Inspection on 23/09/08 for Gracelands

This inspection was carried out on 23rd September 2008.

CSCI found this care home to be providing an Adequate service.

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

Gracelands 26/09/07

Gracelands 09/08/06

Gracelands 30/11/05

Gracelands 06/07/05

Gracelands 09/11/04

Gracelands 30/04/04

Extracts from inspection reports are licensed from CQC, this page was updated on 23/11/2008.

CARE HOMES FOR OLDER PEOPLE Gracelands 443 Fishponds Road Fishponds Bristol BS16 3AP Lead Inspector Sandra Jones Unannounced Inspection 23rd September 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Gracelands DS0000026506.V365400.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. Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Gracelands Address 443 Fishponds Road Fishponds Bristol BS16 3AP 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) 0117 9653019 Mrs Rosemarie J Hancock Mrs Rosemarie J Hancock Care Home 6 Category(ies) of Old age, not falling within any other category registration, with number (0) of places Gracelands DS0000026506.V365400.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 only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Old age, not falling within any other category (Code OP) The maximum number of service users who can be accommodated is 6 26th September 2007 Date of last inspection Brief Description of the Service: Graceland’s is operated by Ms Hancock and registered as a care home for six older adults. The property is situated on the Fishponds Rd, in close proximity of shops, amenities and bus routes. It has the appearance of a domestic dwelling, which blends well with its environment. The accommodation is arranged over two floors with communal areas on the ground floor and bedrooms on both floors. The fees charged at the home is £370.00 per week. Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This key inspection was conducted unannounced over one day in September 2008 and focused on the assessment of key standards. The main purpose of the visit was to check on the welfare of the people who use the service, ensure the premises are well maintained and to examine health and safety procedures. During the site visit, the records were examined and feedback was sought from individuals and staff. Prior to the visit some time was spent examining documentation accumulated since the previous inspection including the Annual Quality Assurance Assessment (AQAA). This information was used to plan the inspection visit. “Have your say” surveys were sent to the people living at the home and health care professionals. Three surveys were received from people living at the home and two from Health Care professionals in advance of the inspection. The four individuals currently living at the home were case tracked during the inspection. Case tracking is the method used to assess whether people who use services receive good quality care that meets their individual needs. The inspection included looking at records such as care plans and reviews of the care of people using the service and other related documents. The home’s policies and procedures were also used to confirm the findings. The views of the people living at the home and staff were gathered through face-to-face discussions. What the service does well: People that live at the home said that the home caters for their preferred diets, they knew who to approach with complaints, the staff knew how to meet their needs and they felt safe at the home. Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 6 A visitor to the home made the following statement ‘ the environment is good, my friend was provided with a big television. My friend is happy here and the preferred meals are served which is important to my friend’ The member of staff on duty said ‘Rosie is a good leader, people here are well looked after.’ What has improved since the last inspection? What they could do better: There are three requirements arising from this inspection and these relate to medication and recruitment. The service provider must ensure that individual’s needs are reviewed to ensure the staff can meet their changing needs. A record of homely remedies must be maintained and details of administration including a running balance must be maintained. This will ensure that the people at the home benefit from safe systems of medication. Survey comments received from people at the home indicate that activities that they can participate in are sometimes provided. The service provider must ensure that people at the home can pursue hobbies and interests. This will ensure they are able to maintain their chosen lifestyles. The service provider must seek the names of two referees, one of which must be the last employer and disclosure of criminal history through the application Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 7 form. This will ensure that staff suitable to work with vulnerable adults are employed. 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. Gracelands DS0000026506.V365400.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 Gracelands DS0000026506.V365400.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) Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. There is an effective admissions procedure in place that would enable people wishing to live at the home to make an informed choice about moving there. EVIDENCE: There is a Statement of Purpose available at the home and it says that the rights of the people at the home are at the forefront of the philosophy of care. Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 10 Four people are currently accommodated at the home and they have been living there for a number of years. Comments made through surveys by the people at the home states that they received sufficient information to make decisions about moving into the home. The admission process is detailed in the Statement of Purpose and before moving into the home an assessment of needs must take place. This is to ensure that staff can meet the needs of the people wishing to live at the home. Also stated is that for people funded by the Local Authority, initial assessments completed by the social worker must be provided in advance of an admission to the home. For people that fund their placements, the service provider will undertake needs assessments. The Statement of Purpose confirms that people are encouraged to visit the home before their admission and a trial period is offered. This ensures that staff at the home have the skills and resources necessary to meet the individuals needs. Gracelands DS0000026506.V365400.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) & (10) Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. Health and personal care is based on the individuals needs, they can expect sensitive and prompt support from a skilled staff team. Medication systems must be made safer. EVIDENCE: Case files for the people living at the home are sectioned into personal details, finance, medical, care planning, consents and contracts. Care plan reviews forms include the views of the person, the carers with signatures indicating their agreement with the plan. Care plans amendments describe the changes necessary to the existing care plans. However, two care Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 12 plans have not been reviewed in the last twelve months. The service provider must review care plans with the person to ensure the staff can meet the individuals changing needs. Daily routines specify the individual’s morning/afternoon/evening and nighttime’s routines, which detail times for rising, retiring, preferred activities, likes and dislikes. Daily notes are used by the staff to report their observations of the person, outcomes of visits and activities undertaken. Comments through surveys from three people at the home state that they always receive the care and support they need. Medical needs and community services form part of the care plan. Care plans and documentation evidence that people at the home have access to NHS facilities, the chiropodist and optician visit the home regularly. It is evident from the documentation in place that people have GP involvement and have specialist input. For example, people have support from diabetic services, audiologist and continence advisors. Comments through surveys from the GP indicate that the staff demonstrate a clear understanding of the care needs of the people at the home. Two people were consulted about their healthcare needs. It was stated that there was a recent change with GPs and they were now able to visit the GP’s practice with friends or staff. The member of staff on duty said that medical advise is recorded which ensures that it is followed by the staff. Survey comments from people at the home state that they always receive the medical support they need. The people at the home are ambulant with zimmer frames and do need staff’s support with moving and handling. Medication profiles are in place and list the prescribed medication, its purpose and side effects. Three people have their medications administered by the staff and one person is competent to self-administer their medications. Records of medications administered were checked and correspond with the medications held in safekeeping. Homely remedies are administered when required from a stock supply by the service provider. However, a record of the homely remedies held with a running balance is not currently maintained. A record of homely remedies that includes administration details with a running balance of the medications held must be maintained. Comments from the pharmacist through the survey said that the service provider seeks advice about medications so that it can be managed correctly. The Privacy and Dignity policy is attached to the Statement of Purpose and described are the rights of the people at the home. It reports that its aim is to ensure the environment and services provided respects people’s rights. There is a separate procedure in-house procedure supporting the principles of care Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 13 and sets out the values and principles that define the approach used. Policies and procedures in place confirm that respecting individual’s rights is part of the induction for the home. The member of staff on duty was consulted about the way individuals rights are respected. Examples were given to describe the way individual’s rights to privacy and dignity are respected. People at the home confirmed that the staff respects their rights. Gracelands DS0000026506.V365400.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) & (15) Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. People at the home pursue their hobbies and interest and there are adequate support systems for people to lead active lifestyles. EVIDENCE: The Statement of Purpose says that the aim of the home is to provide a lifestyle for people that satisfy their social, cultural, religious and recreational interests. The arrangements for social activities, hobbies and leisure interests included in the Statement of Purpose and makes clear that there are pets living at the home and daily newspapers are provided to support people with continuing their activities and hobbies. The service provider giving feedback about the activities arranged said that one person helps with the garden, another attends clubs and visits friends and Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 15 one person is able to leave the home to visit shops while the others like watching television. Personal, emotional and social needs form part of the home’s care plans. Individual’s needs in respect of finance and abilities to leave the home without support are included in the care plan. Relationships with family and friends, social needs based on attending clubs, outings and hobbies are also defined. Individuals were asked about the way they occupy themselves during the day. One person said that they visit friends, pursue hobbies and going on outings. This individual also said that the day service they attended had recently closed and attempts with the service provider were being taken to seek alternative placements. Another person said that their preference was to watch television and reading was the way they preferred to spend their day. The member of staff on duty said that there are opportunities to sit and chat with people. Surveys comments from three people at the home state that activities that they can take part are sometimes arranged. The service provider must ensure that people pursue their hobbies and lifestyles. The home recognises the importance of maintaining links with family and friends for this reason visiting at the home is open. A relative was visiting during the inspection and agreed to give feedback about their observations of the standards at the home. This person said that the staff welcomes visitors, refreshments are offered and there are opportunities to discuss welfare issues. It was stated ‘The home is lovely my friend is happy here, it is always clean and tidy and the staff inform me about important issues’ The Food Agency visited and awarded the home three stars following their visit. Adequate amounts of food were found, the service provider said that provisions are purchased daily because of the close proximity to shops. The record of food provided corresponded with the provisions of fresh, frozen and tinned foods. People giving feedback said that the food was good and there was always plenty to eat. One person said that the home caters for their preferences and a vegetarian diet is served. Survey comments from three people at the home state that the meals at the home are always good. Gracelands DS0000026506.V365400.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) & (18) Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. People at the home can expect their concerns to be listened to. Feedback is recognised as important and takes steps to safeguard people from abuse. EVIDENCE: The home’s Complaints procedure is included in the Statement of Purpose and on display in the home. It accepts that people can become dissatisfied and commits to resolving issues of concern. Since the last inspection, the people at the home complained about person living at the home. The service provider said that the home was unable to meet this individuals needs and once the individual moved out, the complaint was resolved. Two people living at the home were consulted about making complaints. Both individuals said that they would approach the service provider with complaints and it was confirmed that they felt safe at the home. Survey comments from Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 17 people at the home state that they know whom to approach if they are not happy. The Equal Opportunities, Abuse and Whisteblowing policies show the home’s commitment to safeguarding people from abuse. The service provider must review the abuse policy to ensure that procedures in place follow No Secrets guidance in terms of the action to be taken. The Whistleblowing policy refers to past cultures of secrecy or intimidations and because of this staff were discouraged from reporting poor practice. The policy supports openness, confirms that staff have a duty to report poor practice and reinforces that staff will be protected from reprisals. Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (19) & (26) Quality in this outcome area is (good). This judgement has been made using available evidence including a visit to this service. The home is well maintained so individuals can benefit from living in a comfortable and clean environment. EVIDENCE: Graceland’s is located on the Fishponds Road close to shops, amenities and bus routes. The property is within a residential environment and maintains an appearance of a domestic dwelling. It is arranged over two floors with bedrooms on both floors and shared space on the ground floor. Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 19 The premises were clean, decorated to a good standard and free from unpleasant odours. Individuals at the home said that the home is kept clean and fresh. Shared facilities consist of a lounge and dining room. The lounge has seating for six residents and in the dining room there is sufficient dining space for individuals to eat their meals together. Within the dining room there is also additional seating for five residents. There is a full bathroom on the ground floor and toilet with hand washbasin. On the first floor there is a full bathroom, which is assisted, with a separate toilet adjacent to the bathroom. The individuals currently accommodated move around the home with Zimmer frames and walking sticks. There is level access and one step to enter the home. The stair lift provides access to the first floor and assists residents with moving around the home independently. Bedrooms are single and two are en-suite and contain a combination of the home’s furniture and personal belongings. As bedrooms are lockable and staff knock before entering bedroom, personal space is private. It was confirmed that keys to bedrooms and the front door are provided. From observation of the premises, the property is well maintained and comfortable. The laundry is sited away from the kitchen; it has a domestic washing machine and hand washing facilities. Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): (27), (28), (29) & (30). Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. People are supported by staff that are competent and experienced. The selection process must be robust to ensure that the staff employed at the home are suitable to work with vulnerable adults EVIDENCE: The recruitment process was examined to establish the robustness of the procedure. The application form was updated since the last inspection and further information must be sought through to ensure the process is robust. The names of two referees, one of which must be the last employer and disclosure of criminal history must be sought through the application form. There are three staff, the service provider and partner working at the home. The rota in place shows that three staff are rostered Monday – Friday mornings and at all other times there are two people rostered which includes the service provider and partner. The service provider and partner reside in the premises and will undertake sleeping-ins. Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 21 There is a training programme and staff have attended statutory training and vocational qualifications. Staff attended Food Hygiene, Safeguarding Adults training recently and one member of staff has not yet attended First Aid training. The service provider said that this course would be completed through NVQ Level 2 training, which this person is undertaking. The manager and two members of staff are currently undertaking vocational qualifications. The member of staff on duty was consulted about their experience of the recruitment process and access to training. This member of staff said that they were recently employed and previously worked for the NHS. They have previous experience of working with older people and their role at the home includes food preparation, cleaning and assisting the people at the home. It was also confirmed that there is an expectation that staff read care plans write daily reports and spend time with people living at the home. It was additionally stated that during their induction the service provider explained the preferred routines of the people at the home, there was a familiarisation with the building, videos that relate to the specific needs of the people at the home and reading policies and procedures. Survey comments from two people at the home state that the staff always listen and act upon what they say and one person said this was usual. It was also stated that the staff are always available when needed. Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 22 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), (35) & (38) Quality in this outcome area is (adequate). This judgement has been made using available evidence including a visit to this service. People at the home can expect to live in a safe environment and can be reassured that standards will be the subject of ongoing monitoring. EVIDENCE: The service provider was consulted about the management of the home. It was stated that the aims and objectives of the home is set by observations of Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 23 the people accommodated, constant supervision which ensure that staff also fulfil the stated aims of the home. Feedback from the people living at the home is used to monitor standards and the provision of training to improve the quality of care provided. Two people living at the home agreed to give feedback about the staff. It was stated that the staff are good and know how to meet their needs. The member of staff on duty was consulted about the systems that provide consistency at the home. It was stated that handovers when shift changes occur take place. The service provider must ensure that the recruitment process is robust and only staff that are suitable to work with vulnerable adults are employed. In terms of activities the service provider must consult the people living at the home about activities so that individuals can pursue their preferred lifestyles. The service provider said that cash is not currently held in safekeeping on behalf of the people at the home. The fire risk assessments assess the potential risk of fire to then take action to reduce the potential of an outbreak of fire. Within the risk assessments, emergency plans, training for staff and existing controls to prevent fire are specified. The service provider also takes steps to ensure people at the home live in a safe environment. Appropriate contractor carry out stair lift, gas and portable electrical equipment checks annually. The home operates a Quality Assurance system, it is the responsibility of the administrator to seek feedback about the standards of care from the people at the home. Documentation that supports the way the standards of care are monitored is in place and sectioned into financial, environmental, staff and people at the home. Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 24 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 X 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 2 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 2 X X X 3 X X 3 Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 25 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 OP29 Regulation 7,9 and 19 Sch.2 Requirement The home’s application form must seek the names of two referees and disclosure of criminal background. The service provider must seek the references from the last or most recent employer Timescale for action 30/12/08 2. OP29 7,9 and 19 Sch.2 13.2 30/12/08 3. OP9 A record of homely remedies 30/11/08 must be maintained and details of administration including a running balance must be maintained. This will ensure that the people at the home benefit from safe systems of medication. 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 Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 26 Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Gracelands DS0000026506.V365400.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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