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Inspection on 27/11/06 for Boundary House

Also see our care home review for Boundary House for more information

This inspection was carried out on 27th November 2006.

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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The acting manager is managing the Home well whilst the Manager is on maternity leave. The staff are enthusiastic about supporting the residents and have a good understanding of their needs. The staff receive good induction and ongoing training which enables them to carry out their roles effectively. The residents are encouraged to make their own choices as far as is possible.

What has improved since the last inspection?

The quantity and quality of the staff training has greatly improved since the appointment of a training manager. Staff continue to work towards achieving NVQ awards. The care plans have started to be reviewed to make the format more accessible for staff.

What the care home could do better:

Two of the bathrooms have an unpleasant smell which needs to be addressed, possibly with the laying of new flooring. The organisation needs to continue their recruitment plans so that there is less reliance on agency staff. The care plans are good but there is a need for some of the individual care plans to be more detailed to provide the staff with very clear guidance.

CARE HOME ADULTS 18-65 Boundary House Haveringland Road Felthorpe Norwich Norfolk NR10 4BZ Lead Inspector Mrs Lella Andrews Unannounced Inspection 27th November 2006 10:50 Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Boundary House Address Haveringland Road Felthorpe Norwich Norfolk NR10 4BZ 01603 754715 01603 400418 deemauree@hotmail.com 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) Mr Canabady Mauree Ms Sandra Bridgwood Mrs Emma Hopkins Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home may accommodate up to ten (10) people who have a Learning Disability, one of whom is over 65 years of age and is named in the Commission’s records. 12th January 2006 Date of last inspection Brief Description of the Service: The Boundary House provides residential care for up to 10 adults with learning disabilities, it is situated on the outskirts of the village of Felthorpe, which is a few miles from the city of Norwich. The home is situated in extensive grounds containing portacabins, greenhouses and other outbuildings. Bedrooms are located on the ground and first floors. There are communal lounge, dining and kitchen areas. There are two bathrooms and one shower room. Service users living in the home access day services, including those operated by the proprietor in North Walsham. The home has its own transport. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains information about the Home that has been gathered since the last Inspection which includes an unannounced visit to the Home on the 27th November 2006. During the visit the Inspector was shown around the communal areas of the Home, spoke to residents and staff, looked at records, spent time discussing issues with the acting manager. Completed comment cards were received from health/social care professionals (3), relatives (5) and residents (9). The residents had received help from staff to complete their comment cards. Comments from relatives include the following: “…my son has had excellent care from all staff…” “…is happy at Boundary House…..chose all their own furniture and décor” Some of the good things that residents mentioned in their comment cards are the food, the staff, the large garden and feeling safe at the Home. The Manager of the Home is currently on maternity leave and one of the Team Leaders has taken on the role of acting manager until she returns. The fees range from £850.00 per week to £1,500.00 per week. What the service does well: The acting manager is managing the Home well whilst the Manager is on maternity leave. The staff are enthusiastic about supporting the residents and have a good understanding of their needs. The staff receive good induction and ongoing training which enables them to carry out their roles effectively. The residents are encouraged to make their own choices as far as is possible. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 6 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. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The Home has suitable processes in place to carry out effective assessments. EVIDENCE: The Home has a suitable assessment procedure which includes the gathering of information about the prospective residents needs from the person themselves, relatives and health/social care professionals. New residents are offered the opportunity to have several visits to the Home prior to moving in. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents individual needs are assessed and the care plans contain guidance for staff about how to meet their needs. Risks are assessed with written guidance available about how to manage identified risks. Appropriate records are kept of the residents finances. Residents are encouraged to make their own decisions as far as possible. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 10 EVIDENCE: The residents comment cards all state that they know that they have a care plan. Two of the care plans were seen and these contain a great deal of information about the needs of the resident. The acting manager said that the care plans are going to be reviewed after staff have received Person Centred Planning training. The new format will make it easier for staff to locate specific information more quickly. The staff are aware of the content of the care plans and are responsible for completed daily notes at the end of each shift. The care plans contain detailed risk assessments and guidance for staff about how to manage particular risks. The Home provides support to people with challenging behaviours and the care plans contain information about how to support individuals at these times. Discussions with staff show that the use of any physical interventions is kept to a minimum and that staff all receive appropriate training with regard to this area. However, the care plans would benefit from being made more clear about the action to be taken in these circumstances. It is recommended that the care plans contain more detailed guidance to staff with regard to the use of any physical interventions. Several of the residents have autism and therefore have specific needs associated with this. The staff who spoke to the Inspector showed a good understanding of autism and how each individuals needs should be met. They communicate well with the residents, many of whom have communication difficulties. Staff receive training with regard to autism and communication. Staff were seen and heard to offer choices to the residents in a range of situations. Examples were given by staff of how different residents are encouraged to make their own choices. Two of the residents were at home as they had chosen not to attend their usual activities that day. The acting manager is in the process of completing financial care plans for the residents. An example of these were seen and they are detailed and contain the necessary information. The system for looking after residents money was explained to the Inspector and records were checked against the cash held and found to be accurate. The Inspector was told that the Proprietor carries out regular checks on the financial records. It is recommended that a record is kept of these checks. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents are supported to take part in a range of activities The rights of the residents are respected The residents enjoy their meals and any special dietary needs are catered for. EVIDENCE: The residents take part in a range of activities during the week. Some attend the day service owned by the same organisation which is located in North Walsham. These residents are supported by staff from the Home whilst they are at the day centre. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 12 Some residents take part in horticulture which is located on the same site as the Home. Other residents take part in activities within Norwich such as using the leisure centre, shopping and educational activities and are supported by staff from the Home. Two of the residents have 1:1 staffing from 8am to 10pm and one resident has 1:1 staffing to access activities during the week. Staff said that there is always enough staff on duty to support residents to take part in activities at weekends. These include shopping, walks, cinema, drives to the coast and other local attractions. The Home is situated in a rural location and there are no facilities within walking distance although there is plenty of countryside to go for walks if that is what the residents like to do. The Home has transport which some of the staff are able to drive. If there are no drivers on duty then the residents are not able to go out. The residents comment cards included additional comments about things that are good at the Home. These include: “the large garden” and “going out”. Two of the residents comment cards stated that they would like to go out more often. The relatives comment cards all stated that they are made to feel welcome at the Home and that the staff keep them informed of the care that their relative receives. The residents comment cards all state that they are able to have visitors. The care plans contain information about the arrangements in place for residents to maintain contact with family and friends. The rights of the residents are respected by the staff. Discussions with staff show that they aim to meet the needs of the residents and that they are keen to enable residents to make their own decisions as far as possible. Staff spent time with residents during the visit, either having a meal together, doing activities or talking. Residents told the Inspector that they enjoy their meals. Two of the comment cards included “the food” as something that is good about the Home. Residents were seen to be offered choices about what they had for lunch and supported to make their own lunch if possible. Some residents assisted with washing up after the meal. Residents are encouraged to go shopping with staff if they wish to. The Inspector was told by the acting manager that the residents are involved in choosing the menus during the residents meetings. The menus show the alternatives that are offered to residents who have particular dietary needs. Consideration is given to where residents sit to have their meals so that mealtimes are as calm and as enjoyable as possible. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The personal and healthcare needs of the residents are met. Medication is managed safely and effectively. EVIDENCE: All of the residents comment cards, except for one, state that they feel well cared for at the Home. The one different answer was “sometimes” to this question. Six of the comment cards indicated that residents “like living at the Home” whilst one answered “sometimes” to this question and two answered “no”. The staff who spoke to the Inspector were sensitive to the issues of privacy and dignity when talking about providing personal care to the residents. Residents are encouraged to maintain and develop their independence with regard to personal care. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 14 The care plans include details about the physical and emotional health care needs of the residents. There is evidence of health and social care professionals being involved in the residents care. The three comment cards received from health/social care professionals all state that there is always a senior member of staff to liase with and that any advice is incorporated in to the residents plan of care. Two of these comment cards include a positive response to the question about whether staff show a good understanding of the needs of the residents whilst one answered “sometimes” to this question. One of the residents comment card makes additional comments about the good, additional care that their relative had received from the Homes staff during a recent hospital stay. One of the staff showed the Inspector the medication system in use at the Home. Appropriate records are kept of medication received at the Home, that administered and any returned to the pharmacy. Medication is stored appropriately and staff receive training. The Inspector was told that staff are only able to administer medication once they have received training, have been assessed as competent and feel confident to do so. Whilst there is written guidance available about the use of PRN (as required) medication it is recommended that this is clearer. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The Home has policies and procedures in place which protect the residents. EVIDENCE: The Home has a complaints procedure although the majority of residents may find this difficult to use due to their communication difficulties. The acting manager described a variety of ways in which staff would recognise if a resident was not happy about something. The Commission has not received any complaints about the Home since the last Inspection. The Home has policies and procedures relating to the protection of the residents. Training is provided to staff about the management of challenging behaviour, the use of physical interventions and also Safeguarding Adults (previously known as the Protection of Vulnerable Adults). Staff who spoke to the Inspector were aware of the whistle blowing policy and were confident that the Manager and the acting manager would deal with any concerns raised appropriately. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Home is fairly bare and is not very homely but this is due to the needs of the residents. The majority of the Home was clean but there are unpleasant odours in two of the bathrooms which needs to be addressed. EVIDENCE: The Inspector was shown around the communal areas of the Home and one of the residents showed the Inspector their bedroom. The majority of the areas of the Home are fairly bare of pictures and ornaments and the Inspector was told that this is due to the behaviour of the residents. The acting manager did say that she has new curtains and blinds waiting to be put up and that some areas of the Home are due to be redecorated shortly. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 17 There is a very unpleasant odour in two of the bathrooms on the first floor and it is required that this is removed. The rest of the Home was clean. There are gloves and hand washing liquid available to the staff around the Home. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff are enthusiastic about their work and work hard to meet the needs of the residents. Staff receive training appropriate to their role. Effective recruitment procedures are followed. EVIDENCE: One of the residents told the Inspector that the staff are kind and that they help her to do things. Three of the residents comment cards include “the staff” in their responses to the question about what is good about the Home. Residents comment cards also contain additional references to the good quality of the staff. One of the residents comment cards states that there are not always enough staff to accompany residents to go on holiday. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 19 The staff who spoke to the Inspector, including the acting manager, were positive about their work at the Home and clear about their role, and that of others within the team. The Inspector was told that there is usually five staff on duty each morning and afternoon, including weekends and that there are two waking night staff on duty each night. The rotas confirm the information given to the Inspector that use of agency staff has been high recently. The acting manager said that recruitment is currently taking place within the organisation and that she expects to be fully staffed shortly. This situation will be monitored during future Inspections. The Inspector spoke to one of the agency staff who has worked at the Home regularly over the last year and knows the residents well. The agency staff said that they have received training in relevant subjects and that they receive good support from the staff team and from the acting manager. The organisation has appointed a training manager in the last few months and this has meant that the quality and quantity of training has improved. Staff now attend mandatory training in a timely way. Although the Home does not yet meet the standard of 50 of staff working towards or having achieved NVQ Level 2 they are actively working towards this target with some staff due to complete shortly and others due to start in the next few months. Two of the staff recruitment files were seen and these show that the appropriate procedure is being followed during recruitment. The Inspector met with the personnel manager in September 2006 to see a selection of CRB disclosures as these are kept centrally rather than in the Home. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The Home is being well managed by the acting manager in the absence of the registered manager. The Home has started to implement a quality assurance process which asks for the views of others about the service that it provides. The health and safety of the staff and residents is given a high priority. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 21 EVIDENCE: The Manager went on maternity leave in October 2006 and one of the Team Leaders is currently in the role of acting manager. The acting manager has attended some in-house management training but has not completed NVQ Level 4. The acting manager is enthusiastic about her work and has a commitment to providing a high standard of care to the residents who live at the Home. The acting manager has a good understanding of the needs of the residents and also knows the staff well. The staff spoke highly of the acting manager and of her management style. They said that she is open and honest in her communication with residents and staff and that she is very approachable. Regular staff meetings take place and staff receive formal and informal supervision. The acting manager is supported by the other Team Leader. Both of these staff take part in the on call service which is provided across the organisation. The Home has started to obtain the views of relatives and health/social care professionals as part of their ongoing quality assurance process. Regulation 26 visits have started to take place with a written report provided following the visit. The Home now needs to bring all of the strands of the quality assurance process together into an annual quality assurance report. A requirement is made about this. A selection of health and safety records were seen, for example, those relating to fire safety. Records show that regular servicing of equipment takes place and that staff receive training. Risk assessments are undertaken with regard to health and safety matters. It is recommended that the names of individual staff taking part in fire drills are recorded to ensure that all take part on a regular basis. The organisation owns several homes around the Norwich area. The organisation does not have computers within the Homes and therefore, no means of gaining the benefits of electronic communication. This means that any documents/records that need to be typed eg. Care plans, review notes, etc have to be sent to the head office for typing and then returned. This may take several days, if not weeks, and in the meantime the information is not available within the Home. It would also be beneficial for the Responsible Individual and the managers within the organisation to be able to communicate by email. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 3 2 X X 3 X Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 2 Standard YA30 YA39 Regulation 23 (2d) 24 Requirement It is required that the unpleasant odours in the bathrooms are removed. It is required that an annual quality assurance report is produced. Timescale for action 31/01/07 31/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard YA6 YA7 YA20 YA42 Good Practice Recommendations It is recommended that the care plans are clearer about the occasions when physical interventions may be used. It is recommended that a record is kept of the audits of residents finances. It is recommended that the PRN guidance is clearer. It is recommended that the names of staff taking part in fire drills are recorded. Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Boundary House DS0000027402.V321913.R02.S.doc Version 5.2 Page 25 - 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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