Inspection on 23/10/07 for Garden Hill Care Home

This inspection was carried out on 23rd October 2007.

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

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

Other inspections for this house

Garden Hill Care Home 04/02/10

Garden Hill Care Home 05/08/09

Garden Hill Care Home 03/09/08

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

CARE HOMES FOR OLDER PEOPLE Garden Hill Care Home 32 St Michaels Avenue South Shields Tyne & Wear NE33 3AN Lead Inspector Hilary Stewart Unannounced Inspection 11:30 23 October and 14 November 2007 rd th 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 Garden Hill Care Home DS0000070307.V352893.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. Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garden Hill Care Home Address 32 St Michaels Avenue South Shields Tyne & Wear NE33 3AN 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) 0191 4975255 0191 4975269 Southern Cross OPCO Ltd Mrs Marilyn Jackman Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home with Nursing - Code N To service users of the following gender: Either Whose primary care needs on admission to the Home are within the following category: Old age, not falling within any other category - Code OP, maximum number of places 40 The maximum number of service users who can be accommodated is: 40 2. Date of last inspection Brief Description of the Service: Garden Hill is a large detached three storeys building in South Shields set in its own grounds. It is a new service although another company has previously registered the premises. The home was registered and opened at the end of April 2007. It has been since been taken over by Southern Cross Healthcare. The building has been improved and refurbished. It is near a bus route and the local shopping centre. The home has gardens to the front and side of the property with a car park to the front. There is a lift provided which enables people to get to the different floors. An emergency call system is provided in all bedrooms. The fees start at £395 per week. Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. How the inspection was carried out Before the visit: We looked at: • Information we have received since it was registered. • How the service dealt with any complaints & concerns. • Any changes to how the home is run. • The provider’s view of how well they care for people. • The views of people who use the service and the staff. The Visit: An unannounced visit was made on 23rd October and another visit on the 14th November 2007. During the visit we: • • • • • • Talked with people who use the service, staff and the manager. Looked at information about the people who use the service & how well their needs are met. Looked at other records, which must be kept. Checked that staff had the knowledge, skills & training to meet the needs of the people they care for. Looked around the building to make sure it was clean, safe & comfortable. Checked what improvements had been made since the last visit. We told the manager what we found. What the service does well: People’s needs are assessed before and after they move into the home to make sure that they can be properly met and staff know how to care for them well. Detailed information is available to help people make an informed choice about the home before moving in. The staff team at the home know that the needs of the people who live there are all different and they are aware of each person’s preferences. This means people know that they are valued and their opinions are taken seriously. Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 6 People have good opportunities to take part in a variety of leisure activities, which help them keep links with the local community and retain social skills. Healthcare needs are met by using a multi-agency approach. This helps residents to stay healthy. The building is clean and well maintained. The recent refurbishment has resulted in comfortable and pleasant surrounding for the people who live at the home. There are procedures in place that make sure the people who live there are protected and kept safe from harm. The manager is qualified and experienced so they can support the staff to meet the needs of the people who live at the home. What has improved since the last inspection? What they could do better: If daily recordings were written in more detail this would make sure that the home have accurate information about how the needs of the people they care for are being met. If the homes medication procedures were always followed this would make sure that the people who live at the home and the staff are kept safe. If the homes resuscitation equipment was kept assembled and checked it would be more readily available in the case of an emergency, which would help to protect the health and well being of the people who live at the home. If the staff at the home all had up to date training in adult protection procedures this would make them more skilled at safeguarding the people at the home. If all of the vetting procedures were carried out this would make sure that only suitable people are employed to work at the home. Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 7 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. Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 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 Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive assessments have been carried out before people move into the home so staff know that they can meet their needs and plans can be made to make sure they get the care and support they require. The home does not provide intermediate care. EVIDENCE: The care files contained a comprehensive assessment of the prospective service users needs. These are carried out by either the manager or senior staff prior to offering a place to any potential resident. The manager described the way she takes into account the residents that are in the home already and the skills of the staff when doing the pre-admission assessments. They were detailed and contained the necessary information on which to base a plan of care. Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 10 The care files contain care manager assessments, which are carried out before admission and given to the home. This helps the manger to decide if the home can provide the right type of service for a specific person. Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All of the people who live at the home have individual care plans; so staff have an accurate and up to date record about how to meet the individual needs for all of the people at the home. The home has systems and procedures to make sure that medication is generally administered following recognised good practice so the people who live at the home are kept safe. There were some gaps in the records. The people who live at the home are supported by the staff with their care needs so they can be as independent as possible whilst respecting their privacy and dignity so they know they are valued as individuals. EVIDENCE: Each resident has a plan of care, based on the admission assessment, which is added to during the placement. It contains an assessment for nutrition, wound Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 12 care, moving and assisting, and continence promotion as well as a dependency score. These are up to date and detailed. They were generally reviewed and updated and reviews are regularly held with the people who live at the home and their representatives. Resident or relatives are consulted when writing the care plans and the people living in the home and the visiting relatives confirmed this. Some of the assessments were not signed and dated but this is a problem with the documentation and the manager agreed to review this. Where the review of the care was due (or even slightly overdue) there was a mechanism for addressing this. Some of the daily recording needed to be in more detail to describe how someone’s day had gone rather than using short judgmental words that may not give an accurate picture. Residents have access to NHS services and facilities. There is a good range of pressure relieving mattresses for the prevention of pressure sores. Nursing action taken for wound care was well recorded. And the home seeks expert advice from external professionals if necessary. The people living in the home could describe the way that their privacy was maintained and staff were observed to do so when delivering care. The residents were complimentary about the care they received and said that the staff treat them in a “friendly and caring” way. An example of a comment made by a relative was “the staff are lovely” and “we are very happy with the care, there were some little problems at first they were dealt with quickly by the Manager”. A resident said I feel “warm comfortable and safe” Staff address the people who live at the home by their preferred name and there was a good relationship seen between them and the staff. The systems for managing medicines in the home are generally in line with safe working practice guidelines however there are a few areas where practice could be improved. The records are in place to show that the staff follow the company policies and procedures when ordering medicines. They check which medicines are needed by cross checking the medicine administration record sheets (MAR) and the tear off slip, and the care records if necessary, to ensure that they are ordering the correct medicines. They then order the prescriptions from the relevant general practitioner. The prescriptions are then checked on receipt from the General Practitioners and are then sent to the chemist for dispensing, a retained photocopy of these would allow the home to check them should any errors occur. The medicines are then again checked against the records when received into the home so that any errors can be picked up. Most administration records are up to date and contain no significant gaps. Some of the hand written entries were not signed by two people to show that they had been checked to reduce the risks of mistakes when copying complex information. All stocks of controlled drugs were checked. Most were recorded and stored securely according to current regulations however there were two Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 13 issues identified. There was a gap in the register entry for one medicine and the record of disposal of an item, which was no longer, required, was inaccurate as it recorded it as having been de-natured and disposed of when it was still in the cupboard. The home has a contract for the disposal of medicines as necessary. The room in which the medications are stored is very small but was tidy. During the visit it was noted that even though there was an extractor fan in the room the temperature was very high. Most medicines must be kept within an identified temperature range and it was not possible to determine if the high temperature would compromise them. The home had some resuscitation equipment including a suction machine. This was not regularly checked and was not prepared for use with the necessary disposable suction catheter and tubing. This would mean that if it were needed in an emergency it would take more time to have it ready to use. It would be beneficial for the home to request a medication audit from its supplying pharmacist, which would give them the opportunity to look at their practices and make improvements as necessary. Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can take part in various social activities and make their own choices as much as possible so they know that their opinions and decisions are taken seriously. Friends and family are encouraged to visit the home at any reasonable time. This helps prevent people feeling and becoming isolated. The people who live at the home are offered varied, well-balanced and nutritious meals in comfortable and pleasant surroundings, which promote their health and well being. EVIDENCE: The manager said that the people at the home have a variety of activities but they are very ad hoc at the present time. They intend to employ an activities coordinator to improve the situation. At the present time they arrange artwork and bingo and to the shops. They have access to a mini bus so intend to use this for trips out. The manager said they intend to start having house meetings where the people can be asked for their ideas and opinions on the activities that have taken place. One person said “I’m quite happy” and “yes I have been Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 15 out”. One relative said, “ The home meets my parent’s needs” another said that they had been trying to get a television aerial fixed in their relatives room for six weeks. The manager staff and the people who live at the home said that their relatives and friends are welcome and encouraged to visit at any reasonable time throughout the day and evening. Visitors were observed on the day, one relative said, “ Most staff are very caring and helpful”. Records showed and staff said that the people who live at the home choose what they want to do during the day. They go to bed and get up when they want and staff said that they are always aware that they must support the people to be as independent as they can. One person said, “ I really like living here”. The home’s menus are based on what the people like and dislike. At a recent meeting the menus had been discussed with the people and their relatives. There is a choice everyday and the manager said there is a 4-week rolling menu. At the time of the visit the cook was making homemade soup and cream cakes. One person said, “the food is good ” and a relative said, “ The meals seem very nice.“ Special diets can be catered for. Hot drinks, fruit and snacks are always available throughout the day and evening. Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A satisfactory complaints procedure is in place to make sure that complaints are dealt with effectively and to the satisfaction of the complainant. Clear protection procedures are in place to protect service users from risk of harm. EVIDENCE: The manager said that the homes complaints procedure is always accessible to the people who live at the home and their relatives. The complaints procedure is also described in the homes statement of purpose, which everyone gets a copy of when they first move in. On person said that they would let staff known if they were unhappy about something a relative when asked did not know about the homes complaints procedure. The manager said and records showed that there had not been any complaints made since the last inspection. Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The building has been refurbished, is generally comfortable, clean and in good repair. This means the home is a pleasant place for people to live. EVIDENCE: The home has been refurbished. Some areas were still being improved upon. Rooms are well decorated and tastefully furnished most have door guards fitted. All of the rooms have en suite facilities. The sitting rooms are comfortable and the dining furniture is suitable for the people who live at the home. All of the bathrooms and toilets had hand wash and paper towels to reduce cross infection. The bathrooms did not have heating which may become an Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 18 issue in the winter. One of the toilets was being used as storage for wheelchairs. The lighting in the home is appropriate and the corridors were clear and spacious. Staff are employed to keep the home clean and hygienic. Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have opportunities for training so they know how to give the people who live at the home good care and meet their needs. Formal training in safeguarding vulnerable adults has not yet been given to all staff at the home, which may mean that staff don’t recognise when to raise an alert. Sufficient numbers of staff are in post to meet the diverse needs of residents. The home has a recruitment procedure to make sure that only suitable people come to work there. Some of the vetting process had not been carried out in full. EVIDENCE: Records showed and staff said that they receive training, which helps them with their work. Mandatory training such as first aid; food hygiene and safeguarding adults training is provided but some had not completed all of this. The manager said that some of the staff team need training in Protection of Vulnerable Adults (POVA) procedures and they are arranging this for staff at this time. Staff said that they did know what to do if someone disclosed abuse to them. The home has a POVA procedure. The manager said that 50 of the staff have vocational qualifications. Sufficient staff were on duty at the time of the visit. The manager and staff said that enough staff worked at the home to cover shifts. Records showed Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 20 that enough staff were on the rota for the following week. A relative said that an improvement to the home would be if there were more staff. One person who lived at the home said that they thought there were always enough staff about. The manager said that all staff have been CRB (Criminal Records Bureau) checked at an enhanced level. They are checked at the main office of the organisation and the manager is informed when this has taken place but does not see the original CRB return. Some records were looked at and they showed that generally people are vetted to make sure they are suitable before they start to work at the home. Records did not show that gaps in peoples work history or reasons why they had left their previous posts been explored. Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager has qualifications and is experienced to run the home in the best interests of the people who live there. There are systems and procedures in place that help to make sure the people who live at the home and staff are safe from risk of harm. The home has a quality assurance system, which helps the home shape the quality of the service it provides and makes sure it is run in the best interests of the people who live there. Staff are not receiving supervision as often as they should. EVIDENCE: The manager said that they have completed the registered manager award and has worked for several years in care homes. It was observed that there was a Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 22 pleasant rapport between the people who live at the home the manager and staff. One member of staff said, “ They are a good manager” and another said, “ they are easy to talk to”. The personal records kept in the home of residents who are receiving assistance to manage their finances were examined and are detailed, logical and appropriate. These are managed by the homes administrator and although they are mainly kept electronically are supported by additional paper records. They are checked weekly by the manager and audited monthly by a regional representative of the company. Receipts were in place for purchases made on behalf of residents and signatures of either two staff or one and the service user were in place. There are no residents moneys kept outside of the home. The manager said that staff had not had individual supervision as often as they should or regular staff meetings. They intend to plan them in the future. Records showed that fire drills and training have taken place. The records did not include fire instruction. Electrical equipment through the home had been safety checked. The manager said that the home has a quality assurance system. As the home has just opened they intend to seek the views of the people who live at the home and their families by sending out surveys and holding meetings. This information is used to improve the service. Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 23 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 24 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 OP36 Regulation 18 Requirement The registered person must make sure that staff receive individual supervision at the required intervals. The registered person must make sure that the recruitment process covers all areas in Schedule 2. The registered person must make sure that all staff receive training in safeguarding adults. The registered person must ensure that: • medication is stored according to current guidance so that people are protected from medication errors; • Handwritten entries on medication charts are signed, dated and witnessed to reduce the risk of mistakes when copying complex information; • Controlled drugs are disposed of according to current relevant regulations and that DS0000070307.V352893.R01.S.doc Timescale for action 01/02/08 2. OP29 19 01/02/08 3. 4. OP30 18 13 01/02/08 01/02/08 OP9 Garden Hill Care Home Version 5.2 Page 25 regular checks are made to ensure no loss or diversion takes place. Resuscitation equipment is kept fit for purpose and checked regularly to ensure its safe use. 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 OP9 Good Practice Recommendations Consider requesting a medication audit from the home’s supplying pharmacist, which would give them the opportunity to look at their practices and make improvements as necessary. The registered manager should review the standard of recording in the care plans. 2 OP7 Garden Hill Care Home DS0000070307.V352893.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South Shields Area Office St Nicholas Building St Nicholas Street Newcastle upon Tyne NE1 1NB 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 Garden Hill Care Home DS0000070307.V352893.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!