Inspection on 19/04/05 for Downs Park Road (93)

This inspection was carried out on 19th April 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Downs Park Road (93) 08/07/07

Downs Park Road (93) 19/12/06

Downs Park Road (93) 30/11/05

Downs Park Road (93) 28/10/04

Downs Park Road (93) 13/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 93 Downs Park Road 93 Downs Park Road Hackney London E5 8JE Lead Inspector Sandra Jacobs-Walls Announced Inspection 19 April 2005 at 10:00am th The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service 93 Downs Park Road Address 93 Downs Park Road, Hackney, London, E5 8JE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8533 5340 info@hilt.org.uk Hackney Independent Living Team Ms Ellen Georgiou Care Home 4 Category(ies) of Learning disability (4) registration, with number of places 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: House not to be left unattended when any tenant is in the house. A worker will always be available by radio pager when house is empty. Date of last inspection 28th October 2004 Brief Description of the Service: 93 Downs Park Road is a care home offering support, personal care and accommodation to a maximum of four service users who have learning difficulties. The home offers support 24 hours a day. The home is a large three-storey terraced house situated in a residential area of Clapton, in the London Borough of Hackney. The home has good bus links and is within walking distance of local shops, and amenities. Hackney Independent Living Team, (HILT) manages the home, which is a voluntary sector provider of care services. At the time of the inspection, four service users were accommodated. 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection took place on April 19 2005. The home’s registered manager was present throughout and assisted with the process, the HILT service manager for the home was also present for a short period of time. The submission of detailed key information as part of the pre-inspection questionnaire proved very useful. No service users were at home at the time of the inspection, so the inspector did not have the opportunity to meet with any service user on this occasion. However, the inspector spoke with a relative via telephone just prior to the day of the inspection and on the day, met with another relative of a current service user. The inspection also involved review of key documents, policies and procedures, review of one service user file in detail, staff information, discussion with management and staff and a tour of the home’s premises. The inspector also met briefly with a speech and language therapist currently working with some of the residents of Downs Park Road As a result of the inspection 8 requirements were made. The inspector would like to thank all those who co-operated and contributed with the inspection process. What the service does well: What has improved since the last inspection? 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 6 The registered manager and staff team have worked hard to address many of the outstanding requirements made at the last inspection in October 2004. The registered manager had been away from the home for a significant period of time since the last inspection. During this time services were delivered to the same high standard; the absence of the registered manager seemingly had little negative impact on the quality of services offered. A senior staff member from another HILT project was assigned to the home as the acting manager. The inspector saw good evidence of policy development and the revision of key documents such as the home’s Statement of Purpose. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 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 standard(s) 1and 5 The home has had no new admissions for a number of years therefore standards 2,3 and 4 were not assessed on this occasion. The home has a Statement of Purpose document and Service User Guide that outlined services offered by the home. However, both documents need to be revised in order to include more appropriate information regarding the home’s complaints procedure. All service users have tenancy agreements on file. EVIDENCE: The home’s Statement of Purpose and Service User Guide were reviewed. Information that was not evident in the Statement of Purpose document at the last inspection was now included. However, information regarding the home’s complaints procedure in both documents was in need of revision in order to ensure that service users can participate fully in the process at all stages. The registered manager produced a draft complaints procedure that was being considered for formal issue by HILT managers. The draft procedure seen appropriately addressed issues of service user participation in the home’s complaints procedure. The registered manager commented that all service users files contained tenancy agreements; the service user file reviewed evidenced a recently reviewed written agreement. 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 9 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 standard(s) 6,7,8,9 and 10 Service users assessed and changing needs and personal goals were well reflected in individual care plans. Service users were encouraged by staff of the home to participate in the decision making process and creative methods were used to ensure service users were consulted on and participate in all aspects of life in the home. Risk assessments are in place and service user information is kept confidential. EVIDENCE: Review of one service user file in detail evidenced that written care plans addressed well the assessed and changing needs of service users. Plans seen were devised from a recently held review meeting at which the service user and his relative were encouraged to participate. Creative methods such as pictorial cues and objects of reference are used by staff to encourage service user choice and participation in the decision making process. This is soon to be further developed with the anticipated introduction of Personal Centred Planning. The registered manager keenly demonstrated some of the risks elements faced by service users and strategies employed by staff to assist eliminate/minimise risks. For example, there a good documentation on file of recommended strategies to minimise the service users fear of birds and animals while out in the community, risks associated with swimming activities 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 10 were explored and staff were advised of the need to encouraged the safe use of supermarket trolleys while shopping with the service user. The registered manager had developed a confidentiality policy, which had been implemented with the staff group highlighting the need for service user information to be kept confidential; the inspector noted that service user files and other information was kept securely locked in a cabinet in the staff office. 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 11 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 standard(s) 11,12,13,14,15,16 and 17 Service users have the opportunity for personal development, to participate in appropriate activities, access the local community and engage in appropriate leisure activities. Service users have appropriate personal and family relationships, their rights and responsibilities are respected and meals offered by the home are varied and nutritious. EVIDENCE: All service users have good opportunities for personal development both within and external to the home. All service users attend day centres during the week where they participate in a range of activities and are encouraged to develop and maintain friendships. Service users are encouraged by staff to access and participate in the local community on a regular basis. Service users accompany staff to local amenities such as the post office, the supermarket, the park etc and participate in a range of leisure activities such as swimming, local walks, canal boat rides, massage and sauna and pottery classes. Some service users also attend a local church. 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 12 The inspector spoke with the mother of one service user, who said of the home; “… they take him everywhere”. Three of the home’s four service users have very frequent contact with family members; two service users see family members on a weekly basis, this was confirmed by the aunt of another service user, who had met with the inspector at the home. The inspector saw examples of weekly meal plans; meals offered were varied and nutritionally balanced. The service user file reviewed contained good information to staff advising of appropriate healthy options to be considered since the service user had an ongoing digestive complaint. The registered manager commented that staff made a concerted effort to ensure that ample fruit and vegetables were available at meal times despite service users reluctance at times to make these choices. 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 13 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 standard(s) 18,19,20 and 21 Service users received personal support in accordance with known or indicated preferences. Service users’ physical and emotional health needs were well met and the home has an effective medication policy in place. Issues of ageing, illness and death were handled respectfully. EVIDENCE: The registered manager commented that good attention is paid to how personal care tasks are performed by staff to ensure that tasks are performed in accordance with service user wishes. The inspector saw on file very detailed written guidance to staff about service user preferences with regard to personal care. Service users bedrooms had pictorial and written directions. In addition, the guidance highlighted which tasks the service user could perform themselves and staff were encouraged to support and prompt only. The file reviewed contained good information regarding the health care needs of the service user, in particular an ongoing issue regarding dental care. Information was explicit in exploring the service user fear of dental treatment and how best to access appropriate treatment. The home has an effective medication policy in place; the registered manager commented that medication errors scarcely occurred. The home also has in place an ‘Ageing, Death and Bereavement’ policy which offers sensitive guidance to staff in managing these issues. The inspector noted that in the lounge area there is a photograph of a 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 14 former resident (since deceased). The registered manager said staff and residents felt it important that the former resident be remembered somehow within the household. 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 15 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 standard(s) 22 and 23 The home has a comprehensive complaints procedure in place; however, this policy is in need of revision to ensure service users can participate fully in all stages of the procedure. The home also has a comprehensive adult protection procedure, however staff must also be made aware of the adult protection procedures of referring social services departments. EVIDENCE: The home had no records of any complaint having been made in the last year. The inspector reviewed the home’s complaints policy, which is in need of revision to appropriately involve service users in all stages of the home’s complaints procedure. The current document advises complainants who wish their complaints to be considered at service manager level to submit complaints in writing. This is in appropriate since none of the home’s current service users are able to write. It may also, in some cases be inappropriate for staff members to support them do so. The registered manager then produced a revised, draft policy, which addressed some of the issues deficient in the original policy document. The inspector was informed that HILT managers were due shortly to review and issue a revised complaints procedure. During the inspection, the inspector met with the relative of one of the service users who wanted to raise concerns she had with regard to some aspects of her niece’s care while at the home. This appeared to be an ongoing issue. The inspector was satisfied that staff had handled these issues appropriately, offering the relative the opportunity to make a complaint if she so wished, which she declined. 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 16 The home has in place a comprehensive adult protection policy, however, staff must have access to local adult protection protocols to supplement existing HILT policies. 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 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 standard(s) 24,25,26, 27, 28. 29 and 30 The home’s premises met all spatial requirements; the home was clean and hygienic. Service users living at Downs Park Road live in a comfortable and safe environment; however, the home is in need of general redecoration that would enhance its appearance as being more homely. Service users bedrooms were generally well furnished and comfortable, but some rooms were also in need of redecoration. The home’s toilet and bathroom facilities were private and sufficient in number; the home does not contain any specialist, disability adaptations or equipment. EVIDENCE: The inspector toured the home’s premises. The wallpaper in the entrance hallway was peeling and in need of replacement. This was also the case for the first floor toilet and the ground floor bathroom. One service user bedroom had a significant crack in the wall adjacent to the bedroom door. This is in need of repair. In contrast, the lounge and kitchen areas were bright, well decorated spacious and well equipped with appropriate recreational materials and equipment. Service user bedrooms evidenced personal effects such as photographs, artwork, CD’s, pictures of country of origin etc. The registered 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 18 manager commented that it was her plan to shortly redecorate all service user bedrooms. 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,33,34,35 and 36 Individual staff roles and responsibilities are clear. The staff group of the home is cohesive and well established, with competent and qualified personnel. The home’s recruitment policies are sound and staff training is adequate. The frequency of individual staff supervision must be increased to reflect good practice and meet timeframes specified in the home’s supervision policies. EVIDENCE: The inspector reviewed the personnel files for five members of the staff team. Files seen contained all required information and documentation, such as CRB disclosures, proof of identification and written references. The registered manager commented that all staff had received job descriptions upon appointment. The staff group have been working as a team for a considerable amount of time and communicate well together. One member of the team interviewed by the inspector commented the staff group operated as a “..tight team” and that “Communication is excellent..…bank workers are good also”. A relative of a current service user of Downs Park Road said of the staff team, “They’re fantastic!” 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 20 The recent absence of the registered manager for a number of months had seemingly not had a negative impact on service delivery; this is partly contributed to the effectiveness of the staff team. Individual staff supervision sessions must be more consistently conducted to ensure current good practices are maintained; files indicated significant gaps in most cases. Staff appeared very committed to care of service users, staff commented that their motivation and job satisfaction was a result of seeing the progress service users had made as a result of staff efforts. One staff member commented, “I enjoy seeing the change in him, it’s like chipping away, knowing there’s something wonderful underneath”. The staff member interviewed talked about training opportunities and the “creative” training staff had recently received in relation to autism. This training had involved the relative of one of the service users (who was also autistic) who very aptly gave insight into her condition and how best care could be delivered. Staff also had access to the Learning Difficulties Award Framework and NVQ training. 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,40,41,42 and 43 Service users of HILT’s Down Park Road very much benefit from a well run home and the effective leadership and management style of the manager. The registered manager is competent, but must complete required training. The home’s monthly monitoring visits must be more consistently conducted; service users health safety and welfare are promoted and protected. The home’s policies and procedures safeguard service users rights and best interests. EVIDENCE: The inspector had the opportunity to speak with two relatives of two of the home’s current service users. One indicated that that while she felt the home was well run, that she was concerned at times for issues around her niece’s personal care. This appears to be an ongoing concern due for further discussion. The other relative who spoke with the inspector said of the home; “You can’t fault it, the staff are great…the home is lovely”. 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 22 The registered manager said she was due to resume participating in the level 4 NVQ qualificatin, this course of study must be completed. The inspector reviewed the home’s records of monthly monitoring visits and found only seven reports (of a total of twelve) could be produced. The inspector was also aware that very few of the monthly monitoring reports had been forwarded to the Commission as required. The inspector was given a copy of the organisation’s annual report which contained financial information confirming the home’ financial viability. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 x x x 3 Standard No 22 23 ENVIRONMENT Score 2 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 93 Downs Park Road Score 3 3 3 Standard No 24 25 26 27 28 29 30 Score 2 2 3 3 3 x 3 Version 1.20 Page 23 G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc 9 10 LIFESTYLES 3 3 Score STAFFING Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 2 3 2 3 3 3 3 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 24 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA1 Regulation 4 &5 Requirement The registered manager must ensure that the homes Statement of Purpose and Service user Guide is revised to include updated information regarding the homes complaints procedure The registered manager must ensure that the homes complaints procdure is appopiately revised The registered manager must ensure that staff have access to local adult protection protocols of relevant statutory agencies The registered manager must ensure that peeling wallpaper in the hallway, upstairs toilet and ground floor bathroom is replaced The registered manager must ensure that the crack in the wall in a service user bedroom is repaired. The registered manager must ensure that individual staff supervision sessions are consistently conducted and documented on file. The registered manager must complete the level 4 NVQ Timescale for action 31/05/05 2. YA22 22(2) 31/05/05 3. YA23 13(6) 31/05/05 4. YA24 23(2)(d) 31/06/05 5. YA25 23(2)(b) 31/06/05 6. YA36 18(2) 31/05/05 7. YA37 9(2)(i) 31/12/05 Page 25 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 qualification 8. YA39 26 The registered individual must ensure that monthly monitoring visits are consistently conducted and subsequent reports are made available to staff and the Comission. 31/05/05 9. 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 Good Practice Recommendations 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 Page 26 Commission for Social Care Inspection 4th Floor, Gredley House 1-11 Broadway, Stratford London E15 4BQ 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 93 Downs Park Road G56 G06 S10267 Downs Park Road V212256 190405 Stage 4.doc Version 1.20 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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