Inspection on 18/07/07 for St Agnes

This inspection was carried out on 18th July 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

St Agnes 25/06/08

St Agnes 07/12/06

St Agnes 08/06/06

St Agnes 09/11/05

St Agnes 05/05/05

St Agnes 04/11/04

St Agnes 24/05/04

St Agnes 09/12/03

St Agnes 21/10/03

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOMES FOR OLDER PEOPLE St Agnes 31/33 Silverbirch Road Erdington Birmingham West Midlands B24 0AR Lead Inspector Mrs Mandy Beck Key Unannounced Inspection 18th July 2007 08:00 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 St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Agnes Address 31/33 Silverbirch Road Erdington Birmingham West Midlands B24 0AR 0121 350 4212 0121 350 4212 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) Residential Care Limited vacant post Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th December 2006 Brief Description of the Service: St. Agnes was originally two large three storey, Victorian style houses. These have been converted and extended to provide a care home for a maximum of 25 older people. The home is situated in a residential area between the Wylde Green and Erdington shopping areas in a road directly off the Sutton Road. Both the shopping areas and the centre of Birmingham are accessible by public transport. The bedrooms are spread over the three floors of the building and are a mix of singles and doubles, some with en suite facilities. The home has a lift to the upper floors however access to some of the bedrooms on each floor requires service users to negotiate some steps. On the ground floor are three lounges, a dining room with the main kitchen leading off, a small laundry and an office. Assisted bathing or showering facilities are available on the ground and first floors and there are ample toilets throughout the home. There is level access into the home and off road parking for a few cars at the front of the home. There is a very large, well-maintained and pleasant garden to the rear. The home charges between £322 and £346 per week this is dependent on whether rooms are shared or single and en suite. Theses charges do not include extras such as newspapers, toiletries and outings. Residents will be expected to pay additional costs for these. St Agnes DS0000016757.V339854.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 visit to the home. It lasted one day and during this time we collected evidence to help make the judgments in this report. We spent time with the service users and staff to help us find out what life is like for the people living at the home. We looked at resident’s files as part of our case tracking process. This process enables us to look at selected residents care in depth and to make decisions about whether the home is meeting their needs. Staff files were also examined to make sure that the home is continuing to recruit people in a manner that safeguards its residents. Information given to the Commission for Social Care Inspection (CSCI) in the home’s Annual Quality Assurance Assessment (AQAA) has also been included in the body of this report. Some of the comments that resident’s made in the questionnaires we sent to them have also been included. The inspector would like to thank all of the residents and staff for their hospitality throughout the day. What the service does well: What has improved since the last inspection? The home has continued to make improvements with its care planning for residents needs. Care plans are in the process of becoming more person St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 6 centred in their approach. This means that residents will benefit from care planned on their individual likes and dislikes. Medication practices have improved, the staff are now recording the temperature of the fridge, this shows that all medicines that require cold storage are being kept at the recommended temperature. Activity provision has improved since the last inspection, more residents said that they were happy with the current arrangements, “I go out to the shops and sometimes I go to the pub”. “There’s a lot to do if you want”. A new cook has now been employed, since her arrival residents have said that the food is of a much better quality. “The food is tasty”. There is now the choice of a cooked breakfast on the menu three times a week following a residents meeting. Staff have received training in adult protection and how to recognise the signs of abuse. Residents can feel confident that staff will act appropriately to keep them safe and free from harm. The home has recently had a new boiler installed, this ensures that the supply of hot water to residents is available at all times. A new shower room has also been installed on the top floor for residents use. What they could do better: The home’s Statement of Purpose and Service User Guide will need to be updated to ensure that they show up to date information about the service the home provides. Residents contracts and terms and conditions of residency must be reviewed so that they show clear information about who will be responsible for paying residents fees, the role and responsibility of the registered provider and the rights and obligations of each resident. The manager must give attention to writing to residents before they are admitted to the home confirming that St Agnes’ is able to meet their needs. The quality assurance system needs to be further developed so that the residents can feel confident the home is run in their best interests. Please contact the provider for advice of actions taken in response to this St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 7 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. St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5,6 Quality in this outcome area is adequate. People who choose to live at this home can feel confident that their needs will be met, although some of the information given to them may not be up to date. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has both a Statement of Purpose and a Service User Guide that tells prospective residents about what life is like at St Agnes and what they can expect if they choose to live there. Both documents need to be updated so that they reflect the current service provision within the home. This needs to happen so that all prospective residents can base their decision about moving into the home on the most up to date information. Residents contracts and terms and conditions of residency also need to be reviewed so that they show clearly who is responsible for payment of the fees, St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 10 the roles and responsibility of the registered providers and the rights and obligations of the residents themselves. Every resident who moves into the home has an in depth assessment of their needs prior to admission. The manager will only agree to admission if she is confident that the home can meet those needs. Two residents files were looked at in depth and it was pleasing to see that both had a detailed assessment that later formed the basis for individual care planning. The manager could further improve this process by writing to individual residents confirming that the home is able to meet their needs before they move into the home. All residents are encouraged to spend time at the home before they agree to move in, this gives them time to make a choice about living there and an opportunity to talk to other residents and staff. Relatives are also encouraged to stay for a meal if they want to. The home does not provide intermediate care facilities. St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is good. Every resident can feel confident that the home will meet their personal and healthcare needs and that they will be treated with respect and dignity at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three residents files were seen as part of the case tracking process. It was pleasing to see that all of them contained risk assessments and care plans that detailed how their needs would be met by staff. The home routinely assesses all of its residents for their risk of falls, malnutrition, and developing pressure sores. There is also a risk assessment for the risk to residents from moving and handling. Each of these risk assessments is kept under regular review and amended, as residents need change. St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 12 Care plans are beginning to take on a more person centred approach. For instance care plans contained information about residents individual wishes, one resident’s night time care plan showed that they like a gin and tonic or horlicks, clean my dentures and put me to bed at 9pm. It also indicated that they preferred a male carer to help them with this. Another plan was very specific about the care of a resident with communication problems, it told staff to approach the resident from the left side and how the resident would indicate their dislike with anything by rolling their fist. Other care plans could be further developed for instance one plan stated “chooses own clothing” but it did not mention if the resident then needed help to put the clothing on or if they could do it themselves. In one resident’s plan it was noted that they had begun to loose weight, the home has taken active steps to manage this weight loss with the help of the district nursing service. It was clear that the resident’s needs were being addressed but there was no care plan to show that this was the case. This was discussed with the manger at the time of the inspection. The home is supported in its care of the residents by the GP’s, district nursing service and other visiting professionals. Residents also benefit from regular visits off the optician, dentist and chiropodist. Medication practices within the home are good and staff have received training to give them the skills and knowledge to administer medication. There are good systems in place for the ordering, receipt and returns of medicines. Since the last inspection the home has now begun to record the temperature of the fridge so that all medicine requiring cold storage are kept within recommended temperatures. The excess stock left at the end of each month is now being carried forward on to the new months Medication Administration Record (MAR) and the variable dose of medication given to service users is being recorded. Residents said that the staff “are golden”, and they “help me and are very kind”. Staff were observed throughout the day knocking on doors before they entered residents bedrooms and toilets. Residents also agreed that they had all of the assistance they needed to meet their requirements. St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. The people who use this service can feel confident that the meals are of a good quality and that they will be encouraged to maintain links with their family and friends. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection there has been some improvements with activity provision in the home. The home does hold regular residents meetings and as a result of this there have been changes to the level and type of activity on offer. Residents said that they wanted to get out of the home more. This had proved difficult recently because the minibus was no longer available for use. The staff are making efforts to take residents out to the shops and the local pubs as they have requested. Indoors there are various board games and jigsaws for residents to use if they wish to. Each resident now has a care plan that looks at their social needs and their individual likes and dislikes when it comes to activities. Visitors are welcomed to the home at all times. They are also encouraged to stay for a meal with the residents if they want to. There was evidence to show St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 14 that relatives often take residents out of the home for trips to the shops or to their home for tea. Residents have also raised issues with the lack of variety at breakfast time and the quality of food in general. Since the last inspection the home has now employed a cook and things appear to be improving. Residents were seen to be enjoying their breakfasts and at lunchtime the inspector sat with them. The meal was hot and very tasty. All residents are offered two choices at each meal time but the cook said if anyone wants something different she is usually able to oblige. Recent changes to the menu have included the introduction of cooked breakfast three days a week and a curry night on Tuesdays. Residents said that this was a popular evening. Drinks and snacks are available to residents at any time of the day. Supper is usually served by the night staff and is usually a milky drink and sandwiches. St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. The people who live in this home can be sure that their views will be listened to and acted upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are good systems in place for the investigation and management of complaints. The complaints policy and procedure that is displayed in the entrance foyer of the building. The manager has also included a “grumbles book” for residents and relatives to complete if they have any grumbles that they feel do not warrant a formal complaint. It was suggested that once a grumble or a complaint has been recorded in these books it is removed by the manager to protect the anonymity of those residents and relatives recording grumbles or complaints. The CSCI has received no complaints about the home and the service it provides to its residents. The adult protection procedures and policy remains unchanged since the last inspection. However more staff have now received training in Safeguarding Adults and recognition of abuse. Staff said that would feel confident reporting suspected abuse and that they would use the home’s Whistleblowing policy to do this. St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 16 St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is adequate. The home is generally well maintained and is pleasant and clean. It is on old building that requires a lot of maintenance. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We walked around the home and spoke to residents in their rooms and the communal lounges. The home was clean and tidy and all the residents spoken to said how much they liked living there. Since the last inspection improvements have been made to the bathing facilities. There is a new shower room on the top floor that is accessible to residents and offers more choice to them. A new boiler has also recently been installed this will help improve the delivery of hot water to residents bedrooms. There have been some problems with the St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 18 hot water since the installation of the boiler. The manager did say that the plumber has ordered the affected part and this will be mended in the very near future. In the meantime they have put systems into place so that residents are not too affected by this. The home does not employ cleaning staff on a daily basis, a cleaning company is supplied three times a week to clean the home. This arrangement may need to be reviewed once the home is running at full occupancy to ensure that the current standard of cleanliness is maintained. It was also pleasing to see that residents who required pressure relieving equipment have this in place. The home is supported by the district nursing service who regularly assess the effectiveness of this equipment. The garden area is extensive and is well maintained. Residents are also encouraged to take part in planting flowers and maintaining the grounds. The front of the home needs a little more attention and could be tidier. The door bell also needs to be repaired so that the home are alerted to the presence of visitors. The manager is aware of this but did say that it was on old bell and the parts are difficult to find to repair it. None of the residents smoke, the home does not have a designated smoking area. The manager said that they would like the home to be a non smoking establishment. This will need to be included in the new Service User Guide so that all prospective residents are aware of this. Infection control practices are improving, there were gloves and aprons freely available for staff to use. All toilets and washing facilities had liquid soap for hand washing. All of these measures will help reduce the risks of cross infection to residents. Some of the staff at the home have also undertaken more training in infection control. Following suggestions from residents the arrangements for the laundering of clothing has been reviewed. Some of the residents now have their laundry done on set days, the manager also said that consideration was being given to providing this service to all residents. It is hoped that this will improve the service to residents. The laundry is small, the walls and floors are not impermeable or easily cleaned. However the home does have good systems in place for the laundering of residents clothing. At present one of the washing machines is out of order and will need to be repaired to ensure the smooth running of the laundry. St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. Staff are employed in sufficient numbers to meet the needs of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs sufficient staff to meet the needs of the residents. When talking to the residents they commented “they are so good to us”, “sometimes you have to wait a little but they do try their best”, “they are always kind to me and help me when I need it”. There has been an improvement in the numbers of staff who have completed training in National Vocational Qualification (NVQ) level 2. All of the current staff group have either completed it or are in the process of doing so. This means that staff will have received the necessary training to do their jobs. There have been no new members of staff since the last inspection. The manager indicated that all staff are now in receipt of appropriate Criminal Records Bureau (CRB) checks. The training matrix is being updated to reflect recent training. The home has also employed to services of an outside trainer. The manager reported that this has been very effective and that more staff have attended this training. She also reported that staff are more attentive and are more responsive. All of St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 20 the catering staff have recently completed training in Food Hygiene and Food Handling. There is more training planned for the coming twelve months. St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. The home is well managed and the people who live their have confidence in the manager in meeting their needs This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager is not yet registered with the CSCI but she is currently undertaking her Registered Managers Award. Both staff and relatives have been very complimentary about her. One staff member said “you can go to her with anything and know that she will do her best to sort it out”. One relative commented “very good have a lot of confidence in her”. As part of the Registered Managers Award the manager is currently building a Quality assurance system for the home. She is currently focusing on the staff St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 22 and staff training but hopes to develop the whole system as her course progresses. The home holds regular residents meetings to give the residents to opportunity to raise issues they want to. Staff meetings are also held regularly so that staff are kept informed of developments within the home. In addition to this the manager audits accident forms, she does this so that she would be able to identify any trends appearing and take action to reduce risk to residents. The home does not handle any money on behalf of residents. Health and safety practices within the home are improving. Staff are receiving the required mandatory training and the manager was able to produce evidence that maintenance checks are being completed and equipment is regularly being serviced. St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 1 X N/A X X 2 St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP1 OP2 Good Practice Recommendations The home’s Statement of Purpose and Service User Guide must be updated so that people can make an accurate informed choice about living at the home. Residents contracts need to show them who is responsible for paying their fees, the role and responsibility of the registered provider and their rights and obligations as residents. Residents should receive a letter from the home that confirms that their needs will be met once they move in As the home increases the number of residents it cares for the manager must review the domestic assistance to ensure that the home remains clean and odour free. The manager should consider applying for registration with the CSCI. The home needs to be able to demonstrate that it is acting in the best interests of residents. The manager needs to further develop systems for DS0000016757.V339854.R01.S.doc Version 5.2 Page 25 3 4 5 6 7 St Agnes OP4 OP19 OP31 OP33 OP36 ensuring that all staff have regular supervision. St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Birmingham Local Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 St Agnes DS0000016757.V339854.R01.S.doc Version 5.2 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!