Inspection on 05/05/05 for St Agnes

This inspection was carried out on 5th May 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 but made no statutory requirements on the home.

Other inspections for this house

St Agnes 25/06/08

St Agnes 18/07/07

St Agnes 07/12/06

St Agnes 08/06/06

St Agnes 09/11/05

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 B24 0AR Lead Inspector Jill Brown Unannounced 5 May 2005 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 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 E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service St Agnes Address 31/33 Silverbirch Road Erdington Birmingham B24 0AR 0121 350 4212 Telephone number Fax number Email 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 Ltd Jacqueline Cutmore (not registered) Care Home 25 Category(ies) of Older People registration, with number of places St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4 November 2004 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 require 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. St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on a day in early May. Four service users files were examined fully, six service users were spoken to and time was spent with the new manager of the home and the deputy manager. Records of complaints, activities, fire checks, lifting equipment and utilities were sampled. Four weeks of staffing rotas were taken to check staffing levels. A tour of the building was undertaken sampling several bedrooms, the lounges, dining areas and communal bathrooms and toilets. The inspector joined residents for the main meal at lunchtime. What the service does well: What has improved since the last inspection? Residents’ weights were being taken on a regular basis. The home showed that they were making efforts to improve activities for residents and were buying equipment to facilitate these. Staff files were more organised so information was more accessible. The home was employing the services of consultant to assist them with their quality assurance assessment. New admissions were having their medication checked with their GP to ensure all the medication was current. St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 6 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. St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 8 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 standard(s) 1 & 3 Whilst the home has information about the service it provides it does not collect information on residents in a consistent way. At least one resident has moved into the home without an assessment being made; this and the lack of consistency can put service users at risk. EVIDENCE: The home had submitted its service user guide and their statement of purpose documents previously and these met the standard. Residents’ case files varied in the amount of information that was collected and in the way it was recorded. One resident’s file had no formal assessment, no care plan, no personal profile, no risk assessment and this is unacceptable. One resident’s file had a lot of information on several formats that did not lend itself to ease of access or retrieval. The personal profiles, where in place, gave staff information on how service users like the care to be given. These were kept with the daily records and so were easily accessible to the staff giving the care but, had not been updated. St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 7, 8, 9 &10 Whilst residents were receiving adequate care on a day-to-day basis, there was no overview to ensure that care plans were clear, conditions were monitored and changes responded to; this potentially puts residents at risk. EVIDENCE: Care plans were on differing formats and were varied in their detail of how care was to be given. A later admission had useful information in the care plan including aids to be used, dislikes in food, actions to prevent falls and so on. Other care plans were very general with a lack of detail on how personal care was to be delivered for concerns raised such as agitation and partial sight. Monitoring charts were not always used where concerns were raised. Risk assessments for moving and handling and so on had not been reviewed for over 4 years in some cases. Entries in the daily records in some cases was not specific enough using phrases such as ‘all care given’. The home ensured new admissions came in with the right medication with the GP but acknowledged that the medication policy had yet to be reviewed in line with the last inspections requirements. A medication administration audit was not undertaken on this inspection but it was seen that administration of medicinal creams needed to be recorded better. St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 10 The home ensured that residents had access to district nurses, specialist health services and chiropody where this was required. Residents had access to GPs when the need arose but reviews were not always arranged. The home did not have a high level of accidents recorded in the accident book. Weights were being undertaken at least monthly but communally recorded. The home did not take other forms of measurement for residents that refused or could not be weighed. Analysis of weights and falls was not routinely being undertaken and this could lead to a failure of appropriate assistance to residents, especially for residents that cannot maintain their concentration to eat a whole meal. Residents had their personal care and laundry needs well attended to but were concerned about the recent delay in the hairdresser coming. The home has some toilet facilities whose doors open on to the main corridor; the staff must be vigilant that residents’ dignity is maintained at all times. Residents were observed to be treated kindly. One resident commented that ‘everyone (staff) is very nice and you couldn’t get better’ this view was supported by all the residents spoken to. St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 12,13 &15 Some improvements were being made on increasing the range of activities for some residents but at the present does not meet the standard and needs of all the residents. Food provided was of a good standard and met the needs of the residents. EVIDENCE: The new manager accepted that the area of provision of activities was one that needed improvement. There was evidence that the home were investing in new resources to enable group activities to take place, had booked an entertainer for VE day and were trying to book someone to provide regular movement through music sessions. One resident said that she liked making the cards, which was a recent activity. Several residents joined in most of the activities scheduled however more needs to be planned for residents that have dementia. Relatives appeared to be welcome in the home and there was no undue restriction on visiting times. The home had planned some events to encourage families to visit and become more involved with the home. The inspector joined residents for a meal. Residents had a choice of shepherds pie or beef burgers and vegetables. The home arranged for residents that did not like this option to have something different and there was a choice of St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 12 puddings suitable for diabetics. The meal was well cooked and residents that needed help were well supported. Some residents had difficulty remaining still for a full meal and some arrangements for food between meals may be required. (See standard 8) St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 16, 17 & 18 The home has a limited view of the complaints process including views and comments, which restricts the home’s capacity to make improvements to the service provided. The lack of training on policies and procedures in adult protection could compromise resident’s safety. EVIDENCE: The home and the Commission have received no formal complaints since the last inspection in November 2004. The inspection of the residents’ records indicated two areas where relatives had raised concerns but these had not been recorded as complaints. This does not show that the home was looking for trends in concerns with a view to rectifying them. The home knew the residents that wished to vote in the general election today. Arrangements were made for them to be taken to the polling station by a member of staff. The home has some outstanding requirements on policies, procedures and training about adult protection and these must be attended to without delay. St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 14 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 standard(s) 19, 21,22,23,26 The home’s management of minor repairs, equipment and odour control had deteriorated since the previous inspection and refurbishment in areas was still needed. This does not make the home pleasant or homely for residents. EVIDENCE: The home had an offensive odour on arrival in the morning and this continued through the day until the manager directed that all clinical waste bins were emptied. Some bedrooms had an odour and required cleaning, refurbishment and decoration. Small repairs were not being identified and therefore not being addressed. Wheelchairs were being used in the home without footplates and detached footplates were in resident’s rooms. The use of wheelchairs without footplates to assist residents mobilising is a danger and increases the risk of injury to them. Some rooms did not have the call leads to the nurse call alarm. One bathroom on the top floor was not being used but needed to be repaired as required on the last inspection in that area of the home. This bathroom St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 15 requires to be converted to provide assisted bathing facilities in order to fully meet the needs of the residents. Bed linen and mattresses sampled were clean and serviceable. Liquid hand wash soap and paper towels were available in all communal bathrooms, toilets and service users bedrooms and this was good practice as it encourages good infection control procedures. St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 The home has improved its recruitment practices. The home has embarked on essential update training and these will help in safeguarding residents. These two areas of improvement should improve the outcomes for service users. EVIDENCE: On the lead up to the new manager starting, the rotas did not demonstrate that managerial hours were available for staff undertaking this role. The current manager’s hours must remain supernumerary. The staff files had improved making information easier to retrieve. The inspector was aware of one member of staff that was awaiting CRB clearance and this must be undertaken without undue delay. The home did not maintain a matrix of staff attendance at training and this does not allow for effective planning of training that needs renewing. The home has some staff that have achieved good standards of training. The home had evidence of training being booked in safe handling of medication and skin care and were actively seeking other training. St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 36, 37 & 38 The lack of sustainable improvement in the management of the home has put service users at risk. The combination of a new manager with input from the consultant and time to implement changes should serve to make the improvements for the home and its residents. EVIDENCE: The home has appointed a new manager; at the time of the inspection she had been in post three weeks. Over the last three years of the home’s operation the management has not been settled and this has been reflected in the lack of consistent documentation and lack of sustained improvement. The new manager has the Registered Managers Award and experience in both managing and working in care homes for older people. St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 18 The homeowner has employed a consultant to assist them in reaching the required standard and to put in place a quality audit tool. The homeowner has in recent months complied with the requirement to have a reported monthly visit to the home. The inspector sampled some maintenance and inspection records for fire, lifting equipment, electrical wiring and gas supply. There were gaps in all of these required records. For example the fire records did not have evidence of a fire drill in the last six months, fire training had not been undertaken, and the coded locks were not freeing as the fire alarm sounded and this potentially puts residents at risk. The home had not informed the inspector of all incidents as required. Some of the home’s key documents did not have a date of implementation such as personal plans and when the service user guide was given to relatives. Some recording was being changed by the use of sticky labels. Staff were not receiving the required levels of recorded supervision. However it was evident that staff monitoring had taken place and as a result disciplinary action had been taken. Risk assessment records and policies were not assessed on this occasion and requirements were brought forward St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x 2 2 2 x x 1 STAFFING Standard No Score 27 2 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 3 x 2 x x 1 2 1 St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 20 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 op3 Regulation 14 (1)(a)(b) (c ) 15 & 13(4)(c ) Requirement Assessments must be completed before the potential resident is admitted. (outstanding since 11/12/03) The home must have care plans in place for all residents showing how care is to be provided. (outstanding since 21/11/03) Daily records must show what care has been provided and anything that effects the residents life. Where risks have been identified this must result in a risk assessment. Actions from risk assessment must be placed on the care plan. (outstannding since 21/11/03) Care plans must be reviewed monthly. (outstanding since the 07/11/02) 3. op8 12(1)(a) 13(1)(b) Data Protection Act Monitoring charts must be used and reviewed regularly for all residents whose condition demands this such as: - fluid intake, behaviour and so on. 31/05/05 Timescale for action 31/05/05 2. op7 31/05/05 St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 21 Analysis of falls and falls or gains in weight must be undertaken and action taken if required. Service users must have their conditions reviewed at least yearly. (outstanding since the 28/02/05) Accident records must be kept in a secure cupboard. The residents must have the availability of the hairdresser on a regular basis. Medication policies must be written to reflect practice including a homely remedy policy and stock purchased to reflect this policy. All staff must adhere to the policies. The medication administration record(MAR) must record the current prescribed medicines only. Liaison with the supplying pharmacist is required to remove all unwanted items. The home must maintain staff audits of competence in administering medication. (the above requirements were not assessed on this occasion and were brought forward.) Cream charts must be completed where in use. 5. 6. op10 op18 12(4)(a) 13(7) & (8) 18(1)(c ) (i) The home must ensure that residents dignity is preserved at all times. The home must devise an appropriate restraint policy. (oustanding since 10/02/04) 06/05/05 30/06/05 4. op9 13(2) 31/05/05 06/05/05 St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 22 13(6) & 17(2) schedule 4 (9) & (10) All staff must receive adult protection training. (outstanding since 31/05/05) All service users belongings must be recorded and a date of the record kept. (outstanding since 31/03/05) The home must ensure the flooring in a shared bedroom is repaired and does not constitute a trip hazard. The 2nd floor bathroom must be made fit for use by residents (outstanding since 11/11/04) and plans made for it meet the needs of the residents in that area. Wheelchairs must have footplates attached and residents must not be transported without them. Call alarm points in bedrooms must have call leads unless the resident cannot use them. If the resident cannot use them clear plans for monitoring must be in place. Bedrooms must be audited for redecoration, repair and odour control and remedial work undertaken. The home must devise a procedure to ensure odour in the home is kept to a minimum and monitor adherence to this. The management hours within the home must be supernumerary to staffing levels. 31/07/05 31/05/05 7. op19 13(4)(c ) 23(2)(b) 23(2)(j) 31/05/05 8. op21 30/06/05 9. op22 13(4)(c ) 06/05/05 06/05/05 10. op23 23(2)(b) (d) 13(3) 30/06/05 11. op26 31/05/05 12. op27 8(1)(iii) 17(2) schedule 4 (6)(e),7 31/05/05 13. op29 19 schedule 2 (7)(8) The member of staff in charge for each shift must noted on the rota. (outstanding since the 28/02/05) No new staff must be employed 06/05/05 without a valid CRB and POVA check. Version 1.30 Page 23 St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc (oustanding since the 23/10/03) 14. op30 18(1)(c ) (i) A matrix of staffs attendance at training must be maintained to show how the home has met the TOPSS targets. (outstanding since 21/01/04) he home must investigate strategies to gain the opinions of service users and that these have affected how the service is delivered. (oustanding since 21/12/03 but not inspected on this occasion and brought forward) All care staff must have recorded supervision for no less than six times a year. ( outstanding since 20/01/04) Mistakes in records must not be covered by sticky labels. Records such as care plans, information given out should record the date they are implemented. A cross gender and intimate care policy must be written. (this requirement was not assessed and is brought forward.) The Manager must send to the Commission a copy of the Landlords Gas Certificate. The manager must send to the Commission a copy of five year wiring certificate. A fire drill must be undertaken. Fire training must be undertaken Coded locks must be released by the sounding of the fire alarm. All incidents and accidents within St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc 16/06/05 15. op32 12(3) 30/06/05 16. op36 18(2) 30/06/05 17. op37 17(2) 31/05/05 18. op38 23(2)(c ) 23(4)(b) (d)(e) 37 & 13(4) (c ) 31/05/05 31/05/05 13/05/05 20/05/05 06/05/05 31/05/05 Page 24 Version 1.30 the Care Home must be reported to the Commission. (outstanding since the 05/11/04) Risk assessments for building, staff and food hazards must be undertaken. (this was not inspected on this occasion and was brought forward.) COSHH must be kept in a locked cupboard and separate to foodstuffs. (this was not inspected on this occasion and this requirement was brought forward.) The home must have programme of activities that includes some activities available to service users with dementiaA copy of this programme must be sent to the Commission. 30/06/05 31/05/05 19. op12 16(2)(n) 30/06/04 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 op16 Good Practice Recommendations It is recommended that the home collects concerns that are not raised as complaints to assist in improving the home. St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection 1st Floor Ladywood House 45-46 Stephenson Street Birmingham, B2 4UZ 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 St Agnes E54 S16757 St Agnes V226759 050505 Stage 4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!