Inspection on 13/09/05 for Eliza House

This inspection was carried out on 13th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Eliza House 19/06/07

Eliza House 28/02/07

Eliza House 25/04/06

Eliza House 05/07/05

Eliza House 02/11/04

Eliza House 11/05/04

Eliza House 18/03/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Eliza House 467 Baker Street Enfield Middlesex EN1 3QX Lead Inspector Jackie Izzard Unannounced Inspection 13th September 2005 09:00 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 Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Eliza House Address 467 Baker Street Enfield Middlesex EN1 3QX 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) 020 8367 8668 020 8367 2129 Peaceform Limited Mr Noah Sagnia Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three specifeid service users who have dementia may remain accommodated in the home. The home must advise the registering authority at such times as any of the specified service users vacates the home. 5th July 2005 Date of last inspection Brief Description of the Service: Eliza House is a purpose built care home for twentysix older people. There are twentysix single bedrooms and residents share a large lounge, divided into two seating areas plus a dining room, bathrooms, shower room and outside seating areas. The home is operated by Peaceform UK Limited who have other care homes in the UK. The home is located a short bus ride away from Enfield Town and is close to a park. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 13 September 2005 and lasted six and a half hours. The home did not know the inspector was coming. The inspector spent time talking to the manager, checking that the things the owner and manager of the home had been asked to do at the last inspection in July had been completed, and talking to eight staff, four relatives and eleven residents at the home. At the time of this inspection there were sixteen residents in the home plus another three who were in hospital. The inspector was able to meet all the sixteen residents during the day. In addition, the inspector looked at various records and observed residents eating their breakfast and lunch. What the service does well: What has improved since the last inspection? The last inspection was 5 July, two months before this inspection. Since then, the way that staff give medication has improved. Medicines are now being given more safely. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 6 The way that staff keep a record of a resident’s medical appointments has also improved. Progress has been made in ensuring that residents’ needs and wishes are written down in a care plan for staff to follow. 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. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 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 Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home ensures that new residents’ needs are assessed prior to coming into the home. EVIDENCE: There has been a period of several months with no new admissions due to concerns about the quality of care provided at the home. There have been improvements over the last few months and Peaceform Ltd are hoping that local authorities will start placing people at Eliza House again. Since the last inspection one new resident has moved into the home. This person had an assessment of her needs on her file. Standard 6 is not applicable to this home as intermediate care is not provided. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Residents’ health needs appear to be met but the manager still needs to ensure that every resident’s healthcare records are up to date to ensure that healthcare needs are being fully met. The home has made improvements in healthcare records and medication practice which is protecting the health of the residents. The home needs to ensure that the care needs of a resident with dementia are fully addressed in her care plan as residents with dementia may have some extra or different needs to other residents. EVIDENCE: A sample of three care plans were read on this occasion. Two of these were of a satisfactory standard and addressed the resident’s needs. The plans include the resident’s preference for bath or showers and how often they wish to have one as a result of requirements made about inadequate personal care by the CSCI in May 2005. A new resident’s care plan has been signed by her next of kin and her file includes records of health appointments, which is good. One of the three files seen did not have an up to date record of health appointments and the manager was asked to ensure that every file is updated. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 10 One care plan was not satisfactory as it did not address all areas of need. This resident who has dementia is regularly left alone in his/her bedroom for long periods. This practice was not mentioned in the care plan. On this occasion, the resident had spilled some of his/her lunch on the bedroom floor. S/he then asked for more food. Advice was given to the manager on improving the quality of life for this resident, including possible activities for this person and a requirement is made to hold a review and update the resident’s care plan. The manager agreed to do so immediately. Medication practice in the home has improved in the last two months. Staff have been instructed to follow careful procedures for giving out medicines at all times. The inspector noted an improvement in the medication records but there were a few occasions when two staff should have signed a record and one hadn’t. The manager said that he was dealing with this matter appropriately. No concerns about medication or health care were noted on this inspection. At the last inspection, the manager was asked to investigate unexplained bruising to resident. This investigation was carried out but the manager had not investigated properly. He said he had misunderstood what he had been asked to do. He was advised that he should not have written a statement on behalf of a relative. This requirement is not repeated as the manager was unable to find out how the bruising had occurred. He assured the inspector that staff have been told they must record and report any bruising or unexplained injury to the manager from now on. Three staff confirmed this. Residents said they were generally happy with the way staff looked after their personal care needs (washing, bathing, dressing and helping them in the toilet). One said that “some are nice, some are rough” and this was reported to the manager who said he would look into this further. The other ten said that generally staff looked after them well so the general feedback was good. One person needed a haircut and records showed she had not had a haircut by hairdresser for over a year, but the manager said this resident did not have any money. This is addressed elsewhere in this report. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Although there have been improvements in the lifestyle at the home this year, more attention needs to be paid to meeting residents’ recreational needs. Residents are generally satisfied with the food provided at the home and are given some choice of meals. EVIDENCE: Eleven residents were taken out on a trip to a pub for lunch in August. They said they really enjoyed this outing. This was the first time most of the residents had been out of the house this year. A second planned outing was cancelled. Another positive improvement in the area of recreation since the last inspection is the addition of a table with paints in the lounge. The inspector asked six residents and two relatives for their comments on activities in the home and whether they felt satisfied with what was on offer. One resident said that her relatives visited frequently and so she did not feel bored. Another said she was satisfied with reading, watching television and did not need staff to provide activities though she would love the opportunity to go out of the home a few times a year. Two relatives and three residents said they would like to see more activities on offer and felt that they spent all day sitting in front of the television. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 12 One relative said that often the television and music were on at the same time. Although some board games have been introduced in recent months, some residents said they do not have enough to do. Five said they would love to go out more often. The home provided a questionnaire to residents earlier this year and asked what activities they would like. At least two people said they would like flower arranging but this activity has not taken place yet. Staff were interacting with residents and spending time chatting with them which is very positive. More residents are sitting in the garden and enjoying some fresh air. The purchase of some new plants has made the garden more interesting for people to sit in. Five residents and one relative were asked for their views on the food. They said that the food was satisfactory. One person said the food was good, another said it was “alright”. One said that if it wasn’t nice, she wouldn’t eat it. The other two said that they liked the food. The inspector observed two mealtimes and saw that residents had a choice of meal. Two staff were observed to be feeding residents in a sensitive way, talking to them, wiping their mouths, offering regular sips of drink and sitting with them throughout the meal. Another staff member was alternating feeding a resident with serving meals until a colleague reminded her to sit down with the resident whilst assisting him/her. Overall there has been good improvement in the way staff help residents to eat over the last year. Not all staff follow good practice. A recommendation was made at the last inspection that residents who are going to be assisted with eating are only served their food when staff are ready to sit with them, so that they do not feel frustrated seeing the meal in front of them and being unable to eat and to prevent the food going cold. At this inspection that recommendation was amended to a suggestion that the manager produce some written guidelines for staff on good practice when assisting a resident to eat so that all staff know what the manager expects. The dining room is clean, light and has sufficient space. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The registered persons need to ensure that the residents’ placing authorities are informed of any situations where residents cannot access their own money, and also to ensure all residents are protected from any risk of financial abuse. EVIDENCE: There have been no complaints about the home since May 2005. The home’s complaints procedure and records will therefore be inspected at the next inspection. Staff have attended a one day course in the protection of older people from abuse. Staff have recently been reminded that any injuries and bruises to residents must be recorded and reported to the manager after a resident had bruises in July which were not recorded. The financial records for three residents were inspected at this inspection. The pre-inspection questionnaire submitted by the home said that all residents receive their personal allowance which was actually not the case. The majority of residents have their money received and looked after by relatives. Others have their money paid into their bank account although some are no longer able to manage their accounts. The inspector found that the home was holding a chequebook for two residents whom the manager said were unable to write their own cheques. One was physically unable to sign his/her name and the other had a diagnosis of dementia. Both these residents said they had no money. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 14 The manager did not know how they could access their bank accounts. A requirement was made that their social workers at Enfield Council are informed of their financial situation and a satisfactory arrangement made for these residents to be able to use their own money. Another resident had no money and the manager said that their relative received their benefits on their behalf. He was advised to request some money from this relative and inform the resident’s social worker of the situation. This person had not received chiropody since February or had a haircut since August 2004 because of having no money. The manager said that it was not possible for the home to pay or lend the resident money for these services. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home is clean and pleasant and attention is paid to health and safety of residents. There is suitable communal space. Some Fire doors and exits need to be checked and made safe in order to further protect residents from risk of fire. The home needs to ensure that any wheelchair user has an appropriate wheelchair and that wheelchairs not in use are stored safely. EVIDENCE: An inspection of a random sample of four bedrooms, the lounges, dining room, gardens and health and safety records was carried out. An inspection of the kitchen by the local Environmental Health Department in February 2005 found the kitchen to be clean. Previous CSCI inspections have not found any concerns in the kitchen so this room was not inspected. A complaint was made in August 2005 to Enfield Council about old appliances and rubbish being stored outside the home. This had been removed before this inspection. There were new plants in the garden. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 16 Inspections of the fire alarm system, electrical wiring, gas appliances, fire equipment and hoists were seen to be up to date. The pre-inspection questionnaire completed by the director of Peaceform Ltd stated that all health and safety checks and records were up to date so only a selection of these were checked by the inspector. All those checked were satisfactory. The manager could not locate the gas certificate so was asked to post a copy to the CSCI. A requirement to remove wheelchairs and walking frames from the lounge and store them safely has not been met so is repeated in this report. The manager said the home is planning to buy a shed to store the items which are not regularly used. The date for compliance with this requirement has not yet been reached. Eight residents use a wheelchair, two of whom use one at all times. A resident who is a full time wheelchair user, but does not have her own wheelchair, is still waiting despite a requirement made for the home to arrange for her to be assessed for one in July. This requirement is also repeated in this report. The home was clean and generally tidy. One fire door (to the lounge) was not closing properly and another (lounge fire exit) was locked despite previous requirements to unlock it. The manager said the key was lost but agreed to arrange for it to be unlocked immediately. He did demonstrate that the door could be pushed open even when locked. Although armchairs have been cleaned after a requirement was made to do so in May 2005, some are soiled again and a requirement is now made to replace them. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Residents are supported by satisfactory numbers of staff on duty who know them well and offer continuity of care. The recruitment practice of the home needs to be tightened to ensure all staff have proper authentic references. This will further protect residents’ safety. EVIDENCE: Staff rotas show that the home continues to provide four staff on duty as prescribed by the CSCI in February 2005. This staffing level means that staff have time to spend with residents talking as well as carrying out personal care and other duties. Staff have formed good relationships with residents and know their needs well. A relative told the inspector that staff were “helpful and very pleasant”. The general feedback from residents about staff was also good. The inspector looked at the staff training records for two new staff members and the recruitment process for three staff. The two new staff had proper references, an application form, CRB clearance, an induction and training in food hygiene, infection control, protection of vulnerable adults since April 2005 and were both trained nurses. These files were both satisfactory. The third file seen was not satisfactory with regard to the recruitment of the staff member. There were two references but no evidence that these were authentic and the references did not relate to employment recorded on the Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 18 application form. A requirement is made to seek further references for this person. The person has been working at the home for some time and there are no reported concerns about this person’s ability to care for residents. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The manager is highly regarded by residents and relatives as somebody who cares for the residents and tries to ensure they are well looked after. The CSCI looks forward to reading the summary of the quality assurance exercise undertaken by the registered persons earlier this year. The director of Peaceform Ltd needs to address the low staff morale in the home as this may affect residents’ wellbeing if staff continue to feel unsupported by their employer. EVIDENCE: The manager is highly regarded by the residents and their relatives. Staff also gave the inspector positive feedback about the manager. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 20 The CSCI have asked the director to employ a deputy manager since February 2005 but although three different people have been recruited none have started working. The manager said that the new deputy would be starting two weeks after this inspection. The director also confirmed this. There is a stable staff team employed at the home which is good for the residents. The inspector met with a group of staff, and in total spoke with eight staff as part of this inspection. The general feedback from staff was that they enjoyed working with the residents and had no complaints about the manager. However, the majority of staff said they were unhappy with their relationship with the director of Peaceform Ltd as they were unhappy with arrangements under which they are paid and that their pay was often inaccurate (receiving less than they believe they are owed). Although the CSCI cannot get involved in the above matters, a requirement is made that that the director takes some action to improve her relationship with the staff team. It is a requirement of Regulation 12 of the Care Homes Regulations 2001 that the registered provider maintains good personal and professional relationships with staff. After the inspection, the provider informed the inspector that the issues identified by staff were being addressed and that she considered their concerns to be resolved. The CSCI is still waiting for a summary of the quality assurance audit undertaken by the registered persons a few months ago. Residents’ finances were inspected and these are addressed in a previous section of this report. Health and safety matters are also addressed in a previous section. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 21 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 2 3 3 2 X X 3 2 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X X 2 X X 3 Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 22 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 Standard OP7 Regulation 15(2) Requirement Timescale for action 30/11/05 2 OP7 12 The registered persons must arrange a review and update the care plan for a specified resident who has dementia. The registered persons must 30/11/05 ensure that, if a resident is not happy to take prescribed medication, that this is clearly addressed in the risk assessment and care plan. This requirement relates to a specified resident. This requirement is restated (previous timescale of 31 August 2005 not met). The registered persons must provide more activities, both within and outside the home, to meet the recreational needs of all residents. The registered persons must ensure all residents are protected from any possibility of financial abuse and therefore must advise the responsible local authorities of the concerns about three specified residents not being able to access their personal money. DS0000010670.V250414.R01.S.doc 4 OP12 16(2)(n) 30/11/05 5 OP18 13(6) 15/11/05 Eliza House Version 5.0 Page 23 6 OP19 23(4)(c) (i)(iii) 7 OP22 23(2)(m) The registered persons must 31/10/05 ensure that every fire door is effectively self closing and no fire exit is locked with a key at any time. The registered persons must 30/09/05 provide a storage area for wheelchairs, walking frames and other equipment. This requirement is restated (previous timescale of 30 September not yet reached). The registered persons must arrange for a wheelchair user to be assessed for receiving her own wheelchair. This requirement is restated (previous timescale of 1 August 2005 not met). The registered persons must replace all stained and worn armchairs with new chairs. The registered person must send a copy of the most recent inspection report for the gas appliances to the CSCI as evidence that this is up to date. The registered persons must ensure that every person employed in the home has two written references which the registered persons have satisfied themselves are authentic. The registered person (director of Peaceform Ltd) must maintain good personal and professional relationships with staff and inform CSCI of what action has been taken to improve current low staff morale. 8 OP22 23(2)(n) 31/10/05 9 10 OP26 OP19 16(2)(c) 23(2)(c) 24/12/05 31/10/05 11 OP29 19(1)(c) 13/09/05 12 OP32 12(5)(a) 30/11/05 Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP15 Good Practice Recommendations Written guidelines on how to assist residents with eating should be given to staff. Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Eliza House DS0000010670.V250414.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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