Inspection on 27/06/06 for Carlton Gate

This inspection was carried out on 27th June 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Carlton Gate 26/11/09

Carlton Gate 17/11/08

Carlton Gate 19/11/07

Carlton Gate 04/01/07

Carlton Gate 24/02/06

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Carlton Gate 10 Florey Lodge Admiral Walk, Harrow Road London W9 3TF Lead Inspector Tony Lawrence Unannounced Inspection 27th July 2006 08:30 Carlton Gate DS0000065285.V301285.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 Carlton Gate DS0000065285.V301285.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. Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carlton Gate Address 10 Florey Lodge Admiral Walk, Harrow Road London W9 3TF 020 7289 2352 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) The Westminster Society Mr Stephen Paul Golden Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th February 2006 Brief Description of the Service: Carlton Gate is a registered care home providing personal care and accommodation for one man and five women with a learning disability. The home provides care for an older client group. Westminster City Council leases the property from the health authority. The home is staffed and care is provided by the Westminster Society, a voluntary organisation. The home is well located to enable residents to use facilities in the local community and is close to shops and transport links. The home is split into two flats, Florey Lodge and Barnard Lodge, each for three people. The accommodation is on the ground floor and is fully accessible to people using wheelchairs. The flat in Florey Gate contains the staff office. Each person living in the home has a single room and these are well decorated and furnished. Each flat has an assisted bathroom and accessible shower room. Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Tuesday 27th June 2006 from 08:30 – 14:30. The Inspector spent time talking with four service users, the manager and care staff on duty. The Inspector also saw all communal parts of the home and three service users’ bedrooms. The care received by three people living in the home was tracked by talking with them and staff responsible for their care and checking care records kept in the home. Two of the four requirements made at the last inspection have been met. Two requirements are repeated. The weekly fees for the home range from £1,313 £1,416. What the service does well: 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. Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 6 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 Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 7 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): 1,2 and 5. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home has clear referral and admission procedures. The Statement of Purpose has been reviewed but more work is needed to make sure that it accurately describes the services offered. EVIDENCE: The home’s Manager and staff confirmed that there has been no change in the group of people living at Carlton Gate since the last inspection. Most of the service users moved to the home from long-stay learning disability hospitals and all have lived together for a number of years. The home’s Statement of Purpose has been reviewed since the management of the service was taken over by the Westminster Society in July 2005. The Statement includes the home’s referrals and admission policies and procedures. The procedures include a full care needs assessment for each prospective service user and a planned programme to introduce the person to the home, including overnight stays. Although the Statement accurately describes the services offered in the home, there is a need to make sure that it is reviewed again to remove references to the previous service provider. Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 8 The three service user files checked by the Inspector each included a letter from the Society’s Head of Registered Care that explains the Society’s plan to review the Licence Agreement with the housing provider. The new Licence will be produced in formats that are accessible to some people living in the home. The Manager confirmed that, until the review is completed, staff are working to the service users’ original Licences, to make sure that individual’s rights and responsibilities are protected. Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Service users’ care needs are well assessed recorded and reviewed. Standards of risk management in the home are good. EVIDENCE: During this visit the Inspector checked the care plan files of three people living in the home. All three plans were last reviewed in January 2006. The care plan reviews cover health and social care issues and there is evidence that service users are involved in planning the review wherever possible. Staff told the Inspector that they work with individuals in the period leading up to the review to make sure that their views on the care they receive are recorded. One service user told the Inspector that they had been at the last review of their care plan and had been able to invite people they wanted to attend. All three care plan files included risk assessments that had been reviewed in May and June 2006. The assessments were well completed and covered fire safety, self-harm, vulnerability, challenging behaviours, medical and communication issues. Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 10 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 and 17. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Although some people living in the home have a good quality of support, staffing levels mean that not all people have the support they need. EVIDENCE: Each person living in the home has a planned weekly programme of activities. The Inspector saw these programmes on the three care plan files reviewed during this visit and also on notice boards in the lounges. The programmes include activities in the home and the local community. Daily care notes completed by staff show that, for some people, there are regular outings to local cafes, shops etc. Although one person attends a local day service, daily care notes showed little evidence of activities or outings provided at other times by staff from the home. Staff told the Inspector that it is very difficult to offer this person opportunities to go out when there is only one member of staff on duty in the flat, supporting three service users. Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 11 Staff described the three people having to do things as a group or two people having to go the lounge in the other flat if the third service user wants to go out. The daily care notes written by staff supporting this person at weekends include very few references to trips out. The person appears to spend the majority of time listening to music or sitting by the fishpond outside the home (although this has to be done as a group). The Inspector noted a particular example of good practise during this visit. A service user told the Inspector that she was going to the Society’s Head Office to help with interviews for new staff. When she returned, the service user talked very animatedly about the experience and told staff what she planned to do with the money she had been paid for her time. On the day of this inspection, five service users were at home for at least half of the day. One person was at home all day, but staff made sure that they supported this person to go out to local shops to buy magazines and sweets. The inspector felt that staff worked well together as a team to make sure that they met individual’s care needs, but this is difficult. Most of the people living at Carlton Gate have significant care needs and there is a need to increase staffing levels to make sure that people are supported appropriately and safely (see Staffing – Standard 33). Staff told the Inspector that service users are supported to have an annual holiday. In recent weeks, two people went to Butlins and a third person went to Folkestone, with a day trip to Paris. The three care plan files reviewed by the Inspector included details of service users’ relatives, friends and other significant people. There is a need to make sure that staff record the contact that service users have with relatives and friends. Daily care notes show that one person asked for support to phone relatives on 22nd and 23rd of June, but there is no record that this happened. Staff told the Inspector that they do not keep a weekly menu record. Service users are supported to make individual choices about what they would like to eat at each mealtime and this is recorded in the daily notes. The records show that service users are offered a varied diet and two people told the Inspector that they always enjoyed the food provided. Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 12 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 and 21. Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. The health care needs of service users are well assessed and recorded and there is evidence of appropriate referrals to healthcare professionals. There is a need to make sure that the home has sufficient staff to support individuals with their personal care. EVIDENCE: The Inspector felt that service users’ health care needs are well recorded and assessed as part of their care plan. All three care plan files reviewed during this visit included clear guidelines for staff on how the person should be supported with their personal care. The issue of staffing levels referred to throughout this report also prevents people receiving support in the way they prefer. Staff said that one person usually requires 1:1 support for all transfers. 80 of the time this does not cause problems, but staff said that 20 of the time 2:1 support is needed and this is not possible when only one member of staff is on duty. Problems also occur when staff begin to support this person on their own and then realise they need a second person to carry out a transfer safely (see Staffing – Standard 33). This person’s care plan also shows that they prefer Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 13 male staff to support them with their personal care. On the day of this inspection, the home manager was available to support the service user, but staff said that this is not always possible as there are only two male staff in the home. The home uses the Boots Monitored Dosage System (MDS) and all prescribed medication is delivered every 28 days. During this visit the Inspector checked the storage and recording of medication in both flats. Secure storage for medication is provided in a lockable metal cabinet in each flat. Opening dates are recorded on bottles of eye drops. The Inspector checked the Medication Administration Records (MAR) for service users in both flats. No errors were seen on the records kept in Florey Lodge. In Barnard Lodge, one MAR sheet had some gaps where staff had not signed the record when giving medication to the service user. Staff must make sure that there are no gaps in the records. If codes are used to record reasons why medication is not given, these should also be defined. The Inspector saw evidence in two care plan files that staff have discussed issues about aging, illness and death with service users and their relatives. Two files included a form where the service user’s funeral arrangements are recorded. One file also included a copy of the service user’s will. Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 14 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. Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home has a clear complaints procedure and service users told the Inspector that they would talk to staff or the manager if they were worried about anything. Complaints are well recorded but there is need to make sure that the manager and staff follow the local authority’s policy and procedures when incidents may involve adult protection issues. In one complaint recorded in March 2006, a service user alleged that a member of staff had handled them roughly. This incident should have been referred to the Adult Protection Coordinator in the Social Services Department, the lead agency for adult protection. The Adult Protection Co-ordinator is the person responsible for arranging a multi-agency strategy meeting to agree how to respond to any allegations and the service provider should not investigate incidents without agreement from the AP Co-ordinator. The Manager must also make sure that the Commission is notified of incidents involving service users. The last inspection report included a requirement that money paid by a service user for the redecoration of their room must be refunded. Although this took place at the time the service was provided by another organisation, the Westminster Society has now been managing the service for almost a year and this issue has not been resolved. The Requirement is repeated in this report and the service user’s money must be repaid without further delay. Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 15 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, 25, 27, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home provides a good standard of private and communal accommodation that is fully accessible. EVIDENCE: During this visit the Inspector saw all communal parts of the home and three service users’ bedrooms. Accommodation is provided on one level and all parts of the home are accessible to service users with restricted mobility. The kitchens are spacious and well equipped, but a lid is needed for the bin in Barnard Lodge. Lounge / dining rooms are also spacious and are comfortably furnished. The service users’ bedrooms the Inspector saw were comfortable, well decorated and highly individualised with the person’s own belongings. There is an assisted bathroom / toilet and a separate wheelchair accessible shower room / toilet in each flat. The bathroom in Florey Lodge is used for storage and staff said that the bath has not worked for months, reducing service users’ choice in how they are supported with their personal care. The Manager confirmed that an engineer has visited the home and the Society must make sure the bath is now repaired without further delay. Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 16 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, 33, 34 and 35 Quality in this outcome area is poor. This judgement has been made using available evidence, including a visit to this service. Although the home has a committed and experienced staff team, staffing levels in the home must be increased to make sure that service users are supported appropriately and safely. EVIDENCE: The last inspection report included a requirement that the Westminster Society must notify the Commission of the results of the review of staffing levels and any proposals to make sure service users receive the care and support they need. This requirement has not been met and is repeated in this report. The major issue arising from this inspection is the need to increase staffing levels to make sure service users are supported safely. On the day of this inspection, the home’s Manager was on duty with three Project Workers, supporting six service users in two separate flats. One service user spent the whole day at home and the other five people were at home for either the morning or afternoon. The Manager and staff team worked well together to meet service users’ needs. The Manager supported one person to make sure they had same gender support with their personal care and later escorted another service user to and from the Society’s Head Office where she helped with staff interviews. Other staff supported service users in the home. Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 17 All six people living in the home have significant care needs and require high levels of support. Current staffing arrangements mean that two staff are on duty in one flat at all times. In the other flat, only one person is on duty for extended periods. This person can ask for support from other staff or the Manager, but this is not always available when needed. It is a requirement of this report that staffing levels are increased to provide two staff on duty in each flat at all times of the waking day. The Manager confirmed that all staff, have completed or are completing their NVQ Level 2 or 3 qualification training, apart from 2 people who have recently started. Although the home has not yet met the target for 50 qualified staff, the Inspector is satisfied that arrangements are in place to achieve this during 2006. The Manager also confirmed that all staff have an Enhanced Disclosure from the Criminal Records Bureau before they start work in the home. Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 18 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, 41, 42 and 43. 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 managed, all policies and procedures are in place and standards of record keeping are good. EVIDENCE: The home’s manager is experienced and registered with the Commission. The Manager confirmed that he is due to start his NVQ Level 4 qualification training in July 2006. Two people living in the home who spoke with the Inspector said that they felt staff listened to them and asked for their views. One person added that staff ‘always try to help’. Regular meetings are held with people living in the home and the last meeting was held in May 2006. Staff have produced minutes of the meeting that make excellent use of photographs to make the information more accessible to some service users. Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 19 All policies and procedures are in place and staff told the Inspector that copies are available in the office for reference. Standards of record keeping are good, although care plan files include lots of information that could be archived. This would make it easier for staff to access the service user’s current assessments, care plan and risk assessments. No health and safety issues were noted during this inspection. Managers from the Westminster Society carry out unannounced monthly monitoring visits. A written report is sent to the home and the Commission after each visit. Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 20 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 2 2 3 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 2 28 3 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 1 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 3 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 3 X 3 X 2 3 3 Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 21 Yes 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 YA1 Regulation 4 Requirement The home’s Statement of Purpose must be reviewed to remove references to the previous service provider. Staff must support service users to take part in appropriate individual activities. Staff must make sure that they support service users to keep in contact with their relatives. Accurate records must be kept of any visits, phone calls, letters etc. Staff must make sure that gaps are not left in the medication records. The Society must follow the local authority’s adult protection policy and procedures when responding to allegations from service users. The Manager must make sure that the Commission is informed of any significant incidents affecting service users. Money paid by a service user for the redecoration of their room must be refunded. Repeat Requirement – original timescale of 31/05/06 not DS0000065285.V301285.R01.S.doc Timescale for action 30/09/06 2. 3. YA12 YA15 16 12 30/09/06 30/09/06 4. 5. YA20 YA23 13 13 31/08/06 31/08/06 6. YA23 37 31/08/06 7. YA23 23 31/08/06 Carlton Gate Version 5.2 Page 22 met. 8. 9. YA28 YA33 23 18 The assisted bath in Barnard 31/08/06 Lodge must be repaired. The Westminster Society must 31/08/06 notify the Commission of the results of the review of staffing levels and any proposals to make sure service users receive the care and support they need. Repeat Requirement – original timescale of 31/05/06 not met. Staffing levels must be increased 31/08/06 to provide two staff on duty in each flat at all times of the waking day. 10. YA33 18 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. Refer to Standard YA20 YA30 YA41 Good Practice Recommendations Staff should define codes used to record when medication is not given to a service user. A lid should be provided for the kitchen bin in Barnard Lodge. Care plan files should be reviewed to make sure that essential information is easy to find. Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Carlton Gate DS0000065285.V301285.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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