Inspection on 05/07/06 for Broadreach

This inspection was carried out on 5th July 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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Broadreach 25/10/07

Broadreach 06/01/06

Broadreach 26/01/05

Broadreach 10/06/04

Similar services:

Clouds House

Closereach

Westcliffe House

Hilldales

Longreach

Chandos House

Cherry Orchards Camphill Community Ltd

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

CARE HOME ADULTS 18-65 Broadreach 465 Tavistock Road Roborough Plymouth Devon PL6 7HE Lead Inspector Fiona Cartlidge Unannounced Inspection 5th July 2006 10:45 Broadreach DS0000003576.V292723.R01.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 Broadreach DS0000003576.V292723.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 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. Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Broadreach Address 465 Tavistock Road Roborough Plymouth Devon PL6 7HE 01752 790000 01752 785750 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) Broadreach House Vacancy Care Home 36 Category(ies) of Past or present alcohol dependence (36), Past or registration, with number present drug dependence (36) of places Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home is registered as a Care Home with Nursing for a maximum of 36 Service Users in the categories past or present alcohol dependence 36 past or present drug dependence 36 6th January 2006 Date of last inspection Brief Description of the Service: Broadreach House is a registered charity providing a range of services in Plymouth, Devon, for the treatment of alcohol and drug dependence. Broadreach is a 36 bedded registered nursing facility for ‘first stage’ treatment for drug and alcohol dependence, for males and females over 18 and up to the age of 65; the normal length of stay is 6 weeks. The house is on the outskirts of Plymouth and is arranged on two floors with access to most parts of the building for Service Users. Most of the accommodation is in shared rooms. There is a variety of bath and shower rooms and WC’s. There is a dining room, a lounge where smoking is permitted and a further smaller lounge/meeting room. There are several private rooms/offices, on the ground floor, used for one to one counselling. The home benefits from well laid out gardens to the front and side of the house where outdoor activities take place in good weather. The home employs 24 hour trained nurse cover, counsellors and other support staff to maintain the programmes of care designed for the Service Users. Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 4 hours and 45 minutes and was unannounced. A partial tour of the home took place when some bedrooms and all communal living rooms were viewed. Personal records of care held in the home on behalf of 3 clients and personnel records of 3 members of staff were inspected. The inspector spoke with 12 residents, 5 staff members as well as the counsellor team leader and acting manager. Written feedback was received from 4 clients and 3 staff. The homes senior staff had also submitted answers to a pre-inspection questionnaire supplied to them by the Commission. What the service does well: What has improved since the last inspection? A range of nursing, care and counselling staff are employed at Broadreach as well as administrative, financial, training and ancillary staff. Much work has been done in recent months to improve working relationships within the home. At the time of the last inspection a divide was evident between the counselling staff and the registered nurses. Cohesive working and interlinking roles and responsibilities has been key to improved working patterns. Staffing levels at times during the day have been revised and staff confirmed a flexible approach Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 6 is now applied to ensure adequate levels of staff in line with the busiest times of the day for example when clients are being admitted. Clients are no longer admitted in the evenings reducing the pressure on a lower level of staff at that time. Feedback from clients and residents during the inspection has provided evidence that the acting manager encourages openness for clients and staff. The acting manager and her team in line with good practise advice have reviewed policies procedures and practises recently. Action has been progressed within agreed timescales to implement requirements made in previous CSCI Inspection reports. A Number of staff spoken to during the inspection felt that management of the home showed a greater commitment to listening and supporting them in their roles in a positive manner which was improving systems of working and ultimately the standards of care provided to clients. 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. Broadreach DS0000003576.V292723.R01.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 Broadreach DS0000003576.V292723.R01.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 at least once during a 12 month period. 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 a safe admission procedure, which helps to ensure that clients will make the best of the treatment available at Broadreach. EVIDENCE: The inspector examined the personal records held on behalf of 3 clients. The records showed that staff at Broadreach gather information about the clients before they are admitted to ensure they can support the clients to make the best of their treatment. Clients are encouraged to visit Broadreach if possible to have an assessment of their needs in person prior to admission being arranged but sometimes because of the distance that some clients live from the home this is not possible so assessments take place via the telephone and both written and verbal information is taken from social and health care professionals involved in the clients care before the residential treatment programme is agreed. One resident spoke about the process taken to arrange their admission the client explained that they had been in such a poor physical and psychological state prior to their admission that they had relied heavily on the professionals around them to arrange their admission. The client told the inspector that as soon as they visited the home and met the staff they had felt supported and positive about the process. Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 9 Written feedback received from 4 clients indicated that 3 of them, had been asked if they wanted to be admitted to Broadreach and the other stated ‘ I asked to be referred to Broadreach because I had been told so much about it from people that had been there before’. Each client has an individual contract for their stay at Broadreach which clearly sets out the restrictions on choice and freedom necessary as part of the treatment programme. Clients consent to any restrictions which are clinically necessary for participation in the programme the contracts specify the circumstances under which clients may leave the premises during treatment. Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 6,7,9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clients know their assessed needs and personal goals are reflected in their individual plan. Clients are encouraged to make decisions about their lives with assistance as needed. Clients are supported to take risks within realistic goals of their treatment programme. EVIDENCE: Being a drug and alcohol rehabilitation unit there are some restrictions on choice and freedom. Clients are made aware of these restrictions, before their entry to the unit. Despite these restrictions there is an emphasis on enablement and self - empowerment. Written feedback from clients when asked – Do you make decisions about what you do each day included: ‘there is set times for group work, I suppose I make my own decisions about what I do in my own time’, ‘this is about me having choices to-day, there is no pressure on me to do anything’. Broadreach uses a pathway approach to care, this is supported by individualised records, which were inspected and found to be regularly Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 11 reviewed; entries are made to the reports on an at least twice daily basis. Records of counselling were seen as were documented individual risk assessments and the inspector observed joint communication between counselling staff about how group work sessions had been received that day the meeting included taking agreed action to meet any communicated individual needs that might require additional staff support. Those clients spoken to confirmed that they were aware and in agreement with the restrictions and structure required within their treatment plans. Through discussion with clients and management it is apparent that clients needs are met. Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clients take part in appropriate activities. Clients agree to limited access to the community. Clients rights are respected within the agreed constraints of the treatment programme. Clients are offered a healthy diet and enjoy their meals and meal times. EVIDENCE: Clients are admitted to Broadreach for a six - week period of treatment and rehabilitation from addictive substances, so it is accepted that activities are restricted as the primary aim is to recover from addiction. As part of the programmes during the week, clients have to take part in a structured day, attending groups and counselling sessions. During the evenings a range of alternative activities are offered, these again mainly relate to the therapeutic approach of the home. Clients cannot go out of the home unattended by staff until they have been under treatment for a set period of time and visitors are only allowed by appointment. Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 13 Clients told the inspector that they sometimes get ‘bored’ and would like the opportunity to play football or pool at times when there is no organised therapeutic activity, it should be understood that this free time is an integral part of the therapeutic programme. During the afternoon of the inspection a number of clients were sitting in the lounge they confirmed that they had attended group therapy sessions in the morning and that they had had the opportunity to join in 1 of 2 yoga sessions that afternoon, but had chosen not to do so. Clients are expected to take responsibility for their own lives and how they affect others, as part of the programme. Written comments received from clients included: ‘basically I abide by the rules of Broadreach by attending group therapy and 1:1 sessions’ Guidance about intimate personal relationships is given to each client within the individual treatment programme contract i.e. for clinical and therapeutic reasons intimate relations are discouraged from developing. The home provides a good selection of meals and takes care to meet clients special diets and food preferences without losing sight of the fact that providing a healthy balanced diet is part of the therapeutic/care regime. All of the clients spoken to during the visit were complimentary about the availability of food, which is provided 4 times a day as well as hot and cold drinks being available at all times. Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 18,19,20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users physical and psychological needs are met. The homes policies and procedures for dealing with medicines are safe. EVIDENCE: Clients at Broadreach do not generally need support in meeting their physical care needs, however they do need support in changing their pattern of lives away from a reliance on addictive substances including re establishment of routines of daily living. Broadreach has an arrangement for registration of clients with a General practitioner who has specialist knowledge in substance misuse. The general practitioner was seeing clients in private within the home at the time of the site visit and staff confirmed that he visits on weekdays for 3 hours a day. A psychiatrist also makes regular visits and more recently a clinical psychologist with specialist knowledge of addictive behaviours also has regular in put to clients at the home. Systems for the management of medicines were seen and found met in full; Registered nurses manage the medication system at Broadreach, records are kept of all medication entering the home and there administration, medication Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 15 no longer in use is also well recorded and disposed of in a safe manner. All medication is stored securely. Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clients are listened to; procedures are in place to protect vulnerable adults. EVIDENCE: Broadreach has a clear complaints procedure, which is displayed in the home; the Commission received written feedback from 4 clients when asked – Do you know who to speak to if you are not happy? all answered yes, when asked do you know how to make a complaint? 1 said no and the other 3 said yes, one commented ‘ if I was not happy I know I can talk to my counsellor’. There was evidence found in the personnel files seen during the inspection that it is mandatory for staff to receive training in the protection of vulnerable adults. A record seen in the personnel file had been signed by the staff member to say that they had been made aware of the grievance discipline and whistle blowing policy and staff harassment and victimisation policy however 3 members of staff spoken to at the time of the inspection said they were unaware of the homes whistle blowing policy. The inspector was provided with a copy of the latest grievance, discipline and whistle blowing policy issued April 2005 due review April 2006 this was included in the procedural manual which she was told is kept in the front administration office. Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 24,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a homely and safe environment the seating in the lounge detracts from their comfort. The home is clean and hygienic. EVIDENCE: Most of the sleeping accommodation at Broadreach is in multi-occupancy rooms. The home believes that the treatment programme is enhanced by peer support and therefore sharing gender appropriate accommodation is part of the programme. The home has 4 single rooms these are allocated following individual needs assessment. Clients were complimentary about the environment confirming it meets their needs with the exception of the seating in the main lounge, which was reported as being ‘hard’ and uncomfortable this has been reported following previous inspections and feedback. Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 18 There are a number of separate rooms for 1:1 counselling offering privacy, comfortable rooms for group work and office facilities for administration purposes. Most areas of the home are well decorated and the home was clean at the time of the inspection. The only odour was that of cigarette fumes. Written feedback was received from 4 clients 2 indicate the home is always fresh and clean and 2 that the home is ‘usually’ fresh and clean. A range of bathing facilities is provided. Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The records and discussion with staff members confirmed that the management are committed to staff training. Recruitment practises are safe. EVIDENCE: A range of registered nursing, care and counselling staff are employed at Broadreach as well as administrative, financial, training and ancillary staff. Much work has been done in recent months to improve working relationships within the home. At the time of the last inspection a divide was evident between the counselling staff and the registered nurses. Cohesive working and interlinking roles and responsibilities has been key to improved working patterns; the nurses said the gap had significantly decreased and counselling staff were respectful of nurses skills as key workers. The staff spoken to feel they have been supported in extending and developing their skills. Staffing levels at times during the day have been revised and staff confirmed a flexible approach is now applied to ensure adequate levels of staff in line with the busiest times of the day for example when clients are being admitted. Clients are no longer admitted in the evenings reducing the pressure on a lower level of staff at that time. Staff told the inspector that they feel well supported, and receive supervision in accordance with the standards. Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 20 The inspector looked at three Personnel files, the records showed a commitment to extremely safe recruitment practises files contained detailed application forms, at least 2 written references, Criminal Record Bureaux checks, induction records, supervision and training and development records, main terms and conditions of employment, interview assessment forms, job descriptions, confidentiality agreements, diversity statements including equal opportunities policy, staff grievance, discipline and whistle blowing policies, and individual staff risk assessment documentation. Records of training provided evidence that mandatory training includes protection of vulnerable adults, diversity and health and safety. On the day of the site visit a number of staff were attending training provided by the local primary care trust (PCT) and drug and alcohol action team (DAAT) about serious untoward incident protocols. All three staff who completed and returned surveys to the Commission confirmed that the home provides funding and time for them to receive relevant training and all indicate they are aware of child and adult protection procedures. One member of staff told the inspector they are currently studying towards a diploma in addictions counselling. Another comment received in writing was’ training course time and courses are paid for, not afraid to ask any member of staff for advice, the manager has an open door policy’. The clients were complimentary about the staff team confirming their needs were met 24 hours a day. Comments received from clients included: ‘I am really impressed with the care and support that I am given here at Broadreach’, ‘the carers have been there for me on a number of occasions when I needed them’, ‘excellent staff felt welcomed and well supported by both nursing and counselling staff’,’ ‘the staff are really wicked’. Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run, but the current person managing the home is not registered under the Care Standards Act 2000. Client’s views underpin self- monitoring, review and development in this home. The health, Safety and welfare of service users is protected. EVIDENCE: The last registered manager resigned their post as manager at Broadreach in February 2006, since then an acting manager has managed the home. The Commission (CSCI) has yet to receive an application for the individual to be registered as manager under the Care Standards Act 2000 and associated regulations (8&9). Feedback from clients and residents during the inspection has provided evidence that the acting manager encourages openness for clients and staff. Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 22 Residents spoken to and those who provided written feedback to the Commission confirmed that they feel listened to and that their views underpin developments in the home. Policies procedures and practises were seen to have been reviewed recently by the acting manager and her team in line with good practise advice. Action has been progressed within agreed timescales to implement requirements made in previous CSCI Inspection reports. Records and discussion confirmed that Staff are trained in health and safety systems on induction and periodically after this. Safety notices were seen displayed throughout the home. A Number of staff spoken to during the inspection felt that management of the home showed a greater commitment to listening and supporting them in their roles in a positive manner which was improving systems of working and ultimately the standards of care provided to clients. Broadreach DS0000003576.V292723.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 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 3 STAFFING Standard No Score 31 X 32 3 33 3 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 X 3 X X 3 X Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 24 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 YA37 Regulation 8 Requirement The Registered Provider must ensure an application is made by a person to be registered with the Commission as manager at Broadreach. Timescale for action 01/11/06 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 YA24 Good Practice Recommendations The seating furniture in the main lounge should be reviewed and replaced. Carried forward from previous inspection year. Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Broadreach DS0000003576.V292723.R01.S.doc Version 5.2 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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