Inspection on 08/11/05 for Fosse House

This inspection was carried out on 8th November 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 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

Fosse House 16/10/07

Fosse House 30/04/07

Fosse House 06/06/06

Fosse House 05/05/05

Fosse House 09/12/04

Fosse House 01/07/04

Fosse House 26/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Fosse House Ermine Close St. Albans Hertfordshire AL3 4LA Lead Inspector Mrs Sheila Knopp Unannounced Inspection 8th November 2005 10:20 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 Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Fosse House Address Ermine Close St. Albans Hertfordshire AL3 4LA 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) 01727 819 700 01727 819 768 fosse@quantumcare.co.uk www.quantumcare.co.uk Quantum Care Limited Care Home 61 Category(ies) of Dementia - over 65 years of age (61), Old age, registration, with number not falling within any other category (61), of places Physical disability over 65 years of age (61) Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5/11.5.05 - inspection report issued 21.6.05 & 18.8.05 - additional visit reports available from CSCI Hertfordshire area office Brief Description of the Service: Fosse House is a purpose built care home for 61 older people, including two rooms for short (or respite) stays. It is a two storey building, with two units on each floor. Three of the units have 15 rooms and one has 16 rooms. Each service user has their own bedroom and each bedroom has en-suite toilet and wash hand basin. Each unit has its own lounge, dining room and kitchen. There is a hairdressing salon on the first floor and a sensory room with bubble lamps, soft lighting and relaxing music. There is a day centre on the ground floor, which is separate from the residential accommodation. There is a large garden that has been creatively designed and landscaped, with paths and patio areas suitable for wheelchairs, an orchard and a pond. The home is close to the parkland leading to St. Alban’s Abbey. It is in a modern residential area, next to a small shopping parade and a ‘Waitrose’ supermarket. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the second planned inspection for the year April 2005 – March 2006. However due to concerns about this home 3 further additional visits have been carried out since 5.5.05. This inspection identified poor practices and a further unannounced inspections will be carried out. It is the opinion of the lead inspector that standards in some areas have deteriorated since the last inspection in August. The focus of this inspection was to follow through social opportunities being provided to residents and check the requirements from the last inspection. Two inspectors spent their time talking to residents and observing the interaction between residents and staff as they assisted residents. The findings of this report are based on discussions and individual contact with 8 residents, 1 visitor and 5 staff. Inspectors tracked the care of 6 service users. Care and administrative records were checked. The views of 4 relatives who returned comment cards to the Commission have been included in this report. Detailed feedback including areas for urgent action were discussed with Ms Jenny Gauthier, Acting Manager during the visit. A total of 14 hours inspection time has been allocated to this inspection. What the service does well: What has improved since the last inspection? Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 6 Following the additional CSCI visits in the summer and complaints made directly to the company, Quantum Care have put an action plan in place to improve standards. This includes the appointment of a new acting manager who has only recently taken up her post. Disposable hand towels and liquid soap were available to staff in the required areas meeting a requirement from the last inspection. Bedroom furniture has been ordered to meet a requirement from the last inspection but it has not yet arrived in the home. What they could do better: The management team need to improve their monitoring of care practices and challenge staff where standards are not met and company policies and procedures are not implemented. The management team and staff must ensure residents receive an adequate daily fluid intake. Service users who are unable to request or access drinks for themselves must be identified and systems put in place to monitor their fluid intake. Quantum Care must ensure that the standard of care planning and record keeping is improved to demonstrate that the need of service users are being addressed and reflect the specialist needs of those with dementia. It is of concern that having raised this as an issue in May 2005 all the care records examined on this occasion had gaps which could lead to inappropriate care being given. The care managers for each unit needs to ensure that company procedures are implemented and standards monitored. The management of the home need to ensure that service users admitted for periods of respite care are properly assessed and staff have clear instructions on how that individual wishes to be cared for. Staff need to keep a record of the nursing care provided by Community Nurses so that it is included in the plan of care. Where instructions for care and treatment are given by the Community Nurses or General Practitioners the daily progress notes and review records need to identify that they have been followed and form part of the review process. The standard of care practices and cleaning needs to be improved to provide service users with odour free rooms and maintain their dignity. Three of the four relatives who returned comment cards to the Commission raised the following concerns about staff:‘Staffing seems a problem’, ‘on the whole staff are brilliant at doing a difficult job’. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 7 ‘I find the permanent staff extremely good but agency staff lack enthusiasm, almost completely’ ‘The carers are always cheerful and helpful, but I feel that they are very understaffed. If there were more carers, they would be able to spend more time with the residents just sitting and talking to them’. A comment by a resident confirmed the observations made by the inspectors that ‘ staff don’t seem to have a lot of time’, they do what they have to do and move on. 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. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 8 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 Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 9 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 needs of service users receiving short periods of respite care are not being adequately assessed to enable a clear plan of care to be put in place for staff to meet their needs safely. EVIDENCE: The Commission is aware of two recent complaints made to Quantum Care raising concerns about the standard of their respite care service. It was identified that the assessment of needs for a service user receiving respite care had not been updated for this stay. Therefore staff were not able to identify whether this individuals needs had changed between visits and that an appropriate plan of care had been put in place. There was no up to date moving and handling assessment. The pressure sore risk assessment had not been updated and despite staff describing treatment to a sore area there was no plan of care to prevent pressure sores. The night care plan which should include details of regular repositioning was blank. Pressure relieving equipment had not been provided. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 10 An assessment prior to admission should identify whether equipment is required to be in place on admission to prevent pressure sores. As there were no details of how this persons continence was being managed the cause of the soreness described by staff in the records could not be identified and worryingly staff had stopped recording any treatment and had not recorded whether the soreness had gone. The acting manager agreed to do an urgent review of the situation and ensure staff had accurate and clear instructions as to the care required. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 11 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 inspectors were unable to confirm that the health needs of all service users were fully met because some people were not receiving an adequate fluid intake. The care plans reviewed did not provide a clear picture of changing needs of service users and the actions required by staff. In some cases significant information was missing which could compromise the health and well being of service users. It was confirmed that appropriate systems are in place to monitor and manage the administration of medicines. However staff need to ensure that prescribed food supplements have been taken before they sign the administration record. Staff need to ensure that the records of the temperature of medicine storage areas are kept up to date to demonstrate medicines are stored correctly. While some staff were observed to be very sensitive towards supporting service users in a dignified manner others appear to be unaware that their actions compromise the dignity of the people they are caring for. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 12 EVIDENCE: Service users in the lounges did not have access to drinks. Several individuals had dry odorous mouths indicating they were not having enough fluids. Staff had signed the medication chart indicating a service user had taken their prescribed daily food supplement drink. However the full open carton had been left on their bedside cabinet. Overall service users had received support to achieve a good standard of personal care. However it is noticeable that some of the residents who are more dependent on staff particularly those with dementia have lank, unstyled hair. The daily records being kept by staff are not linked to the plan of care. This means in some cases that there is no evidence that appropriate care is being provided. An example is an instruction by a doctor for a service user to sit up at night to prevent chest problems. There was no evidence that this information had been transferred into this person’s plan of care or whether the instructions were being carried out. The monthly review that followed did not refer to changes that had occurred in the preceding month. Some care plans had not been reviewed since August. The entries made by staff on each shift in the daily progress notes are ritualistic and usually refer to washing, dressing and eating. Information is not linked to the detail in the plan of care. There is a lack of specific information with staff describing cream having been applied but not detailing what the cream was or where it was applied. There are gaps in the records which require staff to record when personal care was carried out and where residents have declined for example to have a bath no details of the follow up action taken. Staff were observed hurriedly filling in the sheets between care tasks. Several examples were seen of staff just following on from previous entries leading to important information about the care required being left out of the records. The format of the care plans does not easily identify the specialist areas of care required. For example in relation to preventing pressure sores or reflecting the needs of service users with dementia so that staff have clear instructions. A care plan identified that a review was required for a service user who had bedrails on their bed. There was no record of this having been reviewed and no risk assessment in place for their safe use. Protective covers to prevent skin damager were not available. The care plan of another service user identified they were at high risk of developing pressure sores and required a pressurerelieving cushion when they were in the lounge. When checked the service user was observed to be sitting on an ordinary cushion and staff did not know where the specialist cushion was. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 13 Some staff were observed to compromise the dignity of service users by:– wearing latex gloves while carrying out social care tasks and approaching residents in communal areas. This also demonstrates a lack of understanding of infection control principles. The overpowering smell in one bedroom was as a result of staff leaving a urine soaked bed and covering it with a bed cover. Staff on one unit were offering service users their morning coffee in cups without saucers. Immobile residents sitting in one of the lounges did not have access to a call bell and there were no staff around when attention was required. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 14 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 Quantum Care are currently reviewing their approach within the home to providing more individual and unit based social support to service users. There is a need for continued staff training and development of care planning to demonstrate the involvement of service users with dementia in their daily lives which reflects their abilities and promotes a sense of well being. EVIDENCE: While the care plans examined detailed peoples individual interests and social history the information recorded daily and in the care review records did not state how those needs are to be met or how service users have spent their time. The staffing levels and level of activity required to provide personal care to service users does not leave time for staff to interact with residents who require more individual support. There may be a conflict of roles as the person responsible for the activity programme is also a care manager on one of the units. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 15 Following the inspection in August it was recommended that staff spend time in another of the company’s homes where social support to people with dementia is well provided. This had not happened at the time of this inspection but was planned. A manager who provides dementia care training with the company has been working with staff. The home has a sensory room and an activity resource room. A monthly plan of activities is available. Staff spoke of a planned coach trip to look at the autumn colours. Previously the atmosphere in the home has been bright and lively. On this occasion service users were quite subdued. However one group had received some sad news. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 16 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): Not inspected. EVIDENCE: The training taking place at the time of the inspection included abuse awareness. Quantum Care have been very open in sharing the findings of their complaint investigations with the Commission and the action proposed to address issues identified. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 26 The key standards were not fully inspected on this occasion but issues were identified under standard 19 & 26. Not all areas of the home were odour free. The action of staff wearing disposable gloves in the public areas of the home demonstrates lack of awareness in relation to infection control practices. EVIDENCE: There was an unacceptable odour in two bedrooms. Nightingale unit kitchen dining area had old food splashes on the dining room chairs and radiator. This issue was brought to the attention of the manager at the last inspection. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 It was the assessment of the inspectors that the number of staff working on the ground floor units needs to be increased to provide residents with the reassurance that their needs can be met when they request attention and to provide the opportunities for more social interaction The number of staff in the home trained to NVQ level 2 has not yet achieved the 50 level required by the end of 2005. The company recruitment procedures protect service users by ensuring that the required checks are carried out before individuals have contact with service users. There are company wide induction and training programmes in place which cover care practices and management of service users with dementia. The acting manager is reviewing the staff training records to ensure all staff are up to date with the required training to promote the well being of service users. The managers need to ensure that staff are working to the policies, procedures and standards required by the company. As part of the action plan put in place, by Quantum Care, staff have been receiving training in relation to their individual responsibilities to ensure good standards of care are provided. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 19 EVIDENCE: On the day of inspection staff may have been working on unfamiliar units as the rota had been arranged to release staff for training sessions which were taking place in the home. The manager reported that additional staff had come in prior to their training to support the morning routine. Two staff had been allocated to each of the ground floor units and three staff were supporting the service users with dementia. The needs of service users on the day meant that the ground floor staff were working flat out moving from task to task. There was little time for interaction and residents were left unsupervised in the lounges while staff helped service users who needed two people. On two occasions the inspector had to go and find staff from other areas to assist service users who were unable to access a call bell. The poor information in the care plans is another indication of the lack of time to properly review and reflect on the care provided and any changes. The company need to review staffing levels in relation to resident dependency and the need to provide a stimulating environment. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 & 38 The home does not currently have a registered manager. An acting manager with many years of experience within Quantum Care at deputy level has been put in place pending the appointment of a new manager. There are company wide systems in place to ensure that the required servicing of equipment is carried out and records maintained to protect the health & safety of service users and staff. EVIDENCE: Quantum Care are monitoring the overall management of the home and implementation of their action plan to improve standards. The slow progress is disappointing and as evidenced by the poor record keeping, dignity and hygiene issues appears to have deteriorated since the inspection in August. A manager with experience of supporting service users with dementia and providing staff training is supporting the acting manager. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 21 The regional manager has been requested to ensure that the monthly reports provided to the Commission under Regulation 26 reflect details of the progress of the company action plan. Accidents and incidents have been notified to the Commission as required. Service and fire safety records were reviewed to confirm that the required health & safety have been carried out. Staff receive annual updating in food hygiene, infection control, health & safety, basic first aid and fire procedures. The trainer who was present on the day of inspection also raised the issue of staff wearing disposable gloves inappropriately. This is raised as part of the training provided therefore failure to follow correct procedures must be challenged by the care managers in dayto-day contact with staff. Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 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 1 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x x 1 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x x x x x x 3 Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 23 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 3 Regulation 14(1)(2) Requirement An up to date assessment of needs prior to admission is required for all service users including those receiving respite care. Ensure pressure relieving equipment is made available for service users receiving respite care if their further assessment following admission identifies they are at risk of developing pressure sores. Each service users assessment of need must be kept under review and revised as changes occur Each service users care plan must set out in detail the action required by staff in relation to the health, personal and social care needs of service users. Previous requirements made 5.5.05 & 18.8.05 A record of the treatment provided by the community nurses must be kept. Schedule 3(k) Previous requirement made 5.5.05 Details of advice and guidance DS0000019349.V265086.R01.S.doc Timescale for action 08/11/05 2 3 12(1)(a) 08/11/05 3 4 7 7 & 12 14(2)(a) (b) 15(1)(2) 16/12/05 16/12/05 5 8 17(1)(a) 08/11/05 6 8 12(1)(a) 08/11/05 Page 24 Fosse House Version 5.0 7 8 12(1)(a)& 16(2)(i) provided by General Practitioners and community nurses must be recorded in the care plan. Details of the action taken to carry out that advice must be recorded and reviewed. All residents must receive an 08/11/05 adequate daily fluid intake. A full audit must be carried out to ensure monitoring systems are put in place to support service users unable to request or access drinks for themselves. Record the temperatures of medication storage areas. Ensure staff care for service users in a manner which promotes their dignity. Brought forward from 18.8.05 Provide an update on progress to develop a social care programme in line with the company’s approach to dementia care. Repair the call point in Dove Unit lounge and provide an extension lead so that service users are able to attract the attention of staff. All areas of the home must be maintained in an odour free, clean condition. This may require replacement of carpets where other means do not achieve this. Brought forward from 8.8.05 Review staffing levels within the home to 1. Reflect the number of service users who need two people to care for them. 2. To ensure that service users have access to staff when they need them and are adequately supervised. 8 9 9 10 13(2) 12(4)(a) 16/12/05 08/11/05 10 12 16(2)(n) 16/12/05 11 19 23(2)(c) 16/12/05 12 26 16(2)(k) 16/12/05 13 27 18(1)(a) 16/12/05 Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Hertfordshire Area Office Mercury House 1 Broadwater Road Welwyn Garden City Hertfordshire AL7 3BQ 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 Fosse House DS0000019349.V265086.R01.S.doc Version 5.0 Page 27 - 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!