Inspection on 08/04/05 for Foxmead

This inspection was carried out on 8th April 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Foxmead 20/05/08

Foxmead 21/05/07

Foxmead 30/05/06

Foxmead 29/09/05

Foxmead 12/10/04

Foxmead 12/07/04

Similar services:

1 Marten Road

Daubeney House

Three Gables

Deepdene Care Centre

Aldwick House

49 Glendale

Ferndale Residential Care Home

David Gresham House

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

CARE HOMES FOR OLDER PEOPLE Foxmead Horsham Road South Holmwood Dorking Surrey. RH5 4JX Lead Inspector Marianne Barham Unannounced 08 April 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Foxmead Version 1.10 Page 3 SERVICE INFORMATION Name of service Foxmead Address Horsham Road, South Holmwood, Dorking, Surrey. RH5 4JX 01306 888053 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Harrylall Ramdass Mrs Evelyn Ramdass To be confirmed CRH (PC) 14 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (MD(E)) 14. of places Dementia - over 65 years of age (DE(E)) 14. Foxmead Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: The age/age range of the persons to be accommodated will be: Over 65 years of age. Date of last inspection 12th October 2004 Brief Description of the Service: Foxmead is a Victorian property situated four miles south of the town of Dorking. It overlooks a church, and used to be the vicarage. The home currently provides accommodation and care for eleven service users who are elderly with a past or present mental illness. The home has been extended and has ten single and two double bedrooms on the ground and first floor. None of the bedrooms are en-suite, however, all have a washbasin and toilet and bathing facilities are located close to all bedrooms. The first floor can be reached by the main staircase which has a chair lift fitted, however there is a break in the chair lift track on the landing between the ground and first floor. There is no shaft lift fitted. There are two large lounges and a dining room which overlook the garden. The garden is large and well maintained and has wheelchair access via a ramp. There is ample parking to the front of the property and a regular bus service to Dorking which stops outside the home. Foxmead Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection carried out at 10.00 am by two inspectors, Marianne Barham lead inspector for the service, and Kenneth Dunn as the second regulation inspector. The inspection was carried out over a period of four and a half hours and was the first inspection in the commission for Social Care Inspection (CSCI) year April 2005 to March 2006. Three staff members, five service users and a visiting nurse were spoken to during this inspection. A tour of the premises was undertaken and records relating to the care of service users and management of the home were inspected. On the inspectors arrival there were only two staff on duty in the home, with a third out escorting a service user to a planned hospital appointment, no extra staff had been booked to cover this appointment. The manager, Mrs Aisah Millar, who is not yet registered with CSCI, was not present during the inspection owing to illness and the owner, Mrs Ramdass, who was covering her absence was also unavailable. CSCI had not been notified of Mrs Millar’s absence. Two requirements made at the last inspection on 12th October 2004 had not been met. These were to fit covers on to radiators to reduce the risk of burns to service users, and to employ ancillary staff to assist the chef at mealtimes so that service users receive meals that are hot. During this inspection it emerged that the home does not employ a chef and that staff cook the meals, therefore a further requirement has been made that ancillary staff are employed to carry out cooking and cleaning duties so that staff can spend more time with service users. What the service does well: Service users were observed to be smartly dressed and well groomed. Staff were seen to interact positively with service users, showing respect for their privacy and dignity at all times, for example knocking on bedroom doors before entering. Two service users at the home had been discharged from hospital with pressure sores, the visiting nurse spoken to stated that these had been managed well by the home and that aids to help them recover such as pressure relieving mattresses had been provided. Foxmead Version 1.10 Page 6 The staff on duty are to be commended for the high level of personal care they provided to service users even though they were understaffed. The number of staff on duty should have been three care staff and a cook. Though extremely cluttered, the home was clean and free from odour. What has improved since the last inspection? What they could do better: The home is in a poor state of decoration throughout and would benefit from a re-decoration programme being put into place. The home was found to have a lot of clutter generally that made cleaning difficult and time consuming for staff. Ancillary staff must be employed for cooking and cleaning tasks so that staff can spend more time with the service users. There were also obstacles and trip hazards along hallways and walkways throughout the home, these must be removed to ensure the safety of the service users. Covers must be fitted to all radiators that service users have access to so that the risk of burning themselves is reduced. Service users care plans must be reviewed to ensure they meet the National Minimum Standards for older people. The bathing and toileting facilities in the home are not easily accessible for people with mobility problems and must be reviewed regarding their suitability for the service users and a risk assessment carried out for each service user who uses the facilities. The menus are repetitive and offer no alternative choices. These should be reviewed to reflect the category and preferences of the service users and they should be involved in planning them. Care staff working at the home have not yet commenced NVQ training, this must be undertaken as soon as possible. Staffing arrangements need to be reviewed in order that the needs of service users are better met. Foxmead Version 1.10 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Foxmead Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Foxmead Version 1.10 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 standard(s) 2 and 3. (standard 6 is not applicable to this service). It was not possible to assess whether service users have a written contract with the home. It was not possible to assess whether service users have their needs assessed prior to admission. EVIDENCE: No written contracts with the home were available for examination on the day of the inspection, and the service users and staff on duty were unable to confirm that service users have a written contract stating their terms and conditions with the home. Service users care plans were examined and found to contain assessments by care managers. It was not clear if these had been carried out prior to admission as there was no date of admission noted on them. These assessments had been carried out a number of years previously and had not been reviewed. The staff on duty were unable to confirm when service users were admitted to the home or if they had been assessed prior to admission. Foxmead Version 1.10 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 standard(s) 7, 9,10 and 11 Each service user has an individual care plan, however, these did not contain all information to meet the National Minimum Standards. Medication is stored safely and records are generally well maintained. Service users are treated with respect and their right to privacy and dignity is maintained. In the event of a service user dying, they and their family are assured that they will be treated with care, sensitivity and respect. EVIDENCE: Care plans examined were unclear as to service users care needs, had not been regularly reviewed, and did not contain accurate information about service users. For example, two service users who smoke, in one case this was not noted in the care plan and in the other it stated that the service user buys their own cigarettes, when it was observed that this is not the case. It was also observed that these service users are limited to two cigarettes a day, again this was not detailed in the care plan. Foxmead Version 1.10 Page 11 Staff on duty confirmed that they had received training on the administration of medication from Boots, and this was also documented in the medication records. The home has a comprehensive medication policy in place and records were found to be generally well maintained. It was observed, however, that medication had been handwritten on some charts without adequate explanation as to who had prescribed the medication and when, these had also not been signed. The medication is stored appropriately and there are good systems in place for the receipt and disposal of medication, however there was a discrepancy observed in the number of Promazine tablets recorded and those actually in the medication cupboard. The service users were observed to be well groomed and dressed. Interactions between the staff and service users were observed to be respectful and positive, with staff displaying a caring manner in their approach to them. The home has a policy and procedure in place for the death of a service user. This details actions to be taken in the event of a death at the home and also has information on religious and cultural differences to be observed. Foxmead Version 1.10 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 standard(s) 12, 14 and 15 Service users have little opportunity to participate in recreational activities in the home. Service users have little choice and control over their lives. Service users diet is not always wholesome or appealing EVIDENCE: On the day of inspection the service users were observed to be sitting in the communal lounges doing nothing. The television was switched on in the far lounge, however only one service user was actually watching it. The rest of the service users were sat in chairs, some asleep and others just sitting. There were only two staff on duty, and they were extremely busy preparing meals, cleaning the home and doing the laundry. They explained that there should be three staff on duty, but that one staff was escorting a service user to a planned hospital appointment. No extra staff cover had been arranged. There were games and puzzles available in the lounge, but staff did not have time to sit with the service users to facilitate their use. Foxmead Version 1.10 Page 13 Examination of the staff duty roster showed that there had only been two staff on duty for the whole of the week, with the exception of the previous day (7th April 2004) whereby a member of staff was shown to have worked the whole day and then carried on to work the night shift. It was then observed that this same member of staff was the person escorting a service user to the hospital appointment. The staff then explained that the manager was off sick as she had gone to hospital for an operation, and that the owner Mrs Ramdass was managing in her absence. CSCI had not been informed of this. As stated previously in this report, two of the service users smoke cigarettes. The home has a smoking policy in place which states that service users can access their cigarettes freely on request, however it was observed during the inspection that these service users are limited to two cigarettes a day. There was no evidence to show how this decision had been reached and who was involved in making it. One service user has noted in their care plan that they buy their own cigarettes, however it was observed that both service users were given cigarettes from the same packet, which was locked away and the key kept with staff. The menus examined showed that service users were given as main meals sausages on one day and beef burgers on another, each a week. There was no evidence of involving service users in the planning of meals. Service users spoken to stated that the food was all right or okay, when asked, one stated that they didn’t like burgers. Foxmead Version 1.10 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 standard(s) 16 and 17 Service users, their relatives and friends cannot be confident that their complaints will be taken seriously or acted upon. Service users are able to take part in the civic process if they wish. EVIDENCE: There is a comprehensive complaints procedure in place which staff were able to produce for examination, however they were unable to explain the process of dealing with a complaint or show where complaints are recorded. Responses to relatives questionnaires from March 2004 were examined and found to seek relatives views on the service provided, including the home’s response to complaints. There was evidence that service users were registered to vote and staff explained that service users would be supported to vote if they wished to. Foxmead Version 1.10 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 standard(s) 19, 20, 21, 24 and 26. The home was found to be in a poor state of decoration throughout, with superfluous items obstructing hallways and walkways posing a risk to service users. The bathing facilities are not suitable for the needs of the service users. EVIDENCE: All communal areas in the home were observed to be cluttered, with every available surface full of bric a brac. In the far lounge the large window area overlooking the garden is almost completely obscured by the numerous plants that have been placed there. There were net curtains hung across doorways and the archway from lobby into first lounge area. There was a rug on the floor of the dining room placed on a walkway and not secured that poses a risk of trips for staff and service users. There was also four television sets in the dining room, two of which were no longer working, with one in a box under a table for staff training. There was a large vase obstructing the chairlift on the stairs first landing. There was a table holding more bric a brac obstructing a Foxmead Version 1.10 Page 16 fire extinguisher on the top landing and all along the narrow hallway there were plants and ornaments obstructing free movement. Grab rails have been fitted along the hallway but are rendered useless owing to the objects and plants in the way. A cupboard in the hallway was found to be completely full of walking frames, that were so crammed in that there was a real danger they could fall on top of anyone opening the door, which was not locked. A storage room located off of a service users room, again not locked, was found to be full to bursting with old clothes, suitcases, a bed and various other items. The room also contained electricity junction boxes located on an internal wall and next to these was a large area of damp. It was impossible to enter the room owing to the amount of items stored. Tour of bedrooms – all rooms were personalised to some degree with service users own belongings. Several of the bedrooms were found to be cold, with radiators turned off. The bedding provided in many of the rooms was of poor quality and was not sufficient to keep service users warm. It was pleasing to see that window restrictors had been fitted to the first floor windows as required at the last inspection. In bedroom number 8 the mirror above the sink had a crack in the corner that was loose and poses a risk to the service users safety. In bedroom 9 the glass shelf above the sink has a crack that is loose, again posing a risk to service users safety. All of the bedrooms were in a poor state of decoration. There is an alarm call system throughout the home and this was observed to be in working order. There are two bathrooms on the first floor. These are both in a poor state of decoration. The first bathroom has a low bath against two walls posing difficulties for service users getting in and out of it, there is a small grab rail but it was reported by the staff that this is of limited use to most service users. A wheelchair was observed to be stored in this bathroom. There was exposed wiring on the shaver light above the sink. The second bathroom has a low corner bath, again causing difficulty getting in and out for service users. There was a chair hoist in this bathroom, however the staff could not demonstrate how to operate it as they have not been shown. It was pleasing to see that paper towels were available in the bathrooms and toilets as required at the last inspection. Foxmead Version 1.10 Page 17 The kitchen was found to be large and well equipped and maintained. It was therefore disappointing to see that the kitchen flooring was old and held together with tape posing a risk to staff and service users of tripping and being unhygienic. There were two washing machines in the laundry room located off of the kitchen next to the garage. These were found not to have a sluice cycle on them. This is a concern as some of service users are incontinent. There is a tumble dryer located in the garage, however this was not working. On examination of the maintenance records and communication book, it was found that this dryer had not been working for some months. The staff were unable to confirm if this was being addressed. The garage is used as a smoking area for service users, this was overcrowded with boxes and other stored items which poses a risk to service users of a fire hazard. Foxmead Version 1.10 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28 and 30 The home has severe staff shortages which has a negative impact on the standard of care that service users receive. Staff gave information about the training they have received, however they were unable to produce documentary evidence to support this. EVIDENCE: The staff on duty stated that there were only five permanent staff employed at the home including the manager and the owner, Mrs Ramdass, and two regular bank staff. As stated previously in this report, staff rosters were examined and showed that there had only been two staff on duty for the previous week. It was of concern to note the number of hours that some staff members were working, particularly one member of staff working twenty four hours on three occasions during the week 4th –10th April 2004. The staff on duty reported that it was because of the shortage of staff. At the last inspection the manager informed the inspector that the home had permission from the Home Office to recruit staff from the Phillippines, however this has not happened. The staff on duty stated that the manager had tried to recruit staff but no one came or if they did, they only stayed a short while. Foxmead Version 1.10 Page 19 A requirement was made at the last inspection to provide extra help for the chef at mealtimes to ensure food is served hot to service users. This has not been met and it emerged at this inspection that a chef is not employed at the home. A further requirement to employ ancillary staff for cooking and cleaning in the home has been made. Staff on duty reported that they had received training in moving and handling, food hygiene, medication, fire safety and vulnerable adults protection, however the training files were locked away so documentary evidence of this was not seen. At the last inspection the manager informed the inspector that four members of staff were due to commence NVQ level 2 training in late October 2004, however this has not happened and at present no permanent care staff are undertaking this training. Foxmead Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The health, safety and welfare of service users are not protected adequately. EVIDENCE: On the day of the inspection the manager was off sick and the owner was unavailable. The two staff on duty were care workers who had received no training in shift leading, when asked neither was able to say who was in charge of the home that day. At the last inspection a requirement was made to fit covers to all radiators. This has not been done. A further requirement to fit covers to all radiators accessed by service users has been made. Please refer to standards 19 – 26 – environment section of this report for details of shortfalls in health and safety issues. Foxmead Version 1.10 Page 21 Please see standards 27 – 30 – staffing for details of shortfalls in staffing levels and training. Foxmead Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 1 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 x 14 1 15 2 COMPLAINTS AND PROTECTION 1 1 1 x x 2 x x STAFFING Standard No Score 27 1 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 x x x x x x x x 1 Foxmead Version 1.10 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 5 (1) ( c ) Requirement Each service user must have a written contract/statement of terms and conditions with the home. Service users care plans must be reviewed to ensure they meet the National Minimum Standards for Older People Handwritten instructions on medication records must be signed, dated and detail of the precriber recorded. Arrangements must be made to enable service users to engage in local social and community activities, and , having regard for the needs of the service users, staffing and facilities for recreational activities must be provided. Written records must be maintained detailing the reasons for restricting service users cigarettes and who was involved in the decision making process. A record must be kept of all complaints made and include details of investigation and any action taken All trip hazards must be removed from communal Version 1.10 Timescale for action 31/05/05 2. 7 15 (1) (2) ( a - d) 13 (2) 31/05/05 3. 9 11/04/05 4. 12 16 (m) (n) 30/06/05 5. 14 12 (3) 11/04/05 6. 16 17 (2) schedule 4 13 (4) (a) (c) 08/04/05 7. 19 08/04/05 Foxmead Page 24 8. 19 23 (2) (d) 9. 21 23 (2) (n) 10. 24 16 ( c ) 11. 12. 13. 25 26 27 13 (4) (a) (c) 16 (2) (e) 18 (1) (a) 14. 28 18 (1) (a) ( c ) (i) (ii) 16 (2) (i) 15. 15 walkways, also, all items superfluous to the needs of service users and the home must be removed from the site A programme of routine maintenance and renewal of the fabric and decoration of the premises must be produced and implemented and records kept. The registered person must supply the commission with a plan of action to address the inappropriateness of the bathing facilities, to include risk assessments for all service users accessing these facilities. Adequate bedding suitable for the service users needs must be supplied, also privacy curtains in double rooms must be repaired or replaced. Covers must be fitted to all radiators that service users have access to The tumble dryer must be repaired or replace A full review of the current staffing arrangements in relation to the number and category of service users must be undertaken, this is to include the employment of ancillary staff for cleaning and cooking duties. Staff employed at the home must be registered with an NVQ training body and undertake NVQ training. The home must review the current menus on offer to take into account the age and preferences of the service users at the home. 31/05/05 11/04/05 11/04/05 30/06/05 11/04/05 11/04/05 11/04/05 11/04/05 Foxmead Version 1.10 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. 1. Refer to Standard Good Practice Recommendations Foxmead Version 1.10 Page 26 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey. GU7 2QN 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 Foxmead Version 1.10 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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