Inspection on 25/10/05 for Park Avenue 4

This inspection was carried out on 25th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Park Avenue 4 01/05/07

Park Avenue 4 01/08/06

Park Avenue 4 27/06/05

Park Avenue 4 25/10/04

Park Avenue 4 21/06/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Park Avenue 4 Wood Green London N22 7EX Lead Inspector Susan Shamash Unannounced Inspection 25th October 2005 15:00 Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 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 Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 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 Adults 18-65. 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. Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Park Avenue 4 Address Wood Green London N22 7EX Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8888 5055 020 8888 5055 Hoffmann Foundation for Autism Ms Sharon Diana Martin Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th June 2005 Brief Description of the Service: 4 Park Avenue is a registered care home owned by the Hoffman Foundation for Autism, a voluntary organisation that provides services to meet the needs of people with learning difficulties who may also have autistic spectrum disorders. The home is a large converted house with six bedrooms on the first and second floors and the main communal areas on the ground floor. The premises are not suited to meet the needs of service users with significant mobility disabilities. 4 Park Avenue is walking distance to Wood Green shopping centre and a range of public transport links. Hoffman Foundation for Autism also provides a separate day service provision in the adjoining premises. The stated aim of the home is to provide high quality residential service for up to six people with learning disabilities and characteristics that may fall within the autistic spectrum. Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection lasted approximately four hours. The registered manager was present throughout alongside the deputy manager and other members of the staff team. At the start of the inspection a number of residents were arriving back at the home from day activities. The inspector was able to speak to one resident in detail and spent time with five other residents in the presence of staff members in the kitchen and dining area. The inspector also had the opportunity to speak with three staff members briefly during the inspection. The visit was undertaken as a routinely scheduled inspection of the home and to monitor compliance with matters identified at the previous inspection. A tour of the building was conducted, and three care plans, three staff files in addition to a range of other records maintained at the home, were inspected. What the service does well: Park Avenue is a comfortable and well run home that provides a good standard of care for service users with a range of complex needs. The home makes a concerted effort to ensure compliance with requirements issued by the CSCI. Residents generally appear happy and well cared for and at ease with staff members supporting them. The majority of staff at the home have been employed there for over 3 years. Even the bank staff have been working at the home for many years. The low staff turnover helps to give residents a sense of stability and reassurance as their routines are not constantly disrupted by new staff. The living environment is decorated and furnished appropriately, and residents are able to choose the décor of their own rooms and personalise them according to their tastes. Comprehensive care plans and risk assessments are available for all residents, and a range of appropriate activities are available both inside and outside of the home. Residents are also supported to go on holiday at least once a year and to maintain contacts with their family and friends. Pictorial aids are used effectively to meet the communication needs of individual residents. A varied menu is available for residents, with choices to meet their individual and cultural preferences. The home is flexible at supporting residents to assist in tasks of daily living including setting the table, cooking and clearing up. One service user, who has more advanced independent living skills, is supported to cook independently. Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 6 Staff are supervised regularly and undertake a variety of relevant training courses as appropriate. There is a good rapport between residents, management and staff. The manager at the home has been in post since the home first opened five years ago and it remains the inspector’s opinion that the home has benefited from her management. What has improved since the last inspection? What they could do better: As noted above, it is recommended that an improved system be put in place for recording residents’ wishes and decisions regarding their care On the day of the inspection the rear garden and fence were in need of repair to make this comfortable for residents’ use. Unannounced visits by a representative of the provider organisation must be carried out more frequently (on a monthly basis) with copies of the reports of these visits sent to the home and the CSCI each month. There is a need for an improvement in the monitoring of health and safety records and safety certificates for the home to ensure the safety of residents. A current satisfactory electrical installation safety certificate must be obtained for the home, fire alarm testing must be undertaken at least weekly and portable appliances testing must be undertaken at least annually. Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 7 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. Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 9 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 the following standard(s): 2. Detailed service user pre-admission information is available to ensure that their needs are fully assessed and can be met effectively. EVIDENCE: The home is registered for six service users all of whom have lived at the home for at least 2 years. The most recent service user moved into the home in 2003. Detailed assessments were available for each service user, from which care plans had been developed. At the previous inspection the manager satisfied the inspector that she was aware of the need to obtain pre-admission information before any new service user was admitted to the home, and that appropriate admission procedures were in place. Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 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 the following standard(s): 6, 7 and 9. The home’s care planning documents have been improved by recent dated updates to ensure that they reflect service users’ current needs. Service user’s wishes regarding their care are sought consistently, and they are involved as far as possible in all aspects relating to life at the home. Following assessments, service users are supported to take appropriately safeguarded risks and to develop independent living skills. EVIDENCE: Four service user files were examined in detail. All contained detailed care plans with evidence that they had been reviewed within the last six months. Files also contained “guidelines” including detailed care plan and risk assessment information on particular areas of need or concern e.g. dealing with challenging behaviour. As required at the previous inspection these guidelines had been dated so that the currency of the information could be determined. Files contained a person centred plan including useful information about the service user’s needs and wishes obtained through close consultation with Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 11 them. As required at the previous inspection, information in these plans indicated that service users’ wishes and decisions relating to all aspects of their care had been taken into account. However it remains recommended that the home develop further ways in which to record service users’ wishes and decisions regarding their care and support provided to them. The majority of service users have limited levels of verbal communication and some were reluctant to speak to the inspector. However the inspector was able to have a detailed discussion with one service user who was due to go on holiday the morning after the inspection. They told the inspector that they were happy and well looked after at the home. Observation of staff with service users indicated that staff have a good rapport with service users and were very knowledgeable about their individual needs. Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 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 the following standard(s): 12, 13, 14, 16 and 17. The home supports service users to engage in a variety of educational, leisure and daily living activities of their preferences both within the home and in the community. Service user dietary needs and tastes are well catered for by the home and menu options are presented in a pictorial format that encourages service users to make informed choices on what they would like to eat. EVIDENCE: Daily notes recorded for service users included details of a wide range of activities that service users are involved in. The inspector saw daily shift plans that list the names of all the staff on duty and the work or activities that they are to undertake with individual service users. If the activity does not take place, staff record the reasons why and any alternatives offered. The information in the daily shift plans are linked to the information contained in each service user’s weekly activities programme tailored to individual tastes and reviewed when there are changes. Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 13 Activities recorded included computer work, art, cooking, visits to the local park, library, day centres and discos, eating out, shopping, pub visits, cinema trips and drives in the home’s van. The inspector arrived at the home shortly before service users were due return home from day services and other activities organised outside of the home. Service users spoken to indicated that they had enjoyed their daytime activities and were able to engage in activities of their choices within the home. Service users in the home had been on holiday to Great Yarmouth in February. One service user was also due to go on holiday abroad on the day after the inspection and spoke enthusiastically about the journey they were due to take. Service users are encouraged to be involved in household tasks such as preparing meals and cleaning and tidying the house. The home uses communication boards where pictures are used to show the activities that service users will be involved in on a daily basis. The home has a 4-week set menu (with picture aids) and staff advised that individual service users have the opportunity to take it in turns to make meal choices for everyone. Service users who do not like the meal selected still have the option to make their own choices. Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 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 the following standard(s): 18, 19 and 20. Service users are supported with both physical and emotional health needs according to their preferences. The home has stringent medication practices and safeguards as appropriate to minimise potential risks to service users. EVIDENCE: Service user plans include information about their physical, emotional and social needs as appropriate. Daily records, discussion with staff and service users and observation of interactions within the home indicated that these needs are being addressed appropriately. Information is maintained regarding all GP, hospital and health care appointments as appropriate, indicating that regular contact is maintained with health care professionals. There are no service users self-administering medication at present. All staff working in the home have received training in the appropriate administration of medication. Medication received at the home is checked and signed in by staff to ensure that the medication is correct. There is also a weekly check carried out by a member of staff to ensure that medication practices are being followed appropriately. Medication administration records inspected were completed appropriately by staff. Appropriate records of medication returned to the pharmacy were also seen. Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 15 Temperatures are maintained within the required range in the area where medication is stored. As required at the previous inspection, internal and external medications were being stored separately to avoid the risk of cross contamination in the event of leakages. Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 16 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 the following standard(s): 22 and 23. Regular service user forums ensure that service users have a formal channel through which their concerns can be expressed and resolved. Appropriate procedures are in place and all staff have been trained in adult protection to ensure that service users are protected from abuse. EVIDENCE: No new complaints had been received since the previous inspection. An appropriate record of complaints is maintained indicating action taken within appropriate timescales. The manager explained that the home generally holds user forum meetings every three months in addition to six-monthly meetings at the Hoffman Foundation for Autism head office. These meetings encourage service user participation in addition to advocacy from family members and friends and provide a forum where issues of concern can be discussed and addressed. The manager noted that there had not been a forum at the home recently but a meeting was due to be arranged within the next two months. Certificates were available evidencing that staff members had received adult protection training as required at the previous inspection. The inspector also spoke to a number of staff members who confirmed that this training had been relevant and useful. Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 17 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 the following standard(s): 24, 25, 27 and 30. The home environment is comfortable, clean and safe and in a good state of repair and decoration. Service users have personalised their bedrooms and have adequate toilets and bathrooms to meet their individual needs. EVIDENCE: At the previous inspection a requirement was made regarding a stained chair in a named service users room. This had been replaced as appropriate. While the home is comfortable and safe it is generally sparsely decorated. As explained by the manager at the previous inspection, the manager explained that this was because a service user would get agitated and destroy decorations such as pictures and when this occurred other service users were placed at risk of injury. Despite the obvious constraints of decorating communal areas, service users are able to decorate their rooms according to their tastes. The inspector was able to view all service users’ rooms, and a service user spoken to advised that it was very comfortable and decorated in their colour of choice. As required at the previous inspection, the smell detected in a service user’s room had been addressed. The manager advised that the smell was caused by Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 18 a service user using the washbasin in their room inappropriately, and that with appropriate permissions from the service user’s advocates, it was intended that this washbasin would be removed, and the service user would be encouraged to use toilet facilities instead. The home has a large garden at the rear, which was in need of some attention in places where it was overgrown and some repair work was needed to the rear garden fence. A requirement is made accordingly. The manager informed the inspector that these issues regarding the garden and fence had been addressed shortly after the inspection. Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 19 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 and 36. Appropriately experienced, trained and supervised staff support service users effectively according to their individual needs. The home has a rigorous recruitment procedure for new staff members, in order to protect vulnerable service users from harm. EVIDENCE: Four staff files were inspected and these were found to include satisfactory enhanced CRB disclosures, references, identity documents and all the other required information as specified under Schedule 4 of the Care Homes Regulations 2001. One file was missing a copy of a second written reference, and this was provided to the local CSCI area office shortly after the inspection. A selection of staff supervision records were also inspected and these indicated that staff were receiving regular one-to-one supervision meetings as appropriate. This was confirmed by staff members spoken to. The registered manager advised that the staff team were well on the way to meeting the national minimum standard for relevant NVQ qualifications by the end of the year. Staff files included certificates of all relevant training courses undertaken by staff including adult protection, health and safety, food and hygiene, autism awareness, first aid, working with challenging behaviour, fire safety and breakaway techniques. Staff spoken to advised that training provided was useful and relevant. Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 20 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. The home is managed effectively to ensure that service users’ needs are appropriately. There are generally effective quality assurance procedures to ensure that service users’ preferences are taken into account and that the standard of care and support remains high. However this could be improved by more regular visits from the responsible individual appointed by the provider organisation. There is a need for more rigorous monitoring of inspections carried out by external contractors and more regular fire alarm checks must be undertaken in the home to ensure service user’s safety. EVIDENCE: The registered manager advised that she was in the process of completing the Registered Manager’s Award at NVQ level 4. Discussion with the manager and individual staff members and one service user indicated that the manager is very knowledgeable about the needs of service users at the home, and with support from her deputy manager, supports staff effectively to meet these Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 21 needs. The home has effective recording and checking procedures to safeguard service users’ finances as appropriate, with all amounts checked at the end of each shift. Staff meetings are held regularly and minutes indicated that staff are encouraged to express their views about the running of the home. A detailed quality assurance audit had been undertaken for the home as appropriate, however the inspector had not been receiving reports of unannounced visits by the provider organisation to the home on a monthly basis. Since March 2005, reports were only available from July and September. It is required that the provider organisation must conduct monthly unannounced visits to the home. Reports of these visits must be kept in the home and a copy sent to the CSCI. There was no evidence of fire doors wedged open in the home and (as noted at the previous inspection) a door that was in the past regularly wedged open had been fitted with a magnetic door holder linked to the fire alarm. Staff files indicated that staff have received training in health and safety, first aid and food hygiene. Each week a different member of staff is assigned the responsibility of completing a health and safety check list. Regular fire drills are undertaken as appropriate. However the inspector was concerned to note that the frequency of testing fire alarms had recently decreased from weekly to approximately fortnightly. The manager advised that this was due to a staff member leaving, who had previously overseen health and safety practices in the home. This must be addressed. The inspector was also concerned to note that no gas safety certificate was available since 2003, however a current gas certificate was provided to the inspector shortly after the inspection. There was only an unsatisfactory electrical wiring certificate available from July 2005, indicating that there were five urgent actions that must be undertaken to protect the safety of staff and service users at the home. Finally the manager had received advice that portable appliances testing is only required every two years, however the inspector confirmed with the Health and Safety Executive that there has been no change in the recommended frequency of this testing. Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 22 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 X 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 X 3 X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Park Avenue 4 Score 3 3 3 X Standard No 37 38 39 40 41 42 43 Score 3 X 2 X X 2 X DS0000010748.V255883.R01.S.doc Version 5.0 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard 24 Regulation Requirement Timescale for action 10/03/06 2 39 3 42 23(2)(b)(o) The registered persons must ensure that rear garden is attended to in places where it is overgrown and repair work is undertaken on the rear garden fence. 26 The registered persons must ensure that the provider organisation conducts unannounced visits to the home every month. Reports of these visits must be kept in the home and a copy sent to the CSCI. 13(4)(a) The registered persons must ensure that the frequency of testing fire alarms is increased to at least weekly and that this is recorded. Portable electrical appliances must be tested at least annually, and a current satisfactory electrical wiring certificate must be obtained for the home. Copies of these certificates must be sent to the local CSCI area office. 02/12/05 16/12/05 Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard 7 Good Practice Recommendations It is recommended that the home develop further ways in which to record service users’ wishes and decisions regarding their care and support provided to them. Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Park Avenue 4 DS0000010748.V255883.R01.S.doc Version 5.0 Page 26 - 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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