Inspection on 24/09/07 for The Annexe

This inspection was carried out on 24th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Annexe 26/02/07

The Annexe 11/09/06

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 Lella Hudson Unannounced Inspection 24th September 2007 09:30 The Annexe DS0000027605.V352208.R01.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.V352208.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 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.V352208.R01.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 01553 674395 onesixone@bt.openworld.com 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 Sharon Grant, registration pending Care Home 3 Category(ies) of Learning disability (3) registration, with number of places The Annexe DS0000027605.V352208.R01.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. 26th February 2007 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 fees range for current service users from £1263 to £1903. The Home was originally owned by one family before being registered as a limited company with the three original family members being the Directors and one also registered as the Manager. In June 2007 a company called CareTech bought the shares to the company and, therefore, there are new Directors and a new Manager of the service. The current Manager is in the process of applying for registration with CSCI. The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report contains information gathered about the Home since the last Inspection (February 2007).This includes information within comment cards completed by relatives as well as information gathered during an unannounced visit to the Home on Monday 24th September 2007. The information contained in the comment cards was mainly positive with an additional comment stating “the staff are marvellous” During the visit we were shown around the communal areas of the Home, looked at records and spoke to staff and the Manager. Due to communication difficulties it was not possible to gather information from the clients about the service. A further visit to the Home was carried out on the 27th September to gather further information from the Manager and Operations Manager and to provide them with feedback from the inspection process. The Home is still owned by OneSixOne Ltd although there has been a share buyout of this company by CareTech. Therefore, the Directors of the company and the Manager are different from those at the time of the last Inspection, (February 2007), although the nature of the purchase means that there was no need to apply for a new registration with CSCI. The Manager, Sharon Jones, has previously worked as a registered manager in another Home owned by CareTech and has been at this Home for three months. She is in the process of applying to be registered with CSCI. There are currently three clients living at the Home. The Home next door, which is also owned by the company, was also inspected at this time. Considering the inevitable changes that have taken place as a result of the change in Directors and Manager the staff have managed to maintain some consistency of service to the clients and to remain positive about their support of the clients. What the service does well: The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 6 The Home provides attractive and comfortable accommodation for the clients and has an ongoing maintenance and redecoration programme. The regular staff are enthusiastic about working with the clients Clients enjoy their meals and are offered choices. Regular staff receive appropriate training What has improved since the last inspection? 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. The Annexe DS0000027605.V352208.R01.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.V352208.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is written information about the service provided in the Home but this needs some alterations to be completely accurate and also needs to be provided in alternative formats to make it easier for the clients to understand. The Home has an admissions procedure but this has not been inspected on this occasion as no new admissions have taken place. EVIDENCE: The Home has a Statement of Purpose which has been reviewed and updated in light of the changes within the company. There are some minor errors which still need to be addressed to ensure that it provides accurate information for prospective clients and their relatives/representatives. A requirement is made about this. The Home has a Statement of Service document which incorporates the clients contract and the Service User Guide. The ones we saw have not been personalised for the individual clients and the Manager is aware of the need for The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 9 this to happen. This document also needs to be made available in a format suitable for the individual clients. A recommendation is made about this. The company has an appropriate admissions procedure which was unable to be inspected in practice as no new admissions have taken place since the last Inspection. The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The care planning and risk assessment documentation does not provide clear guidance for staff about how to meet the clients needs which means that there is a risk of needs not being met in a consistent way. EVIDENCE: A sample of care plans and risk assessments were seen. CareTechs corporate formats have been introduced for these and information from the previous care plans and risk assessments has been transferred. The quality of the care plans and risk assessments has deteriorated as the corporate formats are not detailed or specific to individuals. There are also areas that are highlighted as risks for individuals, but there are no risk assessments available. This means that there is little detailed guidance for staff about how to meet individuals needs or how to effectively manage The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 11 risks in a consistent way. Although some of the staff team have worked at the Home for some time and know the clients well there have recently been a lot of agency staff working at the Home which makes the need for detailed guidance even more important. An example of the lack of clarity is one of the care plans which states that it depends on how the client is feeling as to whether they will require 2:1 support or not. There was no further explanation to this and, therefore, no clear guidance to staff about when the client would require additional staff support. Requirements are made about the need to improve the care plans and risk assessments. The deputy manager has recently attended Person Centred Planning training and there is a plan to start this process for the clients. The nature of this process is that it can take some time and it therefore cannot replace the need to ensure that the care plans and risk assessments are improved. The staff gave examples of how the clients are offered choices and supported to make their own decisions on a daily basis. This can be particularly difficult due to the communication difficulties that the clients have. Two of the clients have behaviours which can be challenging to those around them and the regular staff are aware of the importance of good effective communication in these situations. There are situations in which the clients are not able to make their own decisions, or where there are restrictions on individuals choices, and the care plans need to include information about these issues. The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The staffing situation means that the opportunities for the clients to go out are greatly reduced at present. Clients are supported to maintain contact with relatives. EVIDENCE: Currently there are vacancies within this staff team and as it is a small staff team this has had a big impact on the staffing arrangements. There are usually two members of staff on duty during the day when all three clients are at home and a sleep in member of staff on at night. The staffing is often reduced to one member of staff on duty when there are only two clients at home and this means that neither of the clients are able to go out. The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 13 Due to the vacancies there are often times when there is only one regular member of staff on duty and an agency staff. The introduction of staff who are not familiar to her can cause real difficulties for one of the clients and often leads to situations which are challenging for those around her. The Manager is aware of this situation and has recruited new staff, two of whom should start work within the next fortnight. One of the clients likes to go out walking and used to have a befriender who supported him with this on a very regular basis. The staff are now responsible for supporting him to go for walks and, if there are agency staff on duty, this can be difficult, if not impossible. The care plans do not contain detailed information about the arrangements in place for enabling the clients to keep in contact with relatives. The relatives comment card states that the staff are mostly good at keeping in contact with them and that they are informed about issues affecting their relative. The Manager has contacted all of the families to inform them of the change in the organisation and to introduce herself. The Home has a cook who prepares the main meal at lunchtime. She has been responsible for ordering and purchasing food as well as preparing menus, but currently a review of these processes is being carried out. The cook knows the clients well and the clients say that she knows what they like and that they are always able to have an alternative. The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The health and personal care needs of the clients are met, but improvements to the care planning system will ensure that staff are clear about how to meet these needs in a consistent way. EVIDENCE: At the last Inspection it was noted that the information about the health and personal care needs of the clients had improved and that this needed to be maintained and regularly reviewed. The new format of the care plans being used means that this information is now less clear and detailed. Health Action Plans have been obtained for the clients, but these have not been completed yet. The Manager is aware that the written information about the clients needs must be improved so that the staff have clear guidance. Due to the current staffing situation there are not always male and female staff on duty. When this happens a female member of staff comes over from the The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 15 Home next door to assist the female clients with personal care. This is not an ideal situation. Staff were observed to support the clients in a respectful and friendly manner. Staff knock on doors prior to entering bedrooms and clients are able to have a key to their bedrooms if they wish to have one. The medication system was looked at. Records are kept of medication received into the Home and of the administration of medication. The new medication procedure was looked at and this needs to be reviewed and some issues need to be clarified. A requirement is made about this. The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Staff have attended training with regard to Safeguarding Adults and so have a better understanding of their responsibilities to report any concerns. Improvements in care planning and risk assessments will provide better guidance for staff to ensure that they can meet the clients needs in a consistent way, particularly with regard to challenging behaviours EVIDENCE: The Home has a new complaints procedure which is the corporate version. There is also a simpler version which may be easier for the clients to understand. Records show that all staff, except for one, have attended training with regard to Safeguarding Adults. This member of staff is booked to attend the training shortly. The staff who spoke to the Inspector, including the Manager, are aware of their responsibilities with regard to concerns about possible abuse. The company are in the process of changing the procedure for supporting the clients with their money and so this was not looked at during this Inspection. As previously mentioned, the care plans and risk assessments need to be improved and this is particularly relevant to issues relating to the management The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 17 of behaviour and to the use of physical interventions. Previously, staff had all attended the same training about the use of physical interventions and the care plans were based on this. However, the company are now using a different training for this issue and so it is important to ensure that a consistent approach is being used by staff. The current staffing situation means that the risks of a situation occurring when someone may be injured as a result of challenging behaviour from at least one of the clients is greatly increased. The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The Home meets the needs of the clients EVIDENCE: The Home is attractively decorated and furnished with the lounge and dining area having recently been redecorated. The communal areas of the Home are fairly bare without ornaments or other items, but this is due to the needs of the clients. On the day of the first visit the Home was without a tumble dryer as they were waiting for a new one to be delivered. This had arrived by the second visit, later that week. The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The staffing situation is poor with the increased use of agency staff meaning that there is a lack of consistency. The regular staff receive appropriate training and support to carry out their roles effectively EVIDENCE: The induction and training provided to staff has greatly improved over the last year and staff said that they have received effective induction which has helped them to carry out their roles. The Manager said that there will be changes in the provision of training as CareTech have their own training department. Some staff have already attended some training provided by CareTech and said that it was enjoyable and relevant to their roles. Currently this training is provided in Cambridge and so staff have to travel, but the Manager said that there are plans to provide some of the training more locally. There is a need to ensure that all staff are receiving consistent The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 20 information whilst there is a change in the training providers, particularly with regard to training about the use of physical interventions. The majority of the staff team have achieved NVQ Level 2 or are working towards this. The deputy manager has achieved NVQ Level 3 in management. As previously mentioned in this report the staffing situation is not adequate. Whilst it is recognised that the Manager is aware of the situation and is taking steps to address it this does not prevent negative outcomes for the clients in the interim. It is required that the staffing situation is improved as a matter of urgency. The relatives comment card states that the staff usually have the right skills and experience. Staff were observed to support the clients in a kind and friendly way. There are clearly good relationships between regular staff and clients. At the last Inspection a requirement was made for the necessary recruitment information to be kept as a minor omission had been noted. All of the recruitment files have been sent to the HR department of CareTech to be reviewed. All of the relevant information required by regulation is now held at the Head Office with proformas confirming receipt of this information held at the service. Therefore, the recruitment files were not able to be seen during this visit, but the Performance Relationship Manager (CSCI) who liases with CareTech is due to visit their Head Office in November 2007 to sample the recruitment files. The requirement is not repeated in this report, but will be commented on within the next report. The Manager has recently started to carry out formal supervisions with staff and records confirm this. The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 & 42 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There has been a very recent change in the management of the Home although all are working hard to reduce the impact of this on the clients. Appropriate measures are taken to protect the health and safety of the clients and staff. EVIDENCE: Previously the company had three Directors, one of whom was also the registered manager of the Home. A social care consultant had also been employed for the last nine months. Following the share buyout by CareTech none of the three previous Directors are involved with the running of the The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 22 Home. The consultant remained for approximately the first month after the sale, but now no longer works at the Home. There was very little handover from the previous Directors. The deputy manager remains in post and initially the Home was managed by CareTech’s area manager for the Eastern region. A new manager, Sharon Jones, was appointed to the Home in July 2007. The manager has previously been a registered manager of a Home for older people and more recently has been working as a deputy manager at a Home for adults with a learning disability. She is currently working towards the Registered Managers Award. She is also in the process of applying for registration with CSCI. The manager and deputy manager spend the majority of their time in the Home next door, but do spend some time in this Home. It is unclear at present as to whether there are senior care staff in this Home who are responsible for the day to day management. There are currently some issues which need to be addressed as staff do not feel well supported at this time. The situation regarding the staff vacancies is being addressed by the manager, but in the meantime it is causing difficulties for the clients and staff. At the last Inspection the Home had recently completed their first annual quality assurance process and a report was produced following this. It is expected that this process will be continued and improved upon. Monthly visits, as per Regulation 26, have been carried out and copies are available in the Home. Training records show that staff have attended a range of health and safety training such as food hygiene, moving and handling, fire safety, health and safety. A sample of records relating to health and safety were seen. Although there is a fire risk assessment it is recommended that this is more detailed. The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 2 3 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 1 33 1 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 1 3 X 1 X LIFESTYLES Standard No Score 11 X 12 1 13 1 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 2 3 X X 3 X The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 2 Standard YA1 Regulation 4 15 Requirement It is required that the information within the Statement of Purpose is accurate It is required that the care plans contain detailed guidance for staff about how to meet the clients needs It is required that risks are appropriately assessed and that records are kept of this It is required that the medication procedure is reviewed and clarified It is required that staffing situation is improved so that staff with the appropriate skills and experience are employed in numbers sufficient to meet the needs of the clients Timescale for action 31/10/07 31/10/07 YA6 3 4 5 YA9 YA20 YA33 13 (4) 13 (2) 18 (1) 31/10/07 30/11/07 05/10/07 The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 25 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 YA1 YA42 Good Practice Recommendations It is recommended that the Service User Guide and contract is available in alternative formats to make it easier for clients to understand It is recommended that the fire risk assessment is more detailed The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 The Annexe DS0000027605.V352208.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!