Inspection on 29/06/07 for Kiln Court

This inspection was carried out on 29th June 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Kiln Court 17/08/06

Kiln Court 08/11/05

Kiln Court 26/04/05

Kiln Court 12/10/04

Kiln Court 19/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Kiln Court Lower Road Faversham Kent ME13 7NY Lead Inspector Lisbeth Scoones Key Unannounced Inspection 29th June 2007 9:45 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Kiln Court DS0000037750.V340332.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Kiln Court Address Lower Road Faversham Kent ME13 7NY 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) 01795 532183 01795 530942 lynda.robinson@kent.gov.uk Kent County Council Mr Michael Philip Roberts Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (29), Physical disability (1) of places Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th August 2006 Brief Description of the Service: Kiln Court, first opened in 1988, is situated in the village of Ospringe, Faversham. The home is owned and run by the local authority, Kent County Council and supports older people over 65 years for long term, short term, respite and intermediate care. The home has one storey with level access throughout the building. There are 30 single bedrooms with wash hand basins and a call bell system fitted. Two bedrooms are available with en suite facilities suitable for people who may use a wheelchair. The home has a number of lounges and dining rooms. The home has pleasant grounds and gardens and is within walking distance of local shops and bus stops. There is a day centre as part of the Kiln Court site. Maximum weekly fees are £364.79 with an additional charge for hair dressing. The inspection report is on display in the entrance lobby. Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection visit was carried out on Friday 29 June 2007 between 09.45 and 17.00. It comprised discussions wit the acting manager, team leader, other care staff on duty and the administrator. The three units, Ospringe, Abbey and Davington were visited, many residents met and 8 residents spoken with. The visit was further informed by an AQAA (Annual Quality and Audit) completed by the acting manager prior to the visit. Twelve comment cards completed by residents and 4 completed by relatives were received. Information thus obtained is incorporated in the report. Documentation was examined in respect of care plans, risk assessments and staff files. What the service does well: What has improved since the last inspection? Improved systems of waste disposal have been introduced. Staff files now contain evidence of CRB checks. However, files could be better organised. A vacant administration post has been filled. A training matrix is in place. Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents and relatives are not provided with detailed information on Kiln Court to enable them to make an informed choice about the home. All residents are provided with a written cocntact. The admission process is being reviewed to ensure that the home can meet assessed needs. Residents in the intermediate care unit are helped to maximise their independence and return home. EVIDENCE: A Statement of Purpose was seen on display. Residents were previously provided with a brochure of the home’s services and facilities. This brochure is no longer used. A Service User Guide must be devised providing residents with the information they need to make an informed choice about where to live. Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 9 Records seen confirm that assessments are carried out prior to admission. Discussions with the acting manager highlighted concerns that she was not always consulted on the care needs of new residents in the intermediate care unit. At times very high dependency residents had been admitted who were medically beyond recuperative care. The acting manager said that, in future, admissions to the intermediate care unit would either be assessed by the Kiln Court Occupational Therapist prior to admission or during a 72-hour assessment process on the unit. Another issue under review relates to the admission of residents on a Friday when the home has had insufficient time to ensure district nurse and GP cover. All care notes examined contain a copy of the written contract, signed by the resident. Discussions with several residents on the intermediate care unit indicate that they are very happy with the service offered. Supportive occupational therapist and care staff encourage and enable them to regain their independence and return home. A resident said, “Everything is adapted just the way you need it.” Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The care-planning format does not provide staff with all the information they need to care for the residents. Residents benefit from having full access to all professional health care services as required. Residents are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: A sample of care plans examined contains information about residents’ care needs. However the format does not allow for comprehensive review. The acting manager is aware of the deficits and is to attend a care-planning workshop on 7th July 2007. The training would then be cascaded to the care staff. Daily records are written but one seen did not reflect a resident’s current care needs. The care-planning training should include the need for daily records to relate to the care plan. Staff must ensure that all risk assessments are Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 11 current, signed and dated. A discussion took place about incorporating the occupational therapist’s notes in the residents’ care plan. It was recommended that details of GP visits and other health care professionals such as CPN, respiratory nurse and continence advisor be recorded in the care plan. All permanent residents are registered with a local Doctor. The short-term and intermediate care residents, if they were local, keep their own Doctor. If not local they would be temporarily registered with a named local GP. The home confirmed a good working relationship with local G.P’s. The district nurses team holds two clinics a week and provides residents’ nursing care. A recent concern that some intermediate care residents required a higher than expected impact on district nurses’ workload is being addressed. See also standard 3. District nurses maintain their own notes and liaise with the GP’s regarding progress or change in condition. The issue of diabetic care staff training remains unresolved. This was referred to in the previous inspection report. District nurses have said they are not happy that the home staff are not trained to monitor the condition or administer medication. Until the training issue is resolved, it is recommended that no residents with diabetic care needs be admitted. Good procedures for the administration of medication are in place. Medication charts are well completed. A spacious clinical room is available for the district nurses team to carry out their nursing duties. The adequacy of this facility is currently being reviewed in respect of effectiveness and an infection-controlled environment. A medication room is used to store three medication trolleys. It was recommended that this room is kept clean and a washbasin installed. See also standard 26. Oxygen cylinders should be returned to the pharmacy and in the meantime safely stored. A chart for the administration of creams and ointments was seen in a resident’s room. However, the chart had not been signed since March 2007. Residents spoken with said how kind, caring and wonderful the staff are and how well they are looked after. A resident said he was very satisfied. These are some of the comments made: “I am very happy and looked after very well”, “With the support and understanding of the staff my relative is doing well”, “The home provides comfortable accommodation and a care free atmosphere enabling my relative to relax and enjoy her stay,” “ Most staff are very friendly.” Residents’ only concern is the high number of agency staff used. These are some of the comments made: “ I do not like some of the agencies,” “ Agency staff can be lax,” “Agency staff are sometimes uncaring and unsporting”. This Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 12 was discussed with the acting manager who demonstrated a good awareness of residents’ views. See also standard 27. Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to maintain contact with family and friends thus ensuring that they continue to receive stimulation and emotional support. Residents are provided with a choice of varied and appetising meals. EVIDENCE: Residents spoken with confirmed that they are very happy at Kiln Court and that they enjoy the lifestyle offered. Since the previous inspection, additional activities have been made available. Some residents attend the day centre. The majority of the residents who completed a comment cards ticked the box “usually” in response to “are there activities arranged by the home that you can take part in”? The acting manager said that it is her intention to find out what individual residents would like to do in respect of individual or organised activities. The home may wish to consider whether a dedicated activity coordinator could Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 14 improve residents’ social life. See also standard 33 in respect of satisfaction surveys. It was noted that residents are encouraged to participate in making choices in their lives and taking responsibility wherever possible for their personal care. Meals are provided through a central kitchen and taken to the units on a heated food trolley. All residents spoken with said the food is always very good and plentiful. The menus are varied and offer a good choice. A resident said that the meals are good but would like hot meals to be served on hot plates. This was discussed with the manager. Another resident said, “never tasted better.” Another resident said that the food was bland and uninspiring. See also standard 33 in respect of quality assurance. A lunchtime session was observed. Meals are well presented and looked appetising. The menu of the day was displayed on the wall. Residents and staff confirmed that a choice is always given at each mealtime. Cooled water is available in the dining area. Residents said that they are offered plenty of drinks and could ask for extra drinks if they wanted more. The kitchen was not visited during this visit. Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by an effective complaints procedure. Residents and relatives feel that their views are listened to and acted upon. Residents are protected from abuse. EVIDENCE: From conversations with residents and the acting manager, it is evident that complaints are taken seriously and acted upon. Residents confirmed that they would know how and who to complain to. Kent County Council had robust procedures in place to ensure that residents are protected from all forms of abuse. Staff spoken with are familiar with the policies. The majority of staff has attended training in Adult Protection. See also standard 30. Recently an allegation was investigated following Adult Protection procedures. The allegation was unfounded. The home is acting upon the recommendations made. Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a spacious and clean environment with safe access to comfortable indoor and outdoor communal areas. However, a maintenance programme needs to be in place. The home would benefit from an infection control audit. EVIDENCE: As stated in the previous report, the home generally is homely and clean. It is however, showing signs of wear and tear. Except for one area, there were no unpleasant smells noted. Residents enjoy the safe gardens and seating areas. There is also a sensory garden, bird feeders and a pond. Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 17 Those bedrooms visited were well personalised and homely. Residents confirmed they were encouraged to bring in personal items to decorate their own rooms. At the previous inspection it was recommended that the home carry out an audit and prepare a programme of routine maintenance and renewal of the fabric and decoration. Such a programme has not yet been prepared. It is acknowledged that the acting manager advised of several improvements and decoration plans for the near future. One such improvement could be the installation of a shower. Apart from two en-suite showers in the intermediate care unit, there are no shower facilities. Apart from the two en-suite facilities mentioned, none of the single bedrooms have an en-suite toilet. One relative said, in response to the question “How do you think the home can improve?” “By putting a toilet in each bedroom.” At the previous inspection an infection control audit was recommended. Such an audit has not been undertaken. This recommendation remains with particular emphasis on the cleanliness in the sluice rooms. As already referred to, the clinical room used by district nurses should be included in the survey. Since the previous inspection the responsibility for the safe handling and disposal of clinical waste has been assigned. The home must ensure that all staff are provided with infection control training. See also standard 30. The programme of fitting safety valves to hot water outlets in bathrooms is now completed. It was recommended that hot water outlets in residents’ bedrooms be risk assessed when necessary. The acting manager discussed the delay in risk assessing the need for radiator covers in corridors. The outcome is currently awaited and will be acted upon. Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from being cared for by staff who have a good understanding of their needs. However, staff shortages have resulted in some inconsistent care. Residents are protected by the home’s employment procedures and benefit from staff who are trained and competent to do their jobs. EVIDENCE: On the day of the visit, the home was staffed by a team leader, 3 care workers and a support worker. For some shifts, the home continues to rely on agency staff to complement the permanent staff in caring for the residents. A resident answered the question “How do you think the care home can improve?” with “By getting a full staff.” The acting manager has been managing the home since Christmas. Some senior members of staff have left. There is no designated deputy manager or senior team leader. The vacant administrator post has now been filled. The acting manager said that a recruitment programme is in place. Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 19 The home currently has 43 of its staff qualified to NVQ level two or above. The Acting Manager is aware that this falls slightly below the required level of 50 but she stated that three staff members are working towards their awards and she hoped to meet the 50 figure very soon. Kent County Council have robust recruitment procedures thus ensuring that residents are protected. Three staff files were viewed and evidenced that appropriate recruitment checks are carried out. Staff files would benefit from audit and system providing clarity and improved access to the contents. Since the previous inspection, the home has a training matrix. A recently introduced scheme encourages staff to take part in training. It was recommended that each member of staff has an individual training profile thus evidencing training received and planned for. The acting manager said that Equality and Diversity training is to be provided for staff. Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from having a manager who is competent and experienced and has a good leadership style and approach. However, a registered manager needs to be appointed. Quality assurance and monitoring systems in the home need to be further developed. EVIDENCE: Since the previous inspection, the Registered Manager left and the appointed manager has been off sick. The home has been managed by the acting manager. At the time of this visit the manager was expected back the following week on a phased part-time basis. Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 21 The acting manager provides clear leadership throughout the home. She is supported by senior staff and her line manager. The acting manager praised her staff for their commitment to the residents. “We work as a team”, she said. The acting manager has managed the service as well as possible during the time of her appointment. It is evident however, that without a deputy manager of senior team leader it has been difficult to fulfil her role. As already referred to, the acting manager is to attend a care-planning workshop. Further training includes “Positive Recruitment” and “training the trainer” in the Mental Capacity Act. As mentioned in the previous reports, quality assurance is an area that must be improved. Whilst regular residents meetings, staff meetings and senior staff meetings take place, no satisfaction surveys have been sent out for a while. Such surveys should include the residents, relatives and visiting professionals such as GP’s, chiropodist, district nurses and others. The results of these surveys should be published and made available to current and prospective residents and their representatives, including the Commission (33.6). An annual development plan is outstanding. Such a plan should be based on systematic cycle of planning, action and review reflecting the aims and outcomes for residents. The home complies with Regulation 26 and monthly visits are made and records maintained. The home only deals with one resident’s monies. An excellent system is in place and records of transactions maintained. The acting manager acknowledged that regular formal staff supervision is overdue. This must now be addressed. Staff spoken to said they feel well supported in their daily work. Supervision should cover all aspects of care, the home’s philosophy of care and career development. See also standard 30 in respect of staff training. Information provided prior to the visit evidences that all safety checks and maintenance of equipment are carried out. Thermostatic mixers valves have been replaced. Following a recent visit from KCC’s Health and Safety Officer, the outcome of the risk assessment for radiator covers in corridors is awaited. Staff receive all statutory training. Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 2 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 x 3 2 x 3 Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 23 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 2 3 Standard OP1 OP3 OP7 Regulation 5 (1) (2) Requirement Timescale for action 15/08/07 15/08/07 15/08/07 4 5 6 7 OP19 OP26 OP33 OP36 That a Service User Guide be provided 14 (1) (b) That the needs of a prospective resident have been assessed by a suitably qualified person 15 (1) (2) That every resident has a (b) (c) (d) comprehensive care plan This has been carried over from the previous inspection report. Previous time scale of 31/10/06 not met 23(1)(a) That the home is maintained in (2)(b)(d) accordance with a maintenance and renewal programme. 13(3) That an infection control audit be carried out 24 (1) (a) That a system of quality (b) (2) (3) assurance be introduced 18(2) That all staff are appropriately supervised. This has been carried over from the previous two reports. Previous timescale of 30/09/06 not met 15/08/07 31/08/07 31/08/07 31/08/07 Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 24 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 OP30 OP33 Good Practice Recommendations That all staff have an individual training and development assessment and profile That an annual development plan based on a systematic cycle of planning, action and review is written Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Kiln Court DS0000037750.V340332.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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