Inspection on 30/06/07 for The Limes

This inspection was carried out on 30th June 2007.

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 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 Limes 05/07/06

The Limes 18/01/06

The Limes 19/08/05

The Limes 31/01/05

The Limes 23/08/04

The Limes 02/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Limes 16a Drayton Wood Road Hellesdon Norwich Norfolk NR6 5BY Lead Inspector Hilary Shephard Unannounced Inspection 30th June 2007 09:10 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 Limes DS0000027285.V345051.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 Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Address 16a Drayton Wood Road Hellesdon Norwich Norfolk NR6 5BY 01603 427424 01603 429003 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) Mr Michael Christophi Mrs Christina Dawn Laffey Care Home 41 Category(ies) of Dementia (41), Old age, not falling within any registration, with number other category (11) of places The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Eleven (11) Older People of either sex and forty-one (41) people of either sex with dementia may be accommodated. The total number not to exceed 41. 5th July 2006 Date of last inspection Brief Description of the Service: The Limes is a care home providing care for 41 older people with dementia, which includes the facility to accommodate 11 older people who do not have dementia. All accommodation, including a choice of lounges, is on the ground floor, and there are secure gardens, which are accessible to all residents. Car parking is provided at the front of the home. The home informed CSCI in June 2007 that their fees are between £333 and £459 per week. Residents are expected to pay for hairdressing, toiletries, magazines, papers, confectionary, chiropody and transport to events or hospital on occasions. The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers care outcomes for people using the service. The key inspection of this service has been carried out using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgments for each outcome group. A total of 3 requirements 1 of which is repeated from two previous inspections were made as a result of this inspection. What the service does well: The home continues to be managed well by a competent and qualified manager. Concerns and complaints are managed well. Residents continue to benefit from the manager monitoring the quality of the service provided and making improvements when required. The premises have been developed in a way that aims to compensate for residents loss of physical and mental abilities. Considerable work has been carried out to the garden areas making them safe and enjoyable for the residents. Residents are cared for in a respectful way, staff are good at helping them to make choices in their daily lives and residents are generally happy and satisfied with the service provided. Residents generally enjoy the food provided and like the way they are cared for by staff. Safe recruitment practices are followed which means that the home is protecting residents from harm. Prospective residents are visited seen by the manager or deputy before admission who provides them with information to help them decide if they want to live in the home. Staff continue to be provided with good induction and training relevant to the needs of the residents. The home is also good at ensuring staff undertake statutory training in health and safety. The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 6 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 Limes DS0000027285.V345051.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 Limes DS0000027285.V345051.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): 3 People who use the service experience good quality outcomes in this area. Prospective residents’ care needs are assessed before admission and this information is used to form part of their care planning. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The way information is gathered about residents before their admission has not changed since previous inspections. Prospective residents are visited in their homes or in hospital by the manager or deputy. An assessment is completed at that visit which is then used as part of the care planning. Information from other sources such as social workers and hospital staff is also used. Residents were spoken with about their admission experience but none were able to remember coming into the home. The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 9 90 of residents in a CSCI survey carried out in June 07 said they had received enough information before admission to help them decide to move in. Care records for two new residents showed that information gathered prior to admission was being used as part of the planning how to meet their care needs. The Limes DS0000027285.V345051.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): 7,8,9,10 People who use the service experience adequate quality outcomes in this area. Residents’ care needs are being addressed but details about care needs in their care records are inconsistent and create the potential for incorrect care to be given. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections carried out in 2006 showed that care records had improved significantly since 2005. Inspections carried out in early 2006 to review care records showed that some records contained good detail about residents’ care needs but others did not. The inconsistency in recording information about care needs was making it difficult for staff to give the appropriate care in a way that was focussing on residents’ needs in accordance with their wishes. The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 11 Significant improvements were seen to the care records at an inspection carried out in November 06 which found that they were focussing on residents needs in a more person centred way. Care staff had been working hard to improve these and had written them with involvement from the residents and their families. Nutritional assessments were not being completed, however the manager explained that was because it had taken her some time to source a good assessment tool. She had been in touch with the dieticians at the hospital, but they were not able to provide training or much support. The June 07 inspection found that some care records contained good detail about residents’ care needs, including a brief life history and assessments of physical care needs such as nutrition. Inconsistencies were seen however in the care records of 2 newly admitted residents. These had not been updated to reflect the care needs and did not contain enough information about how staff should be addressing these. They omitted assessments relating to falls, nutrition and pressure areas. Both residents had significant care needs and one had experienced a significant number of falls over a 3 week period. Another care record of a resident who had been in the home for some time was looked at. This showed the resident’s health was slowly deteriorating but information about how staff should be managing this person’s care needs was too brief and lacked detail. The home’s annual quality assessment for 2007 indicates that staff have had training in person centred care and that the care plans are consistently improving. However, the majority of the care records did not contain enough information or guidance about residents’ emotional, social and psychological care needs to enable these needs to be met. Care records contained information about residents receiving care as required for their physical health needs from the GP, district nurses or relevant healthcare professionals. The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 12 Relatives commented in the CSCI survey that “I approve of how the care home is run and the attention given to my relative” and “they look after my relative as well as they can and I am happy with what they do for him”. 100 of residents who responded indicated they receive the care and support they need. Previous inspections have shown that medication is managed and administered safely. Observations of medicine administration were carried out during the June 07 inspection. These found some potentially unsafe practices where a member of staff was leaving packs of medicines unsecured whilst she gave residents their tablets. The member of staff was experiencing difficulties with administering medicines as an agitated resident constantly interrupted her. The staff spoke of how methods were in place to improve the way medicines were being given and these practices would not occur in the future. Medicine administration record (MAR) charts were checked and showed that medication in the blister packs was being given as prescribed. Quantities of medicines received into the home were not being noted on the MAR charts or being carried forward from the previous month’s supply. This made it difficult to check that residents were being given the correct number of tablets that had not been blister packed. Observations of staff interaction with residents during the June 07 inspection showed staff treating residents with respect. A requirement has been made regarding medication and care planning. The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 People who use the service experience good quality outcomes in this area. The provision of activity, occupation and interaction for residents has improved in the past year although staff could improve the way they meet residents’ emotional, social and psychological health needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspection carried out in July 06 (a weekday) showed that residents were enjoying their lifestyle but care records regarding residents’ activity and social care needs was sporadic. Observations made at an inspection carried out in September 06 (a weekday) showed there were not enough staff available to properly meet the residents’ entire range of needs. Residents’ emotional and social needs were not being met very well and many residents were receiving only limited interaction and stimulation during the visit. Staff were only offering residents verbal choices about meals which made it difficult for some residents to choose their preferred meal. The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 14 Observations made at a further inspection in November 06 (a Saturday) found changes made to the menu as the manager had looked at ways of offering residents choices of meals. Staff were observed to be busy and had little time to meet the residents emotional and social needs. Staff confirmed it was busy and they were not often able to sit and talk with residents. The June 07 inspection found staffing numbers had been increased in the afternoons, which meant that residents were receiving more stimulation and interaction during that period than at previous visits. An activity coordinator who arranges entertainment and activities for residents continues to work with residents between 2 and 4pm most days. Discussions with some of the care staff indicated they had a good idea of the residents’ emotional and social needs and knew how they should be meeting these. Observations showed that although care staff knew how they should be meeting residents emotional and social needs in a person centred way, they were not doing it in practice. Observations showed that in the middle lounge during the first part of the inspection the radio was playing loud pop music and the TV there was muted. Staff did not understand how confusing that could be to people who have dementia. Some residents were enjoying the TV, particularly the tennis, and some enjoyed the old time music played in the main lounge during the afternoon. Some residents said they got bored and did not have enough to occupy themselves and others said they were quite happy and were enjoying being free and easy. The majority of residents were observed to be content. 30 of residents responding in the recent CSCI survey indicated there are activities provided they can take part in. 30 said there usually were and 40 said only sometimes. The relatives’ survey indicated they felt more activities should be provided and were concerned with the amount of time the TV was on during the day. One commented “I am sure my relative would not choose to be stuck indoors in front of TV all day”. Relatives are welcomed into the home and one spoke about visiting the home as often as he wanted to, relatives were satisfied with the care the residents receive. The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 15 Residents spoke about the food being good but they could not remember what they had ordered for their lunch. Two choices were offered at lunchtime and most residents seemed to enjoy their lunch. The manager spoke of how the menu gets changed following feedback and suggestions from residents. The homes annual quality assessment states they received commendations from the hospital dieticians for their nutritional assessments and that the menus are altered to improve the choice of meal. The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 16 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): 16,18 People who use the service experience good quality outcomes in this area. The manager deals with complaints appropriately and makes every effort to ensure residents are protected from harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections have found that the manager handles complaints well, has a good understanding of her role regarding safeguarding adults and ensures staff receive training. The inspection carried out in June 07 found that the manager continues to handle complaints well. One complaint had been received by the home, which was managed sensitively and to the complainant’s satisfaction. Staff spoke of how they would recognise signs of abuse and would not hesitate to report any issues to the manager. Staff also said they have received training in recognising signs of abuse and reporting such issues. The homes annual quality assessment indicates they are receptive to complaints and view them constructively. The manager responds immediately The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 17 to any concerns raised and addresses them until they are resolved. Residents and relatives are aware of the homes complaints & whistle blowing procedures. However, 50 of residents responding in the recent CSCI survey said they were not aware of how to complain. There were mixed views from the relatives who said: “I had concerns that I raised with the manager, but the response was not very helpful” and “I have found the owner and manager both extremely helpful and understanding”. The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 18 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): 19,20,26 People who use the service experience good quality outcomes in this area. Residents’ benefit from an enabling environment and from being able to use the well designed and pleasant gardens. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Significant improvements have been made to the interior and exterior of the home since 2005. Inspections carried out in 2006 noted that some of the carpets needed replacement as they were beginning to become worn and stained. These visits also identified the loudness of the telephone was having a negative impact on some residents well-being. The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 19 No odours had been noted at previous visits, however the July 06 inspection found one bedroom to smell strongly of urine and a requirement was made for the home to be kept free from offensive odours. The manager has also made an effort to provide residents with an environment that tries to compensate for their lost abilities. She has improved signage so residents can find their bedrooms, toilets and bathrooms more easily. The inspection carried out in September 06 found work in all the garden areas was complete. The gardens had been made into pleasant areas of outdoor space for residents who were enjoying sitting out in the courtyard garden. The inspection carried out in June 07 found that a new carpet had been fitted in the main lounge and dining areas. These areas had also been redecorated which has significantly improved their appearance. One bedroom still smelled of urine but the odour was not as strong as at previous visits. The manager advised that many of the carpets (including that one) were steam cleaned on a weekly basis. The home was noted to be clean and free from odours with that one exception. Although the phone volume has been reduced in the small lounge it remains loud and intrusive in the main lounge. The manager explained she is having difficulty sourcing a suitable phone system that fits with the existing system. Garden areas remain pleasant, well maintained and enjoyed by residents. No other changes made to further enhance the environment to provide residents with extra support with their retained functional and cognitive abilities. The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 20 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): 27,28,29,30 People who use the service experience adequate quality outcomes in this area. Although staffing numbers have increased, these have not yet been consistent and staff are not consistently putting their knowledge about person centred care into practice. Therefore residents are not benefiting as much as they should be from being cared for by competent and skilled care staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Weekday and night staffing numbers have slowly increased over the past 2 years, but visits to the home carried out in 2006 found staffing levels too low during afternoons, particularly at weekends. Residents were not receiving enough stimulation, activity or interaction as care staff were too busy with physical care tasks. The inspection carried out in June 07 found the manager had increased staffing levels in the afternoons, particularly at weekends. Rosters showed that 5 or 6 care staff covers most afternoon shifts at weekends, but there have been occasions where this has slipped to 4. The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 21 6 or 7 care staff usually cover morning shifts at weekends, and on occasions there have been 8 staff. Observations showed staff were busy and were having some difficulty caring for a resident who needed constant attention. Residents however, appeared to be well cared for and contented. No other issues relating to inadequate staffing levels were raised or noted at this visit. Relatives in the recent CSCI survey commented: “I have always found the staff very friendly & helpful”, “my relative has nothing but praise for the staff and “all the staff I have met during the time since my relative became a resident have shown such a high level of commitment and involvement with the residents and visitors, I feel they genuinely care”. Staff had the capacity to interact more frequently with residents but were observed focussing mainly on completing other care tasks. Staff spoke about training they had recently attended in basic care and health and safety. Staff records indicated they have received induction and other training in basic care practices. New staff have yet to undertake formal dementia care training. New staff continue to receive induction training with support from senior care staff and the deputy manager. The manager has also been updating care staff about person centred care. The manager advised that out of 35 care staff, 6 had qualified as nurses in another country and 2 care staff have completed NVQ level 2. The deputy manager is undertaking NVQ level 3 and all except 3 care staff are undertaking NVQ 2. Files of new staff showed they have undergone thorough checks before they were allowed to start at the home. The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 22 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): 31,33,35,38 People who use the service experience good quality outcomes in this area. Residents’ benefit from living in a home that is well managed, well maintained and safe. Quality is monitored formally and the manager recognises when improvements are required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections have found the manager qualified, competent and skilled. The manager monitors quality formally and makes improvements where she can. Formal staff supervision has improved over the past two years. The inspection carried out in June 07 found the home continues to be competently managed in a safe way. The manager had completed a fire risk The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 23 assessment, which had been checked by the fire officer at a recent inspection. The manager advised the fire officer has found all aspects of the homes fire safety to be satisfactory. The manager advised no changes had been made to the way they assist residents with their finances and that the financial records were regularly checked with the deputy manager. The manager has not yet completed formally quality monitoring with residents or visitors for this year, but plans to do this soon. The home’s annual quality assessment indicates they have a suggestion box that residents use to post suggestions for improvement. The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 24 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 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 X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Limes DS0000027285.V345051.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? One 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 (1) Requirement Timescale for action 31/10/07 2 OP9 13 (2, 4, c) 16 (k) 3 OP26 People who use the service must receive care appropriate to their needs and wishes and care records should reflect that for all. People who use the service must 10/08/07 be protected from harm by safe medicine administration practices. People who use the service must 31/10/07 be able to live in a home that is free from unpleasant odours. Repeated requirement for 3rd time. Latest deadline of 28/2/07 not met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Limes DS0000027285.V345051.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 Limes DS0000027285.V345051.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. 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