Inspection on 13/03/07 for The Rambles

This inspection was carried out on 13th March 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Rambles 06/07/09

The Rambles 20/08/07

The Rambles 06/06/06

The Rambles 25/11/05

The Rambles 02/08/05

The Rambles 08/02/05

The Rambles 16/08/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Rambles 90 Farleigh Road Backwell North Somerset BS48 3PD Lead Inspector Paul Grey Unannounced Inspection 13th March 2007 09:30 The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 1 The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 2 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 Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 3 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Name of service The Rambles Address 90 Farleigh Road Backwell North Somerset BS48 3PD 01275 790072 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) amanda.reading@brandontrust.org www.brandontrust.org The Brandon Trust Mrs Amanda Reading Care Home 6 Category(ies) of Learning disability (6) registration, with number of places The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 5 SERVICE INFORMATION Conditions of registration: 1. 2. 3. May accommodate up to 6 persons with Learning Disabilities Staffing Notice dated 14/04/1999 applies Manager must be a RN on Part 5 or 14 of the NMC register Date of last inspection 6/6/06 Brief Description of the Service: The Rambles is a pleasant detached bungalow offering supported living for 6 service users with learning disabilities. The service is owned and staffed by The Brandon Trust. Provision of care at the service costs in the region of £1372 per week. The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted over a four-hour period in the absence of the manager. During this time the Inspector conducted a tour of the premises, spoke with 3 staff members, observed care and day-to-day living at the home and reviewed care documentation. The Inspector was able to spend time speaking with 2 service users about their experience living at The Rambles. Again the inspector noted the actions of the service user group to isolate themselves from one identified service user. Service users previously stated they are frightened of one service user. This pattern continues and the inspector noted marked changes in behaviour of service users in the presence of one identified service user. The inspector audited incidents involving this service user over a 3 month period. The home’s documentation over this period revealed a total of 128 incidents of moderate acts physical aggression ( including slapping, pushing and hitting of service users). When combined with incidents also involving intimidating but non physical behaviour directed at the service user group, this figure reached 828 acts of intimidation or physical acts over the 3 month period. Staff felt this was a reduction in the incidents experienced by service users as the identified service user now receives increased time out of the premises. Staff spoken with felt the documented figures were a conservative figure as it was not always possible to document every incident; it also became difficult to judge the number of incidents if they kept re occurring frequently. Given the consistent nature of service user feedback, the extended duration of this placement and the physical lay out of the premises the inspector concludes that The Rambles is unable to meet the needs of the service users. The inspector would also highlight that the Trust has been in correspondence with the Commission regarding moving this service user for some years. The inspector is of the opinion that placement at The Rambles is inappropriate and needs to be addressed as a matter of urgency. This was also highlighted to the Brandon Trust in June 2006 and in late 2005. What the service does well: The service has a well trained and committed staff team. The manager and team have managed a difficult situation as the result of this inappropriate placement. The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 7 The service uses Brandon Trust person centred care planning to generate a good standard of care planning and documentation. 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 Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3, Quality in this outcome area is poor People living in the home feel they have restricted choice about how aspects of their assessed needs are met. The statement of purpose does not reflect the experience of those living in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed 3 care files and spoke with staff. The service has an up to date statement of purpose setting out the aims and objectives of the service. This is a comprehensive document laying out the aims and philosophy of the home. The Inspector noted evidence of continued comprehensive assessment to review the needs of the service user group. The home’s assessments were based on a person centred approach and were of a good standard. The Inspector was able to track service users’ assessed needs through to care planning and implementation of care. The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 10 Significantly, the inspector observed that assessed needs were not consistently met due to inappropriate placement of one service user. The Inspector noted that the home’s ability to meet the needs of 5 of the service users is dependant on the behaviour and needs of one service user. Two service users told the Inspector that they were frightened by the actions of this person, and preferred to stay in their rooms so they would not get slapped or pinched. This continues to impact negatively on the service user group throughout a wide range of day-to-day activities. Observation of care, speaking with staff and service users, and subsequent review of the homes documentation indicate that the service is unable to consistently meet the needs of the majority of the people living at the home. The Inspector noted that there is a continued improvement in the service provision for the single service user who is able to access increased day care activities outside of the home. This appears to offer a degree of respite to the remaining service user group. The outcomes for the service user group under standards 1,2, and 3 remain poor. The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is poor The home cannot fully support people to be in control of their own life in the home. This is often dependent on the needs of one service user. Comprehensive risk assessments are in place but the staff team are not always able to minimise risk at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector reviewed care documentation, spoke with staff and 2 service users. Care planning and assessment is completed using the Brandon Trust’s Person Centered planning documents. These care planning documents generate an in-depth assessment of service users needs and create a The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 12 comprehensive care plan. The care plans are well written and reflected the service users’ goals and aspirations. The Inspector reviewed 3 service user care plans and noted that there is no unreasonable restriction on service users rights by the service. However, again the inspector noted that restrictions are placed on the service user group by the needs and behaviour of one person. These restrictions may manifest themselves in a variety of ways. The ability of the service user group to sit and relax, or spend recreational time as a group is dependant on the presence and behaviour of one service user. Simple activities like watching television or going to the shop are again dependant on and restricted by the needs of one service user. The ability of service users to have family or friends visit is restricted by the behaviour of this person. Visits may have to be confined to a bedroom due to the possibility of intimidating behaviour or an unexpected slap or pinch. Service users are supported by the staff team to make their own decisions regarding everyday matters in their life. The Inspector noted documentary evidence of the staff team supporting service users to make a wide range of day-to-day decisions. However again the ability of the service user to act on this decision may depend on the needs of one person. Service users are supported to take reasonable risks as part of living a normal lifestyle. Staff at the home have appropriately risk assessed activities, reviewed them and support service users where necessary to minimise risk. The staff team have risk assessed the activities of one service user who performs acts of low level aggression or intimidation against the whole service user group. Whilst the team have tried to minimise risk to the group this is not always successful or possible in a small domestic type environment. Auditing the home’s records between January and mid March, the inspector found 128 documented incidents of hitting, pushing or slapping the service user group by one service user. The risk assessments, staff statement, service user statement and documentation of incidents suggest that the staff team are unable to consistently control the level of risk this service user poses to the people living in the home. The inspector recognises the level of risk is a modest one, however it is significant, consistent and does adversely effect the service user group. The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 14, 13, 15, 16 Quality in this outcome area is poor Routines in the home are affected by the needs of one service user and often are focused around meeting the needs of this person. This affects the care outcomes for the remaining service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No service users at The Rambles are in paid employment. Service users are supported to take part in a wide range of day-care and supported activities. This enables service users to take part in appropriate activities outside of the home. The Trust has obtained funding to increase the access to external activities of one service user. This has significantly improved the lives of the service user group who are able to resume a more relaxed life style in the service users absence. The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 14 Service users at the home are supported to engage in a range of activities in the local community. This includes visiting places of interest, individual timeout to help with shopping, and going to the pub or similar activities, (depending on the service users risk assessment). Service users receive support from staff to maintain family links and friendship. Service users are supported to maintain contact via letters, cards or phone calls. The Inspector notes that as service users age, this process is increasingly difficult because the relatives of the service users age also and it becomes more difficult to maintain an active relationship. The daily routines at the house are flexible and designed to support service users standard of living. However, running consistently through service users’ experience at the home were consistent issues with freedom of movement resulting from avoiding close proximity with one service user. This was highlighted previously and remains an issue. This was a consistent issue for the service users at the home. Subject to risk assessment service users are offered a key to their own rooms. In some cases service users prefer to lock themselves in their rooms to avoid exposure to one particular service user. At the time of inspection service users were addressed by their preferred name and the staff team interacted with the service user group, not exclusively with other staff. Service users have unrestricted access to the home and its garden; however, this is once again impacted by the needs off one service user. Service users can choose whether to be alone or in company at the home. However again this is adversely effected by one service users needs. The inspector noted at times the service user group preferred to withdraw from communal areas to their bedrooms despite staff efforts. The inspector noted that there appears to be a continued response on the part of more able service users to avoid communal areas when an identified service user is acting in a manner they find intimidating or aggressive. The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 15 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good Specialist health, nursing and dietary requirements are clearly recorded in each resident’s plan; they give a comprehensive overview of their health needs and act as an indicator of change in health requirements. The Statement of Purpose details the specialist treatments the home can deliver and refers to the skills and ability of the staff group This judgement has been made using available evidence including a visit to this service. EVIDENCE: The staff team provide personal care and support to service users. The inspector noted evidence that personal care is provided with due regard to the service users’ wishes for privacy, dignity and respect. Service users are encouraged and supported to express their own taste and preference in clothing and personal appearance. Service users can get up or go to bed at flexible times and are not subject to unreasonable restriction. The inspector noted statement and documentary evidence indicating that the The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 16 home can demonstrate that they meet service users physical and emotional needs. The inspector notes that some service users have complex needs, and when the inspector tracked needs assessment and the provision of an appropriate service, the home performed very well. Service users are supported to obtain appropriate health care from NHS providers or local GP’s and staff will support service users with visits etc. The Inspector noted in the files sampled that service users are supported with medication by the staff team. To maintain service user safety, the staff team support service users by administering medication. The Inspector reviewed the medication charts and noted no crossings out or omissions on the charts. On reviewing the medication the Inspector noted the stock balanced with medication charts. The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor The service has a complaints procedure that is up to date, very clearly written, and is easy to understand. The policies and procedures regarding protection of residents do not cover all areas required and are not applied to protect the service user group from the consistent low levels of intimidation and aggressive incident. Care outcomes for the service group are poor. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The inspector noted the home has a clearly laid out complaints procedure. Service users spoken with understood who they should complain to if they are unhappy at the home. The inspector noted an outline of the complaints procedure in a format designed to be understood by the service user. The home will document any complaints, at the time of inspection there were none. A record is kept of any complaints. The home has policies and procedures outlining the actions of staff should they see or suspect abuse. The Trust also provides a good standard of training for care staff and managers regarding potential abuse. The home has appropriate policies and procedures regarding whistle-blowing and the inspector noted the Somerset ‘No secrets’ document. The Brandon Trust provide staff with training to understand the causes of physical aggression toward staff. The Trust has a good program of training to cover this eventuality. The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 18 Service users have experienced a reduced amount of physical and psychological aggression from 1 service user as highlighted in previous reports. This appears to be the result of increased day care and timeout for the identified service user. This is an improvement. However, statement evidence from service users indicates that service users are still intimidated by and avoid the named service user and are not protected from abuse. The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is good The home provides a physical environment that is appropriate to the specific needs of the residents who live there. The well-maintained environment provides specialist aids and equipment to meet the needs of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes premises were accessible, safe and well maintained throughout. The furnishings were of good quality and pleasant and domestic in design. The Inspector noted evidence of continued maintenance in the home. The premises are clean and hygienic throughout. The Inspector noted no offensive odours during inspection. The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 20 The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area is good Staff members undertake external qualifications beyond the basic requirements. Managers encourage and enable this and recognise the benefits of a skilled, trained workforce. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. People who use the service report that staff working with them are very skilled in their role, and are consistently able to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Trust has obtained funding for additional staffing to meet the needs of one service user. The Inspector noted evidence that service users are supported by a skilled staff team. Documentation at the home highlighted a wide range of training offered by the Brandon trust for staff members. The Inspector noted in particular the training is given to enable staff to understand the nature of physical and verbal aggression, and how to react when faced with such The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 22 behaviour. The manager at the home is also a trained positive response instructor. In excess of 50 of the care staff at the home have achieved NVQ to or higher. Staff records are held at the Brandon trust Central office. These were assessed and found to be in order. Service users are supported by a well trained staff. The Brandon trust provides training facilities and courses in excess of the required by the sector skills Council workforce. The home has a documented training and development plan and access to ample training from the Brandon trust. This is good practice. The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 23 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 42 Quality in this outcome area is good The service has sound policies and procedures, which the manager effectively reviews and updates, in line with current thinking and practice. The manager is regarded highly by other professionals. Staff are positive in their approach to translate policy into practice. Efficient systems are in place to monitor staff adherence to policies and procedures during their practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s registered manager is a qualified nurse with in excess of the 2 years required experience in management . The manager has consistently demonstrated her ability to meet the written aims and objectives of the home. The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 24 However the inspector notes that this ability is impacted negatively by the inappropriate placement of one service user. The Inspector did not assess standard 39, (quality assurance), on this inspection. The Inspector noted staff were up-to-date with moving and handling, fire safety and positive response training. The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 1 3 2 4 x 5 x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 1 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 1 x LIFESTYLES Standard No Score 11 x 12 x 13 3 14 2 15 2 16 2 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x x x x 3 x The Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 26 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA3 Regulation 14 (2a, 2b), 14 (1d) Requirement The registered person must review their assessment of each service user and confirm in writing to the commission that they are able to meet their needs in respect of their health and welfare. Staff must document all untoward occurrences or incidents of violence or aggression in the home and inform the Commission as appropriate. Staff must continue to work with the funding authority to identify an alternative placement for a named service user The registered person must forward an action plan addressing the incidents of aggression and intimidation experienced by service users along with the proposed strategies to reduce them DS0000020307.V332672.R01.S.doc Timescale for action 30/05/07 2. YA22 17 (1) aSch.3 30/05/07 3. YA23 12 1 (A/B/C)13 614 1 (C/D)14 2 (A) 14 (2a, 2b), 14 (1d) 30/07/07 4. YA23 30/07/07 The Rambles Version 5.2 Page 27 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 Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Rambles DS0000020307.V332672.R01.S.doc Version 5.2 Page 29 - 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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