Inspection on 25/06/07 for Heathfield Gardens

This inspection was carried out on 25th June 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Heathfield Gardens 11/06/08

Heathfield Gardens 12/12/05

Heathfield Gardens 02/08/05

Heathfield Gardens 17/01/05

Heathfield Gardens 06/09/04

Heathfield Gardens 17/09/02

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Heathfield Gardens 163-165 High Street Tibshelf Chesterfield Derbyshire DE55 5NN Lead Inspector Nancy Bradley Unannounced Inspection 25th June 2007 09:30 Heathfield Gardens DS0000002058.V340078.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 Heathfield Gardens DS0000002058.V340078.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. Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Heathfield Gardens Address 163-165 High Street Tibshelf Chesterfield Derbyshire DE55 5NN 01773 872229 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) a.buljeean@mgbcareservices.co.uk MBG Care Services Vacant Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th December 2005 Brief Description of the Service: The home is situated within the rural community of Tibshelf, Derbyshire, which provides many local facilities. Many of the service users access these local facilities within the village. The home consists of two converted adjoining houses to provide one registered home, which provides nursing care for 10 service users with learning disabilities. There are two lounge/dining rooms and bedrooms situated on the ground and first floor. There is the provision of a minibus and local transport. The fees range from £685.57 to £1108.50 per week. Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection and took place over seven hours. The inspector spoke with the Manager and care staff and made a tour of the building. Records were examined relating to two service users and the general operation of the home. Additionally, time was spent in preparation for the visit, looking at the Annual Quality Assurance Assessment (AQAA). There has been no change in the service users living at the home. No family or relatives were present during this visit. At the time of the inspection none of the service users are able to manage their own financial affairs; with several services’ users affairs being subject to Power of Attorney. Four service users completed and returned the “ Have Your Say” questionnaire stating they were very settled, happy at the home and that good activities were provided, they liked the staff and they usually listened to them. The care staff assisted the service users in completing the forms. The Homes Statement Of Purpose, Service User Guide and the last inspection report were not displayed in the main home. All of the service users were able to contribute to the inspection and during the tour of the home spoke with the inspector about life at Heathfield Gardens and the activities they are involved in. What the service does well: What has improved since the last inspection? The majority of the previous requirements have been met. A new manager has been appointed. Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 6 There has been no major change in service users living at Heathfield Gardens. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Heathfield Gardens DS0000002058.V340078.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 Heathfield Gardens DS0000002058.V340078.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that service users’ needs are fully assessed and met prior to admission this ensures that all potential service users’ holistic needs are appropriately met. EVIDENCE: All service users have been at the home for a long time and there are no plans for any further admissions at this stage. There was evidence on file to show that the care needs assessments of the service users were are being reviewed by the referring agency. However the Manager reported that they do have difficulties with one referring agency. Information received at the time of the inspection confirmed that on new care need assessments had been undertaken to determine whether service users needs had changed since their admission to the home. Heathfield Gardens DS0000002058.V340078.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7 and 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Inconsistencies in the care planning system, recording and risk assessments may compromise service delivery and leave service users vulnerable. EVIDENCE: During the visit care plans of two service users were examined. The care staff had compiled the care plans for each service user and evidence was seen of care plans being reviewed. This was not on a regular basis or being formally recorded. Although the home had completed an assessment of need and care plans were in place these were too concise, and had not always been signed by the service user or their representative. Care plans did not show the level of care need required for each service user. The care plan for one service user being used was from the previous placement. Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 10 Individual risk assessments on service users need to be reviewed and incorporated into service users’ care plans. As with care plans they were too concise and did not fully assess the risk. Service users’ records were not easy to navigate and did not follow any set format. Service users are encouraged to be as independent as possible taking responsibility for some of the household tasks, like tidying their room and keeping the communal living area tidy . Heathfield Gardens DS0000002058.V340078.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,15,16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were arrangements in place to enable service user to maintain and develop appropriate relationships, and to participate in activities both in the home and outside in the wider community in accordance with their preferences and wishes. EVIDENCE: The care records of two service users were examined however they did not provide full details of care planning or risk assessments on social, recreational, educational and occupational activities undertaken in the home or wider community. On the day of the visit service users were involved in various activities around the home organised by the staff, with three service users attending an outside course on heath and safety. The daily routines are flexible with the service users being able to make their own decisions about how they spend the day. Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 12 The relationships observed between care staff and service users were open and good-humoured. The service users are encouraged to take pride in their appearance and their preferred style of dress is respected. Information on service users’ records indicated that contact with family and friends were appropriate. Any restrictions on contact must be recorded in service users care plans. The home operates set menu with service users being given a choice if they do not like the options on the menu. From examination of the menus the home is providing a healthy well-balanced and nutritious diet with some service users on special diets. Service users’ weekly weights are recorded. Heathfield Gardens DS0000002058.V340078.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users receive personal and health care support in a way, which promotes their independence and is in accordance with their preferences and beliefs. EVIDENCE: During the visit it was clear that the service users’ privacy and dignity is respected. However, from examination of records when service users need supervision during personal care this is not always fully recorded in their care plan. However there is an issue for one-service user’s privacy when in their bedroom. The manager stated the curtains had been taken down due to health and safety. Although the bedroom was overlooked from the houses close by, this had not been risked assessed or recorded in the care plan as to why or taking account of the service user’s privacy and dignity. From records examined and from discussions with staff, service users’ health and personal needs were being met Service users were generally healthy and records showed that staff promptly contacted the appropriate medical services. All service users attended services within the community including optician, podiatry, dentist, audiologist, and speech and language therapist. Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 14 The home operates and monitors service users’ medication. None of the service users are able to administer their own medication. All staff have received training on medication administration procedures. The arrangements for receipt, administration and disposal of medication were also examined and found to satisfactory. However there is an issue with the safe storage of the prescribed medication. The controlled drugs are kept securely in the upstairs clinical nurse’s room with the general medication being kept down stairs. At the time of the inspection both windows were open giving access to the medication cupboard from the street. This was brought to the attention of the Manager and the Responsible Individual who agreed to look at the security for that room. Due to the current work pattern, service users’ evening medication is administered before the qualified staff leave the premises at 21.00hours. The list of authorised staff signatures needs to be updated The local pharmacy provides the home with all its medication requirements however they do not undertake any medical checks on the homes procedures. Heathfield Gardens DS0000002058.V340078.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are arrangements in place to safeguard service users’ welfare, which enables their concerns and complaints to be listened to and acted upon however current practice leaves service users vulnerable. EVIDENCE: The home has a complaints procedure, which is available to all service users and their representatives. The complaints procedure is also displayed around the home for staff and visitors to see, and several service users have stated in their questionnaires that they know how to make a complaint. Records seen indicated that no complaints had been received from service users or their representatives about their care. The Commission for Social Care Inspection has not received any concerns about this home. The complaints procedure needs to be up date to show the correct contact details fro the Commission for Social Care Inspection. From discussions with the Registered Manager and from records examined there has been no reported incidents or allegations under the safeguarding of adults procedure since the last inspection. The homes policy on the protection of adults was examined. This needs to be reviewed and updated to reflect the change of policy to the Safeguarding of Adults procedures and to make reference to local procedures. The current policy makes reference to Nottinghamshire Abuse procedures, when the home should be adhering to Derbyshire’s procedures. Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 16 The homes policy on restraint /physical intervention is contradictory and needs clarification. Records examined showed staff had been trained in restraint however there was no evidence of this being updated. Staff training records confirmed they had received in house training on adult abuse procedures but these are not up to date. Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable, homely and safe environment, which meets their needs and aspirations EVIDENCE: The Inspector carried out a full tour of the home, accompanied by the Manager. All communal areas were inspected. Service users’ bedrooms were inspected with their agreement and all rooms had been decorated and furnished to their personal choice and were being personalised. The home was clean, well maintained, well furnished, equipped and well lit and heated. However, where personal items, furniture and fittings have been removed for health and safety this needs to be risk assessed and recorded in the service user’s care plan. There is a central kitchen with separate laundry and staff facilities. All of the bedrooms are single with en-suite facilities. All were decorated to a satisfactory standard. There are no outstanding maintenance issues. The home was free of any unpleasant odours or smells on the day of the visit. Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 18 The home has effective infection control procedures in place. Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,34, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has robust recruitment procedures and practices in place which ensure the safety and protect the service users. However these are not always being adhered to. Service users are well supported by an effective staff team who are appropriately trained. EVIDENCE: The home has a good compliment of staff with only one change in the staff group since the last inspection. The staff work flexibly to meet the development and social needs of the service users. The home operates a keyworker system and the staff spoken with during the visit were aware of the individual needs of the service users. Rotas showed that five staff work in the day with two staff covering the waking night. At present care staff provide the night cover. Although the home is registered as a care home with nursing care, from 21.00 until the 07.00, nursing care is not available. In the event of an emergency the staff have to contact the on call manager. Information received from the Annual Quality Assurance Assessment (AQAA) shows that the home has a total of nineteen staff. Currently the home has nine staff holding a NVQ level 2 or above and two working towards this, which Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 20 gives them a sixty percent of care staff qualified. There are four registered nurses, a cook and housekeeper. Staff recruitment records were examined against Schedule 2 of the National Minimum Standard Care Homes for Adults (18-65). All staff have a current Criminal Records Bureau check, are required to provide two personnel references. However the records of two members of staff did not support this. The two personnel references were not on record for one member of staff and in the second case the referees’ did not match the names on the application from. The applicants had not provided a full employment history and gaps in the employment had not been explored. There was no proof of identity on record and the application form did not allow for a full medical disclosure. From discussions with the Manager and from examination of records the home is providing good training and development opportunities. Details of staff training together with training planned were provided by way of the pre inspection questionnaire. All staff have a personal development plan. On examination of staff supervision records there was evidence to show that supervision had taken place. However the frequency did not meet the National Minimum Standard 36.4. Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37,39 and 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home was generally well managed, with staff seeking the views of the service users on the running of the home. EVIDENCE: A new Manager has recently been appointed to Heathfield Gardens and is currently on her induction programme. The Manager stated she has a relevant job description setting out her roles and responsibilities. The Manager has a number of years experience in the care sector and has a qualification in mental health. The Manager will need to register with the Commission for Social Care Inspection and complete a recognised mangers award. The Manager stated that a process for monitoring care and services provided has been established and is in line with the policy operated within MGB Care Services Ltd. The Manager stated there is no other formal system for Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 22 reviewing the quality of care provided. However she is looking to establish a system for meeting with service users on a regular base. As discussed with the Manager quality assurance procedures could be improved with further consultation being undertaken with stakeholders. The Regulation 26 monthly visits have been undertaken however they have not always highlighted where there has been a failure in systems policy and procedures. A sample of service/maintenance records was examined (including gas and electricity services) and there was confirmation that all the equipment had been properly maintained. Evidence of checks having been carried out was provided to the Commission for Social Care Inspection. Systems were in place for the monitoring and maintaining the hot water temperatures. These were examined and found to be within a safe range. At the time of the inspection the home did not have a current and valid Legion Ella certificate. Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 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 2 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 2 X X 3 X Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? 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 15 Requirement Care plans must include all service users’ needs, and kept updated following changes in their assed need and care. Care plans must be completed with involvement of service user, relatives, or the referring agency where possible. Care plans must be reviewed regular intervals and be clearly shown as such. Detailed risk assessments must be complied on all service users. Risk assessments must be regularly reviewed to reflect changes in service users’ care and activities undertaken by service users. The list of authorised signatures must be updated to reflect the current staff group. The home must take steps to make the medical room secure. The complaints procedure must include the current contact details of the Commission for Social Care Inspection. The homes policy on adult protection must be revised and updated to reflect current DS0000002058.V340078.R01.S.doc Timescale for action 31/08/07 2. YA6 15 31/08/07 3. 4. 5. YA6 YA9 YA9 15 15 15 31/08/07 31/08/07 31/08/07 6. 7. 8. YA18 YA18 YA22 13 13 22 31/08/07 31/08/07 31/08/07 9. YA23 13 31/08/07 Heathfield Gardens Version 5.2 Page 25 practice 10. 11. YA23 YA24 13 23 The home must clarify its policy and procedure on restraint /physical intervention. The home must undertake an environmental risk assessment before removing furniture and fitting from service rooms. The home must provide a sufficient number of qualified staff to meet the identified assessed need, of 24-hour care for service users with a nursing need. All applicants must comply with the homes policy and procedures on staff recruitment as outlined in Schedule 2 of the National Minimum Standards. The registered person must ensure that formal supervision occurs at least six times a year. This is a previous requirement. The manager must submit her application to the Commission for Social Care Inspection for Registered Manager. The registered provider must ensure that the Regulation 26 visits monitor all areas of the home as required under that regulation. The Registered Person must consult with stakeholder’s family and friends as part of the homes quality assurance review. 31/08/07 31/08/07 12. YA34 18 31/08/07 13. YA34 19 and Schedule 2 18 31/08/07 14. YA36 31/08/07 15. YA37 7 31/08/07 16. YA34 24 31/08/07 17. YA39 24 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000002058.V340078.R01.S.doc Version 5.2 Page 26 Heathfield Gardens 1. 2. 3. 4. 5 6. YA6 YA6 YA23 YA34 YA34 YA37 All service users records should follow a recognised format. Residents’, or their representatives’, involvement in care plan reviews should be confirmed by means of a signature. All staff should undertake a refreshing course in the Safeguarding of Adults All applicants should provide the days date month year when providing a full employment history. The home should discuss with the contracting authorities the current staffing arrangements, which are in operation from 21hours to 07.00am The manager should complete a recognised managers award. Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Heathfield Gardens DS0000002058.V340078.R01.S.doc Version 5.2 Page 28 - 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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