Inspection on 25/07/08 for Mont Calm

This inspection was carried out on 25th July 2008.

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 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

Mont Calm 19/12/07

Extracts from inspection reports are licensed from CQC, this page was updated on 28/09/2008.

CARE HOMES FOR OLDER PEOPLE Mont Calm 13 Shottendene Road Margate Kent CT9 4NA Lead Inspector Eamonn Kelly Unannounced Inspection 10:00 25th July 2008 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 Mont Calm DS0000071108.V365455.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 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. Mont Calm DS0000071108.V365455.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mont Calm Address 13 Shottendene Road Margate Kent CT9 4NA 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) 01843 221600 j.newell60@hotmail.co.uk Mr Stephen Anthony Castellani Ms Jacqueline Newell Care Home 31 Category(ies) of Dementia (31) registration, with number of places Mont Calm DS0000071108.V365455.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Dementia (DE) The maximum number of service users to be accommodated is 31. Date of last inspection 19th December 2007 Brief Description of the Service: Accommodation is provided for up to 31 people. The premises have twenty-five single and three shared bedrooms situated on 3 floors served by a passenger lift and two stair lifts. Communal facilities including four lounge areas are situated on the ground floor. The home is located in a rural area next to farmland and within easy driving distance of Margate town centre. On-street car parking is available at the front of the premises. Weekly fees are £389 and £500. The items not covered by fees include: clothing, toilet requisites, stationery, dry cleaning, hairdressing, chiropody, physiotherapy, newspapers, medical requisites (other than by prescription), spectacles, hearing aids, batteries, incontinence products and items of a luxury or personal nature; any other treatment or care requested by or necessitated by a resident’s worsening state or health not provided by the NHS, as well as certain forms of entertainment and outings. Mont Calm DS0000071108.V365455.R01.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 2 Star. This means that people who use the service experience good quality outcomes. The inspection took place on 25th July 2008. The methodology used to produce the report includes reference to the AQAA (annual quality assurance assessment) submitted by the manager, meetings with the owner, manager and members of staff and meetings with or observation of three residents. The inspection included a visit to most parts of the premises. Some records used in resident support were checked. A visitor also provided a view about how the service is conducted. The outcomes of the previous inspection report were checked. Checks were also made of information known to the Commission about the service. In keeping with the Commission’s policy of looking closely at specific regulations and standards from time to time, some emphasis was placed on this occasion on how well the service meets Standards 18 and 29 (protection and recruitment). The previous report contained four requirements. Good progress has been made in addressing these areas of practice. This report contains no requirements or recommendations. What the service does well: What has improved since the last inspection? The previous inspection report asked for the following issues to be addressed: • • • A programme of maintenance and decoration of the premises to be carried out. Systems in place to control the spread of infection including improvements to laundry procedures and facilities. Carers to receive an appropriate level of support to enable them to work effectively with people who have high dependency needs and DS0000071108.V365455.R01.S.doc Version 5.2 Page 6 Mont Calm • Improvements to be made in the ways residents are encouraged to remain more physically and mentally active. Good progress has been made in all these areas of practice, procedures and premises maintenance. 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. Mont Calm DS0000071108.V365455.R01.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 Mont Calm DS0000071108.V365455.R01.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. People who use the service experience good quality outcomes. This judgment was made using a range of evidence including a visit to the service. Prospective residents and their supporters receive initial advice and guidance to help them assess the facilities and suitability of the home. EVIDENCE: Prospective residents and their representatives receive assistance and guidance to help them decide if the home is able to meet their support needs. They receive a detailed written guide that contains information about services and facilities. All residents receive a personal contract that contains relevant information on the rights and responsibilities of both parties. Mrs Newell carries out an assessment of prospective resident’s support needs with assistance where necessary from Social Services’ care managers. Most residents have support needs associated with the on-set of dementia as well as substantial mobility problems and other disabilities. The care plan record Mont Calm DS0000071108.V365455.R01.S.doc Version 5.2 Page 9 begun at this stage outlines the support needs of the prospective resident and how these needs would be met. Two care managers provided useful insights into how residents are supported at this stage of admission. They gave their views at the beginning and end of their assessments. They were very satisfied with the support given to the residents they were assessing. The premises are not suitably equipped or staffed for the purpose of providing intermediate support (short-term recuperative care). Long-term care and short periods of respite care for residents are provided. Mont Calm DS0000071108.V365455.R01.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): 7-10. Residents who use the service experience good quality outcomes. This judgment was made using a range of evidence including a visit to the service. Residents receive good healthcare and personal support and care planning procedures assist in progressing this care. EVIDENCE: There is good information about each resident’s background in individual care plans. According to a carer, care plans are an increasingly effective operational tool for staff. The carer said that they are using care plans to identify the changing needs of residents and record how support should be provided. Resident’s care plans have a great deal of information about their support needs. In particular, the risk assessments in each resident’s personal file identify the relevant issues associated with the resident’s continuing support and, in the examples seen, have recently been updated. During the inspection visit, members of staff treated residents with understanding and respect. Discussions about the profiles of three residents and how they are supported also indicate a high level of understanding of and Mont Calm DS0000071108.V365455.R01.S.doc Version 5.2 Page 11 respect for clients. Where difficulties are occurring in the continuing support for some residents, there was evidence that care managers are involved in discussions and efforts are being made to find suitable alternative accommodation. Residents have good access, according to profiles of residents discussed during the inspection, to local NHS community services. There is close contact with local PCT nurses who, for example, provide and change dressings. A visitor who has a long-term association with the service said that residents receive very good social and healthcare support. She also said that carers have a good understanding of the effects of dementia and how to provide the personal support needed. Provision of aromatherapy (with the service included in weekly fees) is a recent innovation. Residents have good access to dentists, chiropodists and opticians according to current care plans. The assistant manager said that only those members of staff who have received specific training are allowed to administer medication and update MAR sheets. Medication records are completed when administration takes place. The AQAA states that resident’s weights are recorded monthly or more often if necessary. GP or dietician involvement is sought where there are concerns. Mont Calm DS0000071108.V365455.R01.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): 12-15. Residents who use the service experience good quality outcomes. This judgment was made using a range of evidence including a visit to the service. Residents receive support in keeping physically and mentally active. EVIDENCE: A visitor who has a long-term association with the service said that residents are supported in keeping physically and mentally active. Residents may receive visitors at any reasonable time and the home encourages this continuing contact. The AQAA states that increasing efforts are being made to involve resident’s family and friends in helping with day-to-day activities. Many residents have the on-set of dementia, mental health difficulties such as depression and other health problems associated with ageing. In some of the profiles discussed during the inspection, it was clear that members of staff are gaining relevant experience in working effectively with people who need specialist support. Some of this knowledge and experience is accruing from attendance on the RVQ Certificate in Dementia Care. Members of staff have a good understanding of each resident’s personality and disabilities and, for example, where a resident has very significant sight impairment a member of staff communicated very effectively with the resident. Mont Calm DS0000071108.V365455.R01.S.doc Version 5.2 Page 13 The AQAA states that residents and family members are encouraged to say what they feel and to give their views about any issue they feel affects them. Many residents were not able because of their dementia to give examples of particular activities promoted at the premises. There were a number of examples seen during the inspection that suggested they are helped to remain mentally and physically active. This included staff assisting a resident with a jigsaw puzzle, helping residents to walk, talking to residents, providing music and helping residents visit the garden. Care plans have been extended to include activities most likely to interest residents and efforts are made to provide these activities. Activities co-ordinators are not employed and carers provide the support thought to be necessary for residents. During the inspection there were four carers on duty rather than what is said to be the usual five. Despite this pressure on available staff time, there was a positive atmosphere and carers were working actively with residents at all times. Mrs Newell said that an aroma-therapist visits each Tuesday with half the residents receiving treatment on alternative weeks. Residents must be accompanied if they wish to visit their bedrooms or move outside the ground floor communal area. This is because of locks at most strategic points in the premises. The introduction of keypads to replace the previous locks and keys has improved this situation for residents and staff. Mrs Newell advises that movement without restriction is therefore limited in the interests of resident’s safety. There are four smaller lounges in this area and there are plans to convert one to an activities room. A member of staff said that residents are offered some choice for evening tea and this always includes a hot meal at this time. On this occasion, residents had a choice of mid-day meal. A record is kept where residents need assistance with meals, support during meals is provided and supplement drinks are given where necessary. A full-time and part-time chef is employed. The AQAA states that both will be encouraged to complete the Certificate in Dementia Care to gain an understanding of the needs of people with dementia. It also states that meals are served at two settings to enable those who need more assistance receive the attention they need. Mont Calm DS0000071108.V365455.R01.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. People who use the service experience good quality outcomes. This judgment was made using a range of evidence including a visit to the service. Residents are protected from abuse by the vigilance and expertise of staff. EVIDENCE: The AQAA states that those residents who can do so and all visitors are involved in saying how improvements would be of benefit to them. It states that use is made of a local advocacy service and quality assurance questionnaires are sent to families, friends and advocates. As outcomes of this consultation during the past seven months, outside services for aromatherapy, exercise classes and arts & crafts have been employed and, for example, new suppliers for fresh foods have been identified. Visitors have been made aware of the complaints procedure and a suggestions box has been placed in the hallway. A member of staff has received training in matters associated with POVA (protection of vulnerable people) and this member of staff provides training in this topic to all staff. Senior members of staff have a good knowledge of adult protection procedures followed by social services departments. The service has a complaint’s procedure that is understood by staff and, according to a visitor, relatives. Reference to this is included in the resident’s guide. The Commission has received no complaints about the service during the past year and the owners confirmed that no safeguarding issues are currently in progress. Mont Calm DS0000071108.V365455.R01.S.doc Version 5.2 Page 15 The annual quality assurance assessment (AQAA) states that members of staff are aware of all the necessary procedures relating to protection of residents. Specific training on the wider implications of POVA (protection of vulnerable adults) forms part of the improvements in staff training and development being put in place. The manager said she is aware of the circumstances where events affecting residents (ie. “notifications” under Regulation 37) must be reported in writing to the Commission. Mont Calm DS0000071108.V365455.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. Residents who use the service experience good quality outcomes. This judgment was made using a range of evidence including a visit to the service. The premises are suitable for use by frail older people. EVIDENCE: Since a new owner took control of the service in December 2007, many improvements have been made. The AQAA refers to, for example, • • • • • General improvements to the internal and external parts of the premises. Carpets replaced in the communal area of the ground floor. New furniture for lounge and dining areas. Replacement of a hoist and Replacement of some beds. The AQAA states that the following improvements will take place over the next 12 months: Mont Calm DS0000071108.V365455.R01.S.doc Version 5.2 Page 17 • • • New soft furnishings and further new bedroom furniture Carpets to replace lino/wood flooring in most bedrooms and Replacing of a lounge with a fully equipped “sensory” lounge. Essential improvements have been made to reduce the risk of infections. This includes the building of a new laundry room. An infection control nurse visited at the request of the manager and the advice given was, according to the manager, followed. During this inspection, there were no unpleasant odours. Two domestic workers were working successfully to keep the premises clean and tidy. The premises have twenty-five single and three shared bedrooms. Resident’s bedrooms are comfortable and well equipped as are the four lounge areas. The garden is suitable for use by frail older people. Two gazebo’s were in use in the garden. Radiators are covered for the safety of residents. Hot water outlets accessible to residents are temperature controlled and are manually checked each week for safety reasons. The AQAA contained declarations relating to safety checks and associated safety certificates being up-to-date. TV reception is poor on many channels despite connection of sets to a loop system; this is an area that will be improved for the benefit of residents. Mont Calm DS0000071108.V365455.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27-30. Residents who use the service experience good quality outcomes. This judgment was made using a range of evidence including a visit to the service. Residents are in the care of a staff group that is receiving opportunities for personal development to enable them to address resident’s support needs. EVIDENCE: The following staff are said to be on duty: • • • • Five care staff on duty every day (8am-8pm), Three care staff (awake) on duty at night. Two domestic staff every day to cover cleaning and laundry from 8am-2pm (4 overall to cover the 7 day week). One full-time and one part-time chef to cover the seven-day week (each does 7-5 or 7-5.30). During the inspection visit, there were 4 carers on duty. The AQAA states that a maintenance person is available five days a week. The manager said that she believes there are suitable numbers of staff on duty to meet the needs of residents. Staff files (and the statement in the AQAA) indicate that all job applicants complete application forms, references are taken up and CRB checks are carried out. The manager carries out formal supervision at appropriate intervals to a standard, she says, that meets Skills for Care (the training Mont Calm DS0000071108.V365455.R01.S.doc Version 5.2 Page 19 organisation for the care sector) requirements. This has led, during the crucial time since a new owner took control of the service, to the identification of specific individual training needs, enrolment on agreed courses and agreement of the types of longer-term RVQ/NCFE appropriate for the service. The staff rota is adhered to, according to Mrs Newell, to ensure that there are sufficient staff on duty at all times to meet the current assessed support needs of residents. She said she is confident that there will then be enough staff available to meet the support needs of residents. The reduction in staff numbers as seen during the inspection was said to be temporary. Good progress is being made on staff development. According to the AQAA, most carers have completed NVQ Level 2 in Care or equivalent. Members of staff are completing a further set of courses (RVQ and NCFE) to enable them to support residents with higher levels of dependency, for example, dementia. Some carers have completed the RVQ Certificate in Dementia Care. A member of staff said that an outcome is new insights into how people with dementia could be better supported and examples of such initiatives were discussed. Some members of staff are completing the RVQ certificate in equality and diversity. The training matrix indicates that members of staff are receiving certificated first aid training so that at least one first aid trained person is on duty during every shift. Since December 2007, most members of staff have received training in infection and control, food hygiene, COSHH, health and safety, moving and handling and protection of vulnerable people. Where available, RVQ/NCFE level training is obtained for staff. Mrs Newell said that this momentum on staff development would continue over the next twelve months particularly in view of the high occupancy level of people with dementia, mental health difficulties and other significant disabilities due to ageing. Mont Calm DS0000071108.V365455.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. Residents who use the service experience good quality outcomes. This judgment was made using a range of evidence including a visit to the service. Residents have the benefit of living in premises where the owner and manager are addressing the need to make improvements so that the home is run in the best interests of residents. EVIDENCE: It is clear (from improvements known to have been made in the meantime and research as shown in this report) that resident’s access to better social and healthcare has improved since the new owner took control took in December 2007. The commitment to quality assurance measures is improving the comfort of residents and their longer-term care and support. Mont Calm DS0000071108.V365455.R01.S.doc Version 5.2 Page 21 Where residents receive services that are additionally charged for, they are invoiced each month. In some cases, as seen during the inspection families provide monies in advance to meet these costs. Receipts are kept and accounts of all transactions are maintained. The policy of the home is that residents or a main supporter retain responsibility for their financial and legal affairs. Mrs Newell made a declaration in the annual quality assurance assessment (AQAA) that all safety certificates and checks are in place and up-to-date. This included the statement that all electrical appliances receive annual checks by an electrician and that appropriate certificates are maintained. Fire safety procedures are followed and fire safety records are, according to the AQAA, up to date. Mr Castellani and Mrs Newell are improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home. This report contains details of the important improvements carried out over the past year. An important aspect of this progress is the introduction of quality assurance surveys and acting on the outcomes of this consultation. They are aware of the need to promote safeguarding and have developed a health and safety policy that meets health and safety requirements and legislation. In the AQAA, they outlined the barriers to improvement and how they are overcoming these barriers. The support being provided to staff has gathered pace and the additional initiatives planned are designed to address operational barriers identified by the owners. Checks show that records are up to date. Recruitment procedures have improved as have the numbers of staff employed. Care plan records are extensive and the evidence is that these are becoming good operational tools for staff. Following the last inspection the manager submitted an improvement plan and the issues identified have been addressed. Mrs Newell has the experience and qualifications necessary for the successful conduct of a care home. The deputy manager has good experience of working with older people and holds a relevant qualification. Mr Castellani is the owner of six other care homes (in Folkestone, Lydd, Herne Bay and Canterbury) and the manager has the additional benefit of being supported by an area manager. Mont Calm DS0000071108.V365455.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 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 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 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 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Mont Calm DS0000071108.V365455.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Mont Calm DS0000071108.V365455.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Mont Calm DS0000071108.V365455.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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!