Inspection on 05/09/06 for Phoenix Lodge

This inspection was carried out on 5th September 2006.

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

The inspector 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 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Phoenix Lodge 18/10/07

Phoenix Lodge 22/05/07

Phoenix Lodge 22/12/05

Phoenix Lodge 17/05/05

Phoenix Lodge 20/12/04

Phoenix Lodge 02/06/04

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

CARE HOME ADULTS 18-65 Rosehill House 30 Rougemont Avenue Torquay Devon TQ2 7JP Lead Inspector Sam Sly Unannounced Inspection 5th September 2006 11:30 Rosehill House DS0000018418.V289128.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 Rosehill House DS0000018418.V289128.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. Rosehill House DS0000018418.V289128.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosehill House Address 30 Rougemont Avenue Torquay Devon TQ2 7JP 01803 615538 01803 613430 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) info@craegmoor.co.uk Parkcare Homes Limited Vacancy Care Home 4 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (4), Physical disability (4) of places Rosehill House DS0000018418.V289128.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 22nd December 2005 Brief Description of the Service: Rosehill House cares for 4 people with physical disabilities and/or mental disorder. It specialises in caring for people who have suffered a brain injury and is owned by a subsidiary of Craegmoor Healthcare Limited. The house is in a residential area of Torquay and near to community amenities. Rosehill is wheelchair accessible with level access throughout and adapted shower rooms and a bathroom with an electric chair. There are four single bedrooms, an office/staff room, lounge, dining room, kitchen and laundry room. The garden to the back of the house is ramped with a patio area. Rosehill House DS0000018418.V289128.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The site visit was unannounced and took place during a weekday in September. The visit included discussion with both residents, observation of their interaction with staff, discussion with the staff members on duty and Rose Gapper the acting manager. Both residents care was case tracked. Care records and health and safety records were examined and a tour of the building, including all bedrooms was made. Since the last key Inspection concerns about the Service resulted in an additional visit by the Commission on 27/07/06. The report for this visit can be obtained by contacted the South Devon office on 01364 651800. The Inspection process also included a review of contact the Commission has had with Rosehill House over the past year and comment cards from three relatives/visitors, five staff, a health professional and two care managers. The required pre-inspection information and data was also received from Emma Richards by the Commission, as was an action plan for requirements made at the last Inspection. The range of fees at Rosehill House is from £817.00 - £1389.45 per week. What the service does well: What has improved since the last inspection? What they could do better: Rosehill House DS0000018418.V289128.R01.S.doc Version 5.2 Page 6 The residents at Rosehill House have complex needs and therefore require highly detailed care plans based on comprehensive assessments and risk assessments. As yet the care planning is not to this standard. The Commission must be assured that a competent, skilled person is managing Rosehill House, therefore an application is required to register a manager. A number of recommendations were made to raise the quality of the service provided to residents at Rosehill House. 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. Rosehill House DS0000018418.V289128.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 Rosehill House DS0000018418.V289128.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Resident’s needs are not comprehensively assessed to enable growth in independence and skills. The proposed aims and objectives of Rosehill House are not reflected in the present information available. EVIDENCE: The assessments and care planning for both residents were examined. Specialist assessments by an Occupational Therapist had taken place and resident’s needs were in the process of being fully re-assessed. However, there was not much change in the information available since the last CSCI visit in July 2006 when a timescale for completion was given of 01/10/06. The acting manager said that a new acting manager was taking over the following week and would be completing holistic assessments, risk assessments and care plans for both residents. Discussion and meetings have taken place between CSCI and the registered provider about plans for a change to the purpose of Rosehill House. The Statement of Purpose and Service User Guide examined have not yet been reviewed to reflect these changes. Rosehill House DS0000018418.V289128.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments did not reflect the changing needs and goals or residents, so staff did not have clear direction about maximising skills and independence. EVIDENCE: The care planning and risk assessment records for both residents were examined. The risk assessments were fairly comprehensive, although a risk identified in records examined had not been updated on one residents risk assessment, and limitations in place did not all have clear action plans and did not indicate that the resident had been involved in the decision-making. Care plans were in place for both residents but again were not holistic and did not reflect the ‘rehabilitation’ nature of the service being provided. The plans did not give a clear picture of resident’s strengths, support needs and future goals. Staff spoken with were clear about the morning routines for both residents, which reflected what was recorded in care plans, however records of activities Rosehill House DS0000018418.V289128.R01.S.doc Version 5.2 Page 10 that residents had taken part in did not link to a structured plan to meet needs and reach goals but were on a more ad hoc basis. Resident’s money held in the building was counted and the amount corresponded to records kept. However, the acting manager was unclear about what Department of Work and Pensions entitlement one resident was getting, who was responsible for both resident’s financial affairs and there were no clear records available. One resident had previously been involved in the handling of their finances, and this was no longer happening. The acting manager was unable to account for this change, and there was no mention of the management of resident’s finances in care plans. Rosehill House DS0000018418.V289128.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents lead fairly active lives and are visible in the community. Family involvement is encouraged and supported. EVIDENCE: Daily records showed that residents had not been involved with regular education or activities over the summer months, however classes were beginning again in the next week. Residents were taken out on trips to local attractions, meals out and involved in day-to-day shopping for food and personal items. Trips out were arranged on the day they happened and destinations were based on places staff thought they would enjoy going. One resident’s interests had recently been re-assessed but their care plan not changed yet to indicate how these interests would be encouraged. Family contact is encouraged, with regular phone contact and visits for both residents. One resident had recently been to London to watch a Rolling Stones gig with staff support. The resident was highly animated about this trip, Rosehill House DS0000018418.V289128.R01.S.doc Version 5.2 Page 12 saying it was really good and wanting to repeat it soon. Whilst at the gig the resident had seen their family too. Whilst at home one resident is encouraged to be involved in the domestic chores around the house and in cooking. A meal was shared with the residents and was enjoyed by all. Meals are cooked that meet the dietary needs of residents, and they are involved in planning the menu. Meal times are unhurried, and one resident is supported to eat. Meals out and take away meals are a regular occurrence. The Home has transport that residents can use free of charge, however only a few staff can drive it which can be a problem on some shifts. Rosehill House DS0000018418.V289128.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The medication procedures at Rosehill House protect residents, and personal care and healthcare needs are met. EVIDENCE: Residents personal care needs were well understood by the staff spoken with, and are documented in the care plans examined. The registered provider has commissioned occupational therapy and physiotherapy assessments to assess the needs of residents. Healthcare needs are also assessed and catered for, with regular reviews with care managers arranged. Both residents are involved in shopping for their clothes and personal items and were dressed in clothes that reflected their personalities. The Home has an assisted bath and shower facilities to meet the needs of residents with limited mobility. Staff have not received any specialist training on acquired head injury or mental health needs, and comments from two care managers and one relative raised concerns about contact, involvement and liaison with professionals and family. However, management changes have been made by the registered provider to try to improve this situation. Rosehill House DS0000018418.V289128.R01.S.doc Version 5.2 Page 14 The medication procedures were examined. A metal drugs cabinet was in use and medicines stored appropriately. There was also available a medication fridge. None of the residents administered their own medication. Medicine administration records were being filled in properly and drugs were being disposed of correctly too. Steps were not being made within the care planning process to maximise resident’s self-administration skills in line with the rehabilitation ethos of the Home. All staff had undertaken a medicine management course since the last Inspection, and staff demonstrated that medication refusals were highlighted to a professional appropriately, or re-administered in a safe timescale. Rosehill House DS0000018418.V289128.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff are able to protect residents from abuse and concerns are dealt with swiftly. EVIDENCE: There have been no complaints since the last Key Inspection, however in the past complaints have been investigated appropriately by the registered provider. The complaints procedure displayed at Rosehill did not contain the timescales by which a complaint should be investigated. The registered provider dealt with a recent adult protection issue appropriately. The adult protection training, which is based on staff reading a booklet and completing a multiple-choice questionnaire, does not refer or include reference to the local authority adult protection procedures and a copy could not be found by the acting manager. Staff spoken with were clear about contacting the manager if they are concerned about abusive practice, they were not so clear about the local adult protection procedures and were not aware of the Alerter’s Guidance. Rosehill House DS0000018418.V289128.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment is homely, clean and safe but to remain so on a long-term basis and to ensure maintenance is proactive and not reactive a maintenance and renewal programme is needed. EVIDENCE: The premises are kept clean but the environmental décor is only adequate with paintwork and carpeting looking shabby and stained. These issues have been picked up by the registered provider in their monthly provider visit in July 2006, however there was no evidence of a maintenance and renewal plan in place with timescales for smaller, and larger projects like these improvements would be made. The day-to-day maintenance book that the acting manager said was kept could not be found either. Resident’s bedrooms are personalised and brightly decorated, and the home is small enough to present in a very homely way. The premises had not been visited by the environmental health department since the last Inspection, but had been visited by the Fire Service, who had left requirements with regard to the emergency lighting and the fire risk assessment. Again there was no Rosehill House DS0000018418.V289128.R01.S.doc Version 5.2 Page 17 maintenance and renewal plan that evidenced that issues highlighted in the fire risk assessment had been resolved. Laundry facilities were clean, hygienic and appropriate to the needs of residents. Five staff required refresher training on infection training and the registered provider had identified this. Rosehill House DS0000018418.V289128.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by a qualified, competent staff team, and are protected by the recruitment procedures. EVIDENCE: The staff on duty were spoken with and observed, staff questionnaires were sent out and staff records were examined. Both residents were also asked about their views on the staff that care for them. Neither resident gave views about staff, but were observed to be friendly, relaxed and interacting at all times with staff on duty. Staff were on duty in sufficient numbers to meet the needs of residents, the only issue identified was that on some shifts no staff member was able to drive the Home’s transport therefore restricting residents access to the community. The acting manager said one resident did occasionally use public transport. Staff were observed to be approachable, interested and motivated in their work. They felt the home was now running more smoothly and that this was benefiting residents. Both staff spoken with had a good knowledge of the care routines of the residents, and knew where the care plans were kept. Turn over of staff had decreased with no staff leaving since the last visit in July 2006. Rosehill House DS0000018418.V289128.R01.S.doc Version 5.2 Page 19 A staff training audit had been carried out and staff training included the administration of medication, health & safety areas, protection of vulnerable adults and equal opportunities, however there was no specialist training provided on working with people with acquired head injury or mental health needs. However, both staff spoken with had worked for many years with people with acquired head injury. Staff were encouraged to complete NVQ training and three have level 2 or above. Supervision was not being carried out regularly and a staff meeting was planned for the following week. The acting manager said she was waiting for the new acting manager to start work. Two staff files were examined and found to contain appropriate recruitment records including criminal record bureau checks. Rosehill House DS0000018418.V289128.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. On the whole residents safety and welfare was protected and promoted at Rosehill House, however some deficits in checks and policies and procedures could potentially put residents at risk. To benefit from a well run home residents require management consistency and stability. EVIDENCE: There has been no registered manager at Rosehill House for over 12 months. In this time the registered provider have employed two acting managers and applied and withdrawn an application to register one of them. The current acting manager said that a new acting manager has been employed to start the following week. This would then mean Rosehill House would have one full time acting manager and one full time deputy manager plus two care staff on duty during the day and one sleeping in at night. The staff spoken with said the present acting manager was supportive and approachable and that the Rosehill House DS0000018418.V289128.R01.S.doc Version 5.2 Page 21 Home was receiving appropriate support from the registered provider. Since the last key Inspection concerns had come to the attention of CSCI about both the support of the then acting manager and of the registered provider. One staff member sent a comment card back, which said: ‘Now the problems have been dealt with I believe the home will not only begin to run smoothly but will be less stressful. Staff and clients will be happier.’ Comments received back from care managers and relatives recorded some concerns about the Home’s abilities to communicate and work in partnership with them, and concerns about not being kept informed of changes or involved in decision-making. The acting manager said steps were being taken to improve the situation with reviews already being held for one resident, with the other being planned. Neither care manager that responded was satisfied with the overall care provided for their client. The registered provider has a Quality Assurance system in place. The Home was visited monthly by the registered provider and a report written. Audits on medication and food safety were examined. However these audits did not pick up deficits found; not all staff had food hygiene certificates and toxic cleaning products used did not have current COSHH sheets. The Quality Assurance system also did not include an annual development plan, and evidence could not be found that residents and stakeholders were involved in the process. There was evidence that staff training in health & safety areas had been identified and training was being organised. The Pre-inspection questionnaire showed all the necessary safety checks on appliances and heating systems took place, and fire safety records were examined and found to be up to date. However, a recent visit by the Fire Service found deficits in the emergency lighting and fire risk assessment. The acting manager was unsure whether issues identified in the fire risk assessment dated August 2005 had been dealt with by the registered provider. The acting manager could not find evidence that the environment is regularly risk assessed. Accidents were recorded appropriately. Rosehill House DS0000018418.V289128.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 2 2 2 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 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 3 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 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 2 X 2 X Rosehill House DS0000018418.V289128.R01.S.doc Version 5.2 Page 23 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 YA2 Regulation 14 Requirement Each resident must have a thorough assessment prior to admission (Timescale 04/03/06 – not met). Each resident must have a detailed care plan that reflects all his or her needs. This plan must be reviewed as needs change (Timescale 04/03/06 – not met). Each resident must have a detailed risk assessment that is reviewed as risks change (Timescale 04/03/06 – not met). An application must be made to register the acting manager. Timescale for action 01/10/06 2. YA6 15 01/10/06 3. YA9 13(4) 01/10/06 4. YA37 8 07/12/06 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 Rosehill House DS0000018418.V289128.R01.S.doc Version 5.2 Page 24 1. 2. 3. 4. YA1 YA6 YA7 YA7 5. 6. YA22 YA23 7. YA24 8. 9. 10. 11. 12. YA18 YA32 YA36 YA39 YA40 YA42 The Home’s Statement or Purpose and Service User Guide should be reviewed in light of the changing purpose of the Service. Daily records should reflect that residents care plans have been followed. Rosehill House should have an equality and diversity policy. Resident’s financial arrangements should be clearly understood by staff and clearly recorded. Residents should be as involved as much as possible in the management of their own finances. The complaints procedure should be accessible to residents and include the timescale by which complaints will be dealt with. The adult protection training should include the Local Authority adult protection procedures and a copy of the Alerter’s Guidance should be accessible and understood by staff. Rosehill House should have a maintenance and renewal programme with timescales for all short-term issues and long-term projects that are identified by in-house visits, and external inspections. Staff should have specialist training in working with people with head injury and mental health needs. Staff should have regular supervision. The Quality Assurance system should include an annual development plan and involve residents and stakeholders. Policies and procedures should be reviewed to ensure they accurately reflect the service, and staff should be fully aware of all policies and procedures. Action should be taken to improve deficits identified in the fire risk assessment and meet requirements made by the fire service. There should be regular environmental risk assessments. Rosehill House DS0000018418.V289128.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Rosehill House DS0000018418.V289128.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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