Inspection on 13/03/06 for Hillgrove

This inspection was carried out on 13th March 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Hillgrove 28/06/06

Hillgrove 06/01/06

Hillgrove 09/02/05

Hillgrove 27/07/04

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

CARE HOMES FOR OLDER PEOPLE Hillgrove 79 Eleanor Road Bidston Wirral CH43 7QW Lead Inspector Leila Mavropoulou Unannounced Inspection 13th March 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 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. Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Hillgrove Address 79 Eleanor Road Bidston Wirral CH43 7QW 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) 0151 652 1708 Mayflower Care Homes Ltd Mrs Kathleen Parker Care Home 23 Category(ies) of Dementia - over 65 years of age (23) registration, with number of places Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration:None Date of last inspection 6th January 2006 Brief Description of the Service: Hillgrove is a large detached property adapted for use as a care home, situated in a quiet residential area of Bidston, Wirral. The home is registered with the Commission for Social Care Inspection for the personal care and support of twenty-three older people who suffer from dementia and other organic psychoses. Accommodation is provided in both single and double rooms on three floors. Access to the upper floors is via a passenger lift. The home is equipped with appropriate aids such as grab rails, ramp, assisted bathrooms and a call alarm system. There is a car park at the front of the home and garden at the rear. Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which lasted five hours. During the inspection three service users, three staff and the registered manager were spoken to find out their views about the service provided at Hillgrove. In addition, service users, staff records and other records were inspected. A tour of the building was carried out. What the service does well: What has improved since the last inspection? Since, last inspection the registered provider and the registered manager have made significant efforts in meeting the requirements made in the previous inspection report. This has included: organisation of staff training on Load Management, two bedrooms carpets have been replaced, the communal lounge carpet has been deep cleaned, new care plan format have been implemented and the staff on call duty has been reviewed. All of the afore mentioned promotes the health and safety of service users. Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 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 Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 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): 1,3,4,5,6 The manager of Hillgrove assesses prospective service users needs to ensure that their care needs could be met at Hillgrove. EVIDENCE: The Statement of Purpose provides information about Hillgrove such as: the facilities offered, staffing etc. The information contained in the Statement of Purpose would give prospective service information regarding the suitability of the Hillgrove in meeting their needs. The Statement of Purpose must be reviewed to ensure it continues to reflect accurately the service. The registered provider must ensure that all information is contained in the Statement of Purpose and does not direct the reader to other documents which they do not have immediate access to. New service user are assessed by the manager before they are admitted to Hillgrove, to ensure service user needs could be met within the existing resources. Service users files show that information obtained from the preadmission assessment is used to develop an initial service user plan and risk assessment. Wherever, possible service users are encouraged to visit the home to ensure that they like the “feel” of the home. Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 9 Since, the last inspection a number of staff have attended a one day training course on understanding Dementia at Liverpool University. It is planned that all staff would attend the course. In the interim period, information will be cascaded from staff that have attended the course and discussion with the manager indicated that she would share the information directly with staff in their individual supervision. The home does not provide intermediate care. Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Regular detailed review of service user needs and appropriate risks assessments would improve the quality of care provided to service users. EVIDENCE: The registered manager has implemented a new service user plan format. However, inspection of a sample of service user plans seen showed that they must be more detailed and associated risk assessments developed to minimise risks. A falls and waterlow risk assessment must be completed to ensure that identified risks are minimised and service users health is promoted. The waterlow form used by the care home was shown to the inspector. It is easy to use and understand by staff that are not medically trained i.e. qualified nurse. Service users daily records seen showed that service users receive regular check up from other health professionals as necessary. Since, the last inspection a Controlled Drug Book has been purchased and an accurate record is kept of service users controlled drugs. These were checked and found to be accurate. A controlled drug cupboard has been purchased and was waiting to be secured to the wall. Inspection of service users medication records showed that that service users medication was not being administered as prescribed e.g. eye drops and creams were not being applied. Discussion Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 11 with the registered manager indicated that the service users were refusing or there was difficulty administering creams as prescribed to service users. However, in the service user plans there were no reference to non-compliance with medication or any evidence that the advice was sought from the service user GP regarding this. Some service user medication records showed that medication was administered and not signed as given. Handwritten entries on service users medication records were not countersigned by another member of staff. The registered person must ensure that an accurate record is maintained of all service users medication received into the care home, administered to service users and returned to the pharmacist. Where service users are prescribed medication only to be taken when necessary there should be consistency in practice by asking service user if the medication is needed. Observation of staff assisting service users with activities of daily living showed that service users right to privacy to dignity and respect are upheld. This was showed through the way in which staff spoke to service users, knocked on their bedroom door before entering and the way in which assistance was provided at mealtimes. In the shared bedrooms, privacy screens are provided to promote service user privacy and new screens were purchased, which were waiting to be put in place. Wherever possible details of service users wishes who are terminally ill or dying are recorded. Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 The social activities should be reviewed to reflect the service users capacity, which would improve the quality of recreational facilities. EVIDENCE: The activities co-ordinator post (20 hours per week) was vacant at the time of the inspection. Activities are provided in morning and afternoon as evidenced in the activities schedule. The registered person should review the activities provided for service users to assess their suitability for service users and to consider alternative activities that reflect their mental capacity. It is recommended that when an activities co-ordinator is appointed that they are provided with suitable training to fulfil their roles and responsibilities. Service users participation in activities should be recorded in their individual activities records to demonstrate their social needs are being met. Discussion with the manager indicated that service users are unable to access community facilities, unless a family member accompanies them. The registered person should make provision for service users to access community facilities from time to time to promote their integration into community life. The service has an unrestricted visiting policy and service users are able to choose where to see their visitors. A small lounge is provided on the first floor where service users could see their visitors in private other than in their Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 13 bedroom. A pay phone is located in this small lounge to enable service users to make and receive calls in private. Service users representatives manage their finances. The service maintains a record of all expenditure made on behalf of service users such as: hairdressing, chiropodist etc and the service user’s representative is invoiced monthly. A varied and nutritious diet is provided with service users special dietary needs being catered for. The inspector was shown a two-week cycle of menus which included alternative meal. A record of the meals prepared is kept in a diary. The registered person must ensure that snacks offered to service users are recorded e.g. suppertime. Staff members were observed assisting service users in a discrete, unhurried and sensitive way during the lunchtime meal. The registered provider has replaced six of the dining chairs and it is hoped that all chairs would be replaced in the coming months as part of the service planned refurbishment programme. The kitchen was clean and tidy and fridge and freezer temperatures are recorded as required. Hillgrove recently had an inspection by the Environmental Health Officer and requirements made from the inspection were met. The food stores were examined and found to be clean, well stocked and well maintained. Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17,18 Hillgrove has various policies and procedures to protect service users from abuse. EVIDENCE: Hillgrove has a complaint procedure, which is displayed in a prominent position. The complaint procedure gives details of how complaints would be investigated, by whom and the timescale for completion of the investigation. There has been no complaint since the last inspection. Staff would support service users to vote if they wish to do so. However, given service users lack of capacity at Hillgrove it is unlikely that they would vote at the general or local government elections. There are various policies and procedures in place to protect the service users and staff from abuse. The service has a copy of the Wirral Adult Protection procedure. Staff left responsible for the care home are aware of the procedure to be followed if there is an alleged incident of abuse. All staff must receive training on managing and physical and verbal aggression to promote the safety of service users and themselves. Where staff have already received training in managing physical and verbal aggression refresher training should be provided to ensure that the staff knowledge and skills is current. Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25, The environment benefits from regular routine maintenance and refurbishment to promote a homely environment for service users. EVIDENCE: The grounds of the home were clean and tidy on the day of the inspection. The home does not use CCTV cameras. Some of the requirements from the previous inspection have been met whilst others are still ongoing due to the nature of the requirement. The service has two communal lounges and a separate dining room on the ground floor, all of which were found to be clean and well presented. The communal rooms could be used for a variety of activities and service users were seen to be freely accessing all of them. The registered person should seek advice from the Health and Safety officer to assess if there are alternative barriers, which could be used to prevent service users from accessing the basement area to improve the safety of service users. The service has a number of toilets and assisted bath and walk in shower to meet the needs of service users. Toilets and bathrooms are situated close to Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 16 service users bedrooms and the communal areas. The small lounge on the first floor has been redecorated since the last inspection. The bedrooms on the upper floors are accessible by a passenger lift and the stairs. Each service user bedroom has a call system. Discussion with the staff indicated that the service users do not use the call system, as they do not have the capacity to do so. In addition, grab rails, raised toilet seats etc are available to promote the safety of service users. All equipment used in the care home is serviced at regular intervals to promote service users safety. A tour of the building showed that two bedroom carpets have been replaced and some of the ceiling tiles have been replaced. It is the intention that all ceiling tiles will be replaced over the coming months. The window in bedroom 16 is rotting and should be repaired/replaced. In bedroom 11, the automatic door closure requires attention. The ground floor toilet near the fire exit door lock needs replacing, as it is not in working order. The wardrobe in bedroom 14 must be secured to the wall to promote the safety of service user. One of the requirements from the Fire Safety Officer regarding the pruning of branches from tree near the fire escape is still outstanding A tour of the building showed that the bedrooms were clean and free from malodour. Most of the bedrooms windows were still open at 4:00pm. The registered person should review the cleaning of the Hillgrove and ensure that service users bedroom windows are closed earlier to enable service users to access a warm bedroom in the afternoon if they wish to do so. All of the radiators have individual thermostats to enable service users to control the heating in their bedroom. Discussion with the registered provider indicated that as part of the home’s refurbishment programme radiator covers are being purchased to promote service users safety. Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 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): 27,29,30 The quality of care could be improved through staff receiving training specific to meet the needs of service users. EVIDENCE: The staff rota and observation during the inspection showed that the staffing level was sufficient to meet the needs of service users. The staffing level varies throughout the day to reflect the level of service users activity. Many of the staff have completed their NVQ level 2 Care Qualification. Since, the last inspection the service has reviewed its on-call system, in the event of an emergency the staff on call will be expected to go to the home to provide additional cover. Domestic and catering staff are employed in sufficient numbers to maintain the cleanliness of the building and dietary needs of service users. Inspection of a sample of staff files showed that some information, which is required to be kept at the care home for staff had not been obtained before the employee commencing their employment at Hillgrove. Staff files seen showed that staff are inducted into their role. However, on one file the induction was incomplete. It is difficult to assess if the service’s induction satisfies the Skills for Living specification as the dates for when training is given/provided cannot be audited easily. Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 18 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): 31,33,34,36,37,38 The quality of care to service users at Hillgrove could be improved through improved administrative systems. EVIDENCE: The manager at Hillgrove was registered with the Commission as the manager in February 2006. Since then, she has undertaken training in Load Management and Understanding Dementia to maintain her skills and knowledge. To date the service has developed its quality assurance system. Discussion with the registered provider and registered manager indicated that the senior management team is now meeting once a month to review the service and to set and review objectives for the service. A staff meeting then follows this meeting where outcomes and information from management meeting is circulated to staff. Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 19 At the time of the inspection, a current Public Liability Insurance certificate was displayed and discussion with the registered provider confirmed that records are kept of all financial transactions for accounting purposed. Staff supervision has recently been implemented. However, the registered provider should include timescales when objectives would be met and by whom. The service users records are kept in a secure place in accordance with the Data Protection Act. However, generally the record keeping at the care home could be improved to promote service users safety and health. The service promotes the health and safety of service users by carrying out regular routine fire checks, maintenance of equipment used and that of the building. Records of incidents/accidents are recorded and where necessary the Commission is notified. The registered person must ensure that all staff including night staff participate in fire drills and a record is kept of when training is given to individual members of staff. Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 20 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 2 X 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 2 2 3 3 3 3 3 2 X STAFFING Standard No Score 27 3 28 X 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 3 X 2 2 2 Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP1 Regulation 4 Requirement The registered person must provide a Statement of Purpose that includes all the information as detailed in schedule 1. This is outstanding from the previous inspection. The registered person must ensure that service users and risks are detailed giving clear guidance on how the assessed needs of service users would be met and identified risks minimise. Timescale for action 28/05/06 2 OP7 13(4)(b,c) 28/05/06 3 OP8 13 4 OP9 13(2) The registered person must 28/05/06 ensure that a falls risk assessment is completed and reviewed regularly where falls have been identified in the service user plan. The registered person must 28/05/06 ensure that an accurate record is maintained of all service users medication received into the care home, its administration and medication returned to the pharmacist. DS0000040990.V287732.R01.S.doc Version 5.1 Page 22 Hillgrove 5 OP12 16 & 18 6 OP15 17 7 OP18 13 & 18 8 OP19 23(2)(d) The registered person must ensure that service users have the opportunity to access community facilities. The registered person must ensure that the activities co-ordinator receives appropriate training for their role and responsibilities. The registered person must ensure that alternative meals offered and snacks offered to service users are recorded. The registered person must ensure that staff receive training on managing and physical and verbal aggression to promote the safety of service users and themselves. Where staff have already received training in managing physical and verbal aggression refresher training should be provided to ensure that the staff knowledge and skills continue to be current. The registered person must ensure that a programme of maintenance and refurbishment is produced and implemented. The window in bedroom 16 is rotting and should be repaired/replaced. In bedroom 11, the automatic door closure requires attention. The ground floor toilet near the fire exit door lock needs replacing, as it is not in working order. The wardrobe in bedroom 14 must be secured to the wall to promote the safety of service user. 28/05/06 28/05/06 28/05/06 28/05/06 9. OP19 23(4) The registered person must ensure that the requirements of the 2005 fire inspection are met. Outstanding from the previous inspection. 28/05/06 Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 23 10. OP19 13(4)(c) The registered person must ensure that unnecessary risks to the health or safety of residents are identified and so far as possible eliminated (Refer to inadequate protection of basement stair entrance). 28/05/06 11. OP25 13(4)(a)(c The registered person must ) ensure that all parts of the home to which residents’ have access are free from hazards and unnecessary risks are as far as possible eliminated. (Refer to unguarded radiator surfaces) 19 28/05/06 12 OP29 The registered person must 28/05/06 ensure that a robust recruitment procedure is put in place and that all documents are as per schedule 2 are obtained and kept in personnel files The registered person must ensure that all staff are inducted into their role and have the necessary skills and knowledge to carry out their responsibilities. The registered person must ensure that a details of all training provided to staff are kept. The registered person must ensure that a quality assurance system is developed to review and monitor the quality of care provided to service users at Hillgrove. The registered person must ensure that staff are appropriately supervised and a record is kept of issues. The registered person must ensure that accurate records are kept at the care home as required by the Care Homes The registered person must DS0000040990.V287732.R01.S.doc 13 OP30 18 28/05/06 14 OP33 24 28/05/06 15 OP36 18 & 17 28/05/06 16 OP37 17 28/05/06 17 Hillgrove OP38 13 28/05/06 Page 24 Version 5.1 ensure that all staff receives training in fire prevention and that a record is kept of when training was given. 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. Refer to Standard OP9 Good Practice Recommendations The registered person should ensure that service users are asked if they require medication which should only be taken when required, at times when medication is administered as a matter of routine to promote service user’s comfort. The registered person should ensure that service user participation in activities are recorded in their individual files to demonstrate their social needs are met. The registered person should maintain a record of concerns raised by service users or their family/representatives. 2 OP12 3 OP16 Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS 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 Hillgrove DS0000040990.V287732.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!