Inspection on 18/12/07 for Cheriton

This inspection was carried out on 18th December 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Cheriton 08/01/10

Similar services:

Flint House

St Vincents

The Cotswold Home

Fairways

Newbeech House

Winton House

Treloar College

Rush Court

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

CARE HOMES FOR OLDER PEOPLE Cheriton 9 Stubbs Wood Chesham Bois Amersham Bucks HP6 6EY Lead Inspector Joan Browne Key Unannounced Inspection 18th December 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000070919.V357204.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000070919.V357204.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cheriton Address 9 Stubbs Wood Chesham Bois Amersham Bucks HP6 6EY 01753 536350 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) Mrs Sushma Nayer Mr Vipin Parkash Nayar Eileen May Oliver Care Home 27 Category(ies) of Dementia (0), Mental disorder, excluding registration, with number learning disability or dementia (0), Old age, not of places falling within any other category (0), Physical disability (0) DS0000070919.V357204.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care Home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category/ies Old age, not falling within any other category (OP) Dementia (DE) Mental Disorder, excluding learning disability or dementia (MD) Physical Disability (PD) The maximum number of service users who can be accommodated is: 27. 19th May 2006 2. Date of last inspection Brief Description of the Service: Cheriton home for older people is a detached property located in Chesham Bois. The home is registered for 27 older people. The accommodation consists of all single rooms. There are two large lounges and a separate dining room. One of the lounges allows pleasant views over the grounds. The home is equipped with a passenger lift and grab rails around the home for those who are less physically able. Public transport is easily accessible and is in walking distance from the village and a short drive from Amersham. The home is supported by a local general practitioner (GP) surgery and other health care resources are available through a referral from the general practitioner. There is an established staff team who support the care of residents. The range of fees are £525.00- £625.00 per week. DS0000070919.V357204.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection of the service was an unannounced key inspection. We arrived at the service at 09.45 am and the inspection lasted for approximately seven and a half hours. This inspection was a thorough look at how well the service is doing. It took into account information provided by the service’s manager and any information received about the home since the last inspection. We saw most areas of the home and looked at records and documents relating to the care of the people using the service and staff members. Because people are not always able to tell us about their experiences we used a formal way to observe people in this inspection to help us understand. We call this the ‘Short Observational Framework for Inspection (SOFI). This involved us observing up to five people who use services for two hours and recording their experiences at regular intervals. This included their state of well being, and how they interacted with staff members, other people who use services and the environment. We asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that we sent out and their views are included in this report. We looked at how the service was meeting the standards set by the government and in this report made judgements about the outcomes for people living in the home. From the evidence seen and comments received we considered that the home was providing a good service to meet individuals’ diverse needs. Improvement in staff’s practice when administering medication and infection control matters and the authenticity of references for overseas staff have been identified as requiring attention in this report to ensure that people using the service health and safety are not compromised. What the service does well: Our observations show that people living in the home have a good relationship with the staff team and that staff are kind and caring. People living in the home say that the food provided in the home is wholesome and tasty. DS0000070919.V357204.R01.S.doc Version 5.2 Page 6 Relatives say that they are made to feel welcome by staff and they are able to visit people living in the home at any time. People living in the home said that the home was clean and free from odours. 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. The summary of this inspection report can be made available in other formats on request. DS0000070919.V357204.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000070919.V357204.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are confident that the the home can support them. This is because individuals needs are assessed prior to taking up the placement. EVIDENCE: Four residents care plans were viewed. The plans contained a detailed assessment of need reflecting the standard. For those residents who were being funded by a placing authority care management assessments were in place. The manager confirmed that she visits prospective residents in their own home or in hospital to make sure that the home is able to meet individuals needs. We spoke to individuals recently admitted to the home who confirmed that they were happy living in the home and their care needs were being met. The home does not provide intermediate care therefore standard 6 was not assessed. DS0000070919.V357204.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home has systems in place to ensure that people living in the home health and personal care needs would be met. Individuals right to privacy and dignity are respected by staff. EVIDENCE: All residents living in the home have a care plan identifying what they health and personal care needs are. There has been an improvement in the detailing of information in care plans. Plans seen identified how needs should be met. Risk assessments relating to individuals moving and handling and dietary needs were in place. However, there was no risk assessment in place for tissue viability (pressure sore). A recommendation is made in this report to ensure that risk assessments are in place for individuals who have developed or at risk of developing pressure sores. This would ensure that the appropriate intervention is actioned and recorded in the care plan. There was evidence seen confirming that plans were reviewed monthly or as and when required and individuals’ weights were being monitored. DS0000070919.V357204.R01.S.doc Version 5.2 Page 10 All residents were registered with a general practitioner of their choice and have access to specialist health care facilities such as dental, chiropody and optical treatments. The home receives good support from the district nursing services. Those residents being cared for in bed looked comfortable and well cared for. The appropriate pressure relieving equipment to prevent pressure sores was in place. Turning charts and fluid balance charts were being maintained. The medication system and records in place in the home overall were satisfactory. No unexplained gaps on the medication administration record (MAR) sheets were noted. The controlled drug register was checked and the tablets in the cupboard corresponded with the records. Some inconsistencies in staffs practice was observed. For example, two white tablets were observed in a medicine pot in the medication trolley. During the lunch time medication round a staff member was observed touching the tablet when administering it to a resident. It was also noted that medication was administered to residents whilst they were eating lunch. The practice of administering medication at the same time lunch is served should be reviewed to prevent individuals getting distracted when eating their lunch. Information from our survey showed that people were confident that the home was supporting them appropriately with their health care needs. It was noted that a particular resident was prescribed for Alendronic Acid tablet, which is administered once a week for the treatment of osteoporosis. Strict guidelines shoud be followed when administering the medication. There was no written protocol in place to inform staff how to administer the medication. It is recommended that the home should develop a protocol to ensure that all staff are fully aware of contra-indications and how the medication should be administered. As a good practice a further recommendation is made for the home to retain a list of staff members authorised to give medicines, which should include a record of their approved initials. From our observation staff members treat people living in the home with respect and support them to maintain they dignity. For example, staff were observed offering praise and encouragement to people using services. The homes manager recognise that there are some cultural and language difficulties between the staff group and the people living at the home. Some people sho responded to our survey also commented on these difficulties. The manager has looked into finding ways to improve the issue. Suitable training has been identified for staff, which should enable them to communicate more effectively with people living in the home. The manager identified in the annual quality assurance assessment that the home had an excellent end of life care for people living in the home. DS0000070919.V357204.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People are encouraged to maintain links with family members and friends. They could benefit from more consultation about the regularity and type of activity they wish to participate in to meet their diverse needs. EVIDENCE: The home employs an occupational therapist twice weekly who provides exercise to music therapy and quizzes for mental agility. There is also a person who facilitates arts and crafts every other week. Information from our survey showed that people living in the home enjoyed the arts and crafts activities provided. They also said that they could benefit from more reading lamps in the lounge areas to improve the lighting. We observed there were long periods when no organised activities were provided. However, since the inspection we were made aware that in-house activities such as bingo and board games are provided. A ‘Pets as Therapy’ dog visits the home and also a variety of entertainers. The manager stated that individuals are asked about their preferred interests at assessment and on admission. People living in the home could benefit from more frequent consultation on the regularity and type of activity they wish to participate in on a regular basis so that the home knows their expectations and can make a plan to suit. From our observations DS0000070919.V357204.R01.S.doc Version 5.2 Page 12 people at the home have good relationships with staff members and value interaction with them Visitors spoken to during the inspection said that staff made them feel welcome when they visit and always offered them a cup of tea. Individuals said that they enjoyed their food, and the chef was aware of their food preferences. The food menu seen reflected that the chef provided a variety of dishes to encourage residents to try new and sometimes unfamiliar food. Most people enjoyed the social interaction in the dining room at lunchtime. DS0000070919.V357204.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peole living in the home and their relatives said that they had confidence in the homes complaints procedure. Staff had undertaken training in the safeguarding of vulnerable adults, which should ensure that individuls are not placed at risk of harm or abuse. EVIDENCE: The homes complaints procedure was displayed in the front entrance of the home. People who responded to our survey said that they knew how to make a complaint. The home reflected in its annual quality assurance assessment (AQAA) that it had not received any complaints within the last twelve months. No complainant had contacted the Commission with information concerning a complaint about the service. The home has policies and procedures in place to protect people living in the home from potential harm or abuse. Records seen reflected that staff members had undertaken training in safeguarding of vulnerable adults. The home reflected in its completed AQAA that it had referred one safeguarding incident to be investigated. The manager confirmed that the incident was satisfactorily investigated. A requirement has been made in this report for the home to review its recruitment process and make sure that references DS0000070919.V357204.R01.S.doc Version 5.2 Page 14 obtained for overseas staff are authentic and addressed to the person who requested them, and not ‘To whom it may concern.’ DS0000070919.V357204.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People live in a home that is clean, pleasant and hygienic. The infection control practice in the home needs to be improved to ensure that people are not put at risk by poor infection control practice. EVIDENCE: The home has a pleasant front garden area with seating. There are adequate communal areas consisting of two lounge dining areas. Bathrooms and toilets are situated over two floors. All bedrooms are single occupancy. It was noted that some bedrooms, corridors and the large lounge had been redecorated, which has enhanced the environment. We were told that further refurbishment work was planned. Floor coverings have been replaced in bedrooms, the hall, stairs and landing areas. Floor coverings of the non-slip DS0000070919.V357204.R01.S.doc Version 5.2 Page 16 type had been replaced in toilets and bathrooms. Raised areas were noted in the floor coverings in some toilets that were recently replaced. The manager said that matters were in hand to remedy the defect, which should ensure that people using the service safety is not compromised. The manager confirmed that the requirements from the fire officers visit have been complied with. The home was inspected by the environmental health officer recently and was awarded a silver certificate for maintaining high standards of hygiene in the kitchen. The home was clean pleasant and free from odours on the day of the inspection. The lounge area looked attractive with the Christmas decorations, which gave it a warm and friendly feel. The laundry room is situated away from where food was stored and prepared. The floor and wall finishes in the laundry room were satisfactorily maintained. It was noted that clean linen was stored on the floor in the laundry room. This practice must be reviewed to prevent any spread of infection. Staff were observed wearing gloves when not providing personal care. Staff are reminded that gloves are not a substitute for hand hygiene and must be discarded after each activity for which they were worn in order to prevent the transmission of microorganisms to other sites or to other residents. It was also noted that used gloves and aprons were being disposed of in a general waste bin instead of the clinical waste bin. This practice must be reviewed to prevent cross infection in the home. The home has a dedicated housekeeper and people using the service said during the inspection visit and through our survey that the home was always clean, fresh and tidy. DS0000070919.V357204.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28, 29 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home needs to review its recruitment practice to ensure that references for overseas staff members are checked for authenticity. This would ensure that staff who have been appropriately recruited care for people using services. EVIDENCE: The home has a staff rota reflecting the number of staff on duty on every shift. From our observations the number of care staff on duty was appropriate to meet the needs of people in the home on the day of the inspection visit. The care staff team are valued by the people living at the home. Individuals and visitors spoken to on the day of the inspection visit made several positive comments about them. Staff were described as ‘caring particularly in times of illness’ and ‘nice people who generally care.’ The number of staff members with the national vocational qualification (NVQ) at level 2 in care does not reach the expected level of 50 . The manager was working to increase the numbers. DS0000070919.V357204.R01.S.doc Version 5.2 Page 18 Four staff’s files were examined. The majority of staff were recruited from overseas. All staff completed an application form and two references and enhanced criminal record bureau (CRB) checks and terms and conditions of employment were seen in individuals’ files. It was found that references were of a ‘to whom it may concern’ type and there was no evidence seen that their authenticity was checked. It is required that references for overseas employees must be checked for authenticity to comply fully with current recruitment legislations and to ensure that people using services are not put at risk. The home needs to provide copies of the general social care council (GSCC) code of conduct to all staff, to ensure that staff are familiar and abide with the code. The home has an ongoing training programme to meet the needs of the people living at the home, including training in the care of dementia and safeguarding of vulnerable adult. The home has developed a training matrix, which makes it easy to identify which member of staff need training. DS0000070919.V357204.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The home aims to provide a consistent service to people using the service. However, shortfalls identified in staff’s medication practice and in the infection control practice in the home would need to be addressed to ensure that People living in the home health and safety are not compromised. DS0000070919.V357204.R01.S.doc Version 5.2 Page 20 EVIDENCE: The manager is a trained nurse and has been working at the home for approximately three years. She has gained the registered manager’s award and is supported by a deputy manager, an assistant manager and care staff. The manager said that there were clear lines of accountability within the home. Information in staff’s surveys reflected that regular staff meetings were held and that the manager was approachable. The manager said that she regularly target the views of people using the service and relatives to make sure that they are happy with the provision of care. Regular internal auditing of medication administration record sheets is carried out. Staff’s competencies in the administration of medication are regularly assessed. However, staff’s medication practice would need to be closely monitored to ensure that people using the service health and safety is not compromised. The manager confirmed that the home does not hold residents’ money. Examination of a sample of health and safety records indicated that they were in order. Routine servicing and maintenance of equipment are undertaken at appropriate intervals to ensure that they are in working order and safe to use. The home only has one health and safety officer. As a good practice it is recommended that a second health and safety officer is nominated to ensure that all safety checks relating to the fire panel are carried out within the agreed timescales. DS0000070919.V357204.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 DS0000070919.V357204.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP26 Regulation 13(3) Requirement Timescale for action 31/01/08 2. OP29 19(1(c) To comply with best practice guidelines and in the interests of people using the service safety used gloves and aprons must not be disposed of in general waste bins. To comply with current 31/01/08 legislations references for overseas employees must be checked for authenticity to ensure that people using services are not put at risk. 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 OP8 Good Practice Recommendations People using the service who have developed or at risk of developing pressure sores should have a risk assessment to ensure that the appropriate intervention is actioned and recorded in the care plan. In the interests of people using the service safety and to comply with best practice guidelines a protocol should be DS0000070919.V357204.R01.S.doc Version 5.2 Page 23 2 OP9 3 OP9 4 5 OP9 OP9 6 7 OP12 OP26 8 9 10 OP26 OP26 OP29 developed for the administration of Alendronic Acid medication. In the interests of people using the service safety and to comply with best practice guidelines tablets should not be taken out of their original packets and stored in a medicine pot in the medication trolley. To comply with best practice guidelines the home should retain a list of staff members authorised to give medicines, which includes a record of their approved initials. The practice of administering medication at the same time lunch is served should be reviewed to prevent people using the service from being distracted when eating their lunch. The views of people living in the home should be sought about the regularity and type of activity they want so that the home can make a plan to suit their expectations. To comply with best practice guidelines and to prevent the spread of infection to people using services, staff should not substitute the use of gloves for hand hygiene and used gloves should be discarded after each activity. To comply with best practice guidelines and to prevent the spread of infection to people using services clinical waste bins should be preferably of the foot pedal type. To comply with best practice guidelines and prevent the spread of infection to people using services clean linen should not be stored on the floor in the laundry room. To comply with best practice guidelines the home should provide a copy of the general social care council (GSCC) code of conduct to all staff to ensure that they are familiar with the code of conduct and implement it in when providing care to people using the service. DS0000070919.V357204.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000070919.V357204.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!