Inspection on 19/12/05 for Peterborough Avenue

This inspection was carried out on 19th December 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Peterborough Avenue 15/01/07

Peterborough Avenue 11/01/06

Peterborough Avenue 21/03/05

Peterborough Avenue 08/07/04

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 Peterborough Avenue 71 Peterborough Avenue Cranham Upminster Essex RM14 3LL Lead Inspector Harbinder Ghir Unannounced Inspection 08:00 16 & 19th December 2005 th Peterborough Avenue DS0000027888.V273368.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 Peterborough Avenue DS0000027888.V273368.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. Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Peterborough Avenue Address 71 Peterborough Avenue Cranham Upminster Essex RM14 3LL 01708 225196 01708 225196 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) Ms Rita Antoinette Lewis Ms Rita Antoinette Lewis Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th September 2005 Brief Description of the Service: Cara Linn Care Home at 71 Peterborough Avenue is a care home registered to provide long term care, support and accommodation to 3 adults with learning disabilities. Residents’ independence is promoted at all times and they are enabled to live as independently as possible. The home is a semi-detatched house with car parking facilities to the front of the building. The home is located in a residential area of Cranham, close to shops in the Upminster area, public transport and the M25, A127 and the A12. The home employs staff, working a roster, which gives 24-hour cover. Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Harbinder Ghir, Regulatory Inspector, undertook this unannounced inspection on the 16th and 19 th December 2005 and was at the premises from 1.30pm to 4.35pm and 9.40am to 11.35am. A second visit was undertaken to meet residents at the home. The visit included talking with residents and staff. Some judgements about quality of life within the home were taken from direct conversation with staff and observation. Relatives were spoken to at the home and were also contacted via telephone. In addition a tour of the premises was undertaken and some records were looked at. What the service does well: What has improved since the last inspection? The manager has recruited three new members of staff to ensure the manager has sufficient breaks from being on call. Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 6 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. Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 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 Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3,4,5 Service users’ needs are fully assessed prior to admission, ensuring that their needs can be met by the home. Service users have access to specialist services if they need them. EVIDENCE: Comprehensive pre –admission assessments are completed by the registered manager prior to service users being admitted to the home, to ensure their needs will be met by the home. Pre-admission assessments viewed were completed in full involving the potential resident, covering all aspects health, personal, social, communication, emotional and mental health needs. Three contracts were viewed. Residents receive a written contract of terms and conditions, which was very comprehensive and were signed by the resident or their representatives. The registered manager confirmed that trial visits to the home are encouraged and are an opportunity for potential residents and their family to identify how appropriate the home is for them in meeting their needs. Residents are offered day visits and can also stay overnight at the home. Residents can access specialist services, which are tailored to meet their individual needs. During the inspection a Community Learning Disability Nurse was visiting the home to provide one to one sessions for a resident. Other Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 9 specialist services that residents accessed included psychiatric services and the input of practice and diabetic nurses. Staff have the skills to deliver the agreed services and can communicate with residents within the limitations of residents’ abilities. This was observed throughout the inspection. A relative spoken to also stated that the staff team are very caring and look after the residents very well and that he has never had any concerns or complaints with the standard of care provided at the home. Peterborough Avenue DS0000027888.V273368.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, 8, 9. There is a comprehensive, clear and consistent care planning system in place, which provided staff with the information they needed to meet the needs of residents. Residents are supported to make active choices and decisions throughout their daily living and areas of risk are assessed. EVIDENCE: Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 11 Care plans inspected were very comprehensive and provided detailed information on how service users’ needs are to be met. Care plans were divided into sub sections, which were easy to read and follow. Care plans seen were divided into sections covering daily routines, all aspects of personal, health, social, emotional, mental, communication and educational needs. Residents are involved as far as possible in setting up the care plan and are encouraged to attend their care plan reviews. Care plans set out specialist requirements and how they are met. A Community Learning Disabilities Nurse spoken to during the inspection informed that residents’ needs are comprehensively identified and are well met. He stated that residents are always happy when he has visited the home and felt that residents were very well looked after by the home. Care plans reviews were completed monthly and were actioned and amended accordingly. Care plan files seen demonstrated that residents are enabled to take risks within a comprehensive risk management framework. Risk management strategies are recorded in individual care records of all residents and held on file. Risk assessments were in place for individual areas of identified risk and steps had been taken to reduce risk where possible, clear guidance was given to staff. For one resident documentation seen included risk areas associated with travelling on public transport and how these are to be reduced. Risk assessments were up to date, reviewed regularly by the home and by multidisciplinary professionals. A record of reviews, which are held annually and completed by Social Workers, was also viewed. The individual daily records for residents demonstrated involvement in the daily running of the home as far as their abilities allow. Residents’ independence is promoted at all times by the care staff at the home. Staff, where required, assisted residents to manage their own finances by accompanying them when going to the bank. Some residents contributed to the running of the home by participating in domestic duties, such as cleaning their rooms and going out shopping to the local supermarket. One resident spoken to informed that he cleans his rooms and loves to make and tea and coffee. During the inspection the resident independently made tea for all residents and the inspector. Peterborough Avenue DS0000027888.V273368.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): 11, 12, 13, 14, 15, 16, 17 Residents are provided with the support to maintain their independence and in areas of personal development according to their needs and wishes. Residents are engaged in community life; enjoy a range of leisure activities and a varied and nutritional diet. EVIDENCE: Care plans showed that the development of personal, social and emotional skills are fundamental to the service provided. Staff support residents to develop practical life skills for example by supporting them with managing their finances. All residents have the opportunity to be involved with the local church and attend weekly meetings if they choose. Care records identified some residents attending church on a weekly basis. A resident spoken to informed how he conducted music to a church service he attended. Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 13 Residents are offered opportunities to develop educational skills and seek employment opportunities as far as their abilities allow. All residents attend day centres and local colleges. One resident informed that he attends college where he has undertaken a letters and numeracy course. Others attend colleges where their daily living skills are promoted. One of the colleges attended included sessions in computers, music therapy, art groups and keep fit groups. A resident spoken to informed that he really enjoys going to college and his day centres. He informed that he also completes voluntary work for Harold Wood Hospital where he does the gardening for them. Each resident has their own personalised weekly activity programme where they are offered opportunities to participate in a range of leisure activities both within the home and in the local community. Staff enable residents as far as possible to integrate into community life by providing information and access to community facilities and events. As part of the Christmas festivities within the home, residents have been attending local Pantomimes and on the first day of the inspection had all gone to the local theatre to watch Snow White. Group trips and outings are available for those who share the same interests. Residents are also supported and encouraged to pursue their own interests and hobbies. Some of the activities residents are involved in included visiting gardens, parks, libraries, and going out shopping. One resident spoken to stated that he loves going out for walks and goes out for a walk every Sunday. All residents are provided with the option of a holiday outside the home, which they choose and plan. This year residents informed that they went to Newquay for a week, where they were on a coach trip and participated in an activities programme. The quality of social and leisure care has exceeded national minimum standards, and scores of 4 have been awarded in relation to Standards 13 and 14. Residents’ family and friends can visit anytime of the day. Residents are encouraged to go out with their families and develop personal relationships. The home facilitates family relationships by providing transport to residents to enable them to visit their families. One resident visited his sister every Sunday and was transported by care staff. A relative spoken to informed that the home makes a point of promoting family relationships and that they can visit the home at any time and are always made to feel welcome. She informed that they are invited to birthday celebrations and messages and gifts are always passed on to their loved one. Another relative spoken to informed that he visits the home anytime and takes his loved one out. Personal relationships are also promoted. One resident has a girlfriend. The resident informed that his girlfriend will be coming to the home’s Christmas meal and that he sees her regularly. Meals are provided by the home, which are varied and healthy. Residents are encouraged to participate in cooking where they are able to and are supported by staff. The home has a pictorial menu where residents can choose their preference of meals. Residents can also display their own picture cards of their Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 14 preferred meals. Diabetic and specialist diets are well catered for. The home does not keep a record of residents’ nutritional intake. The home must keep a record of all food served for each service to ensure their nutritional intake is monitored. This is Requirement 1. Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 15 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, 21 Residents’ wishes in the event of death are established and are handled with respect and as the individual would wish. Personal, physical and emotional healthcare is provided in a way that meets residents’ needs. EVIDENCE: All residents have a detailed plan of their daily routine including what support is needed in relation to personal hygiene. Personal support takes account of individual preferences and residents’ choice of dress and appearance is respected. A relative spoken to informed that since her brother has been at the home his personal hygiene and grooming has improved so much and that he looks so much better physically. Residents are supported to attend appointments with treatment by health care professionals. Care records showed that residents’ health is monitored and prompt referrals are made. Personal support takes account of individual preferences and is provided in private. Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 16 The wishes of residents in relation to dying and death are established and are documented in the care plan file. The home has a comprehensive policy and procedure on dying and death. Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 17 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): The above standards were not assessed at this inspection and will tested at the next inspection. EVIDENCE: Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 18 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, 26, 27, 28, 29, 30 Residents’ benefit from living in a safe, well-maintained and clean environment. Décor, furnishings and fittings are of a good standard and provide a homely and pleasant living environment, which enhances residents’ comfort. EVIDENCE: The premises were comfortable, bright, airy, clean and free from offensive odours. Furnishings and fittings in communal areas were of good quality, domestic and unobtrusive. The home provides a homely environment to meet the needs of service users. Relatives spoken with described the home as a home from home environment. Another relative spoken to informed that her brother, who is a resident at the home, describes the home as his home. The home provides a main lounge, with a dining room, a conservatory, a quiet lounge, and kitchen area. There is a communal assisted bathroom and an additional toilet on the ground floor. The grounds around the home were well maintained and were equipped with suitable garden furniture. Residents are Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 19 encouraged to maintain the grounds as one resident informed that he helps to do the gardening. Residents’ rooms were seen during the inspection. All rooms were comfortable with adequate furnishings and were also personalised by residents. Rooms had been personalised by one resident with West Ham Football Club merchandise and teddies as he stated that he loved to collect teddies. Another resident stated that he loved doing Jigsaws, which were seen in his room. A resident spoken to stated that he liked his room and was happy at the home. All rooms were lockable and can be overridden by staff in an emergency. Specialist equipment for those residents in need was in place. Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 20 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): 31, 32, 33, 34, 35, 36 Staff were aware of their and other’s job roles and responsibilities, providing clarity of roles to residents. There is a good match of qualified staff offering consistency within the home. Staff morale is high resulting in an enthusiastic workforce that works positively with service users to improve their quality of life. Recruitment processes need to be more robust to ensure the protection of people living at the home. The staff group receive adequate training to meet the needs of residents. Staff receive supervision on a regular basis. EVIDENCE: The registered manager has appointed three new members of staff to ensure she has sufficient breaks from working with service users and has met the requirement identified in the last inspection report. The GSCC Code of Conduct is covered in the induction-training programme. Staff receive a comprehensive induction programme and attend mandatory training organised by the home. Forthcoming training organised by the Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 21 registered manager includes training in Adult Protection and Dementia. The Manager is working in conjunction with the Learning Skills Council and Employer Training Pilot to more training opportunities for staff. As a result two members of staff are in the process of completing their NVQ qualification, whilst one member of staff has enrolled on the course independently. LDAF training has also been identified for members of staff. Staff training files viewed were up to date to reflect the training staff had attended and completed. It was evident from the activities in the home that the staff were highly motivated and committed to the service user group. The staff team consists of permanent members of staff. The staff duty rota was seen; this showed that staff were working appropriate hours and the home was adequately staffed. During the inspection it was observed that adequate numbers of staff were on duty. There are two members of staff per shift. On inspecting the homes recruitment procedure, three staff files were viewed during the inspection. All three files were complete with all relevant checks made required by the regulations with the exception of Criminal Record Bureau checks made by the Home. The manager had obtained copies of Criminal Record Bureau checks made by previous employers. Criminal Record Bureau checks are not yet portable, and must be obtained by the employer before a new member of staff commences work. The registered person must complete a Criminal Record Bureau check for all new employees. This is Requirement 1. Staff records seen identified members of staff were being supervised regularly. A supervision programme for all members of staff was in place. The manager informed that they are trying to supervise all staff at least six times a year. Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 22 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, 38, 39 Residents’ benefit from an experienced manager who recognises their needs and manages the home well. The manager has a clear vision for the home, which she has effectively communicated to residents, relatives and staff. The systems for Service User consultation are good with evidence that Service User views are sought and acted on. EVIDENCE: The manager has many years experience of working with this service user group and has completed her Registered Managers Award and is also a qualified nurse. The registered manager communicates a clear sense of direction, leadership and openness. One resident spoken to informed that the manager was very supportive. The manager had developed relationships of trust with service users, which was observed during the inspection. Relatives spoken to spoke very highly of the registered manager. One relative stated Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 23 that the manager was very caring and that they were delighted with the care provided at the home. Another relative informed that the manager of the home is doing a remarkable job and is very responsible, and that a very high standard of care is provided at the home. Lines of accountability within the home and with external management are clearly understood. The quality assurance system includes seeking the views of residents by the home holding monthly meetings. The minutes included ways in which issues raised will be actioned by the staff team. Records of quality assurance surveys were also seen, which are sent out yearly to residents and their relatives or representatives. The results of surveys are discussed with staff and residents in residents’ meetings. Stakeholder evaluation surveys are also given to Stakeholders including Social Workers, General Practitioners, day centre officers and college tutors on a yearly basis. Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 24 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 3 3 3 Standard No 22 23 Score X x ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 4 14 4 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 3 3 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Peterborough Avenue Score 3 3 X 3 Standard No 37 38 39 40 41 42 43 Score 3 3 3 X X X X DS0000027888.V273368.R01.S.doc Version 5.0 Page 25 Yes 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 YA17 Regulation Requirement Timescale for action 19/03/06 2 YA34 17(2)Schedule The Registered Manager must 4(13) ensure that a current record is maintained of all food served in the home to each service user to monitor their nutritional intake. (Previous timescale of 29/04/05 not met) 19 Schedule 2 The Registered Manager must not employ a person to work at the care home unless a Criminal Record Bureau Check, taken up by the new employer, has been received and indicates no cause for concern. 19/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford IG1 4PU 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 Peterborough Avenue DS0000027888.V273368.R01.S.doc Version 5.0 Page 27 - 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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