Inspection on 03/01/07 for Knaresborough Road (151)

This inspection was carried out on 3rd January 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

Knaresborough Road (151) 13/12/05

Knaresborough Road (151) 06/05/05

Knaresborough Road (151) 16/12/04

Similar services:

Larch Avenue

Alderson Road 12

Cranworth Close Registered Care Home

The Cornerstone

John Street Nursing Home

Pennine Camphill

Whitwood House

Whitwood Hall

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

CARE HOME ADULTS 18-65 Knaresborough Road (151) 151 Knaresborough Road Harrogate North Yorkshire HG2 7NW Lead Inspector David White Key Unannounced Inspection 3rd January 2007 09:00 Knaresborough Road (151) DS0000061613.V322798.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 Knaresborough Road (151) DS0000061613.V322798.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. Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Knaresborough Road (151) Address 151 Knaresborough Road Harrogate North Yorkshire HG2 7NW 01423 546326 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) www.homestogether.net Homes Together Ltd Post vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to have an associated sensory impairment. Date of last inspection 13th December 2005 Brief Description of the Service: 151 Knaresborough Road is registered to provide residential social and personal care for 8 adults who have learning disabilities and an associated sensory impairment. The home is a large well maintained property situated between Harrogate and Knaresborough and has good access to services and amenities. The registered provider is Homes Together Ltd. At the time of the site visit the fees for the home ranged from £700 to £2200 per week and does not include costs for toiletries, hairdressing, transport, chiropody and reflexology. Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows an unannounced site visit undertaken on 3 January 2006. This visit was carried out by one Regulation Inspector and took 6.5 hours with 4 hours preparation time. The home was able to return the requested information before this site visit, and surveys were sent out to relatives, care managers and other professionals who had contact with the home. Surveys were received from five relatives and three care managers and a GP. The report includes information from the Regulation Inspector’s inspection record, which details the history of the home and relevant information about what has been happening in the home since the previous inspection visit. The site visit included an inspection of the premises. The visit involved looking at three residents’ care records, including the assessments, care plans and medication records for each resident. Staff rotas and health and safety documentation were inspected as well as two of the home’s policies and procedures. Most of the residents communicate in a very specialised way, however it was possible to have discussion with one resident. Many of the findings are based on observation of the interactions between residents and staff. Discussion was had with three members of care staff, a reflexology specialist who was visiting the home, the manager of the home and a director of Homes Together Limited. The focus of the inspection was on a number of key standards and inspecting the case records of a number of residents to establish whether they corresponded with their experiences of life in the home. The manager and director were available throughout the inspection and the findings were discussed at the end of the inspection. What the service does well: Staff encourage the residents to make choices for themselves to enable them to have control over their daily lives. Residents are able to enjoy a variety of activities and be involved in the local community. Residents live in homely surroundings and the home has a good atmosphere and this promotes residents’ comfort. The staff team are committed towards providing good standards of care for residents and are well trained to give them the skills and knowledge to meet residents’ needs. Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 6 Staffing turnover is low and this ensures that the staff team is consistent and familiar with the very individualised and specific needs of the residents. The home is managed well and this means that concerns are addressed, residents’ interests are safeguarded and good standards of care are maintained. 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. Knaresborough Road (151) DS0000061613.V322798.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 Knaresborough Road (151) DS0000061613.V322798.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): 2 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Proper pre-admission procedures are in place so that prospective residents can feel confident that their needs will be met by the home. EVIDENCE: Although no residents had been admitted into the home since the previous inspection visit it was noted within the care records of three residents that the home did have proper pre-admission procedures in place. All the care records contained information that had been obtained from other sources such as placing authorities before any decision had been made about whether the home would be able to meet the person’s needs. Prospective residents and their relatives would be invited to spend time at the home before making any decision about moving in. Each resident has an individual contract explaining the terms and conditions of their stay at the home and they also have a charter of rights to protect their interests. Knaresborough Road (151) DS0000061613.V322798.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. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to make their own choices about their lives taking into account any risks that need to be considered. EVIDENCE: The care records of three residents gave clear information about their personal, social and health care needs. Each care record is individualised and takes into account the very specific needs of each resident. Information is available about the type and level of support needed and there are clear guidelines as to what actions staff are to take in ensuring needs are met. The information also includes the resident’s preferences about aspects of their daily living including their dietary likes and dislikes and how they are to be assisted with eating if they are unable to do this for themselves. A resident said that she likes to get up at a certain time in a morning and staff provide support to Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 10 enable this to happen. Staff made comments that the care plans are “easy to follow”. The home has a key worker system which staff said works well. This also enables staff to spend time with residents on an individual basis. A number of risk assessments are in place to promote the resident’s independence and choice whilst taking into account any risks from this. Within the care records there is information about medical and other appointments that residents have attended. In some cases this information is not specific in explaining the reasons for the appointment and the outcomes from this. It is the intention of the management to introduce new care planning documentation into the home in the form of “Individual Service Plans” which will focus more on how each individual resident wishes to be cared for and will include the views of others such as relatives and care managers who know the residents well. An example of this documentation was seen and will provide staff with more detailed and easier to access information about each resident in order to make sure that residents’ needs are met. Staff meetings are regularly held to discuss any changing needs of the residents and care plan reviews are organised with the involvement of the resident, their relatives and care manager where possible. Knaresborough Road (151) DS0000061613.V322798.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. This judgement has been made using available evidence including a visit to this service. Residents have the opportunity to enjoy activities both in and outside of the home and have involvement with the local community. EVIDENCE: Residents have an individual activity programme to support them in meeting their social needs. Some of the residents do not wish to become involved in activities, particularly those that are arranged outside of the home. Others enjoy going to the local facilities such as the swimming pool, cafes and pubs and some like to go for walks. One resident said that she has visited the local theatre in the past and has enjoyed a trip to Scarborough. Some of the residents have reflexology sessions that are held at the home and the person carrying out these sessions who was visiting the home at the time of the site visit made comments that the sessions helped to relax the residents and to reduce any agitation. Relatives made comments in surveys that the activities Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 12 on offer at the home are “appropriate” for the resident group and this was supported by the evidence from the site visit. Residents are encouraged to maintain relationships with their family and friends and visiting times are flexible. Consideration is given to health promotion around the residents’ personal relationships with others. Mealtimes are an important part of the day for the residents. The home has a part-time cook who provides a cooked meal at lunchtime. At the time of the site visit the cook was visiting a local supermarket to purchase some fresh produce. Menus are varied and alternative food options are available if someone does not want what is on the menu although this was rare. On occasions residents enjoy a takeaway meal. Meals are unhurried and one resident could be seen eating separately from the other residents at her own request. Residents are able to have snacks and drinks between mealtimes. Knaresborough Road (151) DS0000061613.V322798.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 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Respectful staff meet residents’ personal and healthcare needs. EVIDENCE: Staff could be seen to be interacting well with residents despite limitations in some of the residents’ communication abilities. Support was being provided in a dignified manner and staff addressed people by their preferred names. Induction and other ongoing training cover areas of care practice which aims to promote the privacy and respect of the resident and protects their rights. Each resident had a General Practitioner and access to dental, chiropody and optical services when required. The home has links with the local community resource team for people with a learning disability from whom they seek advice and make referrals where this is appropriate. The residents have visual impairment and some are also hard of hearing. Although the manager is aware of the local resources to support people who are hard of hearing these are not readily accessed and it would be beneficial to residents if better links with Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 14 these resources could be established. Surveys from a GP, relatives and care managers made comments that the staff are good at communicating with them and about the quality of care the staff team provide at the home and a reflexology specialist visiting the home also said this. The medication systems are satisfactory and records are accurate and up to date and medication is stored properly. None of the residents administer their own medication. All staff have received medication training and further training is planned. Knaresborough Road (151) DS0000061613.V322798.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. This judgement has been made using available evidence including a visit to this service. Clear complaints and adult protection policies and procedures are in place and understood by the staff to safeguard the interests of service users. EVIDENCE: The home has a complaints procedure that clearly details how complaints would be dealt with and this was available in different formats to promote people’s understanding of it. Because of the complexity of the residents’ needs it is highly unlikely that they would be able to use the procedure, however staff have a good understanding of each residents’ behaviour and feel confident that they would be able to recognise if a resident was unhappy or dissatisfied and would take actions to address this. Surveys received from relatives indicate that they are aware of the home’s complaints procedure. The home has a policy and procedure in place for the protection of vulnerable adults and staff have all attended abuse awareness training and receive regular updates to remind them of the policy. Staff have a good understanding of what would constitute abuse and knew what actions to take if abuse is suspected. Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 16 Staff support residents in managing their monies and residents have access to their monies at all times. Most of the residents have their own bank account and their bankbooks are kept secure. The home stores monies on behalf of the residents and these are all held individually. Systems are in place for the recording of incoming and outgoing monies for each resident and receipts are kept of monies spent. A random check of the monies tallied with the records. Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 17 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, comfortable and safe for the residents, although ongoing maintenance and refurbishment work needs to continue to maintain a pleasant living environment for the residents. EVIDENCE: The atmosphere in the environment is homely. The accommodation is situated over two floors. Access throughout the home is via stairs only although there is ramped access to and from the home to assist people with mobility problems. The issue with the tree root subsidence is ongoing and is being monitored by the local council and project management team from Homes Together Limited. Repair work is planned although is yet to happen and this has caused delays in the refurbishment of the lounge. Other maintenance and refurbishment work has been taken place since the previous inspection visit. There is now a new toilet on the ground floor and an unused kitchen has been converted into a Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 18 storeroom and toilet. Laminate flooring has been fitted to some parts of the ground floor and staff said that this has been helpful for the residents with visual impairment in knowing when they are entering different parts of the home. Some parts of the home have had re-decoration and this is a continual process due to damage caused to paintwork by the residents. Further work is ongoing with the intention of modernising all the bathroom areas. Resident bedrooms are spacious and personalised. Call bells are available in all individual and communal areas of the home to enable residents to have access to staff at all times. There is specialist equipment around the home to support residents with their independence and mobility. The environment is adapted to minimise risks to residents such as the locking of certain rooms and the securing of fixtures and fittings. The home employs a cleaner to help maintain hygiene standards in the home. Good cleaning and hygiene systems are in place to minimise any risk of infection. The home is clean and well maintained. The home has a fire risk assessment in place and the manager consults with the local fire authority for fire safety advice and a recommendation from a recent fire officer’s visit has been acted upon. Fire safety equipment tests and maintenance records are up to date. Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive a good standard of care from a well-motivated and enthusiastic staff team, however aspects of the recruitment procedures needs to improve to make sure residents are safeguarded from any risk of harm. EVIDENCE: The home has good staffing levels with at least four members of staff on duty at all times through the day. On a night there are two waking night staff. Staff feel that staffing levels are good and staff could be seen providing care to residents in an unhurried manner. Staff morale at the home is good and staff turnover is low which is beneficial to residents in making sure that they receive consistent care from staff who are very familiar with their individual and complex needs. Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 20 The home has recruitment procedures in place and in general these are followed. However in one instance a member of staff had started working at the home without written references being requested because she had previously worked at the home. This matter needs addressing in order to safeguard residents from potential harm. Criminal Record Bureau (CRB) checks are carried out and the records are held at the organisation’s central office. The home does have some basic information available about the details of the checks. However the information does not state which checks have been made and there is no information about the level of disclosure. More information about the CRB checks needs to be available to make sure that proper recruitment procedures are being followed to protect residents. All the staff receive a range of training to equip them in meeting the needs of the resident group. This includes training on challenging behaviour, autism awareness and non-violent crisis intervention and the home has an ongoing commitment to NVQ training. Staff could be seen interacting with the residents and residents’ needs are clearly met. However, it was evident through discussion with staff that some of them have not had specific training to support them in their communication with people who have visual impairment and hearing difficulties. Staff made comments that this sometimes limits their ability to be able to communicate with some residents and feel some training in this area would be “beneficial and helpful”. Staff have regular individual supervision and this is recorded so that support is given to staff and management are aware of any staffing issues. Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run in the best interests of the service users and overall proper attention is given to ensuring their health and safety. EVIDENCE: The manager has now been in post for five months and has submitted an application to become the registered manager of the home with the Commission for Social Care Inspection (CSCI). A senior support worker helps to support the manager with the leadership of the home. Staff made comments that the manager is “approachable and supportive” and feel they are well supported in doing their jobs. Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 22 Since the previous inspection visit there has been improvements to the quality assurance system. Questionnaires have been sent out to and returned by relatives, care managers and other professionals and the findings from these were available at the time of the site visit. Most of the feedback about the home is positive and areas for improvement are being acted on. Care plan reviews involve where possible the resident, their relatives and care manager so that they can give their views on the care and services being offered. Staff meetings are held and encourage the views of everyone to improve standards within the home. A senior member of the organisation visits the home regularly and produces a report of their findings. The home has proper arrangements in place to make sure that health and safety practices promote a safe environment for residents, relatives and visitors to the home. A random selection of the required health and safety certificates are up to date and satisfactory. All staff receive health and safety training and accidents are clearly recorded in the home’s accident book to safeguard the interests of residents. The manager needs to make sure that proper pre-employment checks are done for all new members of staff before they start work at the home in order to protect residents from possible harm. Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 3 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 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 3 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 X 3 X 3 X X 3 X Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 YA34 Regulation 19 Requirement The registered person must obtain two written references prior to employing new members of staff to safeguard residents from potential harm. The registered person must have more detailed information about the Criminal Record Bureau checks that have been carried out on prospective employees to show that proper recruitment procedures are being followed to safeguard residents. Timescale for action 03/02/07 2. YA34 17 03/02/07 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. Refer to Standard YA6 Good Practice Recommendations Records of input from health professionals should be more detailed so that staff are clear about what actions have been and are to be taken in order to make sure that residents’ health care needs are met. Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 25 2. YA19 3. YA35 The registered person should look at ways of improving links with local services and resources for people with hearing difficulties so that specialist advice, support and guidance can be sought. The registered person should make arrangements for all staff to have training to enhance their communication skills with people who have visual impairment and hearing difficulties. Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Knaresborough Road (151) DS0000061613.V322798.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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