Inspection on 18/10/05 for Norwood 54 Old Church Lane

This inspection was carried out on 18th October 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Norwood 54 Old Church Lane 02/10/08

Norwood 54 Old Church Lane 22/09/06

Norwood 54 Old Church Lane 01/02/06

Norwood 54 Old Church Lane 02/03/05

Norwood 54 Old Church Lane 10/09/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 54 Old Church Lane 54 Old Church Lane Stanmore Middlesex HA7 2RP Lead Inspector Virginia Allen Unannounced Inspection 18th October 2005 1:00 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 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 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 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. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service 54 Old Church Lane Address 54 Old Church Lane Stanmore Middlesex HA7 2RP 020 8954 6498 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) Norwood Care Home 6 Category(ies) of Learning disability (6) registration, with number of places 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 Service User may have additional physical disabilities Date of last inspection 2nd March 2005 Brief Description of the Service: 54 Old Church Lane is located in a residential area of Stanmore. It is a registered care home that offers personal care to six service users who have learning disabilities. The organisation has voluntarily reduced this number to five so that the double-room need not be shared. The registered provider is Norwood, a national care organisation that specialises in providing services to people of a Jewish culture. The home is situated within a residential area of Stanmore. It is in keeping with other homes in the area. There is parking available in the forecourt for up to three cars, and on s8urrounding roads. Local transport links are shops are within 10 to 15 minutes walk. The building includes a lounge, a dining room, a ground-floor bedroom, a ground-floor shower room, four upstairs bedrooms, and a separate upstairs bathroom and shower room. Access to the first floor is by passenger lift or stairs. The home had a secluded and fair-sized garden. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection occurred on a cool Tuesday afternoon in early October. The service users were celebrating Sukkot and as a consequence, all of the service users were at home during the inspection. The inspector spoke with all of the service users. Those who could express themselves reported being satisfied with the home. The inspector also spoke with the support workers who were on duty and the deputy manager. The inspector would like to thank those who assisted with the inspection. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 6 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 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 7 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): 2,3,4,5 Individual aspirations and needs are assessed and prospective service users know that the home they choose will meet their needs. Prospective service users have an opportunity to visit and test-drive the home. A written contract and/or statement of terms and conditions are given to the service user. EVIDENCE: The home has not had the opportunity to admit a new service user for 2-3 years. However, the inspector noted the admission procedure and viewed the files of current service users. Prior to admission a prospective service user is given all of the information needed to help make a decision about where they want to live. The information outlines the purpose of the home and the ways in which the home is able to meet the needs of the service user. The prospective service user is encouraged to visit the home and to spend time at the home before they make their decision. The manager of the home makes a comprehensive assessment of the prospective service user’s needs to assist with the decision. The deputy manager told the inspector that assurance is given to the service user that the home could meet their needs before they are admitted. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 8 The inspector noted that each of the service user files contained their contract with their funding authorities and the organisation for the placement of the home. They also contained the terms and conditions of the home with the use of pictures and icons. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Service users know that their assessed needs and goals are reflected in their care plan. Service users make decisions about their lives with help and participate in all aspects of life in the home. Service users are supported to take risks as part of being independent. Their records are kept strictly confidential. EVIDENCE: From the detailed assessments, individual service user care plans are devised. Inspection of the care plans showed that they reflected the needs of the service user and their “likes” and “dislikes”. All aspects of the service users daily routine are recorded in their care plans, as are their support needs. Risk assessments covering a comprehensive range of activities are documented in each of the service user files. In particular each file had a missing person assessment of risk and a form with personal details of the service user and a photo ID that could be given to police in the event of a service user becoming lost during independent travel. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 10 During the inspection staff were observed treating service users with respect and dignity. They were called by their chosen names and staff were seen to spend time working out the service users wishes. Three of the service users were seated in the lounge room talking with one of the support workers. Service users were seen during the inspection moving about the house freely. The home has regular meeting at which the service user is encouraged to participate by giving their opinions on a variety of topics. These meetings are documented in a book that is kept in the office. Confidential information in the home is stored in lockable filing cabinets in an office that is also lockable. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Service users have the opportunity for personal development and are encouraged to take part in peer and culturally appropriate activities. Service users participate in the local community and engage in appropriate leisure pursuits. Service users are encouraged to have appropriate personal and family relationships and their rights are respected and responsibilities recognised. Service users have a healthy and appropriate diet. EVIDENCE: 54 Old Church Lane is a Jewish home for those with learning disabilities. Hence, service users participate in a range of festivals and observances in keeping with the Jewish religion. Service users are taken to the synagogue on holy days. For Shabbat each week, volunteers come to the home to prepare the table with items such as candles. Special prayers are offered and nonalcoholic wine is served along with the roast dinner. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 12 The Rabbi visits the home regularly to offer support and assistance to the home and the service users. Documentation shows that the service users are out and about during the day. Support workers assist the service user to participate in shopping, going to the cinema, attending concerts or going for walks. It is difficult for service users to participate in outside activities in the evening because the staff ratio is not adequate. This also applies to weekends when it is difficult to take service users to the synagogue due to lack of staffing. Activities within the home include weekly aromatherapy, weekly sing-a-longs, and professional massages. Service users are able to watch TV and video in the lounge or listen to music. One service user told the inspector that he enjoyed playing the piano. Another service user showed the inspector his stereo equipment in his bedroom. It was noted that permission was requested from the service user before entering their bedrooms. Service users have unrestricted access to the home’s grounds and during the inspection the service users were seen to be moving around freely. The house has a no smoking policy and this was explained to the inspector by one of the service users. The deputy manager informed the inspector that family are encouraged to visit the home. One service user visits his mother, and another visits his sister. One service user rings his brother. One service user has a sister who does not live in the area and one service user has no relatives at all. This service user has an advocate who visits weekly. Two other service users also have an advocate. Service users wishes’ concerning family contact is documented in the service user’s file. The inspector viewed the daily menu and talked with the deputy manager about special diets. In accordance with Jewish belief, all meat and dairy products are kept separate. This was reflected in the menu. Meat is Kasha. Items in the refrigerator that had been opened were dated. Fridge/freezer temperatures were recorded. Support staff are responsible for the cooking and during the inspection staff were observed preparing the evening meal. The inspector talked with several service users who told the inspector that they were happy with the meals. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 13 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 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): 18,19,20,21 Service users receive appropriate personal support and their physical and emotional health needs are met. Medications are given in accordance with safety standards. The illness and death wishes of the service users are documented. EVIDENCE: The service user’s individual likes, dislikes and wishes with regard to all aspects of daily care are clearly documented in their care plan. The inspector noted that service users are referred to a variety of professionals for advice such as chiropody, ophthalmologist annually, dentist 6 monthly, dermatology, psychiatry or for specialist therapy such as massage or aromatherapy. All service users have regular appointments with their GP. The home is supported by community health services. Referrals are made by the GP to relevant services. One service user was referred to the district nurse and now uses an air mattress. Two of the beds are adjustable. Referrals have also been made to the continence nurse. All visits are documented in the individual service user files. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 15 The home has two wheelchair users and has the appropriate wheelchair access within and without the building. There is an elevator for use between floors. The home weighs the service users regularly and reports any variations to the GP. The inspector checked the locked medication cupboard. This was organised and tidy. None of the medications were out of date. The medication charts were complete and met with the relevant standards. The issue identified in the last report relating to the recording of variable doses has now been rectified. The inspector spoke with a support worker who was trained to administer medications and she was familiar with the issue and the new rules for documentation. The inspector viewed documentation in the care plans relating to the service user’s wishes in the event of death. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 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 Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. EVIDENCE: The inspector viewed the complaints procedure, which was written in a format that is easy for the service user to understand. This is on display in the home and filed in the policy and procedure manual. There have been no complaints since the last inspection. A monitoring sheet is checked and signed monthly. The home has an Adult Protection policy and a Whistle-Blowing policy. All staff have received the Protection of Vulnerable Adult training and are committed to it. The inspector viewed system for the handling of the service users finances. Each service user has two forms. Form one form documents the money as it is given to the service user. Form two documents daily expenditure. The money documented on form one is kept in the home’s safe. The money for daily expenditure is kept in a purse and stored in a locked tin. Only the manager can access the safe. The support workers can access the tin for daily use. All money is counted and signed for at the 2pm handover of support workers. One support worker keeps his own change. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 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): 24,25,26,27,28,29,30 Service users live in a homely, comfortable and safe environment and their bedrooms suit their needs and lifestyles. However the upkeep of the garden needed a little improvement, and this was starting to be addressed. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms, with one exception, provide sufficient privacy and meet their needs. Shared spaces complement and supplement service users’ rooms and the home is clean and hygienic. However minor décor issues in the laundry area must be addressed. EVIDENCE: The home is situated in a quite residential area. The house is in keeping with the other residences in the lane. The interior of the home is domestic in nature as are the furniture and fittings. The carpet has been replaced in the lounge and the hallway in accordance with the requirements from the last inspection. The ambiance is homely and comfortable. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 18 The home has a reasonable sized back garden and the deputy manager reported to the inspector that the large shed is to be re-sited in the near future to provide a more welcoming environment for the service user. On the day of inspection it was noted that the lawn needed to be mowed and the garden area needed weeding. Two of the service users invited the inspector to view their bedrooms. These were comfortable and individual. They were decorated with the service user’s personal belongings. All bedrooms were lockable and the keys stored in the office. There is a bathroom with an electronically-operated bath seat and a shower on the first floor. There is also a separate shower. Both have a separate toilet and a sink. There is a shower room with a toilet on the ground floor. All of the facilities are lockable which allows for privacy. The locks can be over-ridden in an emergency. There was a requirement in the last report pertaining to the variability of hot water in the sinks. The deputy manager explained that this is being dealt with and a possible cause has been identified. The communal areas of the home are comfortable and homely. The home has replaced the sofas that were in need of replacement and has replaced the carpet that had been damaged. The kitchen, which is relatively new, is bright and airy. It was found during the unannounced inspection to be very clean and tidy. The laundry is small but adequate with a washing machine and dryer. The home has a passenger life and two service users use wheelchairs. There is a mobile hoist and an assisted bathing facility. There is a policy of infection control in the house. During the inspection the house was free from any offensive odours. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 19 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): 32,33,34,35 Competent and qualified staff that work as an effective team support service users. However there are at times insufficient staffing numbers to fully support service users needs. 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. EVIDENCE: During the inspection staff were observed interacting with the service users in the dining room and in the lounge room. The interaction was comfortable and the staff were polite and friendly towards the service users. The deputy manager informed the inspector that the manager had completed NVQ level 3 and was studying NVQ level 4. The home employed two support workers overnight. One is completing NVQ level 2 and one is studying nursing. During the day one staff member is a nurse, one has NVQ level 3, one has NVQ level 2 and two staff are study NVQ level 2. The inspector viewed the rota. Three staff are employed in the morning, two in the afternoon and two overnight. Two staff are employed for day shifts at weekends. Two staff for the evening and weekend shifts is not adequate if service users require 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 20 supervised outings. There was good evidence that the organisation are attempting to address this. In-service training is vigorous. The inspector was informed that all staff have been trained in the administration of medications, food hygiene, Jewish way of life, first aid, epilepsy, health and safety, protection of vulnerable adult and whistle blowing policy and risk assessing. There are currently no vacancies in the home. One member of staff is recently employed. The deputy manager assured the inspector that a current CRB check is required by the organisation before new staff are employed. They are also required to supply two recent references. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 21 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): 37,38,40,42 Service users benefit from a well run home. They benefit from the ethos of the management. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. The health, safety and welfare of service users are promoted and protected. EVIDENCE: The registered manager has completed NVQ level 3 and is currently doing NVQ level 4. He is also studying towards the registered managers award and the assessors award. The manager previously worked as a senior practitioner in another home run by the same organisation and has about ten years of experience working with people who have learning disabilities. He has applied for SCSI registration as manager. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 22 The inspector was told that the ethos of the home was that is was person centred and the promotion of independence of the service user. During the inspection service users were seen to mix freely with the home staff. Interaction between staff and service user was comfortable and friendly. The home’s quality assurance policy can be viewed on the web site at www.norward.org.uk The inspector viewed the policy and procedure documentation for the home. This contained the policies that govern the home and the care practice within the home. The documents were in keeping with regulations governing practice. The home’s health and safety certificates were inspected. Gas appliances certificate was issued on 17th June 05, Electricity 12th July 05, Legionella check 19th April 05, Passenger lift 24th February 05, Fires safety certificate 12th January 04 (this is due to be checked early 06), Fire alarm test certificate 7th October 05. The home’s fire procedure was on display. 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 23 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 3 3 3 Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 2 3 3 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 2 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 54 Old Church Lane Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X 3 X DS0000017551.V258153.R01.S.doc Version 5.0 Page 24 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 YA33 Regulation 18 (1) (a) Requirement Afternoon shift and weekend shifts need one more support worker to allow the service users the opportunity to pursue activities outside of the home. The garden needs to be weeded and the lawn kept mowed. Although the cause of the variable hot water flow has been identified, the problem needs to be rectified straight away. The laundry flooring requires replacement in the area where it is missing (a small section on the right-hand side on entry into the room) (timescale on 19/4/04 & 1/8/05 not met) The small but significant crack to the left-hand wall of the laundry room must be rectified, for appearance and hygiene issue (timescale of 1/10/05 not met) Timescale for action 20/12/05 2 3 YA24 YA27 23 (2b) 23 (2) © 15/11/05 20/12/05 4 YA30 16 (2) © 20/12/05 5 YA30 23 (2) (b) 20/12/05 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 25 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 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Harrow Area office Fourth Floor Aspect Gate 166 College Road Harrow HA1 1BH 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 54 Old Church Lane DS0000017551.V258153.R01.S.doc Version 5.0 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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