Inspection on 11/09/06 for The Annexe

This inspection was carried out on 11th September 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 no outstanding requirements from the previous inspection report, but made 14 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Annexe 24/09/07

The Annexe 26/02/07

The Annexe 16/11/05

The Annexe 11/11/04

The Annexe 26/04/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 The Annexe 161 Wootton Road Kings Lynn Norfolk PE30 4BU Lead Inspector Mrs Lella Andrews Unannounced Inspection 11th September 2006 01:15 The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 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 The Annexe DS0000027605.V311839.R02.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Annexe Address 161 Wootton Road Kings Lynn Norfolk PE30 4BU 01553 673194 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) One-Six-One Limited Andrew Orford Care Home 3 Category(ies) of Learning disability (3) registration, with number of places The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 3 people, of either sex, with a Learning Disability, may be accommodated. 16th November 2005 Date of last inspection Brief Description of the Service: The Annexe is a care home providing care to three people with learning disabilities. It is situated within the grounds of One-Six-One another residential care home owned by the proprietors. The Annexe is in a residential area of Kings Lynn, within approximately a mile of the town centre. There are local shops, library and other amenities within the immediate vicinity of the home. The premises consist of accommodation on two floors accessed by the stairs. There is a lounge, kitchen, dining area, utility area, bathroom and one bedroom on the ground floor. Two further bedrooms are located on the first floor in addition to the staff sleep-in room. There is also a patio and garden area. The home provides care for ambulant people who may require consistent support for their behavioural needs. The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection report includes information gathered during an unannounced visit to the Home which was carried out between 1.15pm and 5.30pm on Monday 11th September 2006. This included a tour of the building, discussion with staff as well as inspection of records and the medication system. Two of the clients were at home at the time of the visit but due to their specific needs at the time it was not possible for the Inspector to communicate with them or to spend much time observing staff supporting the clients. One completed comment card was received from a relative and this contained positive responses, including confirmation that they are satisfied with the care provided to their relative. The fees range from £1,374 to £2,635 and are negotiated on an individual basis prior to the client moving into the Home. What the service does well: What has improved since the last inspection? Records of the weekly smoke detector checks are being kept. The auditing of the medication system has improved so that any issues are picked up quickly and addressed. The Home has senior staff who are taking on more responsibilities within the staff team. The Annexe DS0000027605.V311839.R02.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 Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: There have been no new admissions to the Home. The Home has an admissions procedure in the event of any admissions. Therefore, this standard has not been inspected. The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the service. The care plans contain detailed information about how to meet the clients needs but there is a need to include more detail about the use of physical interventions. Risks are considered and recorded briefly. Improvements need to be made to the system for looking after clients money to ensure that the system is more easy to audit and to ensure that all involved are clear about their responsibilities. EVIDENCE: Two of the care plans were seen. These have been reviewed and updated within the last few months and contain clear information about how to meet the clients needs except for situations requiring physical intervention by staff. It is required that the care plans contain detailed guidance to staff The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 10 about physical interventions/restraint that may be required to be used with clients. The care plans are written in a very personal way so that the staff are able to gain a good understanding of the individual preferences and wishes of the clients. Staff said that they are introduced to the care plans during their induction and that they are aware of any changes made to the plans. Staff are responsible for completing records at the end of each shift and also complete more detailed records and incident forms for any situation requiring further explanation. The risk assessments are basic but are available within the care plans. It is required that a risk assessment is completed for those clients where physical intervention, of any kind, is used by staff. The financial arrangements were not inspected on this occasion as they had been inspected at the Home next door which is owned by the same company. The Inspector was told that the arrangements in place are the same as at the other Home and so the following requirements are also made in this report. A requirement is made for each client to have a financial care plan which clearly states the agreements in place for looking after clients money. A recommendation is made for clients to pay any charges, such as mileage, on at least a monthly basis. A requirement is made for the statement of terms and conditions to include the fees payable for each client and to clearly state the rates payable for any other charges, such as mileage. A requirement is made for the holiday procedure to more clearly explain the rates of charges for holidays. The staff understand that importance of effective communication, particularly with clients with autism and/or behaviour which is challenging. Staff gave examples of how the views of the clients are sought. However, three of the six staff working at the Home have worked there for less than eight months and so are still in the process of learning and developing communication skills with clients who have autism and few verbal communication skills. The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the service. Clients are supported to take part in activities of their choosing and at a pace which suits them. Clients are supported to maintain contact with friends and relatives. Clients receive a varied diet and are offered choices about what they eat. EVIDENCE: The clients are supported by staff to take part in a range of activities. One of the clients attends formal day services three days per week. Staff support clients to access local facilities such as shops and local attractions. One of the clients enjoys walking and has a befriender who visits on a regular basis to support them to go walking. Risk assessments are present for some of the activities that the clients take part in. The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 12 Due to the behaviour of two of the clients it takes time for new members of staff to develop their competence and build up confidence to either support a client to go out or to remain in the Home with the other clients. As there are only two members of staff on duty at any time it is difficult to see how this is done effectively with so many new members of the team although the staff said that activities away from the Home do take place on a regular basis. The staff from the main house next door provide support to staff remaining at the Home if required. The daily notes show that the client who likes to go walking is supported to do so on a daily basis and that the other clients do walk to the local shops on a regular basis. One of the staff said that one of the clients is being supported to go to a leisure activity later this week and described the planning for this. The Home shares the use of two cars with the other Home next door. Staff were seen to respect the privacy of the clients. Clients are able to spend time in their rooms or in the communal areas of the Home as they wish. The completed comment card from a relative states that they are made to feel welcome in the Home when they visit and that they are satisfied with the care provided at the Home. The Home has a cook who prepares the lunchtime meals five days per week and writes the menu that the staff follow for the other meals. Staff said that the cook knows what the clients like and dislike and the menu is written accordingly. Staff said that there is always other food available to prepare an alternative if a client chooses not to have what is on the menu and that there are always snacks and fruit available. One of the clients has information in their care plan relating to specific dietary needs. The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the service. Staff have a good understanding of the personal care needs of the clients. The female clients dignity is compromised on occasion due to only male staff being on duty. The care plans need to contain clearer information relating to the physical and emotional health care needs of the clients. Medication is managed appropriately and regular audits are in place with any problems being identified and action taken to improve the situation. EVIDENCE: The care plans contain information about how to provide personal care for each of the clients and these are written in an individualised way, including attention to small details. Currently there are more male staff working at the Home than female and so there are often two male members of staff on duty. Both of the female clients require assistance with some aspects of their personal care. Staff said that, on some occasions, female staff from the other Home come to over to assist the clients. Neither of the clients are able to effectively state whether they agree to having male carers support them at The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 14 these times. It is not very satisfactory for the female clients to have support from male staff, or from staff who work at another Home, for very personal support. It is recommended that female care staff provide assistance with personal care to female clients. The care plans need to contain more detail about the physical and emotional health care needs of the clients as these are currently not detailed enough. A requirement is made about this. The medication system was inspected during the visit and was found to be satisfactory. The deputy manager is responsible for overseeing the medication procedures and has systems in place to monitor its effectiveness. Records show that she has identified errors in the recording system recently and that these have now been addressed. One of the senior care staff is now taking on more responsibility with regard to the medication procedures. Staff receive appropriate training with regard to the administration of medication. The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome group is poor. This judgement has been made using available evidence including a visit to the service. The overall judgement is assessed as poor due to the ongoing investigation in to the allegation of abuse. The Home has a complaints procedure but it needs updating to reflect the Commissions change in name. Staff need to all receive appropriate training with regard to the protection of vulnerable adults and the procedure needs updating to ensure that it is accurate. EVIDENCE: The complaints procedure in the policies and procedures file still has the NCSC name on and so it is required that this is updated to reflect the change in name of the Commission and that a copy is sent to all relatives. It would be difficult for any of the clients to make a complaint in a meaningful way but staff described how they interpret clients behaviour which may indicate that they are not happy about something. The relatives comment card states that they are not aware of the complaints procedure. The Pre Inspection Questionnaire states that no complaints have been made about the Home. The protection of vulnerable adults procedure kept in the Home is outdated and a requirement is made for this to be updated. It is also required The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 16 that all staff receive formal training with regard to the protection of vulnerable adults. Staff said that they are aware of the whistle blowing procedure and that they are confident that the management of the Home would take seriously any concerns/allegations brought to them. There is currently an outstanding adult protection situation at the Home next door which is not yet resolved. That Home is also owned and managed by the same organisation. The management of the Homes are working appropriately with all others involved in the investigation into this situation. The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome group is good. This judgement has been made using available evidence including a visit to the service. The Home provides a comfortable, homely environment for the clients to live in. EVIDENCE: The Inspector saw the communal areas of the Home during the visit. The Home is decorated and furnished in a homely and attractive way. However, the Home is bare of ornaments and other such items due to the needs of the clients. The Home was clean and there are processes in place for maintaining the cleanliness and hygiene standards within the Home. The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34 and 35 Quality in this outcome group is adequate. This judgement has been made using available evidence including a visit to the service. Staff receive induction training and support but there is a need to ensure that this is carried out in a timely manner and is effective. Staff receive some ongoing training but there is a need to ensure that additional training is provided as a matter of urgency to ensure that the needs of the clients are met. Appropriate recruitment procedures are carried out which provide protection for the clients. EVIDENCE: The Inspector spoke to four members of staff during the visit to the Home. Staff are positive about their work with the clients and have respect for the clients. There are currently six members of the staff team and three of these have worked at the Home for less than a year. The Manager has started to delegate additional responsibilities to two of the senior care staff so that they are encouraged to take on a more supervisory role to the newer members of The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 19 staff. Whilst staff are clear about their own roles they are not all clear about the roles of other members within the team. There are usually two members of staff on duty at any one time although staff did say that, on occasion, there has only been one member of staff on duty but that this would be an unusual situation. Staff said that they are always able to obtain assistance from the staff team working at the Home next door if they need to. The staffing rotas do not accurately reflect the actual staff working at any one time as they do not show sickness/leave and the cover that is arranged. It is required that the rotas are a true reflection of staff on duty. The comment card completed by a relative stated that there are always enough staff on duty. Newer members of staff said that they have received induction from the manager, assistant manager and the senior care staff. Records are kept of this induction but for some staff this can take quite a long time to complete as the staff team is small and they often do not work with the person who is mentoring them during their induction. The Pre Inspection Questionnaire states the two members of staff have completed NVQ Level 2 and a requirement is made for additional staff to undertake NVQ training. Requirements for other areas of training are made elsewhere within this report. The majority of the training provided to the staff is via the use of videos and questionnaires and it is important that the Manager ensures that the staff receive formal training in addition as appropriate. Appropriate recruitment procedures are carried out for new members of staff. The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 Quality in this outcome group is poor. This judgement has been made using available evidence including a visit to the service. In general, the management and staff take health and safety matters seriously. However, the issues relating to the use of physical interventions and the allegation of abuse within the organisation mean that the protection afforded to the clients is currently not as robust as it should be. The management and staff work hard to obtain the views of the clients but there is a need to improve and formalise the quality assurance process. EVIDENCE: The Manager and the assistant manager provide management support to the Home. They visit the Home on a daily basis but do not actually work alongside the staff. Due to the needs of the clients it can be difficult for support to be provided in an informal basis as the presence of additional staff in the Home can be disruptive. Discussions with staff highlight that there is not a clear The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 21 sense of leadership within the Home and it is recommended that the Manager addresses this situation. Regular team meetings take place for the staff team which the Manager attends. The development plan has not been completed for the year 2006/07 but the Manager has plans to complete this which will include updates on work planned in the plan for 2005/06. The manager said that questionnaires were sent to relatives and professionals in February 2006, with six returned. The analysis of this data will be used as part of the planning for the forthcoming development plan. The analysis provided by the manager shows that overall relatives and professionals were mixed in their views about the overall quality of the service with all rating as either adequate and moving towards good, good or excellent. It is required that an annual quality assurance report is produced and that a copy is sent to the Commission. It is also required that monthly visits are carried out as per Regulation 26 and that a report is sent to the Commission. The service manager used to carry out these visits but is no longer working at the Home. The fire procedure for the Home is not accurate and it is required that this is updated. Staff said that they have been told the procedure to follow in the event of a fire as part of their induction. Records are now being kept of the weekly checks on the smoke detectors and the emergency lights. As previously mentioned in this report the issues of the use of physical interventions (restraint) and the allegation of abuse raise concerns about the health and safety of the clients. The Annexe DS0000027605.V311839.R02.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 Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 2 32 2 33 X 34 3 35 2 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 3 X X 2 2 X X 1 X The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 23 no 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 YA6 Regulation 15 Requirement It is required that a detailed care plan is kept relating to the use of physical restraint and any other physical interventions. It is required that a risk assessment is carried out for the use of physical restraint and any other physical interventions. It is required that each client has a financial care plan. It is required that the statement of terms and conditions is updated and contains individual information about the fees and any other charges payable by the client. It is required that the holiday policy contains clear information abut the charges payable by the client. It is required that the care plans contain more detail about the physical/emotional health needs of the clients. It is required that the complaints procedure contains the accurate details of the Commission. It is required that all staff receive formal training about the protection of vulnerable adults. DS0000027605.V311839.R02.S.doc Timescale for action 31/10/06 2 YA9 13 (4) 31/10/06 3 4 YA7 YA7 15 5 15/10/06 31/10/06 5 YA7 5 31/10/06 6 YA19 15 31/10/06 7 8 YA22 YA23 22 13 (6) 31/10/06 31/12/06 The Annexe Version 5.2 Page 24 9 10 YA23 YA32 13 (6) 18 It is required that the protection of vulnerable adults procedure is updated so that it is accurate. It is required that plans are in place to increase the amount of staff who have completed NVQ training. It is required that the rota is an accurate reflection of which staff are on duty. It is required that an annual quality assurance report is produced and a copy sent to the Commission. It is required that monthly visits take place and that the report is sent to the Commission. It is required that the fire procedure is accurate. 31/10/06 31/12/06 11 12 YA32 YA39 17 (2) 24 30/09/06 31/03/07 13 14 YA39 YA39 26 23 (4) 30/09/06 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 YA18 YA7 Good Practice Recommendations It is recommended that female staff provide personal care to the female clients. It is recommended that the clients are charged on at least a monthly basis for those things that they pay for. The Annexe DS0000027605.V311839.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 The Annexe DS0000027605.V311839.R02.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. 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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