Inspection on 18/01/07 for Dunley Hall

This inspection was carried out on 18th January 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Dunley Hall 26/01/06

Dunley Hall 09/08/05

Dunley Hall 21/02/05

Dunley Hall 10/08/04

Dunley Hall 25/02/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Dunley Hall Dunley Hall Dunley Nr Stourport-on-Severn Worcestershire DY13 0TX Lead Inspector Nic Andrews Unannounced Inspection 09:35 18 and 22 January 2007 th nd X10015.doc Version 1.40 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 Dunley Hall DS0000055364.V327243.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dunley Hall Address Dunley Hall Dunley Nr Stourport-on-Severn Worcestershire DY13 0TX 01299 822040 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) Mrs Monica Arjan McGlynn Trading as Minster Grange Residential Home Ms Elizabeth Joy Flood Care Home 19 Category(ies) of Dementia - over 65 years of age (19), Old age, registration, with number not falling within any other category (19), of places Physical disability over 65 years of age (19) Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: There were no conditions of registration other than those referred to on the previous page of this report. Date of last inspection 26 and 30 January 2006 Brief Description of the Service: Dunley Hall is a large, adapted residence occupying a secluded position near to the centre of the village of Dunley. The home stands in its own grounds at the end of a drive that provides shared access to other residents who live nearby. The home is accessible to people who use wheelchairs. There are car-parking facilities at the front of the premises. The service users are accommodated on the ground and first floor in 13 single bedrooms and three double bedrooms. Eight of the single bedrooms and all three double bedrooms have an en suite facility. The home provides two lounges and a separate dining room. The home also has a passenger lift. The home is registered to provide a residential i.e. personal, care service for a maximum of 19 people over the age of 65 years, who may also have a physical disability and/or a dementia illness. The main purpose of the home is to provide a high standard of care in a secure and happy environment for people who are unable or who do not wish to live alone. The homes stated aims are to provide all service users with a life that is as normal as possible, given their health and needs, in homely surroundings and with care which will enable them to live as independently as possible with privacy, dignity and with the opportunity to make their own choices. It is the intention of the registered provider to provide an extension to the premises that will increase the number of service users for which the home is registered. At the time of the inspection the home’s fees ranged from £1520.00 to £1720.00 per month. Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that took place over the course of two days. The home was inspected against the key National Minimum Standards. Time was spent with the registered manager and acting manager assessing the home’s response to the requirements and recommendations that were made as a result of the previous inspection. Various records and a number of policies and procedures that the home is required to maintain were inspected. A tour of the premises was also made. Individual discussions were held with four service users, the relative of one service user and two members of staff. As part of the inspection ‘Comment Cards’ were issued to the relatives/visitors of the service users and to visiting professionals. A total of five Comment Cards were completed and returned. The majority of responses to the questions that were asked were positive and the additional comments contained in the Comment Cards are reflected in this report. What the service does well: What has improved since the last inspection? The registered manager felt that the home had continued to develop care practice on a person centred approach. The home had been recognised by staff in the health and social care department of a local college for its good practice and had taken part in the production of a promotional DVD used for training purposes. The home had also achieved the ‘Having Your say’ award for the second consecutive year. It was stated that, since the previous Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 6 inspection, six bedrooms had been refurbished and new bedspreads and matching pillowcases had been provided. One of the bathrooms had been refurbished and a new hoist installed. The main entrance had been painted and the rear courtyard had had new stone covering. A new hot water boiler had been installed in the kitchen. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, and 5. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. Prospective service users were encouraged to make visits to the home prior to admission. However, aspects of the admission process needed to be improved in order to ensure that the service users’ rights and safety were fully protected. EVIDENCE: A copy of the home’s statement of purpose was made available for inspection. The statement of purpose contained relevant information and the contents were satisfactory. However, the document should be checked for typographical errors. A copy of the home’s service users’ guide was made available for inspection. The service users’ guide also contained relevant information. However, the service users’ guide should also be checked for typographical errors and, in addition, be amended as follows, • The reference to the registered provider being the manager of Field View is out of date and should be changed/deleted. • Information should be included about how to contact the local health care authority. Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 9 The standard form of contract for the provision of services and facilities by the registered provider to service users must be included as an integral part of the service users’ guide. A notice was displayed in the main corridor informing visitors of the availability of the statement of purpose and service users’ guide. A copy of the home’s statement of terms and conditions of residence (contract) was made available for inspection. The contents of the contract were satisfactory. However, three of the service users’ files that were inspected contained contracts that had not been signed by the registered provider. The registered provider should sign all of the service users’ contracts. It was stated that the registered manager together with the acting manager usually carried out the assessments of prospective service users. A recommendation was made in regard to Standard 3 as a result of the previous inspection. The recommendation was that the form used by the home for assessing the care needs of prospective service users should be revised in order to ensure that there is sufficient space to record all of the relevant information. A copy of the assessment form was made available for inspection. The recommendation had been implemented. It was also noted that the assessment form included a reference to all of the aspects of care listed in Standard 3.3. However, of the files that were inspected, the assessment form in respect of one service user who was admitted in August 2006 had not been fully completed. In particular, the details relating to communication skills, aims and objectives, family involvement and medication etc had been omitted. A full written assessment must be completed before the admission of any service user. It was noted that the inventory of the personal belongings in respect of the same service user had also not been completed. The assessment form in respect of another service user stated ‘Dementia’. However, no specific details were provided regarding the way in which the dementia manifested itself e.g. memory loss, disorientation as to time/place, confusion, anxiety state etc. The care needs of prospective service users must be thoroughly assessed and accurate and detailed information regarding their needs fully recorded in order that a comprehensive care plan that will meet their needs can be prepared. The staff with whom discussions were held confirmed that prospective service users were given the opportunity to make pre-admission visits to enable them to make a decision about moving into the home. The service users also said that either they or their relatives had visited the home prior to admission. The statement of purpose and service users’ guide contained relevant information about the home’s policy on emergency admissions. It was stated that two service users had been admitted in an emergency since December 2006. The home offered a trial period of four weeks following admission. • Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The home provided satisfactory care plans and there was evidence to show that the service users healthcare needs were being met. The service users felt that they were treated with dignity and respect. However, the storage, control and handling of medication did not ensure the safety of the service users. EVIDENCE: It was confirmed that all of the service users had a care plan. A requirement was made as a result of the previous inspection that the work that has commenced to improve the contents of the care plans and to ensure that they are dated and signed by the service user whenever capable and/or representative (if any) and reviewed by the care staff at least once a month must be completed. The contents of the care plans that were inspected were satisfactory. The care plans had been signed by the service users and/or their representative. There was evidence to show that the care plans were also being reviewed. However, the dates on the care plans and the dates when they were reviewed referred only to the month and year. In order to ensure that the care plans are being prepared and reviewed by the care staff within the appropriate timescales i.e. at least once a month, the dates on the care plans must be specific. Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 11 It was confirmed that all of the service users were registered with local GP’s surgeries. None of the service users had pressure sores. However, one service user was using a pressure relieving mattress and cushion. The district nurse was visiting two service users at the present time. The continence adviser visited the home to assess new service users or to reassess existing service users when necessary. Two service users received visits from the community psychiatric nurse every six weeks. The home carried out nutritional screening of the service users. The optician visited the home to carry out eyesight checks once a year or more frequently if necessary. The chiropodist visited the home every six weeks or more frequently if necessary. In the Comment Card completed by the relative of one service user the medical care and attention was described as, ‘excellent’. Two requirements were made in regard to Standard 9 as a result of the previous inspection. The first requirement was that the administration of controlled drugs must be witnessed by another designated and appropriately trained member of staff at all times and their signature recorded in the controlled drug register. The controlled drug register was made available for inspection. It was noted that two service users were in receipt of controlled drugs. The record was satisfactory and the requirement had been implemented. The second requirement was that the list of the names and signatures of all the staff involved in the administration of medication must be updated and accurately maintained. It was confirmed that only the senior staff administered the service users’ medication. The list of the names of the staff that were involved in the administration of medication was made available for inspection. It was noted that the list included the names of three members of staff who no longer worked at the home. Therefore, the requirement had not been implemented and still stands. The arrangements for the safe storage of medication were satisfactory. It was stated that access to the medication storage was restricted to the senior member of staff on duty. However, it was noted with concern that medication that was to be returned to the pharmacy was kept on open shelves in the office awaiting collection. It was stated that the office was always kept locked when not in use. Nevertheless, in order to avoid any possible risks of theft or misuse, all medication must be stored in a secure, lockable cupboard at all times. The staff evidenced the prescriptions before they were sent to the pharmacy and a copy of returned medication was maintained. None of the service users were self-administering. The home had a dedicated fridge for medication that required cold storage. However, the fridge was not working properly and a consistent temperature was not being maintained. The fridge must be replaced with a new fridge that is fit for purpose. The registered manager confirmed that approximately 50 of the staff had undertaken the accredited distance learning medication training provided by Wolverhampton College. In addition, the local pharmacist had provided a half-day training session for staff involved in administration of medication on 29 September 2006. It was confirmed that four members of staff needed to undertake accredited training in the administration of Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 12 medication. The medication that had been written on to the MAR charts by hand had not always been checked and signed for by a second member of staff. The records of the medication administered were checked. However, the check revealed that a tablet had been dispensed into a damp plastic container and was water damaged as a result. A tablet had been taken from the next days supply to compensate for the tablet that had not been administered. However, no written explanation of what had happened had been recorded. A copy of the policy and procedure for the administration of medication was made available for inspection. The policy did not include the name of the home, the procedure to be followed in the event of a drug administration error occurring or a statement that, when a service user dies, medicines will be retained for a period of seven days in case there is a coroner’s inquest. The policy should be reviewed, amended, signed by the registered manager and dated. The staff with whom discussions were held recognised the importance of maintaining the service users’ privacy and dignity. The answers to the questions that they were asked revealed an understanding of the principles of good care practice as outlined in Standard 10. The staff induction included guidance on how to treat service users with respect. The service users with whom discussions were held confirmed that they were treated with respect by the staff and that their right to privacy was upheld. The home had a mobile handset to enable the service users to make and receive telephone calls in private. It was confirmed that the service users wore their own clothes at all times. However, it was also stated that the home had a supply of clothing for use in an emergency. It was also confirmed that the service users were referred to by their preferred terms of address and that medical examinations, treatment and other meetings of a confidential nature were always conducted in private. A requirement was made in regard to Standard 10 as a result of the previous inspection that fixed screening must be provided in bedroom 2 in order to ensure the service users’ privacy and dignity. The requirement had not been implemented and still stands. Standard 11 was not fully inspected on this occasion. However, the home’s response to the recommendation that was made as a result of the previous inspection was assessed. The recommendation was that the process of discussing and recording the service users’ wishes concerning terminal care and the arrangements after death should be completed. The registered manager confirmed that the recommendation had been implemented. Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. The quality outcome in this area was good. This judgement has been made using available evidence including a visit to this service. The service users were encouraged to maintain contact with their relatives and friends and to exercise choice in regard to their daily lives. The food provided was varied, wholesome and nutritious. EVIDENCE: A recommendation was made in regard to Standard 12 as a result of the previous inspection. The recommendation was that the range of social and recreational activities provided by the home should be increased in order to stimulate and engage the interest of more service users in accordance with their needs, choices and abilities, including those with a dementia illness, and a record of the activities provided maintained. The recommendation was regarded as having been implemented. It was confirmed that a variety of activities was provided. These included a jewellery party, fashion shows, a library, skittles, manicures, videos, hoopla and the use of ‘Let’s Talk’ discussion cards. A musical entertainer visited the home once a month and a hairdresser visited twice a week. Mobility Plus held a music and movement session every two weeks. A Halloween party had been held and the service users had been involved in making Christmas decorations. It was stated that the Brownies visited twice a year to sing songs and to talk to the service users. A local Anglican minister visited the home every two months to hold a Communion service. The minister of the Methodist Church also visited on occasions. Since Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 14 the previous inspection there had been an outing to the tearooms at Great Witley for eight service users. Occasionally, individual service users are taken to Stourport on Severn. It was felt that the provision of a suitable vehicle for use by the home would considerably enhance the opportunity to extend the number and range of outings and social excursions for service users. The home’s activities log had been kept up to date. However, the entertainment audit had not been completed since 17 July 2006. The service users were informed verbally about the activities that were arranged on their behalf. Information was also displayed on the notice boards. Three of the service users with whom discussions were held said that they were satisfied with the social activities provided within the home. One service user said that she did not join in because she ‘couldn’t stand the noise’. However, they all expressed their satisfaction with the daily routines of the home and confirmed that they were able to exercise choice e.g. regarding the clothes they wore, where they ate their meals and the time they wished to get up and go to bed. The relative of one service user stated in the Comment Card that the home could be improved by the provision of ‘more activity for the more able people’. Another respondent stated, ‘Sometimes encouragement is needed so that residents express their needs. Male residents are in the minority and activities are more female oriented’. There were no unnecessary restrictions on visiting. It was stated that visitors were made welcome and were encouraged to be involved in the home’s social events. The service users’ guide stated, ‘We actively encourage relatives, friends and representatives of service users to be involved in the preassessment, admission and in the planning of their (the service users’) care’ The service users and one relative with whom discussions were held confirmed that visitors were made welcome and were offered a drink. It was stated that the service users were encouraged to handle their own finances for as long as they were able to do so. However, in the majority of cases, their relatives often assumed this responsibility. The service users’ guide contained details of the local advocacy service and information about the advocacy service was also displayed on the notice board. The service users’ guide referred to the home’s practice of encouraging the service users to bring some of their personal possessions with them when they were admitted. The service users’ guide also referred to the service users’ right of access to the records held about them by the home. The service users were served breakfast between 7.30 and 9.30 am. Lunch was served between 12.00 and 1.00 pm and the teatime meal was served between 4.45 and 5.30 pm. Supper was served at 7.00 and 9.00 pm. Drinks and snacks were available throughout the day. Mid- morning and midafternoon drinks were served at 11.00 am and 3.00 pm respectively. None of the service users required special diets for religious or cultural reasons. However, one service user was provided with soft food and another was given food that compensated for things that she was unable to eat for medical Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 15 reasons. Two service users required staff assistance with eating and at least one member of staff was always present with the service users at mealtimes. At lunch time a choice of meat and at least three types of vegetable in addition to potatoes was offered. An alternative meal is offered to any service user that does not like the meal provided. A new menu was provided each week. This was said to give greater flexibility and be more cost effective. The record of the food was balanced and nutritious. The head chef consulted the service users on a daily basis regarding their food preferences. The food provided was also discussed at the service users’ monthly meetings. The home had recently embarked on ‘Safer Food-Better Business’. A record of the food temperatures and of the fridge and freezer temperatures was maintained. Food and fluid intake charts were also maintained when necessary. It was confirmed that all of the kitchen equipment was working satisfactorily. A cleaning schedule was maintained. The kitchen had a fire blanket, a fire extinguisher and a first aid box. A notice board was obtained during the inspection so that the daily menu could be displayed for the service users. The head chef demonstrated a good understanding of the dietary needs of older people and a committed and enthusiastic approach to her work. Three of the service users with whom discussions were held described the food as either ‘good’ or ‘very good’. A fourth service user said, ‘The food is better some days than others but it’s alright. It’s not a first class hotel but the food is very appreciated’. In the Comment Card completed by the relative of one service user the food was described as, ‘Home cooked, thoughtfully prepared so that it doesn’t interfere with false teeth and have to be cut up’. The food that was observed being served during the inspection was wholesome, appealing and well-presented. Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The home had satisfactory policies and procedures to ensure the protection of service users from abuse. However, the record of complaints was not being accurately maintained and kept up to date. EVIDENCE: The home had a satisfactory complaints procedure. A book containing matters that the service users and/or their relatives wished to discuss with the acting manager had been maintained up to 17 July 2006. Unfortunately, the book had ‘gone missing’. Since the previous inspection the home had recorded four complaints dated 14/02/06, 06/04/06, 15/05/06 and 10/06/06 respectively. The registered manager said that there had been other complaints since then but these had not been recorded. The record of the complaint made on 15/05/06 had been dealt with by a senior member of staff who had since left the home. The complaint had not been recorded in sufficient detail. The service users and the one relative with whom discussions were held said that the staff were approachable. They also said that they felt confident about making a complaint and that, if they had to do this, that the matter would be taken seriously and dealt with quickly and appropriately. The home had two policies and procedures on the protection of vulnerable adults from abuse. The most recent policy must be removed from the folder containing copies of the home’s policies and procedures and replaced with the most recent and correctly worded policy. This should be done in order to ensure that the staff do not investigate any potential incidents of abuse. The registered manager confirmed that no incidents of suspected or alleged abuse Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 17 had been reported to her or had otherwise come to her attention since the previous inspection. The registered manager also confirmed that she had had no reason to refer any member or former member of staff for consideration for inclusion on the POVA register. The home had a satisfactory ‘whistle blowing’ policy. The home’s policy on dealing with challenging behaviour called ‘Management of Violence Policy’ was satisfactory. The policy stated that, ‘Any physical restraint must be of a degree appropriate to the actual danger or resistance shown by a resident’. The home’s policy regarding the service users’ money and financial affairs was satisfactory. The registered manager stated that the staff would receive guidance on this policy through NVQ training. However, the issues referred to in the policy should also be reinforced through staff meetings and supervision meetings. The acting manager and registered manager had not undertaken training in the protection of vulnerable adults from abuse at a level appropriate for managers. Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The service users lived in a clean, comfortable and homely environment. However, the access to the premises did not fully ensure the safety of the service users, staff and other visitors. EVIDENCE: The home was located in a rural setting at the end of a long drive. The drive had numerous potholes that posed a potential hazard to service users and other visitors. The drive must be resurfaced and made safe. It was stated that this work would commence within a few days of the date of the inspection. The home was suitable for its purpose and had been appropriately adapted for the needs of older people. A cold-water dispenser had been provided in the hall near to the main entrance. A record of the routine maintenance and renewal of the fabric and decoration of the premises was maintained. One of the bathrooms on the first floor had a wall-mounted electric heater. It was stated that this was only switched on to warm the bathroom prior to use. However, the heater posed a potential risk to the service users and should be removed and replaced with a safer, more appropriate form of heating. The Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 19 acting manager subsequently confirmed that this had been done. It was noted that the walls on the first floor corridor were in the process of being painted. The acting manager stated that this work would be completed by the end of January 2007. An empty urine bottle had been left in one of the toilets on the ground floor. This was removed during the inspection. It was confirmed that urine bottles were normally kept in the service users’ bedrooms. A portable heater was removed from one of the bedrooms during the inspection. The central heating should normally be sufficient to provide a satisfactory level of heating. Portable heaters pose a potential risk to the safety of service users and should only be used in exceptional circumstances following a risk assessment. The kitchen was in need of refurbishment and the kitchen walls were in need of tiling. It was stated that this work would be completed when the proposed extension was built. The relative of one service user stated in the Comment Card that a desirable improvement for the home would be the provision of ‘en suite facilities in each room’. Another respondent stated, ‘On rare occasions staff have been unaware of mobility issues and have used wheelchair when (the service user) could be encouraged to exercise. Equipment like chairs could be better for the disabled, upright and high back which is not easily tripped over’. It was also stated that one of the ways in which the home could improve was, ‘not leave urine bottles on view in resident’s room where visitors come’. Standard 21 was not fully inspected on this occasion. However, the home’s response to the two requirements and one recommendation that were made as a result of the previous inspection was assessed. The first requirement that the items stored in the bathroom on the first floor must be removed and the bathroom refurbished and used appropriately for its intended purpose had not been implemented and still stands. The second requirement that paper towel dispensers must be provided near to the wash hand facilities in all of the communal toilets and bathrooms had not been fully implemented. The acting manager subsequently confirmed that the requirement had been implemented. It was confirmed that the recommendation that all of the communal bathing facilities should be clearly marked had been implemented. Standard 22 was not fully inspected on this occasion. However, the home’s response to the one recommendation that was made as a result of the previous inspection was assessed. The recommendation was that the advice of a qualified occupational therapist should be sought in order to ensure that the home provides all of the recommended disability equipment and environmental adaptations to meet the needs of the service users. The recommendation had not been implemented and still stands. Standard 24 was not fully inspected on this occasion. However, the home’s response to the three requirements and two recommendations that were made as a result of the previous inspection was assessed. The first requirement was that all of the items of furniture specified in Standard 24.2 must be provided in rooms occupied by service users. This requirement was not fully assessed Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 20 during this inspection. Therefore, the requirement is repeated in this report and the timescale for the implementation of the requirement has been extended. The second requirement was that a suitable single action lock must be fitted to the door of bedroom 14 and action taken to ensure that the door closes properly on its rebate. The requirement had been implemented. The third requirement was that a lockable storage space must be provided in all of the bedrooms for each service user with a key that he or she can retain. It was confirmed that the requirement had been implemented. The first recommendation that the Fire Safety Officer should be asked to confirm, preferably in writing, that the locks on the bedroom doors are of a suitable type had not been implemented and still stands. The second recommendation that the decision of the service users regarding whether to have a key to their bedrooms should be recorded in their care plans had been implemented. Standard 25 was not fully inspected on this occasion. However, it was confirmed that the requirement that was made as a result of the previous inspection that the exposed pipe-work in bedroom 6 must be boxed had been implemented. The laundry facilities and wall and floor surfaces were satisfactory. The washing machine had a sluicing programme. The laundry had a wash hand basin, paper towels and a liquid soap dispenser. The premises were clean and tidy and there were no unpleasant odours. The recommendation that was made as a result of the previous inspection that the home’s infection control policy should be signed and dated by the registered manager and reviewed at least every twelve months had been implemented. The service users with whom discussions were held expressed their satisfaction with the standard of cleanliness in regard to the premises and their own personal clothing. One service user said, ‘The laundry is very efficient and quick’. Another service user said, ‘Everything is spotless’. The Comment Card completed by the relative of one service user stated, ‘We chose this home because of the high standard of care and cleanliness.’ Another respondent stated that the home was a ‘lovely place, spotlessly clean at all times and nothing is too much trouble for the staff’. Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The service users’ needs were being met by staff who were receiving further training. However, the service users were not fully protected by the home’s staff recruitment procedures. EVIDENCE: A copy of the home’s staff duty rota was made available for inspection. The home employed staff to undertake caring duties during the working day for a total of 307 hours per week (approximately). However, it was noted that between 2.00 and 6.00 pm each day, in addition to the acting manager and head chef, there was only one senior care assistant and one care assistant on duty. The acting manager felt that this was sufficient to meet the care needs of the service users. However, the level of staffing during the afternoons will inevitably limit the amount of individual attention that the staff can give to the service users and the range of social activities provided during this period. It could also result in service users having to wait for longer periods before they receive attention. It was noted that the home had a vacancy for a deputy manager (full-time) and a vacancy for a part-time care assistant for 16 hours per week. At night there was always one member of staff on waking duty and another member of staff asleep and on-call. A full-time head chef and a parttime cook were employed for catering duties. The home employed two parttime cleaners for a total of 22 hours per week. Another member of staff was employed to carry out cleaning duties for between 8 and 12 hours per week. One member of staff was employed to do ironing duties for 6 hours per week and a gardener was employed for 5 hours per week. A maintenance man Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 22 worked at the home for between 20 and 25 hours per week. The service users and relative with whom discussions were held spoke positively about the staff. One service user said, ‘The staff are extremely pleasant and always obliging and do their acceptable best but sometimes they are overworked. Sometimes they are a bit thin on the ground through no fault of their own. Sometimes there’s a slight delay but very seldom’. Another service user described the staff as ‘very pleasant and very helpful and very attentive to my needs’. Another service user said, ‘The staff are very thoughtful. Sometimes they are away but they’re coping. I can’t be in a better place for being cared for’. The relative of one service user stated, ‘The staff are extremely nice, very helpful and nothing is too much trouble for them’. One relative stated in their Comment Card, ‘The home is always well maintained and the staff are always pleasant and hardworking. In the event of any problems arising they contact me without delay. They appear to be genuinely concerned for the welfare of the residents. They take good care of my mother and I feel confident that she is being properly looked after.’ Another respondent stated that the staff were ‘very kind and caring towards the people they look after’. Another respondent stated, ‘My mother and I are extremely happy with the quality of service provided’. Another respondent described the staff as ‘kind and caring’. Currently, a total of 19 members of staff were employed for caring duties (days and nights). The registered manager stated that the number of staff that had successfully completed the NVQ level 2 training had fallen following the recent resignation of several staff. Nevertheless, there were still 10 members of staff employed by the home who had attained the NVQ level 2 qualification. This exceeded the level of 50 trained members of care staff with NVQ level 2 as required by the National Minimum Standards. A small number of staff had also completed the NVQ level 3 training. Six members of staff were undertaking the NVQ level 2 training. The requirement that was made as a result of the previous inspection that arrangements must be made for staff to receive training that will enable a minimum of 50 of the care staff to attain a qualification at NVQ level 2 or equivalent had been implemented. The files of three members of staff who had been appointed since the previous inspection were made available for inspection. It was noted that in the case of one member of staff the second reference was in the form of a personal testimonial addressed ‘to whom it may concern’ and had not been dated. The file contained a copy of a contract that had not been signed or dated. This had been subsequently rectified by the provision of a second ‘Statement of Particulars of Employment’. The file in respect of another member of staff included a CRB check that was dated two months after the employee had commenced working at the home. The registered manager stated that a former member of staff who had been responsible for carrying out the checks had not followed the correct recruitment procedures. The third file also contained one personal testimonial. In addition, another member of staff who had a CRB check dated 21 December 2006 was said to have commenced working at the home at the ‘end of October or beginning of November 2006’. Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 23 The file for the same member of staff was not available for inspection. It was stated that the file had ‘gone missing’. The staff recruitment procedures, particularly in regard to references and CRB checks, did not fully protect the service users. It is important that the references that are obtained are given in response to specific requests made by the home and relate to the work that the prospective member of staff will be required to undertake. Four requirements were made in regard to Standard 29 as a result of the previous inspection. Three requirements related to written references and CRB checks. The first two requirements had not been implemented and still stand. In regard to the third requirement it was confirmed that an enhanced disclosure check had been obtained from the CRB in respect of all other staff employed by the home. Therefore, the third requirement had been implemented. The fourth requirement that a photograph and proof of identity in respect of each member of staff must be obtained and kept in the home had, apart from the missing file in respect of one staff member, been implemented. A requirement was made in regard to Standard 30 as a result of the previous inspection that all staff must have individual training and development assessments and profiles that include details of all their training needs and how these will be met in the future had not been fully implemented and still stands. It was noted that the home had an individual training file in respect of each member of staff. However, the training information contained in the files was not up to date and did not show the future training needs and how these would be met. The home had its own induction training programme that included instruction on issues relating to treating service users with privacy and respect. The registered manager stated that new staff were employed on the basis/expectation that they would undertake the home’s induction training and that this would be followed by NVQ level 2 training. Any deficits in the NVQ training would be made up with other training provided by external agencies. It was confirmed that the staff received at least three paid days training per year. Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. The quality outcome in this area was adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for managing the home were unsatisfactory. The systems for ensuring the quality of the service needed to be developed and maintained. EVIDENCE: The registered manager was competent and experienced and had the necessary skills to manage the home. However, since February 2006, the registered manager had been working as the acting manager in another home owned by the same registered provider. An acting manager had been recently appointed to manage Dunley Hall with support and supervision being provided by the registered manager. The home had, in effect, been without a permanent registered manager for almost a year. The acting manager intended to make an application for registration but had not yet done so. It was subsequently confirmed by the registered provider that such an application would be made. The situation was unsatisfactory and urgent action must be taken to resolve the matter. The home had, in effect, been without a Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 25 permanent registered manager for almost a year. The registered manager stated that she did not have a job description. One requirement and four recommendations were made in regard to Standard 33 as a result of the previous inspection. The requirement was that a quality assurance system must be introduced. It was noted that the home had purchased a commercially produced quality assurance system. However, various aspects of the system needed to be updated. The requirement had not been fully implemented. The first recommendation was that there should be an annual development plan for the home, based on a systematic cycle of planning, action, review, reflecting aims and outcomes for service users. The recommendation had not been implemented and still stands. The second recommendation was that the results of service user surveys should be published and made available to current and prospective service users, their representatives and other interested parties, including the CSCI. The registered manager confirmed that questionnaires had been issued to the service users at the beginning of 2005 and 2006. It was also confirmed that the service users had been given feedback about the results and that a notice had been displayed informing the service users and their visitors of the availability of the summary of the results. The summary of the results had been produced in ‘easy to read’ format i.e. in the form of pie charts with large print. The recommendation had been implemented. The third recommendation was that written evidence should be provided to demonstrate the home’s commitment to lifelong learning and development for each service user linked to the implementation of their individual care plans. The registered manager said that the recommendation was being implemented in practice but was not being written down. The recommendation still stands. The fourth recommendation was that the views of family and friends and of stakeholders in the community should be sought on how the home is achieving goals for service users. The registered manager confirmed that in March/April 2006 a questionnaire had been issued to the service users’ relatives and to visiting professionals. However, the results of the questionnaires had not yet been analysed or published. The registered manager was advised to provide those who had taken part in the survey with a copy of the summary of the results. Standard 34 was not fully inspected on this occasion. However, the home’s response to the recommendation that was made as a result of the previous inspection that a business and financial plan for the establishment should be drawn up, made open to inspection and reviewed annually was assessed. The recommendation had not been implemented and still stands. It was confirmed that no person employed by or connected with the running of the home acted as an agent or appointee on behalf of any of the service users. Money was held for safekeeping by the home on behalf of the service users. The money and accounts were maintained separately in individual wallets. Following a theft in 2006 the home had provided a safe in which the service users money was now kept. A recommendation was made as a result of the Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 26 previous inspection that the records of the service users’ finances maintained by the home should be accurate and up to date. The records of the service users money was checked and these were satisfactory. The recommendation had been implemented. However, an independent person should periodically audit the service users’ finances. It was stated that the home did not hold for safekeeping any possessions or valuables belonging to any of the service users. The registered manager confirmed that she had held supervision meetings with two of the senior staff during October 2006. A detailed record of the meetings had been maintained. The home had an appropriate form for recording staff supervision. However, the supervision of other staff had not been maintained at the required frequency. Standard 37 was not fully inspected on this occasion. However, the home’s response to the requirement that was made as a result of the previous inspection was assessed. The requirement was that visits to the home by the registered provider must take place at least once a month and copies of a written report on the conduct of the care home must be supplied to the registered manager and the Commission in accordance with Regulation 26. The copy of the last Regulation 26 report that was made available for inspection by the registered manager was dated 14 August 2006. Therefore, the requirement had not been implemented and still stands. Advice was given to the registered manager about the way in which the contents of the reports should be improved. A requirement was made in regard to Standard 38 as a result of the previous inspection. The requirement was that window-opening restrictors must be fitted to the windows in bedrooms 3, 9 and 12 and to the window in the corridor near to bedroom 8 on the first floor. It was confirmed that the requirement had been implemented. The most recent visit by the Fire Safety Officer took place on 24 May 2006. One of the Fire Safety Officer’s recommendations regarding the review and completion of the home’s fire safety risk assessment had not been implemented. The recommendation is restated in this report as a requirement. This matter must be dealt with as a priority. A fire drill was due on 18 January 2007. On 22 January 2007 the registered manager confirmed that a fire drill had been carried out. Fire safety training had been arranged for 31 January 2007. The acting manager and registered manager had not undertaken the fire safety training for managers. A risk assessment on one service user that smoked was carried out and recorded during the inspection. Accidents were being recorded. However, some of the accident sheets contained various omissions e.g. the time of the accident, whether any injuries had been sustained or first aid had been administered and details of any investigation into the cause of the accident. Advanced dementia training had been undertaken by the acting manager and registered manager and other staff had undertaken first level dementia training. The home’s health and safety policy had not been reviewed since 11 Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 27 January 2005. Risk assessments that had been carried out and recorded for safe working practice topics were made available for inspection. However, these did not included the regular servicing of boilers and central heating systems. Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 28 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 1 Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? YES 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 2 Standard OP1 OP3 Regulation 5 14 Requirement The service users’ guide must be amended in accordance with the guidance given in this report. A full, accurate and detailed written assessment must be completed in respect of all prospective service users prior to admission. The specific date of the preparation and subsequent reviews of the care plans must be recorded to show that the care plans are reviewed at least once a month. The list of the names and signatures of all the staff involved in the administration of medication must be updated and accurately maintained. (Previous timescale 06/02/06 not met). Medication must be stored securely in a lockable cupboard at all times. A dedicated fridge for storing medication must be provided and a daily record of the temperature maintained to ensure that the medication is DS0000055364.V327243.R01.S.doc Timescale for action 28/02/07 28/02/07 3 OP7 15 28/02/07 4 OP9 13 28/02/07 5 6 OP9 OP9 13 13 28/02/07 28/02/07 Dunley Hall Version 5.2 Page 30 7 OP9 13 8 OP9 13 9 OP9 13 10 OP10 16 11 OP16 22 12 OP18 12,13 13 OP18 13,18 14 OP19 13,23 15 OP19 13 stored at a temperature of between 2 and 8 degrees C. All the staff involved in the administration of medication must receive accredited training that includes basic knowledge of how medicines are used and how to recognise and deal with problems in use and the principles behind all aspects of the home’s policy on medicines handling and records. A clear, written record must be maintained of all errors that occur in the administration of medication so that a full audit of medicines can be undertaken. The policy and procedure for the administration of medication must be reviewed and amended in accordance with the guidance given in this report, singed and dated. Fixed screening must be provided in bedroom 2 in order to ensure the service users’ privacy and dignity. (Previous timescale 31/03/06 not met). The record of all complaints made by service users or their relatives/representatives must be fully and accurately maintained at all times. The home must maintain one correctly worded policy and procedure on the protection of vulnerable adults from abuse. The registered manager and acting manager must undertake training in the protection of vulnerable adults from abuse at a level that is appropriate for managers. The potholes in the driveway must be filled in and the surface of the driveway levelled and made safe. The electric bar heater in the DS0000055364.V327243.R01.S.doc 31/03/07 28/02/07 28/02/07 28/02/07 28/02/07 28/02/07 31/03/07 28/02/07 24/01/07 Page 31 Dunley Hall Version 5.2 16 OP21 23 17 OP21 13,16 18 OP24 16 19 OP29 19 20 OP29 19 21 OP29 19 22 OP30 18 bathroom on the first floor must be removed and replaced, if necessary, with a more suitable form of heating. The items stored in the bathroom on the first floor must be removed and the bathroom refurbished and used appropriately for its intended purpose. (Previous timescale 30/06/06 not met). Paper towel dispensers must be provided near to the wash hand facilities in all of the communal toilets and bathrooms. (Previous timescale 03/02/06 not met). All of the items of furniture specified in Standard 24.2 must be provided in rooms occupied by service users, including the items referred to in the report dated 26/01/06 in relation to bedrooms 4 and 10. (Previous timescale 31/03/06 has been extended). Two written references must be obtained before appointing any member of staff and any gaps in employment records must be explored. (Previous timescale 30/01/06 not met). An enhanced disclosure check from the Criminal Records Bureau must be obtained for all new staff before their appointments are confirmed. (Previous timescale 30/01/06 not met). All of the missing information regarding the recruitment and employment of one member of staff must be replaced. All staff must have individual training and development assessments and profiles that include details of all their training needs and how these will be met in the future. DS0000055364.V327243.R01.S.doc 28/02/07 28/02/07 28/02/07 28/02/07 28/02/07 31/03/07 31/03/07 Dunley Hall Version 5.2 Page 32 23 OP31 8 24 OP33 24 25 26 OP36 OP37 18 26 27 OP38 13,23 28 OP38 13,23 29 30 OP38 OP38 13,17 13 (Previous timescale 31/03/06 not met). The acting manager must make an application to the CSCI to become the registered manager of the home. The quality assurance system that has been introduced must be updated and maintained in order to become an effective means of monitoring the quality of the service provided by the home. Care staff must receive formal supervision at least six times a year. Visits to the home by the registered provider must take place at least once a month and copies of a written report on the conduct of the care home must be supplied to the registered manager in accordance with Regulation 26. (Previous timescale 30/06/06 not met). The fire risk assessment must be reviewed and completed by a competent person in accordance with the recommendations of the Fire Safety Officer. The registered manager and acting manager must undertake the fire safety training for managers. The accident records must be completed in full and include all of the relevant details. Risk assessments must be carried out and recorded for all the safe working practice topics covered in Standards 38.2 and 38.3 including the regular servicing of boilers and central heating systems 28/02/07 31/03/07 30/06/07 28/02/07 28/02/07 31/03/07 28/02/07 28/02/07 Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 33 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 OP2 Good Practice Recommendations All of the service users’ contracts should be signed by the service user and/or his or her representative and by an appropriate representative of the home i.e. the registered provider. The medication that is recorded on the MAR charts by hand should be referenced back to the original prescription, checked by a second member of staff and the MAR chart signed by both staff. The entertainment audit should be completed at frequent intervals in order to ensure that a satisfactory range of social and recreational activities is maintained. Consideration should be given to the provision of a suitable vehicle for transporting service users on outings. The advice of a qualified Occupational Therapist should be sought in order to ensure that the home provides all of the recommended disability equipment and environmental adaptations to meet the needs of the service users. The Fire Safety Officer should be asked to confirm, preferably in writing, that the locks on the bedroom doors are of a suitable type. A job description for the registered manager that enables him/her to take responsibility for fulfilling all of the necessary duties associated with managing the care home should be provided. There should be an annual development plan for the home, based on a systematic cycle of planning, action, review, reflecting aims and outcomes for service users. Written evidence should be provided to demonstrate the home’s commitment to lifelong learning and development for each service user linked to the implementation of their individual care plans. The results of the survey of the views of family and friends and of stakeholders in the community on how the home is achieving goals for service users should be analysed and published and a copy of the summary of the results issued to those who have taken part. A business and financial plan for the establishment should be drawn up, made open to inspection and reviewed annually. DS0000055364.V327243.R01.S.doc Version 5.2 Page 34 2 OP9 3 4 5 OP12 OP12 OP22 6 7 OP24 OP31 8 9 OP33 OP33 10 OP33 11 OP34 Dunley Hall 12 13 OP35 OP38 The financial accounts maintained on behalf of the service users should be regularly and independently audited at least every two months. The health and safety policy should be reviewed at least annually and amended/updated where necessary in the light of any changed circumstances, signed and dated by the registered manager. Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 35 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: 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 Dunley Hall DS0000055364.V327243.R01.S.doc Version 5.2 Page 36 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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