Inspection on 29/08/06 for Fir Trees

This inspection was carried out on 29th August 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Fir Trees 17/10/07

Fir Trees 28/11/05

Fir Trees 14/06/05

Fir Trees 12/01/05

Fir Trees 29/06/04

Fir Trees 18/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Fir Trees Gorse Hall Road Dukinfield Tameside SK16 5HN Lead Inspector Janet Ranson Unannounced Inspection 29th August 2006 10:00 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 Fir Trees DS0000005591.V306907.R03.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. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Fir Trees Address Gorse Hall Road Dukinfield Tameside SK16 5HN 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) 0161 338 2977 0161 304 8384 firtrees@tamesidecg.co.uk Tameside Care Limited Anne Robertson Boyd Dobson Care Home 45 Category(ies) of Dementia - over 65 years of age (45), Old age, registration, with number not falling within any other category (45), of places Physical disability over 65 years of age (45) Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 45 service users to include: *up to 45 service users in the category of DE(E) (Dementia over 65 years of age); *up to 45 service users in the category of PD(E) (Physical disability over 65 years of age); *up to 45 service users in the category of OP (Old age not falling within any other category). The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 28th November 2005 2. Date of last inspection Brief Description of the Service: Fir Trees is a large, purpose built home. Tameside Care Limited (a not for profit company) is now the registered provider. The home has been extended and developed over the years to provide care for up to 45 elderly people, some of whom may have dementia or a physical disability. A day care unit is also located within the building but is not subject to regulation. Single room accommodation is provided over two floors. Fortyone bedrooms also benefit from en-suite facilities. Lounge and dining areas are located on both floors and each dining area has its own domestic kitchen. There are aids and adaptations to meet the assessed needs of the service users, in addition to a passenger lift. A landscaped garden is situated in the centre of the building and is fully accessible from the home. Fir Trees is located within a residential area of Dukinfield, close to the market town of Ashton-under-Lyne, with all the associated local facilities. Fees for accommodation and care at the home range from £343.66 for a single room to £356.66 for a single room with en-suite facilities. Additional charges are also made for hairdressing and chiropody services, newspapers and personal toiletries. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key inspection, which included an unannounced site visit by two inspectors to the home. The site visit took place on Tuesday, 29th August 2006 and covered a period of nine hours from 10am until 7pm. Time was spent talking to residents, relatives, staff and a district nurse, in addition to observing the home’s routine and staff interaction with residents. A total of five residents’ care needs were looked at in detail. Individual details of their experiences and care were examined from the point of admission to their current care. A tour of the building was conducted and a selection of staff and residents’ records was examined, including records of care, medication records, employment and training records. Requirements made at the previous inspection (7th December 2005) were checked to see if the provider had done as we asked. Questionnaires were left at the home for use by residents, their relatives and the staff to comment on the service. Stamped addressed envelopes were provided; any comments received will be taken into consideration at the next key inspection. In addition to carers, the organisation employs administration staff, a maintenance person, teams of catering and domestic staff. What the service does well: The internal and external appearance of the home is of a very high standard and provides a pleasant, comfortable environment for residents to live in. The residents have full access to the landscaped garden. The residents said that staff were kind and looked after them well. particular, a resident said she felt “safe especially during the night.” In Visitors said that they were made to feel very welcome and staff were friendly. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 6 The home has a good activities programme providing various leisure pursuits within the building during the afternoons. The Saturday night social evening had been reinstated by popular demand. The home in general was calm and peaceful with staff undertaking care tasks in a relaxed and considerate manner. Meal times were observed to be leisurely and residents were afforded the time to eat their meal at their own pace. Each person was enabled to choose what he or she wanted to eat. The lunchtime meal was described by a resident as “up to the usual standard.” Staff team members spoken to had received training in various aspects of their role. What has improved since the last inspection? 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. Fir Trees DS0000005591.V306907.R03.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 Fir Trees DS0000005591.V306907.R03.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The quality rating in this outcome area is good. The residents have access to information about the home to assist them to make an informed choice. Systems are in place to ensure the residents’ needs can be fully identified and met by the home. Standard 6 Intermediate care is not provided at Fir Trees. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: A range of care records were examined. They all contained pre-admission assessments. The manager or team leaders undertake their own assessment of all prospective residents prior to admission. This information was shared verbally with staff and the written assessment placed on the resident’s care file. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 9 The assessments are corporate in design. They were found to be well documented giving individual details of personal preferences and social abilities. Two relatives who were visiting the home said they had been involved in the assessment process carried out by the resident’s social worker. One relative stated she was aware of the home’s “good reputation” as another member of her family had lived at Fir Trees. The home’s statement of purpose and service user guide, located in the main hallway, were available to the residents and members of the general public. Fir Trees DS0000005591.V306907.R03.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 The quality rating in this outcome area is good. The residents’ personal care, health and welfare needs are fully documented and reviewed. The residents’ identified health needs are fully met by the various healthcare professionals and by the provision of specialist equipment. The residents are enabled to self medicate wherever possible. The residents are treated with respect and their privacy is maintained at all times. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: The home was calm and peaceful and residents were observed to be provided with assistance in a timely and patient manner. A relative confirmed the atmosphere in the home was usually calm. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 11 A sample of resident care records was examined. They were found to be recorded to an acceptable standard. Assessments recorded at admission to the home were detailed and care plans referred to the resident by preferred title. The care plans were reviewed at regular intervals. Each identified need has a plan of care, which includes personal hygiene, continence issues, mobility and dexterity, moving and handling assessment, tissue viability and nutrition. Visits from the district nursing service, chiropodist, physiotherapist, general practitioner and opticians were all noted within the individual care file. The district nursing service is currently involved on a daily basis with those residents identified as requiring nursing care. The nurse said they were quite busy at Fir Trees addressing health care needs, in particular, one person who had been discharged from hospital with pressure sores. She was arranging for additional specialist equipment to be delivered and had already arranged for a specialist mattress and cushion to be put in place. Other equipment and aids to daily living could be seen throughout the home. At interview a male carer stated he would respect a female resident’s wishes regarding a same sex carer. He said he would always ask if he could provide assistance and also described how one female resident usually asked for him to assist her to her bedroom where he withdraws in order that a female carer could provide personal care. Individual wishes concerning end of life care were not always documented. Two relatives said they were satisfied with the care provided and felt they were kept informed of any changes in condition. A number of residents’ medication administration records were examined and compared with the individual prescription. They were found to be documented in the approved manner. There was also possible evidence of overstocking of some controlled drugs. This issue was discussed with the manager. At all times, and in both areas of the home, staff could be seen and heard to treat the residents with the greatest respect. Carers were observed using good interpersonal skills with the residents who responded in a positive way. The residents were generally appropriately dressed for the season, clean and tidy. All the bedroom doors are lockable and staff could be seen knocking and waiting for a response prior to entering bedrooms. A resident said she was aware she could have a key to her bedroom but had declined the offer. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 12 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): 12, 13, 14 & 15 The quality rating in this outcome area is good. The choices offered to the residents meet with their requirements and needs and enable them to exercise day-to-day control over their lives. The residents can participate in a programme of daily activities. Visitors are made to feel welcome and remain in contact with their relative’s care. The contents of the menu appeared nutritious and well balanced, with a choice provided at each mealtime. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: The home’s assessment procedures document the prospective resident’s religion. Spiritual needs are met by various lay visitors from the local area who visit the home at regular intervals. Visitors could be seen throughout the home during the site visit. A relative said she visited at different times of the day and was always greeted warmly “the staff are all very friendly”. She was usually advised of any changes in her relative’s care needs. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 13 There are plans for a part-time dedicated activities organiser to commence in the near future at the home. The activities programme was displayed in the home; it showed an activity session each afternoon. Two sessions are carried out by external practioners. At the time of the site visit armchair aerobics and the accompanying music had been enjoyed. One resident said he tried to do all the exercises, even though he had difficulty in raising his arms. Another said they were aware of the activities but chose not to attend any of them. The Saturday social evening had been reinstated, as requested by the residents. A resident said he really enjoyed this, as there was usually a good singalong. There had been no trips out the building and it is understood there are none planned for the near future. This is an area that should be given consideration by the manager. A meal was observed at lunchtime. The hot food was served individually from a bain-marie in each of the dining rooms (ground and first floor). Each resident had been assisted to make a choice from the menu the day previously. The daily menu was clearly displayed in both dining areas. The meal looked appetising and was nicely presented. Each resident who spoke with the inspector confirmed the meals to be of good quality and tasty. Snacks were available with the afternoon tea. A three week menu was examined and discussed with the cook. She clearly demonstrated her understand of individual dietary needs, various likes and dislikes and had recently sought advice from the dietician regarding a medical diet. Food stocks were good, with fresh produce delivered every other day. The kitchen is appropriately equipped, with all appliances reported to be in full working order. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 14 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): 16 & 18 The quality rating in this outcome area is good. The residents and staff were confident their complaints would be treated with respect and acted upon. The policies, procedures and staff training protect the residents from potential abuse. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: The organisation has a complaints policy and procedure. The policy is clearly displayed within the home; one resident pointed it out to the inspector but said she “wouldn’t bother with all that, she would speak to the boss.” It is also contained in the resident’s contract (terms and conditions). During discussions with the residents it was apparent that some were not aware of the complaints process however they could say that if they were not happy they would speak to their family or a carer. There have been no reports of Protection of Vulnerable Adults (POVA) investigations since the previous inspection. The majority of staff have attended the specialist training concerning POVA. Carers who spoke with the inspectors confirmed their understanding of the requirements and their duty to report such incidents. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 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): 19 & 26 The quality rating in this outcome area is good. Fir Trees provides a warm, clean and well-maintained environment with a good standard of furnishings and fittings. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: Fir Trees is maintained and furnished to a good standard. The building was clean and, with one exception, odour free. The lack of storage provision created some untidy areas, particularly in bathrooms and a dining area on the first floor. It is understood there are plans to change some bedrooms, update some floor coverings and create storage areas. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 16 Individual bedrooms have, in the main, been nicely personalised. All rooms are single occupancy, with the majority having en-suite facilities. A resident said she particularly appreciated her own “loo”. A resident said she had brought “bit and bobs” from her former home, although not too much because “there wasn’t enough room.” The living and dining areas on both floors provided pleasant seating areas. They were clean, tidy and had a calm and relaxed atmosphere. There were a variety of armchairs and settees for the residents and their visitors’ comfort. The home employs a maintenance person who is responsible for any small repairs and heavy cleaning. The requirements made at the last inspection concerning the lack of heating in some areas had been addressed. It is understood that new central heating boilers had been installed and it is anticipated that they will provide an even ambient temperature throughout the home at the required time of year. The home’s security had also been improved by the provision of a digital lock and doorbell to the front entrance. A button to the side of the front door allows for a simple exit from the home. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 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): 27, 28, 29 & 30 The quality rating in this outcome area is good. The residents receive care from well-trained staff who respond to the residents and visitors in a respectful manner. The system of training is good, providing the staff with the knowledge and understanding to enable them to provide a good quality of care to the residents. The organisation’s recruitment policy provides protection to the residents from potential abuse. This judgement has been made using available evidence, including a visit to the service. EVIDENCE: Staffing levels in the home were maintained at an appropriate level to meet the residents’ needs during the day (8am-8pm). This equates to five carers and supernumerary senior staff until 8pm. From 8pm until 8am there are three carers, one of whom is designated as a senior carer. The numbers of night staffing was discussed with the manager; she assured the inspector that at times of greater need she drafts a further night carer in to provide additional care. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 18 The home had a relaxed peaceful atmosphere. Staff did not rush and interactions with residents were pleasant. Those staff who spoke with the inspectors were complimentary about working in the home and said they felt trained and supported to deliver a good service. A selection of employment records was examined. It was noted that all the required information was obtained before commencement of employment. This included two satisfactory references and clearance from the Criminal Records Bureau (CRB). In all cases, an application form had been completed. In one case there were gaps in the individual employment history and the references did not reflect the names provided in the application form. The manager could not provide an explanation for this anomaly but understood the requirement for a full employment history to be provided by the applicant. The organisation provides a good system of training for all the staff. It was confirmed by the staff and the manager that all the mandatory training was in place and the National Vocational Qualification at level 2 provided for all the carers. A newly employed carer said he enjoyed the training aspect of the job as it gave greater confidence and skills. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 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): 31, 33, 35 & 38 The quality rating in this outcome area is good. The use of questionnaires and continued reviewing of care plans enables the residents and their relatives to be involved in the delivery of care. Systems are in place to protect the residents’ financial interests and to ensure their health and safety at all times. This judgement has been made using available evidence, including a visit to the service. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 20 EVIDENCE: The manager is registered with the Commission for Social Care Inspection as a fit person. She was previously the deputy manager and has achieved the Registered Manager’s Award. The manager is supported through the organisation by the operations director and in the home by senior carers. Reports of Regulation 26 visits made to the home by the registered provider or their representative are supplied to the Commission for Social Care Inspection as required. The operations manager undertakes the visits and the manager stated that all visits were unannounced. In addition, the organisation carries out customer satisfaction surveys. The outcomes of such surveys are made available to all interested parties. All the individual care plans are reviewed at regular intervals. An advocate provided through the local Citizens Advice Centre is available for the ongoing annual assessment of need. A visitor confirmed she was aware of the system of reviews and was usually invited to attend in order that she could support her relative. Fir Trees manages small amounts of personal finances for the residents. Records of expenditure were available for inspection. The residents are consulted about various aspects of their lives, including the contents of the menu and the activities within the home. The cook confirmed she spoke with the residents about the meals and asked for any suggestions concerning the menu. A Saturday night social event had been reinstated after a request from the residents. A maintenance person undertakes the required testing and monitoring for health and safety. Records detailing the various aspects of the health and safety monitoring were available for inspection. An issue concerning draught excluders that were found to have been nailed to three first floor bedroom doors was discussed with the organisation’s health and safety manager who attended the inspection specifically for this purpose. It was his professional judgement that the draught excluder would not compromise the intumescent strip that provides protection from heat and smoke in the event of fire. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 21 During a tour of the building it was noted that a quantity of razor wire had been placed on the top of a fence that bordered the garden of a private house. The fence formed a part of the home’s side boundary. A quantity of the wire had slipped over the fence into Fir Trees’ garden. The manager was urged to have this hazard removed from the property and to dispose of it in a safe manner. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 22 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 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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 OP29 Regulation 19 Requirement The registered person must ensure that any gaps in prospective employees’ previous work history are investigated and documented at interview. Timescale for action 01/10/06 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 2 Refer to Standard OP12 OP38 Good Practice Recommendations The registered person should make arrangements for residents to make trips out of the building. The registered person must ensure the garden is free from hazards. Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ashton-under-Lyne Area Office 2nd Floor, Heritage Wharf Portland Place Ashton-u-Lyne Lancs OL7 0QD 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 Fir Trees DS0000005591.V306907.R03.S.doc Version 5.2 Page 25 - 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!