Inspection on 18/01/07 for Riverside

This inspection was carried out on 18th January 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Riverside 25/01/06

Riverside 25/10/05

Riverside 23/02/05

Riverside 21/07/04

Riverside 25/03/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

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

CARE HOME ADULTS 18-65 Riverside Coventry Road Bulwell Nottingham NG6 8RA Lead Inspector Rob Cooper Key Unannounced Inspection 18th January 2007 10:00 Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Riverside Address Coventry Road Bulwell Nottingham NG6 8RA 0115 9277418 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) maureen.rickett@nottinghamcity.gov.uk Nottingham City Council Mrs Maureen Rickett Care Home 22 Category(ies) of Learning disability (22) registration, with number of places Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2 residents over the age of 60 Date of last inspection 25th January 2006 Brief Description of the Service: Riverside is a purpose built care home, owned and staffed by Nottingham City Council. The home is situated approximately three miles from the city centre, and is close to local shops and transport options, including the tram. Care is provided for twenty-two people with a learning disability, with sixteen places deemed medium term, and six beds for emergency/ respite care. The home is situated on two floors, with the upper floor being accessed via stairs. There are a number of ground floor bedrooms, and assisted bathing facilities, so that a person with restricted mobility could live at Riverside and have their needs met. Fees: Fees are individually assessed by resident’s social workers, and will depend on individual circumstances. Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection – so that no one at Riverside knew that the inspection was going to take place. The inspection took approximately three hours through the middle of the day with one Inspector present. The method used to carry out the inspection was to send out a questionnaire, which asked questions about the service, to gather statistics, such as how many service users there are, the numbers of staff etc. This was followed with a visit to Riverside, where a method called case tracking was used; this involved identifying three residents and looking at their individual files and making a judgement about the quality of care they are receiving, and if their needs are being met. This also included a partial tour of Riverside, looking at the activities and facilities on offer, and talking to staff and residents. Two members of staff were also asked their views on how service user’s needs are being met. What the service does well: What has improved since the last inspection? Three requirements were set at the last inspection. Of these two have been met – one relating to addressing residents healthcare needs, and case tracking Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 6 of three residents found no problems in relation to residents health care needs being met. The second concerned the replacing of two badly stained baths, and both baths have been replaced. The third requirement related to the ‘bigger picture’ of upgrading the entire Riverside building. The City Council who own and manage Riverside are actively looking at alternative accommodation, as it is acknowledged that the building needs so much renovation, that it would be better to move completely. A recommendation was also made in respect of this issue, and neither the requirement or recommendation are considered relevant now, in the light of the City Council’s plans to move location. There is an excellent pictorial menu, so that residents who find it difficult to understand the spoken word can see pictures of the food that is being prepared for their meals. 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. Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12&5 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Prospective residents at Riverside have the information they need to make an informed choice about where to live. Prospective residents at Riverside have their individual aspirations and needs assessed. Each resident has a written contract/statement of the terms and conditions of residence for Riverside. EVIDENCE: The service user guide and statement of purpose were both seen for Riverside, the statement of purpose was found to contain all of the information that Care Homes regulations say that they should. The service user guide gives a good indication of what it is like to live at Riverside, including providing colour photographs of the bedrooms and living areas. Three resident’s files were seen as part of the case tracking process; each file had an Extended Community Care Assessment, which had been completed by a social worker before the individual moved into Riverside. In addition there were other assessments, which had a person centred approach, and used signs and symbols so that the residents could understand them. Each of the three files that were seen contained a copy of the terms and conditions of residence, which gave such information as the bedroom to be occupied, services provided and simple rules. Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 67&9 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Residents know that their assessed and changing needs and personal goals are reflected in their individual plan of care at Riverside, however evidence shows that they are not always reviewed regularly. Residents make decisions about their lives with assistance if needed. Residents at Riverside are supported to take risks as part of an independent lifestyle. EVIDENCE: Each of the three resident’s files that were seen contained an individual plan of care. The plans were written from a person centred point of view, and much of the documentation contained signs and symbols and pictures, plus one file had details of a Dyna Myte communication aid, with which staff are helping the resident to communicate. Each of the three files had a care plans covering a wide number of needs, however two files showed that the care plans had not been reviewed since the early months of 2006! Care Homes Regulations require that resident’s care plans are reviewed regularly, with a recommended minimum period of six monthly. Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 10 There was clear evidence within the resident’s files of the involvement of the speech and language department in resident’s lives. There is an obvious link between decision-making and the ability to communicate those decisions. Some of the resident’s files had communication passports and information presented in a way that residents would be able to understand, which suggested their involvement. There were also details identified within the files, which showed resident’s likes and dislikes, and daily programmes of activities. Two residents were spoken with, and one was just off to a job working in a charity shop, and told me how much she liked working there, and that she had been involved in the decision to find the job. The second resident had just returned from a shopping trip into town, he had been in on the tram on his own, and he explained how he made many of the decisions in his life about what to do and where to go. Each of the three resident’s files that were seen contained detailed risk assessments. These covered every day risks, such as bathing, and use of hot water when making drinks, through to wider individual risks, such as travelling unaccompanied on public transport. Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12 13 15 & 17 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Residents are able to take part in age, peer and culturally appropriate activities. Residents at Riverside are part of the local community. Residents at Riverside have appropriate personal, family and sexual relationships. Residents are offered a healthy diet, and enjoy their meals and mealtimes. EVIDENCE: The record of resident’s activities was seen, and this reflected that there was an organised programme of activities taking place. Discussions with two residents showed that residents are quite happy with the type of activity organised, and that activities were taking place both within Riverside and out in the wider community. As already identified two residents were spoken with, one who has a job in a charity shop, while the second had been out shopping. Both residents said that they regularly left Riverside to use local facilities including the pubs, the Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 12 church, and shops. Evidence seen in the resident’s files, showed that there was regular trips out from Riverside into the surrounding community. The resident’s files showed that there is regular family contact for many of the residents, and while no relatives were visiting Riverside during the inspection, three residents when asked said that they saw family members regularly. This was both at Riverside and at their relatives’ homes. All three residents said that there was not a problem with visiting, and there were no restrictions. Since the last inspection Riverside have introduced pictures of food as part of their menu planning, so that residents who have limited understanding of the spoken word can see pictures showing them what is for dinner. In addition a pictorial menu is displayed outside the kitchen for residents to see what meals are being prepared. Two residents were asked about the food at Riverside: one said that the “food is very nice, it’s lovely.” While the second thought that: “the food is always very good, there is always a choice.” Riverside try to ensure that there is always a healthy option at meal times and so salads and yoghurts are readily available. Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18 19 & 20 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Residents at Riverside receive personal support in the way that they prefer. Resident’s physical and emotional health needs are met. Residents, where appropriate retain, administer and control their own medication, and are protected by Riverside’s policies and procedures for dealing with medication. EVIDENCE: Each of the three files seen as part of the case tracking process identified individual resident’s personal choices. There was evidence of input from the speech and language department with the emphasis on improving individual’s communication, which would obviously allow residents better access to choice, and to identify their personal choices. In each of the three files the individual’s likes and dislikes had been identified – in two cases this was in a signs and symbols format, and each of the likes and dislikes profiles identified some elements of personal care and support. At the last inspection a requirement was set relating to resident’s health care needs. This was as a result of information being identified in resident’s files Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 14 that was both out-of-date and unclear. At this key inspection all three of the resident’s files that were seen contained up-to-date information about health care needs that was easy to understand. One resident was asked about health care needs, and they said that there wasn’t a problem; they could see a doctor when they wanted to – usually to talk about the resident’s tablets, and if they were unwell, the staff would either take them to see a doctor, or call one to Riverside. Riverside uses a monitored dosage system, which is supplied by Boots (the Chemists). This system provides each resident with a weekly card, which contains each dose of medication in a blister pack, for ease of the staff dispensing it. The records relating to ordering, dispensing, and where appropriate destroying or returning medication to the pharmacy was seen, and all found to be complete and correct, with no obvious errors or omissions. Medication was also seen to be stored securely. Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Residents at Riverside feel that their views are listened to and acted upon. Residents are potentially at risk from abuse, neglect and self-harm. EVIDENCE: Two residents were asked about making complaints, and both said that they felt happy talking to the staff, and that the manager was approachable, so that they could talk to her if they wanted to, although when asked neither had ever mad a complaint, and both said they were quite happy with the way things were at Riverside. The complaints procedure is prominently displayed and is included in the service user guide. A review of the complaints records showed that three complaints had been received since the last inspection, and that these had been dealt with in line with Riverside’s complaints procedure. Staff training records were unclear with regard to training in safeguarding adults, so it was not possible to assess whether all staff were adequately trained to identify abusive behaviour and deal with it. This training is vital in ensuring that staff are equipped with the skills to safeguard the people in their care. This training needs to be regularly updated (annually) to ensure that staff are receiving the latest information. Of the three files that were seen, one contained a risk analysis form, which identified the likelihood of the resident abusing others or being abused. This was an excellent form, and clearly evidenced that staff had considered the issues with this individual. It is recommended that this form be used for all individuals living at Riverside. Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Residents at Riverside live in a potentially unsafe, although homely and comfortable environment. Riverside is clean and hygienic. EVIDENCE: The City Council who own and manage Riverside are reviewing the accommodation. There is a major problem with asbestos within the roof spaces, and while this is contained, it is potentially a major problem. The building is over thirty years old, and is need of a major refurbishment, which is made more difficult as a result of the asbestos. As a result alternative accommodation is being considered. Therefore no requirements will be made in respect of the building at this inspection. There is clear evidence of attempts to make Riverside homely and comfortable. Unfortunately it’s 1970’s ‘open plan’ style does not really lend itself to this, and while the efforts of the staff are to be applauded – soft cushions and quiet sitting areas, the actual building remains the problem. At the last inspection a Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 17 requirement was made in relation to two baths, which were badly stained. Both of these baths have now been replaced, and the bathrooms much improved as a result. A second requirement relating to the redecoration and general upgrading of the building is no longer relevant in the light of the decision to move. The building was found to be clean and tidy, and two residents when asked said that they thought that the staff worked hard to keep it that way, and that it was “always very nice.” Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32 34 35 & 36 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Competent and qualified staff support the residents at Riverside. Resident’s rights are supported and protected by Riverside’s recruitment policies and procedures. Residents at Riverside have their individual and joint needs met by appropriately trained staff. Resident’s benefit from well supported and supervised staff. EVIDENCE: The staffing rota for Riverside was seen, and this showed that there were sufficient numbers of staff on duty, and that there were more senior qualified staff available at all times to guide the staff team. Discussions with one resident about the staff evidenced that this particular resident did not feel there was an issue with regard to numbers of staff on duty or their ability to do their jobs. Riverside is a care home owned, managed and operated by Nottingham City Council, all of their recruitment is managed centrally through the council’s Human Resources department, and an appointment to visit and inspect staff records will be made later in 2007. Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 19 A review of the staff training records showed that there is an ongoing programme of staff training in the National Vocational Qualification (NVQ). This is the industry standard within care for staff training. However the staff training records were found to be out-of-date and it was difficult to assess which staff have which qualifications. Care Home Regulations require that staff are suitably qualified and experienced, and ‘receive training that is appropriate to the work they perform.’ Therefore it is vital that staff training records can reflect this through up-to-date and thorough record keeping. Two staff files were seen, and both contained details relating to formal supervision – this is a one to one session where staff members are able to discuss their work with a more senior member of staff. Two staff members were asked about supervision and both said that they received formal supervision approximately once every two months, which is in line with the recommendations from Care Homes Regulations and was borne out by the evidence in the staff files. Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 & 42 Quality in this outcome area is good; this judgement has been made using available evidence including a visit to this service. Residents at Riverside benefit from a well run home. Residents are confident their views underpin all self-monitoring, review and development by Riverside. The health, safety and welfare of residents and staff at Riverside are promoted and protected. EVIDENCE: Riverside is managed by Maureen Ricketts who has been through the Commission for Social Care Inspection’s screening process and been deemed a ‘fit person’ to manage a care home. A review of Maureen’s experience and training qualifications supported this view. Records relating to resident’s meetings show that only two meetings took place in 2006. Resident’s meetings are the formal channel through which resident’s can raise issues and make their views known and recorded in the minutes of Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 21 the meeting. Ideally these meetings should take place monthly, which they have not, so it is strongly recommended that resident’s meetings are organised on a formal basis, and take place on a regular monthly basis. Riverside does not have a quality assurance system in place, and this means that there is no formal internal review of the service being offered. The Quality Tree would be an obvious tool that could be used to overcome this shortage, and steps should be taken to introduce a quality assurance system as soon as possible. A range of health & safety records were seen, and all found to be correct and up-to-date. These included the fire safety records, the Control of Substances Hazardous to Health (COSHH) records, and the water testing records for Legionella. Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 4 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 4 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 X 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 3 X 2 X X 3 X Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 23 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. 1. 2. Standard YA6 YA23 Regulation Requirement Timescale for action 30/04/07 30/06/07 3. YA35 4. YA39 Regulation The Registered person must 15 (1) keep the service user plan under review. Regulation The Registered person must 18 (1) ensure that the persons employed to work at the care home receive – training appropriate to the work they are to perform. Namely training in safeguarding adults, and the protection of vulnerable adults. Regulation The Registered person must 18 (1) ensure that the persons employed to work at the care home receive – training appropriate to the work they are to perform. Namely by updating staff training records so that they evidence the training received by individual members of staff, and are able to be used as a basis for analysing staff members’ training needs. Regulation The Registered person must 24 ensure that there is a quality assurance system in place to review the quality of the service. 30/06/07 30/04/07 Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 24 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 YA23 YA39 Good Practice Recommendations The Registered person should consider using the risk analysis form in the identified resident’s care file for every resident, as it has an excellent risk analysis for abuse. The Registered person should ensure that resident’s meetings are arranged and take place on a monthly basis. Riverside DS0000037796.V317704.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Riverside DS0000037796.V317704.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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