Inspection on 30/07/08 for The Orchard

This inspection was carried out on 30th July 2008.

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 but made no statutory requirements on the home.

Other inspections for this house

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Maple Lodge

Heathlands

Aston Court Nursing Home

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Ravenhurst

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Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE The Orchard 1-2 Station Street Darlaston Walsall West Midlands WS10 8BG Lead Inspector Amanda Hennessy Key Unannounced Inspection 30th July 2008 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 Orchard DS0000071725.V369224.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 Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Orchard Address 1-2 Station Street Darlaston Walsall West Midlands WS10 8BG 0121 526 4895 0121 568 6756 orchardresidentialhome@btconnect.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) C & V Residential Ltd Yvonne Ireland Care Home 32 Category(ies) of Dementia (20), Old age, not falling within any registration, with number other category (32) of places The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only (Code PC) To service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age not falling within any other category (OP) 32 Dementia over 55 years of age (DE) 20 The maximum number of service users to be accommodated is 32. 2. Date of last inspection 30th January 2008 Brief Description of the Service: The Orchard provides accommodation for up to thirty two older people some of whom may have dementia or a mental health disorder. The home has twenty-four single rooms and four shared bedrooms located on both the ground and first floor. Seven bedrooms have en suite facilities. Bathrooms and toilets are situated in close proximity to communal areas and bedrooms. A passenger lift provides access between the ground and first floors. There are two lounges and a separate dining room on the ground floor. Kitchen and laundry is also available at the home. The home is accessible via public transport and is close to all local amenities. There is an enclosed patio style garden with garden furniture at the rear of the home, with a smoking shelter; car parking is available at the front of the home. Fees that the home charges were not detailed in the service user guide seen. For information about fees the reader is advised to contact the home direct. The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. The means the people who use this service experience adequate quality outcomes. Two Inspectors carried out this unannounced inspection on one day. The inspection was undertaken between 09.30 and 17.00hrs. As it was unannounced neither the home nor the provider knew we were going. The homes manager was present throughout the inspection. Information for the report was gathered from a number of sources: a questionnaire- Annual Quality Assurance Assessment (AQAA) was completed before the inspection by the homes manager/ proprietor was sent to us; We looked at the premises, records and documents. We had discussions with the manager and care staff plus visitors and people who live at the home to gain their views on what it is like to live in and receive care at the home. We looked at how the service has responded to any concerns, how it protects people from abuse and how staff are recruited and trained. We also looked at the number of staff available to care for people at the home. Three people who live in the home were ‘case tracked’ this process involves establishing people’s experiences of living in the care home by meeting or observing them, discussing their care with staff, looking at care files, and focusing on outcomes of the care that they receive. Tracking peoples’ care helps us understand the experience of people who use the service. What the service does well: The home is clean, has been recently decorated and provides suitable aids and adaptations for people living there. There are friendly staff in sufficient numbers who have good training opportunities to assist people living there. People said that: “the staff are lovely”. There is a range of activities, with at least one different activity each day, which people enjoy. Monthly day trips out have been arranged throughout the summer. The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The home has three requirements and four good practice requirements as a result of this inspection. Care records need to reflect all peoples’ needs, choices and capabilities to give confidence that peoples’ needs will be met. Staff must also update care records regularly and ensure that whenever possible individuals are involved in the planning and review of their care. The manager also needs to ensure that all people wishing to live at the home (including those admitted for respite care) have an assessment of their needs. Bed rail risk assessments are available but need to more fully identify any risks to the person concerned. Bedrails can pose a serious risk if required checks are not undertaken. There needs to be required and up to date information about the home contained within the service user guide and statement of purpose. If this information is available people would have required information they need to make an informed choice about living at the home. The home needs to develop a quality assurance system. If an effective quality assurance programme is available this can help to identify further developments that would improve outcomes for people living at the home. The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 7 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 Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 8 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 Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 9 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, 6 Quality in this outcome area is poor. People may not have sufficient information to enable them to make an informed choice that the home is suitable for their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a “Charter of Residents rights”. The Home Manager told us that she thought this was the homes version of the service user guide but it did not include all required information. The home also has a Statement of Purpose but was found to be out of date giving information about the homes previous manager. There is a need to ensure that both the statement of purpose and service user guide contain required information to inform people about the home. The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 10 We were told that the manager goes out to assess people’s needs before they come to live at the home. We did not see an assessment of needs in all peoples’ records that we looked at and particularly those people admitted for respite care. The lack of information about peoples needs means that staff are not made aware of them before they come in to the home. We also found that the lack of records of assessment was reflected in the poor care records and instructions for staff that we saw. Introductory visits and trial stays are encouraged by the home, ensuring that people have time to make decisions about coming to live at the home. Intermediate care is not provided by the home. The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 11 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. The lack of up to date records of care needs and detailed risk assessments may mean that there is a lack of awareness of people needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People who live at the home have a very basic plan of their care, which did not reflect all people’s needs, choices and capabilities. For example there was insufficient information about one person who had previously had a pressure sore and needed a special mattress (although the mattress was in place on their bed). We also looked at people records who we were told had challenging needs but their plans of care did not say that their needs were challenging and if they had any challenging needs, there were no instructions for staff how to manage or monitor their challenging behaviour. There have been attempts to make care records more “person centred” although this needs further development. One positive example how staff are developing person centred care was: The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 12 “has a tendency to wander late afternoon and evening. She can be alert and orientated one minute and confused and afraid the next.” We found that people’s care records were not reviewed regularly, records seen had not been reviewed since 22/02/08 and there was no evidence to show that people living at the home were involved in this review process. It was positive that all staff we spoke to had a good knowledge of people living at the home and their care needs. Required risk assessments such as moving and handling, falls, nutrition and pressure sore risk were available but had not been reviewed for some time. The Manager told us that she was revising care records but this had only just started at time of the inspection. People have access to other healthcare professionals according to their needs Records seen show that people are regularly seen by their doctor, district nurses, chiropodist and opticians. Medication practices at the home have improved since the last inspection. There are good records in place for the ordering of repeat prescriptions and the receipt, administration and disposal of medicines. We suggested that by two staff checking and confirming handwritten entries on medication sheets that any risk of error could be minimised. Only staff that have had training in the safe handling of medicines give out medicines. We saw that people were treated respectfully and spoken to politely throughout our inspection. People agreed when we asked them about staff respecting them: “the staff are lovely”. Staff were courteous and knocked on doors before they entered taking care to maintain people’s dignity. The Orchard DS0000071725.V369224.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 and 15. Quality in this outcome area is adequate. Lifestyle at the home would meet the needs of most people although the lack of records of people’s interests makes it difficult for staff to ensure that activities are what people would usually enjoy and take part in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home does not have an activities co-ordinator. We were told that senior care staff, arrange activities which usually take place in the afternoon. The home has an activities programme identifying activities such as karaoke, art and crafts, board games, bowling, hoopla, bingo, dominoes. We were also told that trips out have also included: bowling and visits to Trentham Gardens, Woburn Abbey and Safari Park, a visit to the tropical palm house at Stapeley Water Garden is arranged for August 2008 and in September 2008 a trip has been organised to Southport. We highlighted a need at the previous inspection for people’s interests to be identified so that activities can be planned round them. Staff have, started to The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 14 discuss interests with people living at the home but this needs further development. We were told that one person has an advocate with Age Concern. The Manager told us that neither she or her staff have had training in the Mental Capacity Act. We advised that there is a need that staff have training to highlight their responsibilities within the act as soon as possible. Care plans identified people’s religion and nationality; the Registered Manager confirmed that there was no one in residence who required any specific support or assistance with regards to their culture or religious beliefs. We were told that a monthly Church of England service takes place. Visitors are welcome at the home at anytime. One relative and another visitor we spoke to confirmed that they visit whenever they wanted to. The home has a four-week menu, which identified that a varied well-balanced diet is provided. A choice of main meal is always available. People living at the home can choose where they prefer to have their meals. It was nice to see that all dining tables had tablecloths, flowers, cruets and appropriate cutlery. Staff support people to be as independent as possible, we were told that two people prefer to eat with their fingers and they are provided with finger foods to maximise their independence. Staff spoken to told us that there are no specialist dietary requirements, in relation to culture or religion; the home did cater for the dietary needs of people who have diabetes. The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 15 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 adequate. The home has systems in place to respond to concerns but they need some improvement to fully ensure that people will be listened to and kept safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints policy and procedure. People can find the complaints procedure displayed in the home. The home does not have a ‘complaints and compliments book’ but is hoping to introduce one shortly and also have an post box where people can highlight any concerns before they become major issues. The home has not had any complaints since our previous inspection. People that we spoke to said they would discuss any concerns that they had: “the manager)”. Staff also told us : “ if any resident said they were unhappy I would get the manager to speak to them.” We highlighted a need for improved risk assessments to be in place for bedrails and that they should be reviewed regularly to minimise the risks to people living at the home. Staff all told us that they had adult protection training. The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 16 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 and 26. Quality in this outcome area is adequate. The home is clean, recently decorated and provides suitable aids and adaptations for people but the lacks of homely touches. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is a large detached house that has been converted to provide residential care for up to thirty- two older people. The home has been decorated, has had new carpets and has had new furniture throughout since the previous inspection. The refurbishment wasn’t quite finished at the time of the inspection. We found that there were only net curtains at the windows of the dining room and lounges and walls were also bare with the exception of locks and door handles were displayed on pieces of board to attract people’s The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 17 attention. The majority of corridor walls are coated with ‘Artex’, which is very rough and could easily damage fragile skin if people knocked against the walls. There is one corridor named the ‘memory corridor’ with lots of interesting things to look at including photographs of film stars of the 1930’s, 40’s and 50’s. The front area also had differing objects of interest from the 1930’s, 40’s, 50’s and 60’s for example, an old radio, mangle and sewing machine. People living at the home only have limited access to this area of interest, as there is a locked door before coming into the reception area. The home has a large lounge, separate dining room and a small lounge that they may choose to sit in. Bedrooms are on the both the ground and first floor, with a passenger lift accessing the first floor. There are double rooms but not all were being used as double rooms. Privacy screens are available in those rooms occupied by two people and people are given the option if they want to share a room or not. The majority of bedrooms have been personalised with the ornaments, small items of furniture and family photographs. The home provides people with a range of equipment to support them to be as independent as possible. There are grab and hand rails around the building. Hoists are available for moving people safely. A staff call system is available throughout the home. The bathrooms are clean and provide sufficient aids and adaptations for those people who need assistance and support. The garden consists of paved areas (no grass area) with raised borders where tables and chairs are available for people to sit outside if they wish to. There is a greenhouse where tomatoes are being grown. A shelter is available in the garden area for people wishing to smoke. The home has appropriate arrangements in place such as liquid soap, gloves and aprons to minimise the risk of cross infection. The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 18 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. The home has suitably trained staff on duty in sufficient numbers to meet the needs of the people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People told us that there are ‘sufficient staff to meet their needs. Care staff are supported by; kitchen staff seven days a week, domestic staff five days a week and laundry staff six days a week. Staff we met spoke positively about support and training they receive and were knowledgeable about peoples’ needs. We observed good interaction between staff and people living at the home. Eleven of the twenty- two care staff have a care qualification (National Vocational Level 2 or above) a further seven staff are about to commence their National Vocation Qualification. This gives confidence that staff are ‘given good training opportunities’ to enable them to be knowledgeable and understand peoples’ care needs. People were complementary about the staff and told us: “They are good”. The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 19 Staff recruitment and selection is generally completed to the required standard. Required checks such as references and a Criminal Record Bureau (CRB) check are undertaken before staff commence employment at the home. Some improvements in record keeping such as start date and a record of verbal references would give additional assurance that people are protected from people who are unsuitable to work with vulnerable people. We were told that new staff have, induction training that meets the “Skills for Care” standards. Records of staff induction were available. The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 20 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 and 38. Quality in this outcome area is adequate. Improving and developing the systems and practices that are in place could better protect people’s health, safety and wellbeing. Development of quality monitoring processes is needed to make sure that the service is run in the best interests of those who use it. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has worked at the home since February 2008. She has worked in residential care homes for several years and has managed another home. The manager undertakes regular training to ensure her knowledge and skills are The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 21 kept up to date and holds a required management qualification. Staff told us that they found the Manager approachable. The home does not have a quality assurance system although the manager is going to develop one. The manager has started with a standardised format but this needs to be developed to ensure that it works for this specific home. We did have some surveys returned although the Manager had not forwarded them to us she gave them to us at the time of our inspection. There is a need that people can be assured that their comments are made anonymously. Meetings for people do not take place although there are regular staff meetings. The manager confirmed that regular staff supervision has not taken place since May 2007 but this is something she is going to focus upon. It was positive to hear that people are encouraged when able to manage their own money. Staff do not manage any person’s personal allowance but look after small amounts of money on their behalf. Sampling showed that suitable records were being kept with receipts supporting most transactions. Balances we checked were all found to be correct. Staff all told us that they had regular mandatory training and there were records of training in the staff files that we looked at. All maintenance contracts seen were up to date. We spot checked the homes maintenance contracts and saw records of the home’s hot water temperatures, fire system and fire drills and were satisfied these are being maintained to protect the people living at the home. As previously highlighted there is a need to improve risk assessments to ensure that any risks to people living, working or visiting the home is minimised. The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 1 x 1 x 3 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 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 1 x 3 1 x 2 The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 Requirement All people wishing to live at the home (including those admitted for respite care) should have an assessment of their needs which they are involved in. People living at the home must have a plan of care that identifies their all their needs, choices and capabilities, giving staff instructions on how their needs should be met, it should be reviewed regularly and whenever possible people living in the home should be involved in the drawing up of it and its review. This will ensure that people receive the appropriate level of care and assistance to promote their wellbeing. There must be appropriate risk assessments in place when people need bedrails to highlight and address the potential risk of harm to residents. Timescale for action 31/08/08 2 OP7 12 and 15 31/08/08 3 OP7 13(4)(c ) 31/08/08 The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 24 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 Refer to Standard OP7 OP9 OP14 OP36 Good Practice Recommendations Plans of care should be “ person centred” reflecting peoples needs, choice and capabilities. Two members of staff should confirm the accuracy of the entry for handwritten entries on the medication administration record. Staff should receive training in the mental capacity act. Staff should receive regular (at least six times a year) formal supervision that is recorded. The Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection West Midlands West Midlands Regional Contact Team 3rd Floor 77 Paradise Circus Queensway Birmingham, B1 2DT 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 Orchard DS0000071725.V369224.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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