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Inspection on 19/06/07 for Manor Barn

Also see our care home review for Manor Barn for more information

This inspection was carried out on 19th June 2007.

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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

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

Staff have developed good relationships with people and are aware of how they like to live their lives. The home has a lot of personal information and work closely with other services to make sure they can support people. The information telling staff how people communicate is good and the manger and staff share a lot of information. Staff make sure people are able to choose a holiday each year that is suitable for them. This is very important to them. People like their home and feel safe. They have independent lifestyles that they enjoy and their choices are respected by staff. Staff get good support from the manager and senior staff.

What has improved since the last inspection?

New systems for recording risk assessments is being used that makes sure people are kept safe when doing activities. The number of staff on duty makes sure people are able to do the things they choose. The lounge carpet has been replaced and parts of the home have been decorated.

What the care home could do better:

Fire safety and other health and safety checks must be kept up to date to make sure people living in the home are safe at all times. When staff go to a training course it should be written on their personal training record so that the manager can plan future training to meet their needs. Staff should have their training needs assessed each year and personal targets agreed with them. A record of all complaint investigations and their outcome should be kept in the home.

CARE HOME ADULTS 18-65 Manor Barn Wattsfield Lane Kendal Cumbria LA9 5HF Lead Inspector Ray Mowat Unannounced Inspection 19th June 2007 08:30 Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 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 Manor Barn DS0000022687.V339821.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Manor Barn Address Wattsfield Lane Kendal Cumbria LA9 5HF 01539 735025 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) carol.pounder@oakleatrust.co.uk www.oakleatrust.co.uk The Oaklea Trust Miss Shelley Louise Stokes Care Home 5 Category(ies) of Learning disability (2), Learning disability over registration, with number 65 years of age (3), Physical disability over 65 of places years of age (4) Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 5 service users to include: up to 2 service users in the category of LD (Learning disabilities) up to 3 service users in the category of LD(E) (Learning disabilities over 65 years of age) up to 4 service users in the category of PD(E) (Physical disabilities over 65 years of age) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 6th July 2006 2. Date of last inspection Brief Description of the Service: Manor Barn is a converted barn, in a residential area of Kendal, Cumbria within walking distance of the amenities of the town centre. It is registered to provide residential care for five people with a learning disability, some of whom may have elderly needs or a physical disability. The accommodation is on three floors. There is ramped access to the property from a car park at the front of the building. There is a small garden to the front and a larger private garden to the rear of the building, which leads to a riverside walk. On the lower ground floor there is a self-contained flat, this has a lounge with a small kitchen/dining area, a single bedroom with fully accessible en-suite toilet and shower facilities. Also situated on the ground floor but separated from the registered accommodation, are several rooms used as offices by the Trust. The middle floor has three single bedrooms, two of which have en-suite facilities and showers. There is a large lounge/dining room leading to a kitchen and utility room. The upper floor has a self-contained flat with a single bedroom, with ensuite facilities and a lounge with kitchenette. Also on this floor is a staff sleepin room, which is also used as an office. The fees for the home are currently £642.60, with additional charges made for personal expenses such as toiletries. Inspection reports are made available to residents and their representatives on request. Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this inspection visit I met with four of the people living in the home. I also met with two care staff and a senior care staff who were on duty during the visit. I received four questionnaires from people living in the home. I also received feedback from relatives, Social Workers and other health professionals. I also visited the home on an unannounced random inspection in February 07 to check on progress toward meeting the requirements made at a previous key inspection. A copy of this report can be requested from the Commission For Social Care Inspection. What the service does well: What has improved since the last inspection? New systems for recording risk assessments is being used that makes sure people are kept safe when doing activities. The number of staff on duty makes sure people are able to do the things they choose. The lounge carpet has been replaced and parts of the home have been decorated. Manor Barn DS0000022687.V339821.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. The summary of this inspection report can be made available in other formats on request. Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s individual needs and preferences are assessed to ensure a suitable service can be provided. People are given sufficient information to make an informed choice about moving into the home. EVIDENCE: There have been no new admissions to the home since the last inspection. Assessments completed as part of the admission process have been kept under review ensuring individual needs are monitored and care plans updated to meet changing needs. Because the majority of referrals to the home are from a Social worker all the residents have a Social work assessment on file. There was also evidence of specialist assessments being completed by other health professionals in addition to the home completing their own needs assessment, which are all used to compile the comprehensive care plans. In particular the home have some excellent communication assessments, which are valuable for ensuring the staff understand residents needs and preferences and communicate with them in a consistent manner. All the residents had an up to date contract of terms and conditions signed and agreed by them or their representative and held on their personal file. Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are informative and reflect individual needs and choices, providing valuable information to staff to help them to give people personalised support and personal care. EVIDENCE: Detailed needs assessments are completed for all the people living in the home, these are kept under review so that any changes are recorded and the care plan is updated. The assessments reflected individual needs and preferences including the level of support people require to lead an independent lifestyle. Assessments and care plans are cross referenced to risk assessments to ensure people are safe. The assessments and care plans record information relating to personal care needs, health care, communication, medication, promoting independence and cultural needs. This ensures a personalised service is provided that responds to the diverse needs of people living in the home. Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 Page 10 A new risk assessment format has been introduced, which identifies hazards under five main headings. The hazard is identified as well as individual control measures that will minimise or remove the risk and also who is affected. The areas assessed are wide ranging ensuring people are kept safe, while enjoying a fulfilling lifestyle of their choice. Daily care records are completed by staff including more detailed reports of significant events such as healthcare appointments and contact with other services and agencies. Staff are then kept up to date with changes as they occur therefore ensuring a continuity of care is maintained. Based on my discussions with people living in the home and the staff and also from the written records, people receive appropriate support to access the health services they require. I looked in detail at three people’s personal files. They were well organised and easy to follow with up to date information. They had been agreed and signed by the resident or their representative and were kept under review. Each person living in the home has a key worker, who is a member of staff who works closely with them to develop a care plan that meets their individual needs and preferences. They develop a good understanding of the individual and will support them to lead an independent and fulfilling lifestyle. In addition to consultation with key workers there are regular house meetings when people make decisions about all aspects of home life. This was evident from my observations and discussions with people throughout the day, as one resident said, “It’s our house and we do what we want to do”. Personal and confidential information is securely stored at all times with staff having a good understanding for the need to maintain confidentiality both within and outside the home. Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living in the home are able to pursue their chosen lifestyle with appropriate support from staff. They are leading independent lives and their rights and choices are respected. EVIDENCE: Three of the people living at Manor Barn enjoy a high level of autonomy and lead an independent lifestyle both in the home and in the local community. Staff provide unobtrusive support taking on an enabling role and encouraging people to be more independent. During this visit I observed staff offering choices to people and respecting their decisions. Support and encouragement was provided to people to get involved with various household tasks, such as laundry, washing pots and shopping, which they obviously were keen to do and took great pride in achieving the task. A daily events record is maintained by staff that records when people have exercised rights and choices and Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 Page 12 recognition of any achievements. These reflected a good range of activities that people were involved with both in the home and in the local community. People are using the local amenities both independently and with staff support this might be a trip to the local shops, post office or enjoying a social visit to the local pub for a drink or a meal. A visit to a local social club where they can meet up with friends is another weekly activity some of the residents particularly enjoyed. The house overlooks some local allotments one of which was being rented by the home so that people could enjoy their interest in gardening. Two people in particular get a lot of enjoyment from this hobby. During this visit one of them returned from the allotment with some lettuce they had grown and were obviously very proud of their achievements. One person is effectively retired from vocational and educational activities and enjoys a sedentary lifestyle. This is respected by staff and responded to appropriately. People living in the home collectively fund a lease car, which has proved very popular and enables them to “get out and about in the local community” as well as going for longer day trips. Everyone had been on or had planned a one-week holiday, which they talked enthusiastically about and is something that they look forward to and get a lot of enjoyment from. Staff support people with all aspects of the planning and the booking of the holiday ensuring it is appropriate for them and their safety and welfare is maintained. The meals and mealtimes are very flexible and planned around the needs and preferences of the residents who have a lot of autonomy in the choosing and preparation of meals. Choices are confirmed using a pictorial menu book, which is good practice. Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Careful monitoring and documentation make sure personal and healthcare needs are being met. Staff also ensure people have access to appropriate health services when the need arises. Personal support is agreed with individuals and provided to them in their preferred manner. EVIDENCE: Through the one to one support and consultation by key workers, the development of individual care plans and regular house meetings, people are able to contribute to all aspects of home life and raise any issues that are important to them. People enjoy a lot of autonomy making individual choices on a daily basis. This could be what time to get up or go to bed or how they will spend their day. Routine and specialist health care needs are responded to as required. A good example of this was a recent assessment by a Social Worker for the visually impaired, who has subsequently provided aids and adaptations to make the home environment more accessible and to promote people’s independence Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 Page 14 with tasks. Another example of multi agency working was the development of guidelines for staff to support and guide their practice when dealing with violence and aggression. Regular review meetings are also held that ensure needs are monitored and changes in need are recorded and responded to. I examined the content of the medication cupboard and checked them against the records held. Medical record sheets (MAR charts) were up to date and had been signed as required. A record of all medication entering or leaving the home was also up to date. PRN procedures were in place for all “as and when” medication, to guide staff so that they all knew how and when to administer. Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Policies and procedures support and encourage good practice and safeguard people from abuse. EVIDENCE: Everyone living in the home is issued with an audio and typed version of the complaints procedure making it more accessible to them and more easily understood. Family or advocates are also encouraged to support people to raise any issues or concerns. Based on my discussions with staff they have a good understanding about their role in recording and responding to complaints. However there was a record of a complaint made to the home about the behaviour of someone living there, when they were accessing the community independently. The complaint was recorded but in the managers absence there was no evidence of how the complaint was investigated, if it was resolved and how it was fedback to the complainant. It is recommended a full record of complaints and their investigation is recorded and maintained in the home. There are suitable policies and procedures in place to safeguard people from mistreatment and abuse. Staff receive suitable training and have a good understanding of their role and responsibilities in relation to recognising and responding to suspicion of or actual abuse. Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Manor Barn is a safe and comfortable home. It is well maintained and has suitable facilities and equipment to meet the needs of the people living there. EVIDENCE: Since the last key inspection the lounge carpet has been replaced and repairs and decoration of particular areas of the home have been completed as required. A programme of planned maintenance is in place that should ensure the environment is safe and comfortable. Bedrooms have been personalised with people having their own furniture and belongings and choosing their own style of décor. People spent time both in their own rooms and in the communal areas of the home a choice which is respected by staff. Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 Page 17 Toilet and bathroom facilities are appropriate for the needs of the people living in the home with suitable aids and adaptations provided to promote independence. All areas of the home were clean and hygienic and there were no malodours. Some of the people living in Manor Barn are keen gardeners so they have rented an allotment that is opposite the home, which they particularly enjoy. They have planted vegetables and also take pride in planting and looking after some window boxes and planters outside the house. Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a settled staff team who have a good understanding of individual’s needs and preferences and how they want to live their lives, therefore providing a consistent and reliable service. EVIDENCE: I examined the staff rota for a three-week period. Absences were covered by permanent staff or relief staff ensuring there were sufficient staff on duty to provide appropriate support at all times. The allocation of staff hours was targeted at key times making sure there were enough staff to support people’s chosen activities and lifestyles. During a shift senior staff will allocate tasks and ensure a flexible approach so that individual needs are met and chosen routines are supported. Although the central training unit produce an individual staff training record for all staff members, it was evident from talking to staff and examining there files and training records, these were not an accurate reflection of training completed by staff. A good example of this was certificates of attendance on file in the home but no record of the course on the training record. Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 Page 19 This recording could be strengthened, by ensuring each member of staff has a personal training record that is kept up to date in the home and is available for inspection. I examined staff supervision records, which are held in the home. The manager or senior staff provide formal supervision to care staff on a regular basis. Records were detailed and reflected good practice with training and personal development encouraged and supported and policies and procedures clarified. Both parties signed the record with actions agreed. Although annual appraisals have taken place previously they were now overdue, so should now be reviewed and a personal development plan agreed. Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. On the whole the home is well managed and people are involved in all aspects of decision making and their rights are respected. Some routine health and safety checks were inconsistent and must be reviewed to maintain the safety of the people living there. EVIDENCE: The manager and supervisor have both completed their NVQ 4 and management development programme. They work closely together to provide support and guidance to the staff team, ensuring a consistent and reliable service is maintained for the people living in the home. Staff said “communication is good” and they got “good support”. Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 Page 21 Staff complete a handover checklist at the end of each shift to make sure all the tasks and checks have been completed including medication, finance and health and safety checks. Despite this system being in place there were some inconsistent records relating to the cleaning of showerheads, high water temperature records and emergency lighting. This is subject to a requirement. All safety checks must be completed in the required timescales and remedial action taken when hazards are noted to safeguard people living in the home. A formal Quality assurance consultation takes place on an annual basis with the home using a questionnaire in an accessible format (Widgit). From the results of this a house development plan was produced, which was shared with residents and other interested parties. Resident’s meetings and staff meetings are held on a regular basis where all aspects of home life can be discussed and actions agreed. Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 3 3 X 3 2 X Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA42 Regulation 13 Requirement All safety checks must be completed in the required timescales and remedial action taken when hazards are noted, to safeguard people living in the home. Timescale for action 07/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA22 YA35 YA36 Good Practice Recommendations A full record of complaints and their investigation should be recorded and maintained in the home. An up to date training record for each member of staff should be maintained in the home and be available for inspection. All staff should have an annual appraisal to review their performance and agree a development plan. Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Manor Barn DS0000022687.V339821.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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