Inspection on 04/08/05 for Little Ashmill RCH

This inspection was carried out on 4th August 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Little Ashmill RCH 29/11/07

Little Ashmill RCH 07/12/06

Little Ashmill RCH 08/12/05

Little Ashmill RCH 30/11/04

Little Ashmill RCH 08/06/04

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

CARE HOME ADULTS 18-65 Little Ashmill RCH 21 Stanhope Way Great Barr Birmingham B43 7UB Lead Inspector Maggie Bennett Unannounced 4 August 2005 th 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. Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Little Ashmill RCH Address 21 Stanhope Way Great Barr Birmingham B43 7UB 0121 360 5842 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) Mrs Tuula Kham Mr Robin Ballantine Care Home 5 Category(ies) of PD - Physical Disability (5) registration, with number of places Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age Range 18 - 65 years. Date of last inspection 13th November 2004 Brief Description of the Service: Little Ashmill is registered to care for five people between the ages of 18 and 65 who have a physical disability. The property is a detached house, which has been extensively modernised and refurbished to meet the needs of this service user group. It is situated in a residential area in Great Barr and has shops and a public house nearby. All service users have their own bedroom, which is provided wsith an en suite shower and toilet. All rooms are designed to be accessible to those using wheelchairs. There is a vertical lift to the first floor. The laundry is reached via an outside path and is therefore not accessible to the service users. Those using wheelchairs would be unable to prepare meals in the kitchen. Little Ashmill is comfortable and well equipped and because of its smaller size, achieves a homely atmosphere. Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on a weekday afternoon, between 2.00 p.m. and 6.40 p.m. All the service users were at home at the time of the visit. During the course of the inspection the care plans of two service users’ were seen in order to “case track” the care and support received. Daily records were seen for each service user. Documents to verify proper health and safety practices were inspected. All five service users were spoken to and the quality of the care received was discussed with two service users. Discussion also took place with three care staff and the manager of the home. There were no relatives or friends visiting at the time of the inspection. A copy of the home’s internal audit was seen. What the service does well: What has improved since the last inspection? The majority of the requirements made with regard to the environment at the last inspection have now been met. There is a lower rate of staff turnover and sickness and there is optimism that the home is developing a stable and committed staff group. The appointment of senior carers has enabled the manager to spend more time developing care plans and providing these and other documents in accessible formats. The benefits of this are already in evidence and this work is ongoing. The home now has in place a Quality Assurance system. An Action Plan has been produced following a recent audit. Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 Page 6 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. Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.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 Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.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) 1 There is now a comprehensive Statement of Purpose in place. The registered manager is to produce the accompanying service users’ guide in a number of formats, which will enable prospective service users to make an informed choice about whether to live at Little Ashmill. EVIDENCE: Since the last inspection the Statement of Purpose has been updated and now includes all those details required by Regulation. The registered manager is currently working on producing the service users’ guide in a number of different formats, which will be accessible to the individual service users. This includes the use of audio-tapes and Makaton symbols. Standard 2 (Assessments) was not assessed on this occasion, as there have been no new admissions to the home since the last inspection. At that time all service users had received the benefit of a proper assessment prior to their admission to the home. Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.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 The systems for care planning continue to improve at the home and work on producing these in accessible formats is ongoing. This completed work and the implementation of regular reviews will enable service users to be more involved in their care planning. EVIDENCE: The registered manager has been working hard on developing comprehensive care plans for each service user. Two of these were seen at the inspection and included clear details of how the individual needs of the service users were to be met. The plans would benefit from more information on service users goals and desired outcomes. Care plans are drawn up with the involvement of the service user and it is recommended that, where possible, service users sign their plans. The registered manager is currently developing the care plans in formats which are accessible to each service user. All service users have a copy of their plans in their rooms. There is a keyworker system in operation. It is recommended that an informal review takes place every month and that this is recorded. Six monthly reviews must take place. Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 Page 10 The registered manager has written to social workers requesting such reviews, but in the majority of cases, these have not taken place. The home must, therefore, arrange such a reviews, which must reflect any changing needs. Agreed changes to the care plan must be recorded and actioned. Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 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 standard(s) 12 and 16 There are excellent opportunities for appropriate educational activities at the home and service users are clearly benefiting from this. Service users’ rights are respected and their privacy upheld. EVIDENCE: All service users attend Day Centres, Colleges or Clubs according to their individual needs. Care is taken to ensure that appropriate opportunities for further education and literacy and numeracy training are provided, although availability is sometimes limited. The centres attended include the Deaf Institute at Edgbaston and Ellwood Day Centre. One service user takes part in activities with Birmingham Multi Care. The service users clearly benefit from these activities and some are keen to participate in more. Although not specifically inspected on this occasion, some of the staff spoken to said that they would like service users to have more opportunities for social activities, particularly during the holiday times. They would like the home to have a minibus, as taxi fares are so expensive and Ring and Ride is difficult to access. One service user talked enthusiastically about her trips to the shops, whilst another indicated that he would like to go out more. Another service Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 Page 12 user was to be taken to the Test Match at Edgbaston and is also accompanied occasionally to Aston Villa home matches. A holiday has been arranged for three of the service users, to take place in October 2005. Two of the service users spoken to confirmed that they were encouraged to make choices and had freedom of movement around the home. For those service users with hearing loss, flashing lights have been fitted instead of doorbells, to ensure privacy. All service users have a key to their room and all are handed their own mail. It was clear during the inspection that staff fully interact with service users. There is unrestricted access to the home, apart from to the laundry (which is approached from outside) and the kitchen (which is not safely accessible to service users in wheelchairs without supervision). Service users are, however, supervised and assisted in the kitchen to make drinks and snacks whenever they wish. Rules on smoking, alcohol and drugs are now stated in the home’s contract. Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 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 standard(s) 18, 19 and 20. Service users’ wishes as to how they are supported and assisted are adhered to. The home is proactive in ensuring that healthcare needs are met. There are sound procedures in place with regard to medication administration. Appropriate medication training must take place to ensure service users’ protection. EVIDENCE: Two of the service users spoken to during the inspection confirmed that staff assist them in the way they prefer. One said: “They help me how I want. They do whatever I want them to do. They’re ever so kind.” All personal support takes place in private. Service users are consulted about which staff work with them, as there are occasions when service users are assisted by staff of the opposite sex. Service users always choose their own clothes and are taken out to buy new clothes. From discussion with service users, it is clear that they are able to exercise their own choice in relation to getting up, going to bed and all other aspects of their life. The home is proactive in obtaining appropriate equipment for the service users. At the time of the inspection a new, electric wheelchair and communication aid had been ordered for one person. Staff have received training in moving and handling, including the use of the hoists. There is Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 Page 14 evidence from care plans that specialist healthcare assistance and advice is obtained through the G.P. Service users are supported to have access to all their healthcare needs. It is recommended that one of the male service users is referred for screening. Service users visit a dentist in the community, but other healthcare professionals, such as optician and chiropodist, visit the home regularly. All service users are accompanied to outpatient and other appointments. There is evidence that service users’ health is monitored and steps taken promptly where there are concerns. It remains a recommendation that the G.P. is requested to provide each service user with an annual health check and review of medication. Service users’ consent to medication has been obtained and verification of this is recorded on their files. None of the present service users take charge of their own medication, although all have a lockable facility in their rooms in which to keep medication, if they should wish to do so. Records of medicines received, administered and leaving were seen at the inspection and all were in good order. Controlled drugs are administered, stored and recorded correctly. The times of administration of medicines must be stated on the label of the medicine as well as on the administration record. All tablets must be described so that staff are able to distinguish them. All staff who administer medication must receive accredited training (training to date has been foundation training only). Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 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 standard(s) 22 There is a satisfactory complaints procedure and evidence that service users’ concerns are listened to and acted upon. EVIDENCE: There is a complaints procedure in place, copies of which have been given to the service users. This is not yet available in a format which is accessible to all the service users. The registered manager hopes to complete this task in the near future. One of the service users spoken to during the inspection said that she had in the past felt able to speak with the manager when she had a concern. An example of a complaint made last year by a service user was noted, which was handled promptly and sensitively. Appropriate records are kept of any complaints made. Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 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 standard(s) 28 and 29 The communal space in the home is comfortable and well maintained. Specialist equipment is provided to meet the service users’ needs. EVIDENCE: Statutory requirements were made in respect of Standards 28 and 29 at the last inspection. Both have now been met. The radiator in the dining room is now working satisfactorily. Communal space at the time of the inspection was in good order and several service users were enjoying the landscaped garden. Private consultations and visits take place in the service users’ rooms, as there is no separate private meeting area. Throughout the home there are a number of items of equipment to assist service users. These include a vertical lift, bathroom fittings, en suite showers, a call alarm system and lowered light switches. There is storage and recharging facilities for wheelchairs. Flashing light fire alarms have now been provided in rooms where service users have hearing loss. Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 Page 17 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 and 35. Staffing levels are satisfactory at present, but any decrease would affect the well-being of the service users. The opportunities for staff to air their views and contribute to future planning are poor, with infrequent staff meetings and formal supervision. Recruitment procedures are sound and protect service users. There are gaps in staff training which need to be filled in order to ensure that service users’ needs are met by appropriately trained staff. EVIDENCE: At the time of the inspection there were 3 care staff on duty, plus the Registered Manager. Rotas seen showed that this is the usual pattern, with 3 care staff on duty from 7.00 a.m. to 10.00 p.m. and 2 waking night staff from 10.00 p.m. to 7.00 a.m. No domestic staff are employed, care staff carrying out cleaning and cooking duties. Staff spoken to during the inspection said that the majority of service users needed two carers to assist them with personal care. It is therefore essential that these staff ratios do not drop. Rates of staff turnover and sickness have decreased since the last inspection and there is optimism that a stable staff team is developing at Little Ashmill. Specialist advice is provided by visiting healthcare professionals. At present the staff team does not reflect the cultural/gender composition of service users. Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 Page 18 The quality of the care provided by staff was discussed with two service users. The service users were generally happy with their care. One person said: “I couldn’t wish for nicer people.” Regular staff meetings are not taking place and neither is staff supervision. Staff spoken to during the inspection were unhappy about this, as they did not feel there was a forum for them to voice their ideas and concerns. Staff use a variety of methods to communicate with their service users. Training in Makaton for service users and staff has still not taken place. One service user is to be provided with an electronic communication aid. There are thorough recruitment procedures in place. The files of newly recruited staff were seen at the inspection and showed that all appropriate checks are carried out. All staff files must contain a photograph of the employee. Service users are invited to meet potential staff and to give their views on the person’s suitability to work in the home. Staff are given copies of the General Social Care Council Code of Conduct. All appointments are subject to a three-month probationary period. As at the last inspection in November 2004, a training and development plan for the staff group was not available. A copy of this must be forwarded to the Commission. The plan must also include details of induction and foundation training for new starters, which must meet Skills for Care specifications. In addition, each staff member must have an individual training and development assessment and profile. This must include specific training in the needs of people with a physical disability. There have been some further training opportunities, including “Recognising and Dealing with Discrimination”, Moving and Handling and Food Hygiene. Some of the staff spoken to were not entirely satisfied with the standard of the training provided and this needs to be discussed at a staff meeting. Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 Page 19 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) 39 and 42 Service users’ views are sought through periodic questionnaires and on a “one to one” basis. There are good systems in place to ensure the health, safety and welfare of service users. EVIDENCE: The home carried out an audit between January 2005 and June 2005. Questionnaires were sent to service users, relatives and visiting professionals. There was a good response from service users and relatives and an Action Plan was developed following this exercise. As stated in Standard 6 above, service users’ plans of care would benefit from more information on service users’ goals and desired outcomes. Whenever a visit is made to Little Ashmill, staff enable service users to speak with the inspector, if that is their wish. Staff have recently taken part in moving and handling, food hygiene and infection control training. The staff training and development plan to be forwarded to the Commission will give further details on planned training in first aid and fire safety. Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 Page 20 Fire fighting equipment was checked in February 2005 and records seen verify that the fire alarms are checked each week and the emergency lights on a monthly basis. Fire drills take place each month. The fire alarm system was checked in July 2005. The lift was last serviced in June 2004 and the home’s manager is arranging a service this month (August 2005). The latest Gas Safety Certificate is dated 24th June 2005. The hoists were last serviced in May 2005. Water temperatures are checked on a weekly basis. Annual checks take place for Legionella. The home has produced a statement of the policy, organisation and arrangements for maintaining safe working practices. Risk assessments for safe working practice topics are currently being written. As stated in Standard 35 above, all new staff must receive induction and foundation training to Skills for Care specifications on all safe working practice topics. Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 Page 21 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 2 x x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x 3 3 x Standard No 11 12 13 14 15 16 17 x 4 x x x 3 x Standard No 31 32 33 34 35 36 Score x x 3 x 2 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Little Ashmill RCH Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x x 3 x x 2 x E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 Page 22 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 1 Regulation 4(1) Requirement Timescale for action 30/09/05 2. 6 3. 6 4. 20 5. 6. 20 20 7. 35 The service users guide must be available in a format which is accessible to individual service users. (This document is currently being developed). 15 Service users plans of care must be in an accessible format. (Prevous timescale of 28/02/05 not met). 15(2)(b)(c Care plans must be formally )(d) reviewed on a six monthly basis. (Previous timescale of 31/01/05 not met). 13(2) The times of administration of medicines must be stated on the label of the medicine as well as on the administration record. 13(2) All tablets must be described so that staff are able to distinguish them. 13(2) and Staff who administer medication 18(1)(c)(i must receive accredited training. ) (Previous timescale of 31/01/05 not met). 18(1)(c) A training and development plan for the staff group must be forwarded to the Commission. Each staff member must have an individual training and development assessment and profile. The plan must also E55_S43608_Little Ashmill_V238820_040805_stg4.doc 30/09/05 30/09/05 11/08/05 11/08/05 30/09/05 31/08/05 Little Ashmill RCH Version 1.40 Page 23 8. 36 18(2) include details of induction and foundation training for new starters, which must meet Skills for Care specifications. (Previous timescale of 28/05/05 not met). Care staff must receive regular supervision. Staff meetings must take place on a regular basis. 31/08/05 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. 5. 6. Refer to Standard 6 6 14 19 6 19 Good Practice Recommendations It is recommended that informal reviews take place each month and that this is recorded. It is recommended that care plans contain more information on service users goals and desired outcomes. It is recommended that further discussion about leisure activities takes place with service users and during Staff Meetings. It is recommended that one male service user is referred for routine screening. It is recommended that, where possible, service users sign their care plans. It is recommended that the G.P. is requested to provide each service user with an annual health check and review of medication. Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 Page 24 Commission for Social Care Inspection Halesowen Office West Point, Ground Floor Mucklow Hill, Halesowen West Midlands, B62 8DA 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 Little Ashmill RCH E55_S43608_Little Ashmill_V238820_040805_stg4.doc Version 1.40 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. 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