Inspection on 12/09/06 for Harwood Court

This inspection was carried out on 12th September 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

Harwood Court 18/09/07

Harwood Court 31/01/06

Harwood Court 23/11/05

Harwood Court 02/09/04

Harwood Court 06/07/04

Harwood Court 26/03/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Harwood Court Highburn Cramlington Northumberland NE23 6AZ Lead Inspector Carole McKay Key Unannounced Inspection 12th and 15th September 2006 10:30 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 Harwood Court DS0000000604.V296376.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. Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Harwood Court Address Highburn Cramlington Northumberland NE23 6AZ 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) 01670-712492 01670-735626 home.cra@mha.org.uk home.fxg@mha.org.uk Methodist Homes for the Aged vacant Care Home 35 Category(ies) of Old age, not falling within any other category registration, with number (35) of places Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st January 2006 Brief Description of the Service: Harwood Court is a well established home, which provides single room en suite accommodation and personal care to 35 persons. The premises are purpose built with large gardens and are well located for services and shops in the middle of Cramlington. Run by Methodist Homes for the Aged, a national voluntary organisation, the home has a Christian based ethos and welcomes applications from people of all faiths. The home benefits from the support of a small but committed group of volunteers and has a well-established staff team, but the home has had three changes of manager in the last two years. During recent months Harwood Court has had a period without a manager. This coincided with staff Summer holidays and the long-term sick leave of one of the Assistant Unit Managers. This led to a shortage of staff. The home has had to rely on agency staff to cover, in order to keep to the minimum staff numbers. Mrs Bernadette Bell is the current manager. Mrs Bell has previously been registered in respect of another service and has been in post for one month. An emphasis is placed on social activity and independence. The home has a lively social activity programme and volunteers help support service users in maintaining links with the community. Service user involvement in the running of the home is also encouraged. Copies of previous inspection reports are available in the home. The current fees range from £378 to £414. Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A tour of the building took place. The care, medication, financial and health and safety records were examined. Service users and visitors were interviewed. The minutes of the meetings with service users were looked at. Discussions took place with care staff, the cook, two of the assistant unit managers and the manager of the home. What the service does well: What has improved since the last inspection? The home has a manager who has undertaken the registered managers award. Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 6 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. Harwood Court DS0000000604.V296376.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 Harwood Court DS0000000604.V296376.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): 3,6 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users can expect that their needs will be assessed before moving into the home. The manager has an audit process for ensuring that assessments are kept up to date. Staff are supported to carry out the assessment. Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 9 EVIDENCE: The service does not provide intermediate care. This standard was not examined further. The home has an assessment document, which is completed for each person coming to live at the home. This is comprehensive and covers those matters listed in the minimum care standard. Each service user has a service user plan and each one contains a completed assessment. These are based on the care management assessment, where service users have these. The manager has produced some tools to help staff with carrying out parts of the assessment process. This will make sure that all of service users’ needs are addressed in the plan of care. The new manager was undertaking a full audit of the assessments for service users. This had identified that some assessments needed to be updated and this has been arranged. Harwood Court DS0000000604.V296376.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 good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users can expect to have a plan of how their care will be delivered. This will address their health care needs and will be reviewed. The manager ensures that these are reviewed and updated. The right to privacy and dignity is respected. EVIDENCE: Each service user has a plan of care. These include the health care arrangements. There is evidence in the files of routine health checks being arranged, as well as involvement of health care professionals for specific illnesses and special needs. The records show that specialist consultants had been involved. Community nurses called to see various service users. Arrangements were made to make sure that these visits took place in private. One service user was waiting in her room for her care manager to call and the administrator made sure that the office door was closed when confidential information was being shared. Some service users are addressed by their first names and others by their surnames, or other title. Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 11 A dependency rating scale is in use. The care files contain risk assessments for falls and pressure sores. Where scores are high for risks these were not followed with an outcome in a plan of care, in every case. It is not clear how staff that carry out these assessments are expected to respond to a change in risk or dependency outcomes. The manager has produced some tools that will help staff to follow this through more clearly and is introducing a more detailed nutritional assessment. Weight monitoring is not standardised. Some weights are recorded in imperial measure and others in metric. This could be confusing for staff when trying to track weight gain or loss. The home has a separate room for the storage of medication, which is not used for any other purpose. Since the last inspection the home has changed the kind of medication system it uses. Medications are delivered in blister packs prepared by the pharmacist. This is known as a monitored dose system or MDS. The medication records are up to date and well kept. Medication sensitivities and allergies are clearly recorded. Medications are securely stored under correct temperatures. Temperatures are monitored and recorded. Storage space for medicines is well organised, however the staff said that the space is now insufficient for the new system in use in the home. The MDS packs for the medicine round about to be given are stored in the trolley until given out. Then these are replaced with the MDS packs for the next round of medications. MDS packs not in the trolley are stored in cupboards in the treatment room. Not all of these are lockable. Though the room is kept locked when not in use. The medication trolley is safely stored. Controlled drugs are properly stored and accounted for. Previously senior staff have undertaken training in managing medications through a distance-learning course. Staff have also received training in use of the monitored dose system, which has been recently introduced in the home. The Manager of the service said that she has plans to move the medication storage to a larger room nearby, in order that an office can be accommodated on the ground floor. The date for work to start on this has not yet been confirmed. All of this ensures that service users are safe from receiving the wrong medication or missing medication that is important to their health and well being. Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 12 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 and 15 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. There has been some shortfall in the social activity and choice service users could usually expect at this home. This arose from a period of shortage of staff. The new manager has solutions in place to address the shortfalls. EVIDENCE: Staff shortages during the summer have affected the level of choice for service users. One of the service users said that staff had been too busy of late to spend much time chatting with her. During a service user meeting with the new manager, the service users had complained about slowness of the laundry arrangements and that they had been unable to have a bath when they would like to. These matters were recorded in the minutes from the meeting. The new manager has addressed the staffing levels. Part of this involves agency staff covering shifts so that the basic care can be given in the way and at times people prefer. The recruitment of a new activity organiser has also just been achieved and notices about forthcoming activities and outings are posted up on the notice board. Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 13 Service users spiritual needs are addressed. Regular services are held at the home and those people who wish to attend church are supported to do so. The volunteers assist with this. The home usually has two cooks, but one cook has been on long term leave and recently left. The cook on duty said that recent staff shortages had affected the quality of mealtimes for service users. Menus have not been updated this year and the care staff have had to provide cover in the kitchen at evening mealtimes. There has been a noticeable deterioration in the presentation of the dining room. The manager has arranged for the carpet to be replaced, for the room to be redecorated and new curtains to be purchased. The manager has also produced some updated menus, though these are not yet introduced. A new Cook has just been appointed. Service users said that they could have their meals in their rooms if they prefer this. The home’s visitors’ book is kept in the hallway of the home. Visitors are frequent and positive messages are left in the comments book. These comments included positive experiences about social activity. Service users’ rooms contain their personal possessions. This includes furniture and furnishings. Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made from evidence gathered both during and before the visit to this service. Service users are confident to make complaints. Service users and staff can expect that complaints will be taken seriously and investigated. The manager will act to protect service users from harm and makes sure that staff have up to date training in this. EVIDENCE: A comments/ compliments book is available at the entrance to the home. The home has a suitable complaints procedure and keeps a record of complaints. The procedure is included in the Service User Guide The Commission for Social Care Inspection has received one anonymous complaint. This was referred to the manager to investigate. The manager has addressed all aspects of the complaint very promptly in the short time she has been at the home. This covered staffing levels and staff training. The manager said that she intends to keep a confidential record of complaints and will include the investigation and outcome in the record. The manager said that updated training is arranged for staff in protection of vulnerable adults. This is to be delivered in house by a representative of Methodist Homes. The manager recently handled an allegation of theft promptly. The matter was appropriately referred to the police. Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 15 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): 19,26 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Service users live in a spacious and accessible home. The general level of cleanliness and maintenance is good, with the exception of the dining area. This needs attention. EVIDENCE: The home is purpose built and is set in large attractive gardens There is level access at its main entrance. A shaft lift is installed to access the first floor for people who cannot manage stairs. Previously Harwood Court has been maintained to a good standard. This situation continues in most parts of the home, but the dining room and kitchen are showing signs of wear. The carpet and décor in the dining room is marked and one of the curtains is missing. The kitchen tiles are damaged in places and the flooring and skirting boards are damaged. The cook said that this makes them difficult to keep clean. The manager has ordered a new carpet and Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 16 arranged for redecoration of the room and new curtains to be fitted. The manager said that a carpet washing machine had been purchased and will be used to keep the carpet clean until it is replaced. The shelving in the kitchen has been replaced and the manager said that the handyman will be replacing tiles and repainting the skirting boards. The grounds are looking a little neglected, as the extensive lawns have grown long. The manager said that the lawn mowers were out of order when she came t the home, so the handyman has been unable to cut them. These are now repaired and the handyman is waiting for dry weather to cut the lawns. The rest of the home is clean and well presented. The home has a wellequipped laundry room and employs a laundry assistant. This post has recently become vacant. This has resulted in returns of laundry to service users being slower than usual. Some of the service users raised this as a concern with the new manager during a recent meeting with her. A new laundry assistant has been appointed. Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 17 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 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The service is staffed to the expected level with the use of agency staff. Service users can expect the levels of permanent staffing to return to normal in the near future. Training targets are identified to make sure that service users are cared for by competent staff. The home’s recruitment procedures safeguard service users. EVIDENCE: The home has experienced some staff shortages since the last inspection. The manager post was vacant for several weeks and there has been some longterm sick leave. This coincided with the summer holiday period and resulted in agency staff being used. The service users said that there had been staff shortages and the staff were very busy because of this. The kitchen staff said that they had been particularly stretched during this period and it meant that care staff had to cover for evening meals. The cook said that the meal was prepared by the kitchen staff, ready for care staff to finish cooking and to serve to the service users. The care staff said that this had been manageable, provided they worked as a team and work was re prioritised at the time of the meal so that care of service users came first. The new manager has recruited agency care staff to cover the rota. Prior to the new manager being appointed the staff team covered for vacant posts, as the senior staff were unaware that they could use agency staff. A new cook has been appointed and until this person can take up her post, a retired cook is Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 18 covering this vacancy. Recruiting staff for vacant kitchen assistant posts is underway and one post has been filled. The manager has conducted an audit of staff training and has identified that some training requires updating. The manager has dates for these training events. 68 of the care staff hold a qualification. The staff files show that the home has a robust recruitment procedure. The staff files include application forms and these include health and criminal conviction declarations, along with a full education and employment history. Applicants are asked to provide the contact details of two referees. Criminal record checks are taken up by the organisation that runs the home at its head office. Written letters confirming which checks have been made and their outcome are in staff files. The manager has carried out an audit of training and has arranged for all training that has fallen behind schedule, during the absence of a manager, to be updated. Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 19 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): 31,33,35,38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The service is run by a competent manager who is able to identify how the quality of the service can improve. Service users financial interests and general safety are protected. EVIDENCE: The manager Bernadette Bell has undertaken the registered manager’s’ award and is awaiting her certificate. Bernadette has experience of managing a similar service and has been registered with CSCI in respect of that service. Bernadette has made application to be registered in respect of Harwood Court. Despite only being at the home for a short time Bernadette has had meetings with the staff team and the service users and has identified areas that service Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 20 users want to see improved and is addressing shortfalls in recruitment and record keeping. The manager is supported by one administrator and a team of assistant unit managers, as well as senior care staff. The lines of accountability are clear, however there is evidence that the assistant unit managers are not clear about their role when deputising for the manager. Four of the staff in the home carry out an internal audit, which incorporates spending two days, four times per year, gathering service user views. An annual quality plan is produced from the auditing process along with an annual business plan. The manager described her own system of monitoring assessment, care planning, medication and falls risk assessments for quality assurance purposes. The manager has identified ways in which record keeping can be made simpler so that staff can more easily cross reference care. This will make sure that when the care needs of service users change the staff are up to date with this as soon as possible. The monies and valuables of some service users are securely stored in the home. The records and receipts for these monies are kept properly and up to date. This makes sure that service users’ rights are protected. Contracts are kept in the office for the servicing of lifting equipment. The current certificates for servicing of lifting equipment are available, dated 23/02/06. This equipment includes: fixed hoists at assisted baths, mobile hoists and the shaft lift. Electrical safety checks are carried out. Certificates of safety checks on minor installations are available, dated 07/11/05. The handyman once per year carries out tests of portable appliances. The last recorded test was carried out in November 2005. The calibration of the testing equipment was carried out on 01/07/05. A certificate of safety for the gas supply and appliances was dated, 07/04/05. Contracts are in place for the testing and servicing of the fire alarm system and fire fighting equipment. Detailed records of the following safety checks are maintained up to date: weekly tests of the fire alarm, weekly inspections of fire extinguishers, fire doors, fire escape routes. The records show that the most recent fire drill was carried out on 21/03/08. One of the staff has undertaken the competent person fire training and provides training to the staff. Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 21 Water temperature checks are not available. Food temperature checks are up to date. An internal system of recording and reporting accidents, injuries and incidents is in place. Methodist Homes has a system for auditing the rate of accidents in its services. Memos are issued to the home concerning the rate of injuries as part of the quality assurance process. Methodist Homes for the Aged have produced a corporate Health and Safety Manual, a copy of which was available in the home at the time of the inspection. Policies and procedures have been devised, which cover: moving and handling; fire safety; first aid; food hygiene; infection control; safe storage and disposal of hazardous substances. Harwood Court DS0000000604.V296376.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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Harwood Court DS0000000604.V296376.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 OP7 Regulation 14 Requirement Where risk assessments are carried out for safety and well being of service users, the risks identified should be reflected in the service user plan in every case. TIMESCALE 31/05/06 NOT MET The registered manager to give notice in writing of changes to the premises to do with office accommodation and medicines storage. The registered manager to confirm that the dining room and kitchen have been refurbished and to consult with the local EHO about the kitchen improvements. The manager to confirm when all staff vacancies are filled by permanent staff and updates to staff training have been carried out. The manager must ensure that water temperature checks and fire safety instructions are up to date. DS0000000604.V296376.R01.S.doc Timescale for action 30/11/06 2. OP9 39(h) 30/11/06 3 OP26 23(2)(b), 16(2)(j) 31/12/06 4 OP27 18(1)(a) 31/12/06 5 OP38 23 (2)(b), (4)(d) 30/11/06 Harwood Court 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 OP8 OP8 OP31 Good Practice Recommendations The staff should have procedures to follow in response to outcomes of risk assessments. Weights should be recorded in imperial or metric measures, but not in both. The role of staff who deputise for the manager in her absence should be made clear. Harwood Court DS0000000604.V296376.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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 Harwood Court DS0000000604.V296376.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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