Inspection on 13/07/05 for Trinity Street

This inspection was carried out on 13th July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Trinity Street 22/04/08

Trinity Street 27/04/07

Trinity Street 31/10/06

Trinity Street 26/01/06

Trinity Street 29/03/05

Trinity Street 29/09/04

Trinity Street 16/03/04

Similar services:

Whiteley House

Tyndale Avenue

2-10 Norfolk Road

Bennfield House Nursing Home

Eastfield Residential Home

Sign Health

Springwood

Fairburn Mews

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

CARE HOME ADULTS 18-65 Trinity Street 27 Trinity Street Batley Carr Dewsbury WF17 7JZ Lead Inspector Jacinta Lockwood Unannounced 13 July 2005 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. Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Trinity Street Address 27 Trinity Street Batley Carr Dewsbury WF17 7JZ 01924 456160 01924 458001 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) Richmond Fellowship Ms Paula Malone Care Home - personal care only 12 Category(ies) of Mental Disorder 12 registration, with number of places Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Conditions of this registration are listed on the registration certificate displayed at the service. Date of last inspection 29.03.05 Brief Description of the Service: Trinity Street is a care home providing personal care and accommodation for up to 12 adults with enduring mental health problems. Nursing care is not provided. It is operated by the Richmond Fellowship, a national charitable organisation specialising in the care of people with mental health problems. The home is situated in a suburb of Dewsbury with good local amenities and easy access into the town centre.The home is purpose built and consists of 3 bungalows interlinked by glass corridors containing small conservatory areas. There are enclosed gardens to one side of the property. Each of the bungalows contains 4 single bedrooms with wash hand basins, and self-contained facilities for the communal use of residents. Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out an unannounced inspection of Trinity Street on 13.07.05. The inspection started at 11.30am and lasted 7.25 hours. The deputy manager, who is managing the home on a day to day basis in the absence of the registered manager, assisted the inspector. The following inspection methods were used: - discussion with staff, residents, management and a healthcare professional; a limited tour of the premises; inspection of records including support plans, pre-admission assessments and risk assessments; medication stock and records; food records; service user meeting minutes; complaints records; staffing rota, staff training records; health and safety records, including fire safety; some policies and procedures. What the service does well: What has improved since the last inspection? Some health and safety issues identified at the time of the last inspection have been addressed. Alterations have been made to the way staff are deployed at the home to ensure the continuity of staff and to ensure that sufficient staff are on duty to meet the needs of residents. Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 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. Trinity Street J51J01_s26333_trinity street_v238646_130705.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 Trinity Street J51J01_s26333_trinity street_v238646_130705.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, 4 Prospective residents do not have access to a statement of purpose and service user’s guide, which contains all of the information required to help them to make an informed choice about the care home. Potential residents are encouraged to visit the home before admission and preadmission assessment information is obtained. EVIDENCE: A up to date and detailed statement of purpose and service users’ guide which contains all required information will provide prospective residents with the information they need to make an informed choice about where to live. Detailed assessment information is obtained before a resident moves into the home and this forms the basis of the residents’ plan of care. Written confirmation is provided following assessment that the home can meet the residents’ needs. There is a probationary period of between 6-12 weeks before the placement is made permanent. Residents are encouraged to visit the home and to have overnight stays before a formal admittance is agreed. A resident who was recently admitted said that visits had taken place before moving into the home and assessment took place. Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 9 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, 8, 9 Residents are involved in care planning and are supported by staff to make decisions about their lives. Residents are supported to take risks as part of an independent lifestyle. Residents are consulted and supported to participate in the life of the home. EVIDENCE: Care plans and risk assessments are started during pre-admission visits to the home. Care plans and risk assessments for two residents were inspected and were detailed and easy to read. These are kept under review. Some records had not been signed, and some not dated. Records should be dated so that the currency of the information is clear. Also, where there is space for significant people to sign records, for example, residents or the project manager, signatures should be obtained. Where residents do not wish to sign this should be recorded. Residents meetings provide an opportunity for residents to be consulted on and contribute to a range of issues related to the running of the home. Residents receive feedback about the outcomes of their involvement through the minutes of the meetings. It is recommended, however, that where action is being taken to address issues raised, the date any action was taken together Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 10 with the name of the person responsible and any outcome should be recorded so that residents are kept fully informed. Residents said that they feel supported by staff who help them to make decisions about their lives. Two residents said staff had supported them to make their private accommodation comfortable and reflect their tastes and interests. One resident said that staff supported him to use ordinary, community-based services. Where limitations are placed on residents these are risk assessed and recorded. Staff spoken to had a good understanding of residents’ support needs as recorded on personal support plans. Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 11 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) 17 Nutritional advice is sought for residents when necessary to ensure a satisfactory diet, but records do not show whether the meals provided for residents are balanced and nutritious. EVIDENCE: The acting manager said that the home provides one hot meal a day and residents are supported to choose and shop twice weekly. Residents can choose to buy and cook their own meals if they prefer. The cooking club has restarted where each week residents take it in turns to choose a meal, shop for the ingredients and prepare the meal for their fellow housemates with support from staff. One resident said he had enjoyed cooking a meal for everyone which they had enjoyed eating and that he would like to cook for everyone again. Fresh fruit was available for residents to help themselves. Following a previous requirement, a record of food taken throughout the day has been introduced, but there were numerous gaps in recording. This must be addressed so that a detailed record is available to determine whether residents are provided with a nutritious, varied and balanced diet. Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 12 A resident, who had received advice from a nutritionist, showed the inspector a list of foods that can be enjoyed and those that should be limited to ensure a satisfactory diet. Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 13 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 Current residents attend to their own personal hygiene needs. The residents have access to a range of services that ensure their physical and emotional health needs are met. The residents, where able, may manage their own medication in accordance with the home’s policies and procedures. EVIDENCE: Current residents attend to their own personal hygiene needs. They choose how to dress and appearance reflects individual tastes. It was evident from records and discussion with residents, staff and a visiting healthcare professional that residents’ physical and emotional healthcare needs are met. A visiting member of the Assertive Outreach Team commented positively on the work that staff do with residents at Trinity Street. Where residents are able, they are supported and encouraged to retain responsibility for their own medication. Policies and procedures are in place and residents who control their own medicines sign a contract for doing so. Secure storage is provided in individual bedrooms. Samples checked tallied with records held with the exception of one sample of Aspirin where one tablet was unaccounted for. The inspector was concerned to find that some tablets Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 14 given to a resident were left unattended on a coffee table. Staff need to be more vigilant when administering medication to residents so that tablets are not left lying around. Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 15 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 The registered provider takes complaints seriously and acts upon them. Some processes are in place to protect residents from abuse, but all staff need to receive formal adult protection training to ensure that residents are protected from the potential risk of abuse. EVIDENCE: Complaints information was on display in the entrance area. Some residents spoken to had used the procedure and were satisfied that their concerns had been listened to and acted upon. A newly admitted resident said that he was aware of how to make a complaint should he wish to do so. A record of complaints is maintained at the home. Policies and procedures on adult protection are available. An ongoing adult protection issue was being dealt with. Relevant professionals had been contacted and involved. Increased staffing was in place pending the outcome of the matter and the residents involved were receiving support. Staff have received internal training in the prevention of abuse to vulnerable adults, however, formal external training has yet to take place. The deputy manager said that an external training provider had been approached and that they were waiting for places to become available. Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 16 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, 26, 27, 30 Generally, a safe, comfortable and hygienic environment is provided for residents who are able to have their own possessions around them. However, outstanding issues and those identified during this inspection could leave residents in a potentially unsafe environment. EVIDENCE: The home offers good communal space for residents. There are twelve single rooms, with wash hand basins, divided into units of four rooms in three interconnected bungalows. Each bungalow has a lounge and dining/kitchen area. Residents’ bedrooms reflected their personal tastes and interests and those spoken to said they liked their rooms and that they were comfortable. Bedrooms doors are fitted with locks and secure storage is also available. It was difficult to gain access to a locked vacant bedroom as the override mechanism was worn. The lock must be replaced before a resident uses the room, to ensure that, in an emergency, staff can gain access to the locked bedroom. The pillows in one of the bedrooms seen were stained and these must be cleaned or replaced. A recommendation regarding bedroom furniture has been carried forward as not all of the furniture recommended in the National Minimum Standards for Adults is provided. Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 17 There were no unpleasant odours in the home. Since the last inspection a daily checklist has been introduced to inform staff of communal areas that need cleaning. However, some areas of the home such as skirting boards, radiators and cooker hoods were not clean and gave the home an uncared for appearance. It is recommended that a cleaning schedule covering all areas of the home be implemented to maintain satisfactory levels of cleanliness and hygiene. A light shade was missing in one of the bathrooms seen and this should be replaced. The box enclosing pipe work to the toilet in the shower room was damaged and the paint chipped. This must be addressed to ensure that satisfactory hygiene standards and safety can be maintained. The inspector was informed that discussions have taken place with a quantity surveyor and quotations were being obtained regarding the shower cubicle. Residents have raised difficulties with the shower cubicle on a number of occasions and it is important that this ongoing issue is resolved without further delay. There have been ongoing concerns about water temperatures at the home. The deputy manager explained that someone was visiting the home during the week of the inspection to put mixer valves in place to ensure that water is delivered close to 43 degrees Celsius. A letter requesting the work was provided to the inspector. There are spacious grounds surrounding the property, which residents can access for outdoor activities such as barbeques. A greenhouse is also available. The grounds were in need of attention; the grass was overgrown and there were items of debris, which could pose a health and safety hazard. The deputy manager explained that a gardener was due to start work at the home and would be responsible for maintaining the garden area. Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 18 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, 33, 35 Staffing levels were sufficient to meet the current needs of residents. Generally, staff were meeting residents’ current needs in a skilled and effective manner. EVIDENCE: It is positive to note from discussion with the home’s NVQ assessor that NVQ training is ongoing and that the minimum 50 target for care staff to have achieved an NVQ care award at level 2 or above is almost met. Some staff have yet to start NVQ training. A range of relevant training has been provided to staff. The deputy manager said he was to attend first aid training in the near future. However, the staff training record had not been updated, so full training information was not available. Some copy certificates of relevant basic training were seen and staff spoken to confirmed that relevant training such as NVQ, food hygiene, movement and handling and fire safety had been provided. Staffing levels have been increased on a temporary basis because of an ongoing adult protection issue. Staffing levels are currently 3 on the morning and afternoon shift plus management and two wakeful night staff. Staffing levels are usually 2 support workers morning and afternoon with one wakeful and one sleeping in support worker throughout the night. Staff vacancies are Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 19 being recruited to and existing staff and agency staff cover vacant shifts. A member of staff said that staff morale had improved recently and that staff were working well as a team. Staff were seen to respect and interact with residents in a skilled and positive manner. Residents said that good relationships existed with staff and that staff supported them with activities of daily living. Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 20 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) 42 Generally, residents’ health, safety and welfare is promoted and protected. EVIDENCE: The service provider has a comprehensive set of policies, procedures and records for health and safety. A resident said that he felt safe at the home. A member of staff is competent to train staff in fire safety. Records and discussion with staff indicate that fire safety training and drills have taken place and is ongoing. However, a record should be maintained of the content of fire safety training and those receiving the training should sign an attendance register as confirmation of training received. Fire safety checks are carried out, but there were some gaps in recording these. Fire safety equipment is serviced. A fire risk assessment is in place. No fire doors were propped open at the time of the inspection. First aid equipment was available, but not all staff have received first aid training as previously required and this must be addressed. Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 21 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 1 3 x x x Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 2 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 1 x 2 1 x x 1 Standard No 11 12 13 14 15 16 17 x x x x x x 1 Standard No 31 32 33 34 35 36 Score x 1 1 x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Trinity Street Score 3 3 1 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 1 Regulation 4 Requirement The service provider must produce a statement of purpose, which meets the requirement of the schedule. (Timescale of 30.11.04 not met.) Records must be kept of the food provided for service users in sufficient detail to enable any person inspecting the record to determine whether the diet is satisfactory, in relation to nutrition and otherwise, and of any special diets prepared for individual service users. (Timescale of 15.05.05 not met.) Action must be taken to ensure that: (a) medication stock can be reconciled with records held; (b) staff are vigilant when medication has been administered to residents so that medication is not left lying around Stained pillows must be washed or replaced; the box surrounding the identified toilet must be repaired or replaced; Action must be taken to ensure that hot water is delivered at a temperature around 43 degrees Celsius. (Timescales of 15.11.04 Timescale for action 24.08.05 2. 17 17(2) Schedule 4(13) 17.08.05 3. 20 13(2) 17.08.05 4. 24 16(2)(c) 24.08.05 5. 27 23(2)(j) 24.08.05 Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 23 and 31.05.05 not met.) 6. 7. 30 32 23(2)(d) 13(4) All parts of the care home must 17.08.05 be kept clean. Suitable arrangements must be 07.09.05 made for the training of staff in first aid. (Timescales of 31.01.05 and 30.06.05 not met). Existing staff vacancies must be 07.09.05 recruited to. (Timescale of 15.06.05 not met). 8. 33 18(1)(a) (b) 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. Refer to Standard 6 8 Good Practice Recommendations Records should be signed and dated. Where residents do not wish to sign records, this should be recorded. Where action is being taken to address issues raised by residents, the date any action was taken together with the name of the person responsible and any outcome should be recorded on any action plan attached to the minutes of residents meetings, so that residents are kept fully informed. The service provider should increase the level of training provided on the prevention of abuse to vulnerable adults. This recommendation is brought forward. The privacy lock to the identified vacant bedroom door should be replaced before a resident occupies the room. The lock should have an override facility to allow staff access in an emergency. Light fittings should be fitted with light shades. This recommendation is brought forward. The external grounds should be maintained to a satisfactory standard. Facilities in residents’ bedrooms listed under standard 26 of the National Minimum Standards should be provided to each resident unless it is agreed otherwise in the person’s individual plan, or it has been identified as in the persons best interests. If resident bedrooms are not large enough to accommodate the recommended furniture, this should be acknowledged within residents plans and the homes statement of purpose and service users guide. J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 24 3. 4. 23 24 5. 6. 7. 24 24 26 Trinity Street 8. 27 9. 10. 11. 12. 30 32 42 42 The shower cubicle in bungalow 29 should meet the needs of current service users.The registered person should explore how the shower cubicle in bungalow 29 could be increased in size. A cleaning schedule should be introduced to ensure that alll parts of the home including skirting boards, radiators and cooker hoods are kept clean. 50 of care staff should achieve an NVQ level 2 (or equivalent) care award by 31.12.05. There should be no gaps in recording health and safety checks. Fire safety training records should include details of the nature of the training provided together with a record signed by persons receiving the training. Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 25 Commission for Social Care Inspection Park View House Woodvale Office Park Wooodvale Road Brighouse HD6 4AB 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 Trinity Street J51J01_s26333_trinity street_v238646_130705.doc Version 1.40 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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