Inspection on 08/02/06 for The Cedars

This inspection was carried out on 8th February 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Cedars 16/06/08

The Cedars 04/07/07

The Cedars 14/08/06

The Cedars 12/08/05

The Cedars 08/03/05

The Cedars 21/07/04

The Cedars 05/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Cedars 144 London Road Gloucester Glos GL2 0RS Lead Inspector Ms Tanya Harding Unannounced Inspection 8th February 2006 08:30 The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 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 Cedars DS0000016601.V283080.R01.S.doc Version 5.1 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 Cedars DS0000016601.V283080.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Cedars Address 144 London Road Gloucester Glos GL2 0RS 01452 500899 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) Cotswold Care Services Limited Stacey Elizabeth Joanne Ruck Care Home 9 Category(ies) of Learning disability (9) registration, with number of places The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th August 2005 Brief Description of the Service: The Cedars provides care and accommodation for up to nine adults with learning disabilities. The home is owned and run by Cotswold Care Services Limited, which is a subsidiary of the Craegmoor Healthcare group. It is a large three-storey detached Victorian house about a mile from the centre of Gloucester. All service users are provided with single bedrooms. Communal areas include the kitchen, dining room and lounge. There is also an enclosed rear garden and an annexe, which accommodates the day-centre. This is used by service users from the Cedars and by service users from other local Craegmoor homes. The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit commenced at 8.30 on Wednesday morning and lasted over five hours. The registered manager was present throughout the visit the main purpose of which was to follow up previously issued requirements. All of the service users were greeted and three were spoken with. A number of records were examined including care plans, risk assessments and financial records. Interactions between staff and service users were observed and feedback was received from some staff about the support they provide to the service users and the training they receive. This reports presents evidence that the home has a potential to offer good quality service and there is a dedicated management and staff team who are willing to learn and develop. However, the organisational systems for ensuring that the right support is given to the home to develop good practices are not seen as effective. What the service does well: What has improved since the last inspection? What they could do better: There should be greater understanding by staff about empowering approaches in order to maximise the opportunities for service users to exercise their rights and do things independently. Minor improvements to the way service users’ financial records are maintained should ensure that there is always an easy audit trail of all expenditure. This is important to minimise any possible confusion which may lead to errors and increased potential for mismanagement. Further investment in staff training would equip staff with the skills and knowledge to respond appropriately to the specialist needs of the service users and should promote better practices in the home. The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 Page 6 The shortfalls in the environment need to be addressed to ensure compliance with health and safety legislation and to make the facilities in the home safe and pleasant for the service users. This refers to the need to relocate the laundry room to a more suitable area and to improve the shower facility so that people can use this more independently and existing hazards are removed. The manager needs to receive good quality regular support and additional training in order for her to develop the necessary skills in leading the home towards improvement. 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 Cedars DS0000016601.V283080.R01.S.doc Version 5.1 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 Cedars DS0000016601.V283080.R01.S.doc Version 5.1 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): 2 EVIDENCE: The manager advised that there are two vacancies in the home and that she has been looking at referrals. She explained her understanding of the admissions process and this was felt to be satisfactory. However, the manager has herself acknowledged lack of training and experience in carrying out assessments and should be supported in making decisions about suitable admissions to the home. The manager advised that she has turned down two referrals as prospective service users had complex mental health needs and behaviour challenges which she felt would impact negatively onto the existing service user group. Information obtained for the newest service user from their previous placement is being used to inform staff practice and develop new care plans. There was evidence of close consultation with the person and their family. The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 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): 7 Systems for recording income and expenditure are detailed and thorough, but further clarity is needed to make these more robust and offer better protection to service users from financial misuse. EVIDENCE: The home keeps records of service users’ income and expenditure. People receive their weekly personal allowance and the manager is looking at ways in which service users can be supported to manage this more independently. An audit of financial records showed that some service users have been charged for car parking when out on activities. The manager advised that ordinarily car parking would be paid for out of the travel costs. Clarification needs to be sought about who is responsible for such costs and staff must be advised about this for future trips out. If it is found that the service users have incurred car-parking costs unnecessarily, these must be refunded to the individuals. It was noted that regular payments are made to a relative of one service user. The manager explained her understanding of this arrangement which has The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 Page 10 existed for sometime. However, there was no formal recorded agreement or detail of this and this needs to be provided. The service users have building society accounts for any savings they may have. One building society book was in the manager’s name only and this needs to be amended to clarify that the manager is acting on behalf of the service user. The manager explained that there have been difficulties in obtaining benefits for the newest resident and the person is currently being subsidised by Craegmoor Health Care with weekly allowances of £18.80. It is anticipated that once the person received their correct benefit entitlement, Craegmoor will recoup any subsidies. The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 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): 13, 16 and 17 Opportunities for service users to be involved in activities of ordinary living are promoted although can be improved on. More detailed recording of the food provided in the home would present further evidence of the varied and wholesome diet which promotes the wellbeing of the service users. EVIDENCE: Staff spoken with felt that part of their role was to support the service users to be as independent as possible. People are supported to make their own snacks and meals, and do their own laundry and cleaning. One service user was cooking a curry on the day of the visit. The person was supported by a member of staff and said they enjoyed cooking and have regular opportunities for this in the home. This is very positive. Observations in the home during the visit showed that opportunities for service users to be more independent could be increased. For example it was observed that a staff member prepared breakfast and a drink for one service user in the kitchen and brought this out to the dining area for the person to have. It may have been possible to involve the service user with some of this preparation The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 Page 12 whether in the kitchen or in the dining room. For example the person could have been given the option to put their own milk into their hot chocolate. It is felt that even very simple changes in the way staff work can promote greater independence and the ‘do with’ approach. One service user was getting ready to go out shopping with their key-worker and said they were looking forward to their trip. Access to the kitchen is restricted for the reasons which are documented in care plans. On the day of the visit one service user was observed to try to access the kitchen. The person knocked a number of times and was waiting very patiently for some time before staff opened the door. There were at least two staff in the kitchen and no clear reason was noted as to why the service user was made to wait. Care should be exercised when restricting access in such a way, so that it is not seen as if staff are making the kitchen their space and limiting access for the wrong reasons. The kitchen in the home is domestic in size and has all of the necessary appliances and additional food storage areas. The fridges/ freezers and the store cupboard appeared to be well stoked and opened food was stored appropriately in the fridge. Better detail needs to be recorded about the food which is provided for the service users in order to make a detailed nutritional assessment if this may become necessary. Any variations to the main menu and details of vegetables / fruit served should be recorded. The home has had a visit from the Environmental Health department and needs to action the requirements made for improving the safety of food practices. The manager advised that a new freezer is being obtained as required. The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 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): Not assessed. EVIDENCE: There was evidence of good follow up by the manager about the health issues experienced by one service user and further appointments have been scheduled to review the person’s medication. The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 Page 14 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 An open approach is being promoted about raising concerns and complaints and this should ensure that service users are listened to and are better protected from any poor and abusive practices. EVIDENCE: Information about advocacy service and the complaints procedure is displayed clearly in the main hall. The manager advised that the first residents’ meeting was held the week before the inspection and was seen as very positive. Discussions with staff provided evidence that opportunities are provided for each service user to have a regular meetings with their key-workers. This usually takes place during a monthly key-worker day where there is a chance for the service user to engage in an activity they enjoy, do some housekeeping or have a trip out. Staff members spoken with felt that the majority of the service users will say if there is something they may be unhappy with. For people who have communication difficulties there is guidance in care plans about recognising signs of upset and distress. A staff member spoken with advised that training in Protection of Vulnerable Adults was held a few weeks before the inspection. She felt that the team have found this session useful in analysing the way they work and interact with the service users. The training included information about the Whistle Blowing procedure and information about different types of abuse and procedures for reporting abuse and poor practice. Staff also receive training in CPI (Crisis Prevention) which incorporates techniques for dealing with aggression and use of physical intervention. The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 Page 15 One person appeared to be very anxious on the day of the inspection. Staff were observed to be managing this patiently and using a consistent approach to which the service user responded well. The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 Page 16 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 Aspects of the environment pose hazards to the service users and staff and reflect negatively on the otherwise homely and welcoming atmosphere. EVIDENCE: The home has two minibuses and a car for transporting the service users to activities. One minibus was seen to be very dirty inside and this needs to be addressed. The service users have access to an enclosed garden and can go out into the garden independently through out the day. Some of the environmental improvements detailed in the last inspection report have not been actioned and must be addressed. Since the inspection further discussion has taken place about the shower on the second floor. The manager hopes to approach an occupational therapist for advice on adaptations which may improve this facility. At least two door handles were very loose on the day of the visit and the maintenance personnel addressed this there and then. The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 Page 17 The Environmental Health Officer’s report identifies a number of problem areas with the current laundry, including poor ventilation, excessive heat and lack of space for safe manoeuvrability. Issues with the unsuitability of the laundry have been discussed for a number of years and the Organisation needs to take decisive action on improving this situation. The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 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): 32, 34, 35 and 36 Service users are supported by staff who are caring, but would need further training and guidance to develop their skills and knowledge in order to achieve good outcomes for the individuals. Recruitment practices may not be sufficiently robust to prevent employment of undesirable staff and could potentially put service users at risk of abuse. EVIDENCE: There was some evidence that staff use their initiative during quieter shifts to read care plans and other guidance about support needed for service users. Staff felt it was important to develop a good relationship with the service users and to get to know them well. Interactions between staff and service users observed on the day of the visit were overall very positive and respectful. A number of staff files were examined to assess whether the necessary improvements have been made to recruitment procedures. A number of shortfalls have again been identified and must be addressed to ensure that complete and satisfactory information is obtained for all staff working in the home. 1. There was evidence that staff have commenced employment before a CRB disclosure has been obtained and without a formal and documented risk assessment. 2. Claims which have been made on some applications about training achievements were not backed up by corresponding certificates. The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 Page 19 3. ID documents were not always present on file. 4. Gaps in employment not always explained. Discussions with staff provided evidence that they received mandatory training including First Aid, Fire safety, COSHH, Health and Safety and Food Hygiene and manual handling. Training needs of the team were discussed with the manager. There has been no formal communication training and this needs to be provided. Some in-house training has been sources about Autism and service users’ rights. All of the staff have completed CPI training. Many have completed training on safe handling of medication. Some staff are yet to access the POVA training and Food Hygiene. The manager hopes that all of the mandatory training will be up-to-date by May 2006. A detailed training matrix is kept and a copy was provided to the inspector. Some staff are completing NVQ awards. The manager advised that she has made a formal complaint about the lack of support staff have received with their NVQ work. There was no evidence of formal recorded supervision on staff files. The manager advised that all staff have had a recent supervision and the relevant paperwork is in the process of being completed. The responsibility for supervising staff has been divided between the manager and the deputy manager although neither have received any formal training in supervising staff and this must be provided. The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 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): 37 and 42 Service users benefit from a dedicated manager, who recognises their own strengths and learning needs and is keen to develop their skills. Lack of structured and effective support and training for the manager may compromise their ability to run the home competently and to improve the quality of the service. Shortfalls in health and safety aspects of the home could potentially compromise the welfare of the service users. EVIDENCE: The registered manager is very new to management and has recognised that there are many aspects of the role which needs further training and development in. The manager advised that she has received good informal support from the area manager, who is assigned to The Cedars on a temporary basis. The manager said she has received one formal supervision in December 2005 although no recorded evidence of this could be provided. The support arrangements are now changing and an area manager from another county is likely to take on this role. The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 Page 21 The organisation has a number of systems and records which it expects the managers to maintain, for example the manager has not received any training about attendance management but is expected to complete the relevant forms. The Commission has an expectation that the manager will receive regular formal support in her role as well as the necessary training and guidance. There needs to be a formally agreed training and development plan for the manager, as well regular recorded supervisions and this will be monitored during future visits. A visit from the fire officer in 2005 resulted in a requirements being made to repair or replace a number of fire doors which have deteriorated and no longer provide the necessary protection and to ensure that escape routes are adequately lit. The manager advised that this will be undertaken by the Company, however no evidence was seen of when the work was likely to commence. The fire officer’s report states that the work has to be undertaken by 1st March 2006 and that non-compliance will result in enforcement action. The Commission requires that fire safety compliance is achieved as quickly as possible and within specified time-scales. Copies of recent fire safety and food safety reports have been provided to the Commission for reference. The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 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 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 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 2 X X X LIFESTYLES Standard No Score 11 2 12 X 13 X 14 X 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X X X 2 X X X X 2 X The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 Page 23 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA7 Regulation 12 and 13(6) Requirement Ensure there is clear guidance about any additional charges for service (this refers to car parking costs). Ensure all staff receive guidance on this. If it is found that the service users have incurred car parking costs unnecessarily, these must be refunded to the individuals. Ensure the building society book which was found to be in the manager’s name only is amended to clarify that the manager is acting on behalf of the service user. 2 YA9 13 (4) Ensure risk assessments clearly identify the level of assessed risk. (Good progress has been made with risk assessments within original timescale of 31/01/06) Better detail needs to be recorded about the food which is provided for the service users in the home. Any variations to the main menu DS0000016601.V283080.R01.S.doc Timescale for action 30/04/06 30/04/06 3 YA17 17 30/04/06 The Cedars Version 5.1 Page 24 4 YA24 23 and details of vegetables / fruit served should be recorded. Carry out the required improvements to the environment: 1. Improve the first floor shower facility to make this safe for more independent use and to ensure this is suitable for the needs of the service users who use it. (Timescale of 31/01/06 not met). 2. Carry out repairs to the patio. (Timescale of 31/01/06 not met). 3. Remove / cover sharp artex in Room 8. (Timescale of 31/01/06 not met). 4. Provide additional lighting in Room 7. 5. Ensure the minibuses are cleaned regularly. Ensure that requirements received from the Environmental Health Department regarding the laundry are complied with. This may be resolved by moving the laundry facility to a more appropriate location. Ensure staff are not employed in the home until all necessary and satisfactory information and employment checks have been obtained (see text for detail). Where staff are required to start employment before a CRB and POVA disclosure has been obtained, the home must discuss this with the Commission and ensure that a suitable and robust risk assessment is in place for the staff member. 31/05/06 5 YA24 23 31/05/06 6 YA34 19 31/03/06 The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 Page 25 7 8 YA35 YA36 18 18 (Timescale of 30/11/05 not met) Training in communication needs to be provided for all staff. Staff responsible for carrying out staff supervisions must receive appropriate training in this. The manager must receive regular formal support and training relevant to their role. Carry out fire safety work as detailed in the Fire Officer’s report dated 19th December 2005. 31/05/06 30/04/06 9 10 YA37 YA42 18 23 30/04/06 01/03/06 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 Refer to Standard YA6 Good Practice Recommendations There should be consultation with the Community Learning Disabilities Team with regards to communication needs of the service users. Any advice received from the team should be incorporated into the existing plans of care. Staff should receive guidance on how to work in a more enabling and empowering way in order to increase the opportunities for service users to be more independent. 2 YA11 The Cedars DS0000016601.V283080.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 Cedars DS0000016601.V283080.R01.S.doc Version 5.1 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. 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