Inspection on 18/07/07 for Pennsylvania House

This inspection was carried out on 18th July 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

Pennsylvania House 13/09/06

Pennsylvania House 16/01/06

Pennsylvania House 07/09/05

Pennsylvania House 09/03/05

Pennsylvania House 27/07/04

Pennsylvania House 30/03/04

Similar services:

2 Perhaver Park

The Vicarage

Fairfields Country Rest Home

St George`s

5 Seafield Road

Credence House

Poldhu

Queensmount

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

CARE HOMES FOR OLDER PEOPLE Pennsylvania House 7-9 Powderham Crescent Exeter Devon EX4 6DA Lead Inspector Sue Dewis Unannounced Inspection 18 and 20 July 2007 10:00 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 Pennsylvania House DS0000022007.V338395.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. Pennsylvania House DS0000022007.V338395.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pennsylvania House Address 7-9 Powderham Crescent Exeter Devon EX4 6DA 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) 01392 256346 01392 433224 henry-morgan@tiscali.co.uk Mr Henry Arnold Morgan Mr Henry Arnold Morgan Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Learning registration, with number disability over 65 years of age (25), Mental of places Disorder, excluding learning disability or dementia - over 65 years of age (25), Old age, not falling within any other category (25) Pennsylvania House DS0000022007.V338395.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th September 2006 Brief Description of the Service: Pennsylvania House, is a privately owned home, situated in a residential area of Exeter. It is within a short walk of the city centre. It comprises three adjoining terraced houses with accommodation on the ground, first and second floors. There is a small communal lounge on the ground floor, and a larger one on the first floor. The dining room is on the ground floor. A passenger lift provides access to the upper floors. To the front is a small garden and there is car parking and a small courtyard area to the rear. Mr Morgan is planning a large extension to the rear of the building, which will incorporate a new laundry, dining area and garden. The home provides care and accommodation for a maximum of twenty-five older people with dementia, mental health needs and learning disabilities. The reports from CSCI inspections are displayed on notice boards around the home. Fees range from £297.04 to £450.00 per week. Fees do not include hairdressing, chiropody or outings. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at http:/www.oft.gov.uk . Pennsylvania House DS0000022007.V338395.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over 12 hours, on two days towards the end of July 2007. During the inspection 3 people were case tracked. This involves looking at peoples’ individual plans of care, and speaking with the person and staff who care for them. This enables the Commission to better understand the experience of everyone living at the home. As part of the inspection process CSCI likes to ask as many people as possible for their opinion on how the home is run. This included sending out questionnaires out to 7 people living at the home, 7 representatives, 25 health and social care professionals (including GPs and care managers) and 8 staff. At the time of writing the report, responses had been received from 2 people living at the home, 2 health and social care professionals and 3 staff. During the visit 3 people living at the home were spoken with individually and 5 in a group setting. Two representatives who were visiting the home were also spoken with. We also sat for a short time watching an activities session, and on the second day spent an hour in the upstairs lounge observing the interaction between staff and people living at the home. We also spoke with 6 staff and the care manager and the owner. A full tour of the building was made and a sample of records was looked at, including medications, care plans, the fire log book and staff files What the service does well: Pennsylvania House is well managed and provides a safe, comfortable and homely place in which individuals can live their lives as they choose. There was good interaction observed between individuals and staff. Those individuals and their representatives who were spoken with were happy with the care they receive at the home. The home tries to treat people as individuals with each one receiving the care and support they need and want. There is a good assessment process that assures people thinking of moving into the home that their needs will be met, and there is good care planning that ensures all aspects of care continue to be monitored and needs met. Staffing levels are sufficient and recruitment and training is robust to ensure individuals are protected from harm. All records, including those relating to Pennsylvania House DS0000022007.V338395.R01.S.doc Version 5.2 Page 6 medication administration, fire precautions, risks and finances were well maintained. There is a clear and simple complaints procedure and any complaints made to the home are investigated. People felt that meals were very good and there was a good variety of food available. There was also a high degree of satisfaction with the level of activities and entertainment available. 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. Pennsylvania House DS0000022007.V338395.R01.S.doc Version 5.2 Page 7 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 Pennsylvania House DS0000022007.V338395.R01.S.doc Version 5.2 Page 8 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): 2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals thinking of moving into the home are encouraged to visit, and an assessment of the support they require ensures that the home can appropriately meet their care needs. The home does not provide intermediate care. EVIDENCE: The files of three people were inspected. Each file showed either a contract between the owner and the individual or the owner and the placing authority. Concerns had been raised by a representative about the level of recent fee increases, as they felt that increase was excessive. Current good practice Pennsylvania House DS0000022007.V338395.R01.S.doc Version 5.2 Page 9 recommendations are that any increases should be made with reference to clear and objective criteria. Discussions with the owner indicated that whilst the increase is over that of inflation, the level of increase was determined by the increases in staffing costs and other general household expenses. Also, the increase was made in line with the terms and conditions specified in the contract between the individual and the owner. All three files contained detailed pre-admission assessments to determine if the home can meet their needs. There was also some evidence that people had visited the home prior to moving in. None of the people spoken with were able to remember if they had visited the home prior to moving in. The home does not provide intermediate care. Pennsylvania House DS0000022007.V338395.R01.S.doc Version 5.2 Page 10 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 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are well formulated and give clear information to enable staff to meet the health and social care needs of individuals. Though there is not also the evidence that this has been followed through. Individuals are treated with dignity and respect and their health care needs are well met, with evidence of good multidisciplinary working taking place where necessary. To ensure the safety of individuals, all medicines are stored securely and administered appropriately. EVIDENCE: Four care plans were inspected. They are based on information collected prior to admission and cover physical abilities and likes and dislikes as well as Pennsylvania House DS0000022007.V338395.R01.S.doc Version 5.2 Page 11 nutritional, pressure area and moving and handling assessments Each plan also contains a ‘life history’ for each individual and some of this information is also recorded in the ‘key-worker’ books that contain information on hobbies and anything they may like to try. Care plans set out detailed instructions to staff on how to meet the day-to-day needs of individuals. However, there was little evidence that some instructions had been carried through. For example one plan stated that the individual must be encouraged to leave their room and mix with others, but there was no evidence of this happening. Another stated that the individual liked ‘company to chat with, going to the pub and smoking, but again there was no evidence of any of this happening. On the whole though, there was some useful information recorded including information on ‘signs to be aware of that indicate ..could have a fit’. Also some recordings show that an individual had had a massage and had taken part in a flower arranging session. Individuals and staff that were spoken with confirmed that activities did take place on a regular basis and that staff spent time with individuals talking with them and talking them for walks and to the shops. It was just that this was not recorded. The files showed evidence of regular reviews, but contained little evidence of the individual’s and/or their representative’s involvement in drawing up and reviewing their care plan. There were some signatures on some files, but they were not dated and did not indicate how satisfied they were with the plan. There was evidence that health care needs are well met and it was possible to see where an issue regarding an individual’s weight had been addressed. A District Nurse was spoken with and they felt that the home was very willing and able to carry out any instructions she gave and that she had never had any concerns over the quality of the care provided. Though care plans do provide information on health and personal care needs and how they are to be met, they are a little confusing and it is sometimes difficult to see where issues have been recorded if at all. The home uses the Boots MDS system (blister packs). All medicines are stored securely in a locked cupboard. Medication is administered and signed for appropriately, with the relevant ‘blister pack’ taken to the individual before the medication is removed, and staff sign to say it has been taken. In line with the home’s policy and procedure all medicines received into and returned from the home are counted and recorded, and all staff who administer medicines have received appropriate training. Pennsylvania House DS0000022007.V338395.R01.S.doc Version 5.2 Page 12 Staff were seen to respect the privacy of individuals, knocking on doors and generally offering personal care in a discreet manner. However, there were two instances when staff were a little indiscreet, one when a member of staff told an individual in the main lounge that they needed to ‘check their pad’ and another at lunch time when individuals were referred to as ‘feeders’. The care manager overheard one of these remarks and spoke to the staff concerned. These two instances were the only that were observed throughout the visit that raised concerns and individuals did say that staff were very good and always kind to them. Pennsylvania House DS0000022007.V338395.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Links with visitors and the community are good, giving opportunities to support and enrich individuals’ social life. The home offers a suitable range of activities and entertainments to stimulate and occupy individuals. Meals were seen to be well presented, providing nutritious variety and choice for individuals. EVIDENCE: There is a list of activities for the week displayed on the notice boards in the lounges, which includes orientation and massage sessions. On the afternoon of the first visit we spoke to a lady who was providing a gentle exercise session. She said that she visited each week for about an hour and spent time in each lounge encouraging residents to join in with the sessions. Pennsylvania House DS0000022007.V338395.R01.S.doc Version 5.2 Page 14 Individuals said that they generally spend their time as they please, reading, knitting or watching TV. They said that they enjoyed the activities, and there was usually something going on every afternoon. The entrance hall has recently been decorated and individuals said that they had helped to choose the wallpaper. On the second visit, we sat in the upstairs lounge and observed staff and individuals living at the home. Two staff were encouraging individuals to join in activities, playing skittles and throwing a ball. Another member of staff was asking people what they wanted for tea and several other staff entered the room to see what was happening. There was especially good interaction between the staff and individuals at this time. There was good eye contact and general chat as each individual was encouraged to throw or catch the ball. One individual was drawing and writing, but always stopped when it was their turn to throw the ball. During the first visit a local priest visited for communion, this usually takes place once a month and other services take place weekly. Positive comments (via surveys) were received from two representatives about the care their relative receives from the home. They said that their relatives had been at the home for some time and that they were always kept informed of any changes with their relatives. Two representatives were spoken with during the visit and they said that they were always made welcome and encouraged to ring at any time. On person said that staff were always on hand to give all attention to their relatives and that the home was ‘like one big happy family’. Individuals living at the home said that their visitors were always made welcome and encouraged to visit. All residents praised the standard and variety of food and said that there were three choices at lunch and ‘you can pick what you want’. Menus are displayed in the entrance hall and showed a range of nutritious food on offer. Special and medical diets can be provided. Pennsylvania House DS0000022007.V338395.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are dealt with appropriately and individuals are protected by staff who are able to recognise abuse and know their duty to report poor practice. EVIDENCE: There is a clear and simple complaints procedure displayed in the main hall and the communal lounges. Individuals living at the home told the inspector that they felt they could talk to the care manager about any concerns they had and felt that they would be dealt with. They also said that if they needed anything they could talk to their key-worker. Two members of staff have completed the POVA (Protection Of Vulnerable Adults) training for trainers, and are able to ensure all staff are kept up to date with these issues. Four care staff and one general assistant were spoken with and they were all able to describe differing types of abuse and were clear about the procedures to be followed if they suspected abuse was taking place. This included contacting outside agencies if necessary. One concern had been raised with the Commission about the increase in fees. Please see Standard 2. Pennsylvania House DS0000022007.V338395.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, 24 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home generally provides individuals with a clean, safe, comfortable and homely place to live. EVIDENCE: A full tour of the communal areas of the home was made and several individual bedrooms were looked at. There is only a small courtyard that is not easily accessed at the rear of the home. However, there is small area at the front of the house and a private park opposite the home to which the home has a key, and to which residents Pennsylvania House DS0000022007.V338395.R01.S.doc Version 5.2 Page 17 are regularly taken. The redevelopment that is planned to the rear of the building will include a safe and secure garden area. Cleanliness of the home has been an issue at previous inspections and steps have been taken to address the matter. During both visits the home was clean and tidy. The home is generally comfortable and well maintained, some areas have recently been decorated and new carpets fitted. However, there are still some ‘finishing touches’ needed, for example several curtains were coming down from the rails and the hall and stairs have a range of miss-matching carpets. The individual bedrooms that were looked at were very different, reflecting the personality of the occupant and they contained many personal items. People said that they were happy with their rooms and had everything they needed in them. There is a range of aids and adaptations around the home, including grab rails, raised toilet seats and bath hoists. Laundry facilities at the home are now suitable, as the floor does now has an impervious covering, which helps prevent infection control procedures being compromised. A new laundry is to be incorporated into the major extension to the home that is planned for the near future. Staff have received training in infection control procedures and said that disposable gloves and aprons were readily available if needed. These were seen around the home. Staff wear different coloured tabards when giving personal care or serving food. Pennsylvania House DS0000022007.V338395.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are well trained and are available throughout the day and night in sufficient numbers to meet the needs of the current individuals. The procedures for the recruitment of staff are robust and offer full protection to individuals. EVIDENCE: There are generally five care staff on duty during the morning and four during the afternoon and evening. There is also a general assistant, a cook, the care manager and the owner at the home during the day. Staffing levels are suitable to meet the numbers and needs of the individuals currently living at the home. Individuals told the inspector that they did not have to wait very long for any help they may need. Discussions with staff indicated that they were very aware of the needs of the individuals living at the home and said they are able to spend some time with those they are key-worker for on a one to one basis. Pennsylvania House DS0000022007.V338395.R01.S.doc Version 5.2 Page 19 The general assistant that was spoken with is under 18 and was very clear that they are unable to assist individuals with personal care tasks. A newly appointed staff member was at the home for induction. She was very clear that she was currently unable to have unsupervised access to any individual living at the home. People living at the home and their representatives were very complimentary about the staff, saying they ‘are always cheerful’ and ‘there is always someone on hand’. Staff said and records confirmed that they have received training in the Protection of Vulnerable Adults, fire practices, dementia and medication administration. Staff are also encouraged to take NVQ’s, with seven already having achieved this and a further eleven working towards them. Three staff files were looked at. All three contained all the required information including two references and a satisfactory police check. There is currently only a very brief statement about their mental and physical health and new application forms will require more detail in this area. Pennsylvania House DS0000022007.V338395.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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed resulting in practices that generally promote and safeguard the health, safety and welfare of the individuals. EVIDENCE: Mr Morgan has owned the home for many years and he is supported by a care manager who has their RMA (Registered Managers Award) and has recently completed the NVQ 4 in care. Staff were very complimentary about the care Pennsylvania House DS0000022007.V338395.R01.S.doc Version 5.2 Page 21 manager, feeling that she provided good support to them and encouraged them to work as a team. The home has a variety of quality assurance systems in place, including occasional residents’ meetings, care plan reviews and checks on the quality of food provided. The home manages monies for several residents and uses the ‘Microsoft Money’ system to manage the TSB Residents’ Account. Three residents’ accounts were checked, all were appropriately maintained and had the correct money held in separate wallets. The home submitted an AQAA (Annual Quality Assurance Assessment) prior to the visit that provided evidence that Pennsylvania House complies with health and safety legislation in relation to the maintenance of equipment, storage of hazardous substances, health and safety checks and risk assessments. The fire logbook, record of fire safety training and accident and incident records were found to be accurate and up to date. So that the risk of burning from hot surfaces is minimised, there is a programme to ensure all radiators within the home are covered. All windows above ground floor level are fitted with restrictors, in order to minimise the risk of any resident falling from these windows. There is now a programme for fitting thermostatic valves to all sink taps, in order that the risk of scalding from hot water is minimised. The home is appropriately insured, with the current certificate expiring in November 2007. Pennsylvania House DS0000022007.V338395.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 X 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X 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 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Pennsylvania House DS0000022007.V338395.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP7 OP38 OP38 Good Practice Recommendations You should ensure that care plans evidence work that is undertaken with individuals You should ensure all radiators are guarded You should ensure that thermostatic mixer valves are fitted to all sinks that residents have access to Pennsylvania House DS0000022007.V338395.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Pennsylvania House DS0000022007.V338395.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!