Inspection on 30/05/06 for Milton House

This inspection was carried out on 30th May 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Milton House 16/12/08

Milton House 14/02/08

Milton House 28/08/07

Milton House 12/04/07

Milton House 23/01/06

Milton House 19/09/05

Milton House 06/01/05

Milton House 09/09/04

Milton House 19/02/04

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

CARE HOMES FOR OLDER PEOPLE Milton House 58 Avenue Road Westcliff On Sea Essex SS0 7PJ Lead Inspector Christine Bennett & Pauline Marshall Unannounced Key Inspection 10:00 16th-30th May 2006 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Milton House Address 58 Avenue Road Westcliff On Sea Essex SS0 7PJ 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) 01702 437222 01702 436536 Mr Davie Vive-Kananda Manager post vacant Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 23/01/06 Brief Description of the Service: Milton House is owned and managed as part of the Strathmore Care group of homes. Milton House provides accommodation for 28 older people. The home has 24 single and 2 double bedrooms. Not all bedrooms have an en suite facility. There are 2 lounges and a dining room. There is a car parking area to the front of the building and a small secure garden/patio courtyard style area. Milton House is situated close to central Southend and has good access to local bus and train routes. The home has an up to date Statement of Purpose, Service User Guide, and a copy of the last CSCI inspection report in the entrance hall. A resident’s handbook is placed in each bedroom. The current scale of charges as at May 2006 is between £427 - £476 per week depending on dependency needs. Extras charged are for hairdressing, chiropody, toiletries and newspapers. Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key site visit was unannounced and took place on 16th May 2006 by two inspectors over a six and a half hour period. At this inspection all the key standards and the progress since the last inspection were assessed. As part of this inspection particular consideration was given to the standard of care of residents who have a history of falls or have been assessed to be at high risk of falling. A pre inspection questionnaire had been completed by the home prior to this visit. The registered provider and the training officer were available during the day, and the inspectors were assisted throughout the day by the home’s acting manager. A tour of the premises took place and a random selection of records and policies were examined. Time was spent with the residents, observing care practices, and conversation took place with many of them and any visitors to the home. A district nurse and an NVQ assessor were also visiting the home and gave their views. Staff were also given the opportunity to speak with the inspectors. Feedback was given to the acting manager at the end of the site visit. What the service does well: What has improved since the last inspection? Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 6 The home has an acting manager in post, supported by three members of senior management. She is committed to improving the standards of the home and people said that the home has improved since she started. The person in the laundry had a good understanding of the different temperatures to be used for various items, relating to infection control. The home has regular meetings for the residents, their relatives and the staff to seek their views on the running of the home. 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. Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Lack of detail in the pre admission assessment does not identify if the home can meet individual needs. EVIDENCE: The Statement of Purpose and Service User Guide have recently been updated to reflect the services that the home can give to future residents. These are displayed in the entrance hall, along with a copy of the last inspection report. The acting manager confirmed that admissions to the home are being arranged by the company head office. A new pre admission form has been introduced, which allows for a fuller history to be taken from a prospective resident to ensure that their needs can be met. This form and the referral form from Social Services are not always competed sufficiently, and are not particularly personalised to confirm that individual needs can be met. Prospective residents and their families have the opportunity to visit the home prior to admission, and a visitor confirmed that she and her mother came to the home Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 9 twice before moving in. The acting manager hopes to have a greater input into this procedure in the future. Intermediate care is not provided by the home. Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care planning does not always provide all the information to ensure a resident’s needs are met. EVIDENCE: The care plans were examined for three residents. There was no evidence to show that the residents or their relatives had been involved in the initial care planning or in subsequent reviews. All of the plans examined had shortfalls in details recorded, and the acting manager acknowledged that they did not identify all the care needs, risk assessments and their management. The registered provider is in the process of formulating a new plan and is incorporating the views of other health professionals before this plan is implemented in the home. This is intended to be a more comprehensive document for staff to use. Details of visits by professionals to residents are recorded in a communal diary. This does not provide confidentiality for the residents and the acting Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 11 manager, who had inherited this system when she took on her role, was keen to use an alternative method to protect the residents’ privacy. All residents have access to local health care services, and the acting manager was able to evidence situations when she had contacted outside professionals, including GPs, District Nurses, a continence advisor and an optician to seek advice to improve the well being of individual residents. One resident who had been living in the home for six months confirmed that she had received new glasses. A District Nurse was visiting the home during the site visit and confirmed that she felt confident in the care that was being given in the home, and that the staff always contact her if she is needed outside of the routine visits that she makes to the home. An outside training assessor, who was also visiting the home said, “I have never seen anything that concerns me”. A relative who visits her mother daily said, “They are good at getting medical help, they discuss it with me all the time”. Residents and visitors were happy with the care being given in the home. They confirmed that the home has a good laundry service and they always get their own clothes back. One visitor said, “The laundry is absolutely fabulous, she gets all her own clothes back”. Although the home does not have an allocated visitor’s room, residents can use their own bedroom to maintain their privacy and dignity. One resident confirmed that he had bought his own furniture and TV into the home for his bedroom, and some bedrooms were seen to have their own phone installed. The home has a medication policy and medication was stored correctly. The home must evidence that the medication policy and procedure are regularly reviewed and updated if necessary. Medication records were generally completed, although there were minor omissions on two of the five records checked. It was noted that the medicine trolley was left open with medication accessible to residents, whilst a member of the care team delivered medication to residents in their bedrooms on the first floor. Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome is adequate. The judgement has been made using available evidence including a visit to the service. Staff at the home do what they can within their resources and abilities to provide occupation for the residents, but there are long periods when they are not being stimulated/attended. EVIDENCE: The acting manager is committed to improving the occupation of residents in the home, and details of NAPA (National Association for Providers of Activities for Older People) were sent to her following the site visit. An activities programme is planned twice daily, and evidence was seen of a forthcoming clothes party, but the provision of any activity is dependant on the care staff having the time, and a visitor to the home said, “I think there could be a bit more on the activities front”. On the day of the site visit, most of the residents were in one lounge, as the carpet was being cleaned in the other one. The television was on, but nobody seemed to be watching it. Some residents were seen to be chatting to each other, and when asked how they spent their time, said, “Same old thing – nothing”. They spent long periods on their own, as the care staff were Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 13 assisting with kitchen duties and looking after individual care needs. A visitor confirmed that on occasions she has involved some of the residents in a group activity. One lady confirmed that she is enabled to fulfil her religious beliefs by a vicar coming each week to give her communion. The residents confirmed that they get a choice of food. There is no kitchen assistant, and a member of the care staff is allocated to give the morning drinks and ask the residents their choice for lunch. The menus seen did not actually reflect what was on offer. The cook has recently been appointed to the home and residents’ opinions differed about the food they receive, although generally it was positive. One resident said, “It is mediocre, not tasty or appetising, we don’t go hungry but we need a bit more variety, we get a lot of mince and sausages”. Another said that she would like cabbage but it took a week to order. A visitor said that her mother was happy with the food, she was offered a choice and there is a good variety. Other residents said that the food was marvellous, they get a choice and one lady said she has a glass of Guinness each day with her lunch. Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The home responds well to complaints and residents are protected by good understanding by the staff of POVA issues. EVIDENCE: The complaints procedure is presently under review by the Company. Two complaints have been received by the home since the last inspection. One related to missing laundry and the other related to the time a resident was assisted out of bed in the morning. Both had been recorded appropriately and had been satisfactorily resolved within the agreed timescale. An anonymous concern had been received by CSCI relating to pesticide control, cleanliness of the home and management of the home. These issues were investigated promptly by the service manager. The training officer for the company arranges training in the protection of vulnerable adults on a regular basis, and all staff spoken with, had a good understanding of forms of abuse, and the reporting of abuse. There have been no allegations of abuse in the home. Milton House DS0000015457.V293485.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Some areas of the home do no not provide residents with a well maintained, attractive and safe place in which to live. EVIDENCE: The acting manager is not aware of an annual redecoration plan. The registered provider has stated in a monthly report that a planned development is to be formulated for the home. On the day of the site visit, the garden was being tended by the maintenance person and a concrete ramp was in the process of being constructed to enable easier access from one of the lounge areas. One resident told how he liked to assist in the garden. This is an attractive area with a gazebo and tables and chairs for the residents. The entrance hall to the home has been reviewed with photos and names of the members of staff and generally looks attractive and bright. A new electronic device has been fitted to the front door to provide security for the residents. Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 16 Areas in the home needed attention – there was staining on the hallway carpet and some curtains were hanging off the rail. Many of the beds were of the hospital type, with a flat hard mattress. The acting manager confirmed that the call bell system needed attention. New tables and chairs have been bought for the dining area. The home was generally clean and tidy, with no unpleasant odours. Evidence was seen of a regular cleaning schedule. Two of the bedrooms seen randomly had an odour of urine. The laundry facilities are good and the person working in the laundry had a good knowledge of infection control, and safe practice in the laundry area. The kitchen area was in need of attention. The cooker was dirty and the training officer confirmed that a new cooker was on order for the home. The cook has had training in food hygiene in March 2006. However he depends on assistance from the care staff, both in the kitchen and in the serving of food. On the day of the site visit, fish had been stored in the fridge and not dated, a dirty tea towel was being used on which to drain dishes, and the rinsing water was not hot. These matters were brought to the attention of the acting manager. The home must seek advice on controlling infection, and ensure any training received has been adequate for individual needs. Milton House DS0000015457.V293485.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome is poor. This outcome has been made using available evidence including a visit to the service. Shortfalls in staff recruitment could put residents at risk. Staffing levels or deployment mean residents’ needs are not always being met. EVIDENCE: The acting manager spoke of good teamwork amongst the staff and they were seen to be friendly and kind to the residents. The residents, relatives and health professionals all spoke very highly of the staff team and the standard of care given. The recruitment files of three new members of staff were examined and there were shortfalls in the recording and processing of information. One had only one reference on file and another had commenced employment before there had been clearance from the Criminal Records Bureau. Another did not have a reference from either of the last two employers in this country, but a general reference from another country. A system that is not robust could potentially place the residents at risk. The CRB was not on file, and was bought from head office at the request of the inspectors. Care staff at the home are responsible for providing activities for the residents and also assisting in kitchen duties. The home must ensure that there are enough staff at all times to meet the needs of the residents. During the site Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 18 visit, a relative said that she felt there are not enough staff sometimes. She said that the call bell is not always answered quickly enough, or an additional staff member is sought, causing her relative to “have an accident”. A resident was in her bedroom and was seen to be calling out and choking on her breakfast. There were no staff around, and due to the layout of the home, it was some minutes before two staff were located in the main lounge. One was serving the mid morning drinks and the other was assisting the residents. In order to assist the resident, the lounge did not have a staff member present for a long period. The home has a training officer who arranges an induction and training programme for each individual member of staff. A portfolio system is being introduced for staff to record this training. The home must ensure that any training that has been received is adequate for individual needs. This relates specifically to food hygiene and infection control in the kitchen. The home recruits a large number of staff from abroad, and must clarify if any qualification they have achieved in their own country is the equivalent to an NVQ qualification, in order to meet the standards required in this country, and as stated in the Statement of Purpose. The home has been sent a memo by the director of the company to ensure that staff do not work excessively long hours. The duty rota of the home identified that some staff are working in excess of 60 hours per week and also that their roles either overlap with shifts that they are working in the home or in a sister home. The duty rota should accurately reflect the hours worked by each staff member Milton House DS0000015457.V293485.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has a more stable management structure in place, which needs to be formalised to continue the improvement since the last inspection. EVIDENCE: The acting manager has been in post since March 2006. She is committed to making improvements in the home, and these were seen at the inspection, despite being in post for a short time. She is being supported in this role by the registered provider, the training officer and the operations manager and she requires formal supervision to take place on a regular basis to evaluate her performance. A relative was very complimentary about her, saying that the home has improved and is more organised since her arrival. She spoke of her desire to consistently provide a high quality service and ways in which she Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 20 hopes to achieve this aim. The home must continue to endeavour to provide a permanent manager. Quality monitoring systems are in place, with residents, relatives and staff meetings taking place on a regular basis. A monthly report (Reg 26) was given to the inspectors by the registered provider at the site visit. The home has an efficient system in place to safeguard any money that it holds on the residents’ behalf, including record keeping. Checks revealed it to be accurate and up to date. The home has a good record of health and safety compliance. The home has an awareness and understanding of promoting equality and diversity when delivering a service to it’s residents. Milton House DS0000015457.V293485.R01.S.doc Version 5.1 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 3 X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14 Requirement The registered person must ensure that adequate documentation is in place to demonstrate that an appropriate assessment process has taken place to ensure that the home can meet all assessed needs prior to any admission taking place. This is a repeat requirement 2. OP7 15 The registered person must ensure that all residents have a current comprehensive plan of care in place. Care needs must be identified, how they are to be met, who by and how often. In addition, there must be evidence of regular reviews and appropriate changes made (if any). Documentation must be able to demonstrate adequate management of identified risk and all other associated care documentation must be maintained in a appropriate manner and be compliant with regulatory and NMS requirements. DS0000015457.V293485.R01.S.doc Timescale for action 01/09/06 01/09/06 Milton House Version 5.1 Page 23 This is a repeat requirement 3. OP9 13 The registered person must ensure the safekeeping of any medication held in the home This is a repeat requirement 4. OP12 16 The registered person must consult with residents and provide recreation to occupy their time This is a repeat requirement 5. OP19 13,16 & 23 The registered person must ensure that the environment and equipment within the home is in a good state of repair, be safe, suitable, adequate and maintained in accordance with regulatory requirements and the NMS. Full details are within report but include: All residents must have access to a fully functional call bell system. Old and worn furniture, fitments and fittings must be replaced with suitable and adequate replacements. Suitable beds for a residential setting must be provided. 01/09/06 01/09/06 01/09/06 Wardrobes must be fitted in a secure manner. This is a repeat requirement 6. OP26 13 Adequate universal infection DS0000015457.V293485.R01.S.doc 01/09/06 Page 24 Milton House Version 5.1 control management systems must be in place concerning the kitchen area. 7. OP27 18 The registered person must ensure and demonstrate that there are sufficient competent and skilled staff on duty at all times to meet the needs of residents. This is a repeat requirement The registered person must maintain an accurate rota within the home in accordance with regulatory and NMS requirements. Full details are within the report. This is a repeat requirement The registered provider must review the adequacy of current staff training within the home and/or the competence of staff. Full details are within the report. This is a repeat requirement The registered provider must operate a thorough recruitment programme to protect the residents 01/09/06 8. OP27 17 01/09/06 9. OP30 19 01/09/06 10. OP29 19 01/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations Records kept regarding daily menus should correspond with the food that is actually offered and be recorded DS0000015457.V293485.R01.S.doc Version 5.1 Page 25 Milton House accurately 2. 3. OP28 OP38 Evidence sought that qualifications gained in another country should be equivalent to NVQ 2 or above. Policies and procedures should be reviewed and updated if necessary annually. Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Milton House DS0000015457.V293485.R01.S.doc Version 5.1 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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