Inspection on 10/07/07 for Firstlings

This inspection was carried out on 10th July 2007.

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

Firstlings 10/07/06

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Firstlings 7 The Street Heybridge Maldon Essex CM9 4NB Lead Inspector Jane Offord Key Unannounced Inspection 10th July 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 Firstlings DS0000067731.V345697.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. Firstlings DS0000067731.V345697.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Firstlings Address 7 The Street Heybridge Maldon Essex CM9 4NB 01621 853747 01708 478151 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) Sohal Healthcare Limited Manager post vacant Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32), Physical disability (1) of places Firstlings DS0000067731.V345697.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 32 persons) One person who requires care by reason of a physical disability, whose name was made known to the Commission in July 2003 The total number of service users accommodated must not exceed 32 persons 10th July 2006 Date of last inspection Brief Description of the Service: Firstling is a large detached three-storey property, which was originally constructed as a vicarage. The home changed ownership a year ago and is now owned by Sohal Healthcare, which is a company owning several other care homes in the eastern area. The home is registered to accommodate 32 elderly people (over the age of 65) including 1 place for a resident with a physical disability. There is one room used for respite care. The accommodation is all in single rooms, with twenty-five rooms offering ensuite toilet facilities; one room also has a private bath. Communal bathing facilities comprise four bathrooms (all with assisted baths). The main lounges/dining rooms are on the ground floor with quiet sitting areas on the first and second floors. The home benefits from two conservatories and attractively maintained gardens. There is a shaft passenger lift serving all three floors and stair lifts to all floors. There is an internal courtyard that is accessible from a number of doors on the ground floor and has wheelchair ramps. Firstlings is situated on a busy main road with regular public transport services. Local shops in Heybridge are close-by, with the main town centre of Maldon approximately half a mile away. Car parking is available at the front of the building. The fees for the home range between £2215.20p and £2343.00p monthly depending on the accommodation, the needs of the resident and the funder. Fees do not include the cost of toiletries, hairdressing, chiropody and newspapers. Firstlings DS0000067731.V345697.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection looking at the core standards for care of older people took place on a weekday between 9.30 and 15.30. The registered manager was present for most of the time and assisted with the inspection process by providing files and information. This report has been compiled using information available prior to the inspection and evidence found during the visit. During the day a tour of the home was undertaken with the manager but all areas were revisited later. A number of staff, residents and visitors were spoken with and care practice was observed. A selection of files, policies and records were inspected and part of a medication administration round was followed. The kitchen and laundry were seen and the serving of the lunchtime meal observed. On the day of inspection the home was clean and tidy with no unpleasant odours present. Residents looked comfortable and relaxed in their surroundings and were enjoying a variety of pastimes. Conversation between staff and residents was friendly and appropriate. Staff encouraged residents with gentle prompting to maintain as much independence as possible. The meal at lunchtime looked appetising and was enjoyed by those residents spoken with. What the service does well: The service offers a high level of individualised support to residents in an attractive, comfortable environment. The house and grounds are maintained to a good standard and provide plenty of space for residents to spend time together or in private. Recruitment procedures are thorough and there is a commitment to supporting staff training for the jobs they do. The meals offered are nutritious and attractively presented with a range of choice and plenty of home made items such as cakes and pastry. There are a variety of activities organised and residents can choose to participate or not. Firstlings DS0000067731.V345697.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Firstlings DS0000067731.V345697.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 Firstlings DS0000067731.V345697.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): 3, 6. Quality in this outcome area is excellent. People who use this service can expect to have their needs assessed and be certain the home can meet them prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: This service does not offer intermediate care. Three residents’ files were seen and each one contained a pre-admission assessment of need. The assessment covered areas of health need such as mobility, overall physical health, continence, diet, oral and foot care, medication and communication. Mental health needs and cognition were assessed and the prospective resident’s social wishes were noted. A past medical history was recorded with any particular areas of risk such as a history of falls. Firstlings DS0000067731.V345697.R01.S.doc Version 5.2 Page 9 On the day of inspection the registered manager had an appointment to visit two potential residents to undertake pre-admission assessments. The two people were a married couple who wanted to remain together. When the manager returned from the assessment they expressed some concern that the home may not be able to meet the needs of one of the couple. They had not offered them a place yet as they felt they needed further information before making a decision. The home does a survey of new residents after admission to ensure that they have had a smooth transition and received all the help and information they needed. The questionnaire included whether the resident had an understanding of why they were coming to the home, whether they were made welcome, whether they felt their needs had been understood, if the room they were using was to their liking and whether a statement of purpose and brochure had been given to them or their representative. One response seen said they had been made, ‘very welcome’, and staff had been, ‘helpful’. Firstlings DS0000067731.V345697.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 excellent. People who use this service can expect to have their health needs met, be treated with respect and protected by the home’s medication practices. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On admission to the home an assessment of needs is completed and forms the basis on which the resident’s care plan is composed. The assessment covers all aspects of physical health and any medical conditions that require monitoring. The section on mental health assesses cognition, memory and any anxiety or depressive illness. The record includes social interests and hobbies. One record had noted, ‘XXXX enjoys watching sport on TV’, another said, ‘would like to take Holy Communion regularly’. The files also contained some life history work, a recent photograph of the resident and the residents’ wishes in the event of their death. Firstlings DS0000067731.V345697.R01.S.doc Version 5.2 Page 11 The care plans contained individual interventions that related to the assessments. Areas covered were how personal hygiene needs were to be met, the level of assistance required to transfer and mobilise, whether the resident had any continence needs, the management of any wounds or sore areas, their preferred diet and the use of any eating aids such as a plate guard and any night needs. There were risk assessments for moving and handling, pressure area care and falls. Each care plan had a section on socialising and whether the resident enjoyed company or preferred to remain in their room. One intervention said, ‘spend time to talk with YYYY as they are grieving over the recent death of their spouse’. The records had contact details for all the health professionals involved with the care of the residents including the GP, community nurse, optician and chiropodist. There was a record in each file of visits to or by any health care professional and information about treatment prescribed. A visiting community nurse was spoken with and they said they felt the level of care offered by the home was high. They received appropriate referrals for assessment and the carers followed their instructions for treatment correctly. One resident with a history of falls had a comprehensive falls risk assessment and a record of all their falls with details of time and place. They had had a hip x-ray to exclude physical problems and a referral had been made to the specialist falls consultant nurse for an assessment and advice about managing the problem and protecting the resident from harm. Another resident with a progressive degenerative condition has daily exercises helped by the carers. They have a monthly visit from a physiotherapist who prescribes the exercise regime. Staff were observed knocking on doors prior to entering rooms and asking residents where they would like to sit. One member of staff spoken with talked about how they preserved the dignity of residents during personal care. Staff adjusted clothing when residents moved to a different seat or were transferred to a wheelchair. The medication policy was seen and was a comprehensive guide to all aspects of the management of medicines. It included guidance on homely remedies, the covert administration of medication, non-compliance and altering medicines from the format licensed by the manufacturer. Part of a medication administration round was followed. The trolley was secured each time the carer left it to give out medicines. The medication administration records (MAR sheets) all had identification photographs attached and there were no signature gaps noted. The carer washed their hands before and after administering eye drops and dispensed tablets with a non-touch technique. The controlled drugs (CDs) register was seen and a random check made of the stocks. The CDs tallied with the records. Firstlings DS0000067731.V345697.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is excellent. People who use this service can expect to be offered meaningful pastimes and a well-balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs an activities co-ordinator who was on annual leave on the day of inspection. Their records of activities organised were seen and showed that there were frequently external musical entertainers visiting the home and a summer fete had been organised in June that had to be held indoors as the weather was bad. Nevertheless £550 was raised to go towards the activities social fund. One of the carers said they would organise the weekly Bingo session in the absence of the activities co-ordinator as the residents so enjoyed the session. The internal courtyard had some pots of tomatoes and beans growing as well as raised beds of flowers. One resident said they had assisted with the Firstlings DS0000067731.V345697.R01.S.doc Version 5.2 Page 13 planting and how much they appreciated the garden. The courtyard has level access for wheelchair users. All the residents’ files seen contained contact details of the next of kin and other people important to the resident. There was life history work in each file so staff knew of the resident’s interests and previous occupation. Spiritual beliefs were recorded and the resident’s final wishes. The home celebrates Holy Communion once a month but is situated next door to a protestant church so residents could attend more frequently if they chose. The home has a policy of open visiting at any reasonable time that suits the resident. Visitors were seen coming and going during the day and were greeted by staff. The home has a number of small lounges and seating areas so residents can meet visitors in private without having to take them to their bedroom. The kitchens were visited and the cook spoken with. They explained where the stores are bought from including meat from a local butcher. The food stored in refrigerators and freezers was all labelled and dated and the records of temperatures showed they were functioning within safe limits for food storage. The daily and weekly cleaning rotas were seen and completed fully. The menus offered a choice of main dishes at lunch, a cooked breakfast and a cooked snack supper or sandwiches. Salad or jacket potatoes with fillings were available as alternatives to main meals. The lunchtime meal was seen served and on the day was a choice of minced beef cobbler or chicken grills with mashed potato and vegetables followed by blancmange. There was a choice of fruit squashes or water to drink. The residents spoken with said they had enjoyed the meal. One resident said, ‘the food here is lovely, I can’t fault it’. Firstlings DS0000067731.V345697.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality in this outcome area is good. People who use this service can be confident that any concerns will be taken seriously and that they will be protected from abuse by staff knowledge and training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections have found that the home’s complaints policy is robust and meets the standard required by the National Minimum Standards (NMS) for care of older people. CSCI has not received a complaint about this service since before the last inspection. The complaints log showed there had been two complaints from residents this year. One concerned some personal items of equipment not functioning in a room and the other about dusty furniture in a bedroom. There was evidence that both issues were addressed on the day of complaint and the complainants had signed the log to say they were satisfied with the service’s response. The protection of vulnerable adults’ policy (POVA) was seen and contained clear guidance on the management of any concerns that a resident was suffering abuse in any form. Staff spoken with confirmed that they had had POVA training and the training matrix that was seen verified this. Staff Firstlings DS0000067731.V345697.R01.S.doc Version 5.2 Page 15 questioned were clear about their duty of care and what they would do if they had any concerns. Firstlings DS0000067731.V345697.R01.S.doc Version 5.2 Page 16 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, 26. Quality in this outcome area is excellent. People who use this service will live in a clean, pleasant and attractive environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Firstlings is a large red brick house that was once the vicarage to St. Andrews church next door. It has been extended and now the accommodation consists of twenty-five en suite rooms and seven single rooms with a wash hand basin. There is a passenger lift and stair lifts to all floors. The home has two main lounges on the ground floor both with a conservatory leading to the gardens. There are smaller lounges on the first and second floors. The home is attractively decorated with matching soft furnishings and comfortable Firstlings DS0000067731.V345697.R01.S.doc Version 5.2 Page 17 furniture. On the day of inspection everywhere was clean and tidy with no unpleasant odours noted. The laundry was visited and the laundry worker spoken with. They talked about the training they had received that included health and safety, POVA and control of substances hazardous to health (COSHH). The laundry was clean and tidy and the washing machines had an automated product feed to eliminate unnecessary handling of chemicals. The member of staff said they had had additional training when the machines had changed to the automatic feed system. They were able to describe how soiled linen was managed to prevent cross infection and the use of protective gloves and aprons. The policy folder did not contain any guidance on managing soiled linen and this was raised with the manager who later supplied a policy but it was not up to date guidance. Firstlings DS0000067731.V345697.R01.S.doc Version 5.2 Page 18 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 good. People who use this service can expect to be supported by correctly recruited and trained staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rotas were seen and showed that during the day there were five carers on duty in the morning and four for a late shift. At night there were three carers. In addition there was an ancillary team of kitchen, domestic and laundry staff to support the care team. The manager was supernumerary and there was an activities co-ordinator during the week. Staff spoken with said there were adequate staff numbers to meet the needs of the present residents. The files for three newly appointed staff members were looked at and all contained a full work history and documentary evidence that the person’s identity had been verified. There were two references and a criminal records bureau (CRB) check that had been received before the member of staff had commenced in employment. The induction programme covered health and safety, fire awareness, moving and handling, POVA, continence and pressure area care. In addition areas such as the caring environment and mealtimes for residents were included. Firstlings DS0000067731.V345697.R01.S.doc Version 5.2 Page 19 The training matrix showed regular updates for staff of mandatory training such as moving and handling, food hygiene, infection control and POVA. Additional training for staff giving medication was recorded and the carer who did the lunchtime medication round confirmed that they had done training offered by a pharmacy group. Staff spoken with talked of recent training on person centred dementia care. The home employs eighteen carers of whom seven have achieved an NVQ at level 2 or above. The manager said there are a further four carers who wish to enrol on the course. When they have completed the home will more than meet the required standard of at least 50 of carers holding the qualification. Firstlings DS0000067731.V345697.R01.S.doc Version 5.2 Page 20 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 excellent. People who use this service can expect to have their views sought and their finances and welfare protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is processing an application with CSCI to be registered for the home. They have the required experience and qualifications and for the last year, since the change of ownership, have been doing the job competently. Firstlings DS0000067731.V345697.R01.S.doc Version 5.2 Page 21 The system for managing residents’ monies remains the same as previously when it was considered safe and offered an audit trail. Money is kept in a safe in the managers office and only two people have access to it. As well a seeking feedback from residents after their admission the home holds regular residents and relatives’ meetings with the minutes available to any person who cannot or chooses not to attend. Minutes seen showed that information about changes in the home were discussed as well as plans for future outings and activities. People were informed that the decorators would be in the house soon and a discussion around maintenance and upkeep of the gardens took place. Meals, new staff, the new conservatory and a planned picnic were other items of note. The fire log was inspected and recorded that a fire officer had visited the home in January 2007 in response to fire alarms going off. No fire was discovered but water was flooding from the top floor. Residents from the first and second floors were taken to the ground floor lounges and an electrician was called to check all the wiring was safe. Fire detectors, emergency lighting and the nurse call system was checked and found to be satisfactory by external consultants in June 2007. The records showed fire alarms are tested fortnightly. During a tour of the home one sluice was found unlocked and contained some products that fall under the COSHH regulations. A member of the domestic staff was clear about their responsibilities in regard of COSHH and the products they used from their trolley to do the cleaning with. They were also aware of the importance of keeping their trolley in sight when they were working and locking it up when not in use. Maintenance records seen showed that all the fire extinguishers were checked in January 2007, there was a gas safety certificate from March 2007, the passenger lift had been serviced in July 2007 and hoists and baths had been tested in April and June respectively. Firstlings DS0000067731.V345697.R01.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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X 4 X X 2 Firstlings DS0000067731.V345697.R01.S.doc Version 5.2 Page 23 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 OP38 Regulation 13 (4) (a) Requirement Cupboards and sluices that contain products that fall under COSHH regulations must be kept locked to protect residents’ access to harmful substances. This is a repeat requirement. Timescale for action 10/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP26 OP31 Good Practice Recommendations The policy for the management of soiled linen should be reviewed in light of guidance available to ensure staff and residents are not at risk of cross infection. An application for registration of the manager with CSCI should be rapidly processed to ensure the home is under good management and residents can be confident that the staff are given clear direction. Firstlings DS0000067731.V345697.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Firstlings DS0000067731.V345697.R01.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. 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