Inspection on 03/04/07 for Elm Lea Residential Care Home

This inspection was carried out on 3rd April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Elm Lea Residential Care Home 22/08/08

Elm Lea Residential Care Home 01/10/07

Elm Lea Residential Care Home 31/05/06

Elm Lea Residential Care Home 27/10/05

Elm Lea Residential Care Home 25/05/05

Elm Lea Residential Care Home 08/11/04

Elm Lea Residential Care Home 24/09/04

Elm Lea Residential Care Home 06/07/04

Elm Lea Residential Care Home 08/06/04

Elm Lea Residential Care Home 04/05/04

Elm Lea Residential Care Home 14/03/04

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

CARE HOMES FOR OLDER PEOPLE Elm Lea Residential Care Home 17 Bartholomew Lane Saltwood Hythe Kent CT21 4BX Lead Inspector Mrs Sue Gaskell Key Unannounced Inspection 3rd April 2007 09:30 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 Elm Lea Residential Care Home DS0000054357.V333393.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. Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elm Lea Residential Care Home Address 17 Bartholomew Lane Saltwood Hythe Kent CT21 4BX 01303 269891 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) renuka15@hotmail.com Mrs Renuka Oojageer Mr Mookesh Oojageer Mrs Renuka Oojageer Care Home 15 Category(ies) of Old age, not falling within any other category registration, with number (15) of places Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st May 2006 Brief Description of the Service: Elmlea is registered to provide accommodation and personal care for fourteen Older People. Ownership of the home was transferred to Mr and Mrs Oojageer on 18th December 2003. Elmlea occupies detached premises with fourteen single bedrooms, all of which have en-suite facilities. Accommodation is on the ground and first floor and the Home has a shaft lift. There is a well maintained garden for Residents’ use. There are two assisted baths, one on each floor. The Residents have a choice of sitting areas, with the main lounge/dining room, a conservatory and a small quiet room for their use. The Home is located on the outskirts of a small sized town, with good access to shops, public transport and other public amenities, some of which are within walking distance. The current scale of charges at the home range between £295-£350 per week. Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 3rd April 2007, between 9.30am and 3.30pm and was carried out by Mrs Sue Gaskell and Mr Terry Bush. The purpose of this inspection was to clarify the judgements and rating given at the previous inspection, This was in response to adult protection investigations concerning the home, and two concerns received from residents’ relatives since the last inspection. We spoke with the registered manager who is also one of the registered owners, five residents and two care staff. The residents said that they like living in the home. They said that they are treated with respect and well cared for. The inspection process also consisted of information collected before and during the visit to the service, and written feedback from three residents and two residents’ relatives after the site visit finished. Other information seen included updated policies and procedures, general assessments, risk assessments and care plans, and staff recruitment, training and supervision records. A thorough inspection was carried out of the premises. A number of urgent requirements were made following this inspection. What the service does well: What has improved since the last inspection? Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 6 The service user guide includes details regarding fees. Care plans have been reviewed. Staff have received training in the use of hoists, The lounge and some bedrooms have been decorated and re-carpeted. 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. Elm Lea Residential Care Home DS0000054357.V333393.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 Elm Lea Residential Care Home DS0000054357.V333393.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, 3 & 6 Quality in this outcome area is poor. There is no evidence to show how the home will promote and support equality and diversity. The lack of a consistent pre-admission procedure may result in residents’ needs not being met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 9 The home has a statement of purpose, which sets out the aims and objectives of the home. There is a service user guide which provides basic information about the service including the fees. They are both made available to residents in a standard format. They are not produced in large print or made easier to understand in any way. They do not contain specific information explaining how the home will promote and support people from different social ethnic or cultural backgrounds or people with specific disability or personal needs. Residents are provided with a contract explaining the terms and conditions of residence. The contracts provide information on what residents can expect to receive for the fee they pay. There is an admissions procedure that includes a pre-admission assessment of the prospective resident. A file of one recently admitted resident includes an assessment profile but the assessment is not dated. There is no evidence of any service user involvement in the assessment or initial care plan. An adult protection investigation carried out since the previous inspection highlighted two occasions when proper pre-admission assessments have not been carried out. Neither of those residents still live in the home. Most of the residents are self-funding which means that there may not have been consultation with appropriate healthcare professionals about whether the home is able to meet prospective residents’ needs. Whilst staff may have the necessary skills and ability to care for residents who are admitted, lack of staff at the time of the inspection may mean that residents’ needs are not met. Elm Lea Residential Care Home DS0000054357.V333393.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 & 10 Quality in this outcome area is adequate. Residents’ needs and rights may be compromised by inconsistent care plans and lack of staff. Residents are generally protected by the home’s policies and procedures for dealing with their medication. Residents are able to make choices and are treated with respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 11 Each resident has a care plan that includes personal and healthcare needs, likes and dislikes, moving and handling assessments and some risk assessments. Two resident’s care plans refer to their wish to have their bedroom doors open at night but there are no risk assessments around this issue. Most of the moving and handling assessments, a “falls checklist” and other risk assessments, lack dates. The level of information in the care plans is not currently consistent. One care plan was updated in February 2007. and another in March 2007. Others state a review date, with the comment “no change”. Some residents said that they are aware that the home keeps records on them but there is no written evidence to show that residents are involved in the preparation or review of their care plan. Residents have access to local health care services. The local District Nurses call regularly and one had attended to a resident on the morning of the inspection following an identified need the night before. Residents are able to choose their own GP and all have access to dentists, opticians and other community services. Residents’ healthcare needs are generally monitored and appropriate action taken. The registered manager, who is also one of the registered owners said that although she is a qualified nurse she is aware that she must seek external professional advice on health care issues. She acknowledged that there had been a recent problem where although a resident had been assessed as requiring nursing care, there was a delay in finding another placement for the resident. There is evidence in the care plan of monitoring residents’ health care needs and general well being, eg some residents are weighed weekly. The home has a medication policy which is accessible to staff. The medication records are up to date for each resident. There are appropriate records for the receipt, administration and disposal of medication. The place of storage is adequate. The home needs to consult with the GP or pharmacist over the amount of certain medication to keep on the premises. There are no risk assessments to indicate that the home considers enabling some residents to look after and administer their own medication safely. Although the manager keeps a training matrix on display which indicates that there is a high level of training, some of the files lack copies of training Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 12 certificates. The manager said that this is because staff have kept the certificates. The current lack of staff on duty means that some tasks are neglected. One member of staff spoke of the need to treat residents with respect and to consider dignity when delivering personal care. We saw examples of this member of staff assisting a resident with great sensitivity. Residents said that they like living in the home. They said that they are treated with respect and well cared for. Elm Lea Residential Care Home DS0000054357.V333393.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 & 15 Quality in this outcome area is adequate. Daily life generally meets the residents’ lifestyle preferences and expectations. Residents choices are respected. Residents would benefit from a better planned menu. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 14 One resident and another resident’s relative who were interviewed said that they are often asked whether they need anything and that they are encouraged to make choices wherever possible. One resident’s relative said that she can visit whenever she wants and she is always made welcome. However, although the manager and staff referred to respecting the choices and wishes of the residents, this could be affected by the lack of staff. There is currently no person employed specifically for cooking. On the day of the inspection the cooking was being done by a member of staff who said that she helps out when she is needed. The main meal served on the day of the inspection was served at mid day. Residents were offered a choice of “toad in the hole” or pizza. Residents said that although they are not usually offered a choice as such, there will be some sort of alternative meal available. Three residents said that the food is generally to their liking. Two residents said that drinks are available throughout the day and evening. There is a reasonable range of dry foods in the food store but some of the items in the fridge were beyond their “sell by” date. There have been two concerns raised since the last inspection about the quality and quantity of the food. The residents appeared to be seated comfortably and given appropriate cutlery. Although some staff are trained to help those residents who need help when eating and are sensitive in their approach, lack of staff may affect this. Residents said that there are a range of activities in the home, such as bingo and sing songs, and there have been occasional outings. Where possible residents manage their own money. Records are kept for any involvement in residents’ finances. Residents are able to have personal possessions in their room. Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 15 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, 17 & 18 Quality in this outcome area is adequate. Residents’ complaints are recorded and dealt with appropriately and they are protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The majority of staff have undertaken training in the area of ‘Adult Protection’ either through attending a specific training course or/and as part of NVQ training. The member of staff spoken to showed a good awareness of adult protection issues. There have been two adult protection alerts regarding the home since the last inspection and one concern addressed to a funding authority. The manager said that she is very keen to address any issues. Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 16 There was reference in one resident’s file to a complaint and details of how it was addressed. Three residents and one resident’s relative said that they would feel comfortable mentioning any problems to staff or the owners. Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 17 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, 20, 24, 25 & 26 Quality in this outcome area is poor. Residents live in a comfortable environment but are at risk from lack of a planned cleaning and maintenance routine. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 18 The service provides a homely environment and residents said they are comfortable. Residents can personalise their rooms and choose where they sit in the communal areas.. The home is generally tidy but the kitchen, bathrooms and WC’s are not sufficiently clean, eg floors and hand-basins etc. Some of the bedrooms are also not sufficiently clean, eg in room 12 there are marks on the wallpaper and the rim of the WC is badly soiled. There are no separate domestic staff and the current number of care staff on shift is such that they do not have time to attend to these areas. The lounge and some of the bedrooms have been decorated and re-carpeted in the past few weeks. Whilst the owners are in the process of further making improvements, there are a number of areas requiring urgent attention. These include the following: Some locks on bedroom doors are of a type where the staff may not be able to access the room in an emergency. One bath is so badly corroded that the bare metal is exposed. Some of the bedrooms contain mis-matched furniture that is below an acceptable standard, eg the tables in rooms 1, 4, 7 and 9 require renovation or replacement. Some bedroom chairs, eg rooms 7 and 11 are badly soiled. Some cisterns needs attention, eg room 7, 10 and 11. Bedroom radiators are of a low surface temperature type and are not covered, and may present a risk. Although some of the rooms have en-suite facilities not all of the residents make use of these as they require the assisted bathing facility. Some of these unused facilities are used for storage. There are no risk assessments regarding such storage. There are notes in some residents’ files stating that they wish for their doors to be open at night. This should be risk assessed along with other fire safety requirements. The manager said that she was unaware that fire safety risk assessments must be carried out. Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 19 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 & 30 Quality in this outcome area is poor. Residents are protected by the home’s recruitment and training procedures but their care and safety may be compromised by lack of staffing. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels at the time of the inspection appeared inadequate to meet residents’ needs in terms of their daily care and the home’s domestic needs. There were three staff on duty at the time of this inspection, including the manager and cook. Although there are currently only nine residents in the home, some residents require a considerable amount of assistance. Therefore other residents requiring assistance may have to wait for an unacceptable long time. Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 20 The owner/manager said there is not an issue with staff shift patterns or staff always working in the same teams, as the staff rota is adjusted in order to ensure a mix of skills and experience. One established member of staff said that she has received on-going training and that supervision and assistance with training have improved recently. Both staff interviewed confirmed that they had to complete application forms, and that the home applied for their references, CRB checks, and evidence of identity. Four staff files were inspected. They contained evidence of references, CRB checks etc. Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 21 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 & 38 Quality in this outcome area is poor. Residents do not live in a safe, clean environment. Some management issues require urgent attention. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 22 One of the registered owners is also managing the home and has a high level of involvement with all aspects of life of the home. Whilst she has made improvements to various practices and facilities, there are a number of outstanding and new issues that require urgent attention. These include the following: Neither refrigerator appears to be working at a safe temperature. There is unlabelled food in the freezer. The exterior of the refrigerators are badly corroded. Whilst this may not present a health risk it indicates that they have been in use for some time and may be due for replacement. Several first floor windows are unrestricted. Topical creams and items such as Steradent are not locked away. There are hazardous materials stored in an unlockable bedroom. There is an external staircase which is potentially slippery and could present a risk. The gardens are generally well maintained apart from a section of wall which needs attention. There was no obvious hazardous waste in the garden or grounds. Most of the records are adequately maintained but the issues identified indicate that care practices are not being followed or reviewed. Some of the issues referred to in this report were highlighted at the previous inspection. Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 23 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 ENVIRONMENT CHOICE OF HOME Standard No Score 1 2 3 4 5 6 Standard No 19 20 21 22 23 24 25 26 Score 1 X 1 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 1 1 X X X 1 1 1 STAFFING Standard No Score 27 1 28 1 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 3 X X 1 Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 24 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 OP3 Regulation 14 Requirement All prospective residents should have a pre-admission assessment carried out by a suitably qualified person. The pre-assessment process needs to include the assessment of the home’s capacity to meet the needs of the resident. Statement of purpose, service user guide and contracts should include details of how home will promote and support equality and diversity. Care Plans to be organised into a more consistent format. Any review of care plans to include the Resident and their representatives wherever possible. A substantial alternative to meals of the day must be available at all times. The premises must be accessible, safe and well DS0000054357.V333393.R01.S.doc Timescale for action 30/04/07 2 OP4 14 30/04/07 3 OP4 4 30/06/07 4 OP7 15 30/06/07 5 OP15 16 30/04/07 6 OP19 13 30/04/07 Elm Lea Residential Care Home Version 5.2 Page 25 maintained. 7 OP19 13 Provide written evidence of consultation with the Environmental Health Officer regarding the safety of the external staircase, together with any advice given and action taken. Carry our fire safety risk assessments for all fire safety issues including bedroom doors left open at night . Provide safe, adequate and suitable furniture in bedrooms and communal areas. Provide locks on bedroom doors which enable access by staff in the event of an emergency. Ensure radiators do not present a risk to residents. The premises must be kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation and published professional guidance. Suitably qualified, competent and experienced persons must be working in the home at all times, in numbers sufficient to carry out care, catering and domestic tasks. 30/04/07 8 OP19 23 30/04/07 9 OP20 16 31/05/07 10 OP24 12 & 13 30/04/07 11 12 OP25 OP26 13 23, 12, 13, 16 31/05/07 30/04/07 13 OP27 18 30/04/07 14 OP33 12 Policies, procedures and 31/05/07 practices regarding care, hygiene and maintenance should be reviewed regularly. Fire safety, food safety and DS0000054357.V333393.R01.S.doc 15 OP38 16 & 23 30/04/07 Version 5.2 Page 26 Elm Lea Residential Care Home general health and safety legislation must be followed, including storage and labelling. All hazardous substances, including Steradent tablets, must be stored safely. 16 OP38 13 Ensure residents are not at risk from unrestricted windows. 30/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Elm Lea Residential Care Home DS0000054357.V333393.R01.S.doc Version 5.2 Page 28 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!