Inspection on 22/09/05 for Cravenside

This inspection was carried out on 22nd 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

Cravenside 04/06/08

Cravenside 11/07/07

Cravenside 02/05/06

Cravenside 20/04/05

Cravenside 07/10/04

Cravenside 05/04/04

Cravenside 09/09/03

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

CARE HOMES FOR OLDER PEOPLE Cravenside Lower North Avenue Barnoldswick Lancs BB18 6DP Lead Inspector Keren Nicholls Unannounced 22 September 2005 9.00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Cravenside Address Lower North Avenue Barnoldswick Lancs BB18 6DP 01282 816790 01282 853620 karen.mason@careservices.lancscc.gov.uk Lancashire County Care Services Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Julie Burns Care Home 44 Category(ies) of PD Physical disability 6 registration, with number DE(E) Dementia - over 65 years of age 15 of places OP Old age 21 MD(E) Mental Disorder, excluding learning disability or dementia over 65 2 PD(E) Physical disability over 65 years of age 6 Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should at all times employ a suitably qualified manager who is registered with Commission for Social Care Inspection 2. Within the overall total of 44, a maximum of 21 service users requiring personal care who fall into the category of OP (either sex) 3. Within the overall total of 44, a maximum of 15 service users requiring personal care who fall into the category of DE(E) (either sex) 4. Within the overall total of 44, a maximum of 2 (named) service users requiring personal care who fall into the category of MD(E) (female) 5. Within the overall total of 44, a maximum of 6 service users requiring personal care who fall into the category of PD(E) for intermediate care only (either sex) 6. Within the overall total of 44, a maximum of 6 service users requiring personal care who fall into the category of PD for intermediate care only (either sex) Date of last inspection 20 April 2005 Brief Description of the Service: Cravenside provides 24-hour accommodation and care to older people, older people who also have a dementia and people needing rehabilitation care and day care. The home is owned and managed by Lancashire County Care Services, which is a Lancashire County Council direct services organisation. The home is located near to Barnoldswick town centre, with footpath access to the town centre shops and other amenities. The home looks out onto a green and has an enclosed protected garden at the front. There are sitting areas and a car park by the front entrance. The premises are purpose-built, comprising two ground floor and three first floor residential units (accommodating between 6 to 8 people per unit) and a first floor day care lounge. There is a passenger lift. Two of the ground floor Units are home to older people who also have dementia. Each Unit has single bedrooms, a bathroom, toilets and a communal lounge/dining area with integral kitchen (for light meals and snacks). The day care space may be used by all residents and consists of a large activites/dining room and hairdressing salon. The home has separate smoking rooms on both floors. The main kitchen and pay telephone are located on the ground floor. The home provides limited car and mini-bus transport (booked in advance). Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days. A total of 12.40 hours were spent at the home. During this time the inspector spoke to 16 residents, staff on duty, the manager and senior staff. She read written information, including records, looked at the rehabilitation unit, observed care practices on the dementia care units and looked round the building. Two residents and one relative returned comments cards and one person’s relative wrote a letter to the Commission. Since the last inspection, the Commission has received a complaint about the laundry service. This was investigated by the home, but is not yet fully resolved. What the service does well: What has improved since the last inspection? A new manager had been registered with the Commission. She had improved care plan review in consultation with residents and was involved in rehabilitation review meetings. Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 6 Staff had introduced a monthly newsletter, to ensure that everyone had up to date information about what was going on in the home. Residents’ lives had been enhanced by the provision of reminiscence photographs. The staff training and development programme had progressed, with several more staff enrolling on an NVQ course and undertaking health and safety training. What they could do better: The home’s fire procedures were not being followed. The current practice was not safe and residents and staff did not know what they should do in the event of a fire. An official letter was left at the home to tell the manager that this must be put right within the next seven days or enforcement action would be taken. Appropriate action was taken in the timescale. The manager should ensure that she tells prospective residents, in writing, how the home will meet their needs, before they are admitted. The care plan format was difficult to follow and did not include some problems identified by residents. Plans and care diary recording could be improved so that staff and residents know exactly what needs to be done to ensure that resident’s needs are fully met. Residents on the rehabilitation unit would have liked more information about the home prior to their stay, and would like to meet staff as part of the assessment process. It was also recommended that in order to protect the safety and welfare of residents that all staff working on this unit should have specialist rehabilitation, first aid and safe administration of medicines training. The bathrooms in the dementia care units need altering to ensure that all the residents can use them in comfort. Complaints about the laundry service have not been fully resolved. The manager should improve the laundry service, to ensure that clothes do not go missing and linen and clothing is returned to residents in a satisfactory condition within a reasonable time. Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 7 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. Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 9 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 standard(s) 1, 3, 4, 5 and 6 There was a good admission process, including assessment by trained people, which ensured that prospective residents had appropriate information about the home and that they could be sure their needs would be met. However, clients of the intermediate (rehabilitation) unit had insufficient information to enable them to make an informed choice about whether Cravenside was the right place for them. EVIDENCE: The home had prepared a suitable Service User’s Guide (giving information about living at the home and about the complaints procedure), which had been given to residents and/or their representatives. Residents, or their relatives had visited the home prior to their admission and were satisfied that they knew what the home offered. The manager and other trained people had assessed needs before admission, to ensure they could be met at Cravenside. The residents on the rehabilitation unit had not been given the service users guide. Although they understood about the rehabilitation process, residents said that they would have liked a pre-admission discussion with the staff and written information about the home, as they “didn’t know what they were coming to”. Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 10 All residents knew that they could have a ‘trial’ visit and some people knew the home well from previously attending day care. One person commented that he had a trial stay of two weeks, but felt the discussion about permanency following this had been insufficient. The trial period reviews should be recorded and show how residents have been consulted and their wishes taken into consideration. The manager was reminded that she must ensure that following assessment, she confirms in writing to new residents that the home can meet their needs (see Regulation 14 (d)). The residents of the intermediate care (rehabilitation unit) wished to say that the staff were a “really good bunch” and that they were very happy with all aspects of the home, including the food, cleanliness, staff attitude and competence and the premises. This unit provided appropriate care to enable residents to return home and live more independently. Most, but not all staff had undertaken specific training in rehabilitation care. Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 11 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 standard(s) 7, 8, 9 and 10 There were satisfactory arrangements for identifying and meeting residents’ needs and for respecting their privacy and dignity. In order to fully meet needs, care plans could be improved. Medication practices had improved, but all staff should be trained prior to administering medicines, to ensure risks are minimised. EVIDENCE: A new monthly care plan review ensured that changing needs were identified and health and personal needs were met. Care plans and care diary records were variable and the layout difficult to follow. Some could be improved by providing details based on needs assessment and by grouping needs together. Care plans and notes should state why a course of action is to be, or has been followed and what effect a care practice had. Several people on one unit described a situation that was badly affecting their lives resulting in emotional needs not being met, but was not recognised in their care plans. Everyone spoken with thought their privacy and dignity was respected, that staff were kind and courteous and they felt well cared for. It was recommended that staff ensure prompts such as the day/date boards on the dementia care units are correct. To minimise risk, the rehabilitation unit staff should be trained before administering medicines. Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 12 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 standard(s) 12 to 15 Social activities within and outside the home provided daily variety and interest. Staff positively enabled residents’ contact with family and the local community. Meals were of good nutritious quality, offered choice and were enjoyed by service users. Practices at the home ensured that residents had choices and control over their lives. EVIDENCE: Residents said they were very happy with the range of activities. Several enjoyed attending day care for quizzes, word games and exercises. Some residents were out visiting a butterfly farm on the second day of inspection. Activities, such as pie and peas supper, mini market and Halloween party were organised and residents had access to books, TV, videos and music. Reminiscence photographs had been provided on the dementia care units. Everyone said that visitors were made welcome and they could meet people in private if they wished. Residents said they could be alone and undisturbed in their rooms and staff respected their privacy when helping them with personal care. Residents said they got up and went to bed and went out when they chose and they chose how to personalise their own rooms. Most people managed their own finances, with support from family. The meals were singled out for particular praise, with comments such as “marvellous”, “plenty of choice” and “absolutely first class”. Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 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 standard(s) 18 Robust procedures were in place to respond quickly to suspicion or evidence of abuse. Staff had a good understanding of how to protect residents and ensure their safety. EVIDENCE: The home had thorough adult protection procedures, based on ‘No Secrets in Lancashire’ guidance. These documents set out the response should there be any allegations or evidence of abusive practice. Practices and procedures protected the financial affairs of residents. The manager reported that the majority of staff had received training in protecting the service users and training was ongoing. Staff spoken with had a good understanding of protection issues (including ‘whistle blowing’). Staff were properly supervised and procedures for referral of staff unsuitable to work with vulnerable adults to the Protection of Vulnerable Adults register were in place. However, it was not clear from discussion with residents and staff, or from care records that verbal and physical aggression by one resident was being dealt with appropriately either for the person concerned or for others. The manager was advised to investigate and bring about action that meets the needs of all the residents concerned. Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 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 standard(s) 19, 21, 22, 23, 24, 25 and 26 The home had an excellent standard of cleanliness throughout. Communal areas and bedrooms inspected were odour-free. Aids and adaptations helped residents with independence. There were no obvious hazards to safety and the building and grounds were maintained in good order, providing a safe, comfortable and ‘homely’ environment. The bathrooms on the dementia care units do not meet the current resident’s needs and the laundry system remains problematical. EVIDENCE: The décor, furnishings and the majority of furniture was domestic in character and conveyed a ‘homely’ feel in the Units. The home was warm and bright. Private bedroom accommodation was inspected with the permission of the occupants. Bedrooms were clean, comfortably furnished, nicely decorated and carpeted and personalised with the personal possessions. Each reflected the occupant’s interests and personality and residents said they were very happy with and comfortable in their bedrooms, which they used at any time they wished and could keep secure and private with a door lock. Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 15 Bedrooms were not en-suite, but night commodes were provided and toilets and bathrooms were near to living and bedrooms. Except for those on the dementia care units, bathrooms were spacious and clean, with aids and adaptations to enable independence and to suit the needs of disabled people. The dementia care unit bathrooms were too small to meet the needs of residents who needed to use a wheelchair and to have staff assistance. Consequently, some residents were being denied the opportunity and choice of having a bath on their unit and had to use facilities on upstairs units. The manager explained that extensions to the bathrooms are under discussion with the Lancashire County Care Services property team, but no progress had been made since the last inspection. The laundry service had not significantly improved since the last inspection. On the second day of inspection, staff shortages meant that washing tasks were not completed in the morning, resulting in a backlog of dirty laundry. Staff reported difficulty in leaving residents unattended to complete laundry duties and the service to residents was suffering with spoilt and missing clothing. The importance of respecting clothing and linen as part of respecting resident’s dignity was discussed with the manager. Ways to improve could include: • • • • • • • Care staff undertaking more cleaning tasks on the unit, so freeing domestic time for laundry; a designated worker each day to spend time in the laundry; residents and staff doing laundry work together as part of skills maintenance and independence; providing washing machines on each unit; using volunteers; including residents’ laundry requirements in their care plans; each unit having planned designated laundry days. Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 A well trained, competent and motivated staff team met resident’s needs. EVIDENCE: Rotas confirmed that there were normally sufficient staff for there to be a member of staff on every unit, with an extra person ‘floating’ between the two dementia care units. On the second inspection day, unexpected sickness absence resulted in a shortfall on day-care and the dementia unit. Residents said that they were very happy with the staff. Various people said “the staff are lovely”, “kind”, “helpful” and “very nice”. Residents clearly enjoyed good relationships with the staff. Staff were observed to treat residents with patience and respect. Residents thought staff met their needs, but some commented that they would like staff to sit down and talk with them more, especially if they were in bed and not feeling too well. The domestic staff were busy, and as mentioned in the previous section all staff were finding it difficult to find time to provide a satisfactory laundry service. The cook commented that cleaning assistance in the main kitchen was limited and some cleaning tasks, such as the walls and fly screens were not completed as often as she would like. However, the staff team were maintaining satisfactory standards of hygiene and cleanliness. There was a good training and development programme for all staff, which ensured that everyone was competent to do their jobs. Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 34 and 38 A manager, newly registered with the Commission, provided appropriate leadership and ensured that Cravenside was run in residents’ best interests. Good staff training and policies and procedures protected residents’ health and safety. However the fire safety procedure was not followed, which did not properly protect residents’ welfare. EVIDENCE: An experienced and qualified manager had recently been registered with the Commission. Residents and staff had a good opinion of her qualities and skills and thought she was approachable. She had put into practice a new care plan review system, which had improved consultation with residents. She intended to continue to update her knowledge and skills by attending a higher-level dementia care training course. Comprehensive policies and procedures, staff training and good record keeping underpinned health and safety issues at the home. However, the fire procedure was not followed, resulting in potential risk to residents. Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 18 The home had sound accounting and financial procedures and appropriate up to date insurances. However, the business and financial plans were out of date, the plan for the Lancashire County Care Services being for 2004 and the business plan for Cravenside 2002. Up to date plans should be made available for inspection, so that residents can be sure that the home is able to meet the commitments specified in the home’s Statement of Purpose. Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 2 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION 3 x 2 3 3 3 3 2 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 3 x x 2 x x x 2 Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 20 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 5(1)(2) Requirement The manager must give a copy of the service users guide to every service user, including those using the rehabilition unit The manager must confirm in writing to every service user that, following assessment, the home can meet their needs. All the staff who administer medicines on the rehabilitation unit must have appropriate accredited training Suitable bathing facilities, which meet the needs of the residents must be provided in the two dementia care Units. (Timescale of 31/7/05 not met). Fire drills and practices must be held at suitable intervals and that staff and (as far as practicable) service users are aware of the procedure to be followed in the event of a fire, including the procedure for saving life. (Timescale of 30/4/05 not met). Timescale for action Prior to admission As part of the admission process Prior to administering medicines 31/12/05 2. 4 14(d) 3. 9 13(2) 4. 21 23(j) 5. 38 23(4)(e) 29/9/05 and at appropriate regular intervals in the future Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 21 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 6 7 Good Practice Recommendations That all the staff working on the intermediate (rehabilitation) unit undertake specific training (6.3) That residents care plans more closely follow their needs assessments and that all plans should detail the action that should be taken by care staff to ensure that health, personal and social care needs are met (7.2) That the manager investigates incidents of aggression by a resident on one unit and ensures that appropriate action is taken to meet the needs, safety and protection of everyone on the unit (18.5) This recommendation carried forward from the last inspection: That the manager improves the laundry service to ensure hygiene standards are maintained and that the service meets the needs of the residents (26.1) The manager should ensure that there is a business and financial plan, open to inspection and reviewed annually (34.5). 3. 18 4. 26 5. 34 Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 22 Commission for Social Care Inspection Unit 4 Petre Road Clayton-le-Moors Accrington BB5 5JB 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 Cravenside F57 F07 S35008 Cravenside V247663 20.9.05 Stage 4 doc.doc Version 1.40 Page 23 - 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!