Inspection on 20/01/06 for Josephine Butler

This inspection was carried out on 20th January 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Josephine Butler 20/04/10

Josephine Butler 04/02/10

Josephine Butler 25/03/09

Josephine Butler 10/07/08

Josephine Butler 19/09/07

Josephine Butler 17/05/06

Josephine Butler 27/07/05

Josephine Butler 15/12/04

Josephine Butler 23/09/04

Josephine Butler 14/04/04

Josephine Butler 17/06/03

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

CARE HOME ADULTS 18-65 Josephine Butler 34 Alexandra Drive Liverpool Merseyside L17 8TE Lead Inspector Leila Mavropoulou Unannounced Inspection 20th January 2006 12:00 Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 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 Josephine Butler DS0000025114.V280269.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 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. Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Josephine Butler Address 34 Alexandra Drive Liverpool Merseyside L17 8TE 0151 727 7877 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 Harold Smith Philip David Wade Care Home 21 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (21) of places Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Residents between ages of 16 - 64 years To accommodate one named service user over the age of 65 years Date of last inspection 27th July 2005 Brief Description of the Service: Josephine Butler House a large detached property set in its own grounds in the Sefton Park area of Liverpool. It is short walk from Sefton Park, Lark Lane, shops, pubs and public transport. The home provides care and personal support to younger people between the ages of 18-65 years that have mental disorder. The accommodation is provided on three floors with the communal areas: lounge, dining room, conservatory, games room and quite room the ground floor. All the residents’ accommodation is provided in single bedrooms. Residents are able to access the first and second by the passenger lift. The residents at the home require little assistance with personal care except for supervision and encouragement. The home is staffed twenty-four hours a day by a Registered Mental Nurse and support workers. The residents are encouraged by staff to access various community facilities and to maintain their independence. Josephine Butler DS0000025114.V280269.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 that lasted five hours. During this time eight service users were spoken to and four members of staff and the registered manager. A sample of service users care plans and risk assessments were inspected as well as staffing and other health and safety records. Also, tour of the building was made. What the service does well: 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. Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 Page 6 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 Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 Page 7 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): 1,2,3,4, The admission procedure at Josephine Butler House would enable service user to be confident about the home being able to meet their needs. This is supported by feedback from the registered manager following their assessment. EVIDENCE: The Statement of Purpose provides information about all aspect of the service provided at Josephine Butler House such as: staffing level, philosophy of care, activities etc. The Statement of Purpose is easy to read. The information contained in the Statement of Purpose enables prospective service users and placing health professional to make an initial decision regarding the suitability of the service. The nursing staff at the care home makes an assessment of the service user needs prior to admission to ensure that the facilities offered are suitable and staff have the necessary skills to meet the service user assessed needs. From the information obtained from the pre-admission assessment an initial service user plan and risk assessment is developed showing how the assessed needs of the service users would be met. All of the service users are given a written terms and conditions of the home as evidenced in the service user files. The contract includes information on restrictions placed on service users such as: smoking, alcohol and use drugs. Prospective service users are encouraged to visit the home to meet other service users and staff to get a “feel” for the home. The visits will vary depending on individual needs and preferences. Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 Page 8 Many of care staff have several years experience of working with people with mental health illness and a qualified mental health nurse is on duty throughout the day. At the time of inspection, the home has stopped taking emergency admissions. Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 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): 6,7,8,9,10, The staff monitors closely the service user health to ensure that appropriate care and support is provided to maintain their health. EVIDENCE: The service users have detailed care plans and risk assessments showing how their assessed needs would be met and how identified risks would be minimised. Some of the service users care plans are not easy to understand all staff, as nursing abbreviations are used. The registered manager must ensure that there is consistency in the writing of service users care plans to ensure that it can be understood by all staff. The service user plans inspected showed that where possible the service user has been consulted about the content of the plan. The plans are reviewed at regular intervals. Observation during the inspection and discussion with service users and staff clearly showed that the service users make decisions over their daily lives. Service users have a weekly activity plan, which show activities that the service user would like to do and whether it actually took place. This includes activities that the service users engage independently or with staff. All of the service users manage their own finance, make decisions about maintaining contact with their family and the frequency and choose level of participation in community activities or activities in the home etc. Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 Page 10 The registered manager organises monthly service users meetings. However, the attendance and participation of the service users is poor. The manager should review some of the home’s policy and procedures to ensure that the service users are able to understand them easily. Staff supports service users to take responsible risks as identified in their service user plan. Some of service users have kettles in their bedroom for which risk assessments have been developed to minimise risks. The service has a missing person policy and individual times are given to each service user before the home’s missing person policy is implemented. It is recommended that the staff should ensure that the service user have form of identification on their person. Service users records are kept in a secure place and discussion with staff confirm that they understand the home’s policy on confidentiality of information. Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 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): 11,12,13,14,15,16,17 Staff supports the service users to develop new skills and to maintain personal relationships. EVIDENCE: Service users are responsible for maintaining their bedrooms with the support from their key worker to ensure that service user maintains daily living skills. This also, includes being responsible for their laundry. Service users make decisions over all aspect over their daily lives, such as choosing to spend time on their own in their bedroom or in the communal areas with other service users. Some service users choose to attend college to improve their knowledge and skills. Currently, one service user attends college learning how to care for animals and three service users attend a day centre twice a week and one does gardening. The service is located close to shops, pubs, library, etc. Observation during the inspection showed that service users access these regularly throughout the day. The service is close to a main road where service users could access a number of buses. Most service users have a bus pass. Service users weekly activity sheets show that service users access a wide range of community activities to reflect their interests. The service does not Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 Page 12 bring in entertainment, as service users are able to access a wide range of entertainment in the community, where they have the opportunity to meet others that do share the same disability. Currently, the service does not contribute towards service users holidays. Observation and discussion with service users show that they are supported to maintain interests they had prior to coming into the care home and to develop new ones such as: listening to books, gardening, learning how to use a computer etc. Staff supports service users to maintain contact with their family and friends. Some service users regularly spend overnight stay with their family or for longer periods if they wish, whilst other has shorter visits depending on their individual circumstances. Where necessary staff would accompany the service user on their visit as identified in their service user plan. All parts of the home are easily accessible to service users. The service has a large garden to the rear of the property, which is used by service users during the warmer weather and there is large tarmac area to the front of the property, which is used as a parking area for staff and visitors. Service users are provided with a key to their bedroom door to promote their privacy. However, staff are able to unlock the service user bedroom door in an emergency. Discussion with service user indicated that they are very happy with the food provided at the care home. A record is kept of all food provided to service users and there was evidence of a choice of meal being offered to service users. Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 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, Staff monitors service users physical and mental health needs and ensure that appropriate interventions are carried out. EVIDENCE: Currently, service users are mobile and do not require assistance with transferring. Most staff have attended training on moving and handling. Observation and discussion with service users and staff confirm that they choose the when to go to bed and the time they get up. Observation and discussion with a service user show that service user’s key worker provides assistance with personal care as identified in the service user plan. Some of service user continue to have additional support from the Community Psychiatric Nurse and has regular review of their medication and metal health needs by the psychiatrist. The staff monitors closely the health of the service users and where necessary advice is sought from the service user GP or other relevant health professional. Where necessary staff from the care home would accompany service users to outpatient appointment and visit to the chiropodist, optician or dentist. Staff at the care home currently administers the service users medication. The home uses a monitor dosage system and records are kept of all medication received into the care home, administered and returned to the pharmacist. The service users medication record keeping has improved. The qualified Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 Page 14 nursing staff are responsible for the administration of the service users medication. Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 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, Staff at the care home supports service users or their representatives to raise concerns through the home’s complaint procedure to improve the quality of care provided at Josephine Butler. EVIDENCE: The service has a complaint procedure, which is displayed in a prominent position. A suggestion box is available to enable stakeholders to raise his or her concerns or make comment about the service. The service has various policies and procedures in place to protect service users and staff from all forms of abuse. However, the registered person must ensure that all staff receives training on calm and restraint. In addition, the registered person must ensure that all qualified staff are aware of Liverpool Adult Protection Procedure. Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 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): 24,25,26,27,28,29,30 Service users are happy with the accommodation provided at Josephine Butler House and the providers are working towards improving the physical environment of the service. EVIDENCE: The location of the home is well situated to meet the needs of service users as: shops, pubs, library, a number of buses and train can be accessed by a short walk. The quality of the furnishings in the communal areas and service users bedrooms has improved to provide a more “homely” environment for service users. There is a large lounge, which is designated as the smoking room, as most of service users smoke. All parts of the building is accessible to service users by a passenger lift. The furnishings in the bedroom reflect service users style and preferences. New bedroom furniture has been purchased for all the bedrooms and service users said that they liked them and that it had improved the “look” of their bedroom. However, the registered person must ensure that the wardrobes are secured to the wall to promote the health and safety of service users. Service users are encouraged to bring into the care home their own furniture to personalise their bedroom. The home has a number of toilets and bathrooms, which are close to service users bedrooms and the communal areas. However, even though the flooring Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 Page 17 in the bathrooms has been replaced the bathrooms should be refurbished through the service planned maintenance and renewal programme. The service has a number of communal areas, which could be used for a variety of purposes. These include a television lounge, a conservatory, which is used by service users as a quiet area, a smoking lounge, a games room where there is a pool table and a large dining room. Every bedroom has a call system, which service users use to access assistance from staff. However, a bell must be placed inside the lounges on the ground floor, as staff are could not hear the call system when the lounge door is closed. The laundry facility is sited away from the food preparation area. The service users are responsible for their laundry with the support of staff. The service has various policies and procedures on infection control and staff is provided with some information as part of their induction. Health and safety training has been booked for staff in the next three months. Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 Page 18 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): 31,32,33,34,35,36 Staff have the time to get to know service users. Thus, enabling staff and management to develop a service to meet the identified needs of service users. EVIDENCE: Staff at the care home are aware of their knowledge and skills and would seek further advice from other specialist health professionals, even through there is a qualified Registered Mental Nurse on duty at all times. Staff at the care home have a good rapport with service users and are approachable and accessible. Discussion with staff indicates that they have an awareness of the aims and objectives of the service and the home’s policies and procedures. The staff are encouraged to work towards achieving an NVQ level 2 &3 care qualification. The service is working towards 50 of its staff group achieving NVQ level 2 Care Award. The registered manager has implemented staff supervision through which the training needs of staff have been identified. Hence, the level of training courses booked for staff to attend in the coming months. The registered manager is providing in house training on various aspects of mental health. This is to improve staff understanding of service user mental health. The staffing level meets the needs of service user. The staffing level is reviewed to reflect the activity of service users such as: accompanying service user to outpatient appointments or home visit. Staff sickness level and turnover has improved to provide continuity of care to service users. Staff meetings are being held and minutes are kept of the meetings. Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 Page 19 The service promotes the safety of service users by ensuring that two written references and a Criminal Record Bureau check is obtained for all staff before they commence their employment at Josephine Butler. Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 Page 20 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): 37,38,39,40,41,42 The management of the home is improving through the implementation of the service policies and procedures to improve the quality of care provided. EVIDENCE: The manager has implemented a number of systems, which are being adhered to by all staff. This has resulted in increase accountability of staff and an improvement in the quality of care to service users. The registered manager is working toward the NVQ level 4 Management qualifications. Service users and staff are encouraged to be involved in the development of the service provided at Josephine Butler House by being accessible and through staff and service user meetings. The registered manager has developed a system of monitoring the quality of care provided at Josephine Butler House. However, the information needs to be analysed to identify where improvements could be made and a copy of the findings must be forwarded to the Commission. The service has various policies and procedures to promote the rights and safety of service users and staff. These are review regularly by the registered person, to ensure that they reflect current legislation and best practice. Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 Page 21 The record keeping in the service has improved. The service users would be able to assist in the maintenance of their records if they wish. Service user and staff records are kept in secure place and are well maintained. Improvements could be made in promoting the health and safety of service users by: ensuring that a risk assessment is carried out of the building and to ensure that all staff receive training in managing physical and verbal aggression, moving and handling, health and safety, to improve the staff induction. The service carries out regular fire check and maintenance of the all equipment use in the service. The registered person must ensure that qualified staff report to the Commission all significant incidents to service users and staff. A` record is kept of all accidents to staff and service users in the care home and where necessary other authorities are informed such as: Health and Safety Executive. The service has a current Public Liability Insurance and maintains and their clear lines of accountability between the registered manager and registered provider of the care home. Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 Page 22 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 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 3 26 2 27 2 28 3 29 2 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 2 3 2 3 3 2 3 Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 Page 23 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 YA23 Regulation 18 Requirement The registered person must ensure that all qualified staff are aware of Liverpool Adult Protection Policy. The registered person must ensure that the home is in a good state of repair internally and externally through a planned maintenance and renewal programme such as: replacement of carpets in service users bedroom, refurbishment of bathrooms and decorating of service users bedrooms. The registered person is required to forward an action plan for the decorating/replacement of the service. The registered person must ensure that the wardrobes in service user bedrooms are secured to the wall. The registered person must ensure that the bathrooms and toilets are decorated. The registered person must ensure that the staff are able to hear the call system when the lounge door is closed. The registered person must DS0000025114.V280269.R01.S.doc Timescale for action 30/03/06 2 YA24 23 30/03/06 3 YA26 13 30/03/06 4 5 YA27 YA29 23 23 30/03/06 30/03/06 5 YA39 26 30/03/06 Page 24 Josephine Butler Version 5.1 6 YA42 18 7 YA42 23 & 37 ensure that a report of their monthly visit to the care home is forwarded to the Commission. The registered person must ensure that all staff receives training on Health and Safety, food, first aid, moving and handling and physical and verbal aggression. The registered person must ensure that current risk assessments are in place of the entire building. This is outstanding from the last inspection. The registered person must ensure that qualified staff are aware that the Commission must be notified of all significant incident to service users and in the home immediately by telephone initially and then followed in writing. 30/03/06 30/03/06 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 YA6 Good Practice Recommendations The registered person should ensure that there is consistency in the way the service users plans are written to ensure that the content of the plan is easily understood by all staff responsible for the delivery of the service user care. The registered person should ensure that all service users have some form of identification on their person when they go out of the home. The registered person should include a minimum of seven days holiday for long-term service user outside the home, which is included in their weekly fee to meet all of the requirements of this standard. The registered person should ensure that the registered person has a training budget to enable them to DS0000025114.V280269.R01.S.doc Version 5.1 Page 25 2. 3. YA9 YA14 4 YA35 Josephine Butler 5 YA37 prioritisation of staff training. The registered person should complete their NVQ level 4 Management qualification to satisfy the National Minimum Standards of 2001. Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 Page 26 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 Josephine Butler DS0000025114.V280269.R01.S.doc Version 5.1 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. 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!