Inspection on 03/01/08 for Marwood

This inspection was carried out on 3rd January 2008.

CSCI found this care home to be providing an Poor service.

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

Other inspections for this house

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Marwood 57 Ashby Road Shepshed Leicestershire LE12 9BS Lead Inspector Keith Williamson Unannounced Inspection 09:30 3 January 2008 rd 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 Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Marwood Address 57 Ashby Road Shepshed Leicestershire LE12 9BS 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) 01509 600625 01509 600625 None Shankar Leicester Ltd Gaynor Fairbrother Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Marwood DS0000070333.V354613.R02.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 - Code PC To service users of the following gender: Either Whose primary care needs on admission to the home is within the following category: 2. Old Age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 18 First inspection of a re-registered service. Date of last inspection Brief Description of the Service: Marwood Residential Home is a care home providing personal care and accommodation for 18 older people. The home is situated on the outskirts of Shepshed and is easily reached by private and public transport. There is parking available in the grounds of the home. The accommodation is a modern two-storey detached house with a purpose built extension to the rear. A large conservatory and patio area overlook wellmaintained and private gardens, which are accessible for the Service Users. There is a mixture of single and shared bedrooms on both floors and some of them have en-suite facilities. The first floor can be accessed by stairs, a stair lift or by a passenger lift. The fees range from £325.00 to £450.00. There are extra charges for hairdressing, chiropody, newspapers and personal items. A copy of the latest Commission for Social Care Inspection, inspection report is available from the home. Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The focus of the inspections is on outcomes for Service Users and their views of the service provided. The primary method of Inspection used was ‘case tracking’ which involves selecting a sample number of Service Users and tracking the care they received through looking at their records, talking with them where possible, and looking at their accommodation, in this case three Service Users were chosen. This inspection took place over one day, commencing at 9.30am and took seven hours to complete. An opportunity was taken to look around the home, view records, policies and care plans and to talk to Service Users and staff. Information was gathered prior to the site visit from sources such as Service Users and their relatives. Further information was obtained from the Annual Quality Assurance Assessment (AQAA), which gives information on the home, and is filled in by the registered manager. Twelve of the Service Users were seen and four spoken with during the visit. What the service does well: The home is well situated, and has been extended to its present size. The building is tastefully decorated and well maintained. Staff were seen to be asking residents if they required their pain relief. Privacy and dignity for Service Users is good with appropriately fitting bathroom and toilet door locks, and staff who respect Service Users private space. Activities are provided for the majority of Service Users in the home. Visiting is unrestricted in the home. Menus are good homely cooking is produced by the cook following discussion with the Service Users, and meals suit the majority of Service Users in the home. Service Users who commented, stated We have a wonderful cook, and good food”, “the foods good I am happy with the one choice” and “they give me what I want, porridge and a poached egg on toast at breakfast, and sandwiches for tea, I don’t want anything else”. Service Users stated they had a number of choices in the home, a variety of areas in which to eat their meals being one. Staff were seen to relate well with Service Users, they respected their privacy and dignity being seen to knock and wait for permission to enter prior to Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 6 entering their private accommodation. Activities are provided for the majority of Service Users in the home. Staff recruitment is secure with all staff recently employed having the appropriate checks in place. 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. The summary of this inspection report can be made available in other formats on request. Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The assessment process for Service Users is not detailed or effective; resulting in a lack of accurate and detailed information for staff to ensure care needs shall be met. EVIDENCE: The Statement of Purpose, which sets out the latest aims, objectives and philosophy of the home, about its services, facilities, and current staffing, was available for inspection and is available for open viewing in the foyer of the home. There is currently no information from the quality assurance exercise undertaken recently. Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 9 Two of the three Service Users did not have an appropriate contract in place; one Service User stated, “I don’t know how much I pay”. All Service Users must have appropriate information supplied by the Responsible Person of the terms and conditions of their stay, prior to moving in the home. The assessment information for three recently admitted Service Users, was only partially complete, and was not adequate in providing the amount of detail from which a plan of care could be compiled. This places Service Users at risk of not receiving the care that they require. The home does not provide Intermediate care. Marwood DS0000070333.V354613.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, & 10 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Service Users are not looked after well in respect of their health, medication and personal care needs, areas of risk are not assessed appropriately, resulting in Service Users being placed at risk in the home. EVIDENCE: Care plans for the three Service Users did not include the detail for staff to enable them to undertake health or personal care on a consistent basis. All care plans viewed had single line enteries, which did not offer adequate instruction on care for Service Users. When asked staff stated they knew how to care for Service Users by “word of mouth from the report, before coming on duty”. Health care issues were not adequately detailed and no information regarding individual care toward weight monitoring, nutritional screening or pressure Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 11 area care even when a Service User had a special pressure relieving mattress in place. There were no risk assessments included in, or available to back up the plans of care. Medication was managed reasonably well, with no missing signatures in the medication administration records (these MAR charts are used to record what medicine has been given and when). Admission information did not contain details about medication or an individual’s health for all the Service Users, for example information for a Service Users medication was not filled in on arrival. Care plans did not include detailed and complete information on medication or health to allow management of an individual’s conditions. The MAR charts were well organised and had separators, but no photographs for different service users. The policy and procedure for medication has been reviewed recently, but does not contain enough explanation on how medication should be managed in the home. There was evidence that the privacy and dignity of Service Users was respected. Staff were seen to relate well to Service Users, to knock and await permission to enter prior to entering their private accommodation. Marwood DS0000070333.V354613.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service Users are offered positive choices for social care. EVIDENCE: There was no social care recorded in assessments, or plans of care, this resulted in Service Users not being stimulated on an individual basis and planned way. For example no details of the Service Users previous social interests or routines of daily living were recorded. There was some effort to provide food likes and dislikes along with information on diets. Some activities are taking place in the home, with a member of staff providing games such as bingo and dominoes. These are planned in advance, and the Service Users spoken with were happy with the current arrangements. Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 13 Some of the Service Users’ relatives and friends comments regarding trips out were indicating, (staff) “could provide a little more entertainment, and maybe an occasional outing” and “provide more entertainment both internally and organise some day trips”. But the opinion of the Service Users is that they do not wish trips out. Though perhaps the possibilities of one to one trips out could be explored with the group. Service Users spiritual needs appear well cared for with some going out to church, and a visiting curate undertaking communion. Meals are prepared by the cook, and a separate member of staff provides the teatime meal, which consists of a choice of a hot meal and sandwiches. The main meal at lunchtime does not provide a choice, however the Service Users are happy with the choice provided, stating, “We have a wonderful cook, and good food”, “the foods good I am happy with the one choice” and “they give me what I want, porridge and a poached egg on toast at breakfast, and sandwiches for tea, I don’t want anything else”. Service Users confirmed they had a choice of eating in the dining room, lounge or bedroom. Meals produced match the ethnic basis of the current Service User group. Marwood DS0000070333.V354613.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. Service Users are not protected by appropriate medication procedures or safe accounting of Service Users personal monies resulting in Service Users being placed at risk in the home. EVIDENCE: The complaints policy and procedure is up to date, and the contact details are available in the paperwork handed to all Service Users prior to admission to the home. There has been one complaint made to the registered manager, the details of which were not available to the inspector. These must be kept in the home, and made available at the next visit to the service. There have been no complaints forwarded to the Commission for Social Care Inspection. Staff have knowledge of protection of adult protection issues, however do not relate these to the inconsistent practices within medication administration and poor financial accounting of Service Users finances. Staff are aware of adult protection issues and are familiar with the terminology associated with this. It would be advisable for all staff to have refresher training to heighten their awareness of the broader issues involved. Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 & 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The premises are suitable for the stated purpose, being well maintained and offering a good standard of accommodation. EVIDENCE: The home is well decorated throughout with a number of public areas in which Service Users can meet with relatives and friends. At the visit the Christmas decorations were still in place, the home was pleasantly warm, and the Service Users relaxed. Service Users personal bedroom space, and public areas of the home were pleasantly decorated, and contained personal items such as photos and Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 16 ornaments. Adaptations and specialist equipment such as hoists and raised toilet seats were seen in place throughout the home Staff showed an awareness of cross contamination and cross infection issues. The wall and floor surfaces in the laundry area were hygienic and easily cleaned. Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service Users are not supported or protected by the low staffing numbers. EVIDENCE: On the day of the visit there were two care staff on duty as well as the cook, domestic staff and registered manager. The inspector observed a number of Service Users requiring a high degree of assistance with personal care. The registered manager confirmed five of the current Service User group need two staff to assist with mobility and hoisting. The current staffing levels are not adequate in achieving this. Service Users when spoken with indicated that there were times they had to wait for the call bells to be answered, one stating, “you ring the bell, but have to wait, sometimes I have to ring two or three times before they come”. The recruitment process is adequate with all staff now having an appropriate Protection of Vulnerable Adults pova(first) check and Criminal Records Bureaux clearance in place, prior to commencing work. Eight of the current care staff group are qualified to National Vocational Qualification level two or above, this equates to 72 of the total group. Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 18 Staff training is in place, though not all courses have taken place within the required timescales. The registered manager stated she would look at the current process, and ensure training was brought up to date for all staff. Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The management approach does not promote effective care, safety and financial practices in the home for Service Users care and protection. EVIDENCE: The registered manager has experience of working with the current Service User group, and is currently undertaking the National Vocational Qualification level four award. Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 20 The registered manager is aware of the categories under which Service Users can be admitted into the home. Quality assurance questionnaires have been distributed to Service Users and their relatives, those returned have gone directly to the Responsible Individual. This has resulted in no quality assurance information being fed back to the registered manager or being added to the Service User Guide. This is necessary to inform prospective Service Users to the service. The Responsible Individual visits regularly but does not produce a report of these visits. Service Users finances are not kept appropriately; of five seen, one balance and accounting was correct. Properly dated and accurate figures must be maintained to protect Service Users in the home. Staff supervision is not currently undertaken in the home. Staff spoken with confirmed there were staff meetings, which were recorded, though minutes of these were no available for viewing. A sample of Regulation thirty-seven reports (which are used by the home to inform the Commission for Social Care Inspection of serious incidents in the home) were viewed. There was found to be no correlation between the regulation thirty-seven reports, incident or accident reports and enteries in the daily records. Fire records including the weekly fire alarm tests, emergency lighting tests, and the servicing of fire appliances were all found to be up to date. The fire risk assessment was also seen this has also been updated. There are currently no risk assesments for personal care, hoisting, or for other general areas within the home. Other safety records viewed included the PAT (appliance testing for portable electrical appliances) and gas certificates; these had been recently completed. However both had outstanding work to be completed, or items to be tested. Staff must be provided with suitable changing facilities as it was noted that staff were using the laundry to change into their uniform, which may pose a risk of cross infection. Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 21 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 1 1 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X 3 X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 1 2 X 1 Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Not applicable 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 OP1 Regulation 4 (1) Requirement The Statement of Purpose (or Service User Guide) must include the feedback from any quality assurance exercise undertaken in the home. This is to ensure the Service Users and families are aware of the services offered in the home and the opinions of those living in the home. All Service Users must have a written contract or statement of terms with the home. This would enable Service Users and their families to be aware of any restrictions and costs placed on them whilst the Service User is in the home. Timescale for action 03/03/08 2 OP2 17 (1) 10/02/08 3 OP3 14 (1) No Service Users must move into 10/02/08 the home without having their needs properly assessed, and been assured those needs could be met. This would ensure Service Users could be assured the home is able to meet the their needs. Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 23 4 OP7 12 (1) All care plans must be sufficiently detailed to enable staff to fully care for individual residents personal social and emotional care. This is to ensure staff are aware of Service Users needs and preferences on an individual basis. 03/03/08 5 OP7 15(1) 13 (4) (c) The Service Users care plans and risk assessments must include details of ‘how’ staff observe and support individual Service Users in relation to mobility and safety. This is to enable all staff to understand Service Users’ individual needs. 10/02/08 6 OP8 12 (1) Care plans must be sufficiently detailed giving adequate instruction for staff to provide individual health care and monitoring to Service Users. This is to ensure Service Users are well cared for. 10/02/08 7 OP9 13 (2) There must be regular medication audits undertaken by a person experienced to do so. This to ensure Service Users medication is monitored and administered safely. 03/03/08 8 OP16 22 (3) The records of complaints must be kept in the home, and made available for inspection purposes. This is to ensure that full information is available on the process of complaint investigation. 10/02/08 Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 24 9 OP18 12.13 Staff must be made fully aware of the areas covered in adult protection. This is to ensure Service Users are protected in the home. 10/02/08 10 OP27 18 (1) a Staffing numbers must be such that Service Users are well cared for in the home. This is to ensure the protection of Service Users in the home. 10/02/08 11 OP33 24 Effective quality monitoring systems must be put in place, to ensure the development of the home is continual, and is to the benefit of Service Users. The outcome of any quality assurance exercise is used to inform any prospective Service Users to the home. This would provide prospective Service Users with the information to make an informed choice regarding a stay in the home. 03/04/08 12 OP33 24 03/03/08 13 OP35 17 (1) Residents personal finance records must be appropriately recorded and records checked to ensure all transaction are accurate. This is to ensure that financial abuse does not take place in the home. Staff must be appropriately supervised, and aspects of practice, the philosophy of the home, and career development covered. This would ensure staff employment policies, induction 10/02/08 14 OP36 18 (1) a 10/02/08 Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 25 and training were all put into practice in the home. 15 OP36 26 (1) The Registered Person must visit the home, and keep a written record of such visits. These must be produced at future visits buy the inspector. This is to ensure the registered manager is fully supported in the home. 16 OP37 17 Accident reports must correlate to entries in the daily records, and accurately reflect the accidents in the home. This is to ensure that records are completed appropriately for health and safety purposes. 17 OP38 17 (2) The outstanding work to the 10/02/08 periodic health and safety checks must be undertaken promptly. This is to ensure a safe environment for the Service Users and staff. 18 OP38 23 (3) a i Staff must be provided with changing facilities. This is to ensure staff can apply appropriate hygiene standards. 03/03/08 10/02/08 10/02/08 Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 26 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 OP15 Good Practice Recommendations It is recommended that a list of alternative meals is produced for use if Service Users request an alternative to the meal offered. Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Marwood DS0000070333.V354613.R02.S.doc Version 5.2 Page 28 - 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!