Inspection on 12/09/06 for Hazel Garth

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 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

Hazel Garth 29/08/07

Hazel Garth 28/02/06

Hazel Garth 24/08/05

Hazel Garth 21/03/05

Hazel Garth 09/08/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Hazel Garth Hazel Road Warwick Estate Knottingley WF11 0LG Lead Inspector Gillian Walsh Key Unannounced Inspection 12th September 2006 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 Hazel Garth DS0000034421.V296184.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. Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hazel Garth Address Hazel Road Warwick Estate Knottingley WF11 0LG 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) 01977 722405 01977 722408 www.wakefield.gov.uk Wakefield MDC Miss Janet Linwood Care Home 24 Category(ies) of Dementia - over 65 years of age (24) registration, with number of places Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Can provide accommodation and care for four named service users in OP category. 28th February 2006 Date of last inspection Brief Description of the Service: Hazel Garth is a care home which has recently changed registration categories from providing personal care and accommodation for 28 older people to providing dementia care for 24 older people. It is owned by Wakefield MDC (Metropolitan District Council) a Local Authority offering a wide range of services to vulnerable people. The home is situated on a residential estate on the outskirts of Knottingley, a small town adjacent to the A1 & M62 motorways and local buses stop very near the entrance to the home. The home was purpose built and was extensively refurbished in 2000 with a further programme of refurbishment taking place as part of the change of registration. It is a two-storey building with both personal and communal accommodation for residents being based on four potentially self-contained wings. All the bedrooms are single and there is a passenger lift. There are large gardens to the side and rear of the premises. The manager said on 13/09/06 that the current charge for living at the home is £494.51 per week. Extra charges made by the home are for hairdressing, newspapers/periodicals and private chiropody. Information about the home is available within the Statement of Purpose and the Service User Guide, both of which have been revised to reflect the changes in the categories of care and are available in the home. Information about the Commission for Social Care Inspection is included in the Service User Guide. Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit to the home which took place from 10am to 3.30 pm on 12 September 2006 and was made as part of a full inspection of the service. As part of this inspection the views of residents, relatives, healthcare professionals, including General Practitioners and involved district nurses, were sought by way of questionnaires. The outcome of this was as follows: Of the 9 resident questionnaires sent out 3 were returned, all of which were favourable but did not contain any specific comments. Of the 9 relative questionnaires sent, 5 were returned, again these were favourable but two people indicated they did not always think there were enough staff available to meet residents’ needs. Other comments were very complimentary, ie “The home and staff are excellent”, “The staff are very caring and helpful” and “I am highly delighted with the standard of care”. Of the 7 health care professional questionnaires sent, 2 were returned; again these were favourable but did not contain specific comments. In writing this report, information and evidence was not only obtained by way of visiting the home but also from notifications and information sent to CSCI and from previous CSCI inspection reports. In gathering evidence, CSCI undertook case tracking, reviewed documentation, sought feedback from residents and their families, staff, the home’s manager and undertook relevant observations and discussions appropriate to needs of the residents, taking into account their needs and communication needs. The inspector would like to thank residents, their relatives and staff for their time and assistance during this inspection. What the service does well: Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 6 Residents and relatives said that they felt the care in the home is very good and that staff are kind and helpful in their approach. Staff were enthusiastic about their jobs and are looking forward to putting their recent training in dementia care into practice. The home provides a pleasant and comfortable environment with facilities available to meet the needs of residents. The standard of food at the home is good and catering staff take a pride in their work. Systems are in place to protect residents from harmful or abusive situations. 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. Hazel Garth DS0000034421.V296184.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 Hazel Garth DS0000034421.V296184.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 and 6. Quality in this outcome area is adequate. This judgement has been made from evidence gathered during the visit to this service. Pre-admission assessments are not always done by a member of the home’s own staff, therefore prospective residents cannot always be fully assured that their assessed needs can be met at the home. A community care assessment is completed by the prospective resident’s social worker. Intermediate care is not available at the home. EVIDENCE: One of the care plan files viewed was for a resident who had been very recently admitted to the home. A community care assessment for this resident had been completed by the social worker but a pre-admission assessment had not been completed by a member of staff from the home. Discussion took place with the deputy manager and a senior care worker about how preadmission assessments should take into account how the prospective resident Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 9 would fit in with existing residents and whether the staff have the appropriate skills to meet the individual’s assessed needs. As a member of the home’s own staff could only properly assess this, a recommendation has been made in this regard. The manager explained that permanent admissions are not being accepted at the home until people already living in WMDC’s homes have been reassessed to see if they would more appropriately be cared for in a dementia care facility. Although respite care is available, the home does not provide intermediate care. Hazel Garth DS0000034421.V296184.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 and 10. Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Care plans do not always set out residents’ care needs which could lead to a lack of consistent care and, although records indicate that residents’ health care needs are being met, a lack of good recording in daily records does not evidence this. Residents are protected by the home’s policies and procedures for dealing with medicines. Staff need to be more observant of residents’ movements, particularly those who are confused, in order to protect their privacy and dignity. EVIDENCE: Each resident has a care plan file which contains a range of assessments including nutrition, skin viability and manual handling. Actual care plans consist of two columns, one headed “strengths and abilities” and the other column for the detail of how staff should give assistance to ensure that needs are met. Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 11 One of the care plans seen was for a person who had been identified as having a specific care need as a result of illness but the actions were simply “to monitor”. In addition, a recent event which potentially could have had a detrimental effect on this person’s well being, had not been noted at all. Another person’s care plan gave no detail at all of any strengths and abilities the person may have, with actions simply stating things like the person “is shaved”. The plan gave no indication of how support should be given, what the person could do for themselves or how the person preferred this support to be given. Additionally, no care plan had been developed for a person with regard to an ongoing medical condition which requires regular medical intervention and daily care and support. Daily records said that the person had been “seen by” the appropriate healthcare professional but did not say that treatment had been given or that the person had needed to rest on their bed to recover. Another care plan said that the resident is “doubly incontinent” and wears a pad. The care plan did not detail any interventions staff should make to promote continence and, furthermore during the visit, the inspector observed the individual concerned access a toilet independently. Several of the care plans seen had not been signed either by the member of staff who had written them or by the resident or their representative. Daily records are kept separately from care plans. Staff confirmed that, as a result of this, they do not regularly refer to the care plans and this has led to a lack of regular evaluation. One of the plans seen had not been evaluated for nine months despite changes in the person’s circumstances. Evidence is available within records that residents’ health care needs are attended to by the appropriate health care professional and a comment card received back from a GP (General Practitioner) and one from a district nurse indicated that they were satisfied with the care provided at the home. Systems for the receipt, storage and administration of medications were checked and, although one inaccuracy of stock balancing was found, this could be clearly explained and accounted for by staff and therefore did not present any risk to residents. The manager said that, due to this slight anomaly, staff would return to weekly stock checks of medications. None of the current residents choose, or are able, to manage their own medications. One resident said that they get on well with all of the staff at the home and, although they had particularly good relationships with certain staff, they were all kind and respectful. Staff spoken with were aware of the residents’ need for privacy and dignity. However, one observation made during the visit, where a male resident entered and used a toilet already occupied by a female resident, neither of whom closed the door, indicated that staff need to be more observant of residents’ movements in order to maintain their privacy and dignity. Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 12 One relative spoken with during the visit said that they were more than happy with the care provided by the home and that staff always appeared to go the extra mile to ensure that residents’ needs were met. Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made from evidence gathered during the visit to this service. There is little evidence that residents’ recreational and social needs are being met on a daily basis although visits from family and friends are encouraged. Although some residents are able to make choices, some institutional practices are evident. Residents are offered a wholesome and very appealing diet. EVIDENCE: The home’s manager said that that the home does not have its own dedicated activities staff but that activities staff employed by Wakefield MDC come to the home 2 or 3 times each month to do activities with residents. The manager said that, other than this, care staff engage residents in activities. Apart from one resident who chooses to sit alone and read, very little evidence of any meaningful activity was observed during the visit. Four residents were observed sitting in a lounge with a television on. The picture on the television was very fuzzy, the volume was low and none of the people were looking at it, neither were they engaging in any conversation. Although the inspector spent a period of twenty minutes in this lounge, no staff Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 14 came to the room either to check that residents were alright or to engage in activities. None of the residents in the lounge were able to give their opinions about how they would like to spend their time although two people became engaged in a conversation with the inspector about how they liked to dance and their memories of dancing. Another group of residents were seen in another lounge where children’s television was being played. Discussion with staff indicated that residents unable to vocalise their opinions are given little choice about where and how they spend their days within the home, as staff tend to seat people in certain lounges. Daily records give little evidence of any time spent engaging residents in conversation or activity. At one point during the visit, all of the care staff were observed to be spending time sitting or standing around the reception desk rather than spending time with residents. When asked about this the senior care assistant said they were “waiting for a handover”. Discussion took place with the assistant manager and senior care assistant about how staff needed to engage with residents at every available opportunity. Opportunities to engage in social activities within the local community are limited, although regular trips out are organised for residents to local pubs, shopping areas etc and there is involvement with local churches. One person was very pleased to be receiving a magazine about the past and present of the local area. Visitors spoken with said that they were always made to feel welcome at the home. One resident said that they were happy that they had choice over such things as when they went to bed and what time they get up and that they were offered choices of food and drinks. The lunchtime meal on the day of the visit was fried or poached fish with home made chips and peas and an alternative of quiche was available for those who did not want the fish. Choices of desserts were brought to the tables on a trolley for residents to choose from. The meal looked very appetising and condiments were available on tables. One resident said that they enjoyed the food at the home but would like more variety in the teatime meal. Some residents tend to be served their meals in the dining area adjacent to the lounge they sit in rather than being asked if they would like to come to the main dining room. Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 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. The systems operated by the home ensure that people can raise concerns and complaints and feedback shows that they are confident that their complaints will be listened to, taken seriously and acted upon. Systems are also in place to ensure that residents are protected from abuse. EVIDENCE: The home’s manager said that no complaints have been received at the home since the last inspection; this was supported by records seen. The home’s complaints policy and procedure is made available to residents and relatives through the Service User Guide and all but one of the returned relative questionnaires indicated that they were aware of the home’s complaints procedure. No complaints about the home have been made to the Commission. Training records indicate that all staff have received training in abuse and protection and awareness of Wakefield MDC’s own policies and procedures for the protection of vulnerable adults. However, some of the staff spoken with did not seem to be fully aware of what may constitute abuse but did say that they would report any suspicions to the person in charge. The home’s manager said that she would arrange for training updates for staff in this subject. Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents live in a well-maintained and pleasant environment. EVIDENCE: The home has recently undergone some refurbishment and provides a safe, pleasant and comfortable environment for residents. Generally, the home appeared clean and tidy although one toilet area was noticed to be in need of cleaning. Discussion took place with the manager about how staff should get into the habit of making regular checks on toilet areas, particularly in view of the changing needs of residents. Hazel Garth DS0000034421.V296184.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 and 30. Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Staff are available in sufficient number to meet residents’ physical needs but consideration needs to be given to staff availability to meet residents’ social needs. Residents are protected by the home’s practices in staff recruitment, training and staff support. EVIDENCE: The manager said that staffing levels are calculated with the aid of the residential staffing forum and would continue to be as occupancy is increased. Two of the relatives’ questionnaires returned to the Commission indicated that, in their opinion, there are not always sufficient numbers of staff on duty. The manager should keep this under review as occupancy grows and the needs of residents change. Observation of the staffing arrangement during the visit was that more organised staff deployment might be needed to enable staff to observe and interact with residents. Consideration should be given to staff being given dedicated time to engage residents in social activities. Staff training is ongoing. Training records indicate that staff receive regular updates in mandatory subjects such as moving and handling and fire safety. Other recent training has concentrated on caring for people with dementia in Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 18 view of the recent change of registration category. Staff said that they feel that the training they had received had been helpful and they were looking forward to putting it into practice. The home’s manager said that four senior members of staff have recently undertaken training in management of medications and others are booked on the course. The manager also said that all new staff go through WMDC’s induction and foundation programme which meets with the Skills for Care Council’s standards. Some induction records were seen and the manager confirmed that supervision sessions are taking place for all staff at least six times each year and usually more often. The majority of staff have also recently had their annual appraisal. Staff records relating to recruitment are held electronically. A selection of these were checked and found to meet with standards. Hazel Garth DS0000034421.V296184.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 and 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 home’s manager demonstrates good abilities in her work at the home. Quality monitoring processes are in place and residents are safeguarded by financial and health and safety procedures within the home. EVIDENCE: The registered manager is a registered nurse who has many years’ experience of managing a care home and has completed the registered managers award. She has recently undertaken additional training in caring for people with dementia. Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 20 A quality monitoring system is in place at the home whereby residents and their families are given questionnaires about the quality of care provision at the home. The manager said that she is yet to collate the results of the latest quality monitoring into a report. Small amounts of residents’ personal allowances are kept, at the individuals’ request, in the home’s safe. Documentation relating to this was checked and found to be appropriate. All of the balances checked could be reconciled with the documentation made. The manager said that one person who has chosen to manage their own finances was supported by staff to open a cheque account with a local bank. Practices relating to health and safety within the home are managed between the home’s manager, maintenance staff and the estates personnel from WMDC. Monthly Regulation 26 visit reports are received from the home, within which matters relating to health and safety are recorded. Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 21 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 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 Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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. Refer to Standard OP3 OP7 Good Practice Recommendations A member of staff from the home should complete preadmission assessments. Care plans should • Give clear details of residents’ needs, abilities and the support they need to meet their needs. • Be signed by the person who has written it and, where possible, the resident or their representative. • Be reviewed on a monthly basis and as needs change. • Be used as a working document. Daily records should give clear details of how residents have spent their day and of any care or treatment the person has received. Staff should be observant of residents’ movements and ensure that their dignity is not compromised. Residents should be given the opportunity, on a daily basis, for stimulation through leisure, recreational and DS0000034421.V296184.R01.S.doc Version 5.2 Page 23 3. 4. OP10 OP12 Hazel Garth 5. 6. 7. OP14 OP18 OP27 social activities appropriate to their assessed needs and interests. Record should be made of residents’ interests and when they have participated in leisure and social activities. Staff should ensure that residents are offered choice in what they do and where they spend their time. Staff should receive updates in recognition of abuse. The manager should keep staffing under review to ensure that staff are available in sufficient number to meet resident needs. Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB 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 Hazel Garth DS0000034421.V296184.R01.S.doc Version 5.2 Page 25 - 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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