Inspection on 28/11/05 for Rosemead

This inspection was carried out on 28th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Rosemead 17/01/07

Rosemead 02/05/06

Rosemead 08/02/06

Rosemead 24/01/05

Rosemead 13/10/04

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 Rosemead 49 School Lane Bidston Wirral CH43 7RE Lead Inspector Natalie Charnley Unannounced Inspection 28th November 2005 11:00 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 Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Rosemead Address 49 School Lane Bidston Wirral CH43 7RE 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) 0151 652 3824 Mrs Mavis Jones Mrs Johanne Huntington-Jones Mrs Mavis Jones Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th January 2005 Brief Description of the Service: Rosemead is a home located in the Bidston area of the Wirral, within a quiet road, close to local shops and transport links. Car parking is available at the front of the building. The home can accommodate up to 14 residents and provides personal care. It is a three story building which has a variety of communal and private areas. A lift is available to take residents between floors. There are eight bedrooms, one of which is ensuite. Three of the bedrooms are shared rooms. The homeowners, one of which is the registered manager, have a flat on the upper floor to which residents don’t have access. Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over a period of one day. The inspector arrived at the home at 11.00 and left at 18.45 .The inspector spoke with 4 staff, the home manager, and 5 residents. No visitors were available at the time of the inspection. The inspector completed the inspection by looking at the homes records, a tour of the building, formal and informal interviews and information from previous inspection reports. The inspector followed an inspection plan written before the start of the inspection to ensure that all areas that needed covering were done so. Feedback was given to the manager during and at the end of the inspection. Outstanding requirements from the last inspection have not been met, therefore requirements and recommendations have been made at the end of this report. Since the inspection has taken place a follow up visit was completed on 14th December and another is arranged for 6th January 2006. What the service does well: What has improved since the last inspection? What they could do better: The home needs to address the following standards as a matter of urgency as they have been assessed as having major shortfalls: 1. Needs assessments (standard 3) All residents moving into the home must have a pre admission assessment completed and put in their notes before they move in. This must cover Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 6 personal care needs, mental state, medical history, social interests/hobbies, medication and safety risks. 2. Meeting Needs (standard 4) Residents at the home that have been identified by staff as having dementia/confusion must have a re-assessment by a qualified person, that will look at their needs and decide if Rosemead is a suitable home for them to live in. 3. Service user plan (standard 7) Residents must have a clear plan of care in place that is updated monthly and based on their pre admission assessment. This plan must outline what staff need to do for a resident and what they can do for themselves. 4. Health Care (standard 8) Residents must be able to access a range of health services and be able to make decisions about all aspects of their lives, supported by staff. All healthcare practices and interventions must be clearly documented in residents notes. Risk assessments need to be put in place top protect residents regarding medication, falls, manual handling, nutrition and pressure area care. 5. Social contact and activities (standard 12) The home must plan and offer residents a variety of activities and record this in residents notes. 6. Protection (standard 18) All staff working at the home must have appropriate checks in place to ensure they are suitable to work with vulnerable people. The manager and staff must make sure they are aware of the local policies and procedures with regard to adult protection and undertake some form of training in this area. 7. Recruitment (standard 29) The home must always have two written references in place for staff before they start work at the home. Staff files must be kept up to date and in an organised way to ensure all documentation is collected. 8. Staff training (standard 30) In order for staff to care for residents appropriately, a wide range of training must be given to staff. Those administering medication need specialist training as well as staff needing support with the core areas of manual handling, health and safety, food hygiene, fire safety and abuse awareness. 9. Quality assurance (standard 33) Residents must be consulted at the home and able to freely express their views. A system to make sure that a good service is provided by the home must be devised and put in place. Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 7 It is concerning that some of the above issues have not been addressed since they were made subjects of requirements and recommendations at the last inspection. A visit on 14.12.05 showed that the home had moved in a positive direction and had developed a new care planning and risk assessment format that had been implemented on 7 care plans. The manager and staff now have a much greater understanding of this area and its importance. 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. Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 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 Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 4 The home do not know if they can meet the needs of new residents before they move in this leaves residents at risk. Residents currently living at the home may not be in the correct type of care environment and may not be having their needs met. EVIDENCE: 5 resident files were looked at during the inspection and none contained any pre admission information. Discussion with the manager revealed that the home do not do a pre admission visit on potential residents and instead leave any assessment of a resident until after they move into the home. This practice is not acceptable; as the home must ensure that any resident that moves in can have their needs met. Following further discussion with the manager and staff, it was identified that 10 out of the 14 residents at the home have varying levels of confusion/dementia. Records at the home have statements such as “confusion has set in”, “very confused” and “aggressive behaviour” recorded. The home must look to have these residents re assessed as soon as possible to Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 10 ensure they are in the correct placement and that their needs are being met. The home must also comply with their conditions and category of registration. One resident, who was very ill, was living at the home. Staff stated that family members wished for her to remain there and not to be moved to hospital. The home did not have any written record of these wishes and had not involved the doctor. Advice was given regarding this situation during the inspection. Staff employed at the home do not have skills and training to support residents who are, by their own admission, “confused” and “aggressive”. Staff felt that they could manage the needs of all residents who live at the home. Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 9 The home does not have a system in place for developing care plans and risk assessments leaving residents at risk form harm. Poor recording makes it difficult to evidence that health care needs of residents are met Medication administration records are well recorded maintaining the safety of residents EVIDENCE: 5 resident care plans were looked at during the inspection. It was clear from reading these documents and from discussion with staff, that staff and the manager did not understand what a care plan was and what details need to be contained in this document. The home has a form called ‘care plan needs’ which contained only basic statements such as ‘has mood swings’ and ‘doesn’t want to take tablets’, no information was available about how staff would care for the residents or outcomes of care to be given. Information was not dated or signed and was very disorganised. No two plans were set out in the same way and different forms were in files. Residents commented, “What is a care plan?” and “haven’t Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 12 heard of my care plan” when asked if they had been involved in deciding what their needs are and in helping formulating a care plan. There was no evidence to show that care plan comments were reviewed or updated. This needs to be done at least once a month or sooner if needs change. Only 3 of the care plans had risk assessments on manual handling in them. These 3 forms were not signed or dated and had not been fully completed. One resident had a ‘client assessment form’ which looked at a residents dependency and had a score on it, however it was not clear what this score meant. Other files had blank risk assessment forms in them and the manager did not know how to complete risk assessments and was not aware of there importance. Residents at the home can have access to a local GP (General Practitioner) and had received visits from a chiropodist. It was very difficult to evidence that other heath professional had visited the home, as records were so poor, however residents confirmed they has seen nurses and doctors. No nutritional screening takes place at the home and residents had no weight records. No physical activity takes place within or outside of the home and resident falls are not monitored. Medication storage and records were checked. The medicine trolley is kept securely in a locked cupboard and MAR (medication administration records) were completed to a high standard and included a photograph of the resident which is good practice. The home need to ensure that they remember to date when medications come into the home and that staff receive appropriate training on medication management. Advice was given after the inspection regarding storage of controlled drugs following discussion with a Commission for Social Care Inspection pharmacy inspector. The home is now going to store controlled drugs within their large safe in the office. Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,and 15 Residents do not participate in activities and are therefore not having a balanced lifestyle. Residents can maintain links with family and friends if they wish Residents have a tasty, balanced diet, however are not always sure of any alternatives on offer. EVIDENCE: Residents were observed during the day and did not move from the lounge area for very long periods of time. On chatting with residents they commented “I couldn’t say what activities I join in with”, “nothing goes on here” and “we never go out”. Discussion with the manager showed that no activities currently go on at the home. The manager stated that residents did not wish to join in with activities and motivating them was very hard. The manager went on to say that on occasions they had attempted to do some sessions of throwing a ball, but very few residents participated. The activity record book was checked but had not been completed since May 2005. Residents stated that they were not asked what activities they would enjoy and would like a trip out of the home. There are plans to hold a party over the Christmas period and bring in an outside entertainer. Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 14 Three residents at the home go to outside clubs in the community, which they enjoy. Residents can have visitors at any time of the day and can meet with them in communal or private areas. The home has a 3 -week rotating menu that offers a choice, however the choice is the same for every day of the week. Residents spoken to made comments such as “meals are lovely but no choices are offered” and “I don’t get a choice but meals are nice”. Drinks are available throughout the day and residents can eat their meals in their rooms if they prefer, however a pleasant dining area is available. One resident is having a special diet as she if finding eating difficult due to her frailty. The home are managing this well and recording what she eats and drinks. Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 15 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home has a satisfactory complaints procedure, however residents are not aware of it or how to use it. Staff have a poor knowledge of adult protection procedures which leaves residents at risk from abuse. EVIDENCE: The home has a record of complaints that have been made, the last being recorded on 30.9.04. This showed that the complaint had been addressed satisfactorily. The manager had difficulty locating the complaints procedure when asked for it, however one was in place. 5 residents were asked if they knew how to make a complaint, all replied that they did not. The staff and manager at the home were not aware of the local policy issued by social services regarding dealing with allegations of abuse. No local policy was available within the home, and staff had not received any training in this area. The manager did not understand what was meant by the term POVA (protection of vulnerable adults) which had to be explained in detail by the inspector. During the previous inspection, it was highlighted that there were staff working at the home without a CRB(criminal record) check and POVA check. These checks have since been completed, however it was found that the home’s cook, who is the husband of the manager, did not have a CRB or POVA check in place. The manager did not see this as a problem as it was her husband. This must be addressed as a matter of urgency. Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The layout and location of the home are suitable for the residents who live there. The home is safe and clean, however some minor areas of maintenance need addressing. The infection control procedures at the home are not known by staff and leave residents at risk. EVIDENCE: A tour of the home was undertaken. The front pathway to the home was severely bumpy and had cracked tarmac. The home must look into having this repaired as it hinders access, especially for wheelchairs of people with poor mobility. The different floors of the home are accessible by a lift and stairs. The resident living on the top floor, which has no lift access is able to use the stairs, but must have a risk assessment put in place. The home is well maintained and pleasantly decorated, which creates a homely atmosphere for residents. Residents commented that they liked the decor at the home and that they were happy with their environment. Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 17 The home was clean and tidy and the domestic interviewed stated that she had plenty of cleaning supplies. No areas of the home had offensive smells and residents stated that their bedrooms were always kept in good condition. Two bottles of bleach were found in the kitchen which were removed during the inspection and the home have infection control policies in place, however staff had not received training in this area and were not sure of the policies. The laundry area at the home was very untidy and is in need of modernisation. Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29 and 30 Staff morale is high resulting in an enthusiastic workforce that works positively to care for residents. Staff recruitment practices are poor leaving residents at risk Staff do not have the necessary skills and training to care for residents that have dementia. They have also not received training in mandatory subjects that are needed by staff to provide holistic care to residents. EVIDENCE: Staff rotas showed that the home have 3 care staff on in the morning, 2 in the afternoon and 1 at night with a member of staff who sleeps in the building (this is usually the manager or her daughter). The staff team is very stable and consists of a number of family members of the owners, which creates a homely feeling, as they know residents very well. Residents spoke highly of staff stating they were “friendly and caring” and felt that they were “well looked after”. 4 staff files were looked at. One file only had one fire training record recorded from April 2004, all other training records were blank, along with the induction checklist and equal opportunity form. A signed staff handbook was available along with two written references and a CRB and POVA check. There was one file without any references at all, and all other staff files showed no records of training. Staff at the home along with the manager accepted that training was Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 19 out of date and needed addressing as a matter of urgency. Only one staff file showed evidence that an induction period had taken place. Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 20 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 38 Quality of care at the home is not monitored and residents views are not sought. The home maintains the health and welfare of residents, however accidents need to be closely monitored to ensure safety of residents. EVIDENCE: The home does not monitor the quality of care at the home at present. Views are not sought from resident, families or any other agencies in order to develop care. Staff did confirm that they have staff meetings every so often. Discussion took place as to how the home could develop this standard. The home has a fire risk assessment that is dated 1.8.02 and is in need of updating. Accidents are well recorded but are stored incorrectly and not in accordance with Data protection legislation and the manager found it hard to Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 21 find these records as they were not available to hand at the time. The records showed that one resident was having frequent falls in the lounge (dated 6.11.05, 9.11.05 and 19.11.05), however the manager was not aware of this, as she does not audit the records. Safety certificates were in place at the home and records of maintenance were seen. The home has a variety of policies and procedures in place relating to health and safety, however staff need training in this area. Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 1 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 X 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X X X X 2 Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 23 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 OP3 Regulation 14 Requirement The registered person must ensure that all residents receive a pre admission assessment and that this is clearly recorded (remains outstanding from previous reports due 1.12.04 and 1.4 05) The registered person must ensure that all residents identified during the inspection receive an assessment to make sure they are in the correct home that can meet their needs The registered person must ensure all residents have a clear and comprehensive plan of care that they are involved with developing and that is updated monthly (remains outstanding from previous reports due 1.12.04 and 1.4.05) The registered person must ensure that risks taken by residents are clearly assessed and recorded. The registered person must ensure that all residents have weights recorded on a regular Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 24 Timescale for action 01/01/06 2 OP4 14 01/02/06 3 OP7 15(1) 01/01/06 4 OP8 13(4)(a) 01/01/06 basis The registered person must ensure residents can access other healthcare professionals and this is clearly documented The registered person must ensure that all staff that give out medication are trained appropriately and receive a competence assessment. The registered person must ensure that all drugs entering the home are correctly signed and dated. The registered person must provide structured and varied activities for residents living at the home. These activities must be recorded The registered manager must ensure all staff working at the home has a POVA and CRB check and that no staff starts work without a POVA first in place. (Remains outstanding from previous reports due 1.12.04 and 1.2.05) The registered person must ensure that staff are trained in infection control procedures and that bleach is not stored on the premises. The registered person must ensure that all staff must have 2 written references on file The registered person must ensure all staff receive mandatory training The registered person must ensure that quality assurance monitoring takes place within the home. 5 OP9 13(2) 01/02/06 6 OP12 16(1)(n) 01/01/06 7 OP18 18(1) 01/01/06 8 OP26 18(1) 01/03/06 9 10 11 OP29 OP30 OP33 19 18(1)(a) 16(2)(m) 01/01/06 01/04/06 01/03/05 Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 25 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 4 5 Refer to Standard OP15 OP16 OP19 OP26 OP38 Good Practice Recommendations The registered person may wish to look at how residents are informed about the meals they eat and the choices that are on offer. The registered person may wish to inform residents and relatives in more detail about the complaints procedure. The registered person may wish to look into re covering the driveway area. The registered person may wish to consider modernising the laundry area. The registered person may wish to look at updating the fire risk assessment and ensuring that accident records are torn of sheets so as to comply with Data protection legislation. Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Rosemead DS0000018933.V272623.R01.S.doc Version 5.0 Page 27 - 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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