Inspection on 16/12/05 for Dalvington

This inspection was carried out on 16th December 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 no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dalvington 27/07/07

Dalvington 03/07/06

Dalvington 20/05/05

Dalvington 06/12/04

Dalvington 16/06/04

Similar services:

Polesworth Group Friary Road

Polesworth Group Pooley Heights

Polesworth Group 32 Station Road

Polesworth Group 70 Long Street

Breme

Polesworth Group 64 Long Street

Polesworth Group 68 Long Street

10 Whitfield Avenue

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

CARE HOME ADULTS 18-65 Dalvington 146 Lower Howsell Road Malvern Worcestershire WR14 1DL Lead Inspector P Wells Announced Inspection 16th December 2005 10:30 Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 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 Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 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. Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Dalvington Address 146 Lower Howsell Road Malvern Worcestershire WR14 1DL 01886 833424 01886 833684 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) Elizabeth Fitzroy Support Care Home 15 Category(ies) of Learning disability (15) registration, with number of places Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. This service is primarily for people with a learning disability but may accommodate people who also have an additional physical disability 20th May 2005 Date of last inspection Brief Description of the Service: The registered provider of this home is the charity ‘Elizabeth Fitzroy Support’. A service is offered to a maximum of fifteen adults between the age of 18 years and 65 years with learning disabilities and physical needs. Accommodation is divided into three units. Dalvington is the main unit. All facilities there are on the ground floor and seven people with moderate to heavy dependency needs can be accommodated. The Willows is a first floor flat within Dalvington that can accommodate two people with minimal care needs and good mobility. The Oaks is a separate and can accommodate six people who are less dependent than those in Dalvington and more dependent than those in The Willows. The entire complex is known as Dalvington and is registered as one establishment called Dalvington. Mr Neil Taggart, the Director of Operations, is the responsible individual for the registered provider. The registered manager, Mrs Sue Vials was promoted to area manager in mid August 2005 and the organisation have been advertising for a new manager. Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine, announced inspection that took place during the day of 16th December 2005. It was announced so that representatives from Elizabeth Fitzroy Trust (EFT) could be present to discuss the plans to upgrade some of the facilities in the home. Time was spent preparing for the inspection – reading the comment cards received, pre inspection questionnaire from the home and reports of the area manager’s monthly visits to the home. Six hours were spent at the home. The focus of the inspection was to discuss the service, in particular the plans for improving the laundry, bathroom, toilet and office facilities (previous requirements) and the new management arrangements. Also to meet with the service uses in The Oaks (whom had been out at the last inspector’s visit). Mrs Sue Vials, area manager, Ms Debbie Barnes, acting manager and Ms Sarah Rossbotham, assistant manager were present. A new manager had been appointed, Mr Lawrence Dolby, who was due to start working at the home on 20th December 2005. His application to register as manager with CSCI is expected. EFT has decided not to fill the Dalvington vacancy, for the time being, which has allowed for the offices to be temporarily re-located into the spare bedroom. This meant work could commence in The Oaks on the new laundry and in Dalvington on the new shower room. A separate medication room has been set up in Dalvington in one of the old offices. The co-operation and time of the managers, service users and staff was appreciated. What the service does well: The service provides a permanent home for up to fifteen service users who have differing needs and disabilities in three units – Dalvington (6), The Oaks (6) and The Willows (2). The atmosphere is relaxed, caring and safe. The staff are experienced and most have worked at the home for some years so know the service users well. The service users `are offered care and support with their individual needs and there is a range of activities in and out of the home. The response to the comment cards sent out by the home, on behalf of CSCI, was high. With support, 12 of the service users replied. The service users living in The Oaks indicated on the cards and at the visit that they were contented with the service they received. The service users living in Dalvington replied that on the whole they were contented but sometimes felt Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 6 there could be improvements. The 10 relatives who replied were satisfied with the overall care provided, with 2 very satisfied. 9 commented that they had not needed to make a complaint. Some of the relatives commented on the following – insufficient staff on duty (5), did not know about the inspections (3), did not know how to make a complaint (2), most of the time kept informed about our relative (1) and did not know of the inspection reports (1). A GP, dentist and 4 of the 6 health care professionals were satisfied with the overall care provided. What has improved since the last inspection? What they could do better: Update the statement of purpose and service user guide then circulate copies to the service users, their representatives and CSCI. Review and improve the service user plans in Dalvington, especially for those service users with special needs. Introduce person centred plans and health action plans for each service user. Review the mix of service users in Dalvington. Ensure that are sufficient staff on duty to meet the varying needs of the service users and allow for them to be involved in activities in and out of the home. Complete the alterations within the agreed timescale. Offer the staff more training opportunities in particular NVQ’s in care. Arrange for the new manager to apply for registration with the CSCI. Establish a recognized quality assurance system into the home. Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 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. Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 8 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 Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 9 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): EVIDENCE: These standards were not assessed on this occasion as there had been no new admissions since December 2004. Copies of the revised statement of purpose and service user guide had not been sent to CSCI, as previously recommended. However these documents will need to be further updated to include details of the new manager and alteration to the buildings. Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 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 Appropriate information was being kept to ensure that the service users assessed needs and goals were known to the staff and consistent care was provided. However in one unit the service user plans needed to be developed. Service users were encouraged to make decisions about their daily routines but some aspects should be reviewed. EVIDENCE: These standards were previously assessed, so on this occasion a sample of service user plans and their risk assessments were viewed. The files for service user living at The Oaks had been reviewed and appeared to appropriately outline the individual needs of service user and how their needs were to be met. The files in Dalvington needed further attention in particular the recording of incidents and management of special needs/challenging behaviour for any service user. Person centres plans were being compiled by staff and need to involve the service users as much as possible and be in a suitable format for them to contribute and own. See page 15 regarding health action plans. Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 11 The service users living in The Oaks indicated on the comment cards and at the visit, that they were contented with the service they received. The service users living in Dalvington replied that on the whole they were contented but sometimes felt their privacy could be better respected (5), they were not safe (4), they did not like living here (3), the activities could be more suitable (3) they were not well cared for (2) and one person would like to be more involved in the decision making of the home. At this visit the inspector learnt that there was continuing incompatibility within the Dalvington group and perhaps the above comments from the service users reflected this. The area manager explained that every effort had been made to assess, review and resolve this, with input from health care professionals. This was commendable. However this situation needs resolving so that the group feel relaxed and staff have sufficient time to look after them. A health care professional also commented on this situation. Although the service users had their own bank/building society accounts, the manager was still the appointee for the majority of service user and this needs reviewing. Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 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): 11,17 The service users were supported to participate in activities in and out of the home and had opportunities for personal development. The service users were offered varied meals and snacks, according to their individual dietary needs. The records to evidence this needed more detail in some aspects. EVIDENCE: These standards were assessed previously and met. On this occasion the inspector met with the service users in The Oaks prior to them going out for lunch. They spoke of attending college, day centres, using the sensory room in Dalvingtion and of their regular music session on Thursdays (the home have a supply of musical instruments and a piano). Both Dalvington and The Oaks continue to have activity organisers who, in consultation with the service users arrange activities in and out of the home. Time was briefly spent individually with a few of the service users in Dalvington. In both units there were menus that indicated that service users were offered a varied and nutritious diet, taking into consideration individual dietary needs, likes and dislikes. The support workers cook as catering staff are not Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 13 employed. If able (as in The Willows), service users do assist with preparation of food and drinks. The Oaks service users were involved planning the menus with pictorial menu books. An individual record of the food provided for service users was kept. However this should include more detail about the vegetables served. It was pleasing to hear that a local greengrocer was going to start delivering the fruit and vegetables. The record of food provided for service users in Dalvington was not always kept up to date and detailed. The system for recording needs reviewing, as previously recommended. Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 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): 19,20 The service users were receiving appropriate support with their health care needs. Relevant records were in place to evidence this although in some aspects these records needed developing. The medication system in Dalvington had improved. Consideration should be given to reviewing the arrangements for physiotherapy. EVIDENCE: It was apparent through discussion, observation and reading a sample of service user plans that the individual health care needs of the service users continued to be met. The home has good links with health care professionals and refer to them when problems arise. Health action plans had been partially introduced but not as envisaged with the service user retaining their own plan, taken with them to health appointments and being kept up to date. It was recommended that staff have training in implementing these plans from the Worcestershire Heath Action Planning team. Then each service user could have their own health action plan file, which would compliment the records kept in the home. The managers were fully aware of the service users who may display challenging behaviour and how this should be managed and recorded by staff. Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 15 However in one example detailed records were not being kept to indicate how often an incident occurred, was managed and the impact on the individual, other service users and staff. The medication system had been inspected routinely, in June, by the local pharmacist, and a CSCI pharmacist inspector also visited. It was pleasing at this visit to view the new, improved storage arrangements for medication in Dalvington and to learn that the requirements and recommendations form the pharmacist inspector had been implemented. The home can arrange private physiotherapy sessions for individual service users. There is not a physiotherapist employed by the home. A health care professional commented on the limited physiotherapy sessions for service users. Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 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): 22,23 There was a suitable procedure in the home to explain how service users and their representatives could complain. Most knew who to speak to if unhappy. There were also systems in place to ensure the service users were being protected. EVIDENCE: The home had a suitable complaints procedure. The comment cards indicated that the majority of service users and their relatives knew of the complaints procedure and how to raise a concern. The managers advised that there had been no complaints since the last visit, although it was known that some service users had raised concerns about about compatibility in the Dalvington group. The mangers were very aware of this and endeavouring to address the issue. The home had procedures for protecting vulnerable adults. The organisation run courses regularly for senior staff and support workers relating to protecting vulnerable adults and managing challenging behaviour. Some staff had attended a training course this year and it was anticipated that another course would be run in Birmingham, which other staff could attend. Difficult situations were managed without the use of physical intervention. Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 17 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 The units were maintained and comfortable for the service users. The upgrading of some of the facilities will be beneficial to both service users and staff. EVIDENCE: Dalvington and The Oaks were warm, clean, safe and bright. For details of the accommodation, see previous report. Some of the service users showed the inspector their bedrooms, which were a good size, suitably furnished and personalised with the service users having chosen the décor. The sensory room had been developed and was a useful resource for all the service users. Discussions focused on the upgrading that has just commenced to improve the bathroom and toilet facilities in Dalvington and install a laundry in The Oaks. Also to provide a separate place for storing and re-charging wheel chairs. Environmental Health had been consulted and Elizabeth Fitzroy Support has appointed a person to oversee this project. Once planning permission has been granted, a temporary building will be erected to provide offices, computer room and further storage space. Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 18 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 The service users were being supported by a staff team who were suitably recruited and had relevant experience, skills and training. More staff should be able to complete NVQ’s in care. The staff vacancies needed to be filled so that the home had a full compliment of permanent staff rather than regularly using relief and agency staff. EVIDENCE: Each unit has it’s own staff group led by an assistant manager with support workers, activity support workers and night staff. The service also has a maintenance person. There had been some staff changes but many of the staff were experienced and had worked at the home for some years. Due to vacancies and sickness, relief and agency staff were being used but the home endeavoured to use the same workers who would know the service. Some of the relatives and health care professionals commented that there they had observed staff shortages and this situation needs to be addressed by the management. The staff spoken with were clear about their duties and responsibilities. The organisation offer a rolling programme of training courses for both support workers and seniors but not locally. It is anticipated that courses will be arranged in Birmingham. New staff undertake the organisation’s induction programme, which includes LDAF. 5 staff had an NVQ in care and 6 were on Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 19 NVQ courses. The home was not yet meeting the recommended level of 50 of staff having an NVQ level 2 or 3 in care. Many of the staff had undertaken training in safe working practices (see page 22) and caring for service users with learning disabilities. A sample of staff files were viewed and it was evident that a suitable recruitment process was adhered to. The staff files were clear and the description given to applicants ‘a day in the life of a support worker’ commendable. Supervision of staff was undertaken by the senior staff the home. Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 20 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): 37, 39, 42 The home will benefit from having a full-time manager. The company need to introduce a recognized quality assurance system. The home had suitable systems in place to ensure the service users’ health and safety were protected. Staff were trained, and familiar with safe working practices. EVIDENCE: The registered manager had been promoted in mid August and since then the home had managed with a senior member of staff acting up. A new manager had been appointed who was due to start on 20th December 2005. Hence this standard could not be assessed. The home does not have an annual development plan.. However the area manager considered the home was audited through her monthly visits and reports (which CSCI have been receiving), feedback to the home and organisation, the five year service evaluation, the health and safety checks. The area manager explained that the service was using the REACH standards, a quality assurance tool that seeks the views of service users and people Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 21 important to them. Service users surveys had been completed but not analysized and letters were being sent out to stakeholders. The standard on safe working practices was fully assessed and it was apparent that there were good systems in place to ensure the health and safety of the service users and staff. The staff had completed training in most safe working practices and it was highlighted that staff needed training in infection control and for some staff refresher courses in safe working practices. All staff had attended a half-day first aid course, at Appointed Persons level, and nine staff were qualified first aiders. With the vulnerability of the service users, it was agreed that the home would benefit from having a first aider on site for each shift and this would be looked at. Fire precaution records were being kept but it was unclear whether all staff had received fire awareness training quarterly and the managers agreed to review and record this. Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 22 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 Standard No Score 1 2 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 3 12 X 13 X 14 X 15 X 16 X 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 2 3 X X X 2 X X 2 X Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 23 No 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 YA6 Regulation 15,13 Requirement All the service user plans must be kept up to date, reviewed and include details of any special needs/challenging behaviour and how these are met. The record of food provided must be detailed to indicate that it is nutritional, varied and balanced for each service user (timescale of 30.09.05 partially met) The premises must be upgraded to provide improved toilet, bathroom, laundry, storage and office facilities (timescale not yet due). There must be opportunities for more staff to complete NVQ’s in care. A quality assurance system must be introduced in accordance with the requirements of Regulation 24 and all of the aspects of Standard 39. The staff must receive training in fire awareness quarterly. Timescale for action 28/02/06 2 YA17 17 31/01/06 3 YA24 23 31/03/06 4 5 YA32 YA39 18 24 31/03/06 31/03/06 6 YA42 24,13,18 31/01/06 Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 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 3 4 5 6 Refer to Standard YA1 YA7 YA8 YA19 YA19 YA33 Good Practice Recommendations Copies of the revised Statement of Purpose and Service User Guide should be sent to the CSCI. The practice of the manager being appointee for service users should be reviewed. The compatibility of the service users in Dalvington should be reconsidered. The arrangements for physiotherapy should be reviewed and developed. Staff should receive training to introduce the Worcestershire Health Action Plans for service users. The staff vacancies should be filled so that the home had a permanent staffing group and is not regularly using relief and agency staff. Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Worcester Local Office Commission for Social Care Inspection The Coach House John Comyn Drive Perdiswell Park, Droitwich Road Worcester WR3 7NW 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 Dalvington DS0000018646.V274954.R01.S.doc Version 5.1 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. 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