Inspection on 03/10/07 for Grosvenor Mews

This inspection was carried out on 3rd October 2007.

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

The inspector 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

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

CARE HOMES FOR OLDER PEOPLE Grosvenor Mews Lancashire Hill Stockport Cheshire SK4 1RH Lead Inspector Bernard Tracey Unannounced Inspection 3rd October 2007 10:00 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 Grosvenor Mews DS0000069122.V351531.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. Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grosvenor Mews Address Lancashire Hill Stockport Cheshire SK4 1RH 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) 0161 480 4844 0161 429 0362 Grosvenor Care (Cheshire) Ltd Vacant Care Home 50 Category(ies) of Dementia (50), Old age, not falling within any registration, with number other category (50) of places Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home with Nursing - code N, to people of the following gender:Either. Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category - Code OP. Dementia - Code DE. The maximum number of people who can be accommodated is: 50 Date of last inspection NEW SERVICE Brief Description of the Service: Grosvenor Mews is a purpose built home situated on a main road close to the Stockport town centre. The home provides personal care for up to 25 service users accommodated on the ground floor. In addition the home provides nursing care for up to 25 service users with dementia accommodated on the first floor. Fees for accommodation and care at the home range from £415.00 to £450.00 per week. Additional charges are also made for hairdressing and chiropody services, newspapers and personal toiletries. The majority of bedrooms are single en-suite. One double room is provided for couples or service users who wish to share. There are separate lounges and dining rooms, two quiet lounges and a conservatory offering a variety of settings in which service users are able to receive visitors, socialise and participate in activities. The home is on a main bus route with a bus stop outside. There is ample parking for visitors cars. Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first key inspection of the home under the ownership of Grosvenor Care, and it included a site visit to the home. The manager was not made aware that this inspection was going to take place. Several weeks before the inspection, questionnaires were sent out to doctors, social workers and nurses, as well as to the residents and their relatives. The questionnaires asked what people thought of the care and services provided by the home. The manager was also asked to fill in a questionnaire, called an Annual Quality Assurance Assessment (AQAA), telling us what they thought they did well, what they need to do better and what they have improved upon. Where appropriate, these comments have been included in the report. We spent over five hours at the home. During this time, we looked at care and medicine records to ensure that health and care needs were met and also studied how information was given to people before they decided to move into the home. A tour of the building was undertaken and time was spent looking at records regarding safety in the home. We also examined files that contained information about how the staff were recruited for their jobs, as well as records about staff training. We spent time speaking to four residents, as well as speaking to eight staff, including the deputy manager and the Operations Manager. We have received one complaint about the service and found that the manager was able to respond in detail to the concerns with a satisfactory outcome. The fees in this service range from £415.00 to £450.00 per week at the time of the visit. There are extra charges for Chiropody, hairdressing and newspapers/magazines. This home does provide nursing care. What the service does well: Grosvenor Mews Nursing and Residential Home provides a safe and comfortable environment and is well suited to the needs of people cared for. Residents benefit from an experienced and stable staff team. They are provided with a good amount of individual care and attention and supported to maintain control over their lives, and the decisions they make are respected. The new owners and management team are committed to providing a high standard of care in the home. Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 6 Care staff receive a range of training to give them the skills and knowledge to meet residents’ needs. The home had some care staff that had worked at the home for a long time and the residents said that they liked the staff and felt safe in the home. Comments such as “the girls are good to me, I wouldnt go anywhere else,” “Im very happy here” were made to us. Comments from a relative were “the staff are superb”, “I have every confidence in them”, “they keep me informed of any changes”. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Grosvenor Mews DS0000069122.V351531.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 Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Standard 6 does not apply Quality in this outcome area is good The Home has robust and well-established procedures in place to introduce new residents and this results in a high number of successful placements. The Home is careful to only take people whose needs they can meet, and equally the individual is given the opportunity to vet the home and make an informed choice of where to live. This judgement has been made using available evidence including a visit to this service EVIDENCE: Admissions are not made to the home until full needs assessment has been undertaken. Files contain relevant paperwork, including social work assessments and reports from health care professionals prior to a person choosing to stay at the home. The manager also carries out an assessment, which includes visits to see the person in their own home or while in hospital. Each resident is provided with a statement of terms and conditions prior to moving to the home. This sets out in detail what is included in the fee, the Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 9 role and responsibility of the provider, and the rights and obligations of the resident. These measures ensure that admissions to the home only take place if the service is confident staff have the skills and ability and qualifications to meet the assessed needs of the prospective resident. This results in successful placements. This procedure is in line with the Home’s Statement of Purpose. Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8 9 10 Quality in this outcome area is adequate. Care plans do not always fully demonstrate how aspects of health, personal and social care needs would be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We examined 5 care plans during our visit to the service. The manager had informed us in the completed questionaire sent before the visit that care plan documentation was under review by the new owners, therefore a selection of newly completed plans was looked at. The detail contained in the care plans varied as did the consistency of records maintained in them. All residents have an individual care plan but not all of those examined had been reviewed at least monthly. Some had completed risk assessments and monitoring charts for individuals in place including blood sugar, blood pressure, weight chart, nutritional assessments and skin and pressure area assessments. There were also falls risk assessments and assessments for manual handling, continence and the use of bed rails in some of those we examined. However one care plan indicated that a resident had not been weighed since August Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 11 despite evidence that she had been losing weight according to previous recordings. An assessment to monitor skin integrity had not been completed and although the individual had been assessed as at risk of falling, a care plan to inform the staff how this risk is minimised had not been devised. A further care plan examined indicated that a resident had no nutritional assessment and had not been weighed in the preceding month. The social assessment is very informative including a social history, hobbies, interests and how people preferred to live their lives, which is useful for staff in understanding the ‘whole’ person. Daily care notes failed to refer to the care plan and describe how the personal and emotional support was being provided. An area of weakness was found in the lack of support and intervention for a small number of residents identified, as having nutritional needs and the home must take action to improve this and provide more information for staff on action to be taken and recording that. For more than one resident there was no record of a referral to the dietician or the use of food supplements following progressive weight loss. These care plans did not describe to staff how diet and nutrition would be managed to maintain weight and a healthy diet. There was no evidence to show that residents or their representatives were routinely involved in the care planning process. Only one of the care plans seen had been signed by a relative to show they had been consulted. Regular appointments are seen as important and there are systems in place to make sure appointments are not missed. In addition a record of health interventions and their outcomes are held on file with evidence of the home liaising with a good range of other services including the GP, Psychiatrist and social worker. Records show that the home arranges for health professionals to visit frail residents in the home and provides facilities to carry out treatment. Records held in the home provide evidence of the input by other healthcare professionals and advice is sought from District Nurses and the Tissue Viability Specialist Nurse as necessary. Medicines were handled well overall however records of medicines received into the home are not being recorded. Visitors confirmed that the residents were treated with respect and in a dignified manner at all times. Privacy is respected at all times. Residents are free to meet with their visitors in the privacy of their own bedroom or in one of the communal areas. Visitors confirmed that they were welcome to visit the home at any time and that the staff were approachable and available to speak with them whenever they wished. One visitor said that it was lovely that the staff were forthcoming with updates of their relatives care without having to ask. Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 12 Visitors spoke highly of the manager, the care and ancillary staff and commented on how committed and caring they were. Comments from residents regarding the care include: “Staff are excellent” “The care is really good and I feel really safe here” Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 14 15 Quality in this outcome area is good Social activities provide daily variation and interest for people living in the home. Residents are able to make positive choices about how they spend their day and friends and families are very much a part of this process. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The routines of the home are planned around the residents’ needs and wishes. There are a number of organised group activities across a normal week, including dominoes, arm chair exercises and sing-a-longs. The home has recently appointed an activities co-ordinator as a replacement for the previous occupant of this post. There was no obligation on residents to join in activities and the social care staff tried to make sure everyone had the opportunity to participate if they wanted. There was reference to activities and occupation in residents care plans, and it could be seen that some people enjoyed a regular walk outside with staff. Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 14 Residents’ ability to exercise choice and control over their lives was limited by the severity of their dementia. Where preferences were known, staff abided by these. In other cases, staff observed residents reactions closely to judge whether they liked something or not, and this information was recorded in their care plan and passed onto other staff. The home operated an open visiting policy meaning residents could have visitors at any time suitable to them. Visitors had to gain entry and exit to the home via staff, as the doors were secured with keypad locks. Religious and spiritual needs are recorded and arrangements are made to allow each person to practice their religion. Food and mealtimes are treated as an occasion and something to look forward to. An experienced cook is responsible for providing nutritional meals that meet the cultural and dietary needs of residents. Care staff are sensitive to the needs of residents, for example the need for encouragement was undertaken in a sensitive and dignified manner. We were shown copies of picture prompts in relation to the menus which are to be used to aid residents when making choices from the menu. Tables are set attractively with table clothes and napkins and appropriate cutlery and aids to help individuals during their meal. Birthdays and celebrations are made special for individual residents. The atmosphere during meal times was relaxed and unhurried. Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 18 Quality in this outcome area is good Residents and relatives have confidence that their concerns will be dealt with. Abuse policies and procedures are in place to protect the residents. This judgement has been made using available evidence including a visit to this service EVIDENCE: The home has a written complaints policy which was not inspected at this site visit. It was reported that there had been no formal complaints since the new owners had taken over the home, though we received one anonymous complaint. The owner was asked to investigate the matter and subsequently provided us with an account of the outcome of the investigation. We examined this report and concluded that the matter had been resolved satisfactorily. Service user questionnaires all indicated that they knew who to speak to if they were not happy. One service user spoken to expressed the view that any complaints would be taken seriously by the staff team. Staff members who were interviewed were also confident that the home would respond appropriately to any complaints that were made. It was reported by the deputy manager that all staff receive training in connection with the protection of vulnerable adults as a part of their induction. The policies and procedures regarding protection of residents are satisfactory and are regularly reviewed and updated in line with regulations and other external guidance. The home had the latest guidance on the local multidisciplinary procedures for reporting abuse. Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 16 Staff have received Adult Protection training and demonstrated an awareness of the content of the policy and know the immediate action to take, and who to refer to. Feedback from relatives and others associated with the home state that they are very satisfied with the service provision, feel very safe and well supported by the home, which has the protection and safety of residents as a priority. Grosvenor Mews DS0000069122.V351531.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 26 Quality in this outcome area is adequate. Improvements are needed to the environment to make it comfortable and homely for residents This judgement has been made using the available evidence including a visit to the service. EVIDENCE: Grosvenor Mews is a purpose built care home. The home is undergoing a major refurbishment to provide a suitable and comfortable environment for residents to live in. Residents are accommodated on two floors; there is a passenger lift and other adaptations around the home to assist people with limited mobility. The majority of bedrooms are single with an en suite toilet and hand basin. There are assisted bathing facilities and plenty of spacious toilets around the home. There are several dining rooms / lounges for communal use. Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 18 The large reception area is used for social gatherings. To the rear and side of the building is an ample car park. There is a plan to make improvements to the front of the home, with the construction of an extended patio area to improve the entrance area and first impressions of the building, as well as providing additional amenities for residents to use. When we visited, the home was undergoing a major refurbishment therefore a full environmental audit was not undertaken. We discussed the planned environmental improvements with the Operations Manager, which confirmed the information that had been provided by the Manager in the Annual Quality Assurance Assessment that had been completed by the home as part of the Inspection. Grosvenor Mews DS0000069122.V351531.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 30 Quality in this outcome area is good. Staffing levels are satisfactory, staff training is provided, and the recruitment methods ensures that the residents are looked after by staff that are suitable to carry out care work. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the site visit sufficient staff were on duty to meet residents care needs. Rotas showed that staff were regularly available in sufficient numbers by day and by night to ensure that care was properly provided. The staff and the manager said that in their opinion there was enough staff to meet the needs and dependency levels of the residents living at the home. We examined the staff rotas and found that as well as employing care staff, the home also employs domestic, catering and maintenance staff. The deputy manager and the staff described a largely stable staff group, some of whom have worked at the home for a considerable time, which ensures that residents are cared for by people they know and are familiar with. Staff morale was improving under the new owners with staff saying that “there is a good atmosphere” and that “we work together well as a group”. Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 20 The residents said that the staff are “kind”, “happy to help” and that they were “patient and considerate”. Fifty percent of the care assistants had an NVQ (national vocational qualification) in care, which is good. All staff complete an induction and foundation training course. There was also evidence of recent training on safeguarding vulnerable adults, fire safety, continence care, wound care and care planning. Planned training sessions for the future included dementia care, and further training in care planning. We examined a selection of staff personnel files and the home’s recruitment practice. All necessary information was in place in line with good practice guidance, including an appropriate application form, job description, photograph, a signed contract of employment, references and a Criminal Record Bureau disclosure The home employed a mixed race staff group and the manager promoted good working relations, and new staff were well supported whilst settling into their role. Grosvenor Mews DS0000069122.V351531.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 38 Quality in this outcome area is good. Service users benefit from living in a well-run home where their safety and welfare are promoted and protected. This judgement has been made using available evidence, including a visit to this service. EVIDENCE: The home has recently restructured the senior team with the creation of a full time administrator post in addition to the manager and deputy manager. The manager is in the process of applying to the Commission of Social Care Inspection to become registered. The management team work closely together to ensure the home is running effectively and efficiently and in the best interests of residents. The home completes an annual quality survey with residents and their representatives, the results of which are reported back to the residents and actions agreed in response. Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 22 One family member spoken to appreciated that they were “kept informed” and were able to feedback to the home about any concerns they may have. The operations manager reported that all appropriate health and safety requirements were met. Staff confirmed the availability and mandatory use of personal protective equipment, such as disposable gloves and aprons. There was documentary evidence seen on staff files confirming that training had been undertaken in connection with health and safety, moving and handling, food hygiene and first aid. Grosvenor Mews DS0000069122.V351531.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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Not Applicable 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 OP7 Regulation 15 Requirement Timescale for action 10/12/07 2. OP8 14 (1) (a) (2) 3. OP9 13 (2) Assessments and care plans must be accurate, comprehensive and regularly reviewed so that the right care can be provided to each resident in a timely manner. Nutritional screening must be 10/12/07 undertaken to ensure that an accurate record of residents’ weights is maintained and appropriate action taken, including referral to the dietician, if needed. A record of all medicines 10/12/07 received in the home must be recorded to ensure medication can be accounted for. Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP7 OP7 OP8 OP19 Good Practice Recommendations Care plans should reflect the personal wishes, preferences and choices of the residents. Wherever possible the individual or their representative should be involved in the review of the care plan. Specialist care needs such as dementia should have care plans recorded in accordance with current good practice in dementia care. The current programme of refurbishment should be completed as soon as possible to improve the environment for the residents. Grosvenor Mews DS0000069122.V351531.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Grosvenor Mews DS0000069122.V351531.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. 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