Inspection on 13/09/05 for Primrose Road (38)

This inspection was carried out on 13th September 2005.

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

Other inspections for this house

Primrose Road (38) 09/10/08

Primrose Road (38) 15/08/06

Primrose Road (38) 12/05/05

Primrose Road (38) 13/01/05

Primrose Road (38) 09/08/04

Primrose Road (38) 16/02/04

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 Primrose Road (38) 38 Primrose Road Leyton London E10 5EE Lead Inspector Rob Cole Unannounced Inspection 13th September 2005 10:00 Primrose Road (38) DS0000007270.V249990.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 Primrose Road (38) DS0000007270.V249990.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. Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Primrose Road (38) Address 38 Primrose Road Leyton London E10 5EE 020 8558 6647 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) Outward Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th May 2005 Brief Description of the Service: The home is situated in a residential area of Leyton in the London Borough of Waltham Forest, and is close to shops, transport links and other local ammenities. The home is purpose built, and accomodates six service users with learning dissabilities. The home is on two floors, and has a lift to allow access to all parts of the building. The home is privately run and part of Outward. Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on the 13/9/05, and was unannounced. The inspector had the opportunity of speaking with staff from the home, service users and their relatives. Overall the inspector was satisfied that Primrose Road is a well run home, and that service users receive generally high levels of care. Service users and their relatives all informed the inspector that they are happy with the care and support provided by the home. There are nevertheless a number of issues found that require attention, and these are highlighted within the report. What the service does well: What has improved since the last inspection? What they could do better: Despite some improvements, there are still a number of issues that must be addressed. Medications must be appropriately stored and recorded and service users must have access to all relevant health care professionals. One service user has not had access to their own bank account for almost two years, and this must be addressed as a matter of urgency. Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 Page 6 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. Primrose Road (38) DS0000007270.V249990.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 Primrose Road (38) DS0000007270.V249990.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): 1,3,4 and 5 The inspector was satisfied that service users are provided with adequate information about the home to help enable them to make an informed choice about the home. This information is provided through documentation, and the opportunity of visiting the home. EVIDENCE: The home has a Statement of Purpose. This has been reviewed since the last inspection, and is now in line with National Minimum Standards (NMS). It contains details of the aims and objectives of the home, the services and facilities provided and of the management and staff team. The Statement is written in plain English. At the previous inspection it was found that the homes Service User Guide was incomplete, for example it did not contain a copy of the homes complaints procedure. During the course of this inspection the Guide could not be located, therefore the requirements set at the previous inspection are repeated in this report. All service users have a written and signed contract/statement of terms and conditions. These set out the rights and responsibilities of each party and fees payable. All service users have a copy of their contract. The home has an admissions procedure in place. This states that a pre admission assessment will be carried out on prospective new service users, and that service users will initially move in on a trial basis, after which a placement review meeting will be held. Although there have been no new admissions to the home since the previous inspection, the home currently has Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 Page 9 a vacancy. Staff informed the inspector that any prospective service users will be given the opportunity of visiting the home prior to making any decisions as to move in or not. Primrose Road (38) DS0000007270.V249990.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 and 10 It is the view of the inspector that service users are supported to make decisions for themselves over their daily lives wherever possible, and that service users are involved in the day to day running of the home. However, the home must ensure that care plans and risk assessments are kept up to date and regularly reviewed. EVIDENCE: All service users have an individual plan of care in place, and these were generally of a high standard. Plans were clear and detailed, and have been reviewed within the past six months. Staff informed the inspector that service users, their relatives, keyworkers and the homes manager are all involved in drawing up care plans. Plans included information on personal care, social and leisure needs, medication and mobility. However, as at the last inspection, the care plan for one service user did not accurately reflect their current needs. Due to a pressure sore this service user now spends most of their time in bed, and receives personal care in bed. Yet their care plans states that they should have a bath every day, and that they are to be supported to attend various community based social activities, which have not been happening due to their pressure sore. It is required that care plans accurately reflect and set out how the home can meet all the assessed needs of service users. All service users Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 Page 11 have risk assessments in place, including very detailed assessments around moving and handling, which set out the risks and also includes strategies for reducing and managing the risks. However, the assessments of other risks were not so comprehensive, for example one risk assessment had not been reviewed in over two years. Two service users had been to Paris for a holiday earlier this year, yet there was no evidence that any risk assessment had been carried out around this. It is required that comprehensive risk assessments are in place for all service users, covering all areas of potential risk to themselves and others, and that these are subject to regular review. Through observation and discussion there was evidence that service users have a large measure of control over their daily lives, for instance when to get up and go to bed, what to wear and what to eat. Service users are given the opportunity of participating in the day to day running of the home, for example the home recently purchased a new carpet for its communal areas, service users informed the inspector that they were involved in choosing this. Regular service user meetings are held, minutes are maintained, these evidenced discussions on activities, holidays and menus. As there have been no new staff recruitment to the home since the previous inspection, the recommendation made then that service users from the home are given the opportunity of been involved in the recruitment of all staff to the home is repeated in this report. The home has a confidentiality policy which makes clear under what circumstances a confidence may be broken in the health, safety and welfare interests of service users and others. Staff demonstrated a good understanding of issues around confidentiality, and confidential records are stored securely. Staff and service users can access these as appropriate. Primrose Road (38) DS0000007270.V249990.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): None The standards in this section were not tested as part of this inspection, but will be tested during the next inspection of the home. EVIDENCE: The standards in this section were not tested as part of this inspection, but will be tested during the next inspection of the home. Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 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 and 20 The inspector was satisfied that the home is able to meet the personal care needs of service users. However, to ensure that all their health care needs are met, the home must ensure that service users have access to health care professionals as appropriate, and that medications are appropriately stored and recorded. EVIDENCE: All service users have personal care guidelines in place as part of their individual care plans. These indicated that service users are encouraged to manage their own personal care as much as possible, and plans included strategies to increase service users independence in terms of their personal care. Service users were all appropriately dressed on the day of inspection, and are able to choose their own clothes to wear, although staff will offer guidance on what is appropriate for the weather. All service users are registered with a GP. Since the last inspection the home now keeps records of all medical appointments, including any follow up action required. These records indicated that service users have had access to various health professionals, including psychiatrists, physiotherapists and the district nurse. However, as at the last inspection there was no evidence that service users have had regular access to dental and eye care, and this must be Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 Page 14 addressed. The home makes use of the Continence Advisory Service, who supply advice and continence products. Used continence products are disposed of appropriately. On the day of inspection one service user was visited by the district nurse, who was able to see the service user in private. The home has a clear and comprehensive medication policy in place, and all staff receive training before they are able to administer medications. No service users currently self medicate or are on any controlled drugs. Medications are stored either in a locked cabinet or within the fridge as appropriate. However, on the day of inspection medications that were stored in the fridge were not kept in a locked container, but were simply placed on the fridge shelf, where service users could access them. It is required that all medications are stored securely. Records are maintained of medications entering the home and those that are returned to the pharmacist, and the home has guidelines in place on the administration of medications prescribed on a PRN basis. However, as at the last inspection there were inconsistencies between the prescribing instructions on medication labels and those on Medication Administration Records (MAR) charts. For example, one service user has been prescribed LORAZAPAM tablets, the label on the medication states this is to be taken daily, yet the MAR charts states that it is to be taken as required. It is required that instructions on MAR charts are consistent with instructions on medication labels, and that both are in line with the prescribing instructions of the medical practitioner who prescribed the medication. Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 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 and 23 It is the view of the inspector that more needs to be done to ensure service users are not at risk from any form of abuse, including financial abuse, for example all staff must receive adult protection training, and the home must ensure that service users have full access to their own bank accounts. EVIDENCE: The home maintains a record of all complaints received. Records evidenced that complaints have been appropriately dealt with. The home has a complains procedure, this was prominently displayed within the home. However, the procedure was only designed for service users, the home must have a complaints procedure for anyone wishing to make a complaint. Further, the procedure on display in the home makes no reference to the CSCI, and this must be addressed. Service users spoken to demonstrated a good understanding of whom they could complain to if they so wished. The home has a copy of the Local Authorities adult protection procedures, and also its own adult protection policy. This appeared to be in line with current legislation. However, as at the previous inspection the home could not evidence that all staff have received training in adult protection issues, and this must be addressed. The home holds money on behalf of service users in a locked safe. Records and receipts are maintained of financial transactions involving service users monies. The inspector checked several records at random, all of which appeared to be satisfactory. Service users have their own bank accounts. One service user has been unable to access their own account for nearly two years. The signatory to this account is a previous manager of the home, who has since left the organisation. Although staff informed the inspector that the Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 Page 16 service user was provided with finances from the organisation, it is required that steps are taken to ensure that the service user has full access to their own bank account. Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 Page 17 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): None The standards in this section were not tested as part of this inspection, but will be tested during the next inspection of the home. EVIDENCE: The standards in this section were not tested as part of this inspection, but will be tested during the next inspection of the home. Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 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): 31,32,32,34,35 and 36 It is the judgement of the inspector that the home is now staffed in sufficient numbers to meet service users needs. Staff have built up good relations with service users, and appear to be sufficiently competent and experienced to carry out their duties. EVIDENCE: The home provides 24-hour support, including an emergency on-call procedure. A staffing rota was on display within the home which accurately reflected the staffing situation on the day of inspection. However, the rota did not clearly indicate who was in charge of the home at any given time, and this must be addressed. Staffing levels have been reviewed since the last inspection, and the inspector was pleased to note that as a result staffing levels have increased, the home now provides an extra eight care hours a day. The home has policies in place on equal opportunities and recruitment and selection. All staff are given a copy of their job description, and a copy of the General Social Care Council codes of conduct. Staff spoken to demonstrated a good understanding of their roles and responsibilities, and of the individual needs of service users. Staff employment records are stored in a locked safe, which could not be accessed at the time of inspection, and consequently requirements set at the previous inspection around recruitment procedures are repeated in this report. Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 Page 19 All new staff undergo a structured induction programme, this includes health and safety and service user issues. The home has an on-going training programme, and staff training records indicated recent training in medication, manual handling, food hygiene and since the last inspection all staff have now received training in fire safety. The inspector was informed that of the eight care staff employed at the home four have a relevant NVQ care qualification, and two further staff are currently working towards such a qualification. Staff informed the inspector that they receive regular formal supervision, and that minutes are taken and they have access to these minutes. Supervision covers service user issues, training and performance. Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 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): 37,39,40,41,42 and 43 The inspector was satisfied that the home is generally well managed. There are appropriate quality assurance systems in place, and health and safety checks are routinely carried out. EVIDENCE: The homes manager has ten years experience of working in residential care. Since the previous inspection they have applied for registration with the CSCI. Various quality assurance systems are in place within the home, for instance staff meetings, service user meetings and staff supervisions all contribute to the quality assurance within the home. Copies of previous inspection reports are available to view in the home, and there was evidence that monthly unannounced Regulation 26 visits have taken place. The home holds policies and procedures in line with NMS, those checked by the inspector, including medication and equal opportunities, appeared to be satisfactory. Record keeping within the home is of a generally good standard. Confidential records are stored securely, and staff and service users can access records as appropriate. Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 Page 21 The home has various health and safety policies in place, such as on fire safety and infection control, and staff receive health and safety training, including food hygiene and manual handling. Fire fighting equipment was situated around the home, this was last serviced on the 17/12/04. Fire exits were clearly signed, and on the day of inspection free from obstruction. Fire alarms are tested weekly, and alarms were last serviced on the 8/8/05. The local fire authority visited the home in April 2005 and found everything to be satisfactory. The home has adequate controls in place to help prevent the spread of infection, for instance staff training on the subject and the provision of protective clothing. Fridge/freezer and hot water temperatures are routinely checked and recorded. The home has in date certificates on gas safety and PAT testing, however, as at the last inspection there was no evidence that the home has had a recent electrical installation safety check, and this must be addressed. The home has in date employer’s liability insurance cover. Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x 3 3 3 Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 2 3 Standard No 24 25 26 27 28 29 30 STAFFING Score x x x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score 3 3 2 2 3 3 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Primrose Road (38) Score 3 2 2 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 3 3 2 3 DS0000007270.V249990.R01.S.doc Version 5.0 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 YA1 Regulation 5 Requirement The registered person must ensure that the homes Service User Guide is dated and regularly reviewed, and in line with National Minimum Standards. (timescale 12/9/05 not met) The registered person must ensure that all service users have access to eye and dental care as appropriate. (timescale 12/9/05 not met) The registered person must ensure that all staff receive training in the protection of vulnerable adults. (timescale 12/9/05 not met) The registered person must ensure that the home has all information required by Schedule 2 of the Care Homes Regulations 2001 for each member of staff working in the home. (timescale 12/9/05 not met) The registered person must ensure that prescribing instructions on medication labels are consistent with those entered on MAR charts, and that both of these are in line with the DS0000007270.V249990.R01.S.doc Timescale for action 31/12/05 2 YA19 13 31/12/05 YA23 3 13 31/12/05 4 YA34 19 31/12/05 5 YA20 13 31/12/05 Primrose Road (38) Version 5.0 Page 24 6 YA6 15 7 YA9 13 8 YA22 22 9 YA42 13 and 23 10 11 YA20 YA23 13 16 12 YA33 17 prescribing instructions of the medical practitioner who prescribed the medication. (timescale 12/9/05 not met) The registered person must ensure that comprehensive care plans are in place for all service users, setting out how the home can meet all their assessed needs, and that these plans are reviewed at least every six months. (timescale 12/9/05 not met) The registered person must ensure that comprehensive risk assesments are in place for all service users, covering all areas of potential risk to themselves and others, and that these assessments are reviewed at least once every twelve months. (timescale 12/9/05 not met) The registered person must ensure that the home has a complaints procedure which is designed for any persons wishing to make a complaint, and that this procedure makes appropriate reference to the CSCI. (timescale 12/9/05 not met) The registered person must ensure that the home undertakes an appropriate electrical installation safety check at least once every five years. (timescale 12/9/05 not met) The registered person must ensure that all medications held in the home are stored securely. The registered person must ensure that all service users have access to their own bank accounts. The registered person must ensure that the staffing rota clearly identifies who is in charge DS0000007270.V249990.R01.S.doc 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 31/12/05 Primrose Road (38) Version 5.0 Page 25 of the home at any given time. Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA8and YA34 Good Practice Recommendations It is recommended that service users from the home are given the opportunity of been involved in all staff recruitment to the home. Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ 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 Primrose Road (38) DS0000007270.V249990.R01.S.doc Version 5.0 Page 28 - 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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