Inspection on 30/05/07 for Quinton House

This inspection was carried out on 30th May 2007.

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 but made no statutory requirements on the home.

Other inspections for this house

Quinton House 23/08/06

Quinton House 25/10/05

Quinton House 28/10/04

Quinton House 24/06/04

Similar services:

Claremont House

Oak Ridge

Coopers Mill Ltd

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Paradise Lodge

Bilney Hall

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

CARE HOMES FOR OLDER PEOPLE Quinton House Harvey Street Watton Thetford Norfolk IP25 6EH Lead Inspector Ruth Hannent Unannounced Inspection 30th May 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Quinton House Address Harvey Street Watton Thetford Norfolk IP25 6EH 01953 882101 01953 882101 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) Quinton Care Homes Limited Position Vacant Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 23rd August 2006 Brief Description of the Service: Quinton House is registered care home providing residential care for twenty three elderly people. It is a classical Georgian building with a modern extension. There are 21 single rooms, 15 of which have en suite facilities There is one double room with en suite facilities. There is a car park at the front of the home. The home is situated in a residential street in the market town of Watton in Norfolk, and is within walking distance of the main street, which has shops and other facilities. The home receives its medical nursing, and other professional services via the local Health Centre. Fees £320 - £390 per week. No email address. Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection that has followed three inspections carried out over the past twelve months. Prior to this inspection (and the one carried out last December) pre inspection questionnaires had been sent to the Manager and to date neither have been returned. Seven comment cards from residents and two from families had been received at the Commission with only one writing any comments in it. The rest were all ticks that were mostly positive about the care provided. Overall the visit lasted five hours with care plans, residents finances, staffing records, rota’s and health and safety data seen. Although this is the third inspection visit in the past year (plus one meeting that was held with the Proprietor) there are still some outstanding requirements that have not been addressed. What the service does well: What has improved since the last inspection? The Home has concentrated on improving the development of the staff and invested time into the skills required for quality care. The meals provided have improved and residents now have more of a choice of what they would like. Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Manager will assess a potential resident to ensure the service offered can meet the needs. EVIDENCE: Assessments of potential residents do take place before a person is offered a place within the Home. At present the Home has only eleven residents out of a possible twenty three. With a registration to accommodate only older people and no specialist service to offer, the Home is finding it difficult to gain custom. No new residents have been admitted since the last inspection. The assessments seen on the last inspection were brief but gave enough information to able to assess the service could meet the individual persons needs. Those people have been in the Home for some time and appear cared for appropriately. Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The health and personal care needs of residents are met but records within the documentation folders are not current or reviewed regularly. EVIDENCE: During the visit four care plans were seen. Each one has details that are able to show what care the person requires. The documents are placed in headed dividers within the care plans to guide readers to the correct part of the care plan. Noted was the poor recording of weight charts that has now been identified by the home and on the staff board in the office was a prompt for staff to weigh the residents. Although all four residents spoken to said they receive good care and that the staff are very good, the documentation in the care plan did not reflect this and it is not obviously reviewed. Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 10 Another resident who is cared for in bed had no record of when turning takes place or a fluid chart to show how much liquid is drunk. This does appear to be happening in practise, as through observation during the visit the person was in a different position, but no records were available to show on which side the person should be or how much had been drunk even when the daily records stated she had drunk very little on a few occasions. (Requirement) What is not evident is how often the care plans are reviewed and some information within them was noted to be no longer current or information not available at all. This is an (outstanding requirement) that was discussed fully at the meeting held with the Manager and Proprietor when the Inspector was told action to ensure reviews were in place would happen straight away. The Home has a good relationship with the District Nurses. The care for the person in bed is being monitored by the Community Health Care Team with regular visit and specialist equipment. The GP visits on request and the information from these visits are recorded in the person’s care plan. One resident felt that information on health needs for the residents is not clear and that communication could be improved such as dates for hospital visits and what the appointment is for could be written down for the person instead of just held in the office. (Recommendation). The Home have good medication procedures. The medication is kept in a locked trolley inside a locked cupboard. The pharmacist works closely with the Home with a good path of communication between the two. Any concerns or queries are dealt with very quickly. An example of a recent concern over medication on a recently discharged resident (from hospital) was clearly explained to the Inspector. All medication is checked in to the Home and all returns are recorded and signed by the pharmacist on return. (Seen) All medication administration record sheets were completed correctly and all resident’s photographs and any allergies were on the front of each record. Conversations heard throughout the visit between staff and residents were appropriate. All doors were knocked upon before entering and each resident was offered choice such as where would you like to sit. ‘Do you want to stay here or move to your room’ ‘Would you like some help with your meal’. Residents who were spoken to around the dining table all stated how the staff help them in a courteous way and that nothing is too much trouble. Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The lifestyle for residents has improved with expectations and preferences being met. Meals are enjoyed and are in suitable surroundings. EVIDENCE: The Home has improved the programme of activities with a designated staff member having three hours a week to plan and encourage activities. Since the last visit gardening has taken place with small pots of vegetables growing in the garden. One to one time by reading is spent with the person in bed and on arrival one person was busy with a jigsaw, one was busy knitting, one talked about the club she goes out to and another walks into town when able. The activities are recorded by this staff member and residents say they are ‘ very contented ‘ with their daily lives. Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 12 The visitors book showed many visitors come and go at the Home. Residents stated that they can have visitors any time and on overhearing a conversation between staff and relatives it was evident that people are made to feel welcome. Two comment cards from relatives stated that they are made to feel welcome and can speak to their relative in private if they so wished. There are no meetings held for friends within the home and no newsletter to update families and friends on the Home developments. (Recommendation). Some residents do manage their own affairs and the Home has recently started to leave leaflets around regarding advocacy to share with residents and visitors. One resident talked of her own room and how she can make it a little like home with all her small bits and pieces around her. Since the last inspection some more effort has gone into the meals offered. Clearer choice is available and food requested is written down for the cook the day before. The four residents around the dining table said the meals were great and that they could always have a choice if they do not like what is on offer. On the day of the inspection the main meal was roast chicken with potatoes, mixed vegetables, Yorkshire pudding and gravy. The sweet was a cream jelly with fresh raspberries. Drinks were placed on the table with no choice on the day and there are no menu’s on the table to discuss and act as a memory jogger. (Recommendation) The Home is just about to introduce staff to a monitoring tool for nutrition to ensure residents are eating and drinking the correct amount of food. (Training date is planned for June). This should improve yet again the food provided and meet the individual needs of the resident’s. Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are addressed although not recorded and staff do understand abuse and how to report concerns of possible abuse. EVIDENCE: A concern made on a comment card received at the Commission regarding the lack of advice to a resident was discussed with the relevant resident and it was clear the concern was around the person’s health needs, which are slowly being addressed. To support this person through the anxious times different ways of informing would alleviate some of the concern with information written down and not just verbally communicated. On talking to the Manager the complaints procedure has never had to be used and record of concerns or complaints are not held. The complaints procedure is on display in the Home as is the Commission’s contact details. No one has contacted the Inspector with a complaint and residents say they are happy to talk to the Manager if they have any concerns. The Home has a whistle blowing procedure and staff know who to report to if they have any concerns. The staff are trained and do understand the signs to look for. (This was discussed with a staff member.) Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The Home has some decorating, structural work and bathroom that needs improving within the building EVIDENCE: The Home does not have a rolling programme of maintenance with some areas of work still in need of improvement. On the last visit the Proprietor talked of the need to replace the central staircase, which has to be made. The stairwell is still in need of decorating with wallpaper coming away from the wall. The dining rooms and lounge have been freshly painted and last year the lighting in the corridor was much improved. Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 15 The grounds outside are a little overgrown and need tending more regularly. The Home have raised funds to buy a shed that now holds garden furniture for placing outside in the warm weather. During the tour it was noted that many of the bedroom doors were wedged open with wooden wedges. This is not permitted by the fire department and all doors must be closed or have a fire door closure that will release when the fire alarm is triggered. (Requirement) The downstairs bathroom is still in need of refurbishment and has been an outstanding requirement over the last three inspections. Although the work has still not been carried out the proprietor has now measured up and stated that a new bathroom will be in place very shortly with the old dark pink suite being replaced with a white suite. The static hoist in this bathroom has been serviced and painted ready for the arrival of the new suite. As this outstanding requirement is about to happen it will not be placed on the requirement page of this report on this occasion. During the walk of the building all areas were noted to be clean and tidy. The Home does follow infection control procedures and has all the relevant equipment, gloves and aprons in places to be easily at hand when required. The laundry was in full action but no unpleasant odours were detected Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The numbers of staff on duty is adequate. The Home has improved the methods for training, however tightening up procedures on recruitment needs to happen. EVIDENCE: The rota for care staff were posted on the wall in the main office. The Home runs with 2 care staff in the morning, 2 in the evening with one waking and one sleeping staff member over night. Between 7 and 9 in the morning the cleaner assists with care then moves to domestic chores. There is a cook who works between 8 and 2 every morning who assists with breakfast, prepares dinner, and then care staff do the teas in the evening. With only eleven residents at present the staffing levels are adequate to ensure care is suitable for the residents. Many of the staff have been employed in the Home for a while and residents spoken to say what a good staff team there is. ‘Many of them do beyond their duty’. ‘For what they do they should be paid more’. ‘Couldn’t be cared for any better’ were just some of the comments said by residents. Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 17 The personnel files were seen on this visit and it was noted that no new staff have been recruited since the last inspection to date. The personnel files are still not all complete and do not hold all the records required as mentioned in Schedule 2 of the National Minimum Standards. (The Home does not have a copy of the National Minimum Standards (Care Homes For Older People). The last inspection highlighted the lack of records within personnel files and this has not been addressed even though a meeting was held with the proprietor and all requirements were to be dealt with. (Outstanding Requirement). The Home has moved towards a comprehensive induction/foundation/training programme with three staff members recently attending a ‘Skills For Care’ conference. In the upstairs office are now individual files for each staff member. These files will start the development for all staff and will include supervision and appraisals that to date have not been taking place. Also three staff members have recently become appointed first aiders and later in June all staff are to be trained by a Senior staff member on the new malnutrition tool. (MUST). All this evidence was seen during the site visit. The training and development of staff has moved forward and needs to continue to offer a quality service to the residents. As staff supervision was a requirement at the last inspection it will not be requested again as the system is now in place although, as yet, not started. Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 37 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some management tasks throughout the home are not in place with some issues still outstanding from previous inspections, although despite these deficits adequate outcomes for residents are being maintained. EVIDENCE: Although the Manager has been in post for nearly 2 years she still is not registered with the Commission. The Care Standards Act 2000 states that all homes will have a Registered Manager. (Recommendation). Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 19 The Manager has also had to start again with the Registered Managers Award and has completed two of the units. The aim, as stated by the manager, is to have achieved this award by November. The Home has been no quality assurance, monitoring programme in place to seek the views of resident’s families and any person who may be involved in the Home and again this was a requirement at the last inspection. (Outstanding Requirement) There are no questionnaires, no meetings for either residents or families no communication through items such as newsletters, no observation tools (MUST will be in place shortly as mentioned earlier in the report) and no recorded Regulation 26 visits from the Proprietor which is also an outstanding requirement from the last inspection. (Outstanding Requirement). Residents’ money is held securely in the safe. Each one has their own money in a separate container and each one has a balance and receipts. One was checked at random on this occasion (two on the previous visit) and all records and money were correct. The health and safety of residents and staff is sometimes compromised by the procedures not being followed. COSHH safety data sheets are not all in place for the cleaning chemicals used in the building. Some are stored in the office folder but one for toilet cleaner and one for the furniture polish could not be found (Requirement). The chemicals themselves are not locked away and some are just placed on the floor in the laundry room with access by residents at any time. (Requirement). The bedroom doors as mentioned previously should not be wedged open that has led to a requirement in standard 19. Staff do attend statutory training that is part of the health and safety requirements and noted was the management of incontinence waste that was placed into the yellow bags, using disposable gloves, tied and then placed in containers that are collected by registered contractors. The staff also report any accidents that occur in the Home and forms recording the incidents are held in the office. One particular concern was shared at the inspection of a resident who is having regular falls and a pattern is beginning to emerge. The Home need to gain advice from the specialist ‘falls’ adviser that may be able to assist with resolving the concerns. (Recommendation). Items requiring servicing are carried out and seen were the service certificates for the passenger lift, hoists and fire equipment. Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x 1 x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 1 x 3 x x 1 Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 15.2 Requirement The Manager and Proprietors must ensure that care plans are comprehensive, kept up-to-date and reviewed a regular intervals. (Outstanding Requirement x 4) The Manager and Proprietors must ensure that all personnel files contain all the relevant paperwork as listed in Schedule 2 of the Care Home Regulations. (Outstanding Requirement x 4) The Manager and Proprietors must at appropriate intervals review the quality of care for residents. (Outstanding Requirement x 2) The Proprietors must visit and record the findings as listed under this regulation and forward a copy of the report to the Commission. (Outstanding Requirement x 2) Timescale for action 01/08/07 2. OP29 19.4(b) sch 2 01/08/07 3. OP33 24 01/08/07 4. OP33 26 01/08/07 Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 22 5. OP7 12.2 The Manager must ensure that fluid charts and turning charts are in place and recorded on resident’s who are cared or in bed. The Manager must ensure that wooden door wedges are not used within the home to prop open any fire doors. The Manager must ensure that all chemicals used for cleaning are stored securely and not accessible by residents. The Manager must ensure that all the chemicals for cleaning have a safety data sheet for all staff to have access to that is up to date. 01/08/07 6. OP19 23.4 (c) i 01/06/07 7. OP38 13.4 (a) 01/08/07 8. OP38 13.6 01/08/07 Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3 Refer to Standard OP31 OP36 OP7 Good Practice Recommendations It is recommended that the manager is registered with the Commission as soon as possible. It is recommended that all staff have supervision at least six times a year. It would benefit the residents if dates for their appointments for chiropody, hospital, hairdresser etc are written onto their calendars in their bedrooms. The residents and their families would benefit from a meeting or newsletter to aid communication. Residents should be offered the choice of drink at the table and not have juice automatically placed in the beaker. To assist with the management of residents falls, advice from an expert may be beneficial. 4 5 6 OP13 OP15 OP38 Quinton House DS0000027480.V341942.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Quinton House DS0000027480.V341942.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. 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