Inspection on 13/12/05 for Ryder House

This inspection was carried out on 13th December 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ryder House 08/06/07

Ryder House 29/01/07

Ryder House 11/07/06

Ryder House 05/05/05

Ryder House 14/02/05

Ryder House 27/09/04

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

CARE HOME ADULTS 18-65 Ryder House 115/116 London Road Dover Kent CT17 0TQ Lead Inspector Mrs Penny McMullan 13 and 15 th th Announced Inspection December 2005 09.30 DS0000023532.V263126.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000023532.V263126.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000023532.V263126.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Ryder House Address 115/116 London Road Dover Kent CT17 0TQ 01304 214832 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) Robinia Care South East Ltd Care Home 14 Category(ies) of Learning disability (12), Physical disability (4) registration, with number of places DS0000023532.V263126.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Residential Care for older people with a learning disability is restricted to 3 persons whose d.o.b is 18/05/1936 and 16/10/1936 and 13/10/1939. 5th May 2005 Date of last inspection Brief Description of the Service: Ryder House is part of the larger Company of Robinia Care, who specialise in care of people with Learning Disability. There is a high commitment from the Company to provide quality care and support to the service users. The home is a large detached property with accommodation for service users on three floors. There are nine single rooms and two shared rooms. The home is located in Dover with easy access to local amenities, and public transport. There is a large well maintained garden to the rear of the property. DS0000023532.V263126.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Ms Ann Gilham has now been appointed as the Manager at Ryder House and commenced employment on 3 October 2005. Ms Gilham has applied to the Commission to become the Registered Manager. Mr D. Rickaby, Operations Manager, Robinia Care was also in attendance. The announced inspection was carried out over a period of 11.5 hours over two days. Discussion took place with service users, staff and management. Feedback from the postal survey was as follows: one comment card from a relative indicates that she is happy overall with the care services being provided and the service users appear happy living at Ryder House. One GP and one health care professional stated overall they are happy with the care being provided. The current service users have limited communication skills; therefore there is only minimal feedback with regard to the services being provided. The new Manager Ms Ann Gilham is focused on the needs of the service user and is aware of what needs to be developed in the home. The lack of a structured staff team and the vacancy for a deputy Manager also new appointments to some senior staff roles has had an impact on the services being provided. The home is experiencing considerable change and the Manager must ensure that an effective staff team is developed to meet the needs of the service users. The Manager must also ensure that Regulation 37 notices are forwarded to the Commission for any incident/accident, which affects the welfare of the residents. Since the last inspection the home has complied with and made some progress towards meeting the outstanding requirements. Revised timescales for outstanding requirements have been made in this report. At the time of the inspection the home was experiencing difficulty with regard to meeting the needs of a new service user who was an emergency admission to the home in November 2005. An assessment of needs had been carried out prior to admission and at that time the home was fully staffed. The assessment indicated that Ryder House could meet the health and social care needs of the service user. The home then experienced staff difficulties with four members of staff leaving the home. To address these issues experienced trained staff currently working within the Robinia care group have supported the home. Recruitment of new staff has also taken place. The current staff team at Ryder House together with new staff members are in the process of induction and need to build in DS0000023532.V263126.R01.S.doc Version 5.0 Page 6 effective systems to meet the needs of the service users. One to one staff are allocated to the new service user to assist with the placement. Although the service user was assessed by the home within four weeks of the placement it was evident that he required additional support with his health and social care needs. The home contacted the relevant health professionals who assessed his medical and care needs and actioned the requirements. The impact of this placement has caused distress to the other service users living within the home. Staff have voiced their concerns with regard to the situation. The Inspector discussed this issue the Manager Ann Gilham and Danny Rickaby, Operations Manager. Despite the home providing additional staff and health care support the home could not continue to support this placement. However the home did recognise the urgency of reassessment for the service user and was able to secure a new placement in another Robina Home, which is an assessment unit. Staff from Ryder House assisted with the transition period and the service user left on 15 December 2005. What the service does well: What has improved since the last inspection? The overall management of the medication has improved since the last inspection. The installation of a stair lift and the home has purchased a portable hoist. A new kitchen was being installed at the time of the inspection. DS0000023532.V263126.R01.S.doc Version 5.0 Page 7 Individual thermostat valves have been fitted to the radiators in the service users bedrooms. 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. DS0000023532.V263126.R01.S.doc Version 5.0 Page 8 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 DS0000023532.V263126.R01.S.doc Version 5.0 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2, The homes Statement of Purpose and Service User Guide are in place and provide Service Users and prospective Service Users with the information they need to make a decision before moving into the home. Arrangements are in place to carry out a detailed and through assessments of needs of service users prior to admission within the home to ensure that all care needs will be met. EVIDENCE: The Statement of Purpose has been revised and is presently at head office being typed. The home is required to forward a revised copy to the Commission on completion. The General Regional Manager/Operations Manager takes the initial referrals of prospective residents. A joint assessment is then carried out with the Registered Manager. Prospective residents and relatives visit the home with their current carers and a detailed care plan is completed to identify and meet the service users needs. DS0000023532.V263126.R01.S.doc Version 5.0 Page 10 The recent service user who was admitted to the home had detailed information recorded and at the time of the assessment it was agreed that Ryder House was a suitable placement. After a four week period the dependency levels changed and the home was not able to meet the complex needs of the service user. DS0000023532.V263126.R01.S.doc Version 5.0 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 The care planning/medical system of recording is not consistent to adequately provide staff with the information they need to meet service users needs. The home endeavours to promote resident’s rights and choices. The home has risk assessments in place however the lack of review will leave service users at risk of harm and their rights to be safe are not protected. EVIDENCE: The service user plans are detailed and cover all aspects of health and social care and include risk assessments and daily record sheets. Some of the information in the plans has not been reviewed since February of this year. One daily record sheet was not completed for one shift and information on body maps were inconsistently recorded. Accidents/incidents were recorded but not fully monitored through the daily report sheets. A requirement has been made in this report. Staff demonstrated their awareness of health care needs but this was not reflected in the recording of the care plans. DS0000023532.V263126.R01.S.doc Version 5.0 Page 12 Any restrictions on choice are clearly recorded in the care plan and risk assessed. The Manager is discussing the use of advocacy services with head office. Staff demonstrated their awareness of promoting service user choice and information on individuals personal choice is recorded in the care plans. The Service User Plans contain risk assessments, but these are not consistently updated. Risk assessments require to be put into place for the moving and handling of service users who may require using the hoist. A requirement has been made in this report. It is recommended that some service user plans may require to be reviewed more frequently due to the ageing service user group. A requirement was made at the last inspection with regard to the updating and reviewing of risk assessments. Although some progress has been made the home must ensure that all risk assessments are reviewed and updated where required. A requirement has been made in this report. DS0000023532.V263126.R01.S.doc Version 5.0 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14,17 The lack of a planned programme of activities is restricting service users access to the local community, leisure facilities. The home is not providing stimulating activities to meet the needs of the residents. The meals in this home are good offering both choice and variety. EVIDENCE: The homes own transport is now back in use. Service users are accessing day care but there have been restrictions in activities due to the presenting needs of the service users. Some service users have been out to the local shops but there are no visits to leisure facilities in recent times. A requirement has been made in this report. The Manager is going to review individual preferences for community activities for all service users. DS0000023532.V263126.R01.S.doc Version 5.0 Page 14 Service users all go to the local shops. The home has started to plan activities within the home but this is currently restricted as the Day Care Co-ordinator is covering the Team Leader role. However a new Team Leaders has now been recruited and it is hoped that a programme of activities will commence in January. A requirement has been made in this report Nutritional needs are recorded in the service user plan. The cook demonstrated her awareness of service users likes and dislikes and alternatives are recorded. Photographs of certain foods are in place to ensure the service users are available to promote their choices. Mealtimes are unhurried and centred on the activities of the service user. Likes and dislikes are recorded on the service user plan also the cook records alternatives and special diets are catered for as and when required. DS0000023532.V263126.R01.S.doc Version 5.0 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Personal care is offered in a way to promote Service Users privacy and dignity however the lack of assessment re service users mobility may result in service users preferences on how to be guided not being carried out. The health needs of residents are monitored with evidence of good multi disciplinary working taking place on a regular basis, however the lack of accurate recording may result in the needs of service users not being met. The medication management of the home has improved however further review is required to ensure the safe transportation and storage of medication. EVIDENCE: Support and personal care needs are detailed in the service user care plan. Each service user has been allocated a key worker and health care professional support is accessed as and when required. The home is required to assess service users mobility re using the portable hoist and implement risk assessments if required. A requirement has been made in this report DS0000023532.V263126.R01.S.doc Version 5.0 Page 16 The current service users are not able to monitor their own health needs. The home has a separate medical folder as well as a medical record sheet in the service user plan. This recording of accidents/incidents appeared in the medical book but was not referred to in the care plan daily reports. Staff were able to demonstrate that the health care needs are monitored appropriately but this information is not reflected in the care plan. A requirement has been made in this report The management of medication within the home has improved however the placement of the cabinet is not appropriate. The home must review the storage of medication in line with the Royal Pharmaceutical Guidelines and provide the safe transportation of medication. Hand written entries in the MAR sheets need to be countersigned to minimise the risk of error. The home has purchased a refrigerator but this has not been installed. A requirement has been made in this report DS0000023532.V263126.R01.S.doc Version 5.0 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The home has a satisfactory complaints system in place. There are robust policies and procedures in place for the protection of vulnerable adults. EVIDENCE: The complaints procedure is in the care plan for each service user. There is a complaints log in the home and there have been no complaints since the last inspection. The home has a clear Complaints Procedure, which is available in large print with signs and symbols. The home has a policy on abuse, which is called Guidelines for Raising Concerns at Work. All staff attends de-escalation skills training and how to deal with aggressive behaviour and 5 staff have attended adult protection training and all staff will be attending the training. DS0000023532.V263126.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,27,30 The standard of the environment within the home is satisfactory providing residents with a comfortable and homely place to live. The home has adequate toilet ad bathroom facilities. Laundry facilities are satisfactory and policies and procedures are in place to control the risk of infection. However the home must ensure that the sluicing facility is minimising the risk of infection. EVIDENCE: The maintenance team are installing a new kitchen, a stair lift has been installed and the home has purchased a portable hoist. The Manager has received quotes for new furniture in the lounge area and is processing the quote through head office. The home was clean and free from offensive odours. There are some areas within the home, which require further decoration, and the Manager has requested this work to be carried out by the maintenance team. The toilet facility opposite the lounge has been reviewed and there is now anti bacterial hand wash in the dispenser also wipes are now available. DS0000023532.V263126.R01.S.doc Version 5.0 Page 19 Laundry facilities are satisfactory and there are policies and procedures for infection control. The home has implemented a safe practice of work with regard to soiled linen. The washing machine has a sluicing facility however the home needs to review this facility to ensure that the temperature of 65 degrees in reached to control the risk of infection. A requirement has been made in this report DS0000023532.V263126.R01.S.doc Version 5.0 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,34, 35 After a period of considerable instability within the staffing team. Qualified experienced staff have been recruited. There are sufficient numbers of staff to build an effective staff team. Arrangements are in place to ensure that residents are supported and protected by the homes recruitment policies and procedures. The home provides ongoing training for all staff however the lack of some mandatory training potentially puts service users and staff at risk. The arrangements for the induction and foundation training are in place. EVIDENCE: The staff team has changed considerably with four members of staff leaving the home, which included senior staff. Although recruitment of two new Team Leaders has been successful, the home still has a vacancy for an Assistant Manager. The new Team Leaders are experienced NVQ II members of staff and induction is taking place. However the team requires time to settle down to become effective and to get to know the service users. The morale of the staff was low due to the changes within the group and the impact of the emergency placement. The new Manager has been in post since October 2005 and is in the process of preparing the structure of the new staff, appointing key DS0000023532.V263126.R01.S.doc Version 5.0 Page 21 workers and identifying lead roles for senior staff. A requirement has been made in this report to ensure that the staff team are effective to ensure the needs of the service user are met. A requirement has been made in this report The staff rota has been reviewed and currently has five members of staff am/pm, one waking and one sleep night staff. CRB and POVA checks are in place and all necessary documentation is on file for the recruitment of new staff. Staff confirmed that the Company is proactive in providing training to meet the needs of the service user. The home has a training matrix and ongoing training has been booked for First Aid, Food and Hygiene, De-escalation, Break away, Adult Protection, Epilepsy, Infection Control and report writing. The induction and foundation training is linked to CWPLD. The home needs to continue to provide all staff with updates and mandatory training. A requirement has been made in this report. DS0000023532.V263126.R01.S.doc Version 5.0 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39,41,42 The systems for resident, relative, staff and other stakeholders consultation are good, however the lack of evidence of specific information with regard to the individual home does not take their views and choices into consideration for the development of the home. The lack of accurate up to date recording potentially puts service users at risk of not having their health and social care needs met. The health, safety and welfare of service users is at risk due to the lack of mandatory training and the review of environmental risk assessments. EVIDENCE: The Company has collated and summarised a quality assurance survey however this was not available at the time of the inspection. The head office confirmed that a detailed quality assurance has been carried out for Ryder House, which is consistent with all Robinia Care Homes. Having viewed this DS0000023532.V263126.R01.S.doc Version 5.0 Page 23 document previously there is no specific data with regard to Ryder House. It is recommended that specific information be provided to evidence that residents/relatives views underpin all self-monitoring, review and development of the individual home. This is a recommendation in this report. Some of the records, service user plans, medical records, and daily record sheets did not reflect the correct information to meet service user needs. Some risk assessments were not reviewed and up to date. This was a requirement from the last inspection. A further requirement has been made in this report with a revised timescale for compliance. All records are secure and stored appropriately. Some members of staff require updates or mandatory training. There is a rolling training programme and a total of 28 members of staff: 18 have received moving and handling, 17 Health and Safety, all First Aid, 12 Infection Control, 18 Basic Food Hygiene and 18 Fire training. Some of the staff are already booked on this training for next year and the Manager was in the process of booking new staff on to these courses. The fire book was in good order and the office confirmed that all appliances have been checked this year. Environmental risk assessments are in place but require to be reviewed. Accidents/incidents are recorded and the action taken, however the monitoring of health care needs is not being fully recorded to reflect the monitoring of service users health care needs. A requirement has been made in this report. DS0000023532.V263126.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 x 2 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x 3 x x 2 LIFESTYLES Standard No Score 11 x 12 x 13 2 14 2 15 x 16 3 17 Standard No 31 32 33 34 35 36 Score x x 2 3 2 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 x Standard No 37 38 39 40 41 42 43 Score x x 2 x 2 2 x DS0000023532.V263126.R01.S.doc Version 5.0 Page 25 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard Regulation Requirement To ensure that the health care needs of service users are recorded and monitored through daily reports To review the plans on a regular basis and update with any changes. To update key worker information The home must ensure that risk assessments are reviewed and updated All service users require an assessment of their choice to access the local community and leisure activities To review service users activities and provide a planned programme of appropriate leisure activities for each service user To ensure that service users are professionally assessed for moving and handling equipment and risk assessments are implemented if required To review the storage and position of the medication cabinet and provide safe transportation when DS0000023532.V263126.R01.S.doc YA19YA6YA42 14,15, Timescale for action 31/01/06 2 3 YA9YA18 YA13 13,15 16 31/01/06 31/01/06 4 YA14 16 31/01/06 5 YA18 12,13 31/01/06 6 YA20 13 31/01/06 Version 5.0 Page 26 7 YA30 13 8 YA33 18 administering medication. To countersign hand written entries on mar sheets to minimise the risk of error The sluicing facilities require to be reviewed to ensure the temperature is 65 degrees to minimise the risk of infection To establish an effective staff team with the competency to meet service users needs To ensure that all staff receive mandatory training or updates. To ensure that all records are accurate, up to date and signed. . This was a requirement from the last inspection, timescale 30/6/05. Revised timescale 31/1/06 To ensure that Accidents/incidents are tracked through to the service user plans and monitored through the daily reports 31/01/06 31/01/06 9 10 YA35YA42 YA41 13,18 17 31/01/06 31/01/06 11 YA42 13 31/01/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard 35 Good Practice Recommendations To provide specific quality assurance information rgarding Ryder House DS0000023532.V263126.R01.S.doc Version 5.0 Page 27 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 DS0000023532.V263126.R01.S.doc Version 5.0 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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