Inspection on 27/09/05 for Charlton Court

This inspection was carried out on 27th September 2005.

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

Charlton Court 19/02/09

Charlton Court 21/08/08

Charlton Court 22/05/07

Charlton Court 19/06/06

Charlton Court 17/01/06

Charlton Court 10/05/05

Charlton Court 07/12/04

Charlton Court 13/05/04

Charlton Court 12/09/02

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

CARE HOMES FOR OLDER PEOPLE Charlton Court 477-479 Bradford Road Pudsey Leeds West Yorkshire LS28 8ED Lead Inspector Nadia Jejna Unannounced Inspection 27th September 2005 11:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Charlton Court DS0000001330.V253271.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Charlton Court Address 477-479 Bradford Road Pudsey Leeds West Yorkshire LS28 8ED 01274 661242 01274 656799 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) Charlton Care Homes Limited Mrs Pamela Moule Care Home 71 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (71), Physical of places disability (2) Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The place for Learning disability under 65 is for the service user specified in the NCSC Notice dated 2 October 2003 The places for Physical Disability under 65 are for the named service users only 10th May 2005 Date of last inspection Brief Description of the Service: Charlton Court is a large, purpose built care home, which provides nursing care for up to 71 service users. It is located in a residential area of the Leeds suburbs and is very close to the boundary with Bradford. Accommodation is provided over two floors, mainly in single rooms, some with en-suite facilities. There are three communal sitting rooms and a dining room. The home has wide corridors and a passenger lift; there are facilities for laundering all communal linen and personal clothing. A central kitchen provides all meals (there is, in addition, a kitchenette on the upper floor where drinks and snacks can be prepared). The home has a large car park for staff and visitors. There are grounds to the rear and an outside area where service users can sit comfortably and safely. There are local facilities nearby – shops, pubs etc.- and it is well placed for access to public transport. Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections a year; these may be announced or unannounced. The last inspection was in May 2005. This showed that the home had not made progress towards meeting requirements and recommendations made at previous inspections and therefore a satisfactory service was not being given to residents. 25 requirements and 12 recommendations were made as a result. This inspection was unannounced and was carried out by two inspectors. The visit started at 11:15 and ended at 17:30 on the 27th September 2005. The purpose of this inspection was to monitor the home’s progress since the last unannounced inspection. Time was spent looking at whether the requirements made at the last visit have been addressed. The inspectors also looked at care plans and other records as well as speaking to the management team, staff and residents. The people who live in the home prefer the term residents, and this is the term that will be used throughout this report. What the service does well: What has improved since the last inspection? The management team have worked hard to address the key issues. Their aim is to continue to develop the service and raise the standard of care. This hard work and determination to improve has paid off as they have now met a large number of the requirements. The Service User Guide has been revised and made available to all current residents as well as prospective residents and their families. Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 6 New care plan formats are being used and staff have worked hard to improve the detail and information they provide. Some of the plans showed that they were moving towards being individual and person centred, this approach is to be encouraged. Policies and procedures have been revised such as those about pressure area care, medication and infection control. Advice on their content has been sought from relevant healthcare professionals before introducing them to staff in the home. New equipment and furniture has been bought for the home, including moving and handling hoists, armchairs, recliner chairs and a new call bell system. The seating arrangements in the dining room and lounges have been reviewed. One of the larger communal areas is going to become a combined lounge and dining room. This will allow for more residents to come down from the first floor rooms to eat their meals as well as to join in with social activities. An unused bedroom will become the separate smoking area for residents. Staffing levels have been increased by 1 on each shift. Staff said this has been a big improvement for them and they could spend more time with residents. Monthly staff meetings have been introduced, which have improved communication, this has made staff more aware of what is happening within the home. Residents and relatives meetings are held at least three monthly, the last one was in May 2005. 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. Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4. Residents and their relatives are provided with the information they need to make a decision about choosing to live at the home. EVIDENCE: The Service User Guide and brochure was revised in July 2005. Copies are available in the reception area. The manager said that copies are given to prospective residents on request and are placed in individuals’ rooms when they are admitted to the home. Copies were seen in residents’ rooms. There are still some residents in the home who do not fall within the registration categories. The manager has requested advice and support from other healthcare professionals in order to review these resident’s needs and find more suitable care homes for them. Training is now being given to staff about caring for people with dementia. Pre admission assessments are carried out to make sure that the home can meet a residents needs before arrangements are made for admission. Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10. There have been improvements with the care plans, which must continue if all of a residents identified needs are to be met. EVIDENCE: Care records for three residents were seen. Each had a care plan and risk assessments but these did not cover all their needs. Some of the care plans gave good information about individuals needs but others were more generalised and could have applied to anybody in the home. They also included comments about general care, which should be automatically practised by all staff in the home. Examples were given to the manager’s and included the following comments ‘ensure bed linen is changed when need arises, ensure hair is brushed and liaise with hairdresser when necessary’. Other information was very detailed and provided clear guidance on how an individual’s needs should be met. The lack of continuity between daily records and the care plans continued in the care plans seen. Staff talked about care needs, which were not included in care plans. One resident was clearly unsettled and staff talked about how they were trying to provide a safe environment for them. But the care plan did not address all of the problems they mentioned. Staff were working with the Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 10 resident in different ways, which could lead to them becoming more unsettled. Clear, detailed care plans would lead to consistent care being given. It was seen that care plans are reviewed monthly and there was evidence that a health issue had been followed up during a monthly review. Residents and relatives have been invited to care planning meetings to discuss the purpose and content of their care plans. This process is still in the early stages, and once properly introduced should become an effective method of involving residents and their families. It was identified at the last inspection that the care plans needed to be more detailed and informative. It was clear that changes have been introduced and that staff have worked hard to implement them. This must be continued. Staff have not received up to date training around care planning and person centred care. It is important that this is done in order to continue improving the standard of care planning. The manager said that the pressure area care policy has been revised. This has been introduced to staff via training sessions. Pressure area care plans were seen and showed that the tissue viability nurse and GP were involved. But there was no information about what setting the pressure relieving air mattress should be. The manager said that the home has bought 2 new hoists and a stand aid hoist. A review of moving and handling equipment available in the home was carried out and there are enough handling belts, slide sheets and other equipment available. The manager said that homes policies and procedures around the administration of medicines have been revised. Changes in the law about disposing of drugs from nursing homes have been taken into account. The policies are being typed properly and will then be implemented with all staff. Residents said that the staff were kind, caring and that they respected their privacy and dignity. Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 and 14. Resident’s social care provision meets their expectations, their choices are respected and they can exercise choice and control over how they spend their time. EVIDENCE: The home employs an activity organiser who has returned to work following a long absence. The manager said that a programme of regular planned activities would be resumed and that they hoped to expand the range of activities offered using the social care needs assessments that are part of the new care plan formats. The manager said they are hoping to find a specialised training course for the activities organiser. Each service user has a ‘social care plan’ to help identify suitable social activities. One plan stated to ‘arrange with activity organiser to see if they are interested in some activities’. This had not been followed up, and staff said that activities provided to them were limited. Suggestions on how social activities could be developed for this service user were discussed. The new care plans contain information about residents preferred times for going to bed, getting up and other daily routines. Residents said that they were able to exercise choice and control over how they spend their time. Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 12 The manager said that systems have been put in place to make sure that residents dietary preferences, likes and dislikes are made known to the chef. This information is given to the chef in writing when new residents are admitted to the home. The seating arrangements in the dining room and lounges have been reviewed. One of the larger communal areas is going to become a combined lounge and dining room. This will allow more residents to come down from the first floor rooms to eat their meals as well as to join in with social activities. An unused bedroom will become the separate smoking area for residents. Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Residents are aware of the complaints procedure and how to use it. Residents are protected by adult protection procedures which staff are aware of. EVIDENCE: A complaints procedure is in place. A copy is displayed in the reception area and is included as part of the Service User Guide. Residents said that they knew what to do and who to speak to if they had any concerns and that they would not hesitate if they were unhappy about something. Records are kept of any complaints made along with copies of letters sent and investigations made. The manager said that the adult protection procedures have been revised and now include contact details for the local authority adult protection unit. Staff said that they would not hesitate to report suspected or actual abuse to the person in charge. The operations manager has completed a train the trainer course in order to provide staff in the home with training about abuse and adult protection. Staff said they were looking forward to getting this and the next session was due to be held within the next 4 weeks. Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 20,22 and 26. Residents are living in a clean, tidy, safe and well-maintained home, which is suitable for their needs. EVIDENCE: The home was clean and tidy. There were no odours. The manager said that there has been a review of the chairs used in the home. As a result a number have been disposed of and new chairs ordered. Risk assessments have been put in place if the chairs used for a residents comfort and safety can be seen as restricting. The full call bell system was being replaced at the time of the inspection. The manager said that this decision had been made because of the problems they had trying to keep the previous system in good working order. The manager said that one of the bathrooms will be made into a wheel in shower room. There was no date as to when the work would be done. Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 15 The domestic supervisor said that the laundry staffing hours had been increased to take into account the increased amounts of laundry now being done in the home. The laundry assistant said that this did give her enough time to do her job. The manager said that the infection control policies have been revised and that a copy had been sent to the infection control nurse for their advice. They were waiting for this to be returned. Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 and 30. Due to the increase in staffing hours, there is now more time for staff to perform their duties and meet the needs of the residents. Not all of the required recruitment records were available, therefore it is not possible to say that the recruitment procedures are safe and protect residents. EVIDENCE: Following the last inspection staffing levels have been increased by 1 on each shift. Staff said this has been a big improvement for them and they could spend more time with residents. They also said that the additional management time working directly with them and residents had helped to improve the quality of care. The manager said that the nurses are allocated at least one day a month when they are supernumerary so that they can spend time reviewing care plans. The staff rota’s were seen. They were written in pencil. The manager was told that they must be written in ink, and changes to the original rota must be identifiable. Shifts are currently written as E (early) or L (late) or No (nights) even though start and finish times may be different. To ensure that the exact hours worked are recorded more detail is required. Management hours must be included. Three staff files were seen. Two of the staff had been recruited in Eastern Europe through an agency. References and proof of identification were available. Application forms had been completed but there were gaps in Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 17 employment, which had not been explored and reference details had not been filled in. Police checks were not available. The acting manager said a police check and a CV (Curriculum Vitae) with full employment details had been obtained but they had been misplaced. The records for the employee recruited by the home had all the information required. Staff have attended a range of training courses including fire safety training, moving and handling, and COSHH (Control Of Substances hazardous to Health). The manager said that 12 staff attended a one day induction training course to TOPSS (Training Organisation for Personal and Social Skills) standards. The manager was aware that the induction and foundation standards are changing in the near future. A training plan was seen but there were no entries after August 2005. Areas of training identified during the last inspection have not yet been given. Residents said that they still had some difficulties communicating with staff who have English as a second language. The manager said that a lot of staff have attended English courses and they are getting information about further courses for those who haven’t. Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33 and 37. The home is being managed in the best interests of the residents but the management arrangements must be made clear to make sure that this continues. EVIDENCE: The home has being going through some management changes and temporary arrangements are in place. During the inspection it was evident there was some uncertainty and confusion about these. The provider and the operations manager said that these would be resolved over the next few weeks. Written confirmation of decisions made must be forwarded to the CSCI. Monthly staff meetings have been introduced, which have improved communication, this has made staff more aware of what is happening within the home. Residents and relatives meetings are held at least three monthly, the last one was in May 2005. The manager said that these are usually well attended. Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 19 A resident survey was carried out in July 2005. The results have been collated and made available to all interested parties. A copy was on the notice board in the reception area. The registered provider visits the home every 2 to 3 weeks. Reports of these visits are not always made available in the home or to the CSCI. The operations manager has completed the first round of formal staff supervisions. Records were available and staff confirmed that they had received this. The operations manager said that more staff would receive training in order to provide formal supervision. Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X 3 X 3 X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 2 X X X 2 X Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP4 Regulation 14 Requirement Timescale for action 31/01/06 2 OP7 14 The manager must make sure that the home can meet the assessed needs of all residents. Where it has been identified that this is not being done, the manager must make sure that these placements are reviewed. (Previous timescales for meeting this standard were 31.3.04, 30.11.04 and 31.3.05. The most recent timescale of 30.9.05 has not yet been met but it was agreed to extend the date because all efforts are being made to meet it.) A plan of care must be in place 31/03/06 for each resident, which shows clearly how all assessed health, personal and social care needs will be met. These must evidence all actions taken and provide an accurate picture of the service users medical, physical and social well-being. Staff must be trained in writing care plans and appropriate systems put in place to ensure this. (Previous timescales which have not been met are 31.10.03, 31.3.04, 30.11.04, 31.3.05 and 30.9.05) DS0000001330.V253271.R01.S.doc Version 5.0 Charlton Court Page 22 3 OP21 23 4 OP29 19 The registered person must make sure that there are sufficient numbers of accessible bathrooms for the numbers of service users in the home. A copy of proposed plans and timescales must be forwarded to the Commission. (Previous timescale which was not met was 30.11.04.) The registered person must make sure that gaps in employment have been explored and records kept. The registered person must make sure that the training programme is kept up to date and that it is implemented with all staff. Training must be made available to staff which equips and enables them to carry out the roles they have been employed to fill and to meet the needs of residents living in the home. This must include mandatory training on safe working practices. The registred person must ensure that all staff can communicate effectively with service users. The CSCI must be notified in writing as soon as decisions have been made about the homes management arrangements. The registered provider must ensure that monthly visits to the home take place and that reports are kept, copies of which must be sent to the CSCI.(This standard was not assessed on this inspection. The previous timescales of 31.1.05 and 30.7.05 have not been met.) All records as outlined in schedules 3 and 4 of the DS0000001330.V253271.R01.S.doc Ongoing 5 OP30 18, 19 Immediate as discussed with the manager Ongoing 6 OP32 39 7 OP33 26 As soon as a decision has been made. 31/12/05 8 OP37 17 31/12/05 Page 23 Charlton Court Version 5.0 Regulations must be available. These must include details of the hours worked by all grades of staff in the home. Records must be kept securely as required by the Data Protection Act. (Previous timescales, which have not been met are 31.3.04, 31.12.04 and 30.7.05). 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 Refer to Standard OP2 Good Practice Recommendations The registered person should ensure that all service users and or their representatives are given copies of the homes contracts/terms and conditions of residence. Copies of which should be available for inspection. (This standard was not assessed on this inspection and the recommendation has been carried forward.) The manager should make sure that care plans for residents with pressure area care needs include information on what settings are to be used for pressure relieving air mattresses. The revised policies and procedures around the administration of medicines should be implemented with all staff as soon as they are available. The registered person should make sure that the information in the social care assessments is incorporated into the care plans, implemented and followed up as part of the care plan review process. A system for tracking and auditing complaints made should be put in place. When the infection control nurse has reviewed the infection control policy it should be implemented with all staff. The registered person should ensure that at least 50 of staff achieve NVQ level 2 by 31st December 2005. (This standard was not assessed on this inspection and the recommendation has been carried forward.) DS0000001330.V253271.R01.S.doc Version 5.0 Page 24 2 OP8 3 4 OP9 OP12 5 6 7 OP16 OP26 OP28 Charlton Court Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Charlton Court DS0000001330.V253271.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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