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Inspection on 08/08/05 for Orchard Care

Also see our care home review for Orchard Care for more information

This inspection was carried out on 8th August 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

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

202 Weston Road provides it residents with a homely environment, set in a residential area, close to numerous local community facilities. The Home has its own transport and each of the residents has opportunity to go out daily. A senior member of staff is specifically employed to arrange and plan activities and the high staffing levels ensure that all of the residents are supported appropriately. Care needs are well documented and regularly reviewed affording the staff adequate information as to how support should be delivered and any identified risks. Staff training and supervision is frequent and well planned. The residents are treated with respect and encouraged, where possible to be involved in the domestic arrangements in the Home. Each of the residents has their own bedroom and there is ample shared accommodation, which allows privacy if required.

What has improved since the last inspection?

A requirement was made at the last inspection that staff receive manual handling training. The organisation has obtained a video and questionnaire training pack.

What the care home could do better:

The information regarding fees is conflicting in The Service Users` Guide and contract formats and more clarification is required. This whole area needs further discussion to ensure that robust procedures are in place, which protectthe residents and the Home. Contracts need to be put in place for each resident. The Statement of Purpose and Service Users` Guide should be reviewed and amended as necessary. Records are not being made of the medication as it comes into the Home and this must be addressed. The organisation are required to send a maintenance plan to the CSCI to show the re-decoration and refurbishment planned. The Home has been open for three years and some of the internal decoration and fittings are looking worn. In a subsequent discussion, the manager spoke of the future plans for the environment, which can be confirmed in the maintenance plan. The manager must ensure that the action identified in the risk assessments is carried out or new assessments carried out.

CARE HOME ADULTS 18-65 Orchard Care 202 Weston Road Meir Stoke-on-Trent Staffordshire ST3 6PE Lead Inspector Sue Jordan Unannounced 8 August 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Orchard Care Address 202 Weston Road Meir Stoke-on-Trent Staffordshire ST3 6PE 01782 342123 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) Orchard Care Mrs Carol Ann Forys CRH 4 Category(ies) of LD - 4 registration, with number of places Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: N/A Date of last inspection 24 February 2005 Brief Description of the Service: Orchard Care is a large two storey detached house situated in a residential area of Weston Coyney.The Home is registered with the Commission for Social Care Inspection to care for four younger adults with a learning disability.At present there are four gentlemen living at Orchard Care.The property is situated on a main road with access to the rear of the property. The gardens are spacious, secure and well maintained and there is a patio area with ample seating and private lawned area.The inside of the property is homely and domestic in character. Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over approximately three hours. The methodologies used were a tour of the Home, an interview with one staff member, informal discussions with one of the residents, the deputy homes manager and the activities senior and observations. Scrutiny of care plans, training records and some Health and Safety records took place. What the service does well: What has improved since the last inspection? What they could do better: The information regarding fees is conflicting in The Service Users’ Guide and contract formats and more clarification is required. This whole area needs further discussion to ensure that robust procedures are in place, which protect Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 6 the residents and the Home. Contracts need to be put in place for each resident. The Statement of Purpose and Service Users’ Guide should be reviewed and amended as necessary. Records are not being made of the medication as it comes into the Home and this must be addressed. The organisation are required to send a maintenance plan to the CSCI to show the re-decoration and refurbishment planned. The Home has been open for three years and some of the internal decoration and fittings are looking worn. In a subsequent discussion, the manager spoke of the future plans for the environment, which can be confirmed in the maintenance plan. The manager must ensure that the action identified in the risk assessments is carried out or new assessments carried out. 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. Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 5 In order that the residents and their families fully understand what they may be expected to personally purchase and what is covered by the fees, clarity is needed throughout the Home’s documentation. EVIDENCE: There is some confusion within the Home’s documentation as to what is covered in the fees and as to what the residents may be expected to purchase themselves. Some items of bedroom furniture have been purchased by the residents and although there is reference to the fact that this may be expected within the contract format seen, this is contradicted in the Service Users’ Guide. This prompted further discussion with the manager, whereby a requirement was made that the financial expectations be more specifically mentioned within the contracts and where possible larger purchases be supported by multi-disciplinary consultation in the event that the resident is unable to comprehend the value and implications. Clarity is needed throughout the Home’s documentation and individual resident’s records. The contract formats have been developed but have not yet been put in place for the individual residents. It is recommended that independent advocates be accessed to assist the residents in their understanding before signing. The Service Users Guide should contain the most up to date inspection report and collation of the quality audit results. The Statement of Purpose and Service Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 9 Users’ Guide would benefit from review and amendments should be made, as and when changes occur. There have been no new admissions to the Home and it was previously established that the residents were assessed prior to their admission. Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8, 9 Care planning is generally well maintained and regularly reviewed, ensuring that the staff have up to date knowledge of the support required by each resident. EVIDENCE: Care plans are in place for each of the residents. These are regularly reviewed and staff reported that they are informed of any changes in the communication book and in handover sessions. Changes are made as and when necessary and these can be initiated by any staff member. There is a key worker system in place, each resident having two designated members of staff. Key worker meetings are held together with, if possible the resident to discuss and review the care plans. Each resident also has a ‘life plan’. These are reviewed at annual meetings and are attended by the resident; the people involved in their life and the relevant staff members. The plan provides a holistic approach and the action required in the next year, for each area is identified. The manager undertakes a global assessment every two years, which looks at every area of the care and support delivered. A member of staff interviewed explained that the residents are consulted on a daily basis regarding all aspects of their daily lives. There is a consistent long-standing staff team and they have gained the Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 11 knowledge needed to understand the needs and wants of those residents less able to convey this verbally. A number of the documents in the residents’ records were undated, including nutritional screening and quality audits. It is recommended that staff be reminded to date all documentation. Risk assessments are in place, which identify any restrictions required to keep the residents and staff safe. These are regularly reviewed. Window screening has been provided in one of the resident’s bedrooms. The reasons given were reasonable and justifiable, and designed to protect the resident’s privacy and dignity. However a risk assessment is required to support the decisions made. Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 12, 13, 14, 15, 16, 17 Daytime activities are planned in advance dependent on individual needs and capabilities and the residents regularly access the local community. Staffing levels are maintained to ensure that all of the residents have equal opportunities. EVIDENCE: The organisation employs a senior day care officer and it is her responsibility to plan suitable activities for the residents. Weekly plans are developed, although these can change due to personal choice. All of the residents have a daily opportunity to go into the community and staffing levels are provided, which allow for two-to-one support, if it is required. The residents use the local community facilities, such as shops, sports centres and pubs. One of the residents attends college and is undertaking courses in personal presentation, computer skills and health and well-being. On the day of this inspection, some of the residents were enjoying the good weather in the patio area, another went for a walk with staff and another went to the local shops. All of the residents have either had or are going on holiday in 2005. Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 13 The staff reported that all of the residents have contact with their families. Meals are provided as per a four-weekly menu, although staff report that alternatives can be given due to the personal choice and preference of the residents. There is no budgetary restriction when purchasing food and two of the residents enjoy accompanying staff to the local supermarket. Food preparation is included in some of the residents’ life skill training. There has been an Environmental Health visit to the Home in 2005. There were no issues identified. Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 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 standard(s) 18, 19, 20 Personal and health care needs are identified within individual care plans. The residents’ physical and emotional health needs are monitored and the relevant medical services accessed. EVIDENCE: The personal support required by each resident is identified in the care plans. Medical and health appointments and visits are recorded and the records indicate that physical and emotional health needs are monitored and the relevant medical services accessed. Medication is provided in ‘blister’ packs by the local pharmacist. None of the present residents are able to self administer their medication and are therefore supported by staff trained in medication administration. Records of administration and medications returned to the pharmacist are maintained. However records must be kept of all medication coming into the Home. There is a facility to store controlled medication, if necessary. Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 15 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 standard(s) 22, 23 The strategies and procedures in the Home protect the residents from abuse, although more clarity regarding what is and what is not included in the fees is required to further safeguard the residents and the Home. EVIDENCE: There have been no complaints made to the Home or the CSCI, (Commission for Social Care Inspection). The complaints procedure is appropriate and contains the necessary information. The staff interviewed demonstrated that they had the knowledge needed to appropriately identify and report issues of abuse. Strategies are in place to protect residents from self-abusive behaviour, if applicable. Staff are trained in the management of challenging behaviour, which includes physical intervention. However emphasis is placed on diverting and distracting the resident. Staff reported that incidents of challenging behaviour have dramatically decreased in the last twelve months, although one of the residents is being closely monitored due to medication changes. Behavioural difficulties are risk assessed to protect the residents and staff. The deputy home leader reported that the POVA, (Protection of Vulnerable Adults), list is accessed during the recruitment process and that all staff have a CRB, (Criminal Records Bureau) disclosure. The system for managing the residents’ personal allowances was checked and all monies are accounted for and receipts obtained. Double signatures witness all transactions. Three of the residents have their own bank accounts and a parent manages the other’s finances. None of the present residents are able to manage their money without support. As identified, some clarity is needed as to what the residents may be expected to purchase and what is provided by the Home. Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 16 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 standard(s) 24, 25, 26, 27, 28, 29, 30 The environment is domestic and homely in style, although some areas would now benefit from re-decoration. EVIDENCE: 202 Weston Road is located in a residential area and provides a homely environment for the residents. Each resident has their own bedroom and there are two lounge areas, a relaxation room, and a large kitchen. The layout of the Home allows the residents privacy if required. There are two bathrooms in the Home and the benefit of a separate laundry area. At the time of this inspection, the staff reported that they are currently working to improve the garden. A patio area is situated at the side of the property. The organisation does not employ domestic staff however the senior staff reported that high levels of staff ensure that their cleaning duties do not impinge on the time needed to provide activities. Where possible the residents are encouraged to assist with the domestic tasks, although in reality this is minimal. The Home has previously been decorated in a modern, cheerful style, however it was noted at this inspection that a number of the rooms are now looking Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 17 ‘tired’ and in need of refreshing. The lounge carpets are quite badly stained and both bathrooms would benefit from re-decoration and new flooring. It was reported that there are plans to redecorate some of the bedrooms. A subsequent conversation with the manager confirmed that the there are ongoing plans in place to continuously maintain and improve the environment. She reported that the lounge and kitchen have been decorated and that new flooring is being planed. Consideration has to be given to the fact that some of the residents have autism and as such do not cope with too many sudden changes. Therefore a requirement is made that a maintenance plan be sent to the CSCI, which evidences the on-going and future plans for re-decoration and maintenance. Some of the residents have brought pieces of personal bedroom furniture into the Home and the bedrooms are personalised and individual. None of the present residents require specific equipment within the Home. A risk assessment has been developed regarding the uncovered radiators, which identifies that the surface temperatures should be checked and recorded regularly. However it was identified that this is not taking place. It is recommended that the radiators be covered to fully safeguard the residents. Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35, 36 The residents are supported by high levels of well supervised and trained staff. EVIDENCE: Three staff plus the activities co-ordinator support the residents throughout the day and three staff are available until 18.30 after which there are two staff until the following morning. Two of the residents have funding for two-to-one ratios and the activities and rotas are planned accordingly. At the time of this inspection there were fourteen care staff employed at the Home, of which two have achieved NVQ 2 or above. Four are registered to start NVQ awards in September 2005. Unfortunately some qualified staff have ceased employment. All new recruits undertake the LDAF award. Staff interviewed reported good training opportunities and some of the recent training includes manual handling, which was a previous requirement. A staff member explained that he had undertaken first aid, manual handling, food and hygiene, management of challenging behaviour and abuse training since commencement of his employment in April 2002. It was not checked whether the staff are receiving refresher training at the appropriate frequencies. Staff report being well supported during one-to-one review meetings, team meetings and annual performance development sessions. Documented evidence was seen. Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38, 39, 41, 42 Generally the Home is well managed and the residents and staff enjoy the benefit of sound support systems. EVIDENCE: The manager, Carol Forys was not present at this inspection. The staff interviewed reported being well supported by the management team and said that they felt able to approach the manager with any concerns. A quality audit questionnaire completed with a resident was seen at this inspection, however the document was not dated and therefore it was not evident as to how recently this took place. Results of the quality audit should be collated and included in The Service Users’ Guide. The organisation has procedures in place to monitor and self-audit the service provided. The Responsible Individual has been carrying out monthly visits as required by Regulation 26 of The Care Homes Regulations, although they could contain more detail. Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 20 The records are well maintained and regularly reviewed, although a reminder to date all documentation was made. Some of the Health and Safety records were checked; fire procedures and testing are appropriate, COSHH products and their relevant data sheets are stored and handled appropriately, PAT testing is undertaken annually and generic risk assessments are available. A risk assessment has been developed regarding the uncovered radiators, which identifies that the surface temperatures should be checked and recorded regularly. However it was identified that this is not taking place. Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 21 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 2 3 x x 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 N/A 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Name Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score x 3 3 x 3 2 x E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 22 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. 2. 3. Standard 1 1 1 Regulation 6 5 (1d) 5 (1b) Requirement The Statement of Purpose and Service Users Guide must be kept under review. The Service Users Guide must contain the most recent inspection report. More clarity is required in The Service Users Guide as to what is and what is not covered in the fees and the cost of extras. More clarity is required in the individual contracts as to what is and what is not covered in the fees and the cost of extras. A risk assessment is required to support the decision for window screening. Records must be kept of all medication coming into the Home The organisation is required to send a maintenance plan to the CSCI The action identified in the risk assessment for the radiators must be followed, or an alternative assessment undertaken. Timescale for action 01/10/05 & on-going 01/10/05 & on-going 01/10/05 4. 5 5 (1b, c) 01/10/05 5. 6. 7. 8. 9 20 24 42 12 (4a) 13 (4) 13 (2) 23 (2b, d) 13 (4a, c) 01/10/05 Immediate & on-going 01/10/05 Immediate Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 23 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. 2. 3. 4. 5. Refer to Standard 1 5 24 39 41 Good Practice Recommendations The views of the service users as ascertained during the quality audit process should be included in The Service Users Guide. Independent advocate assistance should be accessed when supporting the residents to sign their contracts. It is recommended that the radiators in the Home be covered. The quality assurance questionnaires should be dated. It is recommended that the process be repeated annually. It is strongly recommended that all records be dated as evidence of currency. Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Stafford - Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES 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 Name E51-E09 S8320 Orchard Care V243407 08.08.05 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!