Inspection on 27/09/06 for The Rock

This inspection was carried out on 27th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 Rock 02/02/06

The Rock 14/07/05

The Rock 18/01/05

The Rock 07/09/04

The Rock 17/05/04

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Rock 1 Station Road Buckfastleigh Devon TQ11 0BU Lead Inspector Megan Walker Key Unannounced Inspection 27th September 2006 12:00 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 Rock DS0000003840.V309659.R02.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 Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Rock Address 1 Station Road Buckfastleigh Devon TQ11 0BU 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) 01364 642706 the.rock1@btinternet.com Mr Julian Roger Smith Mrs Ruth Millicent Smith Care Home 14 Category(ies) of Dementia - over 65 years of age (14), Old age, registration, with number not falling within any other category (14) of places The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd February 2006 Brief Description of the Service: The Rock is registered to provide accommodation and care for a maximum of fourteen people in the registration categories of Dementia - over 65 years of age and Old Age, not falling within any other category. The Registered Service Providers are Mrs Ruth and Mr Julian Smith. Mrs Smith is responsible for the day-to-day management of the home and Mr Smith manages the maintenance of the home. There is also a competent senior staff team who contribute to the daily running of the home. The home has a good record of long-term employment of its staff. The Rock is a detached house, set in attractive gardens. It is situated in a residential area of Buckfastleigh, close to the village shops and amenities. It is on a bus route. There is a private car park directly opposite the house that provides ample off street parking for staff and visitors. The home is attractively decorated, comfortably furnished and clean. The residents’ private accommodation consists of six double and two single bedrooms. Residents are encouraged to personalise their rooms. There is a dining room and a separate sitting room. The night staff room is also available during the day as a quiet area, and for any relatives/visitors who may prefer to use it for more privacy. One bathroom has a bath with a hoist; another bathroom is only suitable for those able to bathe unassisted. There is also a separate shower room. Adequate toilet facilities are provided. The Registered Providers have two dogs that visit the home. In the past residents have moved in with their pets when it has been feasible. The home also has two chinchillas kept in a cage in one of the communal rooms. The current fees for The Rock range from £363 to £375 according to the assessment of care needs for the individual. Extra costs include hairdressing, chiropody, and other sundry items. The Business Manager provided this information at the time of the fieldwork inspection. The home does not provide intermediate care and it is not registered to provide nursing care. The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork part of this inspection took place on 27th September 2006. It included a tour of the premises, observation of staff and residents in the home, case-tracking residents, inspection of cares plans, staff files, medication, and other records and documentation, talking to staff and residents. The Registered Provider and the Business Manager were present at the time of this inspection visit, and part of the time was spent talking with them about the running of the home. In addition other information used to inform this inspection included the Preinspection Questionnaire completed by the Registered Person, Comments’ cards from two health care practitioners and two GPs who visit the home regularly, three staff, and three relatives. One relative offered an opinion verbally about the care being given by the home’s staff, and the attitudes of staff to visitors. Also taken into account was all other information received by the Commission since the last inspection, and the previous two inspection reports. Two requirements and six “Good Practice” recommendations were made as a consequence of this inspection. What the service does well: What has improved since the last inspection? What they could do better: All staff must be trained and up to date with current guidance and good practice recommendations on “Safeguarding Vulnerable Adults”. They must The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 6 have an understanding of what could be considered “abuse”, and they must know what action must be taken in the event of any such incident be recognised within the home, or affecting an individual resident. Staff must not be employed until all the required checks are in place. This includes CRB checks that are not portable from another place of work. Staff should sign a disclaimer to comply with the European Working Time Directive should they choose to work more than forty eight hours, including overtime, in any seven day period. Information recently collated as part of a quality assurance process should be formalised into some sort of report format. Risk assessments should to be routinely written and kept on individual residents’ care files. Telephone conversations and/or discussions with relatives about care of a resident should be recorded routinely on individual care files as part of or for use in informing the review process. Supervision should be formal as well as informal and practical. It also needs to be routinely recorded. It should take place at least six times a year to meet with the National Minimum Standards. 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 Rock DS0000003840.V309659.R02.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 Rock DS0000003840.V309659.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their families can feel confident that their needs will be assessed before moving into the home. EVIDENCE: At the time of this inspection the majority of the residents at The Rock had been living there for a number of years. As part of the case tracking process, three care files were inspected. Each file had good assessments of need, including where appropriate a separate assessment completed by a Local Authority Care Manager. The Registered Provider stated that she usually visits the prospective resident whether that was in hospital or at home or in another home, unless for any reason this was not practical. She also stated that in such circumstances she would collect information from health care professionals and, if it was appropriate, from a local authority social worker. The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents can feel confident that a staff team that is respectful and reliable will ensure that their care needs are met. EVIDENCE: Each care file inspected had good care plans with attention to detail for each individual. There was a “periodic review” of assessments as well as monthly care plan reviews on each file. Also seen on each file was a record of any medical appointments for the individual. It was evident from talking to staff and the Registered Provider, and from observation of interactions between staff and residents, that staff know the residents well. Personal preferences and whims are respected and each resident is treated as an individual. Some examples of this care practice include one resident who prefers to eat breakfast in the dining room and all other meals staff take to the resident’s room. Staff encourage and enable another resident who likes to help with small The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 10 tasks such as laying and clearing tables. A greenhouse has been set up in the garden to enable a resident who enjoyed gardening, with guidance and prompting from the staff, to potter in there. Mealtimes are long to allow individuals to eat their food in a way that is unhurried. A number of the residents came to The Rock with challenging behaviour. The attitudes to care created within the home by the Registered Provider, and the good levels of care given by staff, have enabled such behaviour to be lessened, and in some cases, cease. One Health Care Practitioner Comment Card received by the Commission praised the home for this. A relative who returned a Comments’ Card to the commission wrote: “The staff are incredibly caring and thoughtful, and have created a good atmosphere.” It was also noted that the level of care provided by the staff could not be measured or expressed via a tick box. The Care Workers Survey had a question: “Is there anything that the home does really well that you would want to tell us about?” Written responses from care staff at the home were: “Residents always come first.” “I think we care for our residents to a very high standard.” “Personal care.” The medication was seen kept in a lockable, fixed cupboard. The staff continue to follow procedures recommended made by a pharmacist inspector who visited the home in the past twelve months. The MAR sheets were all seen up to date and signed accordingly. At the time of this fieldwork visit, none of the residents required any controlled medication, and no one was responsible for their own medication. The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents find the home offers a lifestyle that satisfies their expectations. EVIDENCE: During the inspection visit residents were seen around the home in the dining room, the lounge and in their rooms. The formal programme of activities showed little evidence that it would be appropriate group activity for residents who had dementia care needs, however, individual residents were encouraged and assisted by staff to participate in activities more suitable for their own preferences and capabilities. The Registered Provider acknowledged that the majority of residents had lived at the home for a number of years, consequently their general health and mobility had declined over time. They were therefore frailer and unable to enjoy some of the activities they may have done even six months ago. A relatively new resident, in contrast, since moving into the home had regained mobility and was generally in better health than on arrival at the home. Families and friends are encouraged to visit and to take out their relative. The Registered Provider also involves families in any care changes or measures of The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 12 safety such as provision of cot sides and bumpers, although the written evidence was sporadic. The care plan review process is informed by any such discussions with families. Residents choose the time they get up and the time they go to bed. They can also choose when and where they eat their meals. They receive a balanced diet. Meals are unhurried and staff provide assistance discreetly when it is requested or required. The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 13 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are at risk due to inadequate staff training to safeguard vulnerable adults. EVIDENCE: Since the last inspection neither the home nor the Commission has received any complaints. Inspection of training and development records on staff files showed little evidence of “Safeguarding Vulnerable Adults” training. Discussion with the Business Manager identified that this is an area that has been overlooked as staff have been undertaking NVQ courses and other mandatory training. It was agreed that this training would have priority, and the Business Manager confirmed that she would seek out an appropriate course. The Registered Provider in different contexts throughout this inspection visit described certain behaviour patterns of individual residents. It was not evident from some of these descriptions that the Registered Provider or senior staff team was taking any action that could prevent or minimise such behaviour occurring. It also was not evident that they understood that the circumstances causing such behaviour could be referred to the local Adult Protection Team to resolve. The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents live in a safe, well-maintained environment that is clean, pleasant and hygienic. EVIDENCE: A tour of the premises found that each bedroom was personalised and homey. Screens are provided in the shared rooms. Two rooms had recently been redecorated. Fire door closures had been fitted on all the bedrooms except one. The Business Manager stated that this would be done in the near future. At the time of this visit the upstairs bathroom and shower was not used because all the residents required assistance with a manual hoist in and out of the bath. The downstairs bathroom had a manual hoist that the Business Manager stated was checked twice annually by an external contractor. The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 15 A number of beds were seen with cot sides and bumpers. The Business Manager confirmed that before cot sides and bumpers are fitted to any bed, the individual resident and their family are consulted. She explained that the cot side would only be provided if required for safety reasons, and with this agreement. Records were seen for ‘fridge’ and freezer temperature checks. These were recorded daily, and the Business Manager stated that it was usually her responsibility and that she did the checks early morning before staff start using the ‘fridge’ and freezer. On recommendation from a recent Environmental Health visit, the Registered Provider is going to fit a fly screen across the double doors leading from the kitchen out to the garden. The premises are secure to protect residents from wandering out into the street. Upstairs the door leading to the fire escape has an alarm that sounds downstairs. This was inadvertently set off during this tour of the premises and staff responded promptly and discreetly in accordance with the home’s procedure. The home was found clean and hygienic throughout. It was also found in good order and upkeep. The Business Manager stated that new carpets and armchairs are planned next as part of the ongoing maintenance programme. The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are cared for by trained and motivated staff in sufficient numbers to meet the needs of those currently living in the home however the home’s management team must ensure they comply with current Employment legislation. EVIDENCE: Since the last inspection only one new member of staff has started work at the home. Inspection of a random selection of staff files found that all the necessary checks had been completed, however one CRB check was done for the person to work at another home. Most of the checks were also at least three years old. The Business Manager confirmed that she was aware of the CRB guidance to renew checks after three years, and that it was her intention to do this. She was unaware that CRB checks are not portable from another place of work so confirmed that she would ensure a new check was done immediately. All care staff have NVQ qualifications ranging from Level 2 to Level 4. Five staff have received training on “Safe Handling in Medicines”, and five staff have received training on “Health and Safety in the Workplace”. All staff have up to date first aid training. All staff responsible for handling food had received training in Food Hygiene, however this was found to be due for renewal. The The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 17 Environmental Health Officer informed the Registered Provider about the requirement for staff to attend a seminar on “Safer Food, Better Business”. At the time of this inspection visit they were awaiting confirmation of a place. Inspection of staff training records found that they were not trained and up to date on good practice guidance on “Safeguarding Vulnerable Adults”. The Business Manager was advised at the time of this inspection visit to contact the local authority for advice and information on this subject. [See St 18] Staff receive informal supervision on a daily basis as well as holding an informal daily handover. Occasional staff meetings are also held. There was little evidence of any of these being formally recorded. Inspection of staff hours found that some staff members work fifty hours or more per week. The Business Manager confirmed that staff chose to work these hours. It was acknowledged that if the extra hours were refused by the management team of The Rock, it was likely staff would either leave or seek extra hours elsewhere. The Business Manager was advised at the time of this inspection visit to ensure that all staff were given and signed a copy of the European Directive on Working Time and to include a disclaimer should staff choose to work over 48hours including overtime, in any seven day period. The Business Manager was also advised that this was particularly essential for any staff working night duty. Staff were observed carrying out their duties in a professional, sensitive manner. Feedback from visitors to the home was complimentary regarding the care and attention given by all members of the home’s staff team. The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health, safety and welfare is promoted and protected by a competent and capable manager who is keen to achieve positive outcomes for residents and staff, however, regular formal records must be kept to show this more evidently. EVIDENCE: The Registered Provider manages the home competently. She is approachable and runs the home in an open and transparent way with responsibilities delegated appropriately amongst staff. It became apparent during this inspection visit that information recording was sporadic, either for reasons of time, or assumption that another staff member would take the responsibility and do it. It was therefore discussed during this visit that the senior staff The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 19 could benefit from formal delegation of tasks to ensure that necessary paperwork is completed as required. Staff receive informal supervision daily. They also hold daily “handover” meetings. There was some evidence of formal supervision notes and staff meetings, however these were not regular or recent. As part of the discussion mentioned above, it was agreed that the Registered Provider would consider who would be most suitable from the senior staff team to provide staff with formal and recorded supervision. The Business Manager had collected feedback from families about the care given by the home, and she compiled a newsletter to inform people about events that had taken place at the home. It was agreed at the time of this inspection that all this information would be collated and used to provide a quality assurance review for the home. Some staff hours shown on the duty rota were excessive. [See St. 27] The home does not hold monies for any of its residents. The Business Manger confirmed that all the necessary maintenance checks as reported in the Pre-Inspection Questionnaire were correct and up to date. The recent visit by an Environmental Health Officer required a fly screen to be fitted on the kitchen door, and risk assessments to be completed to comply with Health & Safety legislation. A new fire extinguisher and light fitting have been provided, and amendments have been made to the risk assessments for phased evacuation in the case of a fire in the home, to meet requirements of the Fire Safety Officer’s visit in May this year. All fire training of staff and other fire safety records were up to date. The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 20 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 4 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 1 3 x x 2 x x x 4 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x N/A 2 2 2 The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP18 Regulation 13(6) Requirement The Registered Provider must provide all staff, including herself, with training on “Safeguarding Vulnerable Adults”. CRB checks must be valid for the post held within the home. Timescale for action 31/12/06 2 OP29 Sch 2 (7) 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP22 Good Practice Recommendations To meet this standard the registered persons should arrange for the premises and facilities to be inspected by an occupational therapist with specialist knowledge of the needs of people with dementia. This recommendation is carried forward from previous inspections. The Registered Provider should ensure that all staff are aware of the European Working Time Directive, and have signed a disclaimer accordingly should they choose to work more than 48hrs including overtime in any seven day period. DS0000003840.V309659.R02.S.doc Version 5.2 Page 22 2. OP27 OP38 The Rock 3. OP29 4. 5. 6. OP33 OP36 OP37 The Registered Providers should consider renewing the home’s staff CRB checks when they are three or more years old, in line with the Criminal Records Bureau “Good Practice” guidance. The quality assurance review should be formalised as discussed during the inspection home visit. The Registered Provider should ensure that staff receive formal supervision that is recorded at least six times per year. The Registered Provider should ensure that all records required by regulation for the protection of residents are kept up to date as discussed at the inspection home visit. The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Rock DS0000003840.V309659.R02.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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