Inspection on 23/08/06 for The Summers

This inspection was carried out on 23rd August 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 10 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Summers 27/09/08

The Summers 19/09/07

The Summers 23/11/05

The Summers 09/06/05

The Summers 30/09/04

The Summers 15/06/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Sutton Lodge Nursing Home

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

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

CARE HOME ADULTS 18-65 The Summers The Summers Yeend Close West Molesey Surrey KT8 2NA Lead Inspector Kenneth Dunn Unannounced Inspection 23rd August 2006 10:00 The Summers DS0000060466.V302180.R01.S.doc Version 5.2 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 Summers DS0000060466.V302180.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 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 Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Summers Address The Summers Yeend Close West Molesey Surrey KT8 2NA 020 8979 4689 020 8941 0468 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) Kingston & Wimbledon YMCA Mrs Barbara Chater Care Home 28 Category(ies) of Learning disability (4), Mental disorder, registration, with number excluding learning disability or dementia (1), of places Physical disability (28), Physical disability over 65 years of age (5) The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Adults aged over 35 - 65 years of age. Physical disability (28), Physical disability over 65 years of age (5) The age range of the service users in Flat 4 may be from 25 years for respite care Of the 28 service users accommodated, up to 2 may fall within the category MD Of the 28 service users accommodated, up to 4 may fall within the category LD 23rd November 2005 Date of last inspection Brief Description of the Service: The Summers is a large purpose built detached property located near the town centre of West Molesey, Surrey. The service provides a good standard of accommodation and facilities for up to 28 adults with physical disability, some over 65 years and a maximum of 5 service users with learning disabilities. All current bedrooms are single and are set across two floors. All bedrooms sizes exceed the NMS. The home has a private garden and parking for several cars at the front. The service is owned by the YMCA and managed on a day to day basis by Mrs Barbara Chater who is directly employed by Surrey Social Services. The home accommodates both male and female service users. There is only one lift to the upper floor of the home. The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced site visit to be undertaken by the Commission for Social Care Inspection year April 2006 to March 2007. Mr Kenneth Dunn Regulation Inspector carried out the site visit. The site visit was undertaken over 5 hours. The registered manager of the home has recently retired and as a result their several issues have developed and have produced a negative environment within the home. The acting manager is attempting to work through the issues and to alleviate staff concern in respect of the day-to-day management of the home The inspector was able to speak with several service users during the time spent in the home. A number of staff was spoken to and one commented the home is operating well and feel supported. A number of service users were spoken to, who were able to communicate and able to express themselves. Positive comments were made regarding the staff and service users were happy regarding their daily living routine. Observation made was that service users and staff have a good rapport; they were relaxed and comfortable with staff on duty. A tour of the premises was undertaken. A percentage of care plans and staff files were inspected. The inspector would like to thank the service users, acting manager and staff members for their time, assistance and hospitality during the site visit. What the service does well: What has improved since the last inspection? The was little evidence of improvements being undertaken since the last inspection this may be in part because of changes within the management structure of the home. The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 6 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 Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 7 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 Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Due to changes in the management of the service the information available to the service users is now out of date. Full assessments should been carried out prior to and during the early days of admission which is designed to ensure resident’s needs have been correctly identified and could therefore be met. EVIDENCE: The statement of purpose and the service users guide are very comprehensive, however because of the recent retirement of the registered manager they no longer reflect the managerial structures within the home and do not clearly set out the qualifications and experiences of the senior staff. The responsible individual must ensure that the current situation of the acting manger and the management structure of the home are fully identified and all relevant parties must be copied into the distribution of the new book. The service has had only one new service use since the last inspection a review of his file indicated that the assessment policy and induction process were not complied appropriately by the service. A senior member of staff explained that the service user had been in receipt of long-term respite care at The Summers and they had therefore based his assessment upon the pre-existing documentation. The resulting assessment and care plan have been designed using information established in 2004 and potentially outdated and was not reflective of the service users current status. The acting manager must ensure The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 9 that all service users care plans are reflective of the most current information and assessment possible to ensure that the care offered to the residents is appropriate to their individual needs. The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ individual plans are clear and comprehensive including details of needs and goals. They also incorporate known or indicated preferences and choices, and include in depth risk assessments. EVIDENCE: Staff stated that residents are supported to make decisions affecting their lives in a number of ways. Each resident has an allocated key worker, who is trained to offer one to one support and who knows the resident well and understands his or her needs. Resident meetings are held to enable residents to make decisions and choices, for holidays, menu planning and outings. Staff advised that information is provided to residents to assist with decisionmaking and this is in a format to suit their individual needs. A resident confirmed she knew what the procedure was in the event she was not feeling well and needed assistance. The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 11 The residents regularly access the local community and have been risk assessed to establish the levels of assistance they require to maximise their independence. The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents have opportunities for personal development and to take part in appropriate activities within the home and in the local community. They are supported and enabled to maintain and develop appropriate personal and family relationships. Systems are in place to ensure that residents’ rights are respected. EVIDENCE: The home has care plans drawn up with the involvement of service users, their representatives, care staff and other professionals. However was stated on page 8 of this report they are not all current and do not necessary reflect a true picture of the service user. There is clear evidence contained within the service users individual files that the home involves them in decision making, which is reproduced in the care plans. Observations confirmed staff provided service users with information to The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 13 make decisions about their own lives. The home has a policy of risk taking and risk assessments are in place for service users. The inspector noted some risk assessments were not signed and dated by care staff and action has been required in respect of this matter to ensure risk assessments meet the needs of service users. The assessments must be reviewed and signed to ensure they remain reflective and current. The home has its own transport to enable service users to access community facilities and the inspector noted service users were supported by staff to access shops, pubs, cinema and other places of interest. The home support service users to maintain family links and friendships and the inspector noted relatives visited service users at the home regularly. Observations confirmed service users had unrestricted access in the home and staff supported service users in maintaining their independence. The home has a written weekly menu plan and a record of meals eaten by service users. Service users are involved in planning the menu and in the preparation of meals. The inspector noted the menu offered variety and choice and meals were nicely presented. The manager should consult with a dietician to ensure it meals are nutritious and meets the needs of service users. The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 14 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. Judgement has been made using available evidence including a visit to the service. Personal, physical, and emotional support is offered as outlined in individual care plans. Medication is administered safely. EVIDENCE: Service users are supported in a way that promotes their privacy and dignity and the inspector noted a care staff knocking on doors before entering service users bedrooms. Service users preferences about personal support are recorded in care plans and observations confirmed staff supported service users to maintain their independence in choosing clothing, meals and activities. The home has health action plans and service users have access to a GP, dentist, optician and chiropodist to maintain good health. A review of the service users files demonstrated that some files were regularly reviewed and updated however this was not unanimous across the home and evidence would indicate that some files have not been reviewed for some considerable time. In 4 of files reviewed it was not possible to confirm if a review had been completed as the documents were not updated and signed off by staff to indicate that they had been reassessed. The home has a policy on medications and a Medication protocol dated May 2003. Medication recording sheets were sampled dated and signed by staff and The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 15 had a recent photograph of the service user. The home has a service level agreement with a local chemist and medications are supplied to the home on a monthly basis. The home keeps a record of all medications returned to the pharmacy, which was signed and dated, by care staff and the pharmacist. Medications are stored in a locked metal cabinet secured to the wall in one per flat. Regulation 37 reports received by the CSCI have highlighted issues with medication errors, where two service users have had wrong medication given to them or no medication at all. These incidents have been effectively managed both internally and externally by seeking medical advice, and have not resulted in service users being placed at risk. In discussion with staff it appears that insufficient fulltime staff on duty is a cause for concern. Evidence from the staff rota indicated that on one occasion on the week of the inspection only one directly employed member of staff was on duty during the peak am shifts. A net result was that this member of staff was responsible for the medication on all 4 flats and the medication for 28 service users a further review of staff rotas would indicate that this was not an isolated incident. The manager must ensure that the home has sufficiently trained staff on duty at all times to ensure that the service users are safe guarded. The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All required policies, procedures and practices are in place to ensure that residents are safeguarded, as far as reasonably possible, from harm or abuse. EVIDENCE: The home has a complaint policy; complaints information within the home was currently only available in English. Alternative formats are available however this information is only accessible to service users by making a phone call to Surrey County Council. The home has a policy on abuse and a whistle blowing policy and staff had training in protection of vulnerable adults. A care staff stated that any allegations of abuse would be taken seriously recorded and be handled by the manager. The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. Judgement has been made using available information including a visit to the service. Service users live in a comfortable, safe, and homely environment. EVIDENCE: On the day of the inspection the home was clean, well presented and free from mal odour. The standard of décor was generally good throughout the home however the downstairs corridors and hallways were in need of repainting and decorating due in part to the constant scuffing of wheelchairs and action has been required in respect of this matter. The gardens were well maintained, however the paths were in need of remedial work because of weeds coming through the cracks and this could cause problems with service users with restricted mobility. Bedrooms were nicely decorated, well presented, personalised. In areas the carpets in the main hallways were stained and unsightly. The manager must ensure that the carpets in the halls are kept clean and have the stains removed as a matter of urgency. Furnishings and fittings were of good quality. Staff had training in infection control and observations confirmed staff practised infection control measures by washing The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 18 their hands regularly and using disposable gloves. The home kept a record of repairs and maintenance to the home with appropriate management action taken The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are supported by a limited the staff team. Recruitment practices have delayed the effective employment of staff and there is a heavy reliance upon agency staff. EVIDENCE: Staffing continues to be an issue and a review of the staff rotas indicated that the home had been operating with exceptionally high reliance upon agency staff. On Monday the 21st of August 2006 for example only one directly employed member of staff was on duty and she was supported by 8 agency workers, as stated on pages 14 and 15 of this report this situation places a considerable strain upon the staff member coordinating the duties. A further review of staff rotas would also indicate that there has been a heavy reliance upon staff working excessive overtime in order to maintain staffing levels, on one occasion one member of staff worked almost twice her contracted hours in one week. The manger must ensure that there is at least one full time member of staff on duty in each flat at all times and that the ratio of agency workers should not out number the full time staff. The heavy reliance of excessive overtime hours by staff must also be reviewed. However observations confirmed staff at the home respected service users they were seen to be good listeners and communicators with service users. The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 20 Staff have appropriate training and skills in communication and have an understanding of the cultural beliefs and needs of service users. The home had a training plan for staff dated 2006 and a dedicated budget for staff training. Staff had training in a number of areas. The home is working towards all staff having a (NVQ) National Vocational Qualification and a recommendation has been made for the home to do a plan outlining how NVQ targets would be achieved. Supervision of staff was inconsistent and was confirmed during discussions with care staff in some cases staff members have only received one supervision session this year. The manager has been required in respect of this matter to ensure service users benefit from a well-supported and supervised staff team in line with the National Minimum Standards. The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The management approach in the home provides an open, positive and inclusive atmosphere. The home has a quality assurance and monitoring system in place that is based on seeking the views of the residents. EVIDENCE: The Summers had been successfully managed by the recently retired manager who had developed and advanced the home to ensure that the service users were pre-eminent in the focus of the home. As a result a senior member of staff has taken over the direct day-to-day management of the home. The organisation has made previsions to ensure that the acting manager is effectively supported by the RI and the Service Manager for Surrey County Council and conversations with the RI would indicate that they are very pro active in supporting the manager in this role. The acting manager and the RI stated that they are now attempting to progress the staff team and to move them forward and to further develop the The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 22 home, to ensure that when a new manager is appointed the home will remain service user focused. The RI must ensure that a new manager is appointed by the organisation as soon as possible and that the appointed person applies for registration with the CSCI as soon as they are in post. The home has an effective quality audit monitoring system in place. The service manager completes a regular monthly regulation 26 notification visit and the report is well documented. The records observed on the day of the site visit were found to be well documented and kept up to date. This included certificates for the testing of Legionella, gas, electrical and a number of other areas tested. The home has a business and financial plan; the Kingston and Wimbledon YMCA in partnership with Surrey County Council controls the finances for the home. The service manager monitors the budget for the home. Records are maintained to a high level. Insurance cover for the home is in place. The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 23 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 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 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 2 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 X X 3 X The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 24 No 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 YA2 Regulation 12(2&3).. Requirement Timescale for action 23/08/06 2 YA6 3 4 5 YA16 YA18 YA24 6 YA30 12(2&3), 14()(d), 18(1&3), 19(5)(b), Schedule 3.1(a) The manager must ensure that the homes policies for the introduction of all potential service users are fully robust, and meet the needs of the service and the service users. All policies must be based on the National Minimum Standard for Care Homes for Younger Adults. 15 Schedule The service must ensure that 3.1(b) all care plans a based upon the most current assessment and reviewed at regular intervals. 12(4) The manager must ensure that risk assessments are completed and current. 12(1,2 & 4) Care plans must be reviewed 18(1 & 3) regularly and evidence of this must be provided. 16(1) External paths are in need of 23( 1 & 2) remedial work because of weeds coming through the cracks. 13(3) 16, The manager must ensure that 23 the carpets in the halls are kept clean and have the stains removed. DS0000060466.V302180.R01.S.doc 23/08/06 23/08/06 30/10/06 30/10/06 30/10/06 The Summers Version 5.2 Page 25 7 8 YA33 YA34 18 (1 & a) 19 Schedule 4.6 9 YA36 18(2) 10 YA43 25 The service must be effectively staff at all times. The manager must complete a full review of staffing and recruitment and submit a copy of the review to the CSCI. Emphasising the measures employed to ensure the continuing safety and security of the service users. The manager must ensure that all staff receives appropriate supervision as established by the National Minimum Standards. The RI must ensure that a new manager is appointed by the organisation as soon as possible and that the appointed person applies for registration with the CSCI as soon as they are in post. 23/08/06 30/10/06 23/08/06 23/08/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Summers DS0000060466.V302180.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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