Inspection on 12/09/05 for Cromer House

This inspection was carried out on 12th September 2005.

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

Cromer House 17/06/09

Cromer House 04/05/07

Cromer House 17/05/06

Cromer House 19/05/05

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Cromer House 15 Redan Street Ipswich Suffolk IP1 3PQ Lead Inspector Tina Burns Unannounced Inspection 12th September 2005 11:45 Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 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 Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. 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. Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cromer House Address 15 Redan Street Ipswich Suffolk IP1 3PQ 01473 226399 01473 226396 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) Aitch Care Homes Limited Mr James Boyd Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 The home may accommodate one person, whose name was made known to The Commission in June 2005, aged 17 years. 19th May 2005 Date of last inspection Brief Description of the Service: Cromer House is owned and operated by ACH Ltd. It provides 24 hour support for up to ten residents with learning disabilities. All bedrooms are single with en suite facilities. The home is situated near the centre of Ipswich with good access to community facilities and public transport. Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was a routine unannounced inspection, carried out on a weekday between the hours of 11.45am and 7.00pm. The Registered Manager was not present during the inspection, however the Deputy Manager and Assistant Manager fully contributed to the inspection process. The inspection involved a tour of the premises, discussions with staff and residents and the examination of four care plans and four staff files. The Inspector also looked at a variety of other documents including policies, procedures and medication records. What the service does well: What has improved since the last inspection? Since the last inspection the home has improved it’s recording of medication administered. Records seen were clear and complete and met requirements. The home had also improved its records of meals taken and alternatives offered and these were now sufficiently detailed. The panel of glass covering an area to the basement, and identified as a health and safety issue at the last inspection, had been appropriately fitted with a fixed guard. Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 6 Staff had received training in Physical Intervention and there was some evidence of strategies and risk assessments in place for staff working with individuals with challenging behaviours. 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. Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, and 5. Prospective residents can expect to have their needs assessed prior to admission, however they cannot be assured that their needs will be met without sufficient reviews and opportunities for trial stays. Residents can expect to have a contract which details the homes terms and conditions. EVIDENCE: During the inspection four residents care plans were examined. Each of them contained a copy of the homes Service User Guide. The guides were appropriate to the residents needs and provided clear information about the home and its services using plain language and pictures to aid understanding. Resident’s records contained comprehensive pre admission assessments and personal information. Local authority care managers had undertaken assessments of need and further information had been sought by the home via questionnaires. The questionnaires demonstrated that the home had consulted other relevant professionals, the individuals concerned and their relatives. The home had used the assessments to develop personal support plans and individual risk assessments. The deputy manager confirmed that prospective residents are welcome to visit and experience short stays before admission. However one resident, spoken with during the inspection, had not had the opportunity to visit or be involved Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 9 in the pre admission process due to being “placed” in emergency circumstances. That resident had not had their needs assessment kept under review despite difficulties in meeting their complex needs. It was also evident, through conversations with staff, that existing residents had not been offered a three month settling in period to assess the compatibility of residents and ensure the home could appropriately meet residents needs. Consequently, staff indicated that they had some concerns about the compatibility of existing residents. Contracts were seen to be in place and set out the terms and conditions of the home. Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9. Residents can expect to make informed decisions about their lives and matters in the home. They can also expect to be consulted about their plan of care, however care plans need to be developed to ensure residents needs and aspirations are met. Residents and staff cannot be assured that risks relating to challenging behaviour have been minimised. EVIDENCE: During the inspection four residents care plans were examined. Each plan contained detailed information about the resident’s needs, wishes and aspirations. The home had then used the information to formulate a list of priority goals, action plans and risk assessments. Generally, the four care plans examined were of a good standard and demonstrated the fact that residents had been involved in the development of their plans. However the inspector found that on two occasions, residents had identified their own priority needs and these needs had not been included in their support plans, consequently there was no evidence to indicate that these Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 11 needs were being met. It was also noted that daily records were not always detailed enough and did not reflect the action required from the support plans. Individual risk assessments were in place in each of the care plans seen. However the Inspector found that the risk assessment in place for one resident with challenging behaviour was not detailed enough and did not give sufficient information to enable staff to approach and respond to that resident safely and effectively. It was also identified that despite several incidents of violence towards other residents their personal risk assessments did not include risk of harm from challenging behaviour. Furthermore, there was not a sufficient risk assessment in place regarding the financial risk to one resident who collects two-pound coins in his room. This was a recommendation following the previous inspection. There was evidence that the home gives assistance to enable residents to make informed decisions about their lives. Residents had been consulted about their care plans and there were also records of residents meetings that had been used as a process to consult residents about matters in the home. Where residents decisions had been limited for their own safety and protection records were held within their care plans and supported by risk assessments. On the day of inspection staff were encouraging residents to participate in the domestic routines of the home and enabling them to make decisions about their daily lives, for example meal times and preparation, shopping and leisure activities. One member of staff described the home as having “a strong element of inclusion” and another said, “we work hard to give choices”. Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. Residents can expect to have opportunities for personal development and be encouraged to participate in appropriate social and leisure activities. Furthermore, residents can expect to be fully involved in the planning and preparation of their meals. EVIDENCE: Care plans evidenced that residents have access to a wide range of opportunities to maintain and develop social and independent life skills. Staff confirmed that residents are given opportunities within the house and wider community to fulfil their needs and goals. On the day of inspection residents were observed being actively encouraged to practice their skills with appropriate support. Residents were seen participating in the day to day activities within the home but were also seen coming and going throughout the day to school / college and the local shops. Cromer house has only been open since January 2005 and as such all of the residents were fairly new to the home. The staff confirmed that they were supporting residents in the development of structured weekly programmes and Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 13 gave examples of some of the activities being considered including college and further education courses. Care plans evidenced that residents are supported to ‘get out and about’ on a daily basis. As well as local facilities such as the shops, cinema and football ground, the residents have enjoyed travelling further a field in the homes own ‘people carrier’. Residents spoken with said that they had enjoyed visiting Felixstowe, Southwold, Dunwich, the zoo, bowling and pub meals. Conversations with staff and residents indicated that the home provided good support to maintain family relationships and offer opportunities to create and maintain social networks. However, this was not always reflected in the care plans and daily records. On the day of inspection staff were observed respecting service users rights to privacy. Bedrooms were not entered without resident’s permission and all communication observed between staff and residents demonstrated that staff were respectful and polite. The home had a communal kitchen, which was seen to be clean and hygienic with sufficient facilities. Staff reported that the residents are encouraged to participate in preparing and cooking their own meals and this was observed on the day of inspection. Staff and residents confirmed that residents are involved in shopping for groceries and able to chose their own meals with encouragement and advice about healthy and balanced diets. Records of meals taken and choices offered were seen and satisfactory. Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 The home has appropriate arrangements in place for ensuring residents health needs are met and personal support is provided according to individual’s needs and wishes. EVIDENCE: Care plans, daily records and conversations with staff and residents indicated that staff provide personal support appropriately to individuals. Support was being provided flexibly and in consultation with residents. Staff reported that there were no fixed times for meals, getting up, going to bed or any other activities. Observations on the day of inspection were that residents were supported according to their needs and wishes. Individual care plans identified health care needs and included formats for monitoring health and weight and records of medical visits such as GP’s, community nurses and outpatient appointments. Medication records were examined and seen to be accurate and complete. On the day of inspection medication was appropriately stored in a locked cabinet in the office and held in the original containers marked with the date of Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 15 opening. There were also clear protocols in place providing guidance to staff on the administration of ‘as required’ medication. Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The home has appropriate complaints procedures in place but residents cannot be assured that there are sufficient strategies in place to protect them from harm. EVIDENCE: The home has a complaints procedure in place and this is summarised in the Statement of Purpose and Service User Guide. It includes information on how to make a complaint and the stages and timescales of the complaints process. The complaints procedure was available in different formats to ensure that residents could understand it. Staff spoken to confirmed that they had training on the protection of vulnerable adults as part of their induction and the deputy manager confirmed that the home works within the guidelines of the Suffolk Inter Agency Policy and Procedures for the protection of vulnerable adults. Staff also confirmed that they had training in relation to dealing with challenging behaviour and physical restraint. Records of incidents were seen during the inspection and discussed with the deputy manager. It was confirmed that since the previous inspection there had been 13 incidents of violence by one resident. These included 7 acts of violence to other residents, 1 to a member of staff and 5 of damage to the property. The care plan relating to the individual concerned did not contain sufficiently detailed guidelines to ensure that the individual is supported safely and effectively by staff, neither were there risk assessments in place to ensure the safety of other residents. Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 17 The home had a Physical Intervention Policy written by ACH Ltd in place but this had not been used by the home to develop clear advice to staff trying to manage aggressive behaviour. However, training records and conversations with staff indicated that physical restraint training had taken place. Staff records contained evidence of appropriate recruitment checks including Criminal Record Bureau Disclosure Checks. Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 29 and 30. Residents can expect to live in a clean, comfortable and safe environment with a good standard of facilities to meet their individual needs. EVIDENCE: During a tour of the building all areas were seen to be clean and hygienic and the home was modern, spacious and freshly decorated throughout having been refurbished before opening in January this year. Generally the home was well maintained although there was a large window in the dining room boarded up and waiting replacement following damage by a resident. Furniture and fittings were in keeping with the style and décor of the home and created a comfortable and homely environment. Four bedrooms were seen during the inspection, each had an en-suite bathroom or shower with washbasin and WC. All were spacious and individually decorated and reflected the resident’s likes, dislikes and interests. Residents had been supported to personalise their rooms with their own belongings, for example photographs, computers and televisions. Residents were able to have a key to their own room unless identified as a risk and agreed in their care plan. Residents spoken with on the day of inspection indicated that they were Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 19 happy with their rooms and seemed to enjoy the privacy and independence they offered. All bathrooms and WC’s were well decorated and spacious with suitable working locks. The deputy manager reported that one of the communal baths was soon to be replaced with a specialist bath to meet the needs of a new resident due to move in soon. Some other adaptations had been made to the home, including access ramps for the same resident. The home also had a shaft lift that provides access to the first floor and level access throughout the building. Staff confirmed that residents are encouraged to participate in the laundering of their own clothes and bedding. The laundry facilities were sufficient and provided a commercial washing machine that could be set up to 90 degrees centigrade, and a tumble dryer. The laundry room was clean, hygienic and free from any obvious hazards. Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Residents can expect to be safeguarded by the homes recruitment procedures and be supported by an effective and committed team of staff. EVIDENCE: Staff spoken with on the day of inspection were clearly committed to training and development and reported that they had received comprehensive induction programmes to ensure that they were equipped to ‘do the job’. Training records reflected that training had taken place and included Moving and Handling, Health and Safety, Fire Safety, Abuse Training, Medication training, Understanding Epilepsy, Foundation Certificate in Food Hygiene, First Aid, Confidence to Care, Autism, Child Protection and restraint training. Discussion with the deputy manager and other staff regarding the needs of one resident suggested that there was a need for specialist training in relation to Asperger’s syndrome to enable the individual to be appropriately understood and supported. The deputy manager confirmed that there is a minimum of five staff on duty each shift to provide support to the residents. At times this includes the manager, the deputy manager and the assistant manager, at other times they are supernumerary. The staff rota examined on the day of inspection reflected this. Staff spoken with all had previous relevant experience before joining the team and were very positive about the mix of knowledge and skills amongst the team. Their comments included ‘it’s a good team, very cohesive…’, ‘People Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 21 are genuine, they are here because they like the job and it shows’ and ‘there are lots of very experienced staff here’. Staff reported that staff meetings take place and include agenda items such as admissions, transitions, staff issues, resident’s holidays, health and safety issues and staff training. Four staff files were examined during the inspection. They all contained evidence of thorough recruitment procedures including two written references, Criminal Record Bureau Disclosure Checks and personal identity documentation. Staff records also included copies of supervision contracts and individual supervision’s. Staff spoken with confirmed that they had regular supervision and felt supported by the management team. Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 Residents can expect to be consulted about life in the home. Care practices reflect that the health, welfare and safety of residents are promoted. EVIDENCE: Residents care plans, daily records and minutes of residents meetings demonstrated the homes commitment to actively seeking the views of residents. The home had also recently completed an annual quality assurance review which had included some consultation with residents, relatives / advocates, other professionals and staff. The inspector found that the Quality Assurance Review report was a general summary of achievements since the opening of the home and did not include an action plan based on the results of the review. The homes policies and procedures were available for inspection and included health and safety codes of practice. Staff spoken with and training records examined also evidenced that the home ensured staff had essential health and Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 23 safety training during their induction programme including Manual handling, Fire Safety, Food Hygiene and First Aid. Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 2 1 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 1 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 4 4 4 X 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cromer House Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score X X 3 X X 3 X DS0000062387.V250518.R01.S.doc Version 5.0 Page 25 Are there any outstanding requirements from the last inspection? None 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 9 and 23 Regulation 13.4 13.6 Requirement The Registered Manager must ensure that individual risk assessments are carried out to safeguard residents from challenging behaviour. The Registered Manager must ensure that the strategy plans in place to support a resident in the management of their challenging behaviour are more detailed so that staff can approach and respond to him safely and effectively. The Registered Manager must ensure that needs assessments are kept under review and revised any time that it is necessary. Timescale for action 14/09/05 2 6 12.1 14/09/05 3 3 14.2 14/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard 39 Good Practice Recommendations The Annual Quality Assurance Review should be developed DS0000062387.V250518.R01.S.doc Version 5.0 Page 26 Cromer House 2 32 3 4 5 6 9 6 6 4 into a process that includes a systematic cycle of planning, action and review. The staff training programme should include Aspergers Syndrome to enable staff to develop the skills and knowledge necessary to support individuals with Aspergers Syndrome. Individual risk assessments should include arrangements about the safekeeping of resident’s money. Daily records should consistently reflect the activities agreed in the residents personal care plan. Residents care plans should be developed to include their priority personal goals and aspirations. Prospective residents should have a minimum three month ‘settling in’ period, followed by a review of the trial placement and assessment of compatibility. Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 Cromer House DS0000062387.V250518.R01.S.doc Version 5.0 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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