their relatives are mainly aware of the homes complaints procedure and how to access this. Staff have been suitably trained to deal with adult protection issues should they arise. EVIDENCE: Service users were unable to advise the inspector of their opinions in relation to the complaints process. However comment cards from relatives indicated that on the whole relatives and visitors were aware of the complaints procedure and how to use it. The inspector looked at the complaints book. The complaints book had registered one complaint that initiated an adult protection investigation. The complaint relates to financial neglect discovered by Booth Road in relation to a service users previous home. Booth Road is in no way implicated and reported the situation when it was discovered. Booth Road has an adult protection policy and procedure. Training records indicate that staff have attended adult protection training. Staff were asked by the inspector about their understanding of the vulnerable adults and whistle blowing policy. All staff were able to explain the purpose and use of the policies. 82 BOOTH ROAD Version 1.10 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,27, 28,29,30. The home provides a good standard of personal and communal space in the home. The home is free from offensive odours. Hygiene in the kitchen needs improving and then regular maintaining. EVIDENCE: Booth Road is split into two units of four. These units are furnished in a homely way for the benefit of service users. Service users bedrooms are largely decorated to their taste despite the use of large equipment in some bedrooms. The home has used pictures to indicate to service users the use of some of the rooms in the home e.g. toilets and the laundry room. The bedrooms of some service users were seen. These were personal and appropriately decorated and included service users personal effects. The bedrooms were spacious and had sufficient natural light. The bathroom and toilet facilities were pleasant and large enough to accommodate wheelchairs and service users who require assistance. Records show that all aids in the bathroom are regularly serviced. The shared lounge and dining rooms were also very light and spacious able to accommodate wheelchairs and other comfortable furniture. These were of a good standard. 82 BOOTH ROAD Version 1.10 Page 17 Whilst the home is cleaned by staff members the cooker hood in both kitchens required cleaning. The kitchen cupboards and freezer in both units also required cleaning. This is especially important for service users prone to infection due to their medical condition. Requirements are made in respect of the above issues. The garden was well maintained on the day of inspection, and has a partially shaded roof to ensure service users are not exposed to harmful sunrays during the warmer weather. This was a requirement from the previous inspection that has been met. The previous inspection required the infection control policy to include guidance on the laundering of soiled linen and clothing. This has been done and the guidance has also been added to the laundry room door for reference. 82 BOOTH ROAD Version 1.10 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35,36 The management and staff team are experiencing a period of stability, which enhances the experiences of service users being assisted in a positive way. The recruitment practices and training offered to staff promotes a good quality of care. EVIDENCE: The inspector spoke to five members of staff and was present at one staff team handover. Staff appeared clear about their roles and this is in keeping with their job descriptions. Staff are also clear about their lines of accountability. Staff have had training in a number of areas since the last inspection including moving and handling, Risk assessment, food hygiene awareness, and basic first aid. The manager reviewed the staffing structure as required in the previous inspection. The issue related to the numbers of staff available during the day and night. Following the review, two waking night staff have been employed and they day compliment is regularly reviewed. This is also dependent on how many service users are in the home and what activities are arranged. 82 BOOTH ROAD Version 1.10 Page 19 The inspector looked at the recruitment documentation of four members of staff. All staff had application forms, CRB checks, required identification on their files including two references. The inspector spoke to individual members of staff and found that all staff felt supported and developed by their managers. Staff have been working in Booth Road for varying amounts of time. Staff believed they were encouraged to use their initiative in the home and they recognise their position working with such a vulnerable service user group. Staff confirmed that they have begun to have regular supervision since the appointment of the deputy manager. This is done two monthly although all added that informal supervision takes place on a much more regular basis. 82 BOOTH ROAD Version 1.10 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) ,38,39,42 There is strong leadership in the home and staff welcome the direction and development planned for the home. Service users and their views are genuinely being sought to ensure improvements are made. The home must ensure that opened food is labelled and stored appropriately. EVIDENCE: The manager had in the past experienced recruitment difficulties in the home. This has since been resolved and there is currently only one vacancy. This has been filled but the manager is awaiting the return of the CRB check. All staff were complimentary of the manager and deputy stating that they have encouraged improved practice and keep them informed of any issues and changes that they need to be aware of. The manager has encountered problems with eliciting the views of some service users but continues to try and address this issue in different ways and could demonstrate the efforts made in his area. Comment cards of relatives indicate that there is an open policy of communication developing in the home. The inspector looked at many health and safety aspects of the home and found that all records of fire 82 BOOTH ROAD Version 1.10 Page 21 tests were now up to date as required from the previous inspection. The fire alarms had been tested, and an unplanned evacuation had taken place. The water temperatures are regularly recorded for service users using bath and shower facilities and PAT testing, lift and equipment servicing and electrical installation tests were all up to date. The manager taking into account their responsibilities to service users and staff carries out monthy health and safety checks. These are extensive. The home does not however currently label opened food. Some food is also not appropriately stored. The inspector found open packets of pasta in a cupboard. This was not labelled or placed in a covered jar. Whilst none of the food was out of date the storage would ensure freshness for the duration of its use by date. A requirement is made in respect of this. The manager agreed that this was not acceptable and also advised the inspector that the kitchens in both houses are due to be refitted. This will allow proper storage space and access for service users. The manager informed the inspector that the kitchens will not be out of action at the same time causing minimum disruption to service users in the home and allowing them to continue to have properly cooked food. SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 82 BOOTH ROAD Score x 3 Standard No 22 23 Version 1.10 Score x x Page 22 3 4 5 x 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x 3 3 3 1 Standard No 11 12 13 14 15 16 17 x 3 3 3 x 3 2 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score x 3 3 x x 2 x 82 BOOTH ROAD Version 1.10 Page 23 No 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 17 Regulation 12,(4), (a) Requirement The registered persoon must ensure that staff always feed service users unable to feed themselves sitting down as described in the care plan in an unhurried and dignified manner. the registered person must ensure that record of medicines returned to the pharmacy contain the name of the service user they were originally prescribed for. The registered person must ensure that the cooker hood and freezers in both kitchens is cleaned thoroughly and that standard is regularly maintained The registered person must ensure that the kitchen cupboards are regularly cleaned and that this standard is maintained. The registered person review the need for a cleaner to be employed to maintain an standard of hygeine in the communal areas of the home. The registered person must ensure that opened dry food is properly stored in containers to prevent germs and maintain Version 1.10 Timescale for action 30/04/05 2. 20 13, (2) 30/05/05 3. 30 13, (c ) 30/05/05 4. 30 13 ( c) 30/05/05 5. 30 13 ( c ) 30/06/05 6. 42 16, (2) (g) 30/05/05 82 BOOTH ROAD Page 24 freshness, 7. 42 16, 2, (g) the registered person must ensure that all openend food is clearly labelled thereby avoiding the use of food past it,use by dates after opening. 30/05/05 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 Good Practice Recommendations 82 BOOTH ROAD Version 1.10 Page 25 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London N14 6HA 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 82 BOOTH ROAD Version 1.10 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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