Inspection on 17/09/07 for Piper House

This inspection was carried out on 17th September 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Piper House 24/10/06

Piper House 11/01/06

Piper House 27/06/05

Piper House 31/01/05

Piper House 30/08/04

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 Piper House 2B St Mark`s Road London W11 1RQ Lead Inspector Sheila Lycholit Unannounced Inspection 17th September 2007 10:15 Piper House DS0000035201.V344843.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 Piper House DS0000035201.V344843.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. Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Piper House Address 2B St Mark`s Road London W11 1RQ Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 7229 7623 MICHAEL.DOWNEY@RBKC.GOV.UK Royal Borough of Kensington & Chelsea Michael Anthony Downey Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th October 2006 Brief Description of the Service: Piper House is a residential home for 12 people with learning disabilities, situated in a residential area of North Kensington with good access to transport and other services. The service is provided by the Royal Borough of Kensington and Chelsea. Six service users are accommodated in flat B on the ground floor, which is adapted for people with restricted mobility. Six people, who are more independent, live in flat C on the first floor. Each flat has 6 single bedrooms, a sitting room, kitchen/dining area and bathrooms and lavatories. The main office and a large communal room are on the ground floor. The residents of flat B have access to a garden and patio area. The building is not accessible for wheelchair use above the ground floor. Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place on Monday 17th September 2007 from 10.15AM until 5.15PM. There were 12 people living at Piper House, one of whom was in hospital. It was expected that she would be discharged in a day or so. The Team Leader from flat C was on duty with the Assistant Team Leader and went to visit the resident in hospital at the end of her shift. There was one Support Worker on duty in flat B. The Manager, who had completed a pre inspection assessment form, came on duty at 12PM and was working a late shift. The Team Leader for flat B came on duty at 3PM. Residents were at home or attending day services. One resident was attending a hospital appointment supported by a member of staff. The Inspector was shown around flats B and C by the Team Leaders and met with residents and staff. The Manager made himself available from the time he came on duty. What the service does well: What has improved since the last inspection? The purchase of two Apple Macs and a colour printer has allowed staff to continue to develop the use of multi-media to support communication. A new licence agreement in an accessible format has been given to each resident. The appointment of a Team Leader to flat C has completed the senior staff team and ensured that support provided to residents is more focussed. Night staff have updated their training to bring them in line with other colleagues. Steps have been taken to implement the recommendations of the PCT Community Pharmacist. The garden has been landscaped, with attractive garden furniture, which staff report is well used. The kitchen units in flat B have been replaced creating a more pleasant area for residents to use and to eat in. New furniture has been purchased including wardrobes in flat C and sofas in flat B. Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 6 Negotiations have taken place over a number of months about pruning the trees blocking the light to some rooms in flat C. The Manager confirmed that the work will take place shortly. 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. Piper House DS0000035201.V344843.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 Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Information about the service is available in a variety of formats. Staff work with the multi-professional Learning Disability Team to ensure that residents’ changing needs are regularly assessed. A clear licence agreement with illustrations, as well as text, has been sent to each resident. EVIDENCE: A copy of the statement of purpose and service user’s guide is kept on line and is updated regularly. A video about the service is also available. Copies of the tenants’ charter of rights in relation to the service at Piper House are displayed throughout the building. No new admissions have taken place since 2003. An admission procedure is available. Records show that referrals are regularly made to the Learning Disability Team and to other colleagues to assess residents’ changing needs. Additional staff hours have been made available to support one very frail resident. Copies of an up to date contract in an accessible format were seen on each of the four residents’ files looked at. Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8 and 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Support guidelines and PCPs are available for all residents, though some PCPs would benefit from further development. Steps are taken to regularly consult with residents and to include them in decisions about life at Piper House. EVIDENCE: Each of the four residents files looked at contained support guidelines and a PCP in a pictorial format. The Team Leader for flat C has produced more detailed support guidelines for each of the six residents, which were seen on the agency induction file. Reviews take place regularly and are attended by the resident, family members, and the Placement Monitoring Officer as well as Piper House staff. Detailed notes of reviews are produced that include a number of decisions and actions, which are monitored by the Manager and Team Leaders in supervision. PCPs vary in the detail included and would benefit from further development. Issues raised at reviews should be reflected in the PCP. Staff from Piper House are represented on the local PCP implementation group. Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 10 A regular residents’ meeting takes place in flat C, which is recorded in an accessible format. Residents attend a monthly quality action group facilitated by a former member of staff. Risk assessments seen on residents’ files and on the main file in flat C were comprehensive and detailed. No unnecessary restrictions are placed on residents. Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff recognise the importance of supporting residents’ communication and are continuing to develop the use of multi-media, as well as working closely with the Speech and Language Therapy Team. Residents receive good support to take part in a range of community activities, in addition to day services. A high priority is given to recognising residents’ rights. EVIDENCE: Staff have continued to develop ways of supporting residents’ communication, through the use of multi media, Makaton, PECS and objects of reference. The assistance of the Learning Disability Team, in particular the Speech and Language Therapist, has been sought to support individual residents to express their wishes and feelings. Daily logs and discussion with staff show that residents attend a range of activities in the community in addition to the day service programme. New activities introduced since the last inspection include membership of the local sports centre, which one resident has particularly enjoyed. Activities that Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 12 reflect residents’ ethnic and cultural background have been promoted by staff. A number of residents regularly attend church services and one person attends events at a mosque. On the day of the inspection a number of residents were planning to go to a birthday party being held at a nearby pub. Staff accompany residents on holiday, which in 2007 had included trips to Minorca and Murcia. Photos of holidays, outings and events are displayed throughout the flats. Referrals have been made to the local supported employment project and one resident now has a placement. Relationships with families and friends are well supported. Records and photos show that families attend reviews and events at Piper House and staff make a particular effort to maintain communication with relatives who live abroad, for example by using email. Both flats have a kitchen/dining room with sufficient space for residents to eat together. Illustrated menus are displayed, with dishes that residents have chosen. Staff encourage healthy eating, with fresh fruit and vegetables made available. A detailed care plan and risk assessment has been developed by the Speech and Language Therapist for one resident who is at risk of choking. Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Detailed support guidelines are available indicating staff’s thorough understanding of how residents like to be supported with personal care. A high priority is given to ensuring that residents’ health care needs are regularly assessed. A sound medication policy is available and the recommendations of the Community Pharmacist have been implemented promptly. Sensitive and well planned care is being provided to a resident who is very ill. EVIDENCE: Records and discussion show that new support guidelines have been written for each resident in flat C, bringing practice in line with flat B. Support guidelines were looked at for each person in flat C and two residents in flat B. All were carefully written and reflected staff’s understanding of the ways in which each resident likes to be supported. The Team Leader plans to expand on some of the support guidelines in flat C, which were originally written for the benefit of agency staff. Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 14 Records show that staff work closely with health care colleagues to ensure that any concerns, for example regarding dental care or problems with vision, are followed up and treated. The Manager made a report of an inspection by the Community Pharmacist available to the Inspector. As a result of the recommendations, the home is in the process of changing to a local Pharmacy, which can provide medication using a pre-measured dosage system. Recent MAR sheets seen were fully completed. None of the current residents is able to safely manage his or her medication. Staff are currently trained in-house, though the Manager is seeking an external training course in administering medication for new and existing staff. Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents of Piper House are fully encouraged to express their views about the service. Residents have good access to advocacy services and other external agencies. EVIDENCE: Residents’ views are sought at the residents’ meetings in flat C, at reviews and by means of the Quality Action Group. A number of residents attend groups such as Equal People, where they are encouraged to assert their views. The local advocacy service is also used to ensure that residents’ wishes and views are taken into account both at Piper House and at other services and staff from the advocacy service sometimes attend the Quality Action Group. The complaints procedure has been reviewed to reflect comments from residents and is available in an accessible format. Information about making a complaint, including photos of relevant Managers is displayed in the building. No complaints have been received in the past 12 months. Records and discussion with staff show that one resident has requested to move elsewhere. He has previously made the same request but later changed his mind. The assistance of the Speech and Language Therapist has been sought to clarify his wishes and his reasons for wanting to live elsewhere. All staff receive training in safeguarding adults, with copies of the local multiagency policies and procedures available in the home. Incidents are carefully recorded and incident reports show that any concerns, for example of aggression between residents, are promptly reported to Care Managers. Records of residents’ finances were not checked at this inspection but had been in good order at the previous visit. Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The building is well located, close to shops, public transport and other services. While the building is generally kept in a good state of repair and redecoration, some areas would benefit from updating to provide a more attractive and contemporary environment for residents. Plans need to be developed to ensure that the building meets the future needs of residents. EVIDENCE: Piper House was converted from a larger home into 3 flats in 1994. Two of the flats form the registered home, with the remaining flat providing supported living accommodation. The design of the current building has resulted in the first floor flat C having adequate but rather cramped facilities, while communal space on the ground floor remains little used. Flat C has no access for wheel chair users. A stair lift was installed to assist one resident but he is no longer able to use it safely and has to be carried downstairs. Improvements to the garden have been made since the last inspection, with attractive landscaping and a range of garden furniture. The Team Leader for Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 17 flat B, where there is direct access to the garden, said that it has been well used by residents this summer. The kitchen units in flat B have been replaced creating a more functional and pleasant area for residents and staff. Staff have continued to use photos, many of which are enlarged and attractively framed, to decorated flat B. New photos, also framed, have been purchased for each resident’s door. All bedrooms are single rooms, with 2 bedrooms on the ground floor adapted for wheelchair use. None of the bedrooms has en suite facilities. New wardrobes have been installed in two bedrooms in flat C and a resident whose room was very crowded, has been assisted to re-organise his possessions. One bedroom in flat C remains rather dark from the proximity of nearby trees but the Manager confirmed that agreement has been reached with all parties to cut back these trees in the next few weeks. Two residents showed the Inspector their rooms, which contained a large number of personal possessions, reflecting their interests. While most areas are in an acceptable state of decoration, the accessible bathroom in flat B continues, as at the last inspection in October 2006, to have paint peeling from around the skylight and staining from a previous leak on the ceiling. The skylight itself is in urgent need of cleaning. This bathroom would benefit from refurbishment. The building was clean and tidy at this unannounced visit. Both flats have a laundry area but the washing machine in flat C does not have a sluicing facility and staff are having to take soiled washing to the laundry in flat B. There have been continuing problems with the drier in flat B, which regularly overheats. Future plans for the development of the service need to take into account the likely increase in dependency of some residents, who will need a fully accessible building. Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 and 36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Piper House has a well trained staff team, with a high percentage of support staff achieving at least NVQ3. Staff receive good support from senior staff through regular supervision and staff meetings, in addition to the hands on approach adopted by Team Leaders who work alongside staff. EVIDENCE: All permanent day support staff have achieved NVQ3 or have enrolled on a course. Staff also have access to RBKC’s in-house training programme. New support staff undertake the LDAF/Skills for Care induction in addition to Piper House’s own induction programme. The most recently appointed Team Leader confirmed that she had received a planned induction and that the Manager had made himself available to provide support, though she would have appreciated an earlier opportunity to become familiar with some of the on-line systems. Staffing levels, while not generous, allow residents to be supported in a range of activities. Team Leaders regularly work shifts alongside support staff. Staffing levels may need to be reviewed shortly in the light of concerns about the health of some residents. Additional hours are being used to allow one resident who is very ill to receive one to one care. Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 19 Piper House has achieved a good level of staff retention. New staff are recruited with the assistance of the Department’s HR Team who carryout all recruitment checks. Ways of including residents in staff selection have been developed. A relatively high number of agency hours are being used currently but the Manager has confirmed that only regular agency staff, who know the residents, are used. Agency staff are being employed to cover the additional hours in flat C, maternity leave and the temporary secondment of one member of staff to another service. Records show that regular staff meetings take place and that staff receive supervision every 4 to 6 weeks. A system of annual performance review is in place for permanent staff. Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 41, 42 and 43 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The senior staff team, consisting of the Manager and Team Leaders, is very experienced and well qualified. The health and safety of residents and staff is given a high priority. EVIDENCE: The Manager and Team Leaders are qualified Social Workers, who in addition have completed NVQ4/RMA. All three senior staff have experience in managing residential services prior to working at Piper House. The Manager and Team Leaders take part in the sleeping-in rota and have a detailed knowledge of each resident. The Manager continually updates his training and contributes to service planning and other developments in RBKC. As noted above, a number of initiatives to seek residents’ views have been implemented including a Quality Action Group chaired by an independent person. A business and development plan is available for the service. Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 21 Health and safety is given a high priority. The Manager was expecting a planned inspection by the Borough’s Health and Safety Team later in the month. Training records show that staff receive training in health and safety, including refresher training. Accidents are carefully recorded and steps are being taken to ensure that all staff complete an accredited First Aid course. A fire risk assessment is available, though this will need updating shortly. Weekly checks of fire points are not undertaken, in agreement with RBKC’s Health and Safety Team, because of the distress caused to residents. Checks are made monthly instead. Fire drills have taken place on 2 occasions this year in January and September, rather than 3 monthly as scheduled. The Manager was aware of the omission. The fire detection system and fire fighting equipment are regularly serviced. Hot water temperatures and water quality are checked monthly by an external contractor. The Service Manager visits regularly and her photo is displayed in the building. Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 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 3 26 3 27 2 28 3 29 3 30 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 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 4 4 3 3 X 3 3 3 Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA24 YA30 Regulation 23 16 Requirement Some areas, in particular bathrooms in flat B are in need of redecoration. Sluicing facilities should be available in flat C so that staff do not have to carry soiled linen through the building to flat B. Staff must have the use of reliable laundry equipment. Fire drills should take place quarterly in line with the home’s policy. Timescale for action 31/12/07 31/12/07 3 YA42 23 31/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA6 YA33 Good Practice Recommendations PCPs would benefit from further development. Further consideration may need to be given to staffing levels in view of the changing health care needs of residents. Piper House DS0000035201.V344843.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Piper House DS0000035201.V344843.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!