Inspection on 19/04/06 for Kalmia & Mallow

This inspection was carried out on 19th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Kalmia & Mallow 10/04/07

Kalmia & Mallow 20/10/05

Kalmia & Mallow 09/06/05

Kalmia & Mallow 20/12/04

Kalmia & Mallow 22/04/04

Kalmia & Mallow 30/09/03

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Kalmia & Mallow Dereham Road Watton Thetford Norfolk IP25 6HA Lead Inspector David Welch Unannounced Inspection 19th April 2006 3:20 Kalmia & Mallow DS0000027529.V290745.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 Kalmia & Mallow DS0000027529.V290745.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. Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Kalmia & Mallow Address Dereham Road Watton Thetford Norfolk IP25 6HA 01953 884597 01953 883458 kalmia.mellow@craegmoor.co.uk www.craegmoor.co.uk Conquest Care Homes (Norfolk) Limited 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) Position Vacant Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th October 2005 Brief Description of the Service: Kalmia and Mallow are two interlinked, six bedded bungalows on the outskirts of Watton. Care is provided for up to twelve young adults with a learning disability. The focus of one of the bungalows is on supporting service users with specific behavioural needs. In the other house, staff assist people with quite profound needs, including physical disabilities. The accommodation is purpose built and all on the ground floor. The houses are set in a hollow with quite high banks on three sides so the outlook is restricted. One of the bungalows has a large garden. The other only having a very small area at the back. The service users each have a single bedroom and in both bungalows there are shared bathrooms, lounges and dining rooms. There is parking to the front of the bungalows. The home is owned by the Craegmoor Healthcare organisation. The position of Registered Manager was vacant, but the home was being managed on a day-to-day basis by the Deputy Manager, Ms Nicola Cressey, who, she said, intends to apply for the post in due course. The weekly fee was in the range of £775 to £1112. This covered 24-hour care and accommodation, but residents will be responsible for such things as their own hairdressing, magazines, taxi fares, food purchased off-site and outings. This information was correct on 13th April 2006. Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit took place unannounced, in line with the Commission’s policy. It was explained to the Deputy Manager that the frequency of site visits to care homes will, in future, be dependent on how the Commission, from evidence gained, feels they are being run. Excellent homes are likely to be visited less frequently than homes about which there are some concerns or that are subject to enforcement action and which might close. This was the first site visit of this inspection year and, while not certain, another unannounced random visit could follow before March 2007. The visit was timed to allow some examination of records and contact with people who live and work at the home. The Commission had some information provided by Ms Cressey prior to the visit and she and her staff were able to give some further details of the education and/or work experience, leisure activities, family contact and community links that residents have. On the day following the visit staff faxed to the Commission records of service users’ appointments with the dentist, optician, chiropodist and contact with Community Psychiatric Nurses and access to specialist health care. The Commission’s newly-introduced policy of ‘intelligence gathering’ to provide the ‘bigger picture’ of how the home was operating was explained to a visiting NVQ Assessor. She agreed to e-mail her views and later did so. The father of one resident was spoken with on the telephone when he called the home to speak to his son and his views, too, were useful in forming a view about how Kalmia and Mallow is being run. He agreed to complete a comment card when next he visits the home. Two service users completed and returned comment cards. No other comment cards were received. In coming to its view about the home, the Commission took account of what are called ‘Regulation 26 reports’. These are reports of visits by a senior member of staff in the Craegmoor organisation. The visits are undertaken monthly and should be unannounced. We also looked back at correspondence over the last 12 months between the Commission, the home and Craegmoor. Any relevant letters from interested parties, including professionals and other agencies were also taken into account. This site visit looked at all of the National Minimum Standards that are considered to be particularly important in safeguarding and promoting the welfare of the people living at Kalmia and Mallow. Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better: • • It is important to get a registered manager in post as a matter of urgency. From what the Commission has heard, it is important that the acting manager is supported and encouraged by the organisation through the application process and beyond. Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 7 • • • • • • • • • A more coordinated approach by staff to communicating with one resident, in particular, would improve the resident’s opportunities to choose. The system of communicating to all care staff any changes to residents’ care arrangements should not rely on the Message Book. They should have a far higher profile. ‘Personal’ information about different residents’ care should not be recorded all together in the Message Book, but should be on separate sheets so as not to compromise privacy and confidentiality. Medication administration must be tightened so that people receive their medication regularly and on time It is important that the good efforts to train staff in Protection of Vulnerable Adults continue - to include all staff. Efforts must be made to keep the houses smelling clean and fresh at all times. The specialist bath and sensory garden, recommended by the organisation’s own Area Manager back in January 2006, would provide additional benefits for residents. The recruitment procedures would be improved if written references were only accepted from previous employers and/or professionals and not from personal friends of the applicant or their relatives. Some additional thought should be given to the different ways in which one resident, in particular, is stimulated. Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 8 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. Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 9 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 Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 10 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 and 3. Some good progress has been made in providing documentaton in different formats and besides giving the services users a greater chance to understand them, this will have made staff think about the ways that they communicate with service users. But in respect to one person, in particular, the approach did not appear to be sufficiently coordinated, with staff ploughing their own furrows in a sense. The lack of stimulation, especially at a time when the service user had 1:1 care, was poor. Overall, the Commission considers the quality in this outcome area to be poor. This judgement has been made using available evidence including a site visit to this home, observation and discussion with staff. EVIDENCE: Evidence was seen of documentation, including fire safety procedures, in picture format. Communication profiles were complete for two service users, in particular, who have communication difficulties. There was some evidence of an isolated approach to ensuring that a service user has choices. For instance, one member of staff described the good efforts she is making to establish a sufficient level of communication to enable choices, say about clothes, to be made, by ‘eye pointing’. Another member of staff who is reasonably new in post was observed supporting the resident concerned. While she was kind and considerate she showed little real understanding of how the service user is likely to make her wishes known, or how to seek cues and clues. There was little evidence of the service user being stimulated. On Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 11 four different site visits she has been observed sitting in her chair in front of the television with no apparent interest in what is being shown. There must be some doubt about whether this is suitable stimulation for the person concerned. Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 12 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, 9 and 10. There was evidence to show that most people using this service are able to make decisions, and take considered risks, in respect of their day to day lives, thus increasing their independence, and that this is respected and supported by staff The quality in this outcome area is adequate. EVIDENCE: One service user manages his care with some support from staff. This includes him going into town whenever he wishes and making his own purchases. These are not always appropriate. The choice of food items is particularly concerning, but this represents his own choice. Another service user who is diabetic has fluctuating blood sugar levels owing to the choice of diet especially when out with a family member. There was evidence of service users making their own decisions about choice of clothing, leisure activities, music, menu etc. Staff are clear that they are not allowed to restrict choices unreasonably, but can advise and guide. Information from a third party confirmed that personal details about residents is handled sensitively and in confidence. There is some doubt as to whether the system for making known to care staff any changes to care arranagements was sufficiently robust. Staff said these were Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 13 written in the Message Book. Not only might this compromise privacy, dignity and confidentiality, it is possible that not all staff will see them, especially if they have been on leave or not on shift for some days. There did not seem to be any way that they would be flagged up as a priority. Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 14 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 and 17. Evidence showed that the residents, where possible, and where they wish, have sufficient work experience, community links, leisure activities and family contact, thereby stimulating them and providing interest. The quality in this outcome area is good. EVIDENCE: Formal day care activities off site are split about half and half between residents. Two people, in particular, have no interest and staff said another is unpredictable as to her willingness to attend. All have the opportunity to shop and spend time with staff off site if they wish. Most service users have some family contact if they wish. One, in particular, spends overnights stays with family every 2 or 3 weekends. Some service users do small housekeeping chores such as laying the table, clearing away etc. Some assist with meal preparation with a lot of staff support. There is some meal choice. One person had a pizza on its own while others had lamb chops and vegetables. Staff did know about individual likes and dislikes. Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 15 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 and 20. Residents do have suitable and regular access to external health care facilities and, when necessary, specialist services, including community nurses. Some of the homes own arrangements for the administration of medication do not always appear sufficiently robust to protect and safeguard the welfare of residents. The quality in this outcome area is only ‘adequate’, the problems over medication administration being particularly concerning. EVIDENCE: The home has a hoist for one person who is profoundly disabled. A new, high tech chair has just been delivered. There have been problems with adapting it and staff at the home have taken steps to get the engineer back to adjust it. There is evidence of specialist health care facilities when needed. One person is currently held in secure conditions off site for a mental health assessment. A behaviour therapist visited during inspection to advise on behaviour management for one peson who staff feel is tense. Doctors, NHS dentist, optician and health checks are available. There is an element of choice by residents. Some appointments were not kept. Medication Administration records (MAR sheets) were checked. There was evidence seen of 3 medication irregularity forms for 7th April 2006. Three residents did not have their 8.00pm medication as staff had forgotten. There was another occasion when Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 16 there had been a problem with medication (3rd March 2006), but the two medication irregularity forms had yet to be completed so it was not possible to say why this had happened. One resident had a form of supported self medication, but the arrangement had failed and he had been holding tablets under his tongue and spitting them out after staff had gone away. Another service user is being encouraged to take some responsibiity for his own medication administration by approaching staff when it is time for him to take tablets. He has shown some unwillingness to cooperate with these arrangements. The Regulation 26 visitor recommended in January 2006 that a specialist bath was provided in Mallow. This has yet to be provided. Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 17 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 and 23. The home has made good progress in this regard, but there is still some work to be done in respect of training for all staff so that they are all fully informed and residents’ welfare is safeguarded. The quality in this outcome area is good. EVIDENCE: The training matrix for March 2006 showed that 15 staff have now completed Protection of Vulnerable Adults (POVA) training. Five staff have yet to do this important training, including a Senior Supprot Worker, a Bank worker and a night carer. The Complaint Log was not checked on this occasion. The Complaint procedure is in sign format. Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 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 the following standard(s): 24, 26, 27, 28, 29 and 30. The houses looked fit for purpose, in good repair and well maintained. The provision of a specilaist bath would improve the facilities for one person in particular and for staff who assist and support. The quality in this outcome area is good. EVIDENCE: There were no obviously poorly maintained areas. Most rooms looked inviting. Both houses were nicely furnished and fitted with pictures and ornaments around. The bedrooms were extensively personalised. There is no specialist bath for one person currently in a wheel chair. The sensory garden recommended in January 2006 would benefit service users. A member of staff confirmed she had food handling and food hygiene training. The training matrix showed all but one member of staff had this training. One area in Mallow had an unpleasant odour. Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Some real efforts have been made to improve induction and individual supervision for staff, and to encourage NVQ assessment, thus ensuring carers have access to information and development. Careful consideration must be given when bringing staff into post before their CRB disclosure have been received. Obtaining written references only from professionals or other agencies would improve the robustness of the recruitment proccess. The quality in this outcome area is adequate. EVIDENCE: The training matrix showed that more than 50 of care staff have done, or are doing, NVQ 2 or 3. CRB certificates were seen for two staff appointed since the ‘additional’ site visit in January 2006. Both came into post before their certificates were received. Recruitment procedures were looked into. The manager was advised not to allow written references from personal friends or family members. Induction training had been completed for all new staff in post. Supervision records were up to date with plans for individual sessions every 6 weeks or so. The National Minimum Standards call for 6 sessions a year - so every 8 weeks. Kalmia & Mallow DS0000027529.V290745.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, 39, 41 and 42. The home has been without a registered manager for over a year now and this is of concern to the Commission. We have been unable during this long period to test, through an application process, the fitness of the people put forward to manage the home on a day to day basis and while there have of late been signs of returning stability, this is worrying. The quality in this outcome area is poor. EVIDENCE: No application has yet been made for registration as manager. The Acting Manager took advantage of the inspection to ask some questions about the process. The Commission had received an assurance from Craegmoor that an application would be made by the end of March. This matter is now very urgent. The applicant has yet to make a CRB application. The Message Book was seen to contain some quite ‘personal’ information about residents. This should more properly be on separate sheets and placed in individual case files to maintain privacy and confidentiality. The accident records were examined and found to be in order. Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 1 X 1 1 3 X 3 3 X Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 22 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 YA3 Regulation 12(4)(a) Requirement Timescale for action 19/04/06 2. YA20 13(2) 3. YA23 13(6) The Registered Persons must ensure that a coordinated approach is taken to the matter of communicating with residents, but in particular to a resident with no language skills and who is likely to find it difficult to make their wishes known. The Registered Persons must 19/04/06 ensure that medication administration procedures are sufficiently robust so that residents always receive their medication in line with prescription. The Registered Persons must 09/06/06 continue efforts to provide Protection of Vulnerable Adults (POVA) training for all staff. This is a repeat requirement from the last three inspections. The Registered Persons must ensure that all parts of the home are free from unpleasant odours at all times. The Registered Providers must without delay put forward for registration a suitably qualified and experienced person to DS0000027529.V290745.R01.S.doc 4. YA30 16(2)(k) 19/04/06 5. YA37 9(2)(c)(i) 19/04/06 Kalmia & Mallow Version 5.1 Page 23 manage the home. 6. YA38 12(5)(a) The home has been without a registered manager for over a year now. The Registered Providers must put in place measures, in a real sense, to support the acting manager and to provide assistance and encouragement during any application process. 19/04/06 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. 2. Refer to Standard YA3 YA6 Good Practice Recommendations The Registered Persons should try to find more ways to stimulate one resident, in particular, who has few communication skills. The Registered Persons should introduce a more effective system for sharing information with care staff about any changes in care arrangements for residents. The changes should have a high profile so that all staff, on their return to work, will be made aware of them even if they have not been on shift for some time. The Registered Persons should follow the recommendation of its own Area Manager, made in January 2006, and install a specialist bath in Mallow as soon as possible. The Registered Persons should follow the recommendation of its own Area Manager and create a sensory garden for use by residents. In order to maintain the robustness of the recruitment process the Registered Persons should avoid accepting written references from personal friends or family members and only take into account the written views of previous employers and/or ‘professionals’. The Registered Persons should encourage staff to record information that might be considered ‘personal’ to residents on separate sheets and not in a Message Book that could compromise privacy and confidentiality. 3. 4. 5. YA27 YA28 YA34 6. YA41 Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispin’s Road Norwich NR3 1YF 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 Kalmia & Mallow DS0000027529.V290745.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!