Inspection on 16/01/07 for Lister House, The Royal British Legion

This inspection was carried out on 16th January 2007.

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

Lister House, The Royal British... 14/02/06

Lister House, The Royal British... 23/08/05

Lister House, The Royal British... 01/03/05

Lister House, The Royal British... 14/09/04

Lister House, The Royal British... 20/11/03

Lister House, The Royal British... 28/04/03

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

CARE HOMES FOR OLDER PEOPLE Lister House, The Royal British Legion Southgate Ripon North Yorkshire HG4 1PG Lead Inspector Ms Anne-Marie Foster Key Unannounced Inspection 16th January 2007 09:30 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 Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lister House, The Royal British Legion Address Southgate Ripon North Yorkshire HG4 1PG 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) 01765 607878 01765 690917 www.britishlegion.org.uk The Royal British Legion Mrs Mary Edna Petronelle Fowler Watts Care Home 76 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (55), of places Physical disability (5) Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2006 Brief Description of the Service: Lister House is a large purpose built building set in its own well-kept grounds within near Ripon town centre. The Royal British Legion owns the home and admission there is normally limited to those people who have served or have served in the Armed Forces or their dependants. There is a hydrotherapy pool on site and a staffed physiotherapy department. There are pleasant landscaped gardens. To the front of the home there is a small remembrance garden and a unique arrangement of a small tank, an aeroplane propeller and an anchor as acknowledgement of the homes relationship with the armed forces. A major redevelopment programme has recently been completed, which included building a separate 16 bedded unit in the grounds for people with dementia requiring residential care (called Colsterdale). There are separate areas within the main home for nursing, residential and younger physically disabled service users. The main home is laid out over two floors and the first floor is accessible by passenger lift and stairs. Weekly fees as at January 2007 range from £480 and £685. Extras such as chiropody hairdressing and newspapers are not included in these costs. The home has level access and has its own car park. Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place over seven hours excluding preparation time. The inspector gathered information about the home in a variety of ways: • • • • Pre Inspection Questionnaire: this asks the home for information such as menus and staffing rotas. Asking for the views of relatives and heath professionals: 3 relatives, 3 GPs and 1 care manager filled in comment cards sent out by The Commission. Using information sent to The Commission since the last inspection about incidents, illnesses or deaths in the home. Speaking to service users and staff on the day, and observing their interactions. What the service does well: Staff know the service users well, and treat them with dignity and respect. There are excellent arrangements made to vary the daily life and meet peoples’ social spiritual and recreational needs. Activities are of good quality and are well organised. Good community contacts are maintained. A robust complaints and protection system is in place and service users are confident that any complaint they have will be listened to and acted upon. The home’s environment is excellent and there are very good facilities available to service users, for example the hydrotherapy pool, physiotherapy suite and purpose built kitchen suitable for those people who use a wheelchair. It is a clean and comfortable place to live. Staff training is excellent and well over half of care staff have their National Vocational Qualification Certificate in Care. There are good numbers of qualified nurses in the nursing unit. Knowledgeable staff meets peoples’ needs. There is an excellent, experienced management team, who are open in their approach and who strive to run the home in the service user’ ‘best interests. Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. A thorough pre admission assessment ensures that only people whose care needs can be met, are admitted to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The deputy manager assesses the care needs of prospective service users. This is done by visiting the individual and their relative in their own home or hospital and by involving care managers or health professionals in the assessment as appropriate. Any previous care plans are also looked at so that the deputy manager can get a good idea of the individual’s needs. These help her make a judgement as to whether the home will be able to meet those Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 9 needs, and be a suitable place for the person to live. The home provides intermediate care and staff assist these service users with their rehabilitation in preparation for going back to their home. Two service users said they remembered the assessment process and that it also helped them to choose the home. Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. Service users care needs are well met, however a lack of monthly review of the care plans could mean that changing needs are not always reflected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users spoken with said that the care they received was good. One relative spoken with said that the care was “fantastic” and “the best”. Three relative comment cards received by the inspector were very positive about the home, one relative’s comment was negative saying there weren’t always enough staff available to answer call bells. The inspector looked at the care records of eight service users and, where Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 11 possible spent time talking with these people, and observing interactions with care workers. Whilst care plans were on the whole well written, many that the inspector looked at had not had a monthly review recorded since the last inspection in 2006. The nurse in charge told the inspector that in some cases the review had taken place, but that nothing had been documented. The staff must document the fact that they have reviewed the service user’s care, even if there are no changes. Changing needs must also be reflected in the care plans so that the most appropriate care is given. This was discussed with the registered manager. The home have been waiting for new care plans to be introduced, there has been some delay with this but all care plans will be reviewed soon. Monthly weights are not always documented even when in one case the care plan instructed staff to weigh the service user monthly. A nurse explained that this was because the individual had refused. This must be documented otherwise it looks as though staff have just not done it. The home does promote and maintain service users health, and are always keen to make referrals to outside health professionals such as the GP or tissue viability nurse (a specialist nurse dealing with pressure ulcers) as necessary. These visits are written in the care files. Whilst nutritional screening takes place this must be more detailed in particular in the Colsterdale unit. Those service users who are overweight and gaining more weight, should be assessed and helped in the same way as those who underweight and are still losing weight. The medication system was looked at. One qualified nurse has a responsibility for ordering, disposal and audit of medications and this system works well. The Controlled drugs were looked at and counted and their numbers tallied with the records. The medication administration sheets were looked at and found to be in order. Staff treat service users with dignity and respect. The inspector observed the interactions of service users and staff, and saw lots of good evidence of positive attitudes and healthy rapport. Staff are regularly well informed about matters relating to privacy and like to treat the service users as they would like to be treated. They ensure that they use the appropriate term of address for the service user and knock before entering people’s bedrooms, and treat people with respect. Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is excellent. Service Users live in a home where a great deal of effort is put into enabling service users to take choices and have a varied lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home arranges a large variety of activities that are appropriate to the range of service users living in the home. A researched and well thought out programme is in place and service users have a great deal to choose from. The Christmas programme was very full and included for example, baking, mystery tour, carol singers, two pantomimes, ‘music in the bar’, brass band in the dining room, shopping trips and remembrance services. There are a variety of areas in the home for such events to take place like the community room and bar, sitting rooms, a large activities room and a library. Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 13 These and the usual activities like knitting, bingo and quizzes are ‘advertised’ by poster so that all service users can be sure of what is going on. In Colsterdale Unit, as well as service users being able to attend any of the above, less formal activities take place on a smaller scale. The unit has its own arts and crafts activity room and service users are reminded and encouraged with regard to activities daily. Individual ‘one to one’ reminiscence sessions are ongoing with service users. Service users’ spiritual recreational and social needs are catered for. There is separate provision for those younger disabled service users with a separate dining and sitting area with beverage facilities so they can make their own drink. A purpose built kitchen is also available to those people that use a wheelchair. Kitchen worktops can adjust to the correct height for the service user. This room is available for and can assist the more independent service user. Service users can choose if they want to attend an activity or not and staff find out their likes dislikes and hobbies and record this. Records are kept of which activity the service user joined in with and whether they enjoyed it. This helps the activities person and researcher to tailor a programme to meet peoples’ needs and the home can offer people the chance of a varied lifestyle. The home encourages community contact in a variety of ways. Service users maintain contact with their families and friends as they wish. The home also encourages appropriate outside groups such as The Alzheimer’s Society to use some of its community room facilities. Several service users attend these groups and both parties benefit from the arrangement. Staff help service users to make choices and to have control over their lives. The daily routine is flexible and service users can choose how to spend their day. The inspector observed the lunchtime meal, in the main dining room and in Colsterdale’s dining room. Following consultation with service users the dining experience has improved. Because of the large size of the dining room the chef and cook now use a hot food trolley each which they wheel down each side of the dining room serving meals. Service users and staff feel that this has speeded up the delivery of the meal and is a much better system. The lunch options looked wholesome. The sample of menus that the inspector looked at where balanced and varied and there were several choices at each meal. The inspector spoke with the chef and looked in the kitchen, which was clean and organised. There were plenty of good quality fresh foods available. There were enough staff to assist as necessary. Service users told the inspector that they enjoyed the lunch. Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is excellent. Service Users are protected by very knowledgeable staff that are confident about recognising the signs of abuse and how to report any concerns, and service users are better protected by this. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a clear complaints procedure, which is available to service users, their relatives and staff. Staff spoken with were very confident about how to recognize and report concerns relating to abuse and were able to confirm that they have regular updates to support their knowledge. The home arranges regular training relating to the Protection of Vulnerable Adults. The inspector looked at the most recent Royal British Legion training manual, which is very useful and comprehensive for staff. It is used along with the Local Authority’s guidance. Staff also told the inspector that they had sufficient training, and they were able to demonstrate their knowledge very well, which helps to better support and protect the service users. Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is excellent. Service Users live in a home that is attractive, clean, safe, and well maintained and it has good facilities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The location and the layout of the home suit its purpose. There is a programme of routine maintenance and renewal of fabric and décor. Recent improvements and decoration have been carried out to a high standard, which is of benefit to service users. The grounds are kept tidy, pleasant and safe. Some areas are landscaped and there are areas where service users can sit and enjoy the fresh air. Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 16 The home is clean and comfortable. There were no bad smells. All rooms have en suite bathrooms and are personalised to suit the service user. There are enough bathroom facilities, hoists and aids to meet the needs of the needs of the service users. The inspector looked at all areas: service users’ rooms, communal areas and service areas. The domestic staff work hard to maintain high standards, and each area that the inspector looked at was found to be very clean. The home has two laundries, one in the main home and the other in Colsterdale unit. Both laundries were looked at and found to be very clean with suitable, impermeable flooring and industrial washing machines that have a sluice facility. The laundry system is organised in order to reduce any risks of cross infection from soiled laundry. The inspector looked at the kitchen, which was very clean and organised, correct storage of fresh foods in the fridge were noted. Fridge temperatures are tested and recorded by the cook or chef. The kitchen is about to be refurbished in the near future, which will bring about improvements for the catering staff. Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. Service users live in a home where staff are knowledgeable and caring, although the numbers of staff on duty could, at times be improved. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Whilst there is a good skill mix of staff available, some service users, staff and one relative said that at times numbers were ‘tight’. Two service users and one relatives comment card said that they thought that they had to wait too long for their buzzer to be answered at times. On the day of the inspection several buzzers were answered quickly, but one took longer. This was during the staff handover period, however staff from another area came to help. The numbers of staff were discussed with the registered manager and her deputy. Whilst the registered manager agrees that the home does have difficulties with recruitment (which is a known problem in the area) she does respond to any shortages as soon as she is made aware of them. Staff recently reported that their morning routine felt slightly understaffed. The registered Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 18 manager quickly responded by arranging for an extra carer for two hours per morning to assist. The inspector looked at the rotas and numbers did look satisfactory. This area needs monitoring by the management though as the numbers need to relate to the level of service users dependency. Staff are well qualified with most of the care staff having their NVQ (National Vocational Qualification) Certificate in care. The nursing unit has a good number of qualified nurses on the rota. Care staff working in Colsterdale Dementia residential unit have their NVQ 2 and 3 certificates. There is a Dementia training programme in place at the moment, which will equip staff better with the skills they need to care for those with dementia. Recruitment at the home was looked at. Whilst the registered manager admits that recruitment can be difficult at times, the home is fully staffed by permanent staff. Agency staff are not used unless there are exceptional circumstances and this means there is a good ‘continuity’ of care for service users. The recruitment files of five staff were looked at. The documentation required by legislation was examined including Criminal Record Bureau checks, two written references and employment history. Each file was found to be in order. Staff training is a major priority in the home and staff benefit from working for a large organisation, as training provision is excellent. Staff told the inspector that they felt knowledgeable and well trained. Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is excellent. The home is well managed by an experienced person and knowledgeable management team who run it in the service users’ best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Registered Manager is well qualified and experienced. There is a deputy manager in post who is also an experienced qualified nurse. Each area has its own unit manager. There is an open style of management, and staff and service users agreed that they felt that the managers were approachable. Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 20 A robust quality assurance and quality monitoring system is in place. The home seeks the views of those using the service, by questionnaire and by holding a regular relatives ‘surgery’, alongside residents meetings. The home also asks for the opinions of other ‘stakeholders’ in the community such as GP’s, so that they can be asked about their views on how the home is running. Policies looked at were clear and comprehensive, however nearly all of them were overdue for a review. This is necessary in light of changing legislation and of good practice advice from the Department of Health, local authorities and professional organisations and to ensure staff use up to date and best practice. The home manages small amounts of cash for some of the service users. The inspector looked at the records of transactions and each cash amount was found to be correct. Statements are kept along with receipts. Service users financial interests are safeguarded as far as possible. The health, safety and welfare of service users and staff are promoted and protected. Training in health and safety issues is made a priority and all staff receive relevant and up to date training in areas such as first aid, food hygiene, and fire safety. Hazardous substances are stored safely and hot water temperatures are checked regularly. The inspector tested a sample of hot water temperatures across the home and these were found to be within an acceptable range to prevent scalding accidents. A sample of maintenance work and certificates were looked at and the inspector saw that annual checks carried out by qualified persons had been done. For example the gas boiler and heating system, passenger lift, hoists, fire equipment, and pool filter system are all properly maintained and serviced. These checks are necessary to make sure the home, its service users and staff are kept safe. Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 21 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 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 X 18 4 4 X X X X X X 4 STAFFING Standard No Score 27 2 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 4 X 4 X X 2 Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 22 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 OP7 Regulation 15 (2)(b) Requirement The registered manager must ensure that all care plans are reviewed at least once a month. If there are no changes to the care plan this fact must be recorded. The registered manager should ensure that nutritional screening and monitoring is carried out for all service users that are at risk including those that are overweight. Timescale for action 28/02/07 2 OP8 15 (1) 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP27 OP38 Good Practice Recommendations Staffing levels should continue to be monitored to ensure that peoples needs can be met fully. All policies and procedures should be updated to ensure DS0000039577.V327070.R01.S.doc Version 5.2 Page 23 Lister House, The Royal British Legion that the home is using best practices and procedures. Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Lister House, The Royal British Legion DS0000039577.V327070.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!