Inspection on 17/05/06 for Brunswick Court

This inspection was carried out on 17th May 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Brunswick Court 21/10/08

Brunswick Court 29/10/07

Brunswick Court 10/11/06

Brunswick Court 14/11/05

Brunswick Court 18/05/05

Brunswick Court 08/11/04

Brunswick Court 01/07/04

Brunswick Court 23/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Brunswick Court 62 Stratford Road Watford Hertfordshire WD17 4JB Lead Inspector June Humphreys Key Unannounced Inspection 17th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Brunswick Court Address 62 Stratford Road Watford Hertfordshire WD17 4JB 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) 01923 218333 01923 212109 cooperdupa.com BUPA Care Homes (AKW) Ltd Care Home 91 Category(ies) of Old age, not falling within any other category registration, with number (91), Physical disability (15), Physical disability of places over 65 years of age (91), Terminally ill over 65 years of age (4) Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. This home may accommodate 15 people with physical disability between 50 and 65 years of age. This home may accommodate 2 Services Users between 50 and 65 years of age, for Palliative Care. This home may accommodate 16 older people who require personal care. The home may admit one (named) terminally ill service user who is under 65 years of age. 14th November 2005 Date of last inspection Brief Description of the Service: Brunswick Court is a purposed built residential and nursing home. It is managed by BUPA care homes Ltd. It is situated in a residential area within easy reach of Watford town centre. The Watford Junction rail station and the main bus route are within walking distance, as is motorway access via the M1, and M25. The home has ample parking at the front of the property, and in the basement area located at the rear of the building. The front entrance leads to a large reception area, which allows access to the main building by means of security locks. Security within the building is good. The administrative offices are located on the ground floor. The kitchen, laundry and staff room are in the basement. The en-suite bedrooms are large in size and are located on three floors with access via a lift. The bedrooms on the ground floor are allocated to service users requiring nursing care. Brunswick Court offers ample communal spaces on every floor, including a dinning room and two lounges. The garden is located at the side and rear of the building. The courtyard area has a landscaped woodland area with easy access for wheelchair users. The estimated weekly cost of a placement is between £650.00 and £865.00 per week. Cost is dependent on if the service required is nursing or residential, private or local Authority funded. Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first key inspection for the year 2006/7 under the National Minimum Standards for Care Homes for Older People and the Care Homes Regulations 2001. The last inspection was carried out on the 14th November 2005. This unannounced inspection took place throughout the day of the 17th May, and was conducted by two inspectors. In addition to checking if the statutory requirements made in the last inspection report had been met, discussions were held with service users, members of staff on duty including the manager, and care staff from all floors. It was a very positive inspection with numerous improvements noted in the operation of the home since the last inspection. The service users appeared well cared for, and spoke positively about the staff that supports them. What the service does well: • • The service provides both residential and nursing care meeting the needs of a range of people who require varying levels of support. Service users’ interests and welfare are safeguarded by the homes policies and procedures. Complaints are welcomed, and well investigated Mealtimes are unhurried and social, and staff are attentive to individual needs. The home is well decorated, with the opportunity for service users to personalise their own space. Personal care is offered to service users in a sensitive and unobtrusive manner. • • • Brunswick Court DS0000019341.V295536.R01.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. Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. Prospective service users are provided with detailed information about the service, and are offered the opportunity to visit prior to admission. A comprehensive assessment is completed by qualified, and competent staff, to ascertain if the service required is residential or nursing care. This is reviewed and updated in the first six weeks. EVIDENCE: Each service user has a file that contains an in depth assessment which is carried out prior to admission. The assessments seen included physical and mental health, behaviour, as well as information relating to falls, pressure sores and diet. Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 9 A senior member of staff completes the assessments. The assessment form is then used as the basis for the care plan. Service users spoken to confirmed that they, and their relatives had the opportunity to visit the home to assess the atmosphere, and care approach before making a decision to move in. The format is newly introduced, and has been updated to provide greater detail by the current manager. Extra emphasis is placed on gathering information for service users receiving intermediate care, to try to allow a smooth transition from hospital, usually with a view to them returning home. Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. There has been a great improvement in the amount of information included in care plans since the last inspection. They now provide care staff with the information they need to make sure that service users’ health, personal care and social needs are met. Care plans were reviewed regularly and had, where possible, service user and family involvement. There was one exception seen where a service user had spent a period of time in hospital, and this had not been documented. Information was recorded in the Case notes. Personal care is offered to service users in a sensitive and unobtrusive manner, by staff that knows, and recognise their individuals needs. EVIDENCE: Care plans contained good detailed information of service users likes and dislikes. The care plans were up to date and easy to access. (Eight care plans Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 11 were looked at in detail and only one contained no review of service users needs after a stay in hospital. The person had returned to the home the previous day.) Files viewed had photographs of each service user. All care plans inspected had risk assessment on all aspects of the service users lives. A requirement was made at the last inspection, which has now been acted on and met. The Manager has recently introduced a new system of review. Each service users from each unit have their entire needs and life at the home reviewed one day each month. The inspector observed this process, and care plans were updated immediately. The domestic staff were consulted on the standard of cleanliness of the service users room. The service has improved significantly over the last twelve months in updating and developing practice in this area. Care plans now contain service users’ funeral wishes. This has been added to the care plan and is completed on admission. Each service user is registered with the local G.P and the manager advised that the home is well supported. Professional involvement had been recorded, and dates of new referrals to outside professionals were also apparent. Service users spoken to said that their opinions had been sought, and they were pleased when nursing staff offered professional guidance. The medication records of 4 service users were seen. Only one query was raised with regard to the signing of a medication administration record (MAR) sheet. The current manager has introduced regular auditing of medication, which is undertaken as part of her daily rounds to each floor. This has improved the overall administration of medication, and she advised that there appears to be far less errors. Observation of the care staff at work showed that interaction with service users was caring and respectful. Personal care was delivered discreetly and appropriately in keeping with peoples needs. Feedback from service users spoken to was positive. They said they were “well treated by the staff”, and felt that their privacy was respected - this was seen to be the case in several instances seen during the inspection. There were several service users who were unable to express their views, and the inspector spoke to two relatives who visited regularly. Overall both sets of relatives felt that the service provision was good, meeting the needs of people who required high levels of support. Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. Service users wherever possible, are encouraged to make choices and decisions on how they wish to lives at the home. Service users can maintain contact with family and friends outside the home, and involvement with the local community is encouraged both by outside people being invited into the home, and regular visits offered to go out and join in. An activities co-ordinator is employed in the home. The menu was varied (with several choices) and the food was good. EVIDENCE: Observation during the inspection showed that the routines in the home are flexible and are varied according to individual needs and wishes. There has been an increase in staffing ratios since the last inspection, and combined with the unit not having full occupancy, meant that there were more care staff engaging with service users with one-to-one discussions and staff working in two’s to provide personal care where needed. The atmosphere generally appeared more upbeat and positive, with good interaction between staff and service users. The Company (BUPA) employs an activity co- coordinator. A Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 13 weekly programme of activities was on display. The inspector spent time talking to the co-ordinators (presently two people sharing the role). There appears to be a varied programme offered with regular consultation with service users on the activities offered. Care plans recorded activities that service users enjoyed, and case notes recorded if the person had enjoyed the activity on the day when they participated. Most service users do have personal televisions in their rooms, however the televisions in all the communal areas were found to be far too small for most of the people to see. Relatives said that often, there were also inappropriate programmes being shown i.e. children’s prorammes. Two service users, and one set of carers interviewed both felt it would be nicer to have a varied choice of music that was ‘relaxing’. It is suggested that the activity coordinators find out what sort of music the service user would enjoy on the different floors, and this be offered as an alternative at certain points of the day. The issue of the size of the televisions was raised with the manager and she said that there had been a difficulty with theft of property in the home. Included in this had been several televisions. She is working to try to resolve this difficulty, and agreed that larger televisions would be more beneficial. The home has a varied menu offering two choices each day. The chef has made effort to meet with each individual service user, and where the person is unhappy with the choices of the day he has made a further choice available i.e. on the day several service users were eating egg and chips. Two service users interviewed commented that the meat was sometimes difficult to chew. However, lunch on the day looked appetising and appealing, and the meat tasted was good. Food items were pureed separately for those who need assistance with feeding. Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. BUPA has a comprehensive complaints policy, which is followed within the home. The manager actively encourages service users, and their relatives to make complaints when necessary. Service users’ interests and welfare are safeguarded by means of the homes policies and procedures with regard to vulnerable adults. The provision of adult protection training is part of the mandatory training for all staff. EVIDENCE: Complaints records were viewed on the day of inspection. They are corporate documents, which adequately record the complaint made; and subsequent information relating to the investigation. There have been several complaints since the last inspection, which has resulted in strategy meetings, chaired by Hertfordshire County Council. The current lead inspector (C.S.CI) attended both the meetings. Relatives of the service users made the complaints, and both related to expected standards and frequency of care. The manager has met with the relatives and explained the outcome of the complaints, and both cases have now been closed. Investigation of the complaints demonstrated that staff at the home had endeavoured to offer good care, but the relative’s expectations were higher then what was offered. The quality team from within the organisation (BUPA) had been into the home over the last two days, and no concerns were raised. Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 15 The manager has introduced a Resident/family communication sheet. This is a commitment to try to improve communication with families. The increase in staffing also allows for relatives to talk to senior staff when visiting. Many compliments had been received since the last inspection and the manager showed the recorded information has part of the inspection. Staff spoken to had a good understanding of the principles of adult protection, and was aware of their responsibilities in relation to any alleged incidents or suspicions of abuse. Training in this area is regularly offered, and is scheduled again for later in the year. The financial information regarding service users finances is robust. The inspectors were able to view financial records, which are computerised and located in the central admin office. Four sets of service user records were seen and thoroughly checked, and there was no cause for concern. Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to this service. Brunswick Court is a purpose built care home providing both residential and nursing care. Service users live in a safe, clean, well-maintained environment. EVIDENCE: The home has a detailed programme of re-decoration and this is reflected in the environment, which is bright, clean and tidy. One of the first floor bathrooms is being converted into storage space, to improve storage facilities in the home. Twelve bedrooms are being re decorated as well as the entire first floor corridor. This is undertaken in a planned and organised manner, so disruption to service users is minimal. The inspectors looked into many rooms and bathrooms and overall the unit was found to be odour free; bedrooms being personalised and individual in appearance. However, this was not the case in the immediate entrance to the home where on the day of inspection, the smell of urine was quite unpleasant. The manager was made aware of this and has agreed to take action. Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 17 Equipment was checked as part of the inspection. Hoists and mobility aids had been recently serviced, and replacement of all toilet seats had been undertaken as per the requirement at the last inspection. Laundry facilities are industrial, and are adequate and hygienic with sufficient capacity to cope with the workload generated. Good infection control procedures are in place. Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 The quality in this outcome group is good; this judgement has been made using all available evidence including a visit to this service. The policies and procedures relating to recruitment meet the requirements of the National Minimum Standards, and care homes regulations. Staffing levels within the unit have increased, and are sufficient to meet service users’ needs. Staff have appropriate skills and experience to respond to individual needs. EVIDENCE: Following concerns raised at the last inspection staffing levels were reviewed by the manager and cover increased, particularly early mornings when complaints by service users and relatives had been received. The current staff rota seen, indicated that there were now two trained nurses and four carers on duty both on the am and pm shift on each floor. Staffing levels have not been reduced despite there not being full occupancy. The building does not lend it self well to low staff ratios as some service users rooms are located away from the nursing station. There are call bells in place, and the manager advised that she regularly checked the monitoring sheets to ensure responses are within appropriate times. Care staff spoken with confirmed that daytime levels had improved and more help was available at busy times such as early mornings. The permanent team had also been strengthened by the support and commitment of the manager Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 19 who regularly visits the various floors throughout the day. This process of monitoring has improved the service and the overall morale of the staff team. The standard of care offered has improved over the last two inspections; both in the delivery of care, and the recording of information in care plans. This demonstrates a commitment by both staff, and the management team. There is a range of training being offered to increase and develop knowledge, which is offered in house by the current manager, and staff said that this was helpful in developing practice. They also reported that the ‘hands on style of management’ meant that any errors were picked up and acted on quickly. The files four employees were inspected. They contained all the appropriate security and identity checks including Criminal Records Bureau checks and two up to date references. The administrator in the main office undertakes this work. The current manager has given priority to staff training, and despite changes in the care staff the unit has met the 50 target in relation to completion of N.V.Q level 2 in care. Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 The quality in this outcome group is adequate; this judgement has been made using all available evidence including a visit to this service. The current manager is very experienced in the care of the elderly and has relevant qualifications and management experience, she is however about to leave her post as manager and there is no deputy manager in post at the present time. The home actively seeks the views of service users, and other involved people in order to ensure that a good quality of care is provided. The service users living in the home are generally safeguarded by the current practices in place with regard to health and safety. EVIDENCE: The current manager has a strong commitment to raise and sustain standards. There have been numerous improvements noted in the operation of the home since the last inspection, providing evidence of her effectiveness. However Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 21 there has not been a registered manager at the home for a considerable period of time. A new manager has been appointed and the registration process must be given priority. Due to the size of the home, and the high levels of dependency a deputy manager should also be appointed. There are regular service user meetings held in the home to ensure consultation with regard to the service provided. There is also greater commitment to involve relatives/carers in meetings and feedback was very positive about the recent meeting held. The home receives unannounced monthly monitoring visits from the providers BUPA care, and the reports of the visits are sent to the Commission for Social Care Inspection. Incidents in the home are recorded appropriately, and Regulation 37 forms are received regularly by the CSCI. The high number is related to the provision of palliative care. Policies, procedures and protocols were in place at the home to protect the financial interests of service users. Staff spoken with said that the current manager was approachable, providing appropriate guidance relating to matters of care practice. Her ‘hands on’ approach has developed a positive atmosphere, and an overall improvement in service delivery. The manager has introduced group supervision, as well as one to one sessions continuing to be available. Brunswick Court DS0000019341.V295536.R01.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 X X 3 Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP26 Regulation 16(2)(k) Requirement The manager must ensure that the offensive odour in the front hall is eliminated. The manager must apply for registration with the CSCI. (Outstanding over the previous inspections). Timescale for action 30/06/06 2. OP31 8(1)(a) 31/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Brunswick Court DS0000019341.V295536.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Brunswick Court DS0000019341.V295536.R01.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. 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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