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Inspection on 11/10/06 for Little Oaks Residential Home

Also see our care home review for Little Oaks Residential Home for more information

This inspection was carried out on 11th October 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The home offers friendly, homely support to a small number of residents. The staff team is stable and knows individual residents well. Preferences of routine are known by the staff and they offer support to achieve them. The owners invest time into undertaking in depth quality assurance and auditing compliance with standards. Staff training is up to date and relevant. Staff have supervision every two months with the manager. Care plans generally reflected assessed needs of residents with the required interventions to support residents to maintain independence as long as possible.

What has improved since the last inspection?

Residents` files seen showed that a pre-admission assessment had been carried out by the home prior to admission. Staff who administer medication have had training from the manager, who is a trainer, and been assessed for competence. The owners were in the process of sending questionnaires to outside health professionals to obtain their views of the home to inform the quality assurance process.

What the care home could do better:

The medication policy needs to be expanded to give more detailed guidance for staff and protection for residents. The protection of vulnerable adults (POVA) policy should be updated to bring it in line with county guidelines. Several policies still refer to NCSC instead of CSCI. Temperature records for the medication refrigerator should be kept to ensure it is safe for medication storage. Files for staff are not individual and evidence of identity checks made before commencing in post were not available. The care plan of one resident who was known to suffer from epilepsy did not contain any interventions for managing that condition. Some areas of the home need redecoration, as they look worn and a little shabby. The garden is in need of attention and a lot of garden rubbish should be disposed of. The fire risk assessment is inaccurate as it states there is no source of ignition on the first floor of the home.

CARE HOMES FOR OLDER PEOPLE Little Oaks Residential Home Braxted Road Little Braxted Witham Essex CM8 3ED Lead Inspector Jane Offord Key Unannounced Inspection 11th October 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Little Oaks Residential Home DS0000017869.V307064.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. Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Little Oaks Residential Home Address Braxted Road Little Braxted Witham Essex CM8 3ED 01621 891974 N/A 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) Mrs Gillian Elaine Valentine Mr John Rand Valentine Ms. Bridie Everitt. Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13) of places Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 13 persons) 7th February 2006 Date of last inspection Brief Description of the Service: Little Oaks is an adapted detached property situated in the village of Little Braxted and close to Wickham Bishops. The home is in a rural setting but is near to a bus route. The nearest town is Witham where there are facilities such as shops, pubs, banks, library and post office. Residents accommodation is provided on two floors and consists of eleven single and one shared bedroom. The home has a passenger lift. A lounge/dining room overlooks the rear garden, which is private and secure. The home provides accommodation for older people with low to medium dependency levels. The aim of the home is for residents to live as independently as possible and be fully supported in their physical, emotional and social needs. The fees range from £358.00 to £494.00 depending on the source of funding. The cost of newspapers, hairdressing and chiropody is additional. Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection took place on a weekday between 10.00 and 15.30. The manager was available throughout the day to assist with the inspection and one of the owners was at the home for the second part of the day. During the day three residents’ files, care plans and daily records were seen, as were staff records, the policy folder, some maintenance records, the statement of purpose, the duty rotas and quality assurance information. A number of staff and residents were spoken with, the lunchtime meal serving was observed and part of a medication administration round was followed. Residents looked well dressed and comfortable and were either in the lounge or in their own room. Visitors were welcomed. Interactions between staff and residents were caring and appropriate. The lunch looked appetising and residents were offered choices. What the service does well: What has improved since the last inspection? Residents’ files seen showed that a pre-admission assessment had been carried out by the home prior to admission. Staff who administer medication have had training from the manager, who is a trainer, and been assessed for competence. The owners were in the process of sending questionnaires to outside health professionals to obtain their views of the home to inform the quality assurance process. Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 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 Oaks Residential Home DS0000017869.V307064.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 Little Oaks Residential Home DS0000017869.V307064.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6. Quality for this outcome area was good. People who use this service can expect to have the information they need to make an informed choice about entering the home and have their needs assessed prior to admission. The home does not offer intermediate care. This judgement has been made using information available including a visit to the home. EVIDENCE: The statement of purpose was seen and contained up to date information about the service offered by Little Oaks. The contents covered all the areas required by Standard 1 of the national minimum standards. One resident and relative spoken with said they had been given written information about the home prior to visiting. The relative said they recalled the manager visiting to assess the needs of the prospective resident before they agreed to admit them. There was evidence in the three residents’ files seen of pre-admission assessments being done that covered all areas of care and social need. Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. Quality for this outcome area was good. People who use this service can expect to have a care plan to help meet their needs and have their health care needs met. They can also expect to be treated with respect and be protected by the medication administration practice, however, they cannot be assured that all assessed needs will be on the care plan or that the medication policy offers sufficient guidance to staff. This judgement was made using information available including a visit to the home. EVIDENCE: The residents’ files seen all contained information about the health professionals involved with the resident. There was also a record of any visit made to or by a health professional. So there were contact details for GPs, community nurses, chiropodist, optician and social worker. Regulation 37 reports received from the home indicate that health needs are appropriately monitored and met. One visitor spoken with said that their relative had been quite depressed on admission to the home but staff had worked with the GP and the resident was now much more interested in life and active. Each file contained a life history and recent photograph of the resident. Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 10 Care plans seen covered areas of care such as personal hygiene, dressing/undressing, nutrition, continence, cognition, communication and personal safety. In addition there was information about social interests and family involvement. There were assessments for moving and handling and records of the resident’s weight. It was noted for one resident who had a diagnosis of epilepsy that there was no intervention on their care plan for managing the condition. In discussion with the manager it was clear that staff were aware that the resident’s condition was exacerbated by stress so the care plan should have reflected the strategies used in those circumstances. The lunchtime medication round was observed. Practice was safe. Residents were offered ‘as required’ (PRN) medication and helped to manage tablets if they needed it. The medication administration records (MAR sheets) were inspected and found to be completed correctly. A new practice of two carers checking that medication was administered and both signing records has been commenced as an additional safeguard. The home has a small medication refrigerator that is kept on the bottom of the drug trolley for medication that requires storage at a low temperature. The temperature of this refrigerator is not monitored so there is no check that it is functioning to safe levels for medication storage. The medication policy was seen and was very limited in the guidance it offered. There were no guidelines on the use and recording of homely remedies and in discussion with the manager it was clear that they were used. The policy lacked a procedure for assessing a resident’s ability to self medicate, for managing covert administration of medication, for correctly managing controlled drugs (CDs) and for administering medication in a format not licensed by the manufacturers i.e. crushing tablets. Staff were observed knocking on doors prior to entering a room. Residents’ choice of where they spent their time was respected and staff supported residents to do as much independently as possible. Residents who chose to be in their own room or were being nursed in bed were visited frequently to ensure there was nothing they needed. Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality for this outcome area was good. People who use this service can expect to be encouraged to maintain contact with family and friends, be offered meaningful activities and have a balanced diet. This judgement was made using information available including a visit to the home. EVIDENCE: Each resident’s file seen had a record of the activities the resident had been offered and participated in. They covered art and craft sessions, going out for tea, attending a church service, having a hand massage and nails painted and being visited by the ‘pat dog’. On the day of inspection two residents were overheard comparing their new nail polish that had been applied by a carer that morning. One resident was passing their time knitting and there was a singsong tape played of World War two songs. Residents spoken with said they liked to have the choice of joining in with activities or not depending on how they were feeling. Several visitors came and went during the day. Visitors spoken with said they had no restrictions, within reason, on visiting and were always made welcome. They could visit their relative in the communal rooms or in the resident’s own room. They said they were kept informed/involved with the care of their relative. All the residents’ files seen had contact details of their next of kin. Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 12 Tables in the dining room were laid for lunch with napkins and individual specialised cutlery if required. Residents were offered a choice of apple, pineapple or orange juice to drink. Staff served individual meals from the adjoining kitchen. The main meal on the day of inspection was chicken in a mustard and honey sauce with roast vegetables and broccoli. A salad was available as an alternative. The dessert was Bakewell tart and custard or alternatives such as yoghurt or ice cream. The menus seen offered a roast dinner at least once a week. Teatime choices were from soup, sandwiches and a hot snack such as an omelette, cheese on toast or jacket potatoes. There was fresh fruit available on each dining table for residents to help themselves. The cook said most soups and cakes were home made. A buffet tea is organised for a resident’s birthday and a birthday cake made. The kitchen and food storage cupboards were inspected. Food was stored and labelled correctly. Temperatures of refrigerators and freezers were recorded and seen to be within safe parameters for food storage. Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. Quality for this outcome area is good. People who use this service can expect to have complaints taken seriously and be protected by staff knowledge from abuse, but they cannot be assured that the present policy in the home reflects the current county guidelines. This judgement was made using information available including a visit to the home. EVIDENCE: CSCI are aware of one complaint made since the last inspection. It was referred to the Protection of Vulnerable Adults (POVA) team and the previous inspector was involved in the process. There was no evidence to substantiate the allegation. The home’s complaints policy offers an investigation and feedback for any complaint. Residents and visitors spoken with were all clear about who to approach if they had any concerns. The manager has been trained as a trainer for POVA training. They said that all staff have received up to date POVA information. This was confirmed by documentary evidence and in discussions with staff. Staff were clear about their duty of care and the home includes a whistle blowing policy in the guidance for staff. The home’s POVA policy does not reflect the most recent guidelines issued by the Essex county adult protection committee. Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Quality for this outcome area was good. People who use this service can expect to live in a comfortable, clean home that has regular maintenance but they cannot be assured that the gardens will be well tended. This judgement was made using information available including a visit to the home. EVIDENCE: The home has a large lounge and dining room that is comfortably furnished and light and airy, overlooking the garden. During a tour of the home a number of residents’ rooms were seen and they were all personalised and attractively furnished. The manager explained that there were plans for reallocating the use of some of the upstairs rooms and removing a bathroom that is not used. When the changes happen there will no longer be a shared room but there will still be accommodation for thirteen residents. Some of the corridors were a little dark and the décor looked ‘tired’ but the owner said there is an ongoing programme of redecoration undertaken over a period of time by the maintenance person. They are waiting for some estimates to upgrade the kitchen, as the work surfaces need renewal. Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 15 The home has a maintenance person who was called in urgently to attend to a leak from a pipe on the first floor that was coming through a ceiling on the day of inspection. They said they are in the home several days a week and attend to any running repairs that the staff notify them of. The owner had been working in the garden earlier in the year but had suffered an injury that prevented them undertaking heavy work. The garden looked neglected and there was a large pile of garden rubbish and old furniture near the end of the house that needed to be removed. Some of the comment cards returned to CSCI remarked on the state of the garden. There were no unpleasant odours noted in the home on the day of inspection. The laundry was clean and tidy with all products that are subject to control of substances hazardous to health (COSHH) regulations safely stored. The home has a policy for the management of soiled linen and provides protective clothing for staff to prevent cross infection. Staff spoken with said they had training in infection control and certificates seen confirmed that. Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality for this outcome area was good. People who use this service can expect to be supported by sufficient, well-trained staff to meet their needs. This judgement was made using information available including a visit to the home. EVIDENCE: The duty rotas were seen and showed that during the day there were four carers for the morning shift, three for the afternoon shift and two for the night, one of those doing a sleep-in. In addition the manager worked most days as supernumerary and there was a dedicated cook in the kitchen. As noted in the previous section the home has the services of a maintenance person. Staff files were inspected. The manager does not hold individual files but says they plan to change the system to achieve that. Tracking some staff there was evidence of two references, criminal record bureau (CRB) checks being undertaken and staff contracts and conditions being held. Supervision records and supervision agreements were seen and showed staff had supervision every two months. The records showed discussions took place around training needs, care practice and team working. There was no documentary evidence seen of identification checks that were made on new staff, although as CRBs had been obtained the manager said they had seen documents but not retained copies. In discussion with the maintenance person they confirmed they had received training in POVA, COSHH and Health and Safety. Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 17 Other staff spoken with said they had recently had training in 1st aid, moving and handling and POVA. Certificates in the office confirmed that. The cook said they had undertaken food hygiene training. As noted earlier in the report medication administration training and infection control training has also been done by staff. Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38. Quality for this outcome area was good. People who use this service can expect to have their opinions sought and be protected by the practice in the home. This judgement was made using information available including a visit to the home. EVIDENCE: The registered manager has a number of years experience working in residential care and has attained relevant qualifications for the post they now hold. They have also undertaken a number of courses to enable them to train other staff in mandatory care practice training. The system for managing residents’ personal monies was explained by the manager. All monies are kept in the office safe and individual balances are recorded. The contents of three residents’ wallets were checked against the recorded balance. Two tallied but the third contained too much cash. Looking at the record an addition error was identified that corrected the amount. Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 19 A comprehensive quality assurance folder was seen and showed that the owners had audited each standard of the national minimum standards in March and July 2006. If they were not met an action plan was developed. Questionnaires for residents are given out annually and cover food and mealtimes, standard of care, staff attitude, activities, décor, cleanliness and medical care. The majority of responses seen were satisfied with the service offered by the home. One or two commented that the garden needed some attention. Questionnaires are also sent to other stakeholders such as health professionals who visit the home. One was given to a community nurse who was visiting on the day of inspection. As noted in a previous section of this report staff receive regular supervision that covers a range of issues. Some certificates for maintenance checks carried out on equipment were inspected. Fire alarms and emergency lighting are checked weekly and refrigerator and freezer temperatures are done daily and recorded, with the exception of the medication refrigerator. A fire risk assessment for one resident who is blind was seen and the procedure needed in case of a fire was clear. A generic fire risk assessment for the home stated that there was no source of ignition on the first floor of the home. As all the rooms have electricity this is incorrect. Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 20 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 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 Score 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 21 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 (1) Requirement The registered person must ensure that all assessed needs for a resident have details in their care plan regarding how the need is to be met. The registered person must ensure that the medication administration policy gives full guidance and reference to staff and protects residents. The registered person must ensure that the POVA policy is up to date and includes the most recent guidance from the Essex protection of vulnerable adults committee. The registered person must ensure that the temperature of the medication refrigerator is checked and recorded daily to ensure the refrigerator is functioning correctly for the storage of medicines. The registered person must ensure that the generic fire risk assessment is reviewed and written to reflect the true risks in the home. DS0000017869.V307064.R01.S.doc Timescale for action 05/11/06 2. OP9 13 (2) 30/11/06 3. OP18 13 (6) 30/11/06 4. OP38 13 (2) 13 (4) (c) 11/10/06 5. OP38 23 (4) (a) 05/11/06 Little Oaks Residential Home Version 5.2 Page 22 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 OP19 OP29 Good Practice Recommendations Steps should be taken to tidy the garden and dispose of garden rubbish and old furniture left there. A system for individual staff files should be established and documentary evidence retained of checks made on the identity of prospective staff. Little Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Oaks Residential Home DS0000017869.V307064.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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