Inspection on 03/01/07 for Osborne House

This inspection was carried out on 3rd January 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 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

Osborne House 17/01/06

Osborne House 20/09/05

Osborne House 03/03/05

Osborne House 25/10/04

Osborne House 08/12/03

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Osborne House 18 Compton Avenue Luton LU4 9AZ Lead Inspector Mrs Louise Trainor Unannounced Inspection 3rd January 2007 09:30 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 Osborne House DS0000014942.V321988.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. Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Osborne House Address 18 Compton Avenue Luton LU4 9AZ 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) 01582 493376 F/P 01582 493376 Kairmoore Limited Mrs Bridie Tarbox Care Home 16 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (16), of places Physical disability over 65 years of age (16) Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 17th January 2006 Brief Description of the Service: Osborne House was converted from a large suburban property that was originally used as a domestic dwelling and a doctor’s surgery before conversion to its current use. It is located in a pleasant suburb of Luton near to local railway and bus services. The registered proprietor was Kairmore Ltd. Mrs Tarbox, a co-director, had managed the home for a number of years. The service was registered to provide sixteen older people who may also have dementia and/or physical disabilities. The registration for physical disabilities was not applicable to this service because the home could accommodate older persons with mobility and similar physical needs associated with old age under the category for older people The accommodation was arranged over two floors. It had a shaft lift for access to the upper floor. There were fourteen single rooms and one double room. The bedrooms were located on each floor, each having a washbasin and a call bell system. En-suite toilet and washbasin facilities were provided in four rooms. Communal accommodation was located on the ground floor and consisted of a comfortable lounge, a lounge/diner and an all weather conservatory. Toilet and bathing facilities were available on each floor. The ground floor bathroom had a fixed hoist to aid service users with physical disabilities. This home has recently been granted accreditation for service users with Dementia, by Luton Borough Council, and has also been awarded a five star certificate for food hygiene. The fees for this home range from £410.00 per week to £450.00 per week. Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first Key Inspection for this service, and was carried out by Lead Inspector Louise Trainor on the 3rd of January 2007, between the hours of 09:30 and 17:00. The Home Manager who is also a Co Director of the home was present throughout the day to assist with the inspection, and both staff and service users were also interviewed during the day. As this was this inspectors’ first visit to the home, a full tour of the premises was conducted. Both communal areas and individual’s bedrooms were visited. Two service users were picked at random by the inspector to case track. This involved the inspection of personal care documentation, including care plans and risk assessments, informal discussions with the individual service users and observations of care. The care staff that the inspector interviewed also demonstrated their knowledge of these service user’s needs through discussion. Other documentation relating to staff training, supervision, service users finances, accident / incident reporting, complaints and recruitment were also inspected. The inspector would like to thank everyone involved for their assistance and support throughout the day. What the service does well: All service users are fully assessed, and have the opportunity to visit the home prior to being offered a permanent placement, so they can be sure of the quality, facilities and suitability of the home. Health and personal care needs are clearly set out in individualised care plans for all service users. Activities within this home are organised by three of the care staff. One member of staff is responsible for organising outings and outside entertainers coming into the home, and two other carers arrange a timetable of in house activities. This home also demonstrated an understanding of integrating ‘activities’ into the daily routine of the home. . Service users are encouraged to participate in every day activities such as laying or clearing tables at meal times, or watering Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 Page 6 plants. Although these may seem like simple every day tasks, they are developed into meaningful interactions and activities that keep these service users both mentally and physically stimulated, whilst giving them choices and the opportunity to have control over as many aspects of their lives as possible. It was clear that service users spent their time in the way they wished, and their privacy and personal space was respected by the staff and other service users. There had been no formal complaints relating to this home in the last year and complimentary letters of thanks were endless. Discussion with service users indicated that they had complete confidence that any concerns they may have, would be listened to, taken seriously and acted upon immediately. This home provides a safe, well - maintained and homely environment, so that service users can live comfortably with their own possessions around then. The staff in this home are trained sufficiently to perform their roles in a competent manner, so that service users are in safe hands. The management and leadership of this home clearly promote a high standard of care with the service users independence and well being as the main focus. Staff records show that they all receive supervision from one of the management team every second month, and all staff were able to identify their supervisor and discuss the benefits from this support. What has improved since the last inspection? The home has addressed the issues relating to service users that are seriously ill or dying. They have introduced a ‘Care of the Dying’ sheet, which is completed in a sensitive and timely way; it is then updated regularly to reflect any changes in the individual’s condition. Basic information regarding undertakers, burial or cremation wishes are generally recorded on admission. Letters and cards from relatives of deceased service users indicated that the approach from staff regarding these issues was always caring, sensitive and understanding. Financial records were checked for two service users picked at random by the inspector. All transactions were supported by two signatures and receipts where appropriate. Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Osborne House DS0000014942.V321988.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 Osborne House DS0000014942.V321988.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, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All service users are fully assessed, and have the opportunity to visit the home prior to being offered a permanent placement, so they can be sure of the quality, facilities and suitability of the home. EVIDENCE: All service user files that were inspected had completed, detailed pre admission assessments in them. These included their primary needs at the time of assessment and the level of assistance required in all areas of care. There were details of allergies and medication idiosyncrasies where appropriate, and individuals’ personal preferences and choices had also been recorded. All service users that were interviewed, had either visited the home themselves prior to admission, or had families or representatives that had done this for them. But they all felt they had been well informed, and had been lucky to get a place in this particular home. Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 Page 10 One service user said. “This is one of the few homes around that could give me what I want, I can go to bed and get up when I want, I have my newspaper delivered, I’m well looked after and everyone’s really nice”. Osborne House DS0000014942.V321988.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): 7,8,9,10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and personal care needs are clearly set out in individualised care plans for all service users so that needs are fully met. The recording of the administration of medication that is prescribed as variable doses requires further guidelines to ensure service users are protected. EVIDENCE: All service user files that were examined contained detailed care plans that were reviewed and updated on a regular basis. Each file also contained a ‘service user care plan agreement’ that had been appropriately signed and dated. Care plans ranged from mobilisation and personal hygiene, to mental health needs and recreational pursuits. All service users had risk assessments in place. The files also contain a ‘care of the dying’ sheet. This is completed in the event of someone becoming unwell. An example of this was seen completed for one service user that had become unwell in early December. This had been Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 Page 12 updated regularly and reviewed with the GP as this service users health had improved. This home has a policy that addresses when a service users condition is such that resuscitation should/would not be implemented. This involves the issue of an ‘order’ by the relevant GP, following discussions with the service user / families and other professionals. The ‘order’ that was seen indicated that more detail is required to ensure this system covers all legalities. The manager is keen to ensure this matter is handled appropriately and with compassion and respect. The Medication Administration Record (MAR) sheets were inspected for all service users. These were generally in good order, although PRN medications such as Senakot and Paracetamol were difficult to reconcile with remaining stocks. This was partially due to stocks being transferred from month to month and not clearly documented on the MAR sheets, and partially due to the fact that records for variable dose prescriptions did not clearly indicate exactly what dose had been given. Discussion to resolve this issue took place with the manager during the inspection. Care practices and staff / service user interactions were observed throughout the visit, in particular at lunch- time. Relationships between staff and service users were noted to be familiar but respectful. All service users were being given choices, and the member of staff that was conducting the ‘medication round’, did so in a competent manner and took time to explain to service users what medication they were being offered /given and why. Osborne House DS0000014942.V321988.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 daily life and social activities in this home, allow service users to exercise control and choice over their lives, and satisfies their social, cultural, religious and recreational needs. EVIDENCE: Activities within this home are organised by three of the care staff. One member of staff is responsible for organising outings and outside entertainers coming into the home, and two other carers arrange a timetable of in house activities. This home also demonstrated an understanding of integrating ‘activities’ into the daily routine of the home. Service users are encouraged to participate in every day activities such as laying or clearing tables at meal times, or watering plants. Although these may seem like simple every day tasks, they are developed into meaningful interactions and activities that keep these service users both mentally and physically stimulated, whilst giving them choices and the opportunity to have control over as many aspects of their lives as possible. Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 Page 14 One service user talked about her outing for lunch and her talking books, and another talked of their contentment just being ‘around the home’. The home promotes an open visiting policy, which enables relatives and friends to visit as and when it fits in with other commitments they may have. One of the local churches’ representatives visits the home every second Wednesday and leads a multi faith service. Here service users are invited to receive communion if they wish. At present all service users are of the Church of England denomination. Meals in this home, are all home baked on the premises from fresh ingredients. On the day of the inspection, the lunch- time menu was; Shepherds pie with vegetables, followed by homemade cherry pie and cream. There was no waste noted at all in the dining area after this meal. There is a six week rolling menu, that is changed two or three times a year to fit in with seasonal meals etc. If residents wish, they may request an alternative to any listed meal. One service user is a vegetarian and is well catered for, and another service user told the inspector that she did not like sausages, and would often have a chicken breast instead. There is a residents meeting held every three or four months, and this is used to gather ideas for menu changes. It was noted that suggestions such as bananas with bread and butter had been included on the menu, and were apparently a favourite. Osborne House DS0000014942.V321988.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. There had been no formal complaints relating to this home in the last year and complimentary letters of thanks were endless. Discussion with service users indicated that they had complete confidence that any concerns they may have, would be listened to, taken seriously and acted upon. EVIDENCE: There had been no formal complaints to this home in the last year, and from discussions with the service users, they are all very satisfied with the care they receive in this home. Complimentary cards and cards of thanks were numerous, with comments such as: “You’ve been amazing – like a family”, and “Just to say a big thank you for all your tender loving care”. One service users’ family had thrown a buffet party for all the staff and residents in honour of their father and as a thank you. Protection of Vulnerable Adult training is on the training plan for this home, however one or two staff have not yet attended this training, although the subject is addressed in the induction programme that is followed by all staff. Interviews with staff indicated that they have a clear understanding of what behaviours would constitute abuse, and all were able to identify the action they would take if they witnessed, or suspected any inappropriate behaviour or abuse within the home. Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This home provides a safe, well - maintained and homely environment, so that service users can live comfortably with their own possessions around then. EVIDENCE: This home was clean and well maintained throughout. It was homely and comfortable and on the day of the inspection, was still brightly decorated with Christmas trimmings making it feel quite festive. On entering the communal areas, they had an inviting feel about them, and the service users that were present, were happy and relaxed, and chatted quite enthusiastically about the seasonal activities such as carol singing. There is a conservatory on the ground floor, which has been recently decorated. It has heating in situ and is positioned with a view of the rear gardens. Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 Page 17 Individual’s bedrooms were also visited by the inspector, all were comfortably decorated and were furnished with items that illustrated the individuals life history, and memorabilia that indicated personal preferences and choices had been taken into consideration. One service user stated she had come in a short while ago, empty- handed from hospital. Her room was now very homely, with plants, photographs and personal assets around her, including her own ‘large digit telephone’, talking books and a bottle of sherry, which she enjoyed the occasional ‘tipple’ from. She said. “If you’ve got to go anywhere, this is the place to be”. Another service user was in her room tending to her plants, and talked about how well they were thriving. It was clear that service users spent their time in the way they wished, and their privacy and personal space was respected by the staff and other service users. Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The staff in this home are trained sufficiently to perform their roles in a competent manner, so that service users are in safe hands. EVIDENCE: The team of staff in this home is made up of the manager, who is also a co director of the home, a deputy manager, four lead carers and nine carers. In addition there is a full time cook, and a part time cook who also does care work one night each week. The turnover of staff is low, and staff moral appears good. Staff are happy, well supported and committed to these service users. The files of the two most recent recruits were inspected. Appropriate documentation including references, Home Office paperwork, employment history, personal identification documents were in place. There were CRB documents present in the files, however, it was difficult to identify what date the checks had been carried out, as the retained slip from this document only has a reference number, no date specified. One CRB, was noted to have been requested after the date on the ‘terms of employment’. The manager explained that it was her understanding that staff were permitted to commence an induction period, where they work under supervision, and are additional to Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 Page 19 daily staffing levels prior to these police checks being completed. It was explained that this should only be done as an exception rather than a rule, and the Commission for Social Care Inspection (CSCI) should be made aware in such circumstances. There is a training programme in place. Training is provided by an outside company to this home, and includes both mandatory training, refresher sessions and specialist subject training such as dementia awareness. Staff that were interviewed were positive about their training and supervision, and all were either in the process of, or had completed NVQ 2 or 3, and were up to date with their mandatory training. The two newest members of the team had not yet attended Protection of Vulnerable Adult training, however this subject is addressed in the TOPPS induction that they undertake. All care observed was being carried out in a competent manner and service users repeatedly verbalised their satisfaction with the service. Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 Page 20 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, 33, 35, 36, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management and leadership of this home clearly promote a high standard of care with the service users independence, health and well being as the main focus. EVIDENCE: The manager of this home is also one of three co directors / owners. She works along side the staff continually, thus providing a role model that is visible and accessible at all times. Staff records show that they all receive supervision from one of the management team every second month, and all staff were able to identify their supervisor and discuss the benefits from this support. There is a Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 Page 21 communication/ message book which is used amongst the staff to ensure essential information is passed on as necessary whilst maintaining service user confidentiality, and all staff that were interviewed were confident and knowledgeable when discussing individual service users and their needs with the inspector. Staff also talked about staff meetings and memos as ways that they are kept fully informed about any changes that may occur within the home. The home does not act as appointee for any of the service users that reside here at present, however all have an individual ‘account’ for pocket money and daily spending. The records of two service users’ accounts, picked at random by the inspector, were examined. Both balanced correctly with the funds held in the home, and all transactions were supported by two signatures and receipts. Records of accidents and incidents were inspected; three specific accidents were cross-referenced with the daily record sheets and corresponded correctly. It was noted that not all falls, particularly those less serious, are not reported to the CSCI, however they have been very well documented and follow up action from GP or hospital interventions is very clearly logged. The manager was reminded that CSCI should be made aware of all incidences through the regulation 37 notices. Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 Page 22 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 2 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 2 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Requirement Timescale for action 31/01/07 2. OP29 19(1)(b) (i) The Registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received t the home. The Registered person shall not 09/01/07 employ a person to work in the home unless – He has obtained in respect of that person the information and documents specified inParagraph 1 to 7 of schedule 2 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Osborne House DS0000014942.V321988.R01.S.doc Version 5.2 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. 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