Inspection on 19/10/06 for High Gable House

This inspection was carried out on 19th October 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

High Gable House 10/10/07

High Gable House 22/06/05

High Gable House 05/04/05

High Gable House 04/10/04

High Gable House 30/04/04

High Gable House 01/04/04

Similar services:

Foxley Lane (121a)

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 High Gabel House 292 & 295 Lincoln Road Enfield Middlesex EN1 1SY Lead Inspector Tony Brennan Key Unannounced Inspection 19th October 2006 10:00 High Gabel House DS0000010676.V310742.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 High Gabel House DS0000010676.V310742.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. High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Gabel House Address 292 & 295 Lincoln Road Enfield Middlesex EN1 1SY 020 8804 1115 020 8443 5070 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) Mr V Kowlessur Care Home 9 Category(ies) of Learning disability (9) registration, with number of places High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 4 persons of either sex with learning disabilities in 295 Lincoln Road and 5 persons of either sex with learning disabilities in 292 Lincoln Road. Mr Kowlessur must have regular documented supervision and support from the company until he has successfully completed his NVQ level 4 in management. Two specified service users who are over 65 years of age may remain accommodated in the home. The home must advise the regulating authority at such times as either of the specified service users vacates the home. 22nd June 2005 Date of last inspection Brief Description of the Service: High Gabel House is a private care home of two separate semi-detached houses located on either side of Lincoln Road, Enfield. One house has four registered places (No. 295) and the other has five (No. 292). Both houses have similar ground floor layouts, a lounge and dining area with kitchen attached to the rear. Each of the houses has a small front garden and a larger back garden that is partly paved and accessible to users. The home is close to a good selection of shops, restaurants, transport links and other community facilities located along the A10 and within Enfield Town. The fees are between £600 and £650 a week. This report is available through the internet. Copies may also be obtained from the provider of this service. High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was undertaken as part of the annual inspection programme. The inspection took place over one day. The registered provider, Mr Kowlessur, assisted the inspector. The inspector received comments from the service users, relatives and professionals who live or are connected with High Gabel House. The inspector spoke with six service users and two staff. The inspector observed care practice and staff interaction with service users. The inspector toured the building and examined a number of records relating to the care, health and safety and management of the home. The inspector would like to thank the registered provider and staff who assisted him by answering questions about the running of the home. The inspector would also like to thank people who live at the home and their representatives for commenting on the service. What the service does well: A person who lives at High Gabel House said, “staff treat me well”. The inspector found that there were assessments carried out by the home and care management. These identified the needs of people living at the home. A person who lives at the home said, “things are alright here”. The inspector found that care plans identified their personal, social and health needs. Care plans provided detailed information on how staff should meet their needs. The inspector observed that staff supported people who live at the home to take decisions about how they wished to live. Risks faced by people who live at the home were assessed. One person who lives at the home commented that he felt safe. Comment cards received confirmed that they were provided with activities throughout the day. Daily notes referred to activities taking place each day. A person who lives at the home said, “I help with the washing up and cleaning”. Their involvement in household tasks and shopping was recorded in the care plans and daily notes. Staff spoken to understood the importance of supporting people who live at the home to have friendships. People living at the home confirmed that they had been involved in preparing the menu. A person living at the home commented, “if there are any problems I will speak to the manager”. Comment cards from relatives confirmed that they were aware of how to make a complaint. High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 6 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. High Gabel House DS0000010676.V310742.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 High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25 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’ needs are assessed prior to admission to the home to ensure they receive the care and support required. Service users do not have their rights and responsibilities explained in ways that they can understand. EVIDENCE: A service user said that, “staff treat me well”. The inspector case tracked service users and found that there were assessments from the home and care management. These identified the needs of service users. Where the service user had needs that resulted from their behaviour these were identified. A relative commented, “the care at the home is very good”. The inspector saw that staff understood the needs of service users. Two service users wanted to go out to do some shopping. Staff took time and ensured that the service users could choose where they wanted to go. Staff could explain how they meet the needs of specific service users. Care plans highlighted needs identified in the initial assessments. The inspector saw that all service users had contracts detailing their rights and responsibilities. However, these had not been made available in a form that service users could easily understand and access. The inspector spoke with the registered provider and agreed that the statement of terms and conditions should be made available in a pictorial format as a number of policies and procedures had been provided for service users in this form. High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 679 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Care plans provided detailed information on how the needs of service users would be met, but needed to be developed so that they were more person centred. Service users are supported to make decisions and consulted about how they live in the home. Risks to service users are assessed, but had not been reviewed to ensure their safety. EVIDENCE: A service user said, “things are alright here”. The inspector found that service users had care plans that identified their personal, social and health needs. Care plans provided detailed information on how staff should meet the needs of service users. Service users with needs resulting from challenging behaviour had guidance on how this should be responded to. Care plans had been reviewed regularly and updated. A relative commented, “I am very happy with the care given to my son”. Service users and their representatives had been consulted about the contents of care plans. Care plans did not adopt a person centred approach to the manner in which care is provided. This was discussed with the registered provider who agreed to adopt a person centred approach to care planning. High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 10 The inspector observed that staff supported service users to take decisions about how they wished to live in the home. Service users were able to choose if they wanted the television on, or make a hot drink with staff support. Comment cards received from service users confirmed that they were listened to and were able to make decisions about how they live. Risks to service users were assessed. A service user commented that he felt safe in the home. Risk assessments were found to cover all areas that affected the service user’s daily life. Risk assessments identified the specific risk facing individual service users. Staff spoken to were able to describe how they prevented risks to ensure that service users were safe and were supported to exercise control over how they live. Risks relating to behavioural issues were identified and actions to prevent or lessen the level of risk were discussed. The risk assessments had been agreed with service users or their representatives. However, it was found that risk assessments had not been reviewed to ensure changes to the level of risk were addressed. This was raised with the registered provider who agreed to ensure that all risk assessments are reviewed regularly. High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 15 16 17 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 supported to engage in a range of appropriate activities and community contacts that offer opportunities for personal development. Service users are supported to maintain appropriate personal relationships. Service users are supported to determine their own routines and can choose to live the way they wish. Service users are provided with a choice of varied and balanced meals. EVIDENCE: The inspector found that on the day of the inspection a number of service users were attending the day centres. Two service users were planning a shopping trip. The inspector spoke with them and they confirmed that this was a regular activity, which they enjoyed. Comment cards received from service users confirmed that they were provided with activities throughout the day. Service users daily notes referred to activities taking place each day. These included attending day centres and college. Service users also had programme specific activities to meet their needs. This programme had been agreed with each service user and was available in a picture symbol format to ensure that service users are able to access it. A service user said, “I help with the High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 12 washing up and cleaning”. Service user involvement in household tasks and shopping was recorded in their care plans and daily notes. Service users spoken to confirmed that they attend a church that reflects their religious needs. A service user said, “my mum visits me every week”. Service users commented that they had met friends at their day centre and a local club. Staff spoken to understood the importance of supporting service users to have friendships. A service user said, “I get treated well by the staff”. The inspector observed that service users were able to choose when they did things. Staff spoken to understood the personal care needs of service users and that they must respond in a sensitive manner. Comment cards received from service users confirmed that staff listen and act on what they say. A service user said, “I like the food”. Service users spoken to confirmed that they had been involved in preparing the menu. The menu was available in a pictorial format and was accessible to service users. The registered person explained, and service users confirmed, that the menu is reviewed regularly to ensure that it reflected the preferences of service users. The inspector observed that there were fresh vegetables and fruit available. Two service users explained that they had been involved in doing the weekly shopping. The inspector saw that meals were well presented and they were provided in a relaxed environment. High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 20 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 supported with their personal care needs to ensure that they maintain their independence. Service users are able to access the medical care they need. Service users are protected by safe procedures for handling medication, but all service users must have guidance on when medication is to be used to manage challenging behaviour. EVIDENCE: A service user said, “staff know to help me”. The inspector spoke with staff, and found that they understood the personal needs of individual service users. Care plans outlined the support service users require and how they could be supported to maintain their independence in doing their personal care. Medical needs had been identified as part of the initial assessment and were referred to in care plans and risk assessments. A Service user spoken to had just returned from a visit to his general practitioner. The service user said, ”staff took me, because I had a pain”. Medical notes confirmed that service users had received medical care from a range of health professionals. The inspector saw that one service user whose behaviour can be challenging had been referred to a psychiatrist for assessment. High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 14 The inspector found that records for the administration of medication were all complete. The registered person explained that a procedure was now in place for the safe handling of respite service users’ medication. Staff now sign to say they have received and returned the medicines on arrival and departure of the service user. Records of medication received and returned were complete. Training records and discussions with staff confirmed that they had received training on the safe administration of medicines. Staff could explain when to administer medication to service users who have challenging behaviour. Guidance was in place that showed when service users should be given medication. This included information on when to use medication in the management of challenging behaviour. One service user who had medication for this purpose did not have this guidance. Two other service users also have general guidance on the administration of the medicines. High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 23 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 that their complaints will be listened to, taken seriously and acted upon. Service users are protected from abuse. EVIDENCE: A service user commented, “if there are any problems I will speak to the manager”. Comment cards from relatives confirmed that they were aware of how to make a complaint. The complaints policy explained how to make a complaint and how it would be dealt with. The complaints policy was available in pictorial form so that service users are able to use it. The complaints record showed that there had been no complaints. Comment cards from service users and their representatives confirmed that they had not had to make any complaints. There were comprehensive policies on handling abuse and adult protection. The registered person was clear about his responsibility to report any allegation. There have been no allegations since the last inspection. Training records showed that staff had recently received training in adult protection. Staff spoken to were able to identify possible signs of abuse and knew how to respond if they suspected abuse was taking place. High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 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. Service users live in a safe and comfortable environment that is adapted to meet their needs. The home is a clean and hygienic environment for service users to live in. EVIDENCE: The inspector toured the home and found that it was generally in a good state of repair. A service user said, “I love my bedroom”. Service users’ bedrooms were decorated and furnished in a manner that reflected their personal preferences. There were areas for service users to sit and relax. Service users were able to access the kitchen and other facilities without restrictions. A service user said, “my bedroom is always getting cleaned”. The inspector found that the home was clean and hygienic. Equipment was provided for this purpose. The home has an infection control policy. High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32 34 35 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 users benefit from staff that work as a team and are clear about their roles and responsibilities. Staff do not have all the skills to meet the needs of the service users. There are sufficient staff to meet the needs of the service users. The service users are protected by the home’s recruitment procedures. EVIDENCE: A service user said, “staff treat me well and understand what I need”. Staff were observed throughout the inspection and demonstrated understanding of service users’ needs. The inspector spoke with a member of staff who was able to explain how to respond to service users. Training records showed staff had had training on all the statutory required training with the exception of first aid. A member of staff spoken to had not received training in supporting people with learning disabilities or challenging behaviour. Training records confirmed that not all staff have completed the Learning Disabilities Award Framework training. 50 of staff have completed the National Vocational Qualification at level 2. A number of staff are now doing the same qualification at level 3. The staff rota showed that a consistent level of staff was maintained. Staff spoken to told the inspector they felt that there were sufficient staff available. The inspector examined files of three members of staff. These were found to High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 18 contain all the relevant documentation. Records of staff supervision and discussions with staff confirmed that they had regular supervision. High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 42 Quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. A registered manager needs to be in post to ensure that service users are supported by an effective management structure. Service users views of the service are sought and used as the basis for improvement. Service users and staff health and safety is not always promoted. EVIDENCE: The registered provider explained that there was no registered manager in post. The home has a deputy manager who manages the home with the support of the registered provider. The registered provider explained that he had tried to recruit a manager with no success. The registered provider was asked to ensure that a manager is recruited and applies to the Commission to become the registered manager for the home. The must be done as a matter of urgency. The home has a system to monitor the views of the service users on the service that is provided. Ideas for improvement are sought. A service user High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 20 said, “if there is anything wrong, they will do something to put it right”. A quality survey has been carried out. Service users are consulted about how the home is run. Service users spoken to felt able to share their concerns with staff. Records showed that fire equipment was tested regularly and maintained. Drills were taking place. The fire risk assessment provides details of potential risks of fire. All health and safety policies were available. Certificates for gas and electrical testing were in date. COSHH guidance was in place and chemicals were stored safely. Training on health and safety topics was not complete. Staff needed training on first aid. Records and discussions with staff showed that training is required on fire safety and infection control. The inspector found that the handrail at the top of the stairs was broken off and needs replacing. The drawers in bedroom 2 were broken and must be replaced. High Gabel House DS0000010676.V310742.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 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 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 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 3 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 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 3 X 1 X 3 X X 2 X High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 22 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 YA5 Regulation 5(1)(c) Requirement The registered person must ensure that service users contracts/statement of terms and conditions is available in a pictorial format so that service users are able to access it. The registered person must ensure that risk assessments must be reviewed regularly. The registered person must ensure that training is provided on the following areas; First aid Learning disabilities Challenging behaviour. The registered person must ensure that a manager is appointed for the home. The person appointed must apply for registration as the registered manager to the Commission. The registered person must ensure that the carpet in bedroom 2 is cleaned. The registered person must ensure that the handrail is replaced. Timescale for action 30/11/06 2. 3. YA9 YA35 13 18(1) 30/12/06 30/01/07 4 YA37 8(1) 30/12/06 5 6 YA42 23(2)(d) 23 01/11/06 30/10/06 YA42 High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 23 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 YA6 YA20 Good Practice Recommendations The registered person should ensure that person centred care planning is implemented for service users. The registered person should ensure that guidance is in place for when to use medication as part of managing service users challenging behaviour. High Gabel House DS0000010676.V310742.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 High Gabel House DS0000010676.V310742.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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