Inspection on 28/09/07 for Karamea Care Homes

This inspection was carried out on 28th September 2007.

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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Karamea Care Homes 14/09/06

Karamea Care Homes 07/11/05

Karamea Care Homes 03/05/05

Karamea Care Homes 13/01/05

Karamea Care Homes 12/07/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Karamea Care Homes, 1 & 2 Church Mews Church Street Theale Reading Berkshire RG7 5BZ Lead Inspector Sandra Grainge Unannounced Inspection 28th September 2007 09:45 Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Karamea Care Homes, 1 & 2 Church Mews Address Church Street Theale Reading Berkshire RG7 5BZ 0118 930 3695 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) Mrs Debbie Dickinson Miss Teresa Bieny Care Home 8 Category(ies) of Learning disability over 65 years of age (8) registration, with number of places Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th September 2006 Brief Description of the Service: Karamea Care homes are located in 1& 2 Church Mews, Theale and currently provide care for five adults who have a learning disability; there are existing bedrooms for seven, and the service is registered to provide care for up to eight adults. The home is set back from the main road in a residential area close to local amenities and the town centre; the property consists of two adjacent houses. Both houses have two floors and there are some aids and adaptations in the bathrooms to allow service users to move about more independently. One house accommodates three service users; the other two at present. The service users sometimes spend time together as a group; at other times they remain in their separate houses. Each has its own kitchen, dining room and lounge. Some meals are prepared and shared together; other meals are eaten within the individual houses. All of the bedrooms are single and some of them have en-suite facilities. There is one shared toilet on the ground floor of each house. Each house has a designated staff member on duty during the day and night; in addition, another member of night staff is based in one house to meet the additional night-time needs of service users in either house. Public transport services are close-by and the property has ample space for car parking. The service obtained the Investors In People award in 2005; this is valid until 2008. The fees at the time of the site visit were £1,230.99 per week. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of an unannounced key inspection site visit that was carried out by the Commission for Social Care Inspection (CSCI) under the Inspecting for Better Lives process. Mrs Sandra Grainge, locum Regulatory Inspector, visited the home over six hours. On arrival the home was in the capable charge of a senior carer; the manager joined the Inspector to participate in the visit. A full tour of the premises was carried out and records and documents were sampled, including policies and procedures, residents’ individual files, medication records and staff recruitment and training files. The care for two individuals was “case tracked”. These two individuals and other residents and staff spoke with the Inspector during the visit. An Annual Quality Assurance Assessment (AQAA) had been supplied to the home and this was completed and returned prior to the inspection. Information provided in the AQAA informed this report. The service is registered to provide care for younger adults who have a learning disability, however, because many of the service users have been living in the home for many years they are approaching problems of ageing; in consideration of this, the manager completed an (AQAA) for care of older people. Surveys were sent to healthcare professionals involved in the support and care of service users and a number of CSCI feedback forms were given to residents on the day for completion with support from their key worker, advocate or relative. The Manager informed the Inspector that the people living in the home were not concerned about being known as service users and so that is the term that will be used throughout this report. The requirements and recommendations of the previous inspection report had been met. What the service does well: This service is small and not part of a care home company; so a group of people who have learning difficulties is offered individual, flexible support and care. The same group of individuals has occupied the home together for many years and each individual is very familiar with the staff, most of who have worked with them for a long time. Service Users indicated that they enjoy living in the home and were relaxed and happy around the staff. It was evident that they were expected to be involved in the day-to-day operation of the home in terms of household routines, and making decisions for themselves with support and prompting by staff. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 6 During the last year one of the original group members became ill and eventually died. Arrangements were made for her to stay in the home to receive nursing care in the environment that she was used to. The rest of the service users were informed of the situation and supported to be involved as they wished and to remember their friend. 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. The summary of this inspection report can be made available in other formats on request. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3 Quality in this outcome area is good. A new guide is available for prospective service users; trial visits are offered and the Manager knows the importance of assessment so that needs “match”. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Although no one new has been admitted to the home during the last year a new Service User Guide has been produced in a more appropriate format. The manager has a pre-admission assessment format for prospective service users but is able to use this only after a care manager has recommended a placement in the service. The manager is very aware that the service can offer excellent individual homely care to the right person, this is not apparent in the Statement of Purpose. Staff are aware that a prospective service user must have similar needs and the opportunity to choose to fit into the home with the existing users. Staff have demonstrated during the last year that they have the ability to learn new skills to be able to meet changing dependency needs including those of a terminally ill service user. All existing service users have a written contract in place for care services. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. Quality in this outcome area is good. Each individual has a plan of care to meet his or her individual assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident also has a daily care record that includes records of daily achievements around identified goal plans and a skill chart to monitor progress. The identified goal plans are around maintaining and improving daily living skills and involvement in day-to-day household tasks. Individual records include specific formats to address individual’s needs and behaviours and reflect a thorough approach to recording. Service users are encouraged and supported to make day-to-day decisions and to be actively involved in their care. It was clear that they are proud to be involved in purchasing of their clothes and other items, though none would be able to manage their money without support. Each individual’s choice of food is recorded on kept menu copies. Individual records and storage of service users’ funds are maintained together with receipts for expenditure. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 10 The current residents have limited verbal communication but staff know them well and are able to establish what an individual wants through various nonverbal techniques, including leading, and the use of pictures and photos. Residents are supported to take calculated risks within a risk assessment system. Individual risk assessments are in place across a range of areas, and are countersigned by the staff to confirm they have been read. This is good practice. There was evidence in the files that staff are in the habit of respecting the privacy of individuals and keeping confidences. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. Service users have a lifestyle that meets their needs and they clearly enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was evidence on file that service users have access to counselling and intervention therapy from trained staff. The group in this home is ageing and it is no longer appropriate for them to be seeking employment and vocational training. They have opportunities to continue learning practical life skills and they are supported to remain a part of the local community. They attend the local library, leisure centre, pub, and church. They enjoy dancing classes and leisure activities. One lady is part of a local walking for health group, which she clearly enjoys. Service users often travel by bus because they like to; on the day of the visit one person was gong to a hospital appointment by bus and was looking forward to the trip and the outing with her carer. The manager has made arrangements for the provision of transport that are fair to all service users as required in the previous inspection report. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 12 The service users have a good relationship with members of the local community. There had been a problem with the behaviour of some youths in the nearby football field. The manager had written to the football club and there has been no repetition of the problem. Following the recent death of a service user the landlord of the public house next door, where service users are frequent customers, held the wake after the funeral. The staff in the home had given everyone support and opportunity to grieve for the loss of one of their number. This process was ongoing as was demonstrated by one service user who used photos of the funeral flowers as a comfort. Spiritual needs are met; most enjoy regular attendance at the local church where they are an acknowledged part of the congregation. The oldest service user has decided that he no longer wants to attend church and his wishes are respected. During the afternoon an entertainer came to the home to lead a musical session. Friends from another home joined service users for this enjoyable time and tea. The staff arrange parties and events both in the home and elsewhere to enable service users to meet up with their friends. The daily routines in the home are arranged to suit service users and they were pleased to explain to the inspector how they are responsible for their own share of the running of the home. All the staff demonstrated that they are aware of the importance of diversity and they showed respect for the dignity of those in their care. In particular they were most careful to respect each individual’s privacy, this was especially noticed concerning each individual’s bedroom and property. The menus are planned to include healthy choices and meals are often enjoyed outside the home. Service users’ records showed that they are regularly weighed. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. Quality in this outcome area is good. Personal and healthcare are given to meet individual’s needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Personal support is given to service users, as they require it. Details of need are recorded in the care plan and staff follow these. One service user was very pleased to model the new outfit that he had chosen with his carer. During the last year a long term occupant of the home had become unwell. A decision had been made that it was in her best interest to stay in her own home environment. Medical and nursing staff provided care with the assistance of staff from the home and additional specifically employed staff. Staff from the home were part of the team to provide terminal care and now have additional skills, including the ability to use recognised tools to measure and record pressure area care. The situation was explained to others in the home and they were supported through the loss of a member of their group. There are other references in this report to the wake and photos of the funeral flowers. CSCI was informed of a suspected case of scabies in the home during the year. This was managed properly and several senior staff have attended training for the prevention and management of infection. The service has no policy and procedure for the management of infection, although good practice was Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 14 followed by the provision of liquid soap for staff hand washing. However there were no paper towels available. In addition, neither of the washing machines is capable of sluice and hot wash cycles that are necessary for good practice and management of infection. In view of the increasing age and ill health of service users it is recommended that the need for a sluice-cycle washing machine be kept under regular review. It was not appropriate for any of the existing service users to administer their own medication. The manger had implemented a system for the recording of the quantities of medication entering the home as required following the previous inspection. The practice of administration of medication seen on the visit was good and was very respectful of service user wishes and understanding. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. Service users are safeguarded from abuse, neglect and self-harm. They feel that the staff hear their concerns and take action to put things right for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: CSCI has not received any complaints concerning this service during the last year. A complaints policy and procedure is available in the home and each service user has a copy on file. During the inspection visit it was clear that service users were able to express and make their views known to staff. A record is kept of all issues raised. All staff have received training in protection of vulnerable adults and the home has a copy of the local interagency guidelines on protection. The Registered Individual now records the regular inspection visits; these show opportunity for service users to express their views and concerns. There are good practices in place to protect service users’ money. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27 and 30. Quality in this outcome area is good. Service users live in an environment that is homely, pleasant and allows them to lead as independent a lifestyle as possible. Floor coverings in house 2 are damaged in the kitchen and on the stairs and are to be made safe and replaced as soon as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service is not part of a group; it is homely and individual. Staff are proud of this and the premises are clean and tidy. There were no offensive odours. The property is well situated to enable service users to be a part of the local community; they are able to walk frequently to the local shops, library, pub and bus services. There is evidence in the AQAA that the service strives to give service users an environment that is of their choosing and matches their personality. Each individual is involved with choosing and furnishing their own room. Staff were aware of service user diversity and equality and were observed to respect service user privacy and dignity throughout the visit. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 17 The lounge area in each house is furnished differently. The bedroom and ensuite WC of an individual had been fitted with a new shower to meet increasing disability due to the ageing process. The gardens are large and secluded. Service users and staff have replanted the front garden and the rear garden is furnished with a trampoline and robust garden furniture that the service users enjoy. All fire doors had been fitted with approved devices as required. In house 2 the kitchen flooring is worn and damaged in a doorway and there is a hole in another area near the washing machine. The stair carpet is badly worn and there are holes over the treads. The Manager is to make these areas safe immediately and a plan for replacement is to be sent to CSCI. Neither house has a washing machine that is capable of sluice and hot wash cycles for infection control. No paper towels were provided for staff hand washing. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. Service users are looked after by staff who have the skills to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The AQAA and training records show that staff are given training to meet service user needs. 60 of staff have achieved NVQ level 2 or above. The service recruitment procedure is followed and staff practice is regularly supervised and recorded. Most of the staff have been employed by the service for a considerable time and those on duty at the time of the visit were able to demonstrate that the needs of service users were well known to them. They were able to understand and communicate while they gave care in a respectful and friendly manner. No agency staff have been needed to cover routine shifts. During the last year additional hours have been worked to meet the increased needs of one individual. There was evidence in the home that proper recruitment safety checks are carried out prior to employment of new staff in order to protect service users. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 Quality in this outcome area is good. The service is managed and administered well for the benefit of the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered Manager communicates a clear sense of direction and leadership that staff and service users were seen to understand and appreciate. Processes of operating the home are open and planned in response to service user need. The Manager has endeavoured to seek constructive comment from a quality control survey but received disappointing response from relatives and care managers who say they are “more than content” with the service. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 20 Following the last inspection it was recommended that the manager and provider should consider the expansion of the business plan to fulfil the need for an annual development plan for the home. This has not been achieved. This area should be developed in view of the increasing needs of the ageing service users. All fire door restraints have been replaced by those approved by the fire authority as required. Fire safety checks, drills, equipment service and training records are recorded and kept together in one folder. A file of monthly Regulation 26 visits carried out by the provider is available in the home. Accident records are kept in a record book for the service in addition to a copy in the individual service user’s file. The staff are aware of the issues concerning infection control and senior staff have received recent training. However, there is no policy and procedure in place for the prevention of infection and there were no paper towels available for staff hand washing. In addition the service does not have a washing machine that is capable of a sluice and hot wash cycle. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 N/A 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 2 25 3 26 X 27 3 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 X X 3 X Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 22 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 13(4) (a) Requirement The Registered Individual is to make safe immediately the damaged floor covering on the kitchen floor and stairs of house 2 and send a plan for provision of replacement floor coverings. The Registered Manager must put in place a policy and procedure for infection control and provide paper towels for staff hand washing. Timescale for action 15/11/07 2 YA42 13 (3) 20/11/07 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 YA42 YA29 Good Practice Recommendations The Registered Individual should replace a domestic washing machine with one capable of carrying out sluice and hot wash cycles. The Registered Individual should consider and monitor the ageing process of the existing service users and make plans for provision of suitable facilities in an annual development plan. Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Oxford Office Burgner House, 4630 Kingsgate Oxford Business Park South Cowley Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Karamea Care Homes, 1 & 2 Church Mews DS0000011211.V348745.R01.S.doc Version 5.2 Page 24 - 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!