Inspection on 22/03/07 for Francis House

This inspection was carried out on 22nd March 2007.

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

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

Other inspections for this house

Francis House 27/06/07

Francis House 27/06/06

Francis House 01/02/06

Francis House 24/05/05

Francis House 06/12/04

Francis House 29/07/04

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

CARE HOMES FOR OLDER PEOPLE Francis House 102 Beaconsfield Road Walthamstow London E17 8LU Lead Inspector Zita McCarry Unannounced Inspection 22nd March 2007 09:45 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 Francis House DS0000058691.V333017.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. Francis House DS0000058691.V333017.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Francis House Address 102 Beaconsfield Road Walthamstow London E17 8LU 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) 0208 520 5100/2438 0208 509 0482 London Borough of Waltham Forest Linda Cocks Care Home 32 Category(ies) of Dementia - over 65 years of age (23), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (9) Francis House DS0000058691.V333017.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 named people, One of whom has a learning disability and associated mental health problems, one of whom has a learning disability and one who is under the age of 65 years. 27th June 2006 Date of last inspection Brief Description of the Service: Francis House is a residential care home offering 24-hour care for up to 32 service users (elders). The home is located in a residential area of Walthamstow a short distance from local amenities. Currently the London Borough of Waltham Forest Social Services Department manages the home. Francis House DS0000058691.V333017.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is a report of an unannounced inspection undertaken in mid-March 2007. The inspection was undertaken by two inspectors who toured the building, met with service users, staff and relatives. The inspectors read files relating to the care delivered to service users living in the home and documents pertaining to the management of the service. The registed manager assisted the inspectors in the process. The inspectors would like to thank everyone for their cooperation in the inspection process. What the service does well: What has improved since the last inspection? What they could do better: During the course of this inspection it was evident that recent changes in the composition of staff team had a negative impact of the continuity and quality of care experienced by the service users. The service will have to manage staffing changes better to avoid such occurrences in the future. An immediate requirement notice was served at the inspection. Francis House DS0000058691.V333017.R01.S.doc Version 5.2 Page 6 The Commission has been concerned about the services management of service users medications, following repeated failure to comply with statutory requirements the Commission served an enforcement notice in an attempt to ensure compliance with statutory requirements and secure positive outcomes for service users in that they received their medication as prescribed. However there was substantial evidence at this inspection that the home was in breach of the enforcement notice. The Commission will be taking further action in relation to this. 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. Francis House DS0000058691.V333017.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 Francis House DS0000058691.V333017.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): Quality in this outcome area is good. Service users admitted to the home have had their needs appropriately assessed and can be confident that the home took steps to ensure those needs could be met before an offer of place was made. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed the admission process for two randomly selected service users. Both files reflected detailed care management assessments and the service’s own assessment of need prior to admission. On the recorded assessments undertaken by the manager there was good evidence that the home had considered fully its ability to meet the prospective service users needs. One of the files reflected the involvement of other professional care workers to support the service users admission. This indicates good planning and would have supported the service user in the transition into residential care. The inspector was pleased to note the service undertakes life history Francis House DS0000058691.V333017.R01.S.doc Version 5.2 Page 9 work on service users this information then contributes to the care plans for service users. Such information is crucial in delivering individualised packages of care for service users. Francis House DS0000058691.V333017.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): Quality in this outcome area is poor. Service users living in Francis House do not receive their medications as prescribed. Recent changes in staff have had a negative impact on the care experienced by service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The two randomly selected care plans addressed all areas of need and provided clear direction to staff in respect of the level of support/assistance required of them to meet each individualised area of need. Each care plan was underpinned by a risk assessment, which identified risks. On one risk assessment the risk identified was smoking; the outcome of the risk assessment was for the service user’s cigarettes were to be held by staff in the office. The inspector accepts this may well be the most appropriate method of managing the risk however it would be expected that the service users comments on this loss of control should be acknowledged within the assessment. It was also noted that having decided that the service user was Francis House DS0000058691.V333017.R01.S.doc Version 5.2 Page 11 too unsafe to hold her own cigarettes and lighter there was no direction to staff about the level of supervision to be provided when she was smoking. Service users and/or their advocates must be party to the risk assessment process, this has additional importance when an aspect of personal control is lost. The manager confirmed there was no service user in the home with pressure sores. The district nurse visits to administer insulin. The inspector randomly selected 10 accident records to track as part of the inspection process. These evidenced service user falls and one incident of collapse. The action recorded as taken was appropriate and prompt. The service has made arrangements to ensure that in all instances service user have an escort to hospital in the event of an emergency. The arrangement means that if a service user has to go to hospital during the night and escort is contacted and will meet the service user at the hospital. This is good evidence to demonstrate the service is taking steps to ensure the service user is supported through a health crisis. The inspectors reviewed the homes management of service users medication and found considerable evidence of failure to demonstrate safe management of service users medication. The findings are detailed below: There was evidence that 3 Medication Administration Records (MAR) had been defaced. Service User A Prescribed Anisulpride 50mgs “take one at night”. Signatures were present to record that this medication was given at 0800hrs and 2000hrs between 12th and 20th March 2007. This indicates that staff were not being accountable for their signatures recorded on statutory records. Service User B Prescribed Thiamine 100mg however review of the medication records failed to demonstrate that the service user had his medication on the 17th and 18th March 2007. Service User C Prescribed Omeprazole Capsules 20mg MAR recorded that the medication was administered on 11 occasions from 12th to 22nd March inclusive. However on checking the medication box there was 18 capsules left out of the 28 received. This evidenced that the medication had been administered on 10 occasions not the 11 as recorded on the MAR sheet. This is evidence that a member of staff had signed for a administering the medication when they had not done so. Service User D Prescribed Mirtazapine Oro dispersible 15mgs “one at night”. Between the 12th and 22nd March inclusive the MAR recorded the medication had been Francis House DS0000058691.V333017.R01.S.doc Version 5.2 Page 12 administered as prescribed on 7 occasions and omitted on 3. However on auditing the medication box there were 24 tablets left out of 30 received. This evidenced that the medication had only been administered on 6 occasions and that a member of staff had signed as administered a medication when they clearly had not. Service User E Prescribed Omerprazole 20mg capsules. A box of 23 capsules was commenced on 12th March 2007. The MAR evidenced that the service user had been administered the medication on 11 occasions. There should therefore have been 12 capsules left in the pack but the inspectors found 13. Again evidence that the service user had been administered medication only 10 occasions and that staff had signed for medication clearly not administered. Service User F In the course of checking the medication the inspectors noted a service user was prescribed Dexamethasone eye drops to be administered 2 hourly throughout the day, commencing at 8am. Consequently the drops were due at 8am, 10am, 12midday and 2pm etc. However the inspector checked at 12.45 pm and noted the service user had not been administered her prescribed medication at 10am or 12 midday as required. An enforcement notice was served in August 2006; the findings above indicate a breach of that notice. The Commission will be taking further action as a result of this. On the day of the inspection both inspectors were concerned about the evident lack of skills demonstrated by some staff working in the home. A member of staff was observed to enter a service users toilet without first knocking and waiting for permission to enter, service users dignity was undermined in the approach of some staff. Examples seen were a member of staff startling an unsuspecting service user by approaching her form behind, another member of staff physically attempting to move a service user without first speaking to her. Whilst service users were seated at the dining table a member of staff again approached from behind and put a bib over their heads again without speaking to the service user. The process was robotic and failed to promote the service users dignity. Francis House DS0000058691.V333017.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is poor. Service users living in the home do not have their right to shared private space acknowledged. The cater service is not sufficiently flexible to consistently meet service users nutritional needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each unit within the home has an activity program, on the day of the inspection the activities as advertised were not taking place. The explanation given by staff was that there were insufficient resources. It was observed by both inspectors that the staffing resources on the day of the inspection were also inadequate in relation to skills to provide appropriate leisure and social interaction for people with dementia. There was evidence that two consenting residents who wished to share a bedroom in order to maintain their relationship, had not been afforded the opportunity and privacy, to be able to do so. For example, by using one of their single bedrooms as a shared bedroom, and the other bedroom as a private sitting room, or for storing excess bedroom furniture to ensure that the Francis House DS0000058691.V333017.R01.S.doc Version 5.2 Page 14 shared bedroom provided a safe environment. Unless it can be demonstrated that it would not be in the best interest of either or both of the service users to share a bedroom, or that an assessment of their capacity indicates that they do not have the capacity to make such a decision. Lunch observed in one dining area was chaotic, there was an established member of staff attempting to assist one service user eat her lunch, she was then directing the new agency worker to support other service users. The inspector observed a worker removing a service user plate before she had finished eating indeed the service user was in the process of putting food into her mouth when the plate was removed. Food was put in front of service users again with minimal communication when the inspector asked a service user why she wasn’t eating her lunch of rice and peas with chicken the service user responded “Oh I don’t eat that, I don’t like chicken”. The menu did provide an alternative but it was not offered to the service user. Three service users did not eat lunch and the manager explained that the practice is that meals are plated up and left to be offered later. However on testing this no food had been left for service users who declined to eat at lunch time. The manager rightly directed the senior staff to ask the kitchen staff to prepare a substantial snack to be offer to these service users. The inspectors were surprised and concerned this request, which had been made in the best interests of the service users, was declined and the catering staff refused to undertake the task. It was only after prolonged intervention by the manager observed by the inspectors that the catering staff agreed to provide food for these three service users. It is of concern to the Commission that the provision of adequate nutrition in the service requires such a level of intervention from the registered manager. Francis House DS0000058691.V333017.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good. The service takes prompt action to safeguard the service users living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There were two recorded complaints since the last inspection. Both complaints were responded to appropriately and within timescales. The service has had enquiries under safeguarding adults’ procedures however these have been resolved satisfactorily. The Commission has evidence that demonstrates that in the event of a concern or allegation the service instigates adult protection procedures promptly. Francis House DS0000058691.V333017.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): Quality in this outcome area is adequate. However service users do not consistently live in a clean and odour free environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has completed its refurbishment of the home. The service is accessible and equipped with appropriate furniture. As a security measure the home uses CCTV on the outside of the building only so service users privacy is not compromised. No action has been taken to improve the lighting in service user bedrooms so the previous requirement remains unmet. On the day of the inspection areas within the home had mal odour of urine. The carpet in the large lounge area was very badly stained, whilst the inspector accepts this area has particularly heavy traffic it is a service users lounge. The inspector was advised that the carpet has been deep cleaned Francis House DS0000058691.V333017.R01.S.doc Version 5.2 Page 17 many times but the Staines remain. In this event the floor covering must be replaced. Francis House DS0000058691.V333017.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): Quality in this outcome area is poor. Service users living in the home have experienced a deterioration in the quality of care provided because of inadequately skilled and competent staff recently employed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Over the course of several inspections the Commission has required the service to recruit into its vacant post, the service has repeatedly failed to comply with this requirement. The inspector was advised that approximately 80 of the staff team providing care to service users are agency staff. As a result of the service undertaking its own enquiries the home had to suddenly terminate engagement of most of the agency workers. This resulted in a major influx of new agency workers who were unfamiliar with the service users or their needs. The service had previously notified the Commission of the need to terminate the use of the particular agency workers deployed in the home. There was evidence that the service had prepared to brief the new agency staff but it was evident that there was insufficient established staff to properly supervise and induct the new staff. For example on the day of the inspection the afternoon shift was covered solely by 6 agency staff , the longest serving member of staff had been in post for less than 5 weeks. The inspectors observed the pressure on established staff trying to induct and support new staff whilst continuing their role as carers also. Despite this there was substantial evidence Francis House DS0000058691.V333017.R01.S.doc Version 5.2 Page 19 throughout the inspection that some of the new agency staff were unfamiliar with service users needs, had poor communication skills, failed to address service users with respect and undermined their dignity. One worker was seen to handling a service user in a manner that required immediate intervention as it put the service user at risk. On balance it must be noted that the home’s established staff were struggling to maintain an adequate level of care, reassurance and continuity to service users. It is regrettable there were insufficient numbers of these established competent staff on duty to support the change. There were no additional supervisory management in place to support this major change in staff. The inspectors were sufficiently concerned about the lack of skills of staff providing care to service users that immediate requirement notices were issued to ensure that the service adequately trained, supervised and inducted the new staff. The home has not introduced an induction foundation training framework in line with the National Training Organisation. However the service has invested heavily in the training and development of their established staff. The service has not recruited new staff so the previous requirement has not been tested. It will be tested at the next inspection. Francis House DS0000058691.V333017.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): Quality in this outcome area is poor. At a time of crisis within the service the managing organisation failed to demonstrate effective monitoring and remedy the negative outcomes experienced by service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager holds relevant management qualifications and has substantial experience in the care of older people with dementia. Several weeks before the inspection the managing organisation notified the Commission about the need to replace a high number of agency staff many of whom had worked in the service for a long time and were well established. The change caused major upheaval within the home and the inspectors observed Francis House DS0000058691.V333017.R01.S.doc Version 5.2 Page 21 established staff trying to struggling to maintain an adequate level of care. It is of concern that the service was unable to present anything at inspection about the additional monitoring or resources it had put in place to deal with the major upheaval in the service. The inspector was presented with the results of the survey the managing organisation had undertaken across 3 of its services. The result included Francis House. As the context of the survey, how it was conducted and numbers of service users surveyed was unclear it provides insufficient evidence to demonstrate effective consultation. The homes records pertaining to fire safety and maintenance of equipment were all found to be order. However inspectors observed the unsafe handling of service users, which threaten their safety. Francis House DS0000058691.V333017.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 3 X x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 2 X 1 STAFFING Standard No Score 27 1 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X x x 1 Francis House DS0000058691.V333017.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 OP33 Regulation 24 Requirement The registered provider must implement an system of quality assurance. (That facilitates service user feedback.) Unmet requirement from previous inspection. The registered person must ensure the lighting in service users bedroom is adequate enough to enable service users undertake reading and fine detail activities. Unmet requirement from previous inspection. The registered manager must ensure that service users who have identified interests and preferences are supported to undertake these. The registered provider must recruit into the home’s vacant posts. Unmet from previous inspections. The registered person to ensure that no person works in the home unless a satisfactory CRB disclosure has been obtained by the Local Authority. DS0000058691.V333017.R01.S.doc Timescale for action 22/06/07 2. OP25 23 22/06/07 4. OP12 12 15 22/06/07 5. OP27 27 22/06/07 6. OP29 19 22/06/07 Francis House Version 5.2 Page 24 7. OP30 18 8 OP7 14 9 OP27 OP30 18 10 OP38 18 11 OP27 26 12 OP10 12 13 OP12 12 14 OP15 16 Unmet requirement from previous inspection(s). Not tested at this inspection. The registered manager must ensure that staff receive induction and foundation training that meets the criteria of the NTO. The registered manager must ensure that service users and/or their advocates are involved in their risk assessments. The registered provider must ensure competent staff are brought in to work in the service by 29/03/07 and in the interim you must ensure an adequate level of supervision to ensure a safe delivery of care with immediate effect. The registered manager must ensure service users are approached, moved and handled safely by training all staff that work in the home in appropriate techniques. The registered provider must ensure the home is adequately monitored and major changes appropriately managed so as not to impact negatively on the service users. The registered manager must ensure all staff employed in the home have been trained in and can demonstrate an understanding of the underpinning principles of dignity, respect and privacy. The registered persons are required to consult the two service users and make arrangements for them to have shared private space. The registered person must ensure the catering arrangements are sufficiently flexible to meet the nutritional DS0000058691.V333017.R01.S.doc 22/08/07 22/06/07 22/03/07 22/06/07 22/06/07 22/06/07 22/06/07 22/06/07 Francis House Version 5.2 Page 25 15 OP9 13 16 OP26 23 needs of service users at all times. The registered person must ensure service users are administered their medication as prescribed. The registered person must ensure the flooring in the service users lounge is cleaned or replaced. 28/05/07 22/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Francis House DS0000058691.V333017.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Francis House DS0000058691.V333017.R01.S.doc Version 5.2 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!