Inspection on 21/07/05 for James Phoenix House

This inspection was carried out on 21st July 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

James Phoenix House 31/08/06

James Phoenix House 17/02/06

James Phoenix House 15/02/05

James Phoenix House 25/11/04

James Phoenix House 16/02/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 JAMES PHOENIX HOUSE Hilden Road Padgate Warrington Cheshire, WA2 0JP Lead Inspector Judith Morton Unannounced 21 July 2005 09:30 st 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 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 Stationary 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. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service James Phoenix House Address Hilden Road Padgate Warrington Cheshire, WA2 0JP 01925 444094 01925 826387 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Warrington Borough Council Mrs Pauline Leach Care Home 10 Category(ies) of LD Learning disability (10) registration, with number of places JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. The care home is registered for a maximum of 10 service users in the category of LD (Learning disability, aged 18 to 64 years). 2. The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection 15/02/2005 Brief Description of the Service: James Phoenix House is owned and managed by Warrington Borough Council and is part of the Social Services Special needs and Disability Division. The premises, a two storey building with garden and parking areas, are situated in the Padgate area of Warrington. The service provides short-term care for adults who have a learning disability and live within the Borough of Warrington. Although the home is registered for ten service users, only seven are accommodated for short-term care at any one time. An eighth bed is kept for emergency admissions. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place from 7.30am until 3.45pm so the inspector was able to observe the morning routine and interaction between the staff and service users. Throughout this report the service users/ residents will be referred to as guests as this is the term used by the home. There were three guests staying at James Phoenix House at the time of this inspection. What the service does well: What has improved since the last inspection? What they could do better: Whilst there has been some improvement in the number and type of activities provided outside of the home, some families feel that further improvement could be made in this area. Transport continues to be a problem but fund raising is due to take place to buy a mini-bus for the home. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 6 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. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 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 standard(s) 1, 2, 3, 4 & 5. The home uses symbols and photographs so that people who use the service have information in a form that is easier for them to understand. There has been good use of symbols and photographs and the home has sought specialist advice to ensure its suitability. EVIDENCE: Information about the home is contained in a statement of purpose and service user guide that are available for current and prospective guests. They have been developed with the advice from speech and language therapists to ensure the majority of people with learning difficulties will understand them. The service user guide has been sent out to a number of local day centres so that they can give their comments on whether the information was easy to understand. However, as the guide is still in draft it has not yet been distributed to guests and their families. See requirement 1 Guests have an assessment that is recorded and kept in their individual care file. The information contained in it gives a picture of what their needs and what their likes, dislikes and routines are. There is a life history sheet which inlcudes information on communication, health needs, personal care needs, likes and dislikes, medication and routines. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 9 The staff try to meet individual guests’ social needs by researching activities are available locally and providing support for the person to take part in their chosen activity. An example was that one young person wanted to go to a nightclub. Staff volunteered to alter their working hours to cover until 1am so that this could happen whenever the guest came to stay. Other guests support the local rugby team and are helped by staff to attend the games. There is a transition programme for all potential guests to ensure they are happy with having short breaks at the home. This also gives the staff time to get to know the resident’s needs, likes, dislikes and carry out an assessment. There is a signed agreement about providing short-term care for guests that is kept in their individual care file. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 10 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 standard(s) 6, 7, 8, & 9. Staff have developed different methods of communication, such as using photographs, for individual guests so that they can make choices about what they do when staying at the home. Risk assessments and moving/handling assessments need to be reviewed and updated regularly so that guests and staff are not put at unnecessary risk. EVIDENCE: Many of the guests who visit James Phoenix House are not able to fully understand or recognise their individual plan. However, the plans did reflect the different personalities and needs of the guests. Guests are able to make some decisions about what they do when they are staying and the home but the level and frequency of choice depends largely on the ability of the guest. The main area of choice being made was in meals and drinks. Photographs of the meals to be offered were displayed on a board in the dining room, together with a photograph of the cook who was on duty that day. Some guests were able to choose when they wanted to get up, go to bed, have a shave, or where they wanted to spend their time within the home. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 11 Other choices being made, with assistance if required, were about what activities the guests might want to take part in. There are risk assessments held on the service users files. One guest’s risk assessment had not been updated since 1999. A number of handling assessments needed to be updated, as they had not been reviewed for some time. See requirement 2 Those risk assessments that had been updated contained all the information required to fully inform the staff of the potential risks and how to prevent them. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 12 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 standard(s) 11, 12, 13, 14, & 17 There has been some improvement in the number and type of activities offered to the guests during their stay at James Phoenix House. However, further improvement is needed so that all the guests’ needs and preferences can be met. The meals offered have been reviewed so there are more healthy options available for guests. EVIDENCE: There were two files with information about possible activities/outings and how to organise transport and book tickets if required. The daily records showed that some of the residents used facilities in the local community during their stay, including pubs, gardens and trips out to local events. The questionnaire sent out by the home showed that the families wish for more activities to be provided. All of the families indicated that they would be willing to contribute to entrance fees and transport to make sure that this can happen. The manager acknowledged that there has been a greater use of taxis, staff cars and walking to get guests out and about but there were limitations on this. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 13 At weekends, when there is a staff member who can drive, they have been able to borrow the minibus from the day centre. The manager said that the steering group for the home has decided to fund raise to buy a mini bus. The staffing levels provided in the home can often give the opportunity for key workers to spend time on a 1:1 with the guest they support. The manager said that he intends providing more 1:1 time and encouraging staff to take the guest on an activity for the whole afternoon. The meals offered at the home have been reviewed to ensure there are sufficient healthy options available. During the inspection, the cook ordered a large variety of fresh fruit and vegetables. She makes salads and fresh fruit salad for many of the meals. There is now a water dispenser in the dining room so guests can help themselves to drinks. A number of the guests need help from staff at mealtimes and can take longer than others to complete their meal. There were no food warmers available to make sure that the meal did not end up being cold. It was recommended that ways of resolving this problem should be investigated. See recommendation 1 JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 14 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 standard(s) 18, 19 &20 Guests’ needs are met and support is given in keeping with the way it would be at their homes so each guest receives continuity of care. The storage and administration of medicines has been improved so that medicines are stored and given safely. EVIDENCE: There were risk assessments available for the safe use of various pieces of equipment, including hoists and bed rails. There were also handling assessments completed for each of the guests who use the home. These detailed the level of potential risk when staff were transferring a resident from bed to chair, chair to bath or shower etc and how the risk could be minimised by the correct use of equipment. Some of these were in need of review and updating. (See requirement 2) The information contained in the files showed clearly that the guests’ health needs were being identified, recorded and met throughout their stay. Their GP name address and telephone number was recorded on file in the event of emergencies. Any medication prescribed was being administered appropriately and recorded on their chart. None of the guests would be capable of safely administering their own medication so staff at the home do this for them. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 15 The medication procedures have been reviewed since the last inspection and the medicine storage has been improved. There is a separate labelled shelf in the medication cabinet for each guest’s medication. The medicine administration records were accurate, with the correct codes being used when medicine had not been given as prescribed. However, one guest’s link-book had been left at his day placement so the staff had not been able to record that the guest had refused his medication. It is recommended that if this happens in future, steps are taken to verbally inform the day placement of the situation. See recommendation 2 Senior staff have received medication training and they, and support staff, have had training in more specialist aspects of administration of medication. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 16 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 standard(s) 23 The home has implemented procedures to increase the safeguards for the guests. Staff have received training and information on abuse of vulnerable adults so they can protect guests from possible harm and abuse. EVIDENCE: Many of the guests are unable to verbalise their concerns or complaints and are therefore very vulnerable. Very often their behaviour is the only form of communication that can indicate how they are feeling. The staff spoken with know the guests very well and recognise and record any change in their manner. The staff at James Phoenix House have received adult abuse awareness training to ensure they recognise the various forms that abuse can take. There are policies and procedures on dealing with allegations or instances of abuse available to the staff in the home. Other professionals who are involved with any of the guests who need additional support work closely with staff at the home and the person’s day centre. The daily recordings are detailed and link in with the guests’ identified needs to show clearly that none of the guests’ needs are being neglected. However, a recording made that morning by a member of the night staff did not accurately reflect the situation regarding a guest who had not eaten or drunk anything at breakfast. See recommendation 3 JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 17 As part of the quality assurance system used at the home, questionnaires had been sent to guests and their families to seek their views on the service delivered. There was a 65 response most of which was positive. During the inspection, there was a discussion about recording the time that visitors came into and left the home, so that it could be known who had been in the building at any one time. The manager immediately amended the visitors’ book so that this would happen from now on. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 18 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 standard(s) 24, 25, 26, 27, 28, 29 & 30 Although some improvement is needed to the environment, the overall appearance of the home is comfortable, bright and homely. There are plenty of rooms available so guests can take part in a variety of activities and there is a safe enclosed garden for them to use in good weather. EVIDENCE: The home is bright, comfortable and well decorated. It is homely, with domestic type furniture and fittings and framed pictures on the walls. The bedrooms are individual with matching furniture that suits the décor. The bedrooms are of differing sizes and are allocated according to need – for example, larger rooms are allocated to guests who use wheelchairs or hoists. There are sufficient lounges on both floors to have quiet rooms and rooms for a variety of activities. Chairs and a small table have been put into the conservatory for guests and their key workers to use for 1:1 time. There is also a relaxation/light room and a large room with pool table. There is sufficient equipment available to ensure the safety of guests and the staff when guests are being transferred from chair to bath, chair to bed etc. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 19 There are enough bathrooms and toilets for the number of guests the home is registered to accommodate. Some of the bathrooms have specialised baths and hoists so guests with mobility problems can use them. Two of the bedrooms also had ceiling tracking hoists and the manager said there is funding available to provide another. It is recommended that the toilet and bathroom doors are marked with symbols so that guests can find them easily. See recommendation 4 The carpet in the corridor still requires replacing as it had been mended with duck tape. This was a requirement of the last two inspections. The carpet is fitted partly up the wall and needs attention where it is peeling off outside bedroom number 4. See requirement 3 The bathroom doors had locks on which could be opened from the outside in an emergency by using a metal disc. There was no disc easily available outside one bathroom door for staff if they needed to open it in a hurry and it was recommended that action be taken to address this problem. See recommendation 5 JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, & 36 There is relevant training available for all staff so they can develop their skills and knowledge to work effectively with the guests. Staff are well supported and supervised and their practice so they can contribute effectively to the staff team and the care of the guests. EVIDENCE: There is a clear line of accountability within the home. Staff receive a two week induction training course with Warrington Borough Council before beginning work at James Phoenix House. This includes disability awareness training. Foundation training courses are provided after this and are specific to disability issues. Staff meetings are held regularly and any issues of poor practice are brought up in general to all staff. New staff have weekly supervision for the first couple of months after starting at the home. After this monthly supervision is provided and recorded. The staff supervision files in the home were well organised and contained a development contract and record of training, including any certificates obtained. Staff recruitment files, including all checks carried out, will be checked at the next inspection. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38, 40, &43 The home appeared to be well run in the best interest of the guests. Staff are all aware of their roles and responsibilities and receive regular and frequent supervision to ensure good practice is maintained. EVIDENCE: The manager has applied for registration with the Commission for Social Care Inspection. He has worked in care services for many years has the necessary experience to run the home effectively. The staff appear happy in their work and there is a good atmosphere within the home. There is a clear line of accountability and staff meetings are held regularly to ensure all staff are kept up to date with current issues. There are two files in which all of the departments’ policies and procedures are held for staff to read whenever they wish. The staff cover some of the main policies and procedures in induction training and supervision. They have to sign to say they have been read and understood. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 22 A weekly health and safety check is carried out at the home. Fire drills and evacuations were being held twice a year and the names of staff and guests who took part are recorded. The fire alarms are now being checked by the contractor on a monthly basis. However, there was no signature present to show that the equipment had been inspected in June. The manager must ensure that these checks are being carried out on a monthly basis. See requirement 4 JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 3 3 3 3 Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x x 3 Standard No 31 32 33 34 35 36 Score 3 3 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 JAMES PHOENIX HOUSE Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x 2 3 F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 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 1 Regulation 4 Requirement Timescale for action 01/10/05 2. 3. 9 24 13 13 4. 42 12 The statement of purpose and service user guide must be distributed to all guests and their families. Risk assessments and handling 31/08/05 assessments must be reviewed and updated on a regular basis. The following environmental 01/10/05 issues must be addressed before the next inspection. A) The carpets in the corridor require replacement, B) the wall carpet needs attention outside of room 4 The fire safety equipment must 31/08/05 be checked monthly. 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 17 Good Practice Recommendations Action should be taken to make sure that meals are kept warm when guests take a longer period to finish their meals. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 25 2. 3. 4. 5. 20 23 27 27 Staff must ensure that any relevant information regarding the care and future safety of the guests is passed on to their day placement by any means possible. Care should be taken to ensure the accuracy of daily recordings, particularly if staff are going off duty before a particular activity has concluded. Consideration should be given to putting signs or symbols on the bathroom and toilet doors so that guests can find them easily. Action should be taken to ensure that all bathroom/toilet doors can be opened from the outside easily in an emergency. JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Unit D, Off Rudheath Way Gadbrook Park Northwich Cheshire CW9 7LT 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 JAMES PHOENIX HOUSE F51 F01 S36270 James Phoenix House V239703 210705 Stage 4.doc Version 1.40 Page 27 - 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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