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Inspection on 31/05/06 for New Ridley Road, 27-29

Also see our care home review for New Ridley Road, 27-29 for more information

This inspection was carried out on 31st May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Care is provided in a modern setting in a small residential development with the accommodation maintained to a good standard. Staff, many of whom have worked in the home several years are very caring.

What has improved since the last inspection?

The manager is nearing completion of the Registered Managers Award. She is working with a care manager and the mother of one service user to improve the standard of care planning in the home. A staff training plan is in place covering a range of training appropriate to the needs of service users. A quality assessment document is in use and the views of visitors to the home have been obtained.

What the care home could do better:

Generally the information available to staff for the provision of care is not comprehensive. Activity schedules are produced but little evidence is available that any meaningful activities currently take place. Nursing care tasks are performed without the correct procedures being in place to ensure service users wellbeing is maintained. Although staff are caring, they are often in insufficient numbers or without appropriate support to ensure residents activities can be undertaken regularly.

CARE HOME ADULTS 18-65 New Ridley Road, 27-29 27-29 New Ridley Road Stocksfield Northumberland NE42 2TN Lead Inspector Allan Helmrich Key Unannounced Inspection 31st May 2006 10:00 New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 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 New Ridley Road, 27-29 DS0000000613.V289800.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service New Ridley Road, 27-29 Address 27-29 New Ridley Road Stocksfield Northumberland NE42 2TN 01661 - 844112 01661 844 113 newlife.care@btinternet.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Newlife Care Services Limited Mrs Elaine Mary Coulson Care Home 9 Category(ies) of Learning disability (9) registration, with number of places New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. All persons may also have a physical disability Date of last inspection 2nd December 2005 Brief Description of the Service: New Ridley Road comprises two modern semi-detached bungalows connected internally by a communal lounge. The home is set at the head of a private road in its own grounds and provides ground floor accommodation for 9 adults with a learning disability, some of whom also have a physical disability. The home is owned by New Life Care. It was purpose built approximately nine years ago. All bedrooms are for single occupation, and the accommodation and furnishings are maintained to a good standard. Each unit has a kitchen and lounge/dining area. Bedrooms are not en-suite but have wash hand basins fitted. Residents have use of a mini bus to access educational, training and social events. The home is close to the centre of Stocksfield, with access to local transport systems, shops, leisure amenities and the wider community. The home does not provide nursing care. The home’s fees are £731 per week. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two visits lasting approximately 12 ½ hours. In that time the manager and deputy of the home were interviewed as were several care staff. The service users have limited abilities in communication but time was spent in their company assessing the quality of care they receive. Records were inspected and a tour of the premises was undertaken to assess the standard of the accommodation. Prior to the inspection information was provided by the home and questionnaires made available to service users and visitors were completed by one resident, assisted by a staff member and six visitors. Also prior to the inspection the inspector contacted three care managers for their views of the service. What the service does well: What has improved since the last inspection? The manager is nearing completion of the Registered Managers Award. She is working with a care manager and the mother of one service user to improve the standard of care planning in the home. A staff training plan is in place covering a range of training appropriate to the needs of service users. A quality assessment document is in use and the views of visitors to the home have been obtained. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information to assist prospective service users and their supporters is available to enable them to make a judgement about the home. Insufficient consideration has been given to the use of effective communication methods attempt to involve service users as fully as possible. The home needs to develop a more comprehensive admission process in order to meet the needs of service users. EVIDENCE: The home was able to provide a Statement of Purpose and a brochure with photographs and information useful to prospective residents. The case record of the most recent resident demonstrated that a pre admission assessment was conducted prior to a place being offered. The admission involved care managers and other healthcare professionals. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 9 Given the resident has virtually no ability to communicate, the information collected was not substantial. Little detail was collected regarding the resident’s personal history, interests and hobbies or preferences. This information is necessary in the production of an individual service plan. The file does not contain a photograph of the resident. Although residents’ communication abilities have been assessed and are recorded, currently these are not being developed using the latest techniques for effective communication. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents’ files do not contain all the necessary information needed as the basis for providing appropriate care. Responsible risk taking is supported by assessment. EVIDENCE: Three service plans reviewed were of varying quality. One plan recently produced by the manager, assisted by a care manager from the local authority and the mother of the resident was comprehensive and contained quality information to instruct staff in the provision of good appropriate care. In the other plans there were many gaps in the information provided. One had no photograph of the resident (this was addressed by the second visit), there was little information regarding past hobbies, interests or life history information. Each plan contained a daily routine however the routine was the same each day and for each resident. In practice a more flexible approach was observed during the inspection. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 11 The ability of each service user to communicate was assessed by the home using pictures and questions and the result is recorded in the service user plans. Most of the service users have regular family contact but for anyone without this contact advocates have not been considered. The home does not use communication tools or pictures but the manager is considering this. Each file contained a set of recently produced risk assessments associated with a proposed activity schedule. These are to be used to increase each service users opportunities. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Insufficient appropriate activities are provided by the home. Service users are not provided with regular opportunities to integrate into community life. Daily routines and staffing levels restrict independence. A good healthy and nutritious diet is provided. EVIDENCE: The company has restricted visiting to two hours to enable staff to provide a varied activities programme in the home. However when three service users’ diaries were reviewed, one demonstrated that a service user with minimal contact from relatives had not left the home for nine days and that activity consisted of watching television with other service users or listening to music. Neither of the other diaries demonstrated that a meaningful activities schedule is in place. Staff confirmed that activities are sometimes cancelled due to insufficient staff being on duty. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 13 A central area in the home that was used for relaxation is now rarely used as the special equipment is broken. Service users did visit a community centre in the village but this was closed recently and no substitute has been found. The home has specially adapted transport to enable service users to attend day services and visit places of interest, however only a limited amount of staff feel confident in driving the bus. Two staff on duty confirmed this. The manager is addressing this problem by re-arranging shift patterns. She has also arranged for day services to restart and is producing an activities schedule. The home tries to operate as two independent services but as the majority of service users require two staff to assist them then residents have to be moved from one side of the building to another to enable the remaining staff to supervise them. There is no call alarm system in the home. The home has two kitchens that generally operate independently. Both kitchens were clean and stocked with appropriate levels of food and equipment. The menus are varied and contain a range of nutritious foods. Drinks were offered throughout the day and a range of sandwiches were offered at lunchtime. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff who have worked in the home for several years provide good care based on their long term knowledge. Limited information (for new staff) is available. There is inadequate information to enable staff to meet residents healthcare needs. Appropriate systems are in place for the management and administration of medication. EVIDENCE: Many of the service users have complex medical needs. Although the mother of one service user is unhappy with the overall care provided in the home, staff do work with relevant professionals to meet service users needs, and this view is not typical. One care plan recently completed by the manager, assisted by a care manager and the mother of the service user is very specific and provides the basis for good care. Two other care plans reviewed did not provide the same standard of detail. Personal support is not specific and it could not be ascertained if one service user used a wet or electric shaver. The records for another service user who New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 15 has a device for specialist feeding, do not demonstrate how this is maintained. Not all staff are trained in PEG feeding and the necessary authority from the community nursing service is not recorded. The plan detailing personal support is the same for each day of the week and for each service user. The newest plan is individual and specific in the exact support required. The medication systems were examined for ordering, receiving, administering and disposal. These were found to be well maintained. Staff have received appropriate medication training and they are supported by the home’s policies and procedures. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place which enable staff to advocate on behalf of residents with regard to making complaints. Procedures are in place to protect service users from harm or abuse. EVIDENCE: A complaints procedure is provided to new service users in the home’s Service User Guide and there is a copy of this on the wall in the lobby of the home. The details relating to the commission should be amended. The manager is confident her staff would use the complaints process for any service user with no verbal communication. Each staff member has received training in abuse awareness and the manager has attended a more intense course. Local authority protocols are available for staff and those staff spoken to were confident about its use. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean and well maintained. Decoration and furnishings are domestic and bedrooms are individualized. EVIDENCE: The home is clean, well decorated and well maintained. Communal lounges are domestic in character and bedrooms are individualised. The home is light and airy and free from offensive odours. The grounds are tidy, safe and attractive. The mother of one resident is concerned that door handles are stiff making it difficult for her son to move freely throughout the home. Door handles checked did have strong springs and the door lock to a bathroom was broken. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 36. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Employment processes are not comprehensive and therefore do not ensure that residents are adequately protected. EVIDENCE: Of twelve care staff, eight have achieved a National Vocational Qualification (N.V.Q.) in care, although they have not all received a certificate yet. A range of training has been made available to the staff team recently and a training plan has been produced by the manager to highlight areas for improvement that will benefit the service users. A range of videos used for refresher training are retained in the home. All training required by current legislation is being brought up to date and in addition, recent training has included; capacity to consent and specific healthcare training. Information provided by the home prior to the inspection highlighted issues with the C.R.B. checks for staff. Two staff files were reviewed and no details of checks made by the C.R.B. were in place. The files did contain an audit sheet and two suitable references. Staff induction is recorded and notes of one-toone meetings between the staff member and manager are retained. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 19 Staffing rotas demonstrated that three to five staff are on duty during the waking day. During the first day of inspection only four staff were on duty due to sickness. In the afternoon a carer from another home arrived with transport to take some residents out. During the second day of inspection one carer was required to go with a service user (who was unwell) to hospital. A visitor commented that on many occasions less than five staff are on duty due to training and other things. Staff spoken to did not complain about staffing levels but did comment that activities were cancelled due to lack of staff and also because the staff on duty were not prepared to drive the new transport. The manager is currently reviewing the rotas to ensure a driver is available to take residents out each day. During inspections as stated in Standard 16, residents were moved from one area to another to enable the staff on duty to provide supervision. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems and processes in the home do not guarantee a good and consistent quality of life for the service users. The overall safety of the residents is reasonable. EVIDENCE: Although relatively new to management, the manager is nearing completion of the Registered Managers Award. In addition she has recently attended courses on risk assessment, appraisal and supervision and the protection of vulnerable adults. Staff are clear about their roles and work well as a team but the lack of quality procedures for the home reduces their effectiveness. Many of the current problems will be removed with the production of clear and precise care documents and processes supported fully by the community nursing service. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 21 The manager is conducting a quality audit in the home. Questionnaires have been sent to relatives and supporters of the service users and the manager is assessing the care provided against a set of standards. It is expected that this task will take several months to complete. Maintenance certificates are in place and to ensure the home is safe regular house audits are done. Appropriate insurance has been obtained. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 2 3 2 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 2 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X 2 X 3 X X 3 x New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 23 yes Are there any outstanding requirements from the last 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 YA2 Regulation 14 Requirement Timescale for action 31/12/06 2. YA3 14 Ensure that the information collected prior to the admission of a service user is comprehensive and is sufficient to formulate an effective care plan. This is especially important where the service user’s communication is poor and other information is not readily available to enhance the initial assessment. Review the information relating 31/10/06 to how each service user communicates. Develop communication tools to improve the ability of each service user to communicate. Use the model being trialled for one service user and add pictures and other modern aids as appropriate. Consider the use of advocates. Improve the information included in service users’ plans. Use the model developed with the local authority. Ensure the plans are individualised and that the staff team are involved before introduction. Once the plans are in place a monthly DS0000000613.V289800.R01.S.doc 3. YA6 15 31/10/06 New Ridley Road, 27-29 Version 5.1 Page 24 4. YA12 12 5. YA13 12 assessment should be written into the plan and any changes detailed. THIS IS AN OUTSTANDING REQUIREMENT THAT IS ONLY PARTLY MET. Produce an activities plan for each service user based on their needs and expectations. The activities should be appropriate to the service user and sufficient staff should be available to ensure the programme is regular. The area previously used for therapeutic activity should be reinstated or replaced. ELEMENTS OF THIS REQUIREMENT ARE OUTSTANDING FROM A PREVIOUS INSPECTION. Ensure that a proportion of each service users week is community based. Service users should access community facilities on a regular basis for shopping and personal grooming and this should be reflected in the activities plan mentioned in Standard 12. 30/06/06 30/06/06 6. YA16 4 7. YA18 15 To meet the home’s objective of 31/07/06 running the home as two separate entities and to encourage freedom of movement for the service users, sufficient staff should be on duty to reduce the necessity of moving residents from one area of the home to another throughout the day. An assessment of introducing some form of call/alarm system should be considered. Ensure that personal care 30/06/06 provided by staff is written specifically into the care plan. Regular reviews should be recorded. DS0000000613.V289800.R01.S.doc Version 5.1 Page 25 New Ridley Road, 27-29 8. YA19 15 Ensure that healthcare provided 30/06/06 by staff is written specifically into the care plan. Any procedures such as P.E.G. feeding supported by the community nursing service should be detailed specifically. The care plan should detail the consent of the nursing service, named staff trained to perform the task and details of that training. Regular reviews should be recorded. Ensure each staff member has an appropriate Criminal Records Bureau check obtained specifically for working in New Ridley Road. The Registered Manager should obtain the Registered Managers Award. 31/08/06 9. YA34 18 10. YA37 9 31/12/06 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 YA15 Good Practice Recommendations Visitors are restricted in their visiting to 2 hours a day to enable the home to provide activities. This restriction should be kept under review. New Ridley Road, 27-29 DS0000000613.V289800.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Cramlington Area Office Northumbria House Manor Walks Cramlington Northumberland NE23 6UR 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 New Ridley Road, 27-29 DS0000000613.V289800.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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