Inspection on 03/05/05 for Orford House

This inspection was carried out on 3rd May 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.

Other inspections for this house

Orford House 10/09/07

Orford House 20/02/07

Orford House 17/10/05

Orford House 21/12/04

Orford House 04/05/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Orford House Meadow Hill Woodcote Park Coulsdon, Surrey CR5 2XN Lead Inspector Mohammad Peerbux Announced Inspection 3 May 2005 9:30am 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. Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Orford House Address Meadow Hill, Woodcote Park, Coulsdon, Surrey, CR5 2XN 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) 020 8660 2875 020 8645 0762 Friends of the Elderly Mrs Susan Eastwood Care Home 29 Category(ies) of Old Age (29) registration, with number of places Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 21 December 2004 Brief Description of the Service: Orford House is situated in Coulsdon and owned by Friends of the Elderly, a registered charity. The home is registered to provide care for up to 29 elderly persons. At the time of this inspection there were 27 service users. Orford House is detached property with an internal courtyard and set in secluded wellmaintained grounds, surrounded by paddocks and woods owned by Friends of the Elderly. The grounds are over 45 acres and also accommodate a formal Chinese ornamental garden, an arboretum, lawn areas, flowerbeds and patios. The home is accessed by its’ own and shared private roads that contain speed bumps, and ample parking is provided.Two other Friends of the Elderly homes, ’Woodcote Grove House’ and ‘Selkirk Wing’, which provides nursing care, are also within the grounds.Accommodation in the home includes bedrooms on the ground and first floor.There is a lift serving all residents floors.The communal facilities include one dining room, one drawing room, an activities/ hairdressing room, an indoor gardening room, kitchenettes for the residents’ own use, and a chapel. The chapel is attached to Woodcote Grove House. Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the home’s first inspection for the year 2005/06. The inspection took place over 7 hours and was arranged by advance notification. Some times were spent looking at the policies and procedures, talking to staff and manager and to some of service users. A tour of the building was also carried out and some service users were met in their rooms. The Commission received a high number of responses to the questionnaire sent out; they were from service users, family and professionals. The vast majority were positive about the home, however there were still some comments made about the quality of food at suppertime. The manager is aware of this issue and this is dealing with it at present. Service users advised that they are happy with the care provided in this home. What the service does well: A number of service users and their relatives/friends were very positive about the home, and felt that it provided a good all-round service. They felt that their concerns were listened to, and that the staffs were approachable. Service users spoken to felt that the staffs have built a good relationship with them. Comprehensive information about the home and the services offered (included in the Statement of Purpose and Service User Guide) is available, and potential service users (and their relatives) are encouraged to visit the home, enabling an informed choice regarding the suitability of the home to be made. A sample of service user files was examined. The home was evidenced to have appropriate assessments and care plans in place. Service users’ care and support needs had been properly assessed, and the range of health, care and social needs presented were evidenced as being met. Service users were observed to receive a wholesome, appealing and nutritious diet in pleasant surroundings. Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: While the Statement of Purpose and Service User’s Guide are comprehensive, a recommendation is made to include a review the date on them. The Service User’s Guide must include a copy of the most recent inspection report. All service users have a written contract, however they are not all accurately completed. The medication administration records were audited. There were several instances where prescribed medication had been omitted or administered but not signed for. While it transpired that there were acceptable explanations for this, these explanations had not been recorded. In all cases where medication is not given as prescribed, staff must ensure that they record the reason for this. During the inspection, one staff went into a service users bedroom without knocking on the door first. The service user was in the room at that time .The manager must ensure that staff respects the privacy and dignity of service users at all times. This must be discussed and minuted in staff meetings. The building was clean, tidy and rooms were free of offensive odours apart from one. The manager must ensure that the room is kept free from offensive odours. The manager must ensure that staff files must contain all relevant documentations as per schedule 2 of the revised Care Homes Regulations 2001.One of the staff files sampled did not have a criminal record check or any identification. Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 Page 7 One-to-one supervision sessions are still not being carried out on a regular basis. All staff must receive formal documented supervision at least six times a year. One health and safety issue arose during the inspection. A number of bedroom doors were wedged open and there were no service users in them. The manager must ensure that bedroom doors are not wedged open unless held open by a magnetic door holder that responds to the fire warning system. 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. Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,5 and 6 The Statement of Purpose and Service Users Guide are comprehensive however the Service user’s guide needs to include a copy of the latest inspection report. All service users have a contract between the home and service user. Service users’ needs are fully assessed prior to their admission to ensure their individual needs can be met and they are encouraged to visit the home to assess the quality, facilities and suitability of the home. EVIDENCE: The home has a Statement of Purpose and Service Users Guide that complies with the minimum standards. These are comprehensive. However the service user’s guide did not include the most recent inspection report for which a requirement is made. A recommendation is also made to have a review date on the Statement of Purpose and Service User’s Guide. Each service user has a written contract in place that includes the terms and conditions however the room to be occupied is not always completed. Three contracts were sampled at random; two of them had the same room number Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 Page 10 to be occupied by the service users. A recommendation is made for Service Users’ contracts to be completed accurately. Service users are admitted to the home after the home and the placing authority have carried out a full assessment of their needs. The prospective service user is also involved in the process. This covers all aspects of the person’s life, including strengths, social and cultural needs and psychological needs. The home then develops its own care plans from these assessments and formal reviews of each service user. The Service users are in regular contact with their General Practitioner and other community based health care professionals who visit the home and check that assessed needs are being met. No residents have moved to the home since the last inspection. All prospective service users are offered a trial with a flexible duration based on their needs and choice. Trial visits ranged from invitations to coffee or lunch, or frequently, to respite trials of up to 4 weeks or longer and relatives are also involved in the process. The potential placement is then reviewed following a settling in period, which can be extended if required. The home does not offer intermediate care. Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9,10,and 11 Service users’ health, personal and social care needs are being appropriately met and reviewed however service user’s right to privacy needs to be addressed. The systems for administration of medication are poor and potentially place service users at risk. EVIDENCE: There were good examples of care planning documentation. Care records consist of comprehensive assessment tools, full risk assessments, full records of visiting medical professionals, detailed monitoring and medication records, a new simplified, daily care recording pro-forma, and care plans. The majority of service users in this home are fully ambulant and none had pressure sores at the time of this announced inspection. All service users assessed as being at risk of pressure sores have a separate specific care plan for action to maintain tissue viability. Evidence of regular monitoring, nutritional reviews, management of continence, frequent toileting, hygiene, use of pressure relieving equipment and in-depth record keeping were observed. Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 Page 12 The medication administration records were audited. There were several instances where prescribed medication had been omitted or administered but not signed for. While it transpired that there were acceptable explanations for this, these explanations had not been recorded. In all cases where medication is not given as prescribed, staff must ensure that they record the reason for this. The manager must ensure that medication administration records are accurately completed at all times. During the inspection, one staff went into a service user’s bedroom without knocking on the door first. The service user was in the room at that time .The manager must ensure that staff respects the privacy and dignity of service users at all times. This must be discussed and minuted in staff meetings. Procedures are in place for death and dying and two service users have died since the last inspection. Service users are able to spend their final days in their rooms and specialist medical care is brought in if required and appropriate attention to pain relief given. Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 Service users are being provided with a range of opportunities for recreational and social activity that is in accord with their social, cultural and religious needs. They are assisted to maintain contact with family and friends, and links with the local community are encouraged. Service users are able to exercise choice and control over their lives. Meals are nutritious and balanced and offer a healthy and varied diet for service users. EVIDENCE: The home has an activity lady that visits once week. The Service users take part in different activities such as crosswords, quizzes, and talk on different subjects. They also go out in the community on a regular basis. Service users are encouraged to maintain contact with family and friends. Service users can receive visitors in private in their own rooms, as there are no shared rooms at this home. There are no restrictions on receiving visitors, except those identified by the resident themselves. There is an open visiting policy and visitors are told they can visit at any time. The service users’ comments and observation confirmed that the home is run in a manner that promotes choice and independence. Service users can bring in their own possessions and furniture if they wish and this was observed in residents’ rooms, which had been individualised. Residents can take meals, Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 Page 14 and particularly snacks, at times to suit them and have a choice of meals and alternatives. Food is not prepared on the premises; it is delivered in a heated trolley from the adjoining home. It has consistently been the cause of complaint from service users so the manager is meeting with the chef to resolve the issues. On the day of inspection lunch appeared nutritious and hot. Menus were seen, they are on a four weekly rotation and changed every three months. Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 and 18 Residents, their relatives and friends can be confident that their complaints will be taken seriously and acted upon as an appropriate complaints policy and procedure is in place. Residents’ legal rights are protected. Residents are protected from abuse and are to be living in a safe environment as the home has appropriate adult protection policies and procedures in place. EVIDENCE: The complaints procedure and book were seen. The only complaints had been about the food and steps are being taken to rectify these problems. There were also entries praising the food when it was thought to have been particularly good. No complaints were received during this announced inspection. The manager has ensured that all residents are on the electoral register. Residents have been supported to attend polling stations through provision of transport or would use a postal vote. Information regarding advocacy for supporting residents’ rights is presented to all residents and representatives in the service users guide. The home has the local Adult Protection procedures, a Whistle Blowing Policy and an Abuse Policy. Staff files show that they have signed to say that they have read and understood the policy as a part of their induction programme. Orford House G53 S7136 OrfordHouse V189995 030505 stage4.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) 19,21,22,23 and 26 The home provides a clean, safe, well-maintained environment with residents having access to safe and comfortable facilities. Residents have sufficient aids and adaptations to ensure safety. EVIDENCE: The home is set in its own secluded grounds surrounded by farms, woods and a golf course. The home is accessed by its’ own private roads that contain speed bumps. At the time of the inspection the premises were well furnished in an appropriate style. There are 14 toilets in total. Both toilets and bathrooms were accessible, contained aids and adaptations and were lockable for privacy. One of the parker baths needs replacing; the manager is waiting for a quote. There is only one room with en-suite facilities at this home although there are hand basins in each of the residents’ rooms. Evidence of professional assessment of the premises, was seen by the inspector. Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 Page 17 Lifts, ramps, grab rails, hoists and other aids and adaptations were observed to be present and the home has level access at the back. The toilets and bathrooms were accessible, contained adaptations, hoists and independently accessible baths for people with mobility difficulties. All service users have single rooms within this home. During the inspection, the building was clean, tidy and rooms were free of offensive odours apart from one. The manager explained that the service user has a continence problem and that the carpet was changed two months ago. The manager must ensure that the room is kept free from offensive odours and should consider an alternative form of floor covering. Separate cleaning staffs are employed for cleaning the home. Laundry facilities are situated well away from food preparation and storage areas with easily cleanable floors and walls. Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 Page 18 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 and 30 The home has the numbers and skill mix of staff sufficient to meet service users’ needs and ensure their safety. Recruitment policies have not been consistently followed resulting in service users receiving care from staff members who have not been properly vetted. This potentially leaves people who use the service at risk. EVIDENCE: Details of each service users’ accessed dependency levels, were provided by the manager. Staffing levels are to be no less than those levels required in guidance available before the introduction of the Care Standards Act 2000. The staff roster indicated that the home consistently meet those levels. The manager informed the inspector that 2 staffs have NVQ Level 2, 2 staffs have NVQ Level 3,2 staffs are completing NVQ Level 2 training and 4 staffs will start their NVQ level 2 training soon. There is a procedure for the recruitment of staff. Staff records were examined and were seen to contain references, criminal record checks, original application forms and copies of identification. One of the staff files sampled did not have a criminal record check or any identification. The manager must ensure that staff files must contain all relevant documentations as per schedule 2 of the revised Care Homes Regulations 2001. The Manager was able to demonstrate a programme of training for staff. The Manager reported that further training is being organised. Orford House G53 S7136 OrfordHouse V189995 030505 stage4.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) 31,32,33,35,36,37 and 38 The home management generally provides leadership, guidance and direction to staff to ensure service users receive consistent quality care. However oneto-one supervision sessions are still not being carried out on a regular basis. The home has just been completed its yearly quality assurance programme and yearly internal audit. The health, safety and welfare of service users and staff are not being protected, as fire safety is not being adhered to. EVIDENCE: Throughout the course of the inspection the manager demonstrated a good competent management skills and appears to have created a skilled, positive and enthusiastic workforce. She has many years experience of working with this client group and displayed an insight into the relevant issues. She is hoping to complete her NVQ level4 in management in June 2005. The manager has been seen to actively maintain an open and inclusive relationship with staff and service users. The manager operates an open door Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 Page 20 policy for service users and service users were observed freely raising issues directly with the manager. The minutes of staff meetings sampled at random revealed that they were being held on a regular basis and covered various aspects of staff practices. The home has just been completed its yearly quality assurance programme and yearly internal audit. There is also a survey that is conducted on a regular basis to gain feedback with regards to the home and its services. Service users’ personal allowances are kept separately and secure facilities are provided for the storage of this. Records are kept of items handed over for safekeeping. Although recorded supervision has started, the target of six sessions per year has not yet been achieved. The deputy manager has attended training on staff supervision and will also be supervising staff. The registered manager must ensure that all staff receives formal documented supervision six times a year. Staff appraisals are now about to commence. The home appears to be well organised and record keeping very competently managed. Administration in this home is to a good standard. All statutory record keeping checked by the inspectors were satisfactory; this included food, statement of purpose, service user case files, accidents, incidents, complaints, fire records and so forth. One health and safety issue arose during the inspection. A number of bedroom doors were wedged open and there were no service users in them. The manager must ensure that bedroom doors are not wedged open unless held open by a magnetic door holder that responds to the fire warning system. Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 Page 21 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 2 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x 3 3 3 x x 2 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 2 3 x 3 2 3 2 Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 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. Standard 1 9 Regulation 5(1)(d) 13(2) Requirement Timescale for action 31/07/05 The Service Users Guide must include the a copy of the most recent inspection report. The manager must ensure that 03/07/05 medication administration records are accurately completed at all times. The manager is required to ensure that staff respects the privacy and dignity of service users at all times. This must be discussed and minuted in staff meetings. The manager must ensure that the rooms are kept free from offensive odours. The manager must ensure that staff files must contain all relevant documentations as per schedule 2 of the revised Care Homes Regulations 2001. The registered manager must ensure that all staff receives formal documented supervision six times a year. The manager must ensure that bedroom doors are not wedged open unless held open by a magnetic door holder that responds to the fire warning 31/07/05 3. 10 23(4)(a)( b) 4. 5. 26 29 16(2)(k) 17 31/08/05 31/07/05 6. 36 18(2) 31/07/05 and henceforth 31/07/05 7. 38 23(4)(c) Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 Page 23 system. 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. Refer to Standard 1 2 Good Practice Recommendations It would be good practice if review date in included on the Statement of Purpose and Service Users Guide. It would be good practice for the Service Users’ contracts to be completed accurately. Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 Page 24 Commission for Social Care Inspection 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP 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 Orford House G53 S7136 OrfordHouse V189995 030505 stage4.doc Version 1.30 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. 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