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Inspection on 16/04/07 for Orchard Avenue 10

Also see our care home review for Orchard Avenue 10 for more information

This inspection was carried out on 16th April 2007.

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

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

There is a high standard of care provided to the people who live in the home. The residents say that they enjoy living in the home and there is a very good relationship between the manager, residents and the staff. There is a relaxed and friendly atmosphere and the premises are well maintained, safe and attractive. The people who live in the home are very appreciative of the meals provided and that they are always asked about what they would like to eat. Residents have comfortable, well-decorated rooms and are able to bring their personal furniture and other possessions with them when they move in to the home. There is a consistent group of staff who know the residents well and have formed good relationships with them.

What has improved since the last inspection?

The home has reverted to its registered number of three residents. The mental health status of the residents has been assessed by the G.P. Charts are being used to monitor when a person who is confined to bed for long periods, has their position changed. There has been an improvement in how medication is recorded. A communal dining and lounge area has been provided for residents who wish to socialise with each other. Formal staff supervisions have started, which will enable monitoring of performance and enhance their development in caring for people who live in the home. The Commission for Social Care Inspection is informed by the manager about significant events concerning the residents. A resident`s bedroom has been redecorated.

CARE HOMES FOR OLDER PEOPLE Orchard Avenue 10 10 Orchard Avenue Whetstone London N20 0JA Lead Inspector Tom McKervey Key Unannounced Inspection 16th April 2007 09:50 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Orchard Avenue 10 Address 10 Orchard Avenue Whetstone London N20 0JA 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) 020 8445 2014 Mrs Mabel Blanche Watkins Mrs Mabel Blanche Watkins Care Home 3 Category(ies) of Old age, not falling within any other category registration, with number (3) of places Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users with mobility difficulties who are unable to use the stairs may not be accommodated on the 1st floor of the home. 22nd November 2006 Date of last inspection Brief Description of the Service: 10 Orchard Avenue is a private care home, which was initially registered to provide personal care for a maximum of three older people. The provider/manager lives on site at the home and occupies a first floor bedroom. The homes stated aims are to provide a safe, secure, homely environment for older people, where they will be free from physical, sexual and emotional abuse. The home consists of a detached two-storey property, located in a cul-de-sac / private road, in a quiet residential area of Whetstone, Barnet. There are three single bedrooms, one on the ground floor, and two on the first floor. Following the recent death of one of the residents, a downstairs bedroom is currently being converted to a communal dining room. This was a requirement from previous inspections. There is a toilet on the ground floor, and a bathroom with toilet on the first floor. Also on the ground floor, there is a kitchen, leading to a conservatory, where the laundry equipment is located. There is also another small toilet downstairs. A small garden fronts the property and there is a large garden at the rear. There are good public transport links to the area. The fees for the service range from £470 to £578 per week. Following Inspecting for Better Lives, the provider must make information available about the service, including inspection reports, to people living in the home, and other stakeholders. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection, which took place over a period of three-and-ahalf hours, was carried out as part of the Commission’s inspection programme and to check compliance with the key standards. The manager and two members of staff were present during the inspection. There were two people living in the home and there was one vacancy, which the manager was hoping to fill in the near future. As part of the inspection process, I discussed specific issues with the proprietor regarding her training and qualifications as the manager of the home. I also carried out a full tour of the premises, visited both residents in their rooms, and talked to them about their experiences of living in the home, and interviewed the two staff about their work. I also spoke to a district nurse who was attending to one of the residents on the day of the inspection. I examined the residents’ files, the staff records and other documents that related to the running of the home. What the service does well: There is a high standard of care provided to the people who live in the home. The residents say that they enjoy living in the home and there is a very good relationship between the manager, residents and the staff. There is a relaxed and friendly atmosphere and the premises are well maintained, safe and attractive. The people who live in the home are very appreciative of the meals provided and that they are always asked about what they would like to eat. Residents have comfortable, well-decorated rooms and are able to bring their personal furniture and other possessions with them when they move in to the home. There is a consistent group of staff who know the residents well and have formed good relationships with them. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Residents’ care plans must be reviewed at least monthly and amended if necessary so that staff are aware of any changes in residents’ needs. Staff must enrol on training to at least Level 2 of the National Vocational Qualifications to ensure their competence to practice and to meet the needs of the people who live in the home. Staff must also undertake training in food hygiene to protect residents from harm. The manager must inform the Commission about how the home is to be managed if she is away for a prolonged period. Please contact the provider for advice of actions taken in response to this Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are given a Statement of Purpose/Service User Guide, which provides appropriate information to enable them to decide if the home will meet their needs. People are thoroughly assessed before, and at the time of admission to the home. The people living in the home are well cared for and say they are happy with the service they receive. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 10 EVIDENCE: There is an up to date Statement of Purpose/Service User Guide that describe the service and the fees charged. A named copy is provided in each resident’s room. Since the last inspection, one person had been discharged to a nursing home where their care needs were more appropriately met. As a result, the home’s previous authorisation to accommodate four people, reverted to the registered number; i.e., three people may be accommodated in the home. Following the death of a resident, there is one vacancy. No new residents have been admitted since 2004, but there was evidence in the case files that residents’ needs had been appropriately assessed before, and at the time of admission. Through observation and discussion with the two residents and reading their records, I was satisfied that their needs were being met in the home. One person told me that she was very happy with the service and said the staff looked after her very well. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 & 9. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a good care plan for each resident’s needs, but the care plans must be reviewed on a monthly basis to ensure that staff are aware of any changes in these needs. There is a good system for safely administering and recording medicines. Staff treat the residents with dignity and respect. EVIDENCE: Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 12 Both residents have a written care plan that includes an assessment of their needs and that provide guidance for staff about the care to be provided. Both residents had been recently assessed by the G.P regarding their mental health needs and there is a written record that he is satisfied that their needs are being met in the home. However, the care plans were not being reviewed every month and a requirement is made to address this. One person is mostly bed-bound but there was a record of her being supported to sit out for periods during the week. Pressure-relieving equipment was provided and a record kept of when this person’s position was changed whilst in bed. At the time of the inspection, this resident did not have any pressure ulcers. The other person living in the home has some mobility with staff supporting her to walk. During the inspection, she was being treated by the district nurse for a small pressure ulcer. The nurse told me she was very impressed with the care provided by the staff and would recommend the home to any potential service users. This resident also had appropriate equipment to relieve pressure. Risk assessments had been carried out regarding the occurrence of pressure ulcers and of falling and the residents’ weights were monitored monthly. Only one of the residents is on medication, and the records of the ordering, storage and administration of medicines, were checked and found satisfactory. A resident spoke highly of the care they received, and said that she was always treated with great dignity and respect. Staff were observed knocking on the residents’ doors before entering. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents have a lifestyle appropriate to their needs and abilities and they are able to exercise choice about their lives in the home. Relatives are welcome to visit people living in the home without restriction. The residents say they are very satisfied with the meals provided and a record is kept of what they eat, to ensure that they have a well-balanced and nutritious diet. EVIDENCE: There is no lift in the home, but the resident who is accommodated upstairs, is able to access the downstairs area and gardens with the support of the staff. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 14 Due to there being four people living in the home until recently, there was no communal sitting or dining room, which limited opportunities for the residents to share in joint activities. This problem has now been resolved since the number of residents reverted to three and a room that was being used as a bedroom, is currently being converted to a sitting room/diner. Both people who live in the home at present are frail and elderly and consequently, have limited ability to indulge in physical activities. One resident who is visually impaired, described various radio and television programmes she liked. She also said that a member of the staff often reads books and newspapers to her and she is also able to access the downstairs area and go outside with staff support. There is a television in each resident’s room, which the person who is generally bed-bound, was watching with interest during the inspection. Residents are able to go to bed and get up when they like and they said that staff always ask them what they would like to wear, what to eat and how they wished to spend the day. I noted that there were daily records of how the residents spent their day, including regular visits from their relatives. There is a book for recording visitors to the home. There is no planned menu, but the person who was able to converse, confirmed that she is asked each day what they wished to eat and was very satisfied with the meals. Hot and cold drinks are available on request and fresh fruit was provided. None of the residents require specific ethnic meals and one person has their food liquidised. A record is made each day of what residents actually eat, which showed that they have a varied diet and adequate nutrition. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A resident said that they feel safe in the home and are confident that any complaints would be properly addressed. The staff have been trained in, and were able to demonstrate awareness about adult protection issues. EVIDENCE: The complaints procedure is attached to the residents’ contracts and there is a book for recording any complaints. There is space in the complaints book for recording the response time and the outcome of any investigations. No complaints were logged in the complaints book and the manager said there were no outstanding complaints at the time of the inspection. A resident to whom I spoke, said, “I am very happy living here and I feel safe. The staff are wonderful”. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 16 The local authority’s adult protection procedure is available in the home, and the staff have attended training in adult protection procedures. The two staff on duty were able to describe the procedures and demonstrated a good awareness about their responsibilities to protect residents from potential abuse. I observed how staff interacted with the two residents. They showed a friendly and caring attitude to them. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well maintained, clean and comfortable home and their bedrooms meet their needs. There is good standard of décor throughout the home and there is an attractive garden for the residents to enjoy. The people who live in the home now have a communal area in which to meet and socialise. EVIDENCE: Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 18 I visited all internal and external areas of the home. Since the last inspection, both residents now have single rooms, one downstairs and one on the first floor, both of which were attractively decorated. (One bedroom had recently been refurbished). There was evidence of personal possessions and mementoes, which residents had brought with them when they came to the home, and each person had their own television. A downstairs room that was previously used as a bedroom was in the process of being converted to a communal lounge/dining room for the people who live in the home. This provides somewhere for the people who live in the home to meet and socialise if they want to. This was a requirement at previous inspections. The gardens, flowerbeds and hanging baskets were particularly attractive and enhance the overall appearance of the home. There is also a large summerhouse in the garden. There is a washing machine and drier in the conservatory. The care staff are also responsible for cleaning. All areas of the home were very clean and tidy and there were no offensive odours. The manager informed me that a person is employed on an as and when basis to carry out routine maintenance, and at the time of the inspection, no maintenance problems were identified. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28 & 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There is sufficient staff available to meet the needs of the people who live in the home. None of the staff have attained a National Vocational Qualification, which could compromise their competency in meeting the needs of residents. The staff have attended some training courses. However, none of the staff have been trained in food hygiene, which could pose a risk to the health and safety of the residents. EVIDENCE: No new staff have been employed since the last inspection. The staff have been together for a number of years and are experienced at caring for older people. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 20 At the time of the inspection there were two residents living in the home and there was one vacancy. The rota for the day accurately identified the two staff who were on duty during the inspection. The rota also showed that there is normally two staff on duty during the day and one on waking night duty. This often includes the manager who lives in the home and provides “hands-on” care. She is also available for advice and assistance if required during the night. A resident to whom I spoke, said that staff were always on hand to offer them support immediately. When checking the staff training records, I saw evidence that they had attended courses on moving and handling, fire safety, control of infection and adult protection procedures. However, no one had been trained in food hygiene. None of the staff who work at the home have attained a National Vocational Qualification, which is a requirement in the National Minimum Standards. The manager told me that she was having difficulty “getting staff to go on training”, but when speaking to the staff, they told me they were keen to go on training courses. A requirement is made for training on these subjects to take place. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 35, 36 37 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the provider/manager is experienced at managing the home, she does not have the qualifications required by the National Minimum Standards, which could result in the home not being run efficiently in the best interests of the people who live in the home. There is a relaxed and friendly atmosphere in the home and there is a positive relationship between the manager, staff and the people who live in the home. Residents are safeguarded by either managing their own financial affairs, or their representatives doing so on their behalf. Regular staff supervision takes place, which enables good practice to be developed and monitored. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 22 There have been improvements in records kept in the home, particularly in care plans and medication, which helps to safeguard residents’ welfare. There are good systems in place to protect the health and safety of the people who live in the home, visitors and staff. EVIDENCE: The registered provider/manager has very many years experience of running the home. However, she has no formal qualifications, and she stated that she was unwilling to undertake the National Vocational Qualification, level 4, or equivalent qualification. The manager told me that she has been in contact with a person from an independent training agency who might provide administrative support to help with the management of the home. A requirement is made for the manager to inform the Commission about contingency arrangements for the management of the service in the event of her being absent from the home for any prolonged period. During the inspection, I observed that there was a relaxed and friendly atmosphere in the home and the staff confirmed that the manager was very approachable and sensitive in her dealings with them and the people who live in the home. The staff also said that the manager sets high standards and gives clear instructions about the quality of care to be provided. The manager stated that residents either manage their own financial affairs or their relatives do so, and no money is held in the home on their behalf. Since the last inspection, an annual appraisal of staffs’ performance was carried out and regular formal supervision has started, which was a requirement at previous inspections. Since the last inspection, there has been an improvement in the medication records and care plans, which was a requirement from the last inspection. I saw certificates of safety for the gas central heating system, fire equipment and the water system. Portable electrical appliances had been tested recently and the fire alarms were tested weekly. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 23 There was an up to date certificate of employers liability insurance on display. Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 4 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X 3 X 3 STAFFING Standard No Score 27 3 28 1 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 X X 3 3 3 3 Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 25 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 OP7 Regulation 15(2)(b,c) Timescale for action Care plans must be reviewed at 30/06/07 least monthly to ensure that staff are aware of any changes in residents’ needs. Care staff must undertake 30/09/07 training in National Vocational Qualification at least to level 2. All staff who work at the home 31/07/07 must attend training in food hygiene. This requirement is restated from the last inspection. The previous timescale was 28/02/07. 4. OP31 9(2)(1) The registered manager must 30/06/07 write to the Commission for Social Care Inspection to inform about contingency arrangements for the management of the service in the event of her being absent from the home for any prolonged period. Requirement 2. 3. OP28 OP30 18(1)(a) 18(1)(c) Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 26 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 OP9 Good Practice Recommendations The registered person should obtain Record of Administration of Medicines, (MAR) forms, from the pharmacist. The registered person should obtain audio books for the resident who is visually impaired. 2. OP12 Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Orchard Avenue 10 DS0000010473.V333317.R01.S.doc Version 5.2 Page 28 - 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. 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