Inspection on 01/03/06 for Lyttleton House

This inspection was carried out on 1st March 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Lyttleton House 10/06/09

Lyttleton House 03/07/08

Lyttleton House 27/11/07

Lyttleton House 18/05/07

Lyttleton House 04/09/06

Lyttleton House 12/09/05

Lyttleton House 24/03/05

Lyttleton House 25/08/04

Lyttleton House 04/03/04

Lyttleton House 09/09/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE Lyttleton House 1 Ormond Road Frankley Birmingham B45 0JD Lead Inspector Monica Heaselgrave Unannounced Inspection 10:40 1st March 2006 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 Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Lyttleton House Address 1 Ormond Road Frankley Birmingham B45 0JD 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) 0121 460 1150 0121 457 7726 Birmingham City Council (S) Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. 6. That the home is registered to accommodate 29 people over 65 years who are in need of care for reasons of old age which may include mild dementia. Registration category will be 29 (OP) That minimum staffing levels are maintained at 4 care staff throughout the waking day of 14.5 hours. This condition has not been consistently met. That an application for registration of a manager is submitted by end May 2005. The home must adhere to a laundry policy, which ensures that soiled laundry is not transported through dining areas when meals are served or consumed. This condition is being complied with. That additional to above minimum staffing levels there must be two waking night care staff. This condition is being complied with. 12th September 2005 Date of last inspection Brief Description of the Service: Lyttelton House is owned and managed by Birmingham City Council and is registered to provide care for 30 older adults who may have mild dementia. The building is a bungalow construction and divided into three separate units, each with their own dining area, kitchen and lounge. Facilities briefly include 30 single bedrooms, the majority of which are less than 10 square metres and therefore cannot contain all the items of furniture specified in the standards. Each bedroom has a call system. There is a large communal area in which service users can socialise, this is equipped with a TV, video and music system. The home is situated on a corner plot in a cul-de-sac it has a beautiful open plan frontage with lawn, shrubs and flowers. There is level access to the front door and parking to the front and side of the property. Lyttelton House is located close to local shops and facilities, including public transport. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place between 10:40am and 1:45pm on a weekday. The inspector met with the assistant manager, three care staff, and nine service users. Some service users were unable to articulate their opinions of the care; intermittent observation of their care was undertaken. The lunch time period was observed, and a number of records inspected to include care plans, risk assessments, staff rotas, medication, finances, maintenance records, complaints records, staff meeting minutes and service user meeting minutes, accident records and staff training records. The inspector toured some parts of the three units. This is the second of two inspection visits made this year. Both reports should be read in conjunction in order to have a fuller picture of the service provided. What the service does well: The well-established assessment and admission procedures ensure that the needs of Service Users are known, planned for, and Service Users know what to expect from the home. Those service users spoken with said they were happy that the home would be able to meet their needs, because they had been well consulted. The management of health care needs is good. There are good systems for monitoring, and acting upon any concerns noted. Service users receive their medication in a safe and proper manner, and were seen to have access to the G.P and other health professionals, as they required. Service users who contributed to the inspection spoke fondly of the manager and staff team. They described them as “kind and helpful.” There are established procedures for maintaining service users contact with their family and friends. Some are supported to follow their religious preferences within the home. Staff training opportunities continues to be consistent which ensures staff are competent in meeting the needs of the service users. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 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. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 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 Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 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): 4, 5, 6 The well-established assessment and admission procedures ensure that the needs of Service Users are known, planned for, and Service Users know what to expect from the home. EVIDENCE: At the previous inspection standards 1, 2 and 3 were assessed, two of these were met. In order to meet standard 1, the Service User Guide required updating to include the correct name of the Commission, the manager details and a list of those bedrooms, which do not meet the spatial standards. At this inspection the Assistant manager was not able to confirm if this had been actioned, a copy of the Service User Guide was not available. The manager should therefore forward a copy of the updated version in order that this standard can be met. There is a well- established, pre- admission assessment process. This includes the Service User, their family, and any relevant professionals involved with the care of the Service User. Home visits or visits to the hospital where the prospective service user is residing, are undertaken to support this process. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 9 Trial visits are also undertaken enabling the individual and their family to visit the home, during this the assessment is added to and if considered suitable the individual is offered a place. Families are provided with the Statement Of Purpose and the Complaints Procedure, and have the opportunity to have any questions answered. Service Users spoken to described this experience, positively. Service users records were sampled and confirmed that an assessment of needs is undertaken, and developed into a Care Plan. The Care Plans viewed covered all aspects of needs, this included; mobility, health, risk of falls, continence, weight, manual handling needs, the use of aids or adaptations and social, religious and cultural needs. Those service users spoken with said they were happy that the home would be able to meet their needs, because they had been well consulted. Intermediate care is not provided as part of this service. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9, 11 Service users are protected by the policies and procedures for dealing with medicines. There are good policies and established procedures, which ensure that at the time of death, service users wishes are observed and respected. EVIDENCE: At the previous inspection three of these standards were met. At this inspection the arrangements for the management and administration of medication were assessed and found to be good. Audits undertaken demonstrated that the medicines had been administered as prescribed and recorded accurately. Systems had been installed to check all the medicines received into the home. A medicine policy was seen. All staff that handled medicines, had undertaken accredited training for the safe handling of medicines. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 11 Service users are able to undertake responsibility for their own medication within a risk management framework; currently no one self manages medication. Some service users expressed satisfaction regarding their medication being managed by the staff on their behalf, one service user said, “I have no trouble getting my medication on time, staff are really good.” The arrangements for supporting and respecting service users wishes with regard to their death were explored with staff, who demonstrated a good understanding in this area. There is a policy to guide staff, and some have attended training in this area. There is a good system in place to ensure the wishes and preferences of service users are explored, known and recorded. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 There are established procedures for exploring and maintaining service users contact with their family and friends. Some service users also benefit from contact with the local community, enjoying local day centres, and being supported to follow their religious preferences within the home. EVIDENCE: At the previous inspection three of these standards were met. At this inspection, the arrangements for maintaining service user’s links with their families and involvement with the local community were explored. Some service users were able to confirm that they could receive visitors in the privacy of their own rooms or in communal areas. The inspector also noted that those not able to express an opinion were enjoying the company of friends or relatives. Care plans that were sampled also confirmed that service users community links were known, recorded and maintained. These also contained details of important contacts such as family or friends. This ensures that family and friendship links are maintained. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 13 Some service users confirmed that they receive their mail, however none currently manage their personal and financial affairs independently. The reasons for this are also specified in their care plan. There is an entertainments committee who, with the service users, explore and plan any community activities that are requested. An activities list was also displayed. A church service takes place within the home every Sunday, and the local Vicar visits three monthly. Two service users currently attend local day centres. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17 There is a system in place to respond to complaints, but no record of the investigation or action taken, this makes it difficult to ascertain that all complaints are acted upon. Service users felt they would be listened to and acted upon. There are systems in place to ensure the legal rights of service users are protected. EVIDENCE: A complaints procedure is available which includes information for service users and their families for referring complaints to the Commission. Each service user has a copy of this procedure, which is in their bedroom. There is a record of complaints made, the last dated one being in November 2005, however there was no record of how this complaint was followed up, the details of the investigation or the outcome. A complaints log, should be introduced to include details of the investigation and any action taken. Service users spoken to felt that any complaints they had would be listened to. Senior staff had good awareness of service users legal rights, and had experience of issues such as Power of Attorney, and supporting people to access legal services. This information is stated in service users care plans. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 15 Currently no one utilises Advocacy services, family members undertake this role where necessary. Staff supports service users to vote in elections, and provide access to polling stations, individual service users engage in postal voting. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 16 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): 23 There have been several improvements to the environment, which service users are clearly benefiting from. EVIDENCE: At the previous inspection seven of these standards were assessed, three of which were met. Since the last inspection there have been a lot of new purchases, which the service users are clearly benefiting from. A selection of quilts, curtains, cushions, mirrors, a new fire surround, lamps, and mirrors, have been purchased making the bedrooms and communal areas more comfortable and homely. Service users are clearly happy with these changes, and informed the inspector that they were involved in the choices made. The inspector was informed that new beds and new carpets are ordered which will add to the comfort of service users. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 17 Previous requirements have been met in relation to accessing radiators to control the temperatures in service users bedrooms. An assessment of the premises has also been undertaken to ensure that service users have the equipment they require to maximise their independence, this has led to raised toilet seats being provided and a hand grab rail positioned in the toilet area. These improvements should be added to the premises assessment. The location of the laundry facility remains unchanged. Staff adhere to a laundry policy, which ensures that soiled laundry is not transported through dining areas when meals are served or consumed. Some bedrooms do not meet the standard in terms of size. This must be stated in the Statement of Purpose so that prospective service users can make an informed choice as to whether the size of the bedroom will meet with their needs. Service users spoken with were happy with their rooms, they felt they had sufficient space for their personal belongings, and new soft furnishings such as quilts, curtains had been purchased. They also informed the inspector that new carpets and beds had been ordered, and it was planned to decorate their rooms, these improvements met with their satisfaction. Service users had a lockable room and a lockable piece of furniture to secure their belongings, although only a few chose to utilise their bedroom door keys. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 18 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): 28, 30 There has been a period during which minimum staffing levels, necessary to meet the assessed needs of service users, have not been maintained. Staff training opportunities are evident, and have ensured that staff are competent in meeting the needs of the service users. EVIDENCE: Two standards were assessed at the previous inspection, one of which was met. A requirement was made to maintain minimum staffing levels of 4 care staff, in addition to a senior or manager throughout the waking day. On the day of inspection these levels were being maintained. Rotas were sampled and these demonstrated that minimum staffing levels have not always been maintained. At times the senior staff member makes up the 4th care staff on shift. There are currently staff vacancies of 35hrs, 15hrs and 10hrs (nights). These vacancies have been advertised. A viral infection has increased the staff sickness. Staff are also trying to take outstanding leave before the end of the year. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 19 Discussion with care staff identified their concerns with long shifts due to working overtime, one staff member was working a split shift on the day of inspection, and whilst some were happy to help out, most felt this was tiring. Clearly with the staff sickness and vacancies this has made it difficult at times to maintain staff levels, but every effort must be made to do so, and where this fails the Commission must be informed via regulation 37 so that this can be monitored. An immediate requirement was made for the Responsible Person to comply with the staffing requirements. The inspector was advised that the use of agency staff was being considered. Staff training records were sampled and showed that over 50 of the staff team have achieved NVQ Level 2. Two senior staff are waiting to commence their Level 3, and one senior member has level 3. There is a training and development programme, which ensures training targets are met to equip staff to meet the needs of the service users. Training undertaken since the last inspection has included, Dementia Awareness, Manual Handling, Food Hygiene, 1st Aid, HIV and Fire Training. This ensures staff who continue to develop their skills in providing good standards of care cares for service users. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 20 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 There has been a more settled and consistent management input which has led to benefits for the service users. The quality assurance system needs to be formalised to ensure it is an effective means of seeking the views of service users as to how well the service meets it’s aims EVIDENCE: An application for registration of the manager was received, meeting the conditions of registration. The manager was successful in her application for the registered managers position, and her registration will be processed pending a clear CRB (police) check. A new certificate of registration will be issued at that time. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 21 The manager has many years experience in meeting the needs of older persons, and has the Registered Managers Award. Lyttleton House has had a period of temporary management arrangements. The current manager has now been in post for over a year and has commenced establishing formal systems, such as quality assurance, based on seeking the views of service users, their families and other professionals as to how the home is achieving it’s goals for service users. Staff meetings and service user meetings take place, and it is evident that views are sought and acted upon. Lots of improvements to the premises evidence this. The inspector was informed that monthly audits (regulation 26 visits) are also undertaken to review practice and consult with service users, staff and visitors, however reports for these were not located on the day of the inspection. The results of service user surveys, and anonymous questionnaires should be published and made available to current and prospective service users it was not possible to establish whether this has been achieved. There should be an annual development plan, which reflects the aims and outcomes for service users. This was not seen. Whilst some of this information may be available, in different stages of progress, the manager should now collate this information and ensure it is an effective quality assurance tool. There are systems in place to safeguard service users money. Audits undertaken showed that records are maintained of all transactions, and receipts are kept. Those sampled showed that where service users lack the capacity to manage their own money, written consent is on file for the staff or the family to undertake this on their behalf. Care plans specify whether service users manage their own money. The service users spoken with at the time of the inspection were not in a position to manage their own money, but records showed that purchases are made on their behalf of items important to them. Current staffing shortages have impacted on staff receiving formal supervision. Records were sampled and these showed that eight supervision dates had been planned but were cancelled. Staff spoken to confirmed that short staffing impacted upon supervision. The management of accidents and incidents meets with requirements. There is a good system for monitoring ‘falls’, these are recorded on a monthly basis and reviewed as to the cause, and what preventative action can be taken, and whether it works. Service users are referred to the G.P. and to the falls clinic, where they may have a set of exercises to do, or are provided with aids to Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 22 assist them, such as raised seats, or grab rails. Staff are aware of those vulnerable in this area and care plans specify the assistance that should be provided. The management of safe working practices is good. Staff have received training on all safe-working practices to include manual handling, fire awareness, first aid and food hygiene. Certificates for the maintenance and upkeep of equipment, and records for the testing of water temperatures and fire tests are maintained. The well being of both service users and staff is promoted. Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 23 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 2 X X 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 3 10 X 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 X 2 X X 2 2 2 3 X STAFFING Standard No Score 27 2 28 3 29 X 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 3 Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 4 Requirement The Service User Guide requires updating to include the correct name of the Commission, manager details and those bedrooms, which do not meet spatial standards. This is a previous requirement. 2 OP16 17(2) S4 11 3 OP19 23 The Registered Person must 01/06/06 maintain a record of investigation and action taken, in respect of complaints made. Laundry facilities require relocation. Action plan to be submitted. This is a previous requirement. 4 OP22 23(2)(b) The assessment of premises must be added to, to include the environmental adaptations made. Room sizes do not meet the required standard. This must be stated in the Statement of Purpose, to ensure service users are informed of the space DS0000033561.V276390.R01.S.doc Timescale for action 01/06/06 01/06/06 01/06/06 5 OP24OP23 23(2)(f) 01/06/06 Lyttleton House Version 5.1 Page 25 available to meet their needs. 7 OP27 18(1) Minimum staffing levels must be 01/03/06 complied with as described in the conditions of registration. There should be an effective quality assurance system in place, the results of which are made available to service users, their representatives and the Commission. A written report on the conduct of the care home (Regulation 26 visit), must be available for inspection. The Registered Person must ensure that staff supervision takes place on a regular basis, and at minimum at least 6 times a year. 01/07/06 8 OP33 24 (1,2,3) 9 OP33 26(4)(c) 01/06/06 10 OP36 18(2) 01/06/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Lyttleton House DS0000033561.V276390.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!