Inspection on 27/07/05 for Knowsley Road, 246

This inspection was carried out on 27th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Knowsley Road, 246 24/11/06

Knowsley Road, 246 29/11/05

Knowsley Road, 246 23/03/05

Knowsley Road, 246 26/04/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 246 Knowsley Road 246 Knowsley Road Bootle Liverpool L20 5DQ Lead Inspector Julie Garrity Unannounced 27th July 2005 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 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 Stationary 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. 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 246 Knoswley Road Address 246 Knowsley Road Bootle Liverpool Merseyside L20 5DQ 0151 922 6607 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Expect Limited Care Home 3 Category(ies) of LD - learning Disablility registration, with number of places 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. service users to include up to 3 LD Date of last inspection 23rd March 2005 Brief Description of the Service: 246 Knowsley Road is registered as a care home for three people with a learning disability. The service provider for the home is Expect Limited. Expect Limited provides and manages a number of care homes within the Sefton area. The home is located in a residential area of Bootle and is in keeping with other properties in the area. It is indistinguishable as a residential care home and lends itself to the principles of ordinary community living. There is a small backyard at the rear of the building that leads to a comunal alley way. 246 Knowsley Road has limited parking as it is located on a busy main road. A lounge/ diner is available at the front of the building for the residents. The Home has limited access to individuals with disabilities. The home is located on a busy main road and does not have separate parking facilities. Local facilities include easy access to rail and bus services, there is a bus stop directly outside the home. There area a number of local shops within the area that are approximately a five-minute walk. Pierhead Housing owns the property a local housing association, which is separate to Sefton Support Services. 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 4 and half hours. It was a routine unannounced inspection. All three residents and two care staff were spoken with. Interviews were held with the manager and discussions were also held representatives from Sefton Support Services head office. A tour of the premises was undertaken and care plans, risk assessments, policies, procedures, financial records, medication records and storage of the medications were reviewed. What the service does well: What has improved since the last inspection? What they could do better: There have been several changes in manager and staff team in the Home over the last few years. This has resulted in the Home not meeting many of the previous requirements. The needs of the residents have changed in particular one resident and the Home can no longer meet the individual’s needs. This has impacted on the other residents in the Home and the Health and Safety issues within 264 Knowsley Road. Although requirements have been made in previous reports to make adaptations to the Home to meet this residents needs there has been no progress over the last 18 months towards addressing this area. The healthcare needs, choices of the other residents and health and safety have been compromised. Records within the Home have not been updated these include care plans, risk assessments and individual money records, a meeting was held with Expect Limited to address the issues around residents money. However there still is inappropriate practice in place within the Home that means that the residents are not suitably protected. 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 6 The Home is now showing signs of wear and tear and although there are plans to refurbish and redecorate the Home these are not in writing and have not been shared with the residents. 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. 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The staff are able to assess the needs of residents wishing to move in to 246 Knowsley Road. The Home carries out reasonably detailed assessments that explain the needs of the people being supported and develops plans to meet those assessed needs. EVIDENCE: The residents living in 246 Knowsley Road have done so for a long time and no new residents have moved in the last few years. There are assessment forms that can be used by staff to help them understand the needs of any new residents moving in. The three people living in the Home have their own assessments that note their needs. The residents spoken with told of their ideas about the areas they needed help in. These were the similar to those written in their assessments. Staff spoken with knew a lot about the residents and their strengths and needs. 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 9 Staff are aware of residents support needs and have written a number of these needs in the care plans and risk assessments. There are a number of support needs vital to the care of residents that are not written. This practice runs the risk of inappropriate decisions being made based on staffs point of view rather than individually written need, written from the resident’s ideas and wishes. EVIDENCE: All the plans in the Home were out of date and are in need of updating and reviewing. Many of the needs of the people living in the Home explained by the themselves and the staff were not clearly written in the care records. This was particularly noticeable with regards to one person whose needs have changed and the impact that this has had on the whole of the Home. As the staff team has undergone several changes in the last few months and agency staff have been needed clear care plans are all the more important. Two of the staff who work in the Home have done so for a very long time and explained that they are clear about the residents individual needs. There is some information on supporting residents towards independence and encouraging and supporting individual choices. Staff do have a lot of knowledge in this area but are not able to support the choices they make for the individuals from accurate plans and risk assessments. 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 15, 16, 17 There are a variety of different activities available for two of the individuals. One of the residents is restricted as to the activities and choices they can make, as the access to and from the Home does not meet their needs. Information available in the Home is not a true reflection of what activities actually occur and the choices of the individuals. Whilst the staff try to make good choices for the individuals there is not always enough information available for them to make these decisions. EVIDENCE: The staff in the provide activities outside of the Home. These include trips to Southport, local shops and weekend breaks away. There are some details in care plans that explain individual choices but these are unclear. There is an activities diary available for each resident. These have not been updated for several months and do not reflect the activities that are actually undertaken. The different activities available for one individual are not available. Their ability to leave the Home is poor, due to their physical needs and the lack of suitable aids in getting in and leaving the Home. At present staff are placed at considerable risk in making sure that they are able to go out. 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 11 The residents spoken with and the records detail where family support is in place and how the residents will be supported to maintain appropriate contact with families. Good records of food were kept and detailed varied diets. One person needs a special diet and staff did not have enough information to make sure that a variety of good alternatives that was suitable to the individual were available. 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 21 Medication is stored, recorded and given in a safe manner. The healthcare needs one individual have impacted greatly on the entire Home and little progress has been made in reducing any further deterioration to the resident and the impact that this has on the other residents. EVIDENCE: Records regarding medications in the home were well kept, clear, and accurate and took into account the safety needs of the residents. The impact of the change in health care needs of one particular resident have not been fully explored either within the care plan or within the general management of the Home. The Home has contacted Social Services, The Housing Association and Medical Services such as physiotherapy. There have been a number of suggestions made by all parties. The Home is unable to meet all the care needs of the individual and this has resulted in a further deterioration in other healthcare areas. The resident does not wish to leave the Home and as such it is the responsibility of the management to make arrangements to attend to the health care needs of the individual and reduce the impact that these changes have had on the other two people living in the Home. 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 The rights of the individuals are not safe guarded. Staff are in need of further training in order to fully understand their role and to be confident in raising their concerns appropriately. Residents personal money is not spent appropriatly. EVIDENCE: There are very few financial policies and procedures within the Home that would safe guard the individual’s rights and clearly explain how their money will be dealt with. As with previous inspections the residents had personal money that were not being managed appropriately and they management of their money had not been detailed in their care plans or discussed with the individuals. Staff spoken with were unclear as to their role and were not aware that the usage of the individuals money was inappropriate. There is little understanding amongst the staff of the concept of financial abuse and no evidence that staff have received training in this area. Although there are records regarding residents money these are unclear, staff are confused by the arrangements and subsequently are unable to detail to the residents their finances. Records from Sefton support services were not up to date, did not detail clearly incoming funds and out-going funds. On site records were clear and concise and detailed a number of spending areas that were not appropriate 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 26, 27, 29, 30 The building does not meet the needs of one of the individuals and changes in the layout have reduced the communal space for the other two people living there. 246 Knowsley Road although homely in appearance is also in need of redecoration and refurbishment. EVIDENCE: Although the environment meets some of the needs of two of the residents it does not meet the needs of another who is unable to access bathing facilities and has not accessed a bath or a shower for nearly 18 months. The Home has tried to have alterations undertaken by Liver Housing and this was rejected. The staff said that there is a redecoration budget available and there are plans to redecorate, areas that are in need of addressing that are worn and stained seating in front room, carpets throughout the downstairs, painting in kitchen, disability adaptations (accessing the building) wallpaper in lounge, staircase, lack of bedroom furniture in ground floor bedroom and difficulty in accessing washing facilities from the downstairs bedroom. A plan has not been generated that explains how this work is to be carried out or when. Residents have not been consulted as to the redecoration or what their choices are. 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 15 Laundry facilities are domestic in nature and are in the kitchen area. The issue of accessing the toilet via the kitchen for one individual has issues regarding maintaining good hygiene levels on the kitchen work surfaces that need addressing. 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 16 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34, 35 There is a shortage of staff available and the opportunity to make sure that there is enough staff available to meet the resident’s needs has not been taken. Staff have not received the training that they need to support the residents fully. Additionally there is no evidence that bank staff are checked and trained appropriately before working in the Home. The lack of training and checks on all staff places residents at risk. EVIDENCE: There have been a number of changes in the staff team over the last year. At the moment there are only three staff members who are permanent to the Home. Staff are working a high level of hours in order to maintain a stable staff group. There is no review of the care needs of the residents in order to make sure that there is enough staff available to meet the needs of the residents. On the day of the inspection there was enough staff to make sure that one resident was cared for in the Home and the other two were able to go out for the day. However as the residents activities plan are not reflective of the needs, choices and daily routine of the residents the manager is unable to clearly plan when extra staff will be needed. The Home does use bank staff but the manager is not provided with the information that tells her that the staff are suitable to work within the Home. There are a number of areas of staff training that are out of date for some staff these include, challenging behaviour, protection of vulnerable adults, medication training, fire safety training and moving and handling. 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 17 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 39, 42 Due to the changing needs of one resident health and Safety within the home is not supported appropriately. The lack of a consistent manager has resulted in the Home not being managed in a manner appropriate to the needs of the residents and outstanding issues have continued for long periods of time. A quality assurance scheme has been commenced but without the results being available to the residents and staff there is no means for the staff in the Home to be able to make use of this results. EVIDENCE: 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 18 The manager is new in post and at present is not returned an application form to the Commission for Social Care Inspection. A quality assurance system has started that asks questions of the residents. As yet the results of these are not available for review and a developmental plan designed to increase the quality of the care provided has not been written. Over recent months the Commission for Social Care and inspection has not received copies of the monthly quality visits made from Sefton Support Services. Fire safety checks were recorded and up to date. There were no records of residents fire training. There were no records of fire officer’s checks undertaken within the last 2 years or Environmental Health within the last 2 years months. General certificates for the home were up to date and relevant. Risk assessments are in place in relation to many of the areas in the Home. These do not include staff having to lift a resident in and out of the Home in a wheelchair, contamination of work surfaces in the Home and access to washing and toilet facilities as an example. A number of other risk assessments are in need of updating. 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 19 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score x 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 2 2 x 1 3 Standard No 11 12 13 14 15 16 17 x 2 x x 3 2 2 Standard No 31 32 33 34 35 36 Score x x 2 2 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 246 Knowsley Road Score x 2 3 2 Standard No 37 38 39 40 41 42 43 Score 2 x 2 x x 1 x F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 20 Yes 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 YA 6 Regulation 15 (2) (a) (b) (c) (d) Requirement Timescale for action Timescale extend to 11/09/05. Timescale extend to 11/09/05. 2. YA 7 3. YA 37 4. YA 34 Care plans must cover the needs of the service users taken from assessments and kept up to date. (OUTSTANDING FROM PREVIOUS REPORT) 13 (6) Resident personal allowances must have clearer documentation regarding their bank accounts, these must detail what the debits are for and kept up to date within the Home. Consultation with service users, advocates or the service users representatives must be undertaken before service users purchases are made. Residents must be given the money back for inappropraite spending. (OUTSTANDING FROM PREVIOUS REPORT) 8 (1) (a) A manager’s application for registered manager must be submitted to Commission for Social Care Inspection. (OUTSTANDING FROM PREVIOUS REPORT). 19 (1) (a) Records detailing that Agency (b) (i) (ii) and bank staff must be available (iii) (c) covering the same checks that (3) (4) (a) must be in place for permanent (b) (c) (5) staff. (OUTSTANDING FROM F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Timescale extend to 11/09/05. Timescale extend to 11/09/05. 246 Knowsley Road Version 1.40 Page 21 PREVIOUS REPORT) 5. YA 23 Residents must not purchase items detailed in the contract as provided by the Home. (OUTSTANDING FROM PREVIOUS REPORT) 23 (1) (a) The occupational health (2) (a) recommendations must be put into place. (OUTSTANDING FROM PREVIOUS REPORT) 18 (1) (a) Residents dependency needs must be monitored and appropriate staffing levels in place. (OUTSTANDING FROM 2 PREVIOUS REPORTS) 23 (2) (a) Adaptations to the home must be made to enable access to shower/bathing facilities for one resident whose bedroom has been relocated. (OUTSTANDING FROM 2 PREVIOUS REPORTS) 18 (1) (c) Staff training needs must be (i) identified and training such as moving and handling, protection of vulnerable adults and medications undertaken for all staff working within the Home. training specific to the needs of the residents must be identified, such as challanging behaviour and provided for all staff working in the Home. 23 (1) (a) A maintenance plan must be (2) (a) (b) developed that includes recarpeting, replacing worn furniture, repainting and redecoration of the hall, stairs, landing kitchen, lounge and bedroom on the ground floor. Provision must be made in the ground floor bedroom for storage of clothing and personal items. This plan must be shared with the residents. 26 (1) (2) Sefton Support Services must (a) (b) (c) undertake monbthly quality visits (3) (4) (a) to the Home with a copy of the (b) (c) (d) report forwarded to the F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc 20 (3) Timescale extend to 11/09/05. Timescale extend to 11/09/05. Timescale extend to 11/09/05. Timescale extend to 11/09/05. 6. YA 24 7. YA 33 8. YA 29 9. YA 35 11/09/05 10. YA 24 11/09/05 11. YA 39 11/09/05 246 Knowsley Road Version 1.40 Page 22 (5) (a) (b) Commision for Social Care Inspection. 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. 3. 4. Refer to Standard YA 8 YA 39 YA 6 YA 16 Good Practice Recommendations The home should produce information in a service user accessible format whenever possible The manager should produce an annual developement plan. The care plans should be expanded to include clear reference to the impact of medical needs and the medical interventions that are used. Service users should be supported to further develop domestic skills such as food preparation for all meals in accordance with their assessed capabilities. Service users should be made aware fire safety. Care plans should be reflective of the needs of service users and should included aspects such as management of own funds. The manager should be included in the formation of budgets in the Home. Informatiion regarding the dietry needs of a resident should be made availiable to the staff. 5. 6. 7. 8. YA 42 YA 6 YA 39 YA 17 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Burlington House, South Wing, 2nd Floor Crosby Road North Waterloo, Liverpool L22 0LG 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 246 Knowsley Road F53 F03 S5246 246 Knowsley Road V241720 270705 Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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