Inspection on 04/12/07 for Pathways

This inspection was carried out on 4th December 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Pathways 10/01/07

Pathways 09/02/06

Pathways 06/10/05

Pathways 22/02/05

Pathways 24/09/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Pathways 56a Baden Powell Drive Colchester Essex CO3 4SR Lead Inspector Jane Offord Unannounced Inspection 4th December 2007 10:45 Pathways DS0000017904.V356214.R01.S.doc Version 5.2 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 Pathways DS0000017904.V356214.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 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. Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pathways Address 56a Baden Powell Drive Colchester Essex CO3 4SR 01206 761680 01206 862750 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) Mr Pelandapatirage Gemunu Susantha Dias Mr Jean Ghislain Domingue Mr Jean Ghislain Domingue Care Home 12 Category(ies) of Learning disability (12), Physical disability (12) registration, with number of places Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home accommodates 12 people with learning disabilities who may also have physical disabilities 10th January 2007 Date of last inspection Brief Description of the Service: Pathways is a care home providing personal care and accommodation for 12 individuals with learning disabilities and physical disabilities. Pathways consists of two purpose built detached bungalows, set back from a quiet road in the Shrub End area of Colchester. The home is within easy reach of local shops and a short journey from Colchester town centre, either by public transport or car. The home has its own transport. Both bungalows have a communal lounge and dining room with domestic style kitchens. There are a variety of bathing facilities to accommodate the varying needs and preferences of the residents. All the bedrooms are for single occupation and two of them have en suite facilities. There is a hard car parking area to the front of the bungalows that is shared and a garden with some mature trees to the rear of the buildings. There is level access to the garden and a brick BBQ is available for use. The fees for accommodation and support in Pathways range between £716.00 and £1069.45 weekly. No additional services are provided although residents give up a proportion of their mobility benefit to cover transport costs. Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection looking at the core standards for care of younger adults took place on a weekday between 10.45 and 16.00. The manager and deputy manager were present throughout the day and assisted with the inspection process by providing documents and information. This report has been compiled using information available prior to the inspection, including a completed annual quality assurance assessment (AQAA) and a number of residents’ relatives’ and staff surveys, as well as evidence found on the day. During the day a tour of both bungalows was undertaken with the manager. A number of staff and residents were spoken with and care practice was observed. A selection of documents and policies were looked at including the files of two residents and two new staff members. Some maintenance records, the duty rotas, the menus and medication administration records (MAR sheets) were also inspected. On the day both bungalows were clean and tidy with no unpleasant odours noted. Residents were pursuing a variety of occupations and interactions between staff and residents were friendly and appropriate. Residents looked happy and relaxed in the environment. Staff spoken with said they enjoyed working at Pathways and found the management team supportive and approachable. What the service does well: The home offers a friendly, homely environment to residents with the opportunities to spend time in a group or individually as they choose. College courses and other occupations are accessed as appropriate for the residents. The staff team is stable and has a good in depth knowledge of the residents’ needs, likes and dislikes. Residents’ care plans are detailed and contain a great deal of information about the resident, their physical and social health needs and how they are to be met. Records of health professionals input are informative and relevant. Residents’ own rooms are decorated with input from the resident or family and clearly reflect their gender and interests. The home uses good recruitment procedures with thorough checks on prospective staff members and a full induction programme when staff commence in post. Ongoing training is encouraged. Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2. Quality in this outcome area is good. People who use this service can expect to have sufficient information to make an informed choice about living there and have their needs assessed prior to moving in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The present group of residents have been in the home a number of years so pre-admission assessments were no longer present in the files seen. The statement of purpose and the admission policy were looked at and both include pre-admission assessment as part of the admission procedures. Trial visits to the home, covering a daytime visit, an overnight visit and a short stay form part of the phased plan for admission. A three-month trial period is a standard part of the policy. The manager said they would obtain information from any health professionals and family members available to ensure the prospective resident would ‘fit in’ with the existing group and that their needs could be met by the staff skills. Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9. Quality in this outcome area is good. People who use this service can expect to be supported to make decisions about their lifestyle and have a care plan to reflect their assessed needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The files and care plans for two residents were seen and both contained detailed information about the resident’s likes, dislikes and their preferred lifestyle. The folders were divided into sections headed ‘personal profile’, ‘physical health’, ‘daily activities’, ‘care plan’, ‘care reviews’ and ‘multidisciplinary’. There were also sections for risk assessments, professionals’ reports and input from the resident and their key worker about the care plan interventions. Both files had a recent photograph of the resident for identification purposes and a physical description including height, hair and eye colouring. Information included a brief life history and in one case there was evidence that final wishes had been discussed with the family. Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 10 The daily activities section had a weekly programme of the occupations the resident undertook regularly. Attendance at college for computer lessons or art and craft sessions was built into the programmes. Other pastimes were attending day centres, evening clubs such as Gateway, regular swimming sessions, shopping, doing domestic chores and visits to see family and friends. The care plans covered areas of daily living that the resident needed support with such as personal hygiene but the interventions encouraged independence so one had recorded, ‘may need some help with underwear but can put own top on’. Specific exercises to maintain mobility were recorded in the care plans as well as weight monitoring, anti social behaviour, epileptic seizures, limited road safety knowledge and motivational needs. In discussion with their key worker the residents’ views about their care plan and living in Pathways were obtained and included in a review section. One resident had said, ‘I enjoy living here with the other people but need my own space as well’. Another had said, ‘I like living here but want my own privacy and do not want anyone touching or moving belongings in my room’. Both entries were signed by the respective resident and had been dated within the last three months. Each resident has an Individual Programme Plan that looks at particular areas of support that may be required. Physical issues such as a damaged joint or tight Achilles tendon would be itemised with the interventions needed. Also areas of skills that needed development like communication and understanding of money. One resident had some difficulties in relating to certain people at times and the plan included the management reaction to a situation including support, honesty and reassurance. Not all records were dated making it difficult to know if they were still relevant. Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17. Quality in this outcome area is good. People who use this service can expect to be encouraged to engage in personal development activities and be offered a healthy diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both files seen contained contact details of the residents’ next of kin and other family members. The daily records showed that contact with families was frequent. On the day of inspection one resident was leaving the home with their parent for a shopping trip as the inspector arrived. Another resident spoken with said they were looking forward to going home for Christmas and would be away for several days. The daily records of one resident recorded that they had gone out with a sibling to visit the grave of their parent and would stay out to have lunch together afterwards. Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 12 The activity programme for each resident offered areas of development by attending local centres and college. The manager said unfortunately funding for college places has been reduced and the number of places available has been restricted as well. Even so several residents regularly attend day centres or have art and craft or canvas and beadwork classes. The file of one resident shows they attend a private organisation called Adepta that helps develop work skills and build personal confidence. Additional activities covered having a pub lunch, going to a concert, walking in the park and getting a take away meal. Some residents had recently been involved in a local theatre production and had attended the opening night. The notice board had photographs taken by the local paper with the residents looking splendid and proud in evening dress. Other residents with an interest in military pastimes had been invited to start a local military charity walk and there were photographs of the event on display. To celebrate the birthday of one resident a member of staff took them and some of their friends for a ‘girlie’ sleepover to their home. The resident’s parents had granted permission and the manager had checked the insurance liability. A second member of staff stayed overnight with the group. The menus were seen and work on a four-week rotation that is discussed with residents and likes and dislikes are taken into account. Sometimes the residents of one bungalow will have a take away or a pub meal. The main meals were homely but nutritious dishes such as cottage pie or roast, with hot snacks such as beans on toast or tuna salad available at other meals. Fresh fruit and yoghurts were always available. The kitchens in both bungalows were visited and found to be clean and tidy. Food was stored correctly and the recorded temperatures of refrigerators and freezers showed that they were functioning within safe limits for food storage. Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome area is good. People who use this service can expect to have their health needs met and be protected by the home’s medication practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Both the files seen contained contact details of any health professionals involved with the support of the resident, that included the GP, occupational therapist, physiotherapist, chiropodist and dietician. There were records of medical appointments and a section for multidisciplinary decisions to be recorded. Surveys received before this inspection from health care professionals involved in the care of residents indicate that the health needs of residents are met by the service and medication is correctly managed. Information in the residents’ files seen show that staff are aware of the need for emotional support in some circumstances that the resident may find challenging. Particularly noted were attendance for medical appointments and Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 14 new situations or people. Interventions required included reassurance and constant support. Records showed that staff have received training in the management of medication and this was confirmed in discussion with staff members. The AQAA states that additional training in the understanding and management of epilepsy and diabetes has been accessed in the last year. The medication administration records (MAR sheets) were looked at and showed specimen signatures off all staff qualified to give medication on the front of the folder. No signature gaps were noted in the records but for one resident some pain relief tablets were being given on an ‘as required’ basis when the directions were for four times a day. Some other instructions recorded only ‘as directed’. Both these issues were raised with the manager at the time. The manager said they monitor staff competency to do medication administration and they also do monthly audits of medicines. At the time of inspection the home did not hold any controlled drugs (CDs). Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. People who use this service can expect to have concerns taken seriously and be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Neither the home nor CSCI have received a complaint about the service since before the last inspection. The home has a robust complaints policy that is available with the statement of purpose and in pictorial format on display in both bungalows. Eight relatives’ surveys were received by CSCI before this inspection and seven indicated that they knew the complaints procedure if they had a concern. Seven residents’ surveys were received and all seven said they knew who they could speak to if they were unhappy about something. The policy folder was seen and contained a policy based on the guidance for protection of vulnerable adults (POVA). There have recently been changes to the management and terminology of the protection teams and this area is now called Safeguarding Adults. The referral route is a little different too. This was brought to the manager’s notice and they agreed to access the new guidance and update staff. Staff spoken with were clear about their duty of care and one recently appointed staff member said abuse had been covered during their induction programme. The home has a whistle blowing policy to protect staff who raise concerns about colleagues. Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30. Quality in this outcome area is good. People who use this service can expect to live in a clean, homely environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of both bungalows was undertaken during the day and everywhere was clean and tidy with no unpleasant odours. The hall and lounge in bungalow 1 have been redecorated in the last year and there are plans to redecorate the lounge in bungalow 2 in the coming year. A number of residents’ rooms have also been done in consultation with residents and their families about colour preferences and soft furnishings. Comments in some of the relatives’ surveys received by CSCI say that some of the carpets look shabby and need replacing but that the home is always clean. Surveys from residents and visiting health professionals all say the home is always clean. Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 17 A new hoist has been installed in one of the bathrooms and a shower in the en suite of one resident to meet specific personal hygiene needs. A number of residents’ bedrooms were seen and were clearly personalised by the occupant. There was evidence of a diverse range of interests from military and football to pop stars and animals. There were displays of pictures, posters and personal televisions and music centres. Choice of décor usually indicated the gender of the resident with female rooms being in much softer colours. Laundry is done by the carers and each bungalow has a laundry area. The washing machines have sluicing programmes and hot washes. The infection control policy emphasises good hand washing techniques and liquid soap and paper towels were in evidence around the home. Protective clothing was also available. Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35. Quality in this outcome area is good. People who use this service can expect to be supported by adequate numbers of correctly recruited staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rotas were seen and showed that in each bungalow there are three carers on duty during the daytime and a waking staff member during the night. The manager is supernumerary and the service now has a driver/maintenance person available 9.00-15.00 during the week. The manager and provider share the on-call responsibilities. Staff spoken with said the staffing levels were sufficient to meet the present needs of the residents. The addition of a driver had taken some pressure off the daily transport needs. The service employs twenty-one care staff of whom twelve have achieved an NVQ level 2 qualification or above and four more are working towards one. This gives a percentage of staff with a relevant qualification of well over the recommended 50 . Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 19 The files for two recently appointed staff members were seen and both contained two references and a full work history. A criminal records bureau (CRB) had been undertaken in both cases prior to the person commencing in post and there was documentary evidence that identification checks had been made. The induction documents covered health and safety, fire awareness, food hygiene, POVA, moving and handling, care needs and the role of CSCI. Staff surveys X 6 received by CSCI all said their induction had equipped them for the job they were to do. Staff spoken with on the day said all staff had had POVA instruction within the last year and a number were enrolled on infection control training to be done in the next few months. The AQAA states that all senior staff have completed a course on medication management in the last year, staff spoken with confirmed that. Pathways DS0000017904.V356214.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42. Quality in this outcome area is good. People who use this service can expect to have their views sought and their welfare protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is a qualified nurse with many years experience in nursing and providing residential care. They also hold a certificate in management. They have a relaxed management style with an ‘open door’ policy for staff and residents. Staff spoken with said the manager was supportive and approachable. Interactions observed between the manager and residents were friendly and appropriate. Residents’ surveys received by Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 21 CSCI were all clear that they could approach the manager if there was a concern. The service undertakes an annual quality assurance survey of residents, relatives and staff. The results showed that nine of the twelve residents had completed forms, some with help. The overall outcome was that residents were positive about their life in Pathways and enjoyed their involvement in shopping, choosing meals and décor. They were all able to identify their key worker. Staff responses indicated that they were supported by management and given opportunities to develop professionally. Relatives and visitors said the atmosphere was friendly and they were always welcomed. A number of maintenance records and service certificates were inspected and showed all checks had been made within the last year. There were certificates for checks on hoists, the minibus lift, gas safety and fire alarms. The control of substances hazardous to health (COSHH) guidelines had had the product details updated. There were generic risk assessments in place for electrical equipment, fire, slips/trips and smoking. Pathways DS0000017904.V356214.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 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 Standard No Score 1 3 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? None. 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 YA20 Regulation 13 (2) Requirement Medicines must be given following the instructions recorded on the MAR sheet, which must be explicit and unambiguous, to protect residents and ensure they receive the medication prescribed correctly. Timescale for action 04/12/07 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 YA6 Good Practice Recommendations All care plan documents should be dated to ensure that the interventions are relevant and up to date so that residents receive the support they need. Pathways DS0000017904.V356214.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Pathways DS0000017904.V356214.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!