Inspection on 31/05/05 for Oakland

This inspection was carried out on 31st May 2005.

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 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

Oakland 03/03/08

Oakland 19/10/07

Oakland 23/08/07

Oakland 08/12/06

Oakland 05/05/06

Oakland 31/10/05

Oakland 10/01/05

Oakland 27/05/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Oakland Oakwood House, Bury Road, Rochdale, OL11 5EU. Lead Inspector Tracey Devine Unannounced 31st May 2005 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 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. Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Oakland Address Oakwood House, Bury Road, Rochdale, OL11 5EU. 01706 642448 01706642389 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Highfield Home Properties Limited Care Home 40 Category(ies) of Dementia Elderly (over 65) 18 Old Age 22 registration, with number of places Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 40 service users to include:22 Older People (OP) 18 Adults with Dementia over 65 years (DE(E)). 2.That the service should employ a suitably qualified and experienced Manager who is registered by the Commission of Social Care Inspection. Date of last inspection 10th January 2005 Brief Description of the Service: Oakland is a care home providing personal care for up to 40 older persons aged 65 years plus in two separate units. One unit provides residential care for 22 older persons (over the age of 65 years) and is located on the first floor of the home. The ground floor unit is registered for dementia care for 18 older people over the age of 65 years. The home does not provide nursing care. Accommodation is provided on both levels of the home. All bedrooms are single with a number providing ensuite facilities. A passenger lift services both levels of the home. Oakland is situated approximately 1 mile from the town centre. A regular bus service to the town centre can be accessed within several minutes walking distance of the home. A small car park is available to the front of the home, with the provision of a larger one to the rear of the home. The home is well sign posted and clearly visible from the main road. Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 31st May 2005 by one inspector. A total of 7 hours were spent at the home. Time was spent time on both units, observing staff with the residents, and talking with 3 residents to see what they thought of the home. The Inspector had lunch with the residents on the residential unit. Time was also spent talking with staff, 2 relatives, the manager of the home, and looking at records kept. The areas looked at on this inspection were: how residents were looked after, what residents did during the day, how staff supported them with doing things; whether enough staff were employed, and if staff had received any training which helped them to do their job better. The home has been without a manager registered with the Commission for Social Care Inspection since May 2005. This lack of leadership has meant that staff have not been properly managed, or trained and many staff have left. This period has been difficult for staff and residents alike, and resulted in 5 complaints being made to the CSCI regarding poor care. Staff morale has been low, and some residents have not being looked after as well as they could be. The CSCI has received 5 complaints about the level of care provided and on investigation, some of the issues raised have been found to be true. The parts of the complaints that were found to be true related to poor and missing laundry, staff not taking care to dress residents properly, and medication not being given as prescribed by the GP. The CSCI has made 3 extra visits to the home since the last inspection, to check that the home has made the improvements identified by the CSCI. With the exception of some of the staff training needed, the manager has done everything that the CSCI asked to be done. What the service does well: On talking with residents and relatives, staff were said to be “friendly”, “patient” and “good humoured”. Some members of staff were named by residents and relatives as being very good. Observations made showed that staff and the residents got on well. The home is spacious and allows for residents to move around freely within the individual units. Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 6 The food is traditional and wholesome, portion size is plenty, and residents said they received enough to eat, sometimes “too much”. They said they enjoyed the food, and the menu was varied. 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. Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: None of the key standards were inspected on this occasion. inspected on the next inspection. They will be Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, In the main, care plans were detailed, up to date and reflected the care needed. However, staff were not always following the plans which meant that some residents personal and health care needs were not being fully met. The medication system was being adhered to ensuring that residents received their medication as prescribed. Personal support is offered in such a way that residents’ privacy is upheld. EVIDENCE: Individual plans of care are available and were seen include more detailed information than seen on previous inspections. 3 were selected for inspection. Of these, 2 plans clearly identified the level of care to be provided, and were up to date in respect of daily progress, completion of personal care chart, risk assessments, relatives involvement evidenced, and had been reviewed. The 3rd file contained a care plan which had been started, but had not been finished despite the resident having been in the home since February 2005. The manager was surprised by this has she said she regularly undertakes an audit ensuring that each resident has a care plan, and felt that a care plan had been in place for this resident. However, nothing could be found to support this. Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 10 Residents’ health care needs were documented, and it was evidenced that GP visits are noted, as are visits from chiropodists and district nurses. Nutritional assessments have been undertaken although the weight recordings looked at seemed intermittent. 2 of the care plans detailed that the resident’s weight was to be monitored monthly – recordings did not support such regular checks. 2 residents and 2 relatives were asked if they felt personal care was attended to properly. 1 resident was very clear that he did not receive a wash and a shave daily and said he “did not think it was much to ask for, a shave and a wash every day”. He said that he had mentioned it to the staff but still he did not receive a daily wash and shave.. On interview, it was also evident that this resident needed to have his fingernails trimmed. The resident said he was aware of this, and had asked the staff, but again “nothing was done”. 1 resident was unclear as to what his personal care needs were. This lack of awareness was probably due to his dementia. However, this resident had several days facial hair growth indicating that he had not had a shave for several days. Relatives spoken with said they were generally satisfied with the care provided, although 1 relative said she had asked for a daily shower for her husband and had been informed that staffing levels could not accommodate this frequency. She was unaware of just how often her husband was being showered as staff had not communicated with her any further in respect of bathing. The care plan for this resident was incomplete and did not detail any bathing needs. Another relative spoken with said she felt that her mum “should have tights on daily”, but staff did not put them on, she felt, as it made it easier for them to quickly toilet her mum. Residents wishes in respect of personal care must be upheld at all times. It was observed that a number of residents were not wearing slippers or shoes on the dementia care unit. This was causing distress to 1 resident who was looking for her slippers. Lack of appropriate footwear does not uphold residents’ dignity, and it may contribute to poor mobility and falls. Staff must ensure resident wear appropriate footwear. The medication systems at the home have been inspected several times in the last 12 months by the Pharmacist Inspector. During this time, the system has improved and all staff have now received medication training. The administration of the system was observed during this inspection and was satisfactory. Medication is stored safely. Residents, relatives and staff gave examples of how privacy is maintained at the home, and in the main the examples given were observed during the inspection – such as knocking on bedroom doors before entering, locking bathroom and toilet doors when in use, greeting residents by their preferred name, and assisting discreetly with meals. Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 11 Residents were encouraged to exercise and good practice was seen, during the inspection, of gentle chair exercises being done by some of the residents. Staff were observed to be acting in a natural and friendly manner with residents. Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 Social activities are in place and arranged so that residents on each unit receive some form of stimulation daily. Meals were well managed, providing daily variation, supporting choices for people living in the home. EVIDENCE: Of the care plans in place, details of the social and emotional needs of residents were identified, although as mentioned previously, not all needs were being met. Of those looked at, 2 care plans corresponded with information provided by residents and relatives. Preferred routines regarding rising and retiring are noted, and the interests residents have were detailed. Residents said they could get up when they wanted, and go to bed when they wanted. Observations made during the inspection supported this. An activities person is employed at the home although she has only just returned to work following a period of absence. In her absence, activities continued on both units. With the return of the activities co-ordinator the manager has drafted a new programme for activities on both units. The manager said she has yet to discuss this programme but she anticipates that the formal nature of it will ensure that activities are divided equally ensuring that activities take place on both units during the day. Recent activities have included a trip to the local pub, ball games/exercises, films and music. 2 Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 13 carers are to be insured to drive the minibus ensuring that outings may also be included. The home has an enclosed garden which is accessible to residents with “sitting out” furniture provided. The use of the garden seems to be less popular with residents on the residential unit as they need to walk through the dementia care unit to sit in it. The activities co-ordinator has not undertaken any formal training on providing activities to people with dementia. The activities co-ordinator should consider attending a training course on activities for people with dementia as this would enable her to put into place activities which are beneficial to people with dementia. A 4 weekly menu is in place and residents are offered a choice of food daily. The chef makes sufficient of each meal to allow residents a choice on the day. Observations of the meal times demonstrated residents choosing their meal. Residents and relatives were asked their views on the food served, the variety and the portion size, all commented favourably and felt the food served was good. Residents said they received enough to eat, sometimes “too much”. The menu evidenced vegetables served daily with the main meal of the day, fruit available daily either through desserts such as fresh fruit salad, bananas in custard, fruit crumble, or offered on the supper menu. The inspector sampled the food served at lunch time and found it to be hot, tasty and well presented. The choice offered was sausage and onions, or minced lamb with vegetables both meals served with mash and cabbage, followed by apple pie and cream or rice pudding. Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 17, 18 Systems were in place with regard to the investigation of complaints and adult protection issues, ensuring that residents were listened to and protected. Arrangements for protecting service users at the home are not satisfactory placing them at possible risk of harm or abuse. EVIDENCE: The complaints procedure is well displayed around the home, and in the Service User Guide. The procedure clearly sets out who to make contact with, and how the complaint will be progressed. The manager keeps a record of complaints made and how they are investigated and their outcome. 1 complaint is currently being investigated by the manager. In the last 12 months, the CSCI has received 5 complaints about the home. Some of the complaints were initially made by relatives to the management of the home but they were unhappy with the response received. As such they brought the complaints to the attention of the CSCI. Complaint elements related to poor care, poor laundry and missing clothes, poor communication and management of the home, and issues in respect of medication. The home has worked co-operatively with the CSCI when undertaking the complaint investigations, and the company has produced a plan of action following each complaint to address the issues raised. The company concedes that the numerous relief managers which the home has had during the last 12 months, has impacted on the continuity of leadership to the staff, and the provision of care for residents resulting in some standards of care falling below what is required. Following discussions with the company, CSCI has been undertaking Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 15 extra visits to the home to monitor that the company has implemented action required by the CSCI, and that such action has improved standards. A project manager has been in place at the home since March 2005, and will remain as manager at the home until a permanent manager is recruited. This has provided some stability to the home, and she has spent time ensuring that action required by the CSCI has been implemented, with the exception of some training for staff. Relative meetings have recommenced, and relatives spoken with said they felt the meetings where a positive forum for discussing matters generally, although all felt that if they had individual issues they would seek out the manager to speak to in private. Relatives spoken with said they felt the home had improved in recent months, and this is supported by findings of this inspection. At the time of this inspection, the CSCI was aware of a further complaint against the home which has yet to be investigated. Elements relate to poor personal care, missing laundry, medication, staffing levels, and poor communication between staff. The home has policies and procedures in place regarding the Protection of Vulnerable Adults and staff training regarding this subject should have taken This did not take place and a new date has been place on 17th May 2005. arranged. Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: None of the key standards were inspected on this occasion. inspected on the next inspection. They will be Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 The staffing levels meet the minimum required however, the arrangements for the deployment of staff were inadequate resulting in poor supervision of dementia care residents. Effective deployment of staff will ensure that care needs are met, and residents are safe. The vetting procedures for staff are not adequate, and potentially leave residents at risk. Only limited progress has been made to provide training on a range of subjects for staff. This has resulted in some standards being improved as staff put into practice their training, however, training in respect of dementia care has not been provided leaving staff untrained and lacking in appropriate skills and knowledge. EVIDENCE: The residential unit and the dementia care unit are staffed separately. For the residents on the dementia care unit when full with 18 residents, 3 staff are provided during the day time hours of 8am – 9pm. For the residential unit, when full with 22 residents, 3 staff are provided. At the time of this inspection, the occupancy on the residential unit was 16 with 2 staff provided, and the dementia care unit had 15 residents for which 3 staff were provided. Whilst these levels meet the minimum required, it was observed during the inspection that the morning period on the dementia care Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 18 unit was busy and all staff were assisting residents in rising until around 10.00am. This meant that residents who had already risen were left unattended and unsupervised in the dementia care lounge for significant periods. During this time, observation showed 1 resident to be aggressive towards other residents, and 2 of the residents were known to have numerous falls. As well as the lack of supervision to the dementia care residents, they also had no one to talk to for this significant period, and several fell asleep, and some wandered aimlessly around the lounge. The manager must review the deployment of staff to ensure that residents are appropriately supervised at all times. The importance of engaging with residents should be given greater emphasis with carers. The staff files of 2 carers were selected for inspection. 1 file contained no references although a police check was in place, and the 2nd file could not be found, although the manager said she had seen it and felt that it may have been taken from the home by another manager. The manager must ensure that all staff are suitably vetted and any documentation identified as missing, must be found/retrieved and kept at the home. There has been a high staff turnover and low morale in the last 12 months. The staff turnover has slowed down recently and staff spoken with said they felt the home was improving under the guidance of the manager and that staff morale was rising. A small number of staff have been working at the home now for some time, which offers some continuity for residents. Staff training has improved in the last 12 months with the majority of the staff group having undertaken fire safety training, and moving and handling training. Medication training has also been undertaken by those who are involved in administering medication. Training which should have taken place by 30th May 2005 was for the Protection of Vulnerable Adults, Food hygiene, health and safety, and first aid. Dementia care training was also due to be in place and undertaken by staff working on the dementia care unit. This training has not taken place, and this requirement from the last inspection is now outstanding. This lack of training particularly dementia care training means that staff are working without sufficient knowledge of the care to be provided to such a vulnerable group. Whilst residents said that staff were looking after them well, staff training is an area which needs prioritising. Residents and relatives spoken with were complimentary about staff and mentioned some staff by name as being particularly good. Comments such as “friendly”, “patient”, “understanding”, “having a good rapport”, “good humoured” were used to describe staff. Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: None of these key standards were inspected on this occasion. inspected on the next visit. They will be Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 20 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 3 COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 2 28 x 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 2 x x x x x x x x Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 21 NO 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 7 Regulation 15 Requirement Each resident must have a complete care plan in place which identifies fully the care to be provided. The care plan must be followed by staff, or reasons for it not being followed must be fully documented. A stratergy must be in place to support residents in maintaining personal hygiene if their dementia presents them as refusing such care. Staff must receive training in the Protection of Vulnerable Adults. (Previous timescale of 30th May 2005 not met) The deployment of staff must be reviewed to ensure that a staff presence is maintained in the dementia care lounge. Staff must receive training in respect of food hygiene, health and safety, and first aid. (Previous timescale of 30th May 2005 not met) Timescale for action 30th June 2005 30th June 2005 30th June 2005 2. 7 15 3. 7 15 4. 18 18 30th June 2005 30th June 2005 30th June 2005 5. 27 18 6. 30 18 Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 22 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 Good Practice Recommendations Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Turton Suite, Paragon Business Park, Chorley New Road, Horwich, Bolton, BL6 6HG. 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 Oakland F06 F56 S40406 Oakland V228693 31.05.05 Stage 4.doc Version 1.30 Page 24 - 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!