Inspection on 09/05/07 for Cherry Tree House

This inspection was carried out on 9th May 2007.

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 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

Cherry Tree House 22/09/08

Cherry Tree House 31/10/07

Cherry Tree House 18/09/06

Cherry Tree House 04/10/05

Cherry Tree House 19/07/05

Cherry Tree House 02/09/04

Cherry Tree House 29/04/04

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

CARE HOMES FOR OLDER PEOPLE Cherry Tree House Cherry Tree House 29 St Johns Road Farnham Surrey GU9 8NU Lead Inspector Sandra Holland Unannounced Inspection 9th May 2007 10:45 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 Cherry Tree House DS0000013597.V335193.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. Cherry Tree House DS0000013597.V335193.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cherry Tree House Address Cherry Tree House 29 St Johns Road Farnham Surrey GU9 8NU 01252 734417 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 Gillian Margaret Nicholls Mrs Gillian Margaret Nicholls Care Home 6 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (4) of places Cherry Tree House DS0000013597.V335193.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Up to 2 (two service users may be in the category: dementia for older persons DE (E). 18th September 2006 Date of last inspection Brief Description of the Service: Cherry Tree House is a privately owned detached house that is situated in a quiet road near the centre of Farnham. The property is the family home of Mr and Mrs Nicholls. The home is managed and staffed solely by Mr and Mrs Nicholls and their family. The home has a domestic feel, and service users are accommodated in attractively decorated single rooms. There is a small parking area at the front of the home, and a large, level garden is available for use by the service users. The service is registered to provide personal care for up to six older people, two of whom may have dementia. The fees at this service range from £ 327.00 per week to £ 400.00 per week. Cherry Tree House DS0000013597.V335193.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was carried out by the Commission for Social Care Inspection (CSCI) under the Inspecting for Better Lives process. Mrs Sandra Holland, Regulation Inspector carried out the inspection over four hours. Mrs Gillian Nicholls, Registered Manager and Registered Provider was present representing the service. A full review of information held about the home was reviewed prior to the visit. Resident areas of the property were seen and a number of records and documents were sampled, including care plans, medication administration records and policies and procedures. A pre-inspection questionnaire was supplied to the home and this was completed and returned within the requested timescale. Information provided in the questionnaire will be referred to in this report. CSCI feedback forms were supplied to the home and three of these were completed and returned by residents or their supporters. The people living at the home prefer to be known as residents and this is the term that will be used throughout the report. The inspector would like to thank the residents and staff for their hospitality, time and assistance. What the service does well: Residents are accommodated in a family environment and are invited to be part of family events and celebrations. All care and support is carried out by family members, providing continuity and consistency for residents. A varied menu is offered to residents and meals were of very generous portions. Residents are offered choices, of meals, when to get up and how to spend their time and these are accommodated and respected. Cherry Tree House DS0000013597.V335193.R01.S.doc Version 5.2 Page 6 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. Cherry Tree House DS0000013597.V335193.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 Cherry Tree House DS0000013597.V335193.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 and 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The needs of some, but not all residents have been assessed before they were admitted. EVIDENCE: The providers stated that they usually visit prospective residents to assess their needs before they are admitted to the home. The file of a recently admitted resident was seen, but no record of the pre-admission assessment was held. Other residents are supported financially by local authorities and have been assessed under the care management process, the providers stated, and copies of the assessments had been obtained. The providers stated that intermediate care is not provided. A requirement has been made regarding Standard 3. Cherry Tree House DS0000013597.V335193.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 and 10. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ care plans contained minimal information to guide staff to the support and care required. The administration of medication must be more robust to fully safeguard residents. EVIDENCE: The providers stated that the needs of the residents are well known to staff, as residents live as part of the provider’s extended family and all staff are family members of the providers. Mr and Mrs Nicholls provide most of the care which is provided to residents, with secondary support by their family members. The providers advised that information regarding residents’ needs is usually passed verbally from person to person. The files of a number of residents were seen, including those of recently admitted residents. It was noted that although the providers had obtained a new format of care plan, none of these had been completed. The information contained in the care plans was minimal and consisted mainly of information that had been provided by others, including families or care managers. Cherry Tree House DS0000013597.V335193.R01.S.doc Version 5.2 Page 10 A sheet referring to monthly reviews of the care plan was present in one residents file and had been completed stating “no change”, but no care plan was in place. It was also noted that risks to residents had not been assessed, even though a resident had fallen in recent weeks and sustained a fracture. Residents’ healthcare needs are supported by their general practitioner, and district nurses visit when required, the providers stated. Residents are taken to visit an optician or dentist when required, either by their families or by the providers. The providers advised that a chiropodist visits the home every two months. It was noted that an invitation to a resident for a health check from a local health authority had not been responded to, although it had been received some months ago. It was also noted that a recently admitted resident had not been weighed since admission, although the health needs assessment carried out before admission, referred to significant weight loss. Medication is stored centrally in a locked provision and the providers stated that none of the residents are currently administering their own medication. It was noted that the receipt of medication into the home had not been recorded, so it was not possible to know how much medication should be present or to follow an audit trail. Staff were observed to speak to residents in a friendly and informal, but appropriate way. Residents’ privacy was respected and their bedrooms were only entered after knocking. An immediate requirement has been made regarding Standard 9 and requirements have been made regarding Standard 7 and 8. Cherry Tree House DS0000013597.V335193.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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to join in family activities and are offered a varied diet. EVIDENCE: At the time of inspection, the majority of residents were sitting in the lounge watching television, and one resident was spending time in their room, as they prefer. The providers stated that there is no programme of planned activities, although residents are invited to be involved in family events, including barbeques, visits by a Rainbow group (junior Brownies) and a family christening. One resident goes out to two local social clubs, whilst another prefers not to go out at all, the providers stated. The providers advised that none of the current resident group choose to go to church, although transport is available if they wish to attend. Cherry Tree House DS0000013597.V335193.R01.S.doc Version 5.2 Page 12 All residents have involvement with their families and friends and some go out with them occasionally, the providers advised. The home has a cordless telephone which residents can use in their rooms, to maintain contact with their relatives or friends. A four-week menu plan was supplied with the pre-inspection questionnaire and this indicated that a range of meals are served to suit the residents needs. The providers advised that residents can choose alternative food to that offered, if they prefer. The lunch-time meal was served during the course of the inspection and it appeared well balanced and appetising. The portion sizes were very generous and residents were spoken to whilst enjoying their meal. Three residents had their meal at the dining table, which is positioned in the bay window of the lounge, and two residents had their meals at small tables beside their armchairs. Cherry Tree House DS0000013597.V335193.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 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A complaints procedure is in place, but no complaints have been received. Some, but not all of the staff have been trained in the Safeguarding of Adults. EVIDENCE: Information supplied in the pre-inspection questionnaire, indicated that no complaints had been received during the last year. The providers confirmed this and stated that they do not maintain a complaints record, as no complaints have been received. The providers stated that any complaint or dissatisfaction made verbally would be addressed immediately, to prevent it developing into a more serious matter. The home’s complaints procedure is included in the Statement of Purpose, which was included in residents’ files. In the event of an allegation or suspicion of abuse, the providers stated that they would follow the Surrey Multi-Agency procedure for Safeguarding Adults (formerly Protection of Vulnerable Adults). An up to date copy of the procedure was held in the home for staff to refer to if necessary. The providers stated that they and one of their sons, had received training in the Safeguarding of Adults, but the certificates to confirm this were not available. The providers agreed to forward to CSCI, confirmation of this Cherry Tree House DS0000013597.V335193.R01.S.doc Version 5.2 Page 14 training. The remainder of the staff have not received this training and are required to do so. A small amount of money is held for safekeeping for two residents. The amounts held were checked with the record held and these accurately matched. A requirement has been made regarding Standard 18. Cherry Tree House DS0000013597.V335193.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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is furnished to meet the needs of residents, but areas of hygiene need to be improved to fully protect residents. EVIDENCE: The residents’ bedrooms are all on the ground floor and have been individually decorated. Residents are encouraged to bring their own belongings into the home to make their rooms personal, the providers stated. A recently vacated bedroom was seen and had been personalised with photos, pictures and ornaments. A combined lounge and dining room on the ground floor is available as communal space for residents to use and this was furnished in a homely style to suit the needs of residents. Cherry Tree House DS0000013597.V335193.R01.S.doc Version 5.2 Page 16 The providers stated that they replace and renew decorations and furnishings in the home as required, and do not formally hold a maintenance programme. New carpet had been recently fitted to one bedroom and was seen. It was observed that products hazardous to health were stored in an unlocked cupboard in the ground floor toilet and in the unlocked under-stairs cupboard, and these are referred to at Standard 38 which relates to health and safety. A laundry room is situated in a separate area of the premises and was equipped with the appropriate equipment. Personal protective equipment, including gloves and aprons are available for use by staff to prevent the spread of infection. It was noted that a separate hand-washing basin was available in the kitchen, but this was not being used as other items were stored in it. Paper towels were not available at this basin or in the communal toilet. It is required that these are provided and used, to prevent infection and the spread of infection. Requirements have been made regarding Standard 19 and 26. Cherry Tree House DS0000013597.V335193.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 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The provider and her family carry out all roles in the home and the recommended number of staff are NVQ trained. All staff need to undertake training to enable them to provide a safe standard of care to residents. EVIDENCE: As mentioned previously the home is managed by, and all roles are carried out by the provider and her husband. Their immediate family of two sons and two daughters also provide support and cover the home in the absence of the providers and no new staff have been recruited. The providers stated that as they or their family are always present they do not maintain a formal staff rota, although this is required. The providers or their family provide personal care and carry out all other roles, including shopping, cooking, laundry and housekeeping. Three of the six staff have undertaken and achieved a National Vocational Qualification (NVQ), to level 2 or above, to meet the recommended target of 50 trained staff. The provider and her husband have achieved NVQ Level 4 in Care and certificates to confirm this were seen. The providers stated that one of their sons has achieved NVQ Level 2 and a certificate to confirm this was seen. Cherry Tree House DS0000013597.V335193.R01.S.doc Version 5.2 Page 18 To ensure that family members are fit to work with vulnerable older people, Criminal Record Bureau (CRB) disclosures had been obtained for each person and a record of this was seen. No records were available to confirm that the staff in the home had undertaken any mandatory training courses, such as first aid, fire safety, food hygiene, medication or moving and handling. One family member stated that they had undertaken a first aid course outside of the home, as they are a volunteer with an organisation for young people. The date of this was advised but no certificate was available to confirm it. The providers stated that they would forward the confirmation of dates of any training undertaken. The lack first aid training for staff may have caused the delay in obtaining prompt treatment for a resident who recently fell. The accident record stated “nothing broken”, but the resident was subsequently found to have sustained a fracture. Treatment for this has since been obtained. The resident and staff groups are both made up of males and females and all are of British background. Requirements have been made regarding Standards 27 and 30. Cherry Tree House DS0000013597.V335193.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, 37 and 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home needs to be managed in a more robust way to ensure the health, safety and welfare of residents. EVIDENCE: The providers stated that they have owned and managed the home for many years and they have recently achieved the NVQ Level 4 in care. The number of shortfalls in the required standards noted at this inspection, indicate that the home needs to be managed in a more robust manner, to fully safeguard residents’ health, safety and welfare. A survey to ask residents their views on the quality of the service provided was about to be supplied to residents, the provider stated. The survey form was Cherry Tree House DS0000013597.V335193.R01.S.doc Version 5.2 Page 20 seen and consisted of three questions about the accommodation, food and ways to improve the service. It was noted from the last inspection report, that it had been planned to supply this to residents last autumn, but this had not been carried out. The last completed survey was carried out in 2004 and a copy of this was seen on file. A small amount of money is held for safekeeping by the providers on behalf of two residents. The amounts held were checked with the record held and these accurately matched. It was noted that the record for one of the residents was written on a single sheet of paper. It is recommended that a record book is obtained and used, as this is a more permanent record. The standard of record keeping in the home needs to be improved, as noted in regard to care plans, medication and staff rota. It was also noted that the inspector was not asked to sign in at the home, although it is required that a record is maintained of all visitors to the home, including the names of visitors. The accident record in use in the home does not meet the requirements of the Data Protection Act, and it is recommended that this is changed to a style that does meet these requirements. Information supplied in the pre-inspection questionnaire, indicated that systems and equipment in the home are serviced and maintained to safeguard the health and safety of residents and staff. As mentioned at Standards 19 and 26, shortfalls were noted in the standard of health and safety aspects of the homes’ management. Products hazardous to health were observed to be stored in two unlocked provisions, paper towels were not provided at wash-hand basins and the wash-hand basin in the kitchen was not available to use. The lunch-time meal was served during the course of the inspection and it was observed that the temperature of the hot food served was not recorded. The provider stated that this is usually recorded, but could not find recent records of this. It was noted that no hoist or other method of lifting residents was available in the home, in the event of a fall. The most recent entries in the accident record related to residents falling, but staff have not received training in moving and handling. An immediate requirement has been made regarding Standard 38 and other requirements have been made regarding Standards 31 and 33. A recommendation has been made regarding Standard 35. Cherry Tree House DS0000013597.V335193.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 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 1 10 3 11 X 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 2 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 2 X 2 1 Cherry Tree House DS0000013597.V335193.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 OP3 Regulation 14 Requirement The needs of all prospective residents must be assessed before they are admitted to the home, by a person suitably qualified or suitably trained. A copy of the assessment must be kept in the home. A written care plan must be drawn up for each resident, must be kept up to date and must reflect residents’ current and changing needs. Risks to residents must be assessed and recorded in a written risk assessment. The assessment must record measures to be taken to minimise any risks, must be kept up to date and must reflect residents current and changing needs. Arrangements must be made for residents to receive where necessary, treatment, advice and other services from health care professionals. The receipt of all medication into the home must be recorded. Records relating to medication DS0000013597.V335193.R01.S.doc Timescale for action 09/05/07 2 OP7 15 08/06/07 3 OP7 13 08/06/07 4 OP8 13 (1) (b) 08/06/07 5 OP9 13 (2) 09/05/07 Cherry Tree House Version 5.2 Page 23 6 OP26 13 (3) 7 OP27 17 Schedule 4 18 and 17 Schedule 4 8 OP30 9 10 OP31 OP33 12 24 11 OP37 17 Schedule 4 13 (4) (a) 12 OP19 OP38 must be kept to enable an audit trail to be followed. Arrangements must be made to prevent infection and the spread of infection. Paper towels must be provided and used in the home and wash-hand basins must be used for that purpose only. A copy of the staff duty rota must be maintained and must record the actual times worked by staff. Staff must receive training appropriate to the work they are to perform. This must include training in the Safeguarding of Adults and all mandatory training. A record of the training undertaken by staff must be kept in the home. The home must be managed to ensure the health, safety and welfare of residents. The views of residents and their representatives on the quality of the service provided must be obtained. The records specified in Schedule 4 of The Care Homes Regulations 2001 (As Amended) must be maintained. All parts of the home to which residents have access must be kept free from hazards to their safety. Products hazardous to health must be kept in a locked provision. 09/05/07 08/06/07 10/08/07 09/05/07 10/08/07 09/05/07 09/05/07 Cherry Tree House DS0000013597.V335193.R01.S.doc Version 5.2 Page 24 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 OP35 OP38 Good Practice Recommendations The records of resident’s monies held for safekeeping should be maintained on numbered pages or a book, to ensure all records can be accounted for. Accident records should be recorded in a manner that meets the requirements of the Data Protection Act. Cherry Tree House DS0000013597.V335193.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Cherry Tree House DS0000013597.V335193.R01.S.doc Version 5.2 Page 26 - 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!