Inspection on 09/08/06 for Gracelands

This inspection was carried out on 9th August 2006.

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 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 23/09/08

Gracelands 26/09/07

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Gracelands 443 Fishponds Road Fishponds Bristol BS16 3AP Lead Inspector Sandra Jones Key Unannounced Inspection 9th August 2006 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.V304456.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.V304456.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 NONE rosie@rosie6.wanadoo.co.uk Mrs Rosemarie J Hancock Mrs Rosemarie J Hancock Care Home 6 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (5) Gracelands DS0000026506.V304456.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. MD(E) for one named person. Will revert to all OP when she leaves. May accommodate up to 6 persons aged 65 years and over requiring personal care only. 30th November 2005 Date of last inspection Brief Description of the Service: Gracelands 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. Gracelands DS0000026506.V304456.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was conducted in one day and focused on the assessment of key standards of care. The records were examined and a tour of the premises took place to make judgements on the standards of care. The views of the residents were sought during the inspection to confirm the care practices at the home. Residents surveys were sent to the home before the inspection and five people responded. Two relatives were at the home during the inspection and were consulted on their observations of the standards of care. Members of staff comments were sought on the conduct of the home. What the service does well: What has improved since the last inspection? Gracelands DS0000026506.V304456.R01.S.doc Version 5.2 Page 6 Since the last inspection, residents daily routines which incorporates the individuals likes, dislikes and daily schedules. Individual daily routines with care plans ensure the provision of care is individualised. One member of staff was recruited since the last inspection. This person is undertaking the home’s induction programme and will complete vocational qualification. The service provider has agreed this person can continue with their vocational qualification at the home. What they could do better: 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. Gracelands DS0000026506.V304456.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 Gracelands DS0000026506.V304456.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2&6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The admission procedure must be clear about the assessment conducted for people that self fund their placement. Intermediate care is not offered at the home. EVIDENCE: There is a Referral and Admission policy in place, which confirms that the care needs of potential residents, will be assessed before any admission to the home. Within the policy the arrangements for introductory and trial periods are described. It was understood from the service provider that there are no vacancies at present and none anticipated in the near future. It is acknowledged that generally referrals are from the Local Authority and the care manager conducts the assessments before admission. A procedure must be developed for assessing potential residents that self fund their placements. Gracelands DS0000026506.V304456.R01.S.doc Version 5.2 Page 9 The service provider stated that intermediate care is not offered at the home. Gracelands DS0000026506.V304456.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 at least once during a 12 month period. 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 the service. Care plans are up to date and specific. Residents must sign their care plans to confirm their agreement with the plan of action. Resident’s health care is monitored and where appropriate specialist input is sought through referrals. Resident’s comments suggest that the staff ensure their rights to privacy and dignity is respected. Residents are protected by the medications system in place at the home. EVIDENCE: Case files are sectioned into personal information, medical documentation, care plans and reviews, contracts and consents. Since the last inspection daily routine plans were developed, their likes, dislikes and preferred routines were sought throughout the day. Within the daily routines the morning, afternoon and nighttime schedule is specified, along with the assistance needed from the staff. Care plans are up to date and specific. All aspects of need are assessed and describe is the individual’s abilities along with the staff support needed to meet the identified need. Health care needs, community services, with Gracelands DS0000026506.V304456.R01.S.doc Version 5.2 Page 11 emotional and social needs are also specified. The section for Past Histories relates to medical care received up to the care plan update. Additional information included in the care plans include past occupation and visitors. The information within care plans and daily routines will guide the staff to consistently meet the needs identified in a person centred approach. The service provider explained the current care planning process. It was explained that care plans are updated, as the individuals needs change. Whenever relatives visit the home, the opportunity to discuss their relatives care plan is taken. As the service provider is the main carer, there is no formal structure for reviewing care plans. Care plans must be signed by the resident or relative where appropriate to indicate agreement with the plan of action. Residents physical, medical and access to NHS facilities are incorporated into the care plans. The individual’s ability with the staff support needed to maintain their personal hygiene is described. It is evident from the care plans that three residents require minimal support and three require assistance with all areas of personal care. One resident requires regular support with moving and handling to prevent pressure sores. The Primary Care Trust (PCT) provided a “hospital” bed and pressure-relieving mattress because this individual remains in bed. The service provider described that diet is another source used in the prevention of pressure sores. A high calorie diet is served to maintain the integrity of the skin. There is a Handling Assessment for each person accommodated at the home. The individuals weight, cognitive abilities, handling constraints, equipment needed and history of falls are assessed. From the assessment an action plans is prepared which lists the areas of need with the equipment, techniques to be used and staff support. Generally the residents use Zimmer frames and walking sticks to move around the home independently. Assisted bath to support residents with getting in and out the bath and the stair lift to access all floors are provided to maintain residents level of independence. The assessments must be reviewed to ensure the actions are appropriate to meet the needs. Residents are registered with a local GP and the service provider arranges the appointments with GP’s. The residents giving feedback during the inspection reported that the service provider accompanies them on all medical appointments. The service provider stated that three residents have continence difficulties and the continence advisor visits the home annually to reviews the provision of continence aids. Resident’s access NHS facilities, the optician visits annually and appointments for the dentist are when required. Gracelands DS0000026506.V304456.R01.S.doc Version 5.2 Page 12 Documentation kept in the individual’s case records confirm that resident’s health care is monitored by the staff and where necessary specialist input is sought through GP referrals. There is an accidents book maintained at the home and there were no accidents or incidents since the last inspection. The in-house Privacy and Dignity policy specifies approach at the home. Members of staff must sign to indicate their awareness of the homes policies and procedures. Listed are the resident’s rights towards privacy and dignity with the staff’s expected attitudes. Individual routine plans describe the individuals desired appearance and their preferred mode of address is listed in their care plans. Bedrooms are single and lockable demonstrating that the physical environment supports residents right to privacy. Residents consulted stated that the staff are respectful and observe their rights to privacy and dignity. A monitored dosage system is used at the home and is generally administered by the service provider and her partner. The service provider and her partner have attended external training in April 2005 to ensure their competency with the safe handling of medications. Three residents have regular prescribed medications administered by the staff. Records of administration indicate that records are signed immediately after administering medications. Information leaflets are in place for all prescribed medications. There is a record of medications no longer required at the home, which is countersigned by the pharmacist to indicate receipt for disposal. Gracelands DS0000026506.V304456.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 &15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents undertake daily routines that suit their individual needs. Visitors to the home are welcome at any time. Residents are empowered to maximise their capacity to exercise choice. The home provides residents with three main meals per day, which are varied and appealing. EVIDENCE: The service provider stated that structured activities from outside entertainers are not organised. Residents consulted during the inspection stated that watching television, reading and pursuing individual interest were the usual activities undertaken. One resident visits the library and another attends clubs in the community. Three of five responses received through questionnaires indicated that sometimes activities are organised. Daily routine plans specify the individuals preferred times to rise and retire, mealtimes and daily activities. Care plans contain the individuals spiritual needs, relationships and social needs. It is evident from the care plans that residents enjoy watching television, reading, jigsaw puzzles and socialising with each other and the service provider. Gracelands DS0000026506.V304456.R01.S.doc Version 5.2 Page 14 Residents giving feedback during the inspection confirmed that their relatives are welcome at the home. One relative was at the home during the inspection and reported their total satisfaction with the care provided to their family member. It was further stated that visits can take place at any time and keys to the home are provided. As relatives are provided with keys to the home risk assessments are completed. It was understood from the service provider that for relatives that visit the home regularly keys to the front door are provided. Two residents and three relatives have keys to the front door and relative’s suitability to have the keys is assessed. There is a Confidentiality policy, which endorses the commitment towards safe management of recorded information about residents. The policy confirms resident’s rights to access information kept about them and commits to providing information advocacy, where necessary. Resident’s comments during the inspection stated that they were encouraged to have personal items in their bedrooms. Resident’s comments were endorsed during the tour of the bedrooms. Daily records of food provided are maintained and specified are the beverages and meals provided at the home. It is evident from the records that a continental “style” breakfast, a cooked lunch and light tea is served at the home. Where alternatives are provided, the name of the person and the meal served are recorded. The wide range of fresh, frozen and tinned foods, reflect the menus and establish that residents have a varied diet. Four of the five residents that responded through surveys indicated that they always like the meals. Gracelands DS0000026506.V304456.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents are aware of the complaints procedure and know whom to approach with complaints. The service provider must amend the format to large print, so that residents can read the procedure. Steps are taken to safeguard residents from abuse. EVIDENCE: The home’s Complaint procedure is detailed and specifies the steps to be followed for raising concerns and complaints. There were no complaints received at the home or CSCI for investigation since the last inspection. The five residents that responded through surveys indicated that they know who to speak to if they are unhappy and four know how to make a complaint. The Complaints procedure is on display in a prominent part of the building for residents. The service provider must amend the format to large print, so that residents can read the procedure. Steps are taken at the home to safeguard residents from abuse, there is an inhouse Abuse policy, which follows the “No Secrets” guidance and staff attend external POVA training. The service provider reported that there are no staff currently subject to disciplinary procedures. Gracelands DS0000026506.V304456.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22 & 24 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Gracelands is suited for the purpose of providing accommodation to people over 65. It has a homely atmosphere and is well maintained. Communal areas provide residents with sufficient shared space to socialise as a group. The number of toilets, washing and bathing facilities provided meet the needs of the residents. Equipment and aids are provided to assist less mobile residents with moving around the home. The premises are kept clean and free from unpleasant odours. EVIDENCE: Gracelands 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.V304456.R01.S.doc Version 5.2 Page 17 The premises were clean, decorated to a good standard and free from unpleasant odours. 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 residents 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. Currently the ratio for bathrooms is three people sharing which is above the National Minimum Standard. There is a toilet on each bedroom floor and two bedrooms are en-suite, making the ratio of two people sharing a toilet. The residents 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.V304456.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 at least once during a 12 month period. 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 the service. The service provider and partner are the residents main carers and the staffing levels meet the current needs of the residents. Steps are being taken by the service provider to ensure staff have vocational qualifications. . The service provider must apply for a POVA First check, while the CRB disclosure is in progress. Employees must be provided with copies of the GSC Code of Practice and evidence of receipt must be kept in their personal files. Members of staff attend training that is appropriate to residents changing needs EVIDENCE: The service provider and partner are the main carers and live on the premises. Two staff are employed to maintain staffing levels and are generally rostered from 9:00am-6:00pm, Monday to Friday. Staff at the home have combined roles of cooking, cleaning and caring tasks. The staff providing personal care are over 18 and over 21 for staff left in charge of the home. One member of staff was employed since the last inspection and has partly finished NVQ level 2. The service provider has agreed for the member of staff to continue with the vocational qualification, started before employment at the home. Gracelands DS0000026506.V304456.R01.S.doc Version 5.2 Page 19 The case records of the staff employed at the home were examined during the site visit. Completed application forms, two written references and personal details are held in the personnel files. Criminal Record Bureau (CRB) disclosure checks were obtained for all existing staff. However, a CRB disclosure is outstanding for the most recent employee. While it is acknowledged that the CRB checks are in progress. However, POVA First check from the CRB has not taken place. The Department of Health allows applicants, who have applied for a CRB check, to start work as a care worker under supervision if they are not on the POVA list. The service provider must apply for a POVA First check from the CRB. The most recently employed member of staff agreed to give feedback during the inspections. It was explained that during the induction programme, the service provider introduced residents, explained the role, read the care plans and was provided with the home’s Code of Conduct. A copy of The General Social Care (GSC) Code of Practice has not been provided. Employees must be provided with copies of the GSC Code of Practice and evidence of receipt must be kept in their personal files. Training records for the staff were examined during the inspection. Since the last inspection the service provider and one member of staff undertook statutory update training. Two staff and the service provider have attended Loss and Bereavement and Managing Stress training. It was understood from the service provider that there is no set training programme in place. It is evident during the discussion that the service provider is aware of the statutory training that staff must attend. For this reason the most recent employee will attend Food Hygiene and other statutory training. Gracelands DS0000026506.V304456.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The service provider undertakes training that is appropriate to meet the needs of the residents at the home. The residents have full control over their finances. The routine checks and practices promote the safety of the residents and staff at the home. EVIDENCE: The service provider is in day-to-day control of the home and acts as the main carer for the residents. Since the last inspection, the service provider has attended short courses on Managing Stress, Assertiveness and Loss and Bereavement. Residents and staff feedback was sought about the service provider’s style of management. The member of staff on duty stated that the Gracelands DS0000026506.V304456.R01.S.doc Version 5.2 Page 21 service provider is approachable and open to discussions. Resident’s comments about the management of the home were positive. It was stated that the levels of support provided by the staff meet their needs. One person stated that “ This is a proper home from home, everything is done for us” It was stated by the service provider that the residents currently accommodated have full control of their finances. The home does not currently have resident’s cash in safekeeping. The records that relate to fire safety policies, procedures, checks and practices were examined. It is evident from the records that checks and practices are conducted at the stipulated frequencies. Service certificates and documentation of check conducted by the contractors are in place for the stair lift, portable equipment and boiler indicating that residents and staff’s safety are promoted. Gracelands DS0000026506.V304456.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 2 x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 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 3 3 3 x 3 x x STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x 3 x x 3 Gracelands DS0000026506.V304456.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 OP2 Regulation 4(1)(c) Sch.1 15(1) Requirement The admission procedure must be clear about the assessment conducted before admission to the home. Residents must sign care plans to demonstrate their involvement in the care planning process and agreement with the plan of action. The complaints format must be in large print to ensure residents can read it. POVA first check must be conducted for the new member of staff while the crb is in progress. Members of staff must receive copies of the General Social Care Code of Practice. Timescale for action 30/09/06 2. OP7 30/10/06 3. 4. OP16 OP29 22(2) 19 30/09/06 30/09/06 5 OP29 18(4) 30/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Gracelands Refer to Good Practice Recommendations DS0000026506.V304456.R01.S.doc Version 5.2 Page 24 Standard Gracelands DS0000026506.V304456.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Gracelands DS0000026506.V304456.R01.S.doc Version 5.2 Page 26 - 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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