Inspection on 15/11/06 for The Laurels

This inspection was carried out on 15th November 2006.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Laurels 31/07/09

The Laurels 01/12/08

The Laurels 27/12/07

The Laurels 06/02/06

The Laurels 16/08/05

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Laurels West Carr Road Attleborough Norfolk NR17 1AA Lead Inspector Ann Catterick Unannounced Inspection 15th November 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Laurels Address West Carr Road Attleborough Norfolk NR17 1AA 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) 01953 455427 Gooderham@btconnect.com Goodwood Care Homes Ltd Mr Ian Richard Gooderham Mrs Lois Fagg Care Home 39 Category(ies) of Dementia - over 65 years of age (39), Old age, registration, with number not falling within any other category (39), of places Physical disability (39) The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. No further Service Users falling outside the category of DE(E) to be admitted to the home. 6th February 2006 Date of last inspection Brief Description of the Service: The Laurels is a single storey building that is registered as a residential home. The registration has recently changed to include service users with dementia. The registration for older persons without dementia or for adults over 50 with physical disability is only for those service users who are already in the home. The long term plan is that only service users suffering from dementia will be accommodated. The home provides accommodation in the form of thirty-three single bedrooms and three shared rooms. None of the rooms has en-suite facilities and there are four bathrooms, one shower and eleven toilets available to service users. The shared rooms are only used to provide care to service users that chose to share together. The home does not provide nursing care for service users and health care is by access to community resources. A chiropodist and dentist visit the home as required and a hairdresser visits weekly, for which charges may be made as appropriate. Personal care needs are attended to with assistance as required, although the home states that service users are encouraged to be as independent as possible. Fees include accommodation, furnishings, care and laundry. Fees range from £338 to £460. The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was a key inspection and the site visit was unannounced and took place over a period of two days. The reason for the two days was that this is a large service and had changed registration since the last inspection. Prior to the visit a pre inspection questionnaire was received from the home and nine comment cards from service users and three from health professionals. Comment cards were mostly positive or fairly positive in all areas. No comment cards were received from relatives. Three comment cards were received from professionals. Two of these were positive and one was less positive. The areas of concern expressed by one professional were inspected on the day of inspection and these matter appear to have resolved themselves. Over the two days the inspector was able to speak with service users, relatives, staff, the manager and proprietors. The inspector was able to look at care plans, policies and procedures as well as have a tour of the building. Throughout the two days of the site visit staff were seen to care for service users in a sensitive caring way. Service users and relatives spoke positively about the care received. The home has recently changed its registration to care for service users with a diagnosis of dementia. The proprietors have increased staff numbers and training and have started to develop the environment to meet need. The quality of the service is good and it is expected that by the next inspection the home would have made further improvements continuing to develop the service to the service users needs. What the service does well: The service has a new registration and since this time the proprietors and manager have worked hard to develop the service in the area of providing care for service users with dementia. The general quality of the environment is good. The home has lots of regular communal activities for service users to enjoy. Recruitment and selection of staff takes place in a way that protects the welfare of service users. The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 6 Some comments from service users were: “Well satisfied” “Everybody is so friendly” “Food quite good, well prepared and enough of it” “Staff are nice to get on with” “No real choice for lunch” 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 Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information provided to service users and their families prior to admission to the service is clear and presented well. Assessment takes place prior to admission to the service. EVIDENCE: The Service User Guide is presented as a handbook and includes all relevant information and is well presented and easy to understand. Since the last inspection the registration of the home has changed to provide care for service users with dementia. The home had some vacancies prior to this and once registration changed were quickly approached by commissioners to admit new service users. The outcome of this was that eight new service users were admitted within a five week period. This outcome of this was a very busy time for the home and this was discussed with the manager. On The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 9 reflection this was a lot of admissions in a short space of time but this situation is unlikely to happen again. The home completes its own individual assessment s as well as receiving assessments from placing professionals from the health or social services. It was acknowledged that one service user, soon after admission, clearly presented needs that could not be met in the home and this person has since been placed elsewhere. The manager and proprietors accepted that a lesson had been learnt and the assessment process needs to be very thorough to ensure that the home can meet the needs of all service users placed in their care. . The home is still using the assessment form that was used prior to the dementia care registration recommendation has been made to improve this form and make it more relevant to the present service user group. A recommendation has been made in this area. The home does not offer intermediate care. The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans, when fully completed identify the care and social needs of service users. The home has appropriate policy and procedures around all aspects of medication administration. Service users were seen to be treated in a way that promoted dignity and offered privacy. Some good practice was seen in this outcome area and it is expected that this outcome area will progress to good by the next inspection. EVIDENCE: Several care plans were seen and were adequate although there is opportunity for further development. Not all parts of all care plans were completed and some of the information was limited. Further work needs to be done to collate social history information. The manager and proprietor are aware of this and have plans to further develop these to ensure they are person centred and The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 11 contain all relevant information. A requirement has been made in this area. There was. In the past, some concern with regard skin care within the home, expressed by the community nurses, however following a meeting with the district nurses this concern has now been resolved. Since the change of registration the number of falls have increased significantly. This was audited by the inspector and identified that two service users were falling on a very regular basis. Although incident and accident reports had being completed no clear risk assessment was seen within the individual’s care plan. . This matter was addressed by the completion of the inspection and it was acknowledged that this should have happened earlier. A requirement has been made in this area. Staff were observed caring for service users and care was always provided in a sensitive professional way supporting dignity and encouraging choice. On one occasion on service user was particularly distressed and the inspector was impressed with the calm, competent way the staff involved dealt with this matter. The service user was provided staff at the ratio of two to one and then one to one until the service user felt able to be on their own. The home has a good policy and procedure with regard medication and all staff administering medication have had certificated training. The way in which medication is looked after, received in and out and administered and recorded was inspected. Overall all this was in order. Two errors on the brought forwarded numbers for medication were identified. The member of staff responsible for medication on the day of inspection was able to identify how the error had occurred and ensured more rigorous checks in this area in the future. At all times staff were seen to care for service users in a way that promoted privacy and respect. Service users were seen to be wearing jewellery, having their handbags with them, wearing their glasses. Staff had aimed to ensure as much independence as possible. Relatives spoken to at the time of the inspection spoke very highly of the staff and the way they cared for their family member. Those service users that were able to express a view spoke positively about staff and all service users appeared comfortable and happy in their interactions with staff. The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is aiming to ensure lifestyles meet the needs of service users. Links are made with the local community and friends and families are welcomed into the home. Service users are provided with good quality food in a comfortable environment. EVIDENCE: The home has an activities coordinator who offers 26hrs a week. This is seen as positive although all staff need to be encouraged to spend social one to one time with service users. A notice board at the front of the home identified previous and future activities. Examples of these were, Christmas bazaar, clothes show, pantomime, the biggest coffee morning, smooth sounds group and Holy Communion. Some photos of previous events were displayed. General activities were well provided. Once individual hobbies and preferences for occupation are identified more person centred activity can also take place. The home is going in the right direction in this area. Some service users were making Christmas cards on the day of inspection. The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 13 Relatives spoken with on the days of the visit to the home and within comment cards all said that they were made welcome in the home and could visit their relatives and/or friends in private. Service users would be encouraged to handle their financial affairs if they were able but most service users have family or financial advocates to take responsibility for their monies. The home has two dining areas and service users can choose to eat in these or in their own rooms. The home has two cooks with one being very recently recruited. The lunchtime meal was seen on both days of the inspection and looked appetising and nutritious. On the first day liquidised food was not prepared appropriately but after this was brought to the attention of the home it was served correctly the second day. As the home now provides a service to people with dementia specific training and/or publication would be appropriate to have in this area. A recommendation has been made in this area. Generally positive comments were received with regard meal times. On the first day of inspection the dining room clock was the incorrect time and the menu board had the previous days menu displayed. It is important that these prompts are correct to enable service user to be as informed as possible. A recommendation was made in this area. Also service users were asked what the wanted for lunch tomorrow before they had eaten today’s lunch. A system needs to be devised that enables service users to choose what they are eating as close to the time they eat it as possible. A recommendation has been made in this area. The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies and procedures are in place to protect and empower service users and their families. EVIDENCE: The home has a complaints policy and details of this are in the policy and procedure file as well as the Service User Guide. It is clear and easy to understand encouraging comments compliments and concerns to be expressed. Positive comment on thank you cards were on a notice board within the home. The old complaints policy was still in the procedures file and needed to be destroyed. All staff receive an Adult Protection handbook that gives all of the relevant information and this should be the focus for the policy in the procedure file. Once again an old copy was in place and needed to be destroyed. The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The environment has been significantly improved and once it reflects the needs of service users with dementia it will have at least a good outcome. EVIDENCE: Since the new proprietors have owned the property they have completed extensive decoration and refurbishment. When the proprietors informed the Commission that they were making application to move to caring for people with dementia care needs the inspector for the home and an inspector who specialised in dementia care visited the home to consider the environment and how it could meet need. It was felt the environment has the potential to be suitable for residents with dementia care needs. Most general decoration and refurbishment has been completed and the proprietors are to seeking advice and guidance on how to ensure the environment meets need. Signage is an area that needs to be developed. The proprietors are waiting to attend a The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 16 dementia care conference and are hoping to get advice there on how to move the environment forward. Advice has been given re publications and organisations that should be able to help in this area. Several bedrooms were seen and they were personalised reflecting the personality and preferences of the occupant. Communal areas could be developed to be more interesting environments for service users. Hallways have attractive pictures and the home has a homely feel. It is expected that once the environment has been made to meet the needs of service users with dementia the outcome in this area will be good. The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager may want to look at staffing at particular times of the day to ensure that service users needs are met at all times. Domestic staffing hours are not sufficient at weekends. Staff have and are continuing to receive training to enable them to have the skills to perform their jobs well. The recruitment and selection process promotes the safety and wellbeing of service users. Staff are receiving the training needed to ensure they have knowledge about the differing needs of service users. EVIDENCE: On the first day of inspection 5 care staff and an activities coordinator were on duty in the morning. One member of staff had phoned in sick and a sixth member of staff was called in during the morning. Five care staff were on duty in the afternoon. The manager and proprietors were also in the building. Two staff administer medication in the mornings this is good practice as it ensures that service users receive medication at the correct time. Other care staff serve breakfast and collect breakfast trays at the same time. The rota suggests that enough staff are on duty however an audit of need would ensure that the home has sufficient staff on duty at all times and the rota could be adjusted accordingly. A recommendation has been made in this area. The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 18 The home has minimal domestic staff on at weekends with only three hours each day. This is not sufficient for a home of this size. With a change of registration to service users with additional needs it would be expected that more domestic staffing hours would be needed. A requirement has been made in this area. Staff are being offered appropriate training and specific training relating to dementia care. Recent training had included, food hygiene, dementia awareness in house and distance learning, manual handling, first aid, fire training, abuse awareness, pressure care and medication training. Planned future training includes further dementia care training, infection control, challenging behaviour and further medication training. The inspector was not able to see completed induction and foundation training files as staff kept these with them. They will be looked at in detail at the next inspection. Discussion was had about the new induction standards and the manager and proprietor were aware of these and looking to purchase the best package available. Over 50 of staff have NVQ level 2 or above. Staff spoken to said that training was promoted and supported. Those staff seen working within the home worked with service users in a way that displayed competence and knowledge of the service users needs. The recruitment and selection process within the home is safe and all relevant documentation is received prior to new staff commencing work. The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager and proprietors aims to ensure that the home is run and managed in a way that promotes the health, safety and welfare of the service users and staff. EVIDENCE: The manager has her NVQ in care and management and significant experience in the field of social care. She is aware of the expectation that managers of homes for dementia complete some significant dementia care training such as a certificate, diploma or degree and would be happy to do this. Those staff and service users spoken to spoke well of the manager and proprietors saying they were approachable and supportive. The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 20 The home has started its quality assurance system and has collated some of this information into a format that has been published for relatives or other interested parties. The home needs to continue to develop in this area including more areas of the service within the quality audit. What they are doing is good so it is more of the same. The home only looks after small amounts of money for service users and a sample of these were inspected and were in good order. Formal staff supervision does take place but this needs to be more regular and the manager needs to ensure all appropriate areas regarding practice, training and development are addressed. A recommendation has been made in this area. Staff receive the appropriate training with regard safe working practice including manual handling, fire safety, first aid, food hygiene and infection control. One of the proprietors takes overall responsibility for the maintenance and service of systems and equipment in the home and ensures that the environment is safe and complies with relevant legislation. Some risk assessments were seen to have been carried out but this area could be further developed. A recommendation has been made in this area. Incidents and accidents are appropriately reported. Induction and foundation training takes place. The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x 2 x 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 x 3 3 x 3 The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 22 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. Standard OP7 Regulation 15 Requirement The Registered Provider must ensure that care plans include all relevant information about the service user to ensure that their health and social care needs can be met. The Registered Provider must ensure that unnecessary risks to service users are identified and so far as possible eliminated. This to be done with the use of a risk assessment. The Registered Provider must ensure that the environment meets the needs of service users. This relates particularly to signage. The Registered Provider must ensure that the home has sufficient numbers of domestic staff on duty at all times. Timescale for action 01/02/07 2. OP8 13.4 (c) 01/02/07 3 OP22 23 01/02/07 4 OP27 18.1a 01/02/07 The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 23 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. 3. 4. 5 6 Refer to Standard OP3 OP10 OP15 OP15 OP15 OP27 Good Practice Recommendations That it would be good practice to devise a new assessment form that was more appropriate for assessing the needs of service users with dementia. That it would be good practice to review the policy of leaving bedroom doors open when service users are not in them. That it would be good practice to offer training and provide publications to kitchen staff with regard to preparing meals for people with dementia. That it would be good practice that the menu board in the kitchen displays the correct menu and clock in the dining displays the correct time. That it would be good practice to ask service users what they would like to have for lunch and tea as near as to the time of eating these meals as possible. That it would be good practice to audit staffing roles and responsibilities at different times throughout the day to ensure that sufficient numbers of staff are on duty at all times. That it would be good practice to ensure that formal supervision of staff takes place more regularly and includes all aspects of work including practice, training and development. 7 OP36 The Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 24 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 Laurels DS0000064440.V321766.R01.S.doc Version 5.2 Page 25 - 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!