Inspection on 11/07/05 for Elmhurst

This inspection was carried out on 11th July 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

Elmhurst 19/07/07

Elmhurst 29/09/06

Elmhurst 12/01/06

Elmhurst 16/11/04

Elmhurst 29/06/04

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 ELMHURST 7 Queens Road Enfield Middlesex EN1 1NE Lead Inspector David Hastings Announced 11 July 2005 at 9.30 am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Elmhurst Address 7 Queens Road, Enfield, Middlesex EN1 1NE Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8366 3346 Teen Fook Chon & Julie Chon Mrs Janet Murphy PC - Care Home only 14 beds Category(ies) of OP - Old Age registration, with number of places ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: None 16 November 2004 (unannounced) or 24 February 2005 (additional visit) Brief Description of the Service: Elmhurst is a home for 14 older people. It is owned by Mr and Mrs Chon and is located a short distance from Enfield Town. The home provides a service to older people with a wide range of needs. Some of the older people are very mentally alert and able to maintain their own self-help skills. Some of the other older people have high care needs and require staff support in all aspects of their care. The house is on two levels and there is a lift. There are two shared bedrooms and the others are single. All the rooms have en suit facilities and there is also one assisted bathroom on the ground floor. There is a large lounge/ dining room at the rear of the house overlooking the garden. This room is comfortable and bright with chairs around the edge of the room in a traditional manner. The stated aims of the service are to provide a secure home in which the service user can express their individuality, to seek the maximum development of each service user within their potential and to promote a feeling of self worth for each service user. Date of last inspection ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place on Monday 11th July 2005. A partial tour of the premises took place and case files were examined. Eight residents, two visitors and two staff were spoken to independently. Two feedback forms were received by the CSCI from relatives and were positive regarding the home. Residents and visitors spoken to on the day of the inspection also praised the work of the manager and staff at the home and in general residents said they were happy at the home. The manager is new to the post and was open and helpful throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: Four requirements have been restated from the last inspection relating to staff supervision, provider visits, medication storage and staff terms and conditions. Two further requirements have been issued in connection with medication. The standard of food provision was disappointing. Out of date food was being stored in the kitchen, chopping boards and knife storage was inadequate and residents were not aware of what was for lunch until it was put in front of them. There were no records of what food or activities residents preferred. Five requirements have been issued relating to these matters. The home is generally well maintained but the flooring in the ground floor bathroom needs ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 6 attention. One resident who has developed dementia needs to have a though assessment. Residents are being put at risk by keeping fire doors wedged open and by the lack of any risk assessments in connection with fire safety. The fire alarm and emergency lighting test certificates are out of date. Fourteen new requirements including three immediate requirements have been issued as a result of this inspection. Although this is a large number of requirements the inspectors acknowledge the hard work undertaken by the registered provider, manager and staff to improve the standards of care at the home. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 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 standard(s) 3 and 4 (6 not applicable). Service users have their needs assessed by trained professionals before they move into the home. This ensures that the service user knows the home will be able to meet their needs before they decide to move in. EVIDENCE: Five case files were examined. There was evidence that service users had only been admitted following a detailed assessment undertaken by social workers and other health care professionals. The manager stated that one service user has developed dementia since she was admitted to the home. This service user has not had a review for some time. The manager must apply for a minor variation from the CSCI to enable the service user to stay at the home. The application must also include evidence that a review has taken place by a person qualified to do so. The manager was clear that no service users with a pre assisting diagnosis of dementia would be admitted to the home. ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 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 standard(s) 7, 8, 9 and 10. Service users’ health and personal care needs are set out in an individual plan of care and staff work hard to meet these needs while respecting service users’ privacy and dignity. Service users get the medication they have been prescribed at the right times and by properly trained staff. EVIDENCE: Five care plans were examined. A requirement was issued at the last inspection that all service users have individual risk assessments. These risk assessments were seen on the plans examined. Where individual risks were identified, there were written descriptions for staff concerning how these risks should be reduced. This was also a requirement of the last inspection that has been complied with. There was evidence on the plans that where actions to improve care had been identified in reviews that this should be recorded in care plans. This was seen in a number of the plans and this requirement, from the last inspection, has also been complied with. There was evidence that plans were being reviewed monthly by staff and yearly by social workers. Some plans did not identify service users individual likes and dislikes in relation to food or activities. A requirement has been issued relating to this in the relevant section of this report. ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 10 Plans recorded good access to health care professionals such as doctors, dentists and chiropodists. There was evidence that service users were being weighed on a regular basis. All plans examined contained a pressure sore assessment with detailed action described regarding how the risk of developing pressure sores had been reduced. Three requirements relating to access to dentists, weighing scales and pressure care risk assessments, issued at the last inspection have now all been complied with. Two service users have pressure sores at the home. Records were examined that indicated these were being treated successfully by visiting district nurses. Records in relation to the receipt, administration and disposal of medication were examined. A requirement was issued at the last inspection that medication that needs to be stored in a fridge is stored separately and not in the fridge in the kitchen. The provider has rented a fridge but this does not have a lock on it. The requirement has been amended and restated. Not all medication being received by the home was being recorded. Service users’ photos contained in the medication records did not have the name of the service user written on the back. Two requirements relating to these issues have been made in the relevant section of this report. The records in connection with the administration and disposal of medicines were satisfactory. During the course of the inspection staff were observed supporting service users in a respectful manner. Service users confirmed that staff treated them with respect and in a manner that maintained their privacy and dignity. One visitor to the home commented that staff did the best they could and a relative said that they would not want their mother to go anywhere else. ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 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 standard(s) 12, 13, 14 and 15 The home provides a range of activities for service users including the opportunity to go out to local shops and other outside activities. Visitors to the home are encouraged and welcomed by staff. Staff must ensure that service users’ independence is encouraged as much as possible. Service users must be made aware of what the home’s menu is in advance and the cook must ensure that the food prepared is of a satisfactory standard. EVIDENCE: A requirement was issued at the last inspection that service users are offered opportunities to go out to local shops. The inspectors saw a record of outings to the supermarket and local shops. The manager informed the inspectors that service users are asked what they would like to do at residents meetings and that most service users had requested to go out for short trips rather than whole days out. The requirement has been complied with. Visitors confirmed that staff play games such as bingo and board games with service users. The inspectors observed staff sitting and chatting with service users. One service user was away on holiday at the time of this inspection. Visitors that the inspectors spoke with said that staff always made them welcome and they were offered a cup of tea. The record of visitors to the home indicated that service users could have visitors at any reasonable time. ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 12 A requirement was issued at the last inspection that service users who do not have relatives must be able to access their money from the local authority. The manager informed the inspectors that the placing authorities had discussed this matter at the last review and now the home buys what the service users need and invoice the local authority. This requirement has now been complied with. During the inspection the inspectors met a service user who was in bed. The call bell was not placed near her and she had to shout out for staff assistance. This practice does not maximise service users’ capacity to exercise personal autonomy. It is a requirement that all call bells are placed within reach of service users who are in their room. The kitchen was inspected. Some of the food stored in the home was out of date. The inspectors noted that the potatoes were old and had roots coming out of them. Knives were not being stored properly and a number of coloured chopping boards were missing. Requirements have been made relating to these issues in this report. There was no indication of what the menu was for the day. One service user commented that you “don’t know what your eating until it’s put in front of you”. The homes cook was away on the day of the inspection and a cook from another home was providing the meals. The manager must ensure that service users are aware of what is on the menu in advance so that alternatives can be arranged if required by the service users. ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 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 standard(s) 16 and 18 Complaints are taken seriously and investigated effectively. Service users are protected from abuse by a clear policy and procedure as well as by a suitably trained staff team. EVIDENCE: The record of complaints was examined. One complaint had been recorded since the last inspection. It was clear that this complaint had been dealt with according to the home’s policy and that an investigation had been carried out. The record of the response to the complainant from the registered provider was detailed and appropriate. An requirement was issued at the last inspection that all staff undertake training on adult abuse awareness. Records indicated that this requirement has now been complied with. Staff interviewed had a good understanding of the types of abuse and what they would do if they suspected abusive practice was occurring at the home. The home’s Adult Protection procedure is satisfactory and in line with the local authorities policy. ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 14 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 standard(s) 19, 21, 22 and 26. Service users live in a comfortable, clean, homely and well-maintained environment. The home provides enough lavatories and washing facilities for service users and specialist equipment is provided for service users. EVIDENCE: The premises were inspected. It was noted that the bathroom on the ground floor smelled damp. This may be due to the flooring, which was worn and damaged, allowing water to soak into the floor. The registered provider must address this issue. In general the home was well maintained and decorated to a good standard. A requirement was issued at the last inspection that the ground floor bathroom be cleared of clutter. This requirement has now been complied with. A requirement was issued at the last inspection that service users who need wheelchairs to go out are properly assessed for them. Records were seen of referrals to the doctor for wheelchairs. This requirement has now been complied with. ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 15 The home was clean and tidy and free from offensive odours. The laundry is appropriately equipped. Antibacterial soap was available in all the shared bathrooms and there were adequate supplies of disposables such as wipes, gloves and aprons. Staff have attended infection control training. Visitors to the home confirmed that the home was always clean when they visited. ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30. Service users’ needs are met by an effective, caring and well-trained staff team. Service users are protected by the home’s clear recruitment policy and practice. EVIDENCE: On the day of the inspection there were sufficient staff on duty to meet the needs of the service users. Service users spoken to said they were satisfied with the staffing levels in the home. Service users commented that the staff were very nice. The home has a satisfactory recruitment procedure. Three requirements were issued at the last inspection relating to staff terms and conditions, staff id in their files and staff undertaking CRB checks. The inspectors found that id and CRB checks were present in all staffing files examined. Although all staff files contained copies of staff terms and conditions, a number of these had not been signed. The requirement relating to this has been restated. Apart form terms and conditions, staff files contained all the information required by this standard. Staff files contained training certificates and it was clear that training is seen as a priority at the home. Staff interviewed said there was a good level of training offered by the home including NVQ level 2 training. ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 36 and 38. The home is run by a caring and committed manager who has a good understanding of the needs of service users at the home. Service users’ views are taken into account in order to improve service provision. Service users are being put at risk by breaches in fire safety procedures. EVIDENCE: A requirement was issued at the last inspection that a full time manager be recruited to the home. The manager has been recruited and the inspectors were impressed by her commitment to the new role. Responses to the service users and relatives’ questionnaires have now been collated and the manager was able to give examples of how these responses have informed better practice at the home. This was a requirement that has now been complied with. Records of monthly monitoring visits to the home by the registered provider are still not being sent to the CSCI as required by regulation 26 of the Care Homes Regulations 2001. This requirement from the ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 18 last inspection is restated. A number of supervision records were seen on staff files. The manager informed the inspectors that, as she was relatively new to the post, she had not been able to supervise all the staff as required at the last inspection. This requirement has been restated. There were no records of supervision between the registered provider and the new manager. A requirement relating to this has been issued in this report. Records indicated that staff have received fire safety training. The last fire drill was recorded on 14/06/05 and there was a record of weekly fire alarm checks. Fire risk assessments were not available and an immediate requirement was issued that these are completed. Certificates for maintenance of the fire alarm and emergency lighting were both out of date. An immediate requirement relating to this was issued on the day of the inspection. During a tour of the premises it was found that some service users’ bedroom doors were being wedged open. This practice is very dangerous and the manager closed all these doors straight away. However some service users have requested that their door remain open during the night. An immediate requirement was issued that all bedroom doors are to remain closed unless suitable fire door guards are fitted. Until these guards are fitted it is required that risk assessments be completed for the service users concerned and that regular safety checks are undertaken by night staff. It was also required that the local fire authority must be informed of the outcome of the risk assessments. Other records examined in relation to health and safety were satisfactory. ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 19 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 1 COMPLAINTS AND PROTECTION 2 x 3 3 x x x 3 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 Standard No 16 17 18 Score 3 x 3 3 x 2 x x 2 x 1 ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 20 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 4 Regulation 12(1)b Requirement The registered provider must apply to the CSCI for minor variation of the conditions of registration for the one service user who has developed dementia at the home. This application must include an up to date assessment of the service user by a person qualified to do so. The registered provider must ensure that all service users likes and dislikes in relation to food and activities are identified and recorded in their individual plan of care. The registered provider must ensure that the medication fridge has a suitable lock fitted. (this requirement has been amended and restated) The registered provider must ensure that all photographs of service users are attached to their medication charts and have the persons name written on the back. The registered provider must ensure that all medication received by the home is properly recorded. Timescale for action 31/11/05 2. 7 12(3) 31/10/05 3. 9 13(2) 31/09/05 4. 9 13(2) 31/09/05 5. 9 13(2) 31/09/05 ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 21 6. 7. 14 15 16(2)c 16(2)(j) 8. 9. 15 15 16(2)(g) 16(2)(j) 10. 15 16(2)(i) 11. 19 23(2)b 12. 29 17(2) 13. 33 26 14. 36 18(2) 15. 36 18(2) The registered provider must ensure that call bells are within easy reach of all service users. The registered provider must ensure that all food is constantly monitored and all food that is out of date is thrown away. The registered provider must ensure that all knives are properly stored in the kitchen. The registered provider must ensure that all chopping boards required are provided in the kitchen. The registered provider must ensure that service users are aware of what is on the menu so that alternatives can be provided. The registered provider must ensure that the flooring in the ground floor bathroom is either repaired or replaced. The registered provider must ensure that staff sign their individual terms and conditions.(This requirement is amended and restated) The registered provider must ensure that monthly monitoring visits are undertaken and copies of the reports sent to the CSCI (Timescale of 30/11/04 not met) This requirement is restated. The registered provider must ensure that all staff receive regular supervision.(Timescale of 31/12/04 not met) This requirement is restated. The registered provider must ensure that the manager receives regular supervision and that this supervision is recorded. 31/08/05 31/08/05 31/08/05 31/08/05 31/07/05 31/11/05 31/09/05 31/08/05 31/08/05 31/08/05 ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 22 16. 38 23(4) The registered provider must ensure that risk assessments are carried out in relation to fire safety at the home. 17. 38 23(4) 18. 38 23(4) This was an immediate requiremen t dated 15th July 2005. The registered provider must This was an ensure that no fire doors are to be wedged open at any time. Immediate Where service users require their requiremen t dated door to remain open then these doors must be fitted with 15th July 2005. suitable door guards. Until this time risk assessments must be carried out and the local fire authority informed. The registered provider must This was ensure that the fire alarm and an emergency lighting test immediate certifcates are available for requiremen inspection. t dated 20th July 2005. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 23 Commission for Social Care Inspection 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 ELMHURST G59 S10671 Elmhurst EN1 V221657 11.07.05 Stage 4.doc Version 1.20 Page 24 - 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!