Inspection on 23/10/06 for Harrington Cottage

This inspection was carried out on 23rd October 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Harrington Cottage 14/05/07

Harrington Cottage 06/02/06

Harrington Cottage 05/07/05

Harrington Cottage 24/01/05

Harrington Cottage 05/07/04

Harrington Cottage 19/11/03

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Harrington Cottage Harrington Cottage Forge Hill Aldington Ashford Kent TN25 7DT Lead Inspector Lois Tozer Unannounced Inspection 23rd October 2006 1:50 Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 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 Harrington Cottage DS0000023434.V299317.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 Adults 18-65. 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. Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harrington Cottage Address 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) Harrington Cottage Forge Hill Aldington Ashford Kent TN25 7DT 01233 720814 Canterbury Oast Trust Miss Claire Anne Harman Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th February 2006 Brief Description of the Service: Harrington Cottage is registered to provide accommodation, personal care and support to six people who have a learning disability. Over 50 of staff hold NVQ2 (or above) certificates. A large cottage, set in its own extensive grounds, the home is set well back from the road and is approximately 20 minutes walk from the village shop and 15 minutes from the local pub. Access into the community relies on the homes transport (the bus service is reported as infrequent) so there are two dedicated vehicles provided for communal use. There is a computer and art classroom is situated in the grounds. Communal facilities consist of a good size dining room (that is used as a staff sleep over area at night) and a large lounge, with TV, music and computer. The kitchen (which also houses the washing machine) is freely available for people to use. WC, shower and bathrooms are situated on the 1st floor, with a separate WC on the ground floor. Harrington Cottage is owned and operated by The Canterbury Oast Trust (C.O.T.), a charitable organisation and is managed by Miss Claire Harman, who has an NVQ4 qualification. Miss Harman has been the registered manager of the home since 14th July 2005, and was previously the deputy / acting manager. Fees currently start from £920.56 per week with additional costs being met by the service user for hairdressing, toiletries, magazines, personal admission fees and beauty / chiropody. Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 23rd October 2006 between 1.50pm and 5.30pm. The manager, Miss Claire Harman, service users and staff assisted with the process. Six people live at the home, and all gave some feedback. People were coming and going in and out of the house on appointments and activities. A service user and manager gave a tour of the home. The bathroom suite is due to be replaced within days of this inspection. The shower room was out of order, and service users are looking forward to everything being new and working again. The inspection process consisted of information collected before and during the visit to the home. Other information seen included assessment and care plans, medication records, duty rota and employment paperwork. What the service does well: The home has a friendly, homely atmosphere. Service users are involved in some decision-making processes. People are involved in running their home People are getting out and about into the community a lot. There are lots of opportunities to meet new people and to have fun. Relationships (personal and with families) are supported, and people know that they can seek help from staff to see their friends. Personal interests are encouraged, like planting flowers in boots and playing music. Several people are fully involved in preparing meals. Service user comment cards sent in before the visit said: ‘ I like getting up in the morning, going out with my friends, everybody’s happy and sitting in the garden’. Six cards were returned, and all said they were happy living at house and liked the staff. Six relative comment cards were returned, saying they were all very happy with service, and no problems were noted. Comments included: ‘Harrington Cottage continues to be homely, happy and well run. Neither I or my son have any complaints’. ‘I am very satisfied with the care my son receives at Harrington Cottage’ Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 6 The General Practitioner (GP) returned a card stating that staff were clear about service users medical needs and was satisfied the service provided. 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. Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The overall quality of this outcome group is adequate. This judgement has been made using available evidence including a visit to the service. Needs have been assessed thoroughly, but aspirations have not been considered. EVIDENCE: The pre admissions assessment does draw out support needs, but not aspirations. The manager has identified personal and healthcare support requirements that specialist professionals could help with. Accommodation, day to day living and occupation has been carefully considered. The assessment needs to consider the aspirations of the person, of which there is no mention. The manager says that full consultation took place with the individual and their close family. Assessments are in text only format, which is not the appropriate communication method for the individual. The assessment has not led to a new or reviewed care or person centred plan, the previous placement plan is being used. Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 The overall quality of this outcome group is adequate. This judgement has been made using available evidence including a visit to the service. Individual plans are in place, but have not been developed in full consultation with the service users. For some, decision-making processes are good, but appropriate assessment and consultation is needed for others. General risk management is good, but individual risk assessments are out of date and have not been reviewed after incidents. EVIDENCE: Each individual has a plan, but these have been mainly written on behalf of the service users, rather than in direct consultation with them. Some excellent pieces of work (done photographically) show that the home is on the right track to improve this. There are few individual goals in place. At present, the plans are not led by individuals aspirations, and do not reflect a person centred Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 10 approach, which is strongly recommended. The majority of information is in text form only, but should be in a format the service user can understand. Although input from the speech and language therapist was noted, there were no individual communication assessments – other than noting that the person sometimes made up their own signs. Staff use Makaton communication, but have had only very basic training and do not feel fluent in this method. Staff say that people are involved in household duties ‘to the best of their ability’, but there is no teaching plan or task analysis to increase ability. Some Occupational Therapist assessments are currently taking place. A considerate staff team offer opportunities to people for day-to-day decision making around the home. But, speaking to staff, it was clear that interpretations of decision making rested with the individual staff member. Some documents focus on the person’s deficit’s more than strengths, for example, ability to choose clothing. Improvements in person centred planning are needed, so service users are really being consulted about decisions affecting their lives. General risk management is good, and opens up opportunities for service users to participate in activities. Some assessments have not been reviewed for a considerable time, and do not match up to support plans. Management of behavioural issues has not been reassessed, resulting in a person being sent to their room to calm. This strategy has not been agreed with the individual or multi-agency team. No reassessment of health or environmental issues has taken place to attempt to find out why this may have taken place. Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the 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, 15, 16, 17 The overall quality of this outcome group is good. This judgement has been made using available evidence including a visit to the service. People have lots of choice for educational and occupational activities. A focus on supported paid employment should be developed. Everyone is happy with the amount of community involvement they have. Relationships are well supported. Rights and responsibilities in daily routines could be improved. Meals are of a high quality, but service user participation in this area should be improved. Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 12 EVIDENCE: All service users have interesting and enjoyable educational or occupational activities that have been chosen by them. No one has paid employment, which should be a developmental goal for the future. People get out into the wider community on a regular basis and meet up with friends through established social get togethers. There is a large social network within the organisation and through the use of community facilities. Family and personal relationships are well supported. Staff help service users maintain regular contact with friends and stay in contact with people who live in neighbouring towns. Group outings are planned by the residents during house meetings and are enjoyed. Daily routines are easy going and run at the speed suitable for each individual. Some service users have bedroom door keys; others do not. No one has a front door key, both of these facilities should be assessed and suitable support be put in place. Staff enter the home by ringing on the doorbell, and service users are encouraged to do the same, which is a little odd, since it is their home. All service users have unrestricted access to all communal parts of the house and grounds. Staff say that service user participation in housekeeping tasks has improved, but there is no clear plan in place to consistently encourage and improve the ability of those who have the greater support needs. Staff involve service users in menu planning, and each persons choice is noted on the menu. Some people are more involved with meal preparation than others. Current Occupational Therapist assessments will hopefully increase the level of participation for an individual. Appropriate support needs to be offered to increase everybody’s skill in this area. Service users are supported to see a dietician and encouraged to make healthy choices. The range of food is very good. Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 The overall quality of this outcome group is good. This judgement has been made using available evidence including a visit to the service. People are given respectful personal support, but clearer agreements on promoting independence need to be in place. Physical health needs are well supported, but emotional health has not been considered when dealing with behavioural issues. Staff competently manage medication, but no service user has been assessed to take greater control in this area. EVIDENCE: Service users said that they receive careful personal support, and staff were helpful. Documented support needs are in place, but more focus on developing greater independence really needs to be emphasised. Healthcare has been consistently well supported. People are supported to speak with dieticians and physiotherapists to remain healthy – advice being written down and followed. Medical well-being is well supported too, but Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 14 review of behaviours displayed have not considered potential health issues. The reactive support given (exclusion) has not considered emotional wellbeing. Each individual would benefit from a health action plan designed in a way that they understand. Staff manage medication centrally. It is in good order. Staff have received medication management training and competency assessments have been conducted by the manager, but no-one is currently conducting competency assessments with her, which should be reviewed. It is important that answers to the questions given are explored and expanded where needed. No assessments have been conducted to see if service users can take a greater role in their medication management. The home needs to develop and empower people with control and administration of medication. Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 The overall quality of this outcome group is good. This judgement has been made using available evidence including a visit to the service. Service users who can speak out say their views are listened to and acted upon. Communication skills and methods need improvement to ensure all service users can express how they feel. EVIDENCE: Service users said that they felt staff would help them to sort out problems. They found staff easy to approach. People with communication difficulties made indication that they were happy and would make feelings known. There is a text and pictorial complaints procedure. Incidents that have occurred have been dealt with as unusual outbursts and not pursued. Communication passports and fluent Makaton speakers on the staff team are essential to service users expression of anxiety. Support plans dealing with behavioural issues have not been reviewed regularly, resulting in a service user being excluded. Much more development needs to take place around communication to enable people to say what the problem is. Care management must be consulted and plans reviewed immediately to prevent inappropriate sanctions being used. Service user money management has been reviewed and made much safer. Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 27, 30 The overall quality of this outcome group is good. This judgement has been made using available evidence including a visit to the service. The premises are homely and comfortable, but maintenance issues tend to take a long time to fix. Bathroom refurbishment is overdue, but is about to commence. The home is clean and hygienic. EVIDENCE: The premises are homely and comfortable, service users said they like the home a lot and only want the bathroom improved. The outside of the building needs decoration, which has been an ongoing concern, and was pointed at by a service user. The refurbishment of the bathroom has been outstanding for a long time, but is planned to commence within the week. The shower area is currently out of order, but two WC’s are available The downstairs WC lock should be one that is over-rideable in an emergency, as it is currently just a hook. Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 17 The home is clean and tidy. Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 The overall quality of this outcome group is poor. This judgement has been made using available evidence including a visit to the service. Staff are competent and offer a safe environment, but lack skills in person centred planning. There are shortfalls in the home’s recruitment procedure that leave staff vulnerable. Service users would benefit from staff receipt of training that is based on their assessed needs. EVIDENCE: Over 50 of staff hold NVQ 2 or above. Staff are reported by service users and relatives to be supportive and cheerful. Staff said that they have had some input to learn sign language, but it was a short course and was not used all the time. Staff were not aware of person centred planning as a way of finding out service user aspirations and goals. Specific training around increasing all service user involvement in the home and decision-making is needed. Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 19 Recruitment is a concern. A staff file showed that the organisation had not conducted their own police and POVA check on a staff member. A letter from Human Resources stated that the police check was still valid – they are not transferable between employers. This must be improved, as it is a consistent theme within the organisation. It is the managers’ responsibility to ensure that staff receive appropriate checks prior to commencing employment within the home. It is not clear how meaningfully involved service users are in the recruitment process itself. A large percentage of the training budget is spent on health and safety training. Although this is necessary, the primary focus has to be on service user needs led training. Person centred planning; active support and engagement have to be an important consideration to move the home forward. Training is mainly managed centrally, but it is the responsibility of the manager to identify service user needs and then the training needs of the staff group. It is surprising that service users are not actively involved in the delivery and revision of training such as Makaton. Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The overall quality of this outcome group is adequate. This judgement has been made using available evidence including a visit to the service. The manager is competent, but must focus on keeping the service users aspirations, lifestyles and goals at the heart of service delivery. Quality assurance needs improvement, as not all service users are able to have a full say in the running of the home. Health and safety provision is good. EVIDENCE: The manager holds an NVQ4 qualification and is able to discuss quality assurance processes. Most of the shortfalls in the service hinge around consultation with service users and using a person centred approach to delivering their service. There are some really good pieces of work that have Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 21 developed over the last 8 months, but focus on promoting decision-making, aspirations and independence is needed. The manager must now aim to support the service users to develop to their full potential by revision of practice and using the QA process. The manager should seek really good service user specific training in person centred planning. The quality assurance system in the home is flimsy. Service users have a say at weekly meetings, but mainly this is about the immediate future. There is a lack of consultation about individual and group futures. Better communication packages and understanding by the whole team of its importance is needed to ensure every service user gets a say. The internal review of support and care plans and incident forms has been poor. Repeated incidents have occurred resulting in service user exclusion, but no review of support has taken place. It is the manager’s responsibility to ensure takes place, and should have been raised at the latest through Regulation 26 visits, certainly discussed with care management and prompted a review process. The home is meeting the basic needs of service users, but is not striving to increase independence or take a modern outlook on involving service users fully with lifestyle decision-making. Staff have up to date health and safety training, and a rolling rota is in place to keep people in date. All service certificates were confirmed in date, as were the environmental risk assessments. Accidents and incidents are reported and recorded. Harrington Cottage DS0000023434.V299317.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 Adults 18-65 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 X 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 1 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 2 X 2 X 2 X X 3 X Harrington Cottage DS0000023434.V299317.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 YA6 Regulation 12 14 15 18 Requirement Previous requirement (partially met) timescale unmet 01/12/05 & 1/6/06 - timescale extended; Service user plan be developed in consultation with the individual & presented in an understandable format. Must identify the strengths & needs and show what support will be put in place to promote greater independence and maintain skills. Standards 6, 7, 9, 16, 17, 18, 19, 20, 22, 23, 39. Develop a person centred developmental approach to support and quality assurance. Standards 9, 19 & 23 Keep behavioural management strategies under regular review and ensure all parts of the plan are agreed with the service user and other relevant people. Staff recruitment must comply with the POVA guidance. Timescale for action 01/02/07 2 YA6 15 01/02/07 3 YA9 13 23/11/06 4 YA34 19 01/11/06 Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 24 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 Refer to Standard YA20 YA35 YA37 Good Practice Recommendations Support and encourage service users to take greater control of their medication. Staff training is based on service user assessed needs and promotes service user empowerment. Manager to seek service user specific person centred development training and implement it. Harrington Cottage DS0000023434.V299317.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Harrington Cottage DS0000023434.V299317.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. 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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