Inspection on 18/07/05 for Cedar Avenue

This inspection was carried out on 18th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Cedar Avenue 20/05/08

Cedar Avenue 23/05/07

Cedar Avenue 11/10/06

Cedar Avenue 10/02/06

Cedar Avenue 10/03/05

Cedar Avenue 29/06/04

Cedar Avenue 23/02/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

Pennine Camphill

Muston Road (70)

Grayling

The Cornerstone

John Street Nursing Home

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

CARE HOME ADULTS 18-65 Cedar Avenue 5 Cedar Avenue Edgerton Huddersfield HD1 5QH Lead Inspector Jacinta Lockwood Unannounced 18 July 2005 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 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 Stationary 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. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Cedar Avenue Address 5 Cedar Avenue Edgerton Huddersfield HD1 5QH 01484 530300 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) United Response Care Home 4 Category(ies) of Learning & Physical disability registration, with number of places Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Conditions of this registration are listed on the registration certificate displayed at the service. Date of last inspection 10.03.05 Brief Description of the Service: Cedar Avenue is registered to provide personal care and accommodation for up to four male and female adults aged 18-65 with a learning disability and physical disability. The registered provider is United Response.The purposebuilt bungalow style accommodation is located in a residential setting within walking distance of Huddersfield town centre and local amenities.There is car parking available and the home has its own transport.The home is staffed twenty-four hours a day and there is one wakeful night staff member and one member of staff sleeping in on the premises. An on-call system is also in operation. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out an unannounced inspection of 5 Cedar Avenue on 18th and 20th July 2005. The inspection was carried out over two days because staff and service users were going out on the 18th and there was no one left at the home to assist with the inspection. A range of inspection methods were used including contact with service users, discussion with staff and management; inspection of records including service user care plan and risk assessments, finance, medication, food records, health and safety and maintenance records, some policies and procedures, statement of purpose and service user’s guide. A limited tour was made of the building and grounds. What the service does well: What has improved since the last inspection? There have been no noticeable improvements since the last inspection. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 6 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. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 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 standard(s) 1, 2 Information about the care home is available, but not in a format accessible to people who may use the service. Prospective service users would have their needs assessed before a place was offered to them. EVIDENCE: There have been no new admissions to the care home. Current service users have lived at the home since it opened. Assessment information is available and included in the service users’ support plan. A statement of purpose and service user’s guide is available. However, the documents should be produced in a format suitable for the people for whom the home is intended, for example, appropriate languages, pictures, video, audio or explanation. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 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 standard(s) 6, 7, 9 Service users’ changing needs are not reflected in the plan of care and records are not fully maintained. Service users are offered choice and supported to make decisions and take risks as part of an independent lifestyle. EVIDENCE: Information in the care plan inspected was well laid out, and written in the first person, detailing how staff should provide support to the service user. The plan had been reviewed in February 2005. It was evident from records and discussion that healthcare advice had been received and acted upon, but relevant information had not been included in the service user’s plan of care. Care plans must be updated whenever the person’s needs change so that staff using the plan have clear and up to date information to inform their care practice. More attention should be paid to record keeping, as there were gaps in recording on a service user’s behaviour chart. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 10 Records show that service user’s rights to make decisions have been assessed and where appropriate risk assessments have been drawn up. Risk assessments provided a good level of information relating to risks and there was evidence of review. Care staff spoken to were informed and had a good understanding of service users’ care and support needs. They were observed to offer service users choice and appropriate support was also provided at the time. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 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 standard(s) 12-17 Service users are supported to take part in age, peer and culturally appropriate activities within the local and wider community. Opportunities are provided for service users to engage in social and leisure activities and to maintain and develop relationships with family and friends. Service users’ cultural dietary needs are met and a well balanced diet provided. EVIDENCE: Service users access a variety of social and educational opportunities. Interests and hobbies are recorded. Service users attend day centres throughout the week where activities include building independence skills such as personal care, multi-sensory stimulation and music. Relevant policies and procedures are available. Service users are supported to go shopping and to access local community facilities such as the post office, supermarket, hairdresser, pubs, cafes and restaurants and to take part in social and leisure activities. Staff said that all those living at the home had enjoyed an outing to Southport the previous day and there had been a recent visit to a mela in a local park. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 12 Sensory equipment is available within the home and service users have access to music, television and a computer. Staff explained that service users are supported to participate in activities of daily living using the hand over hand technique when appropriate and that they are included in activities even if they are not actively participating. Staff interacted well with service users and a member of staff included a service user while he swept sand from the home’s minibus following the previous day’s outing. Staff explained that relatives are involved and service users are supported to maintain family contact through visits. Service users’ friends visit them at home and are invited to tea. A service user attends an emotions group, which also provides an opportunity to meet new people. Service users are supported by staff and relatives to fulfil their spiritual needs and take part in religious and family festivals. Staff were observed to respect service users’ privacy and privacy locks were available. Service users are supported with any mail received. Menus and records of food provided, indicate that service users have access to a well-balanced diet. Service users are involved in shopping for food. Cultural dietary needs are met and separate food storage areas provided for Halal products. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 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 standard(s) 18, 19, 20 Generally, service users’ health care needs are met by staff and relevant professionals, but omissions in record keeping pose a potential risk to service users. Support is provided to service users in a flexible, person centred way. There is a lack of attention to detail regarding medication records which could pose a risk to service users. EVIDENCE: Records and discussion with staff indicate that service users receive sensitive and flexible personal support to maximise service users’ privacy, dignity, independence and control over their lives. An aromatherapist visits service users and staff said that service users enjoyed this. Service users’ health needs are met and relevant professionals involved as required. However, healthcare risk assessment records for one service user relating to diabetes were not up to date, (see Standard 6.) Service users were well groomed and looked well cared for. Aids and equipment are available at the home to maximise service users’ independence. Records show that equipment is regularly maintained. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 14 Owing to their high dependency needs, none of the current service users selfmedicate and staff administer the service users’ medication. Two samples were checked. There was evidence that medication is kept under review. Medication was stored securely although care should be taken to ensure that medication for internal and external use is stored separately. Separate shelving was available for this purpose. Improvements have been made to recording keeping generally, and stock checked tallied with records held, but there were gaps in signing for one medication. Staff must sign the record sheet at the time of administration. A record of seizures is maintained for those service users who are prescribed Rectal Diazepam. GP authorisation for the administration of Rectal Diazepam was available, but relevant staff had not signed the authorisation sheet and this should be addressed. The inspector was informed that a controlled drugs book was to be introduced following staff training in the use of the book on 25.07.05. A policy and procedure is available as is information on the types of medication used at the home. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 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 standard(s) 23 Some systems are in place to protect service users from the potential risk of abuse. However, there is evidence of poor practice with regard to the recording and management of service users’ finances. EVIDENCE: The home has a whistle blowing and adult protection policy and procedure. Staff said that training in protection from abuse has been provided. However, training records were not available so it was not possible to verify whether all staff working at the home have received adult protection training. The manager on duty at the time of the inspection explained that service users’ monies are balanced at the handover period and that two members of staff are involved. Two samples of monies were checked and reconciled with records held. However, not all entries on the transaction sheet had been signed by two members of staff in accordance with procedure. There were gaps in recording some details and one amount had been entered incorrectly. It was not possible to reconcile a withdrawal from a bankbook against transaction records. The manager explained that these records had been removed by the service manager and taken to the area office. Records of service users’ monies must be kept in the care home. The manager explained that in future, audits were to take place at the care home. It is of concern that a service user’s benefit book showed that two amounts of money had not been withdrawn and the timescale for doing so had passed. The manager said she would look into this. Once the reason for this possible error has been established, should the service user or his representative have cause to make a complaint, relevant support should be provided. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 16 It is also of concern that financial risk assessments have not been completed as previously recommended. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 30 Generally, Cedar Avenue provides a homely, comfortable and safe environment for service users. EVIDENCE: Cedar Avenue was purpose built and is generally well maintained. The home is in keeping with the local community and offers access to local amenities, local transport and relevant support services. There is level access to the home and the accommodation is comfortable. The home provides a communal lounge and dining/kitchen area plus single bedroom accommodation. The garden is accessible and is well used. Service users who are able can move freely between their private and communal spaces. There was water damage to a small area of floor in the hallway. This had been made safe pending repair. Monthly health and safety checks are carried out and any maintenance issues reported. However some repairs have been outstanding since April 2005 and these should be addressed without further delay. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 18 Over the course of the inspection the home found to be clean, hygienic and free from offensive odours. Secure laundry facilities are provided away from food areas and the laundry area was clean and tidy. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Systems are in place to ensure that staff are appropriately trained to meet service users’ individual and joint needs. EVIDENCE: The manager explained that LDAF (Learning Disability Award Framework) and NVQ (National Vocational Qualification) training is ongoing. United Response provides a range of training appropriate to the service user group including moving and handling, health and safety, food hygiene, epilepsy, autism, active support, cultural awareness, nutrition and healthy living and understanding a learning disability. A member of staff new to Cedar Avenue said she had received induction training but had yet to take part in a fire drill, although she was aware of fire safety procedures. It was not possible to examine individual staff training records. The manager explained that staff training records are kept at the area office. These should be available for inspection. Staff spoken to had a good understanding of service users’ needs and were able to describe ways of working with and supporting service users, offering choice and involving a service user in mopping up some spilled liquid. Staff were seen to interact with service users in a caring and positive way. Staff Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 20 involved service users in conversation about the previous days’ outing and service users responded positively to this. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 42 The home does not have a registered manager and although management systems are in place, these are not being fully maintained. Outstanding health and safety issues and omissions in record keeping pose a potential risk to service users. EVIDENCE: The home has been without a registered manager since November 2004. Leanne Joseph and Debbie Newton who share the role of manager, manage the home on a day to day basis. The Commission has not yet received registered manager applications and this must be addressed. The manager on duty explained that she is receiving management training and is being well supported by her line management. There is evidence elsewhere in the body of the report that some regulations and standards are not being met and the service provider must address this. A sample of equipment service certification for portable electrical appliances, fire equipment, lifting equipment and water checks for legionella were Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 22 inspected and found to be satisfactory. Checks of the fire system and fire drills are carried out. Hot water temperatures in some sinks in bedrooms and a bathroom were recorded around 50 degrees Celsius. Action must be taken to ensure that hot water temperatures are close to 43 degrees Celsius to minimise the risk of scalding. Bath temperature records were within acceptable limits for full body immersion. There was no recorded evidence to indicate that staff at the home have received training to ensure safe working practices, for example, first aid, movement and handling, fire safety and infection control training. Evidence of this should be available for inspection. There were some gaps in recording weekly safety checks of the home’s mini bus. Annual drivers’ checks should have been completed in February 2005 and were overdue. Motor insurance was available. Monthly hazard checks are carried out but there was no record of checks having taken place in May or June this year. Records show that fridge and freezer contents are checked on a weekly basis but there were gaps in recording these checks. To promote security at the home, a door chime has been put in place to alert staff when the door is opened. It was evident that a service user had received hospital treatment following a fall, but a notifiable incident report had not been supplied to the Commission as required. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x x x Standard No 22 23 ENVIRONMENT Score 2 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 1 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cedar Avenue Score 3 1 1 x Standard No 37 38 39 40 41 42 43 Score 1 x x x x 1 x J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 24 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 6 Regulation 15(2) Requirement Service users plans must be updated to reflect changing needs and records associated with the plan must be fully completed. Service user risk assessments must be up to date and reflect current risks. A separate record of controlled drugs receipt, administration and disposal must be kept. These records must be kept in a bound book or register with numbered pages. The bound book will include the balance remaining for each product with a separate record page being maintained for each service user. (Timescale of 31.05.05 not met.) Medication records must be signed at the time of administration. (Timescale of 17.11.05 not fully met.) Records of service users monies must be kept in the care home and must contain the required information. Information and documents in respect of persons working at the care home must be kept in the care home and available for Timescale for action 31.08.05 2. 3. 19 20 13(4)(c) 13(2) 31.08.05 31.08.05 4. 20 13(2) 31.08.05 5. 23 17(2) 31.08.05 6. 34 19(1)(b) Schedule 2 17(2) Schedule 14.09.05 Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 25 4 7. 37 8. 42 9. 10. 42 42 inspection. (Timescales of 25.08.04 & 31.05.05 not met) Care A person shall not manage a Standards care home without being Act 2000 registered with the CSCI, Part II (11 therefore, registered manager application forms must be received for the appointed managers so that the process of registration can begin. 23(2)(j) Hot water temperatures in bedroom and bathroom sinks must be adjusted to deliver water around 43 degrees Celsius. 13(4)(b) Annual drivers checks must be up to date. 37 Accidents to service users must be notified to the Commission as required. 24.08.05 24.08.05 24.08.05 24.08.05 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. Refer to Standard 1 20 Good Practice Recommendations The homes service users guide and statement of purpose should be in a format accessible to those for whom the service is intended. The registered person should ensure: that staff authorised to administer rectal diazepam signed the GP authorisation sheet; that a controlled drugs register be provided for recording the administration of controlled drugs; that medicines for internal and external use are stored seperately. Complaints information provided to service users should include contact details of the Commission for Social Care Inspection. Recorded evidence that all staff working at the care home have received adult protection training should be available for inspection. Service users financial records should be fully and accurately completed. Following investigation of a possible error in managing a J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 26 3. 4. 5. 6. 22 23 23 23 Cedar Avenue 7. 8. 23 23 9. 24 10. 11. 12. 13. 14. 32 35 35 42 42 service users finances, should the service user or his representative have cause to make a complaint regarding this, relevant support should be provided. Service users financial risk assessments should be completed. This recommendation is brought forward. An in-house procedure for current practice in relation to the handling of service users monies and valuables should be available to staff and for inspection purposes. This recommendation is brought forward. Outstanding maintenance issues should be addressed, for example, the shower head should be attached to the wall; the outside kitchen light should be repaired; the bar under the frame to a wheelchair should be secured; the glass panel to the lower oven should be replaced; water damaged flooring in the hallway should be repaired or replaced. 50 of care staff should achieve NVQ level 2 training or equivalent by 31.12.05. This recommendation is brought forwrd. Documentary evidence of staff training should be available for inspection. Disabled trainers should provide disability equality training to staff. This recommendation is brought forward. Evidence that staff have received training in first aid, movement and handling, fire safety and infection control should be available for inspection. Records of monthly hazard checks and weekly fridge/freezer contents checks should be fully completed. Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 27 Commission for Social Care Inspection Park View House Woodvale Office Park Brighouse HD6 4AB 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 Cedar Avenue J51J01_s26335_cedar av_v240146_180705.doc Version 1.40 Page 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!