Inspection on 27/01/06 for Knowles House

This inspection was carried out on 27th January 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Knowles House 13/03/07

Knowles House 10/08/05

Knowles House 07/03/05

Knowles House 20/07/04

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

CARE HOMES FOR OLDER PEOPLE Knowles House 51 Longstone Avenue Harlesden London NW10 3UN Lead Inspector Bernard Burrell Unannounced Inspection 27th January 2006 10:00 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 Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Knowles House Address 51 Longstone Avenue Harlesden London NW10 3UN 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) 020 8961 9563 020 8963 1946 London Borough of Brent Mrs Petrina I Connell Care Home 39 Category(ies) of Dementia (39) registration, with number of places Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th August 2005 Brief Description of the Service: Knowles House is owned by Brent local authority and is registered to provide accommodation and personal care support for up to 39 older people most of whom are experiencing dementia. The home also offers respite accommodation and two emergency care beds. The home is divided into three floors, but only two floors are currently occupied. All bedrooms are single occupancy, equipped with furnishing, washbasin sinks, shower and bath facilities. The home is located in a residential area of Northwest London close to local shopping, transportation, health, social care and leisure services and facilties in Harlesden and Willesden. The residents have access to services provided by visiting health care professionals. The home has a large car park at the front entrance, a paved garden, seating area and also a garden area to the rare. There is a balcony on the first floor, plus several communal lounges, a library and a relaxation room where private meetings can be held. There is also a day centre attached to the home that is used by non-residents. The home is staffed by a registered manager, deputy manager and a number of care support staff. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over one day with assistance from the manager, staff, residents, and relatives of several residents, health and social care professionals, including GPs. The inspection process involved a tour of the building, examination of records and cases files, discussions with the manager, staff and residents, plus sampling of meals provided during the lunch period. There were 38 residents at the home at the time of this inspection, including six who were receiving respite care. The findings indicated that three of the seven requirements from the last inspection were still outstanding at the time of this inspection and have been repeated in this report. Full compliance is now required by or before the new timescales. The findings also indicated the home is managed well and in line with regulatory requirements and guidelines plus current best practice in social and residential care. Residents who spoke and communicated with the inspector reported their satisfaction with life at the home and the caring attitude of staff. The inspector was of the view that good effort is being made to help ensure the life experiences of each resident is fulfilling, safe and secure. What the service does well: The home provides a comfortable environment where residents are able to live and enjoy the facilities and services as if they were in their own homes. There is a dedicated staff team who appeared to offer a good level of support, care plus opportunities for residents to develop their individuality and exercise their independence. Good effort is also being made by the staff and manager to help ensure that residents are integrated into the local community and have full access to the range of services and facilities enjoyed by people living in the area. Staff interacted well with residents during the inspection and there was evidence of appropriate social and emotional stimulation offered to residents. Good effort is made by staff and the manager to reassure new residents and help them settle into life at the home. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: The home’s statement of purpose and service user’s guide were reviewed and updated since the last two inspections. The provider will need to ensure these documents are available by the final stage of this report and that copies are sent to the CSCI. This also relates to the previous requirements from the last inspection reports and full compliance is now required. The provider must ensure that appropriate grab rails and other safety equipment are installed in all bathrooms/shower and other areas of the home where needed to enhance the safety of residents, staff and visitors. This is an outstanding requirement from the last inspection report and full compliance is now required. The manager must ensure that care plans are developed for each resident that reflect their individual assessed care needs, wishes and aspirations. This is an outstanding requirement from the last inspection report and full compliance is now required. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 7 The manager should ensure that all outstanding care reviews are carried out without further delay. The provider must ensure that a risk assessment is carried out plus an action plan to help enhance the safety of the steps leading from the kitchen to the balcony in one of the respite flats. This is an outstanding requirement form the last inspection visit. The manager must ensure that those staff who have not yet undertaken the training in food and hygiene, are offered the opportunity to do so. Five more staff needed to complete this training at the time of this inspection. 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. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 8 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 Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. The admission process involves input from individual residents, their relatives’, social workers/care managers and other professionals. EVIDENCE: The service users’ guide was still under review at the time of this inspection and the inspector was therefore not able to make a judgement about its format and content. This was a requirement in the last inspection report. The manager informed the inspector that she now makes every effort to have input in the assessment process when potential residents are planning to move to the home. This is an improvement from the findings at the last inspection. The manager should continue to play an active role in the assessment process, in addition to the input of the social workers/care managers. Each resident who applies to live permanently at the home is offered a six weeks trial stay. The manager work with each resident or their representative to produce a basic care plan. When the six weeks stay ends, the Older People’s Services Panel of the local authority then makes a decision whether to offer a permanent place. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 10 The manager reported that she carries out individual risk assessments for each resident when they move to the home. The inspector felt more work is needed to help ensure the care needs assessment of residents applying to occupy the respite care beds, should have appropriate and relevant care plans in place to help maximise and promote their independence and living skills. The current care plans are still predominantly generic and do not capture the individually assessed care needs of residents. Improvement is still needed in the care planning records of services for each resident. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Recorded documentations on care plans have improved but work is still needed to help ensure care plans and provisions are linked to assessments and the expressed wishes of residents. Risk assessments are now being completed and recommendations recorded on care plans produced by the home. EVIDENCE: The inspector examined several case files and the findings indicated that care plans were still not comprehensive and holistic. The inspection findings also indicated that although the existing care plans were organised, they were generic and did not focused on the individuality of each resident’s identified care needs, or how these would be met by staff at the home. As pointed out in the last inspection report, the care plans must be reflective of the individual assessments and recommendations from clinical professionals such as GPs, occupational and physiotherapists. The home has worked hard to meet the recommendations and requirements of the last inspection report relating to administration of medication. A generic medicine policy has been purchased and was been adapted for use in the Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 12 home. Storage of medication has improved and the trolley is now securely padlocked. All staff are trained to administer medicines and signatures are now being recorded on the MAR chart. In addition, medicines are now been recorded when they are received in the home. Risks assessments were present in the files but some were still outstanding at the time of this inspection. It is good practice to have the care plans signed by each resident or their next of kin. There should also be evidence to verify that the residents have agreed to the information recorded. There should also be evidence to verify that each resident has been involved in the review process relating to his or her care at the home. In addition, there is still inadequate information on record about the psychological health of each resident, despite the fact a majority of them experience dementia related problems. The inspector had feedback from several relatives and they each made positive comments about the quality of care and support their relations are receiving at the home. One relative stated that ‘my family and I are very happy the way Knowles House are looking after our sister.’ Another relative wrote that, ‘we find staff attentive and caring,’ and according to the son of one resident: “We could not be happier with the standard of care offered to our relative at Knowles House. The manager and staff are caring and attentive.” The manager informed the inspector of action taken to manage incontinence problems experienced by some residents. The district nurses are also asked to make continence assessments and recommendations. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 15. Social and recreational activities are provided but could be more creative, individualised and reflective of each residents assessed needs and preferences. Meals are nutritious, balanced and reflective of each resident’s choices and nutritional and dietary care needs. EVIDENCE: The inspector talked with several residents about their views of the meals provided and other support services at the home. The comments received indicated they are happy with life at the home they received their mails, daily newspapers, are supported to use the telephone service, encouraged to dress in their own clothing and socialise with other each other. The inspector was satisfied the kitchen area is managed efficiently and in line with regulatory food and hygiene practices. Meals are planned on a weekly basis and reflective of resident’s dietary, cultural and ethnic care needs; for example: Kosher, Asian and Caribbean meals. The dining room and kitchen areas were spacious and well maintained. Some of the residents and their relatives commented favourable about the range and quality of food and drink provided. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 14 The manager should ensure that the five staff members, who had not completed the training in food and hygiene at the time of this inspection, do so as a matter of priority. The manager informed the inspector of the activities inside and out of the home that a number of residents participated in. These included light physical exercise, movement to music, sing-along, dominoes, bowling and reflexology. Hairdressing service is also provided at the home for residents who need it. There were however, still insufficient evidence of assessment and care planning of individual resident’s expectations and preferences in social and leisure activities. Some recordings in care plans noted that residents are aware of social activities, able to participate and does so on certain days. The information received from relatives by the inspector indicated that many are very involved in the lives of residents at the home. The manager reported that the relatives are encouraged and do play pro-active roles in the lives of residents, particularly in view of the dementia problems being experienced by most residents. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17, 18 The home’s complaint leaflet has been reviewed and updated in appropriate format and communication style to help meet the needs of most residents. EVIDENCE: The inspection findings indicated that each resident and their relatives are given a copy of the home’s complaints leaflet. This was reviewed and updated in 2005. It has been written in large print with pictorial references to meet the communication abilities and needs of most residents. A few residents who are in the advance stage of dementia are not able to retain or understand the information on the leaflet. However, the inspector was satisfied their relatives are able to and do advocate on their behalf. The inspector saw recorded evidence on the case files of some residents where their relatives have written to the home to request changes in certain care plan and procedures. The home’s manager showed the inspector examples of how these requests have been responded to. There is also a complaints book in place at the home and according to the manager, during the review process, relatives and residents are asked if they are aware of the complaints procedure. The manager informed the inspector that the complaints policy and procedure guidelines used at the home are the same as the corporate ones used by the local borough council. These were being reviewed and updated at the time of this inspection. The inspectors advised that these documents must be produced in format and styles that meet the communication needs and abilities of residents at the home, most of whom suffer from dementia problems. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 16 The information provided by the manager indicated the local social services department manage the financial accounts of some residents. Others have their financial accounts managed by relatives and their next of kin. The home also maintains a limited financial transaction system called the ‘Residents Fund Account’ for individual residents. This is used for small purchases and personal spending on things like hairdressing and manicure treatments. The protection of resident’s wellbeing is promoted through adult protection training offered to staff by the local borough council. This is in addition to on going monitoring by the manager through the staff supervision and appraisals procedures. In addition, the home operates an individual care group system. This involved individual staff who are put in charge on a daily rotation to monitor, record and report each resident’s daily care and activities. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,26. The home is well maintained with renovation and decoration work carried out since the last inspection. Good progress has been made to repair and made safe the uneven pavements at the front and back of the home. Work is needed to install grab rails where needed in some bathrooms EVIDENCE: In the last two years, the home has had various internal and external upgrading, renovation and decoration. This has helped to improve the overall physical appearance of individual and communal rooms. The inspector was satisfied that the home has a good cleaning system in place that is helping to ensure it is well maintained. The main administrative office has also been extended and now offers more working and storage space for staff. There were small flowerbeds and hanging baskets located at the entrance of the home, balconies and other communal areas. These have also helped to enhance the physical appearance of the home. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 18 There is also a range of communal facilities offered at the home. These included: chairs, benches, wheelchairs, a relaxation and private meeting room, plus specialist bath equipment in most bathrooms. One bathroom needs grab rails and other relevant safety measures and equipment to help enhance the safety of residents when they use the facility. This is an outstanding issue from the last inspection report. There were adequate numbers of communal bathrooms and toilets on each floor. The bedrooms of service users were appropriately furnished and each had a washbasin sink, adequate heating and windows that offer natural light and air. The provider has carried out work since the last inspection to repair the uneven and broken pavements at the front and external areas of the home. The provider must ensure that a risk assessment is carried out to help enhance the safety of the steps leading from the kitchen to the balcony in one of the respite flats. This is an outstanding issue form the last inspection visit. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30 The home has adequate staffing cover. Staff have appropriate level of skills and experience to meet the diversified needs of residents. Good supportive services and standards of care are offered to residents and staff. EVIDENCE: The inspection findings indicated that staff are encouraged and supported to undertake various professional training and development courses-including NVQ qualifications- to help enhance their skills and professionalism. The manager is a Registered General Nurse (RGN) and has other relevant professional qualifications and training, including the Higher Standards of Care. She confirmed that she is currently undertaking the Registered Manager’s Award (RMA) training. A training development officer is employed to plan and supervise the training programme for staff. The inspector viewed copies of certificates awarded to staff on completion of set training programmes. The inspection findings indicated that the staff numbers and skill mix were appropriate to the assessed needs of the residents and the size of the home. The duty rota for example, showed that on the night shift, 3 staff are employed plus one other in charge. The agency staff working at the home were all from the same employment agency and have been working at the home on a regular basis. They are well know to many of the residents. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 20 The local borough social services department who owns the home is also responsible for staff employment and follows equal opportunity regulations for employment. The staffing records held at the home showed that each staff has the required two employment references and the relevant and satisfactory CRB and POVA checks. The staff employment records also showed that they received statements of terms and conditions for their employment. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33, 34, 35, 36, 38 The home is managed well with good systems in place to help safeguard the interest and welfare of residents and promote their wellbeing and quality of life. EVIDENCE: The home is managed by a manager and deputy manager with additional senior monitoring and managerial input from officers at the local borough council and social services. There are good systems in place to help protect residents, including appropriate employment practices by the local borough council plus accountability of staff about their roles and responsibilities. Documentation and records were organised, easy to cross-reference. Some were up to date but others were either under review or needed more work to complete required information. For example, risk assessments and care plans linked to individual assessed care needs. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 22 The manager informed the inspector that the Public Trust Officers visit the home to review the financial interests of residents. Two residents manage their financial affairs independently. Other residents have support from their relatives in this area. There was evidence to verify that staff receive appropriate training in core health and social care areas relevant to the performance of their roles and responsibilities. The inspector was shown evidence of electrical, gas and other appliance tests and certification; including fire drills every 3 months, weekly fire alarm test, water testing and servicing of the passenger lift. Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 23 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 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 x 17 3 18 3 3 3 3 2 x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 3 3 3 x 3 Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 24 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 OP1 Regulation 4,5,6 Requirement The home’s statement of purpose and service user’s guide were reviewed and updated since the last two inspections. The provider will need to ensure these documents are available by the final stage of this report and that copies are sent to the CSCI. This also relates to the previous requirements from the last inspection reports and full compliance is now required. The manager must ensure that care plans are developed for each resident that reflect their individual assessed care needs, wishes and aspirations. This is an outstanding requirement from the last inspection report and full compliance is now required. The provider must ensure that appropriate grab rails and other safety equipment are installed in all bathrooms/shower and other areas of the home where needed to enhance the safety of DS0000033481.V280861.R01.S.doc Timescale for action 30/04/06 2 OP7 15 30/04/06 3 OP22 16,23 30/04/06 Knowles House Version 5.1 Page 25 residents, staff and visitors. This is an outstanding requirement from the last inspection report and full compliance is now required. The provider must ensure that a risk assessment is carried out plus an action plan to help enhance the safety of the steps leading from the kitchen to the balcony in one of the respite flats. This is an outstanding requirement form the last inspection visit. 4 OP30 13,16,23 The provider must ensure that a risk assessment is carried out plus an action plan to help enhance the safety of the steps leading from the kitchen to the balcony in one of the respite flats. This is an outstanding requirement form the last inspection visit. 30/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Knowles House DS0000033481.V280861.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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