Inspection on 12/06/06 for Summerfield

This inspection was carried out on 12th June 2006.

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

Summerfield 10/04/08

Summerfield 08/10/07

Summerfield 24/04/07

Summerfield 27/11/06

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

CARE HOMES FOR OLDER PEOPLE Summerfield 42-43 Wellington Road Dudley West Midlands DY1 1RD Lead Inspector Mr Richard Eaves Key Unannounced Inspection 12th June 2005 09:30 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 Summerfield DS0000066864.V298761.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. Summerfield DS0000066864.V298761.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Summerfield Address 42-43 Wellington Road Dudley West Midlands DY1 1RD 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) 01384 239331 Merron Care Ltd Care Home 38 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (15), of places Physical disability over 65 years of age (8) Summerfield DS0000066864.V298761.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 2nd November 2005 Brief Description of the Service: Summerfield was originally a two semi-detached residential properties that have been linked and extended to its present form. The home is registered to provide personal care for up to 38 people with up to 15 places accommodating older people who have dementia, up to 15 places for older people who do not fall within any other category and up to 8 places for people who are over 65 years and have a physical disability. The home comprises of three floors. The basement is used to house the boilers and is also a storage area. The ground floor has a number of bedrooms, two offices, the kitchen, communal areas and hygiene facilities. The first floor accommodates further bedrooms, bathrooms, sluice and toilets. Summerfield Care Home is located near to central Dudley and is situated on a main road, which is also a main bus route. Opposite is the Dudley Leisure Centre, there is a carvery next door and a number of shops are in the local vicinity, a small car park is available to the front of the home. Fees for this home range from £343 - £372 per week. Summerfield DS0000066864.V298761.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection visit was the first since a change of ownership occurred during April of this year and was undertaken by two inspectors from the Commission for Social Care Inspection using the following information: the action plan submitted by the home to the announced inspection undertaken during November 2005, reports from the organisation relating to the conduct of the home, the pre-inspection questionnaire, comment card responses from service users and relatives and records including case files, held at the home. The inspection involved a full tour of the bedrooms, communal rooms and service areas and provided an opportunity to speak with most of the service users and a small number of visitors. What the service does well: What has improved since the last inspection? The home has made excellent progress in addressing all previous requirements although some remain to come to fruition. These include completion of staff training in medication administration. An extensive programme of redecoration and has been undertaken and new furnishings provided for the communal areas. Progress has been made to introduce a broad range of activities across the day and appropriate to the client categories. Summerfield DS0000066864.V298761.R01.S.doc Version 5.2 Page 6 Staffing levels are now more responsive to service user dependency levels and recruitment and selection of staff meets all requirements of good practice and safety of service users. Staff supervisions are now fully organised to meet the requirements of standards. 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. Summerfield DS0000066864.V298761.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 Summerfield DS0000066864.V298761.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4. The overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users and prospective clients are provided with good sources of information about the home and are invited to spend time at the home prior to admission to enable them to make an informed decision about entering the home. Service users have not always received promptly a contract or terms and condition of residency to protect their rights. Needs assessments are completed and service users can feel assured that their needs will be identified. Staff are being trained to ensure that they have the necessary skills to meet service users needs. Summerfield DS0000066864.V298761.R01.S.doc Version 5.2 Page 9 EVIDENCE: Service users case files were seen as part of the case tracking process. There were no contracts or terms of residency for any of the service users whose files were seen, the manager explained that these were kept in the service users business file, one service user had not received a contract due to the trial period not being complete. The contract must be raised immediately on admission, manager must address this promptly to ensure that service users understand the terms and conditions of their stay at Summerfield House. Each individual has their needs assessed by the manager prior to coming into the home. There is evidence to show that the home speaks with the family and service users to agree that the home can meet their needs, there were also standard letters in service users file, unfortunately these had not been completed and related to the previous ownership group of homes. All staff have recently completed an introductory course on dementia care and a further ten are currently undertaking more advanced training in dementia care this will equip them with the skills and knowledge they need to be able to care for people with dementia. Summerfield DS0000066864.V298761.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 The overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Each service user has an individual plan that details some of their care needs. Not all health care needs are being met due to omissions in care planning. Service users are generally treated with respect and dignity and their privacy upheld. EVIDENCE: Each service user has an individual plan of care that details some of their care needs. It was pleasing to see that since the last inspection improvements have been made to the recording of service user information and the development of care plans. There are some areas that continue to need improvement to ensure that service users have all of their needs met. One service user was identified as needing treatment for constipation but there was no management plan to detail how this care was to be delivered. Other residents who have diabetes had care plans but no management plan for dealing with the possibility of hypo/hyperglycaemic episodes. A diagnosis of Summerfield DS0000066864.V298761.R01.S.doc Version 5.2 Page 11 depression was not followed with a care plan (DC). A record of weight loss over a 4 week period had not triggered a plan screening or record of meals taken. A care plan for a service user identified as at high risk of pressure sores identified the need for an air mattress on the bed which was provided but did not follow through to seating or heal protection, the requirement for turns when in bed was not supported with turn chart documentation. Risk assessments were undertaken but these had not been subject to regular review to reflect the changing needs of the service users. The home routinely screens service users for their risk of falls, moving and handling and pressure sore risk. The home does not routinely assess service users for their risk of malnutrition and it was particularly concerning that one new service user had lost over a stone in weight since their admission and no active treatment or professional help had been sought in order to address this problem. Another area of concern was the moving and handling of service users, their individual risk assessments contained little information about the equipment needed to assist service users. Staff were seen to be using lifting belts and had incorrectly stated that the hoist was not strong enough to lift an individual service user and were awaiting delivery of a new one. One service user spoken to stated “the staff can’t move me so I stay in the chair, they lift me up between two of them and put me on the bed sometimes”. Pressure relieving equipment was available after an assessment from the district nursing service. The manager must ensure that those service users who have pressure damage or at high risk are provided with appropriate pressure relieving equipment during the day whilst they are seated. Medication was generally administered and stored in a safe manner. Some of the staff have undertaken training in safe handling of medicines and are awaiting their certificates to demonstrate their competence. Staff are not recording the room temperature where medicines are being stored, this must be done to ensure medicines are being stored safely. In addition to this the temperature of the medicines fridge is not being recorded daily and was seen to be warmer than recommended. Throughout the day service users were spoken to politely and generally treated with dignity by staff. There are areas of improvement needed, it was observed that one service user did not have a belt for his trousers and when he moved his trousers fell down, staff immediately helped to pull them up but made no offer to address the problem. Another service user was being called by a name other than that preferred throughout the morning until staff were informed by visitors. Another service user required specialised footwear that had gone missing, while waiting for this to be sorted out the service user is unable to leave the home for outings with family. Summerfield DS0000066864.V298761.R01.S.doc Version 5.2 Page 12 It is anticipated that these types of deficiencies will be addressed as person centred care is developed following the completion of staff training in dementia care. Summerfield DS0000066864.V298761.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 – 15 The overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides appropriately varied social and recreational activity programme that provides interest and pleasure for the service users. An open visiting policy assists service users to maintain contact with their family and friends. Service users exercise choice and control over their lives. Meals at the home are wholesome and meet the nutritional needs of service users but personal choice is not always demonstrated. EVIDENCE: The activities co-ordinator is currently long term absent but the prepared programme of activities has been progressed by staff and the daily routines amended to provide more opportunities for activities to take place. Events now take place morning and afternoons on all days and include crafts, games, exercises and music. Also planned is a clothing party and entertainers to visit monthly. Summerfield DS0000066864.V298761.R01.S.doc Version 5.2 Page 14 Visiting arrangements remain unchanged and service users continue to receive visitors at any reasonable time in the day and a number were observed to arrive and leave during the course of the day. Most service users receive their visitors in one of the lounges and there appears to be a good relationship between visitors and other service users. Visitors spoken with said they were welcome and very pleased with all aspects of life at the home for their relative. Opportunity was taken to observe the lunchtime meal at which service users were given a meal of gammon and parsley sauce, potato croquettes and mixed vegetables, pudding was peaches and ice cream. The meal served appeared appetising and well received. The menu alternative was not seen to be offered to service users on the dementia area. A number of service users require assistance to eat and drink, and due to a lack of organisation this was disrupted at times when service users wanted to use the toilet a carer stopped helping to feed one service user and assisted the other. This meant that meals were left in front of service users going cold whilst others were being assisted elsewhere. A new menu is being developed including seeking service users views on what they would like to see included. A recommendation is offered that contact should be made with Dudley’s healthy eating advisor. Summerfield DS0000066864.V298761.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home complaints and protection policies are robust providing a safe environment in which service users feel they can voice concerns and that these will be listened and responded to. Staff demonstrate a good knowledge and understanding of adult protection issues which contributes in providing an environment safe from abuse. EVIDENCE: The complaints procedure is readily accessible to service users and their relatives with reference in the contract and the statement of purpose which is readily available in the entrance and the service user guide issued to each service user or family as appropriate. Staff have received adult protection training, it is recommended that senior staff should attend training provided by social services as this will provide practical guidance on how the local policy functions. Summerfield DS0000066864.V298761.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 The overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a good standard of décor, furnishings and managed services providing a safe environment, a comfortable attractive and homely place in which to live. The external areas of the home retain hazards to service user safety. The home is clean and hygienic and free from odours. EVIDENCE: A tour of the building including an inspection of some bedrooms that the inspector was invited to see were found to be mostly nicely personalised and included some items of residents own furniture. The home is in good decorative order and was found to be clean, odour free and hygienic. The level of furnishing is by agreement and a copy of this is kept on the case file. It was observed that approved locks are not fitted to bedroom doors, a lockable facility is available in each room. A failed double glazing unit was noted in room 16, other room facilities such as window restrictors, call bell, radiator Summerfield DS0000066864.V298761.R01.S.doc Version 5.2 Page 17 covers, controlled hot water are all available in each room. A sink plug was missing in room 10. The home has a sluicing disinfector and adequate laundry appliances including a washer with a sluicing facility, the floor of the laundry has been sealed since the last inspection. Liquid soap, paper towels, gloves and aprons were seen in all high risk areas, it is recommended that all staff hand wash areas have a facility for controlled hot water to promote good hand washing practice. No items of communal use were identified in toilets or bathrooms, which promotes good cross infection practice. Summerfield DS0000066864.V298761.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 – 30 The overall quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good mix of staff in sufficient numbers to provide consistency of care that meets service users needs. The home has been proactive in developing a skilled staff group with an understanding of service users needs. Recruitment and selection processes are to a good standard protecting vulnerable people. EVIDENCE: An inspection of the rotas shows that the manager is supernumerary to the allocation and has assistance with administrative duties. The rotas show that care staff allocated are 5 in the morning, afternoon and evening and 3 overnight. Each shift includes a senior carer. Currently 52 of carers hold an award of NVQ at level 2 or above which exceeds the requirement of the standard, further staff are currently enrolled. The recruitment and selection practices at the home are good with an equal opportunities policy in place. An inspection of recently appointed staff files showed they included fully completed application, two references, CRB and POVA disclosures and notes of the interview. Summerfield DS0000066864.V298761.R01.S.doc Version 5.2 Page 19 New staff are subject to induction and foundation training to National Training Organisation specification. Mandatory training is provided for fire safety, moving and handling, basic food hygiene, and first aid. Training provided over the past twelve months in addition to mandatory courses have included NVQ in Care, health and safety, COSHH, dementia care, infection control, prevention of abuse, safe handling of medication, diabetes and end stage of life care. Summerfield DS0000066864.V298761.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 The overall quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Leadership of this home is good and staff demonstrate an awareness of their roles and responsibilities and service users benefit from this consistency. The home has the means and has commenced reviewing its performance, which includes seeking the views of service users and their families but remains to be completed to a standard to inform how service users and families perceive the service. The sound financial management of the home and arrangements for safekeeping of their money safeguards service users personal and financial interests. Staff receive supervision and direction to ensure that the service users receive consistent quality care. Summerfield DS0000066864.V298761.R01.S.doc Version 5.2 Page 21 Environment management and staff training in respect of health and safety ensures service users safety and welfare are protected. EVIDENCE: The new owners and manager have been in post for just 2 months and have established good leadership and relationships with the staff. Progress is being made to implement a quality audit programme, seek service users and relatives views and this will inform a quality development in due course. The home does not act as appointee for service users but assists some service users with their personal allowances the records of which are completed thoroughly. Staff supervision is well established and applied in a relevant process that is intended to cover all aspects of practice over time and is planned to ensure all staff receive at least six supervisions each year. The home has an up to date health and safety policy for safe working practice with a range of risk assessments. Staff receive training and regular updates in health and safety and fire safety. A fire risk assessment was available and this is subject to review as changes occur. Legionella water testing has been undertaken recently but no risk assessment that directed this was available. Certification of a range of servicing and annual inspections undertaken of all utilities and equipment in the home are maintained and up to date. The monitoring of hot water requires to include notes of adjustments made and this must occur if temperature recordings are outside the range of 41°c to 44°c. The home should also undertake anti scald testing and servicing annually and records maintained to show a lifetime record of each hot water mixing valve. Summerfield DS0000066864.V298761.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 4 1 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 1 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 2 Summerfield DS0000066864.V298761.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 OP2 Regulation 5(1)(b)(c) Requirement The registered provider must ensure that all service users are provided with a contract and a terms and conditions of residency in a timely way. Timescale for action 31/07/06 2 OP3 14 (2) (a) (b) These must be reviewed following guidance from the Office of Fair Trading publication 2003 The manager must ensure that 31/07/06 all health needs are documented within the needs assessment and that they are reviewed at least monthly. The manage must ensure that all service users receive confirmation in writing that their needs can be met by the home. The manager must ensure that systems are put into place to demonstrate service user involvement in the planning of their care. Care plans must be more person centred in their planning 31/07/06 3 OP4 14 (1) (d) 4 OP7 15(1) 31/07/06 Summerfield DS0000066864.V298761.R01.S.doc Version 5.2 Page 24 5 OP8 13 (5) sched 3, 3 (m,o,) The manager must ensure that all service users are screened for malnutrition on admission and regularly after that. There must be clear guidance for all staff and management plans formulated for dealing with service users weight loss All risk assessments must be reviewed regularly and reflect the changing needs of service users. The manager must seek advice on the provision of pressure relieving equipment for at risk service users to use when seated out of bed. 31/07/06 7 OP9 13(2) 8 OP15 16(2) All service users moving and handling needs must be reassessed and appropriate and safe systems for lifting introduced. A record must be kept of the 07/07/06 temperature of the medication room and the medication refrigerator and documented action taken if found to be outside recommended safe levels The registered person must 31/07/06 ensure that choice is offered of meals served. The arrangements for the meal service should be reviewed to ensure disruptions are kept to a minimum. The garden is made safe and is accessible for residents. Partially met. This should have been addressed by the 31/7/05 The fitting of bedroom door locks is to be completed. The registered person and manager must implement fully a DS0000066864.V298761.R01.S.doc 9 OP19 23(2)(o) 31/07/06 10 OP33 24 31/08/06 Summerfield Version 5.2 Page 25 11 OP38 13(4)(c) programme quality assurance monitoring that includes obtaining service users and their representatives views. The registered person must ensure that hot water supplies to service users are delivered at a safe temperature. Mixing valves should be monitored serviced and anti-scald tested and records maintained that demonstrate the effectiveness of the valve over its life. 30/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP15 OP18 Good Practice Recommendations In reviewing the menu’s advice should be taken from Dudley healthy eating advisors. In addition to current adult protection training it is recommended that senior staff attend the local social services training. Summerfield DS0000066864.V298761.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Halesowen Record Management Unit Mucklow Office Park, West Point, Ground Floor Mucklow Hill Halesowen West Midlands B62 8DA 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 Summerfield DS0000066864.V298761.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. 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