Inspection on 08/09/05 for The Turrets

This inspection was carried out on 8th September 2005.

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 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 Turrets 18/01/07

The Turrets 13/03/06

The Turrets 21/03/05

The Turrets 11/10/04

The Turrets 12/03/04

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 Turrets 7-9 Glebe Road St George Bristol BS5 8JJ Lead Inspector Andrew Pollard Announced 8 September 09:45 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 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 Stationary 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 Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Turrets Address 7 - 9 Glebe Road St George Bristol BS5 8JJ 0117 9554058 0117 9554058 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Lorna A Arnold Mrs Lorna A Arnold Care home 10 Category(ies) of Learning disabilities,10. registration, with number of places The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 10 people with learning disability. Date of last inspection 21/03/05 Brief Description of the Service: The Turrets is a 10-bed care home for male and female residents with mild learning disabilities, aged between 18 and 64. There are two communal lounges and one dining area.Mrs Arnold is the registered provider and manager who is actively assisted by her husband and eldest daughter.The philosophy is that of an extended family offering support and guidance within a secure framework and structured home life.Local shopping and other public amenities are within walking distance. The home is near a bus route accessing Bristol, Hanham, and Kingswood.Respite and Nursing accommodation are not provided. The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The following methods of evidence gathering have been used in the production of this report; observation, discussion with staff, tour of the home and sampling policies, records and care plans. No residents were present during the inspection and no comment cards were returned. What the service does well: What has improved since the last inspection? What they could do better: Keep more detailed written records of care plan evaluations. Record residents comments as part of care reviews. Develop personal development plans for staff based on appraisal outcomes and ensure appropriate training and updating takes place. Ensure that regulation 37 notices are submitted where appropriate. Evaluate and update risk assessments. The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 Page 6 Arrange for a gas safety inspection to take place. Keep a log of hot water out let temperatures and ensure any risk of scalding is minimised. 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 Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 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 standard(s) 1,2,5 Prospective residents and their families are given relevant information in written or verbal form about the home. Admission and assessment procedures are in place and have worked satisfactorily in the past. Contracts and terms and conditions of services are provided to all residents. EVIDENCE: The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 Page 9 The statements of purpose and service user guides remain as previously submitted and meet the regulatory requirements. A copy of the service user guide has been given to each resident. Additional charges are levied on an individual basis according to usage. Extra charges are levied for such things as hairdressing, toiletries and holidays where applicable. There have been no admissions since the last inspection. There is an admission procedure and supporting documentation in place. The prospective resident, Social workers, community nurses and family members are involved with in providing assessment material, arranging and planning admissions. All residents have social services placement officers and contracts with the relevant Local Authority. Residents are currently placed from W Sussex, Surrey, S Glos and Bristol. There is a service user agreement/ terms and conditions document in place, which contains the necessary information, including the period of notice required. Where able residents have signed these agreements and have their own copy. If advocacy services were required the advocacy group “People First” would most likely be used as one of the residents is an active member of the organisation. Residents are encouraged to undertake certain household tasks as part of their residency at the home, however it was stated that there is no compulsion to do so. The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 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 standard(s) 6,7,9,10 There was evidence of needs, risk assessments and care plans being written however there was minimal evidence of meaningful evaluation or review taking place since the last inspection. Residents are involved with decision-making and consulted about the running of the home within the limits of their willingness or ability to take part. Records are stored and handled in a confidential manner. EVIDENCE: The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 Page 11 Mrs Arnold and Ms Arnold have a shared responsibility for writing and maintaining care plans. All residents have an initial social services care plan, which is adapted and updated over time as the resident’s needs are more fully identified and change. All the care plans have been written in a clear format that sets out the assessed need, the services provided. The format offers good detail and the facility for residents to write their own comments on each aspect of the plan. Although it is accepted that there is little change in the residents needs it was recommended that the resident’s comments should be recorded at each evaluation or review, which is not happening. Of the three care plans checked no written evaluations had been recorded since January 05 or October 04. Individualised risk assessments are written where need be however Mrs Arnold accepted they had not recently been reviewed on the basis that little changes. In general all documents are signed and dated. The home has a written a policy about risk assessment. The policy makes links with national minimum standards and ties in with the policy on protection from abuse. Risk assessments related to environmental and community hazards have been carried out. At present all the residents are assessed as low risk in relation to these potential hazards. Residents have been given bus training to ensure their competence and safety. A resident has currently had the water supply disconnected from their room following frequent flooding and the danger of water ingress into electrical fittings. A risk assessment has been written but there is no written evidence that this has been kept under review. The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 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 standard(s) 12,13,14,16,17 Residents have opportunities to take part in a range of community and leisure activities. Residents make use of community services. Residents are seen and respected as individuals. The recreational and occupational arrangements in the home are well organised individualised and varied. The menus are varied, offer balanced diet and include individual choice. EVIDENCE: The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 Page 13 Three residents attend the Disabled Christian Fellowship; two attend the Kingswood RAC and Downend day centre. Two residents attend the new drop in centres for up to five days per week. One person attends ACTA drama and media workshops. Two residents also have part time jobs at a car trade centre and Healthex laundry. Two people will be attending Adult education classes. One person does volunteer work with the cat protection league and in a charity shop. All residents use community health, Para-medical and dentistry services. Residents make full use of community services and facilities. Many people have well-established links with their families and see them often, sometimes staying over or going on holiday. Several residents have friendships outside of the home and can entertain visitors if they wish. The home is on good terms with their neighbours and a number of the residents are well accepted and known in the local pub. Three residents are attending a local church. All bar two residents are able to be independent in the community. People enjoy going shopping, the cinema, swimming, bowling amongst other activities. The household will be involved with planning any holiday or day trips later in the year, the destinations are chosen by the residents. Residents are in general independent depending on their state of mind and so are self-directing within the limits of their motivation and initiative. Any restrictions are recorded in care plans and based on risk assessment and related to vulnerability. Bed times and rising times are flexible according to the individual’s choice. Smoking is not allowed in bedrooms. At least a month’s record of meals served is kept and showed a varied and balanced diet. The majority of the residents have lunch at work or at their placement. In the past residents have said they enjoyed the food and the portions were good. The last time a food survey when last carried out showed overall satisfaction with the meals. There is no formal choice of meals but individual likes and dislikes are catered for so that an alternative is offered if someone is known not to like the meal of the day. Menu planning is discussed at house meetings. The residents are able to eat independently and have no special dietary needs. Residents take a minimal role in food preparation but are able to make breakfast and drinks as they wish and prepare their own light snacks. The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 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 standard(s) 18, 19, 20 The staff provide appropriate personal care to maintain residents health and well-being. Appropriate arrangements are in place for residents to access primary and secondary healthcare services if need be. The staff properly manages and administer medication. EVIDENCE: The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 Page 15 In general the residents are independent with their personal care although varying degrees of prompting and help is required for some. Residents are able to speak with doctors, dentists and other Para medic and give their consent for treatment where necessary. Staff will accompany residents to appointments if requested to do so. Two residents currently require extra supported in managing their health care needs including attending regular health checks with Doctors and consultants. The general health of the other eight residents is good. One person is seeking to loose weight to alleviate problems with their legs. Other service users have been referred to and are supported by appropriate specialists including community learning disability nurses when appropriate. The residents are registered with a local GP offers a good level of support. Weekly MAR records are kept and a record of all drugs received is made. If need be it is understood what disposal records would be required, no returns have been made. No residents have PRN medication. Ms Arnold has written a medication policy referenced to the national minimum standards. Two residents self medicate and each gets a weekly dossette box. Each person has a lockable container to keep medicines in; the remainder are kept in a lockable cabinet in the locked office. Ms Arnold has completed a course in safe handling of medication and set up training for the other staff in conjunction with the local pharmacist. A meeting was held with staff from the “Valuing People” team to advise on health action plans but thus far the team have not followed it up. The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 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 standard(s) 22,23 There are satisfactory arrangements in place to manage complaints or allegations of abuse. There are arrangements in place for staff training and awareness of POVA matters. EVIDENCE: A complaint procedure including CSCI contact details is available and has given to each resident who signed to acknowledge receipt and understanding of the same. The procedure is contained in the service user guide. There have been no complaints. The manager is aware of the need to log details of any complaints received and the outcome if any are received. A copy of Bristol City Council “No Secrets” guidance has been obtained. Copies of the General Social Care Council code of practice have been given to all the staff. There have never been any allegations of abuse The home has a policy statement about physical intervention based on NAPPI training. Key elements of this training have been cascaded to all staff. The current resident group display no physical or verbal aggression and physical intervention have not been required. The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 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 standard(s) 24,25,27,28,30 The home is suitable for the current resident group The home is generally well maintained clean, safe and comfortable. Bedrooms bathrooms and communal areas suit the needs and tastes of the residents. EVIDENCE: The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 Page 18 The home comprises two linked properties. The home is unsuitable to accommodate people who use a wheelchair. A new boundary wall has been built. There is a patio area at the back of the home. This is also the designated smoking area, however at present no residents smoke. Staff smoke in the office. Bedrooms are decorated in accord with resident’s wishes. Residents can have a key and lock their bedrooms if they wish. There is a communal lounge and a separate activities room which can be used for table games and playing music. All residents are encouraged to use the dining room for meals and snacks. It is well furnished providing comfortable surroundings for the residents. Proper heating and ventilation provision is made. The kitchen is appropriate for the nature of the home. There was no record of fridge or freezer temperatures and no food probe to test hot food temperatures. The laundry facilities comprise of an industrial washing machine and dryer. Residents take and sort their laundry and the staff washes it. The standard of cleaning in the house was good throughout. There were no malodours. The Avon and Wiltshire Health Authority infection control guidance manual was available. The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 34,35, The home is adequately staffed with appropriately experienced staff. The recruitment procedures and records are in good order. The training arrangements are limited in their scope for care staff updating. Staff appraisal takes place. EVIDENCE: The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 Page 20 There is a small, longstanding group of staff that have worked at the Turrets since it first opened in 1995. Three members of the family are regularly working in the home. There has been on change in the staff team since the last inspection. Mr and Mrs Arnold have a flat on the premises and with their daughter cover the sleep in duties. There is always at least two staff on duty when the residents are in. Mr & Mrs Arnold are very often in the home when not officially on duty. All staff carry out various roles in care work, catering and general housekeeping duties. There are no staff vacancies at present. Sickness rates are very low. There are no vacancies. No agency staff have been used. The residents are largely independent and require minimal personal care. The residents have good communication skills. Previously residents have reported interactions with the staff and family were respectful and supportive. Mrs. Arnold is aware of the key principles related to recruitment practice and is aware of the all the recruitment procedures and checks required. The inspector has previously discussed with Mrs Arnold the possibility of involving residents in the recruitment of staff. All staff have had enhanced level CRB checks completed or applications made. All staff have new job descriptions. The General Social Care Council code of practice has been provided for all staff. Mrs Arnold has a Bachelor of Education degree for people with special needs. Ms Arnold has an NVQ level 3 and has completed an NVQ level 4 care manager’s award. NVQ level 2 training for two care staff is to commence with Bristol Council to commence in October. The newly recruited carer has recorded induction training and NVQ level 2 already. There has been no training or updating for staff other than fire safety since the last inspection. Due to the size of the home and the small group of staff no formal supervision sessions are carried out. Such supervision as there is, is informal. Ms Arnold has created an appraisal/performance review document. Two appraisals have been successfully completed. The intention was that all staff would be appraised annually: this has not been achieved. This process will be used to identify learning needs. Informal staff meetings do take place during handover. The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 41,42 The management arrangements are simple and there are clear lines of accountability. There are appropriate arrangements in place to service and repair plant and equipment. However the gas safety inspection is overdue. The home has good Health and Safety arrangements other than management of hot water risks. EVIDENCE: The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 Page 22 The manager Mrs Arnold has been the registered manager since 1995 and has a Bachelor of Education for people with special needs qualification. The deputy manager Ms Arnold has an NVQ level 3 and has completed NVQ level 4 care manager’s award and is undertaking a degree in social work. Ms Arnold developed and updated policies and procedures as part of course work toward the care managers award. There have been no change in the policies since the last inspection. Staff have read all policies and sign to that effect. The policy file is available to the residents should they wish to read it. The home has registration with the Data Protection Agency. Staff records and resident case files are stored securely in the office, which has a keypad lock. Resident’s or visitors can only access the office in the company of staff. There is a health and safety policy which staff are obliged to adhere to. All staff have had training in First Aid and there are three first aid boxes between the two houses. The staff have received training in the use of an oxygen concentrator, which one of the residents requires from time to time. The training has been carried out by BOC who supply and check the equipment. One staff member has been trained in load handling procedures and can if need be carry out risk assessments. No residents are physically disabled. The central heating / gas appliances were last serviced in October 03 and is therfores out of date. Each house has its own boiler, and the hot water temperatures are set on the boiler. The shower has a separate thermostat. No formal monitoring of the hot water outlet temperatures is carried out. The electrical installation safety certificate is in date. The EHO visited the home in January 05 and all was in order. The Fire officer inspected the home in October 04 and all was in order. The fire log book and servicing records were up to date and in order. No regulation 37 notices have been sent. There were two occassions when such should have been submitted once when some residents money was taken without consent by another resident and the second time when a resident was mugged by a stranger. However the manager dealt properly with both incidents in other respects. There have been no accidents since the last inspection. The insurance liability certificate was in date. The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 2 x x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 x 3 3 x 2 Standard No 11 12 13 14 15 16 17 x 3 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score x 2 x 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Turrets Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 x x x 3 2 x D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 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. 2. Standard 2 35 Regulation 15 18.1 c Requirement Carrry out regular reviews of assessments and evaluations of careplans Ensure that staff training and updating takes place relevant to the assessed needs of the residents. Arrange a gas safety inspection and send a copy of the csertificate to the commission. Ensure that Regulation 37 notices are submitted in accord with the provisions of the Regulation. Timescale for action From 8/09/05 By 1/12/05 3. 4. 42 42 13.4 37 By 10/10/05 From 8/09/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard 30 42 2 Good Practice Recommendations Log fridge and freezer temperatures and hot food temperatures. Maintain a log of hot water outlet temperatures in baths and showers and ensure they do not rise above 45 degrees C. Record residents comments related to reassessment and care plan reviews. D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 Page 25 The Turrets The Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 Page 26 Commission for Social Care Inspection 300 Aztec West Almondsbury South Glos. BS32 4RG 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 Turrets D56_D05_S26618_The Turrets_V242237_080905_Stage4.doc Version 1.40 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!