Inspection on 15/11/07 for Marula House

This inspection was carried out on 15th November 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Marula House 05/08/08

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

CARE HOME ADULTS 18-65 Marula House 54 Durham Road Manor Park London E12 5AX Lead Inspector Pauline Lambe Unannounced Inspection 15th November 2007 09:30 Marula House DS0000069527.V354204.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 Marula House DS0000069527.V354204.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. Marula House DS0000069527.V354204.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marula House Address 54 Durham Road Manor Park London E12 5AX 020 8514 3739 020 8514 3739 marulahouse@aol.com 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) Marula House Ltd Virginia Magagula Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Marula House DS0000069527.V354204.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Male whose primary care needs on admission to the home are within the following categories: 2. Mental Disorder excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 3. First inspection Date of last inspection Brief Description of the Service: 54 Durham Road was registered as a care home in 2007. The registered person had previously provided a care service for younger adults with mental health problems at a previous location. The service was relocated to 54 Durham Road and registered with the Commission and as a new service. The property is a terraced family type home situation in a residential road, with easy parking. The property provided three single bedrooms one with en-suite shower room. Adequate shared toilets and bathing facilities were provided. A comfortable lounge was located on the ground floor and a domestic type kitchen, which included laundry facilities. The property had front and rear gardens. The rear garden was well maintained, had shrubs and plants and seating provided. A staff room was provided on the first floor, which could be used as a visitor room. A service had a no smoking policy however residents wishing to smoke could do so in the rear garden. The current fees ranged from £750 - £1150 per week Marula House DS0000069527.V354204.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit for this unannounced key inspection was carried out on 15th November 2007. The manager was in charge of the service and assisted with the inspection. Three residents were living in the home and were seen during the course of the site visit. This was the first inspection of the service since it was registered. The inspection process included a review of the information held on file and provided by the registered person in the annual quality assurance assessment sent to the Commission. The premises were viewed together with care and safety records. Time was spent talking to the residents and a visiting professional. Surveys were sent to residents and relatives to obtain their views of the service however only two surveys were returned to the Commission. The service was well managed and a comfortable homely environment was provided for the residents. Residents were satisfied with the care and support staff provided and with the fact that they were able to make decisions about their lives. What the service does well: What has improved since the last inspection? What they could do better: Resident’s must receive written confirmation that based on assessment the home is suited to meeting their needs. Improvements were needed to medicine management such as the medicine policy and procedure must include management of drug errors and medicines for leave, two members of staff must sign had written entries they make on medicine administration charts, a current prescription must be available for all Marula House DS0000069527.V354204.R01.S.doc Version 5.2 Page 6 medicines administered to residents including topical medicines, staff must not transfer medicines from the original dispensed container to another container and staff must have access to up to date information on medicines. A lock must be fitted to the shower room on the ground floor. Gaps in the employment history of staff must be investigated. A medicine profile should be prepared for each resident and a protocol for the administration of ‘as required’ medicines provided. Staff responsible for the management of medicines should be are assessed annually as competent and evidence provided to show this had been done. Staff should receive updated training on safeguarding adults and medicine management. The registered person should check with the fire safety department as to how frequent fire drills should be held and to confirm that the fire safety training provided for staff is adequate. 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. Marula House DS0000069527.V354204.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 Marula House DS0000069527.V354204.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): Standards 2, 3 and 4. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were admitted based on an assessment of need and were welcome to visit the home prior to admission. There was no evidence to show that residents received written confirmation that the service was suited to meeting their needs. EVIDENCE: The care records for one resident were viewed and included a pre-admission assessment of need. A copy of the person’s community psychiatric assessment was also provided and a care manager assessment prior to admission. There was no evidence seen to show that prior to admission the resident received written confirmation that based on assessment the service was suited to meeting their needs. Requirement 1. Prospective residents were welcome to visit the home prior to admission. The care records viewed showed that the person had made a number of visits including a weekend stay prior to admission. Marula House DS0000069527.V354204.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): Standards 6, 7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans were prepared to show how needs were met and residents were supported and enabled to make decisions about their lives. EVIDENCE: One set of care records was viewed and included assessments and care plans. Work began on developing the care plan from the pre-admission assessments and during the trial visits. The care plans showed how assessed needs were to be met and the plan agreed with the resident. All of the residents were seen during the he inspection and all were happy with how their care needs were met. A visiting social worker was also seen and said that the staff team provided satisfactory care and support to the person she was involved with. Residents seen said they were free to do as they wished. All of the residents went out alone but were expected to let staff know when they were going out and when they would return. Risk assessments were completed relevant to residents care needs for example in relation to nutrition and smoking. Staff Marula House DS0000069527.V354204.R01.S.doc Version 5.2 Page 10 worked with residents to improve their quality of life and to enable them to develop personal skills with the aim of living independent lives. One resident seen was ready to move on to a less supported environment and said that staff in the home had helped him to achieve this independence. Marula House DS0000069527.V354204.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): Standards 12, 13, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were happy with the lifestyle they had in the home and the opportunities available for development of social and personal skills. EVIDENCE: A weekly activity programme was seen in the care records viewed. However this was met based on the resident’s choice and preferences. Residents were encouraged to attend local facilities such as the gym, swimming pool, library and other leisure activities such as cinema, restaurants and shopping. Residents said they had the opportunity to attend these activities but did so if they wished. Residents said they also enjoyed relaxing in the home listening to music or watching TV or DVDs. Residents were supported to maintain contact with family and friends. Two of the residents made regular visits to their family and often stayed overnight or for a weekend. Family and friends were welcome to visit residents in the Marula House DS0000069527.V354204.R01.S.doc Version 5.2 Page 12 home. Residents confirmed that this was the situation and that they were happy with the current arrangements to keep in touch with their family. Residents had keys to their rooms and to the home. Staff entered bedrooms only with resident permission. Daily records seen were very detailed and reflected resident’s ability to express their wishes and to have these addressed. Residents bought and cooked their own food. Residents were able to get up when they liked provided they kept appointments and commitments. Part of the support provided was to encourage residents to shop, prepare and cook nutritious meals independently. Staff offered assistance where needed and this was recorded in the care plan seen. Residents were expected to tidy the kitchen up after they used it. A diary was kept to record meals residents had on a daily basis. Residents were happy with the cooking arrangements and the system in place to store personal foods. Records were kept for fridge, freezer and food temperatures and showed these were kept within safe limits. The kitchen was clean, tidy and well organised. Suitable equipment was provided and was all in working order. Staff ensured that a high standard of hygiene was maintained in the kitchen. Marula House DS0000069527.V354204.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): Standards 18, 19 and 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems were in place to ensure resident’s health and emotional needs were met. Some improvements were required to medicine management. EVIDENCE: The care plan seen included how personal needs were to be met. Most of the residents were self-caring but were prompted by staff in certain areas such as attention to personal hygiene and appearance. Residents were satisfied with how personal care was provided. All residents were registered with a GP. In the care records viewed it was evident the resident had access to other professionals such as the dentist, optician and mental health team. All residents had a six monthly community psychiatric assessment or sooner if needed. Based on the outcome of this assessment care plans were reviewed and altered if needed. Residents met with their key worker for one to one sessions on a regular basis and staff completed a monthly progress report on the residents. Staff worked closely with the mental health team and care managers to ensure the care and Marula House DS0000069527.V354204.R01.S.doc Version 5.2 Page 14 support they provided to residents were appropriate. Residents and relatives were satisfied with how healthcare needs were met. None of the residents fully managed their own medicines. However they did this when they went on weekend leave. Staff encouraged residents to take some responsibility for medicines and residents were supported to come and ask for medicines rather than wait for staff to offer this. A medicine policy and procedure was provided but did not include what action to take when a medicine error occurred or for medicines when a resident is on leave from the home. Safe systems were in place to store and record medicines received into to home and returned for disposal. Medicines were supplied in blister packs on a monthly cycle and the chemist provided pre-printed administration charts. Administration charts were well completed and any gaps in administration explained. Entries made by staff on administration charts had not been signed by two people. The medicines and records for all three residents were checked and found to be correct. One resident had a topical medicine included on their administration chart by staff but there was no current prescription seen for this item. Staff transferred medicines from blister packs to other containers for residents to take when they were on leave. The manager was informed that this practice was not acceptable and she must discuss alternative arrangements with the chemist to supply medicines for residents going on leave from the home. Currently no controlled drugs or homely remedies were used in the home. There was no record to show when staff last received medicine training, however all staff had NVQ qualifications and this included medicine management training. Staff had access to an out of date BNF. A discussion took place with the manager in relation to preparing a medicine profile for each resident, having a protocol for administering ‘as required’ medicines and evidence that all staff responsible for managing medicines are assessed annually as competent. Requirement 2 and recommendations 1 and 2. Marula House DS0000069527.V354204.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): Standards 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Adequate systems were in place to manage complaints and safeguarding adults. EVIDENCE: A satisfactory complaints procedure was provided and included contact details for the Commission. A copy of the complaints procedure was included in the statement of purpose and service user guide. Resident’s aid they would discuss any problems they had with the manager or a member of staff. A system was in place to record complaints made about the service and to show the outcome. Since registration eight complaints had been made. Records seen showed these had been managed appropriately. It was reassuring to note that all complaints regardless of the significance had been recorded. This showed a willingness to listen to and respond to resident wishes. A satisfactory policy and procedure was in place in relation to safeguarding adults. The manager was aware of her responsibility to report allegations or suspicions of abuse to the local authority for investigation. Since registration no safeguarding adult issues had been reported. There was no evidence to show when staff had received training on this topic. See recommendation 2. Marula House DS0000069527.V354204.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): Standards 24, 27 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The property was clean, tidy and well maintained. Resident’s were satisfied with their environment. EVIDENCE: The property was clean, tidy and decorated and furnished to a good standard. The property was homely and provided a comfortable environment for residents. Staff recorded any repairs or health and safety issues and the registered person arranged to have these addressed. Prior to registration the home the property had been fully refurbished to meet its current use. The property had one bedroom with en-suite facilities, a bathroom and toilet on the first floor and a shower room and toilet on the ground floor. Bathing facilities were clean tidy and fitted and decorated to a good standard. The shower room door on the ground floor did not have a lock fitted, which may compromise resident privacy. Residents were satisfied with the environment and with their personal space. Requirement 3. Marula House DS0000069527.V354204.R01.S.doc Version 5.2 Page 17 All areas of the home seen were clean, tidy and odour free. Residents were supported to take part in keeping the property clean and particularly their own bedrooms. Staff assisted residents with this task and took part in the cleaning routines. Laundry equipment was located in the kitchen and residents were supported to do their own laundry on set days of the week. Marula House DS0000069527.V354204.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): Standards 32, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The staff team had the skills and experience needed to meet resident’s needs. Recruitment procedures were good and staff received relevant training and regular supervision. EVIDENCE: A manager and five support workers were employed. All staff had NVQ qualifications above level 2. Only one member of staff was on duty during the day and one waking person at night. An on-call back up system was provided at all times. The manager had two management shifts a week and on these occasions two staff were on duty. Three employee personal files were viewed. The files were well organised and contained all the information required by regulation. One application file showed the person had a gap in employment, which had not been explained. Requirement 4. The manager organised staff training and training needs were discussed during supervision sessions. Records seen showed for three employees showed that Marula House DS0000069527.V354204.R01.S.doc Version 5.2 Page 19 they had received training on moving & handling, life support, health & safety and food hygiene in the last three months. Other training such as safeguarding adults, fire safety and medicine management had not been provided but the manager said these topics were included in the NVQ training. Recommendation 2. Systems were in place to provide staff with regular supervision. From the records seen and staff comments supervision was provided monthly. Marula House DS0000069527.V354204.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): Standards 37, 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems were in place to ensure the safety of residents and others. Efforts were being made to introduce a quality assurance system and the service was well managed. EVIDENCE: The service was well run with effective management systems in place. The manager is to be complimented on her organisation skills. The manager was registered with the Commission and had the skills, qualifications and experience needed to manage the service. Residents spoke highly of the manager and presented as relaxed and comfortable talking to her. Staff meetings were held monthly and minutes kept. Staff meetings were used as training sessions for example a video on safeguarding was shown at the last meeting and a discussion held about the topic. Marula House DS0000069527.V354204.R01.S.doc Version 5.2 Page 21 Resident meetings and joint staff and resident meetings were held regularly. This provided a setting for open discussion to take place and for residents to interact with staff in a formal setting. Residents said that staff listened to them at meetings and responded to queries they had. The manager was working on a quality assurance system and had begun work on getting feedback on the service with the use of satisfaction surveys. Currently no internal audits apart from health and safety were being completed. The responsible person completed visits n line with regulation 26 and sent some reports to the Commission. The manager was aware of the need to complete a quality review of the service and to send any reports prepared to the Commission. How this standard is met will be reassessed at the next inspection. A health & safety policy was provided. As mentioned staff recorded maintenance issues and the manager arranged for these to be addressed. In house health & safety checks were completed monthly. Safety records viewed included gas, electricity, portable appliance and hot water testing. These records were up to date. The home did not have a fire alarm fitted. Smoke alarms were located at risk points and fire extinguishers provided. A fire blanket was provided in the kitchen. The fire safety department visited the home in March 2007 and were satisfied with the safety arrangements. The smoke alarms were tested weekly and one fire drill was held on 10th august 2007. A fire risk assessment was provided and should a fire occur the plan was to evacuate the premises. Therefore residents participated win fire drills. The manager should check with the fire safety department as to how frequently fire drills should be held. Fire safety training was provided using a video and discussion. The manager should check with the fire safety department that this training is adequate. Recommendation 3. Marula House DS0000069527.V354204.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 2 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 2 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 4 33 X 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Marula House DS0000069527.V354204.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? First inspection STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA3 Regulation 14 Requirement Timescale for action 31/12/07 2 YA20 13 The registered person must ensure that resident’s receive written confirmation that based on assessment the home is suited to meeting their needs. 31/12/07 The registered person must ensure safe systems are in place to manage medicines. • The medicine policy and procedure must include management of drug errors and medicines for leave. • Two members of staff must sign had written entries they make on medicine administration charts. A current prescription must be available for all medicines administered to residents including topical medicines. • Staff must not transfer medicines from the original dispensed container to another container. • Staff must have access to up to date information on medicines. Marula House DS0000069527.V354204.R01.S.doc Version 5.2 Page 24 3 YA27 23 4 YA34 19 The registered person must ensure that a lock is fitted to the shower room on the ground floor. The registered person must ensure gaps in the employment history of staff are investigated. 31/12/07 31/12/07 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 Refer to Standard YA13 Good Practice Recommendations The registered person should ensure; • A medicine profile is prepared for each resident • A protocol for the administration of ‘as required’ medicines is provided • And all staff responsible for the management of medicines are assessed annually as competent. The registered person should ensure staff receive updated training on safeguarding adults and medicine management. The registered person should check with the fire safety department as to how frequent fire drills should be held and to confirm that the fire safety training provided for staff is adequate. 2 3 YA35 YA42 Marula House DS0000069527.V354204.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Marula House DS0000069527.V354204.R01.S.doc Version 5.2 Page 26 - 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!