Inspection on 06/06/07 for St Ives Lodge

This inspection was carried out on 6th June 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 Ives Lodge 03/02/06

St Ives Lodge 06/12/05

St Ives Lodge 18/01/05

St Ives Lodge 26/10/04

St Ives Lodge 06/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE St Ives Lodge 27 The Drive Chingford London E4 7AJ Lead Inspector Zita McCarry Unannounced Inspection 10:30 6th June 2007 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 Ives Lodge DS0000007222.V332616.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 Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Ives Lodge Address 27 The Drive Chingford London E4 7AJ 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) 020 8529 7952 0208 529 2444 admin@st.iveslodge.freeserve.co.uk Mr James Deary Mrs Catherine Deary Maureen Lewis Care Home 27 Category(ies) of Dementia (1), Old age, not falling within any registration, with number other category (27) of places St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home can accommodate one (1) named Service User with a Mental Disorder. As agreed on the 4th August 2006, one named service user under the age of 65 years with dementia, can be accommodated. The CSCI must be informed when this service user no longer resides at the home. 3rd February 2006 Date of last inspection Brief Description of the Service: St Ives Lodge is a privately owned residential home for 27 elders providing accommodation and care. The home is one of two homes in the area owned by the organisation. The home has an experienced manager and staff group. The proprietors are very much a part of the day to day running and can be found at one or other of the homes. The home is situated on the edge of Chingford which has a range of shops, and locals amenities. St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report of an unannounced inspection, which took place in early June 2007. As part of the inspection process the inspector read records pertaining to the care of service users and management of the home. She met with service users and staff and observed the practice in the home. The inspector only met with one visitor but received feedback from relatives by returned surveys. The inspector undertook a brief tour of the home and premises, which included the kitchen, laundry and some service users bedrooms. The manager assisted the inspector in the inspection process and the registered providers were available throughout the day. The inspector would like to thank everyone at St Ives for their assistance and contributions throughout the day. What the service does well: What has improved since the last inspection? The service has increased the catering hours to ensure care staff time is not diverted away from care duties. The service has improved upon its accident recordings. St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 Quality in this outcome area is good. Service users can be satisfied that the staff at St Ives Lodge are able to meet the prospective service users needs before admitting them to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed the home’s Statement of Purpose and this is in line with the required detail. The inspector reviewed the records relating to the admission of two service users. Both service users are privately funded and therefore did not have a social worker’s assessment of need in place. However the manager had undertaken a comprehensive assessment that indicated their presenting needs, recent history and brief outline of past history. St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 9 The care plan is created after admission but it was positively noted that the manager summarised her assessment of need and identified any issues that she anticipated might present within the first few days of admission. The summary provided staff with information and strategies to address these potential risks. The inspector spoke with a service user recently admitted, she said she did not view the home prior to admission but this was her choice as she was happy to leave this role to her family. The service user commented positively on the level of support she received from the staff team in the home during and since admission. The manager described the admission process. The inspector was satisfied that the manager not only considered presenting needs and the homes ability to meet them but she gave a recent example of how she was unable to offer placement because of the impact the admission may have on the current service user group. St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 10 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 Quality in this outcome area is adequate. Service users have the arrangements for their care well planned, although the home needs to be more consistent in this area. Service users can be assured that the staff manage the prevention of accidents and medication well. However service users living in St Ives cannot be confident that their privacy will be consistently upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users care plans are detailed documents which are handwritten, the service has just formatted them unto their computer so this should assist in the prompt updating of the arrangements for care. On tracking identified issues regarding a service users change in mobility it was positively noted that staff had recorded the changes on the care plan and drew attention to the change by highlighting the notes. The risk assessment was also updated to reflect the changes and direct staff. However a second care plan did not reflect St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 11 changes in a service users need and particularly in relation to pressure area care and the directions from the district nurse. There was no record on the care plan of the setting for the pressure relieving equipment. Review of a service user records evidenced that the home called in the district nurses for support as soon as there were changes noted in a service users skin condition. This enabled the service user to be provided with pressure relieving equipment and advice promptly. However the care plan was not updated to reflect the district nurses instructions in relation to pressure area care. There were notes in a service users care plan and risk assessment regarding an apparent weight loss, however the home was not monitoring the weight of the service user. The explanation given was that there were no appropriate scales to facilitate this in the home. The service has introduced a new accident form, which provides considerably more detail around staff response to accidents and management follow-ups. The inspector randomly selected accident records from the past six months and noted staff had recorded appropriate action taken in response to accidents. It was noted that one service user had had a higher incidence of accidents. When tracked in the service users care plan it was positively noted that staff had addressed this in a risk assessment and subsequent care plan. The management of service user medication in the home was checked as part of the inspection process. Medication is held securely in the home and administered by staff trained to do so. The service uses a monitored dosage system although some medications cannot be contained in these blister packs. An audit of a random selection of medication was checked and all found to be correct. The medication system in the home is well organised and there was evidence of the service undertaking its own monitoring of the system. It was noted in the course of the inspection that a service user was admitted into a double bedroom for a short stay, whilst another service user for whom that bedroom is her permanent private accommodation occupied it. The service was not unable to demonstrate consultation with either service user nor is it clear if informed consent could be obtained from the service user. The manager confirmed there was a historical context in relation to the service user wishing to share a room. There are no records documenting this, in particular there are no records documenting the service users wish to share a bedroom with an unknown person. Where bedrooms are shared the service must be able to demonstrate that this is a positive choice made by both service users. St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is good. Service users living at St Ives are provided with a nutritious and well-presented food, which is enjoyed as a social occasion. Service users can be assured that relatives and friends visiting them will receive a warm welcome. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides a varied and comprehensive range of activities for groups of service users including entertainers visiting the home, going out for a pub lunch, quizzes etc. There is an activity scheduled every day. Service users also have the opportunity to attend their place of worship outside the home and clergy also visit service users who chose not to go out. There was a lack of detail around the arrangements and planning for individual service users to be supported to in activities / leisure pursuits. However on balance the outcome for the service users was positive in spite of this. Interviews with service users provided evidence that staff support them in meaningful activities. Some service users have their daily paper of choice delivered, others undertake puzzles and Suduko, all confirmed they enjoy staff St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 13 sitting and chatting with them and staff recognised the importance of this social contact. The home accommodates service users social relationships and it is notable several service users have established friendships. The home has an established history of involving relatives and friends in the home, preparations were underway to organise a garden party to celebrate a service users birthday. One service user described how she always receives her visitors in the privacy of her bedroom. The inspector met with a visitor on the day of the inspection and she described how welcoming the manager and her staff team were to her. In surveys completed by relatives all commented on the warm welcome they receive when visiting. The home maintains a record of meals provided to service users the inspector checked the record for the previous day and noted that five different evening meals were provided to the service users. The inspector observed the cook spending time with service users and confirming their choice of foods. The inspector noted that on the day of the inspection lunch and the evening meals were well presented and relaxed social events. The food appeared nutritious and balanced. One service user told the inspector: “The food is very good indeed. I never had any of my family in a care home so I had no idea what to expect I had imagined that if I didn’t like something then I’d have to go without…. But not here I’m always offered alternatives and nothing seems to much bother for them to prepare for me”. A recently admitted service user told the inspector how she was supported to bring her personal possessions with her on admission. Bedrooms seen were well personalised. St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is poor. The service users living in St Ives cannot be assured that the service will consistently adhere to procedures that will protect them from abuse or respond to allegations appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed the service’s handling of complaints. There have been two complaints logged since the last inspection both in relation to missing laundry. The service had responded promptly within time scales. In the course of the inspection a member of staff advised the inspector that there had been incidents in the home concerning two service users that should have triggered the services adult protection procedures. The incidents were confirmed by a service user and her next of kin fully supports the integrity of her disclosure. There was also a transfer letter to the hospital reconfirming the member of staff’s concern about the allegations of assault. The manager has stated both verbally and in writing that she does not consider any physical contact took place although confirms that incidents of assault were reported to her. The service was unable to present any evidence that on receipt of these allegations appropriate action was taken in relation to safeguarding protocols. St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 15 The Commission is satisfied that in this instance the member of staff acted to secure the safety of other service users and the outcome for both service users adequate. The service user who is the alleged victim and her family are satisfied with the outcome. The Commission was not notified of the allegations nor the alleged perpetrator’s admission to hospital, as required. The registered manager is qualified to deliver adult protection training, and all staff have been trained in this field. In discussion with a member of staff who has received the Adult Protection training the inspector was not satisfied that she had sufficient knowledge to respond appropriately to suspicion or allegation of abuse, she was unaware of the role the local authority has in safeguarding procedures and the services responsibility in reporting to them. On reviewing the “Abuse Training Pack” the guidance is ambiguous and outdated. The service, as a matter of urgency, needs to review its safeguarding procedures and training to ensure staff fully understands their reporting responsibilities. These must include details of the Waltham Forest Adult protection team. St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. Service users in St Ives Lodge enjoy a comfortable homely environment that is clean and maintained to a very high standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is made for two joined houses which are on different levels there are three shallow steps between the houses, the inspector observed staff supporting service users negotiate these and they did not appear to present any difficulty. However wheelchair users would have to use both of the homes lifts to get from one side of the home to the other. Again service users and staff reported that this did not present any problems. The inspector undertook a partial tour of the building, which included some service users bedrooms, laundry kitchen, lounges and dining areas etc. The St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 17 home is in good decorative order and evidently well maintained. The service undertakes replacement of carpeting and furniture as part of a cyclical programme. A large conservatory overlooks the garden which is also well maintained. The service was clean and free from malodours. The lounge and dining areas are comfortable and well co-ordinated. There is sufficient space for service users to socialise with each other, watch television, relax in a quiet area or receive visitors in private. St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. Whilst there are competent staff in sufficient numbers to meet the needs of service users the service has failed to adhere to robust recruitment practices that would protect service users from possible abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are 4 care staff plus a senior member of staff on an early shift and 3 care staff supported by a senior member of staff on a late shift with 2 waking night staff. In relatives surveys one relative commented that on occasions when an incident occurs service users may have to wait for assistance. However service users reported staff were available to support them without having to wait. Staff confirmed there are sufficient numbers to enable them to sit and chat with service users. The inspector observed a relaxed unrushed atmosphere in the home and noted positive and supportive interaction between staff and service users. The manager explained that the homes catering hours had been increased to provide a cook to prepare the evening meal and ensure care staff time was not used to provide non-care duties. 13 out the 17 care staff employed hold either an NVQ 2 or 3 award in caring, of the 4 remaining staff one is undertaking the award and the other 3 had just St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 19 been recently appointed. This level of qualified staff exceeds the national minimum standards. The files of three recently recruited staff were inspected to assess the service’s recruitment processes. The homes terms and conditions of employment need to be reviewed as they contrary to regulations. The document states, “you will need to obtain and present to us a criminal record certificate. In the event of you failing to supply such a certificate or that it is should prove unsatisfactory your employment with us will be terminated”. However the service has a legal responsibility to undertake the criminal records disclosure before appointment as these documents are not portable. Further, offers of employment should not be made without the service being in receipt of a satisfactory CRB disclosure. Of the three staff files checked it was evident that the service had commenced employment of all these staff before it was in receipt of full CRB disclosures. Appointment had been made on the basis of POVA first checks, such appointments should be made only in exceptional circumstances, for instance when the service is experiencing a staffing crisis and the appointed staff, having fully satisfied all other pre-employment checks, work under close supervision. The service was unable to evidence the staffing crisis or close supervisory arrangements. In relation to one of these files checked there was no reference from the previous employer despite recent employment in a care post. There was no evidence on any of the files that references and employment history were verified. It was noted that full and satisfactory CRB disclosures were received for all three staff shortly after they were appointed. Despite this it is evident that the recruitment process in the home is not sufficiently robust to protect the safety and wellbeing of service users. The manager of the service is qualified to deliver training in moving and handling, adult protection and dementia care all staff have received training in these areas. Staff have also had training on fire awareness, food hygiene and infection control since the last inspection. St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. Management processes in the recruitment of staff and response to allegations are not sufficiently robust to assure the protection of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been in post for several years and has extensive experience in the care of older people. She holds the Registered Managers Award and an NVQ 4 in management and is qualified to deliver training. The inspector has sought advice around the managers care qualifications, as she does not hold a nursing or social work qualification she will need to undertake the care component of the NVQ 4 award. Service users relatives and staff commented very favourably on the registered manager it was noted she was responsive St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 21 and supportive. One relative commented that the manager “expects high standards from all her staff ……( and that) ….conveys confidence that my mother will be well cared for”. However within the context of this report there is evidence of serious failures by management to protect service users in respect of recruitment and responding to allegations, which has undermined the safety, and wellbeing of service users. The home does not hold or assist any service user in the management of their finances. Any small purchases are made through the petty cash system and relatives are invoiced separately for these. The inspector read records that demonstrated proactive management of health and safety issues within the home. The fire alarm is tested weekly, there were certificates for the servicing of lifting equipment and the records evidenced safe food storage temperatures. St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X X X 3 3 x 3 St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP27 Regulation 19 Requirement The registered manager must ensure all pre-employment checks, as detailed in Schedule 2 of the CHR 2001, are in place and satisfactory before staff are offered employment. Unmet from previous inspection. The registered manager must ensure all care plans accurately reflect the care to be provided. The registered manager must ensure there is appropriate equipment in the home to facilitate the monitoring of service users wellbeing. The registered manager must ensure that bedrooms are shared only as a result of an expressed wish by both parties and evidence of this is available for inspection. The registered manager must ensure that there are clear procedures in place to guide staff in reporting suspicions or actual abuse. All staff must receive training in these revised procedures. DS0000007222.V332616.R01.S.doc Timescale for action 01/08/07 2 3 OP7 OP8 15 16 01/09/07 01/09/07 4 OP10 12 01/09/07 5 OP18 13 10/08/07 St Ives Lodge Version 5.2 Page 24 6 OP18 13 7 OP18 37 The registered persons must ensure that all suspicion, allegation or actual abuse is responded to appropriately. The registered manager must ensure the commission is notified of all occurrences without delay and detailed by regulation. 10/08/07 01/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Ives Lodge DS0000007222.V332616.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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