Inspection on 27/07/06 for Larwood

This inspection was carried out on 27th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Larwood 06/07/07

Larwood 07/03/06

Larwood 27/01/05

Larwood 28/09/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Larwood Fullbrook Lane South Ockendon Essex RM15 5JY Lead Inspector Sarah Axam Unannounced Inspection 27th July & 8 August 2006 11:00 TH Larwood DS0000018114.V293578.R01.S.doc Version 5.1 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 Larwood DS0000018114.V293578.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 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. Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Larwood Address Fullbrook Lane South Ockendon Essex RM15 5JY 01708 857354 01708 857354 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) Redbridge Community Housing Limited [RCHL] Mrs Freda Lee Care Home 8 Category(ies) of Learning disability (4), Physical disability (4) registration, with number of places Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Care to be provided to four (4) adults with learning disabilities Care to be provided to four (4) adults with a physical disability The Home to be used as a Care Home only. Date of last inspection Brief Description of the Service: Larwood is a two-storey purpose built care home in South Ockendon. It has a large secluded garden and has off road parking. It provides accommodation for eight younger adults with severe or profound learning disabilities and also caters for those with additional mobility or physical differences. All residents’ rooms have washing facilities and are spacious enough to accommodate mobility equipment and personal items. Fees are one flat rate of £1,022. 70 per week. Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Site Inspection took place over two different days and a total of 9 hours was spent looking through paperwork speaking to relatives, staff and service users. Throughout both days the manager of the home and Deputy manager were present through out the inspections. On the first Inspection the senior manager was present for the feedback on that day. All key standards were inspected and there was a tour of the premises. What the service does well: What has improved since the last inspection? What they could do better: The manager needs to develop the process of the admission criteria into Larwood and assessment procedures specifically related to potential service users prior to admission. A thorough assessment needs to be implemented so that the manager can demonstrate that the home and environment, staff have skills and training to fully cater for an individuals needs prior to a move. Visits to the home, including an overnight stay if appropriate and consultation with other service users already living in the home should be part of this process. The manager needs to draw up a care plan in consultation with the service user or a representative. The manager needs to use the care standards act 2000 as a guide when carrying out assessments, consultation with both the potential new service users, service users already living in the home, assessing staff skills, setting up training for specific client need and once a move date Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 6 has been agreed, monitoring reviewing and consultation recorded clearly in the care plan. 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. Larwood DS0000018114.V293578.R01.S.doc Version 5.1 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 Larwood DS0000018114.V293578.R01.S.doc Version 5.1 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 the following standard(s): 1,2,3, & 4 Quality in this area is adequate. This Judgement has been made using available evidence including a visit to this service. On the first day of the on site inspection there was no evidence to suggest that the latest resident admitted into Larwood had been given appropriate consultation regarding the move or paperwork evidence to suggest visits were offered. EVIDENCE: On the day of inspection paperwork regarding the latest admission of a service user was looked at. The initial assessment from the social worker was in place. No evidence to suggest visits prior to the home or consultation with the service user were in place at the time of the inspection, however the inspector had been assured these had gone ahead and had been archived. Other assessments sampled in resident’s folders were to a high standard and covered all aspects of an individual’s life that you would expect to see. Professional as well as the ‘home’ assessments was in place. Assessments covered areas such as speech, communication, hearing, vision and language, nutrition, religious requirements and weight gain or loss. Family and social contact, physical and mental health. Meaningful education or occupation and any ‘specific’ individual needs were all included. Family and service users views are evidenced and that consultation had been sought by and recorded within the assessment process. Each assessment had a box to tick to indicate if a specific support plan had been written from issues raised within this assessments process. All aspects of assessments are reviewed on a regular basis. Larwood DS0000018114.V293578.R01.S.doc Version 5.1 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 the following standard(s): 6,7 & 9 Quality in this area is adequate. This Judgement has been made using available evidence including a visit to this service. Inadequate Care Planning guidance for staff and consultation for a service user was evident. EVIDENCE: The home could not evidence that one particular service user had been consulted with regarding initial assessment and his changing needs. The care plans in general did acknowledge requests of service users personal goals. The latest service users to be admitted into the Larwood, his plan did not evidence that his requests had been put into place or explored, such as staying in contact with a particular friend or retaining his day services, although explanantion from the manager suggests that this went ahead. This service user is not able to live his life independently as possible or to attain personal goals as much as could be due to his recent change in behaviour. Policy, procedures, reviews and assessments are in place, however there are guidelines for ‘triggers’ regarding this individual, but no ‘specific’ guidelines for staff of what action to carry out if incidents occur. This is specifically in relation to one service user who may display challenging behaviour towards staff or other service users within the home or unpredictable behaviour when outside within the community towards the public, other service users or staff accompanying them. This may put service users and others at risk. Residents Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 10 care plans sampled evidenced that individuals were actively encouraged to participate in the day-to-day running of the home. The plans recorded day-today activities individuals participated in and what their skill levels are. There is a social activities book which daily records activities undertaken and comments about this. However in some care plans resident’s views were not always recorded or signed for as evidence that consultation had gone ahead. The home has a good procedure on risk assessments and indicates where high risk is apparent and instructs the staff team in how to minimise these risks. Prior to residents moving into the home professional risk assessments are in place. Larwood DS0000018114.V293578.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this area is adequate. This Judgement has been made using available evidence including a visit to this service. The manager and deputy are proactive in this area and they have been creative in finding alternatives to providing activities for the service users. The food provided is balanced, nutritious and menus reflect service user choice. EVIDENCE: Most service users have opportunities to take part in peer, age related activities and be part of the local community, however there is a lack of services within the area which may prevent this from developing further and one specific service user needs to have guidelines in place for staff to enable him to be present within the community more than he presently does so. Generally when speaking with staff on duty, they showed good awareness of the needs of the service users and gave clear examples of how they would support them to develop their skills in general and promote their independent living skills. Staff do consult with service users regarding the choice of daily activity, however this needs to be developed further, by means of recording clearly on a daily basis that service users are consulted, that activities are put into place or if they are not achievable why and evidences this has been Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 12 explored and that service users choices are revisited again at some point. The manager is aware that this needs to be developed further as some service users have lost day activities, 1-1 support, adult education services within the area due to closure, cutbacks and lack of services available. Additionally there are future plans to have two summerhouses built on the property so that service users can use this space for activities and have a change of scenery. The food in the home is of good quality and menus are reflective of service user’s choice. Service users are involved in the food shopping for the home. On the day of inspection it was evidenced that service users are encouraged to partake in the preparation and cooking of snacks and meals. The service users are now growing some of their own vegetables within the grounds of Larwood. The food in the home is of good quality, well presented and meets the dietary needs of people who use the service. Staff are trained to help those individuals who need help when eating and are sensitive in their approach. Larwood DS0000018114.V293578.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this area is good. This Judgement has been made using available evidence including a visit to this service. A holistic approach is taken regarding an individual’s health package. The team work closely with the PCT team and other professionals. Medication checks and systems are in place. EVIDENCE: All health aspects of the clients health care is included in the care plans. Specialist services are provided if needed for an individual and to give staff guidance. There was evidence of regular health checks and reviews when needed. Personal aids and equipment are available and well maintained. Staff spoken to on the day of inspection had a clear idea of what is required by them whilst giving personal care and evidenced that each service user is treated as an individual. Staff also evidenced when spoken with and through observation to respect service users when carrying out personal care needs and keeping their dignity and ensuring privacy. Staff do record changes of need in this area and staff do promote independence as much as possible. Staff have regular training and the homes guidance, policy and procedures promote dignity, respect and privacy. Larwood has a good system for keeping medication safe and administered efficiently by trained and competent staff. On inspection medication was stored and recorded appropriately. Staff spoken with about medication gave clear Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 14 understanding of their responsibilities and of the procedures in use. Management do regular checks of medication. . Larwood DS0000018114.V293578.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this area is adequate. This Judgement has been made using available evidence including a visit to this service. Statutory requirements or the homes / organisations own policy and procedures are not always being met by all of the team. Inappropriate action by staff after incidents potentially places service users at risk. EVIDENCE: During inspection paperwork revealed that a service user had no incident form completed but information was recorded in daily notes, although appropriate medical attention had been sought. No information about this was sent to CSCI or a possibly referral POVA team as expected. No information was in place to explore the reasons why this accident/incident had occurred. Again other paperwork revealed service users who had been physically assaulted by another service user was not referred to the POVA team, although the manager assured me it would be in the future and the homes paperwork was completed. In both these incidents there was no clear-recorded evidence that service users had been consulted with about their options or rights, to complain when these incidents occurred or what the next step in the process would be. Available in the home, in each resident’s room is a user-friendly complaints procedure and policies around this are to a good standard. To develop this further staff need to record such events, as required under the Care Standards act 2000 and evidence that advise about the complaint procedure and an explanation of the process is given to service users in these situations. The manager needs to demonstrate that all staff are aware of what immediate action is needed and what their responsibilities are under these situations regarding who to inform and why. Processes and outcomes need to be clearly evidenced to show matters such as these are resolved satisfactory. Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this area is adequate. This Judgement has been made using available evidence including a visit to this service. In general the cleanliness, standard of decoration is good, individual rooms and communal rooms are personalised. EVIDENCE: The home is very pleasant, clean, bright and odour free. Larwood has a homely feel and is appropriate for the needs of most of the residents who live there. For one service user however who has moved in recently is due to find alternative accommodation that better suits his needs after a review was carried out by a multi-disciplinary team. The layout of the home allows for individuals to spend time away, if wanted, away from each other, apart from a kitchen and lounge on the ground floor there are also these facilities on the first floor. Service users rights to access all areas of the home are not being upheld due to this individuals change in behaviour. This type of environment has the potential to isolate one person. Due to recent incidents with one particular service user, the lack of staff on shift to cater fully for his needs in terms of risk management this is not being used to its full potential. The home needs to address these issues safely this is specifically related to staff having to be within observation distance, not working alone, or letting other service users be alone with this particular individual. Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 17 There has recently been a refurbishment of a shower room on the ground floor this has been carried out to a high standard and is tailor made to the individual service users needs. Individual rooms are personalised and choice of colours and furnishings are of service users choice. Staff training around health and safety and infection control is good and management have a good policy and procedures in place. Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 & 35 Quality in this area is adequate. This Judgement has been made using available evidence including a visit to this service. Overall staff have a good skill, knowledge and training mix, however there is no evident client specific related training e.g. behavioural or breakaway. EVIDENCE: Although the rotas are well thought out and the home is usually well staffed, there are some issues of weakness relating to providing adequate cover specifically related to one particular service user needs. There is need for extra staff at certain times of the day, evening, night and depending on activities planned. Management and senior management for the home are aware of these issues and are in the process of addressing them. Overall the staff team have a good skill mix and are consistently able to meet the needs of most of the service users. All staff have regular and mandatory training and some have completed their NVQ awards. In staff files evidenced job descriptions and clearly defined roles. Supervision and staff meetings are regular and recorded. Staff meetings need to evidence discussion regarding potential new service users into the service prior to them moving in and any issues needs surrounding this. That the identified key workers responsible for that individual have a briefing and outline of the needs and issues relating to the individual, making this move as smooth as possible and allowing the service user to have a member of staff he can initially build a rapport with and any issues picked up Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 19 on are fed back to the team through meetings and through individual supervision with the line manager. Recruitment procedure is to a good standard, although service users could be more involved within the recruitment process. . Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,41 & 42 Quality in this area is adequate. This Judgement has been made using available evidence including a visit to this service. The management within the home and at senior level within the organisation have responded robustly to rectify matters of health & safety when identified. EVIDENCE: The manager is experienced and qualified and is aware of the national care standards. Health and Safety of both the service users and staff, initial and home assessments, including risk assessments of possible potential behaviour issues, the environment layout, staffing skills, experience and training, need to be in place prior to a new service user being admitted. These assessments need to be prioritised regardless of time scales or deadlines for the individual in which to move and senior management need to release the home manager to carry this out. Consultation with service users, staff meeting to share information and a key person needs to be identified before admission goes ahead. In this way risks Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 21 and the continuity of all service users and staff is fully assessed, planned and secured to the best of the homes ability. The homes policy and procedures around admissions needs further development and to be reviewed. Admission regulations and standards included within the Care Standards Act 2000 needs to be incorporated within the admission policy to give the manager further guidance. Regular monthly visits by the registered provider are undertaken and the registered manager ensures that all relevant legislation is complied with. All certificates relating to relevant legislation were inspected and found to be of a good standard. Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 22 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 2 2 2 3 2 4 2 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 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 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 X 3 X 2 X 2 2 X Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 23 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 YA2 Regulation Reg 14 (1)(c ) (2)(a)(b) Requirement The registered manager must ensure that the homes assessment is done prior to any new potential service users moving in and in consultation with a service users or their representative and any restriction are recoded and infringements of rights are recorded and agreed. They must ensure they can meet service user needs and confirm this in writing. This needs to be in place for the next admission. Timescale for action 30/12/06 2 YA3 Reg 18 (1)(a) The registered manager must 30/12/06 ensure that the home prior to any admission can fully meet the needs of the individual and that the staff team have experience and training individually or collectively and that enough staff provision to fully cater for those needs. This needs to be in place for the next admission. Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 24 4 YA9 Reg 14 (1)(c )(2)(a)(b) The registered manager must ensure that risks are assessed prior to moving in and that these are recorded dated and signed. This needs to be in place for the next admission. The registered manager must ensure that any new service user has proper provision for e.g. education or occupation continued or that alternative services are offered. This needs to be in place for the next admission. The registered manager must ensure that any aggressive occurrences experienced by the actions of a service user have a risk assessment carried out and that any physical restraint techniques are recorded clearly including the different stages of outcomes involving multidisciplinary teams if need be. The registered manager must ensure that if an incident occurs where as a service user has needed medical attention this should be recorded appropriately and followed up as a result of any actions taken and outcomes. The registered manager must ensure that any incident that occurs is appropriately recorded and referred under POVA. This refers to one-service users physical assaulting another service user within the home. 30/12/06 5 YA12 Reg 12 (1)(b) 30/12/06 6 YA23 Reg 17 Schedule 3 (3)(p) 30/12/06 7 YA41 Reg 17 sch 3 (3)(j) Sch 4 (12)(a)(b) 30/10/06 YA23 8 Reg 13 (6) 30/10/06 Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 25 9 YA15 Reg 16 (2)(m)(n) The registered manager must ensure that service users prior to admission and once in placement have right to maintain friendships of their choice and have a plan allowing this. This related to the latest admission of a service users and his request to visit his friend and no recorded evidence of this happening. This needs to be in place for the next admission. 30/12/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA8 Good Practice Recommendations The registered person must ensure that service users are offered consultation either on a 1-1 basis, advocacy or by means of residents meetings and issues raised by service users are actioned and feedback given on progress. Larwood DS0000018114.V293578.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Larwood DS0000018114.V293578.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. Re-publishing this information is in breach of the terms of use of that website. 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