Inspection on 27/02/07 for Dexters Ltd The

This inspection was carried out on 27th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dexters Ltd The 04/02/09

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

CARE HOME ADULTS 18-65 Dexters Ltd The 21 Penley`s Grove Street York YO31 7PW Lead Inspector David White Unannounced Inspection 27th February 2007 09:00 Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 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 Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dexters Ltd The Address 21 Penley`s Grove Street York YO31 7PW 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) 01904 644675 01904 628187 The Dexters Limited Mrs Lynne Dexter Care Home 16 Category(ies) of Learning disability (16), Learning disability over registration, with number 65 years of age (16), Mental disorder, excluding of places learning disability or dementia (16), Mental Disorder, excluding learning disability or dementia - over 65 years of age (16) Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 16 (LD), up to 16 (LD(E)), up to 16 (MD) and up to 16 (MD(E)) up to a maximum of 16 service users. Not applicable Date of last inspection Brief Description of the Service: The Dexters is a care home providing personal cares and accommodation for up to sixteen residents with mental health needs and/or learning disabilities. The home is located close to the centre of York and its amenities and leisure facilities. The accommodation is provided in both single and double rooms and there are two self-contained units and an attractive back garden area, which is used by the residents. The Dexters Ltd took over the ownership of the home in October 2005. The current fees for the home as given by the registered provider range from £350 to £475 per week and do not include costs for hairdressing, chiropody and toiletries. Current information about services provided at The Dexters in the form of a statement of purpose, service user guide and the most recent inspection report published by the Commission for Social Care Inspection are available by contacting the home. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows an unannounced site visit undertaken on 27 February 2007. This visit was carried out by one Regulation Inspector and took 6.5 hours with 4 hours preparation time. The home was able to return the requested information before this site visit, and surveys were sent out to relatives and other professionals who had contact with the home. Surveys were received from one relative, two General Practitioners (GPs) and four health and social care professionals. The report includes information from the Regulation Inspector’s inspection record, which details the history of the home and relevant information about what has been happening in the home since The Dexters Ltd took over the ownership in October 2005. The site visit included an inspection of the premises. The visit involved looking at three residents’ care records, including the assessments, care plans and medication records for each resident. Staff rotas and health and safety documentation were inspected. There was discussion with five residents, four members of care staff and the cleaner and time was spent observing the interaction between residents and staff. The focus of the inspection was on a number of key standards and inspecting the case records of a number of residents to establish whether they corresponded with their experiences of life in the home. In the manager’s absence one of the senior care workers was available throughout the inspection and the findings were discussed at the end of the inspection with this person and another senior care worker who was present for part of the site visit. What the service does well: Residents said that the staff are “kind and helpful” and one of them described the staff team as “marvellous” and this encouraged residents to approach staff about any matter. Good care planning systems provide staff with the information needed so that they are aware of the needs of each resident and know what actions they need to take to meet these. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 6 Residents are encouraged to be involved in the local community and are involved in recreational and educational activities to help maintain and develop their skills and interests. Residents are encouraged to make their own decisions about their daily lives and this helps them to maintain their independence. A health care professional survey made comments that the home provides “excellent” care and other professionals who have contact with the home said that the staff are good at communicating with them and keeping them informed and this helps to make sure that residents health needs are met. Residents feel that they are treated with respect and this could be seen at the site visit. The home has a welcoming atmosphere and is homely and this provides residents with a pleasant environment in which to live. The home has a very settled staff team so that residents are able to receive a consistent standard of care from a staff team who are very familiar with their needs. Staff receive a wide range of training that is relevant for the resident group and this helps to improve their care practices so that residents can have confidence that their needs will be understood and met by the staff team. The home is well managed in the best interests of residents so making sure that any concerns are dealt with and good standards are maintained. What has improved since the last inspection? What they could do better: Residents’ medication could be stored more safely to safeguard them from possible harm. Residents could be regularly weighed so that their good health is maintained. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 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 Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Proper pre-admission procedures are in place so that prospective residents can feel confident that their needs will be met by the home. EVIDENCE: The home has a range of information that is given to prospective residents and their representatives prior to making any decision about moving into the home. Since The Dexters Ltd took over the ownership there has been one admission into the home. The care records for this person show that thorough preadmission assessment procedures are followed to make sure that the home is able to meet people’s needs before a place is offered. The records contain information that has been obtained from other sources such as placing authorities so that the home is clear about what kind of support a person requires and the home also carries out their own detailed assessment of the person’s needs to support this process. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 10 Prospective residents and their relatives are invited to spend time at the home before making any decision about moving in and the newly admitted resident said that he was able to have a number of visits to the home before he made a decision to move there and information from these visits is recorded within the person’s care records. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home are encouraged and supported to make their own decisions about their lives whilst taking into account any risks that have been identified. EVIDENCE: Three residents’ care records were looked at and these contain detailed needs assessments, the personal history of each resident and a plan of care that is developed from the identified needs of each individual. The care plans focus on what the residents are able to do for themselves and this encourages their independence. Care plans include clear and easy to follow information about what actions to take in specific situations to promote people’s safety as in the case of a resident who occasionally absconds from the home. The home has a Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 12 key worker system and this enables residents to have one to one support from staff. Daily records are up to date and reflect the cares that are being given. Care plan reviews take place on a regular basis so that any changing needs can be addressed. Residents generally feel that they receive support to be able to make their own decisions. This could be observed at the time of the site visit with staff encouraging residents to make their own choices about their daily routines. Residents made comments that they are encouraged to be involved in the day to day running of the home and regular house meetings are held to seek their views. One resident who is having some difficulties in managing his own monies is receiving some guidance from the Citizen Advice Bureau on how to manage the situation and this is being encouraged by staff. This helps to show that staff act in the best interests of the residents. Each resident has a range of risk assessments in place to promote their independence and safety. There are clear strategies in place to manage any difficult behaviour and the residents are involved with this. Members of staff are well aware of the need to maintain the rights and confidentiality of the residents. The manager explained that on occasions it is not possible to share information with relatives about a resident’s care if as has happened on some occasions the resident does not wish for this to happen. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy a varied lifestyle to suit their preferences and have opportunities to take part in social and occupational activities in the local community. EVIDENCE: Residents participate in a number of activities both in and outside of the home. Some attend local day services and colleges and others are involved in voluntary work. One resident said he is attending a local college for evening classes and has recently started a computer course at a local resource centre. Another resident said she enjoys her voluntary work and it is clearly evident that this is very fulfilling for her and an important part of her life. Some residents like to attend local church services to meet their religious needs. The home has a large car that is used for outings to the seaside. One resident said Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 14 how much he had enjoyed a holiday to Skegness last summer and is intending on going again. The home also has a number of pets that are looked after by the residents. Residents are encouraged to maintain contact with their family and friends. One resident said he is able to speak to his relative every evening and visitors are always welcome at the home. The care plans show that residents are encouraged to make their own decisions and are able to carry out their daily routines as they wish. The aim of the support given is to help people with their independence and one resident has an advocate to act on their behalf and to protect their interests. Residents made favourable comments about the quality of the meals on offer at the home. There is choice available and alternative meals are offered if a resident does not like what is on the menu. Vegetarian options are available for those residents who prefer not to eat meat. Residents tended to have their meals sitting together but could eat elsewhere if they wished to do so. It was noted within the care records that weight monitoring does not take place for all the residents and this needs to be done so that any health needs can be identified and acted on. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive personal support in a dignified manner and have access to health care services so that any health care needs can be met. EVIDENCE: Residents said that they feel “well looked after” by the staff team. One resident said described the staff team as “marvellous” and all said that they receive the support they need and in the way they prefer and this information is set out in each resident’s care plan. The care records include information about each resident’s health care needs and records of input from health professionals are available in the records. Each resident has a GP and access to all other health care specialist services. A survey received from a GP indicates that the home works well with medical services in making sure that residents’ health needs are being met. Comments received from care managers indicate that the home is good at taking advice Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 16 and communicating with other services to keep them informed about relevant issues in the home and a health professional described the care at the home as “excellent”. Some residents receive visits from community psychiatric nurses to support them with their mental health needs and are supported by staff to attend outpatient appointments at the local hospital where their mental health needs are monitored by a psychiatrist. One resident has some mobility problems and the records show that advice has been sought from an occupational therapist to help with this and as a result the home has purchased some new equipment for this purpose. The home has medication procedures in place for the administration, recording, storage and return of medication. The Medication Administration Records are up to date and accurate and medications are received and disposed of correctly and this is recorded. However, residents individual boxed medication is being stored together in baskets and this could lead to residents being given the wrong medication and some insulin is being stored in a domestic fridge with food items and again this could put residents at risk of harm. One resident is administering her own medication and a risk assessment had been undertaken to enable the resident to be able to do this for herself whilst promoting her safety. All the staff team receive appropriate medication training and this is updated as needed. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Clear complaints and adult protection policies and procedures are in place and understood by the staff to safeguard the interests of residents. EVIDENCE: The home has a complaints procedure that clearly details how complaints would be dealt with. Residents know whom they would need to speak to if they wish to raise concerns. Staff are well aware of residents’ rights and how to protect these. The home has a policy and procedure in place for the protection of vulnerable adults and staff have all attended abuse awareness training and receive regular updates. Staff are aware of what they would need to do in response to any abuse occurring. Residents feel that they are “treated well” by the staff team and observation from the site visit supported this. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable, clean and safe environment. EVIDENCE: The home has a friendly and welcoming atmosphere and residents said that they all generally “get on with each other”. Accommodation is over three floors and can be only reached by stairs and there is no ramped access to the home so it would not be suitable for people with mobility problems. Residents made comments that they are pleased with the standard of their accommodation and bedrooms are spacious and personalised. The home has a sufficient number of baths for the number of residents at the home and aids and adaptations are available to help people with their mobility. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 19 There is a main lounge, a dining room and a conservatory where residents can sit indoors and outside there is a back garden with a patio area. The home is clean and tidy and all the necessary health and safety checks are carried out to promote the safety of the environment. Random checks of the hot water temperatures in bathrooms and bedroom sinks were found to be within safe levels. There are separate laundry facilities where residents’ personal clothing and bed linen are looked after. The kitchen is well maintained and regular checks are carried out to promote safe food hygiene practices. The home has an ongoing programme of re-decoration and refurbishment. Furniture and fittings are of a good standard and well maintained. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive a good standard of care from a competent, trained, motivated and well-supported staff team. EVIDENCE: The duty rotas show that there is a sufficient number of staff on duty at all times. Duty rotas are planned around the needs of the residents to make sure that all residents’ needs are being met. As well as care staff the home also employs a cleaner to maintain standards of cleanliness in the home. Residents feel that staffing levels are good and said that staff are “always helpful” and could be easily accessed at any time for assistance and support. At the time of the visit staff could be seen to be providing care in a calm and unhurried manner. The home has a very settled staff team and there is a very low staff turnover so that residents are able to receive a consistent standard of care from a Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 21 committed staff team. Proper recruitment procedures are in place for when any new staff are appointed to protect residents from any possible harm. The staff receive a range of training in a number of different areas and feel that this helps them to be able to do their job more effectively. New staff receive induction training that includes an introduction to the homes policies and procedures and a number of health and safety practices. Staff said they have attended various training days including abuse awareness, moving and handling, first aid, food hygiene and fire safety and these are all regularly updated. They have also attended training that is specific to the resident group in areas such as mental health and they have also received some non-physical crisis intervention training to provide them with more skills and techniques in managing and reducing risks from difficult situations. Staff particularly found a “hearing voices” training session to be particularly useful in helping them to have a better understanding of some residents’ behaviours. The home has an ongoing commitment to NVQ training and most of the staff have either completed or are in the process of completing the training. Staff said that they receive supervision and appraisal on an ongoing basis and regular staff meetings take place. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed in the best interests of the residents and proper attention is given to health and safety to protect them from any harm. EVIDENCE: The registered manager is also a joint proprietor of the home and is well experienced in management and care. The manager was taking leave at the time of the site visit and so was not available; however, residents and staff described her as “helpful, approachable and very supportive”. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 23 The home has quality assurance systems in place to look at ways of improving the care and services provided at the home. Staff meetings and house meetings involving residents are held on a regular basis and the records from these are available. Information about residents is passed on during staff handover periods between shifts and the care records are kept well up to date about what is happening with each resident. Care plan reviews take place for each resident on a periodic basis and relatives and other professionals involved in a person’s care are invited to attend the meeting at the resident’s request and are encouraged to express their feelings about the care and services on offer at the home. The home has proper arrangements in place to make sure that health and safety practices promote a safe environment for residents, relatives and visitors to the home. A random selection of the required health and safety certificates were seen and are up to date and satisfactory. A fire risk assessment of the premises has been carried out and is reviewed on an ongoing basis. All staff receive a range of health and safety training and accidents are clearly recorded in the home’s accident book to safeguard the interests of residents. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 3 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 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 3 X 3 X X 3 X Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13 • Requirement The registered person must make arrangements to store medication such as insulin in a drug fridge. The registered person must make sure that each resident’s boxed medication is stored separately from other residents’ boxed medications so that residents are not put at risk from being given the wrong medication. Timescale for action 27/03/07 • 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 YA17 Good Practice Recommendations The registered person could make arrangements for the periodic monitoring of each resident’s weight so that any health needs can be identified and acted on. Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Dexters Ltd The DS0000065583.V332604.R01.S.doc Version 5.2 Page 27 - 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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