Inspection on 18/02/07 for Reinbek

This inspection was carried out on 18th February 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Reinbek 23/03/09

Reinbek 14/12/05

Reinbek 13/06/05

Reinbek 12/01/05

Reinbek 08/07/04

Reinbek 22/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Reinbek 287 Bramhall Lane Davenport Stockport Cheshire SK3 8TB Lead Inspector Michelle Haller Unannounced Inspection 18th February 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 Reinbek DS0000008582.V330414.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. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Reinbek Address 287 Bramhall Lane Davenport Stockport Cheshire SK3 8TB 0161 483 5252 0161 456 0199 reinbek@boroughcare.org.uk 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) Borough Care Limited Mrs. Ines Kirby Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44), Physical disability over 65 years of age of places (10), Sensory Impairment over 65 years of age (4) Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. A minimum of three waking staff must be on duty every night. Date of last inspection 14th December 2005 Brief Description of the Service: Reinbek is a residential care home that is registered to provide care for up to forty-four residents, specialising in providing care for older people with physical disabilities and sensory impairment. The home is one of twelve homes owned by Borough Care Limited. Mrs Ines Kirby is the registered manager of the home. Reinbek provides permanent residential care and short-stay accommodation. Day care facilities are available for up to four service users per day, Monday to Sunday. Reinbek is a two-story building; it is fully adapted for wheelchair users and has a lift to assist service users to the first floor of the home. The home is comfortably furnished and decorated throughout, the main entrance and two of the downstairs lounges were part of the original building. Accommodation is provided in forty-four single rooms, twenty-two of which have en-suite facilities. The home is structured into four units; each unit has its own kitchen, dining room and lounge facilities. The home had extensive gardens, with a large garden pond and water feature. Many of the bedrooms and lounge areas over look the garden area, providing pleasant views. The garden is easily accessible via four exits from the home, each of which has ramp access for wheelchair users. The home is located in a residential area, on the main Stockport to Bramhall Road. A regular bus service is available and the nearest railway station is Davenport station. The previous CSCI inspection report is made available on request and the home charges Standard £332 weekly; High dependency £390 weekly and there is an additional £10 weekly for en-suite facilities. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection, which included an unannounced site visit to the home, was undertaken on 18th February 2007. Seven service users and relatives were interviewed. Two members of staff were interviewed including a student on placement in the home. In depth discussion with the manager also took place. Examination of five care files and all records and reports pertaining to these service users was undertaken. Other documents concerned with the running of the home were also examined. A tour of the private and communal areas of the home was also undertaken and during the course of the day the interactions between staff and service users was observed. What the service does well: Reinbek provides very homely and relaxing living environment. The units provide a number of smaller lounge and dining areas and this gives the impression of small group living. And also allows service users to develop relationships and become accustomed to one another. The home has a good professional relationship with health care professionals and service users feel that they are well cared for. Comments included ‘I trust in the care that is provided, he gets lots of checks and they even organise the flu jab.’ The variety and quantity of food provided to service users is satisfying and meets their needs. Remarks included ‘meals are alright for me and there is enough- they always ask if we want seconds.’ The home ensures that service users feel listened too and are able to influence what happens on a day-to-day basis. Comments included ‘we have a residents meeting and we voiced our opinions- I mentioned a choice for breakfast and it was put on the menu right away.’ Relatives are very complementary about the running of the home and feel that care staff or managers will take any concerns seriously. Relatives also felt welcomed by staff and commented on the ‘family’ atmosphere promoted by the way things were done and the attitude of staff in the home. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 6 Reinbek provides staff with good opportunities for attending training and have positive links with local training organisations. The home takes its responsibility for safeguarding the well-being and welfare of service users and the staff seriously. Comments from service users include: ‘Everyone is very nice to me- they come in and have a chat and a joke they’re very good’ and ‘Staff are kindthey treat the confused service users very gently.’ What has improved since the last inspection? What they could do better: The home needs to ensure that care plans relate directly to individual needs and are reviewed and updated according to changes in need. All the information about meeting the needs of service users should be provided in the care plans. The home needs to make sure that they obtain a full history of past interests, influences and experiences for service users so that this information is incorporated onto care plans and the opportunity to enjoy more personalised activities is promoted. The home needs to make sure that all records concerning the needs, support and progress of service users are completed in full so that the information requested is actually available. The home must make sure that an accurate and more detailed record is kept of the food and drink intake of service users who have lost weight or who have a reduced appetite. The home should make sure that all documents and information about service user is recorded in stored in keeping with confidentiality guidelines. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 7 The service could also be improved if the key worker system that is in place was made more formal with specific task concerning individual needs highlighted. 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. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 8 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 Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 9 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 (Standard six is not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. In the main, Reinbeck ensures that they can meet the health needs of service users prior to their admission into the home. EVIDENCE: A cross section of service users care files were examined, and these included the most recent admission and a service user requiring intensive support. An admissions checklist is completed and this includes prompts in respect of sleep pattern preferences and dislikes. Although the information is kept in a different files it was possible to assess that, in the majority of cases, health care assessments, risk of falls and moving and handling needs were completed. Information about the most recent admissions provided a clear picture idea of their initial needs. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 10 The majority of service users are mobile and able to communicate well with staff. Although social history is assessed this information, in a significant number of cases, lacked detail. Quality in this area could be improved if the manager made sure that the assessment of psychological and social needs, and past interests for all service users are completed. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 11 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 good. This judgement has been made using available evidence including a visit to this service. Reinbek makes sure that health and personal care delivered is based on individual needs and which respects the individual right to privacy and dignity. EVIDENCE: The care plans examined varied in quality and information provided concerning the actions required by staff to meet the needs of service users. There were examples of good practice, with clearly written instructions and the expected outcome, but this was not seen in all plans. The care plans that were examined tended to identify the same three needs for everyone. Occasionally an additional need and instruction about care was added. The home should rethink this process as it does not demonstrate that service users are treated as individuals or that needs are assessed and prioritised individually. This process also fails to demonstrate that the support provided is person centred. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 12 Assessment information for each service user was not kept in a single file or transferred onto a single care plan and so it could be difficult for staff to keep a track on all the care required and to effectively review the progress of service users. It was apparent that at times the home was unable to demonstrate that they had made the appropriate referrals, maintained detailed records or responded in full to a change in circumstance of all service users. Records, reports and other correspondence did confirm that service users had access to routine and specialist health care including general practitioners, dentist, district nurses, mental health nurses, dieticians, optician and specialist consultants through attending outpatients hospital appointments. Records also confirmed that extra steps were taken to assist with communication such as working with an audiologist to try and use of a personalised loop hearing system. Specialist equipment such as pressure area care beds is provided and staff follow the instructions provided by district nurses and others involved in planning care. Medication is received into the home through a metered dosage system provided by the pharmacist. The medication policy was examined and the guidance promoted safe administration, storage and recording. The independence of service users is promoted as a number manage their own medication. Service users appeared well groomed, neat and tidy. Many were wearing prescription glasses and had been supported in wearing hearing aids. Daily records, though limited in the information provided were written in a respectful manner. Comments from service users included ‘The care in itself cannot be faulted.’ And ‘They are very good – if there is anything wrong they do what is needed and the doctor comes in regularly’, ‘Everyone is very nice to me- they come in and have a chat and a joke they’re very good.’ ‘Staff are kind- they treat the confused service users very gently.’ Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 13 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. Rrecreational and social provision fully meets the resident’s expectations. Food is wholesome, well prepared and dietary needs are met. EVIDENCE: Group activities in the home are organised by an activities co-ordinator who works in Reinbek for three periods a week. The activities co-coordinator has completed an Age Concern course concerning activities for older people, and is about commence a specialist course provided by a local college. Activities described by service users included darts, sing-along, entertainers and arts and crafts. The home also has a library that is stocked with books provided by the home and a mobile local authority library. The activities calendar also included outings, themed evenings and celebrations. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 14 In the main, service users and their relatives expressed a good level of satisfaction with activities and comments about activities included: ‘They’re very good- usually an enjoyable afternoon. The things they do are very good and passes the time away- sometimes they have an entertainer.’ The activity for the afternoon was observed and five services users enjoyed a game of darts. Discussion with some service users indicated that, at times, the type of activity could be seen as demeaning, such as ‘snakes and ladders’ and so they wouldn’t join in. There was little evidence that staff were supporting service users individually to participate in the things they enjoyed. Cross-referencing records indicated that even when a preference was stated this activity was not offered. It is important that the home is able to support service users to keep occupied and alert, by offering activities that they can enjoy and find stimulating, this is especially important for service users who have a tendency to isolate themselves. A significant number of service users have mobile phones or landlines connected in their rooms. All who were interviewed stated that they could visit the home whenever they liked. Family and friends were keen to confirm that staff were welcoming. It was observed that meal times in Reinbek are pleasant and relaxed. Service users sit at tables in small dining areas, and are able to enjoy their meals in a quiet, clean and homely environment. It was noted that independence was maintained through the use of plate guards, specialist cups and other utensils. In order to improve on this area the home needs to make sure that they can demonstrate that they have taken steps to reassess all service users who lose weight. The home should also make sure that are specialist supplements are provided when they have been prescribed for that person and a detailed food and drink intake chart maintained. The lunchtime meal on the day of inspection was lamb casserole. The menu rotates four weekly and included a variety of traditional British meals such as meat casseroles, stews, roasts and pies, vegetables including cauliflower cheese and as accompaniment, and also a range of more modern British meals such as sweet and sour pork, curries and pasta bakes. All those interviewed were keen to praise the food and stated that there was plenty of variety and that it was nicely cooked. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 15 Comments included: ‘The meals are alright for me and there is enough- usually they ask if you want seconds. In the morning and afternoon we’re offered drinks, tea or Bovril, what ever we like. The night staff are very good too.’ And ‘Very nice meals, lovely good selection- always offered seconds if you want it.’ Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 16 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. Arrangements and procedures are in place to safeguard against abuse and service users feel that their concerns are listened to. EVIDENCE: The homes complaints policy is displayed prominently in the home. The complaints log indicated that complaints were dealt with fairly and quickly. Service users confirmed that if they had any complaints these would be listened to. Relatives were able to name two people they would speak to or write to if they had any worries. Those who were interviewed stated that they had not made any complaints. The adult protection policy was examined and the information was clear. Discussion with staff indicated they felt confident in identifying behaviours and omissions that could be considered to be abuse. Examination of the training records confirmed that staff had completed protection of vulnerable adults training since the previous inspection. The manager stated that no adult protection investigations had been carried out in the home since the previous inspection. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 17 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The physical design and environment of Reinbek enables the residents to live in a safe well-maintained and comfortable environment. EVIDENCE: A tour of the entire building and gardens was undertaken. The home was clean and pleasantly decorated and each of the four units has it’s own distinct character. The bathrooms, toilets and other facilities are adapted with raised toilet seats, hoists and grab rails. Maintenance records confirmed that all moving and handling equipment was serviced and maintained by people qualified to do the work. Since the previous inspection general maintenance of the gardens and building has been ongoing and the carpet in one bedroom has been replaced. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 18 Service users were observed walking around the home independently or using the equipment provided. A number of bedrooms were personalised and service users had been able to bring their own furniture. The laundry area was clean, neat and dry and the washing machine has the required sluice facility and hot water temperature. The kitchen was clean and the home is about to begin participating in the ‘Safer food Better business’ initiative that is run by the local Health and Safety department. All areas of the home were clean, conformable, homely and pleasant to use. Remarks made by service users included ‘Can’t fault the home in relation to cleanliness.’ And one person said ‘No nasty niffs.’ Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 19 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 good. This judgement has been made using available evidence including a visit to this service. Reinbek provides staff who are well trained and in sufficient numbers to meet the needs of those living in the home. EVIDENCE: Reinbek is registered for 44 service users and staff on duty numbered 14 including managers, house keeping and kitchen staff. At night there are three wake and watch care staff available. The care staff are allocated split between the units and some service users commented that although in general there were sufficient staffRemarks included: ‘I feel that in general there are enough staff on, they seem to have more on in the afternoon.’ Staff interaction appeared relaxed and unhurried and in the afternoon it was noted that staff did take the time to talk to service users. Staff records confirmed that all had been employed using a robust recruitment and selection process. Application forms, two references and Criminal record bureaux checks were in place. Furthermore there was additional proof of identity and health declaration forms had been signed. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 20 Training is good and a student on placement in the home stated that her placement had reinforced the training and teaching she had received in college. The training calendar and records of attendance confirmed that some staff had received training in the past 12 months which included pressure area care; an introduction about hearing loss; basic and more advanced first aid; loss, grief and bereavement; food safety; falls prevention, infection control moving and handling, palliative care; fire safety and managing conflict. This training is provided through the Borough Care organisation of which Reinbek is a part. Nine day care staff and five night staff have achieved the NVQ level 2 award in care. Three staff are currently completing the award. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 21 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 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management at Reinbek is based on openness and respect. There is an effective quality assurance system in place and the manager is qualified and competent. EVIDENCE: The registered manager has attained the National Vocational Qualification level 4 in management award. The training she has attended since the last inspection included updating her medication training and moving and handling training. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 22 The running of the home appears efficient and supervision records indicated that staff are well managed. Relatives stated that the manager was approachable. Borough Care conducts a yearly review of services, which includes finding out the opinion of service users and their relatives. The outcome of this review is published and made available for all concerned. There are also regular residents meeting and residents confirmed that they could make suggestions about activities, meals and other improvements. Discussion with the manager and cross referencing the manner in which financial transactions are recorded, confirmed that service users money is fully accounted for and kept secure. Steps have been taken to safeguard the health and safety of service users. The fire logs were checked and these confirmed that all lighting and fire exits are checked weekly and fire drills take place monthly. Accident reports are maintained, however, it was noted, however, that the manner in which accidents are recorded should be changed to meet the requirements concerning confidentiality. Borough Care completes an accident audit and produce a report analysing the falls and accidents in the home. Records also confirmed that the manager attended health and safety management meetings that aimed to promote the safety and wellbeing of those living, working or visiting the home. Maintenance records confirmed that electrical and gas safety checks were conducted in accordance with the relevant regulations. Certificates of attendance confirmed that health and safety training including first aid, infection control and food hygiene is provided to staff. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 23 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 23 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 4 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 X 3 X X 3 Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP12 OP37 Good Practice Recommendations The registered person should consult with service users about their social interests and make arrangements for them to engage in local, social and community activities. Recorde keeping should be improved to make sure the home can demonstrate the quality of care they give. Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection 11th Floor, Westpoint 501 Chester Road Old Trafford Manchester M16 9HU 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 Reinbek DS0000008582.V330414.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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