Inspection on 13/09/05 for 41 Bryndale Avenue

This inspection was carried out on 13th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

41 Bryndale Avenue 22/02/08

41 Bryndale Avenue 12/07/06

41 Bryndale Avenue 31/01/06

41 Bryndale Avenue 18/01/05

41 Bryndale Avenue 16/09/04

41 Bryndale Avenue 17/02/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Bryndale Avenue, 41 Flats 13 & 14 Kings Heath Birmingham West Midlands B14 6NQ Lead Inspector Kerry Coulter Unannounced Inspection 13th September 2005 10:30 Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 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 Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 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. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Bryndale Avenue, 41 Flats 13 & 14 Address Kings Heath Birmingham West Midlands B14 6NQ 441 3982 441 3982 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) Sense West Vacant Care Home 2 Category(ies) of Learning disability (2), Sensory impairment (2) registration, with number of places Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Service Users must be aged between 18-65 years The service may provide personal care only for two (2) persons with a learning disability and sensory impairments Changes to separate the alarm system will be completed within 6 months of registration 18th January 2005 Date of last inspection Brief Description of the Service: Flat 13 and 14 Bryndale Avenue is part of a complex of flats which have been purpose built by Moseley and District Housing Association. A number of the flats are leased by SENSE in the Midlands and registered as care homes. The flats accommodate two service users with a sensory disability. The accommodation is situated on the first floor of the block and the flats each comprise of a hall, bedroom, bathroom, lounge and kitchen. In flat 14 there is a sleep in room and a staff office in flat 13. Access to the accommodation can be gained by the main staircase. The flats are situated amongst other registered and non-registered provision. Disabled access is poor; the flat is not suitable to anyone with mobility difficulties. To the front of the flat there is off road parking. There is a communal garden, which is shared with other SENSE registered flats at Bryndale and Shalnecote Grove. SENSE has recently applied to vary the conditions of registration for this home. It is intended that a third flat will form part of the registration and that service user numbers will increase to three. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over four hours. One service user was at home during the inspection. Conversations with the service user were limited due to their complex needs and limited verbal communication abilities. However, the Inspector was able to spend time observing care practices, interactions and support from staff. A tour of both of the flats was made. Care plans and risk assessments were inspected. Staff training and recruitment procedures were examined, and a number of Health and Safety records were inspected. The Inspector had the opportunity to talk to the Manager and informally to support workers and agency staff. What the service does well: What has improved since the last inspection? The home had recently implemented Health Action Plans for all service users. This is a type of care plan for ensuring individuals receive the care they need to stay healthy. Staffing ratios have been increased at weekends to ensure appropriate numbers of staff are on duty to meet individual needs. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 6 A condensing dryer has been purchased. This is an improvement on the old dryer as the window had to be opened when it was in use and this was not always practical in the winter. SENSE have produced a staff development plan, this details the training it aims to provide to staff and the frequency of refresher training. 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. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 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 Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 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): N/A EVIDENCE: None of these standards were assessed at this inspection. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6 and 7 The care planning system in place provides staff with the information they need to satisfactorily meet service users needs. EVIDENCE: One service user care plan was sampled at this inspection. There was detailed information to include history, medical needs, likes and dislikes, care routines, and communication needs. Plans were up to date and clearly detailed the support the service user required from staff. A care plan review meeting had taken place in May, this had been used to develop goals and aspirations. Behaviour management strategies were observed to be detailed and up to date. Each service user has a core team of staff, who meet monthly, to monitor the care plan, progress on achievements, goals, health care and to action any points. Minutes of these core meetings were available in the file sampled. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 10 Members of staff actively encourage each service user to take responsibility for as many things are they are able, within their individual capabilities. They seek to promote choice wherever possible, and respect the choices people make. Individuals’ communication difficulties place some restrictions on how this is put into practice. Where possible, attempts are made to overcome this, for example, through the use of objects of reference. Care records sampled indicate that choice is offered to service users this includes times of going to bed and getting up, meals and activities. Risk assessments for service users activities were not fully assessed at this visit, however the assessments in place for one service user were observed to be up to date. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13 and 17 A range of activities is offered in order to promote personal development and participation in the local community. EVIDENCE: There is specific information on the care plan regarding how to support and enhance service users skills in respect of independent living skills. Through the course of the inspection one service user was observed to be supported by staff to undertake daily living skills such as washing up crockery. Service users have a weekly schedule for planned activities. This is backed up by written guidelines on the support required for each scheduled activity. Discussions with staff and sampling of records evidence that a wide range of activities are on offer both in house and in the community. This includes visits to pubs, parks, preparing lunch and massage therapy. Community facilities such as shops and hairdressers are utilised. Service users are offered an annual holiday, one service user has been to the Canary Islands this year. Lots of photographs of the holiday were on display in her flat, these clearly showed that she had enjoyed the holiday. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 12 Records indicate that planned activities are only occasionally cancelled, where this does happen alternatives are offered. Records of food sampled indicate that service users are offered a varied and healthy diet. Both service users have opportunities to shop for food. They then choose daily what they want to cook and eat with support from staff. At the last inspection in January food stocks in one of the flats were quite low. This was again the case. However records sampled and discussion with staff indicate that the lack of food is due to the behaviour of the service user. To manage this staff assist the service user to shop on a daily basis. Staff also use a system of separating the weeks food into a series of boxes, one for each day of the week. However the Inspector was informed that the service user had eaten the contents of six of the boxes overnight. The Manager will need to review the current food storage arrangements if the current arrangements continue to be unsuccessful to ensure a healthy diet is promoted. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The health needs of service users are well met. The systems for the administration of medication are generally good and ensure service users medication needs are met. EVIDENCE: The Inspector met with one service user who appeared to be well dressed, and to have been supported to wear clothes suited to the weather and temperature. Care records clearly state how service users personal care needs were to be met. Service users health care needs are attended to, and records of appointments and outcomes are maintained in service users files. This included well being checks, diabetic and medication reviews. Service users have had eating and drinking assessments from the Speech and Language Therapist. Where service users receive massage therapy, massage therapy screening had been undertaken to ensure there was no health risk. When service users are unwell staff seek medical advice as appropriate, for example on the day of the inspection advice was sought from the GP as one service user had a bad cough. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 14 A new format for Health Action Planning has been introduced recently. This is something that the Government paper, ‘Valuing People’ recommended that each person with a learning disability had by 2005. This is to ensure individuals receive all the care they need to stay healthy. Good work has been done in seeking to identify and systematically record individuals’ health needs. This should now be built on so that the document moves from being a statement of need to a planning and monitoring tool. General administration of the medication appeared to be good. Medications had been signed when administered and as received. Protocols are available for medication that is prescribed on an ‘as required’ basis. Topical creams were observed. These had been dated when opened. It is good practice that competence assessments are completed for staff administering medication. FP10 prescriptions had not been copied. This is not in line with SENSE’s new medication administration policy. These need to be copied and stored with the relevant MAR chart to ensure all medication dispensed is in line with the prescription. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home has a satisfactory complaints procedure. Adult protection procedures show that service users are being protected from abuse and that their welfare is being promoted. EVIDENCE: The home’s complaint procedure includes information on the role of the CSCI in investigating complaints and is available in a picture format and CD Rom. Some of the service users due to their complex needs are not able to make a complaint and are reliant on staff, relatives or an advocate to act on their behalf. CSCI had investigated no complaints from service users or any other source in respect of this home in the past twelve months. The home was observed to have a copy of the Birmingham Multi Agency Guidelines on adult protection. It took the Deputy Manager some time to locate the new adult protection flowchart. This is a guide for staff as to who they need to inform if they have suspicions or receive an allegation of abuse occurring. It is therefore recommended that the flowchart is kept on display in the office to ensure quicker access for staff. The Deputy Manager stated that the records of service user finances had recently been audited by someone external to the home, the report of the audit has not yet been received. The personal money records of one service user were sampled. Receipts were available for expenditures. Some records had only one staff signature, it is recommended there are two staff signatures to improve the safeguards in place. The staff training matrix indicates that all staff except recently employed staff have completed adult protection training. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 29 The home generally presents as a homely and comfortable environment for the people who live there. EVIDENCE: Each flat has a single bedroom, lounge area and small kitchen. Both of the flats were generally maintained to a satisfactory standard in regards to decoration. A bath panel was observed to require replacement and one settee had a ripped arm. Discussion with the Deputy Manager and records indicate that arrangements are being made for these to be replaced. As recommended at the last inspection a condensing dryer has now been purchased. This is an improvement on the old dryer as the window had to be opened when it was in use and this was not always practical in the winter. At the last inspection the carpet in one bedroom was observed to have a ripped area that had been repaired with grey tape. A requirement was made for a more permanent repair or replacement carpet. The Manager responded in the action plan that it was difficult to replace the carpet as the service user does not easily tolerate changes to her environment but that the carpet would be replaced at a pace to suit the service user. Since the last inspection the Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 17 carpet in the hallway adjacent to the bedroom has also been ripped. Quotes for replacement carpets have now been obtained. Environmental adaptations have been made in accordance with the needs of the individual service users including adapted furniture, doorbells and décor with colour contrast. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 34 Minimum staffing levels were being maintained but only with the use of agency staff. Staff records did not contain all the information required to evidence that recruitment procedures are robust. EVIDENCE: At previous inspections, the need for a review of the rota to ensure that there is some flexibility of staffing levels, particularly at weekends and evenings to has been required. One service user requires 2:1 staffing for most of the day time hours. Observation of the rota indicates that staffing hours have been increased. However discussion with the Deputy Manager indicates that funding for this has still to be agreed, a meeting with the funding authority is planned for the day following the inspection. The home continues to have some staffing vacancies that are being covered by the use of agency staff. The Deputy Manager said that the home tries to use regular agency staff. There is two day and one night vacancy. One new member of staff has been recruited and has been working in the home for only a few days. The remaining vacancies must be recruited to ensure the service users are supported by a consistent team of people who are familiar to them and are fully aware of their needs and communication methods. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 19 The recruitment records for one recently recruited member of staff was sampled. This contained most of the documents required to evidence that a robust recruitment procedure is followed but with the exception of no proof of identity. Staff training was not fully assessed at this inspection as the Deputy Manager was in the process of updating the staff training matrix at the commencement of the inspection. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 The home regularly reviews aspects of its performance through a good programme of self-review and consultations. The arrangements in place for the promotion of the health, safety and welfare of the service users is generally acceptable with the exception of fire training for staff. EVIDENCE: SENSE have an internal quality audit tool, part of the process involves writing to relatives and care professionals to seek their views of the service. An action plan has been completed by the Manager in response to the strategic plan for the home. Evidence of progress towards meeting identified actions has been made. The PDW (Practice Development Worker) is responsible for internal auditing of Care Plans, activity levels and communication systems. Audits of finances and personnel records have also recently been completed. Since the last inspection SENSE have produced a staff development plan, this details the training it aims to provide to staff and the frequency of refresher training. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 21 Records were available to evidence the regular testing and servicing of fire alarms and emergency lighting. However as identified at the last inspection the certificate of servicing of the fire alarms covers three registered services and is unclear as to which systems have actually been serviced unless read in conjunction with the service sheet. It is therefore recommended that each service has its own certificate. During the inspection the Deputy Manager telephoned the servicing engineers to request separate certificates. Records sampled indicate that staff have not all had refresher fire training on a six monthly basis. This needs to be arranged to ensure all staff are aware of fire prevention and how to respond to ensure the safety of service users and themselves in the event of a fire occurring. Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 2 2 X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Bryndale Avenue, 41 Flats 13 & 14 Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score X X 3 X X 2 X DS0000017158.V250287.R01.S.doc Version 5.0 Page 23 YES (TWO) 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 YA20 Regulation 13(2) Requirement A copy of the FP10 prescriptions needs to be retained and stored with the relevant MAR chart to ensure all medication dispensed is in line with the prescription. Repairs to the environment are required: Bedroom/ hall carpet require repair or replacement. (Outstanding requirement from 30/4/05) Bath panel requires replacement. Settee with ripped arm covering requires re-covering or replacement. CSCI to be notified of planned completion dates. Staff vacancies need to be reduced to ensure the service users are supported by a consistent team of people who are familiar to them and are fully aware of their needs and communication methods. Two forms of identification are required for all members of staff. (Outstanding requirement from 28/2/05) Staff require refresher fire DS0000017158.V250287.R01.S.doc Timescale for action 30/11/05 2 YA24 23(2)(d) 30/11/05 3 YA33 18(1)(a) 30/12/05 4 YA34 17 & 19 Schedule 3 13(4) & 30/11/05 5 YA42 13/10/05 Page 24 Bryndale Avenue, 41 Flats 13 & 14 Version 5.0 23 training on a six monthly basis. 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 YA9 YA23 YA23 YA42 Good Practice Recommendations The introduction of the ‘traffic light’ system to highlight level of risk on risk assessments. (Previous recommendation) The adult protection flowchart should be kept on display in the office to ensure quicker access for staff. It is recommended that there are two staff signatures on service user financial records. The certificate of servicing of the fire alarms covers three registered services and is unclear as to which systems have actually been serviced unless read in conjunction with the service sheet. It is therefore recommended that each service has its own certificate. (Previous recommendation) Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Bryndale Avenue, 41 Flats 13 & 14 DS0000017158.V250287.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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