Inspection on 30/10/06 for Underhill House

This inspection was carried out on 30th October 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Underhill House 24/02/06

Underhill House 04/05/05

Underhill House 07/10/04

Underhill House 14/05/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Underhill House Underhill Road Stoke Plymouth Devon PL3 4BP Lead Inspector Anita Sutcliffe Unannounced Inspection 14:00 30 October 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Underhill House DS0000003486.V295825.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Underhill House Address Underhill Road Stoke Plymouth Devon PL3 4BP 01752 561638 01752 606377 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) Mrs Linda Ruth Turner Mr Michael Turner Mrs Linda Ruth Turner Care Home 28 Category(ies) of Dementia (28), Dementia - over 65 years of age registration, with number (28), Old age, not falling within any other of places category (28) Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Age 60yrs Date of last inspection 24th February 2006 Brief Description of the Service: Underhill House is a Residential Care Home owned by Mr and Mrs Turner. Mrs Linda Turner is also the Registered Manager. Underhill House is a large detached property in the residential area of Stoke Village, Plymouth. The home is within walking distance of the local shops, facilities and amenities and close to the bus route into the city centre. The home provides care and support for up to 28 older people, including those with dementia. The home has 4 double bedrooms and 21 single rooms. The current scale of charges are: £326 An additional charge is made for: some transport, some in-house activities, hairdressing, chiropody/podiatry and toiletries/personal items. Information about the home is made available to all prospective service users and a copy of the most recent inspection report is available in the entrance hall. Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Information toward this key inspection was collected since April 2006. Prior to the inspection visit the home provided current information about the service it delivers. Service users (residents), staff, a GP and district nurse had the opportunity to give their views and opinion anonymously. During the two inspection visits each resident and three visitors were met. Staff were interviewed and observed in the course of their work. The home was toured. Records were examined. The care of four residents was examined in detail. The registered manager was met briefly on each occasion but was unable to take part despite her wish to do so. As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk. What the service does well: What has improved since the last inspection? Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 6 The home have decided not to provide locks on residents’ bedroom doors, but the Service Users’ Guide now makes it clear that they will be made available if wanted. What they could do better: A staff member said: “No changes are needed at Underhill. Residents are happy. This shows change is unnecessary”. Whilst residents were found to be happy risk should have been better managed at the home to the benefit of both residents and staff alike. Following feedback regarding this, the manager took immediate steps to address the concerns raised. The concerns included: • • • • • • • • Bath water running very hot, posed a risk from scalds. The temperature control valves, already purchased, were not yet fitted and staff information was incorrect. Staff were routinely lifting a resident from a low bed to a wheelchair. This practice posed a risk to the resident and staff alike. Soiled linen was being hand sluiced; clean linen was being stored in close proximity. This increases the likelihood of cross infection. Staff were using fabric towels, not disposable, after hand-washing. This increased the likelihood of cross-infection. Records, including the assessment of risks, did not show that the risk had been fully thought through, although in some cases it had been. Staff did not have ready access to information about chemicals in use at the home although the information was in the office. Contact details for the Local Authority Adult Protection team were not included in the whistle-blowing policy. Some assessment of need was insufficient, the most important being that of falls, moving and handling and nutrition/dietary needs. Written information, to inform potential residents about the home, must be reviewed. Some is unclear, some incorrect. Residents are not receiving confirmation that their assessed needs can be met at the home. This confirmation protects them. This has been an ongoing requirement. 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. Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 & 3 (6 does not apply to Underhill House) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are unable to make a fully informed choice about the home from the written information available to them. They are not protected through the home’s assurance that their assessed needs can be met. Care needs are met following assessment and planning. EVIDENCE: Residents are supported and helped to adjust to moving to the home. Each had their needs assessment, either through the Local Authority or the home itself. The home’s assessments are good in places, providing staff with some detail from which to plan their care. Discussion was held as to how they can be further improved. The home still fails to write to residents confirming that their assessed needs can be met. This is necessary for their legal protection. Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 9 Information provided to potential residents is in parts very clear and informative. However, the home’s Statement of Purpose incorrectly states that the home provides care for older people with physical disability. Most residents have contracts through the Local Authority and the additional information the home provides within the Service Users’ Guide is informative. Residents privately funded have a Service Contract with the home. Wording used gives the impression that Underhill House is a nursing home, which is incorrect. The words ‘nurse’, ‘nursing care’ and ‘matron’ are included. All written information for potential residents must be reviewed in line with regulations. Information must be clear and correct so that they are able to make an informed decision about the ability of the home to meet their needs. Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and personal care needs are met by skilled and knowledgeable staff. Care records are informative, but continue to lack adequate assessment and management of risk. Medication at the home is well managed. Residents are treated with respect and with regard for their privacy and dignity. EVIDENCE: A district nurse said: “I have complete confidence in them. You ask the staff to do something and they do – they ask if they need information to be confirmed. The care they give is excellent”. Resident surveys indicate that personal care and medical support is always provided as needed. Residents Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 11 looked well care for and records indicate that there is good contact with health care professionals. Care planning records were good in parts. Discussion with senior staff showed how well residents’ needs were actually understood. Records therefore need to reflect the true situation. However, risk continues to be inadequately assessed and recorded. This was of particular concern for moving and handling, falls, nutrition and diet. The inspector was informed that no current resident has the desire or capability of safely handling their medication. This is therefore done for them. Medicines are safely stored. Records are orderly and clear. Staff have received training in the handling of medication and further training is already arranged. The handling of medication is done diligently and professionally. Residents said they are treated with respect at all times. Staff were observed being friendly but polite. Current residents have chosen not to have locks fitted to their bedroom doors for privacy, but this option must be available to each new resident and reviewed regularly for existing residents. (See also the Environment section, Standard 19). Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to lead fulfilled lives, with expectations and preferences met. They receive a diet which they enjoy and which meets their nutritional and health care needs. EVIDENCE: One visitor said: “You can visit any time”. Another said: “I pop in and out”. There are no visiting restrictions and regular visitors are made to feel welcome adding comments: “The place is homely and comfortable”; “My friend seems very happy here”. There are regular social occasions which families are invited to support. These have included a themed BBQ and an Easter bonnet parade. A Christmas party is planned. Regular activities in the home include gentle exercise, arts and crafts, quizzes, bingo and musical entertainment; this was observed during the inspection. Residents also have the opportunity to go out for events. There was a recent theatre trip and a Christmas shopping trip is planned. Residents say they are able to make daily choices and staff seem genuine in their wish to help residents achieve what they want. They work closely with Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 13 family, keeping them well informed. The records of two residents state their chosen religion and their wish to follow their faith. This has been achieved. Residents’ comments about food include: “The food is excellent”. “The food is good. I’m a fussy eater but they do their best” and “The food is wonderful. I’ve put on 8lbs. since I got here”. One said the food was good “now and then”. Where adequate diet is a concern staff monitored this well. However, care records do not provide enough detail of the dietary needs/wishes or how those needs are to be met. Residents said they are happy with the amount of choice they have for meals and records of resident’s meetings indicate that this is discussed with them. Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from the home’s approach to handling complaints. Residents are protected from abuse. EVIDENCE: Neither the home nor the Commission have received any complaints about the service. The home’s complaints policy is clearly written and available to all residents in the guide given to them on admission and kept available for them in their room. This guide also gives the contact details for the Commission and for advocate agencies such as Age Concern, thus protecting them further. Surveys indicate that residents feel very comfortable about approaching the manager if they have a concern and staff listen and act on what they say. Staff said that they have received training in how to protect vulnerable adults from abuse. Two spoken with were confident and correct in their knowledge of how to respond to any concerns they might have. Staff receive a copy of the whistle-blowing procedure, but it does not include the contact details for the Local Authority Adult Protection team. Should staff wish to disclose concerns they need this information to do so. Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents benefit from a comfortable, clean and homely environment, but health and safety could be further improved. EVIDENCE: All areas of the home were visited. It is well maintained and there is an ongoing programme of upgrading. Residents benefit from a choice of lounge areas. They say they are very satisfied with what is provided. Bedrooms are cosy and made homely. The Service Users’ Guide makes it clear that door locks and lockable storage space will be made available if wanted. Current residents have signed to say they do not want them. They must be provided should it be requested, with associated risk assessed and managed. Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 16 A visitor said: “Cleanliness is excellent” and a general practitioner commented on the cleanliness of the home. On both visits the home was fresh and clean. The laundry has a good supply of equipment. Despite this staff are hand sluicing soiled linen. As clean clothes are stored immediately above, this increases the likelihood of cross infection. The registered manager said there were plans to reorganise the laundry in the near future and was made aware that clean and soiled laundry should be separated. Staff currently use fabric towels to dry their hands following personal care to residents. Disposable towels are recommended as they reduce the risk of cross infection. Paper hand towels had been provided in one room before the inspection was complete. Otherwise the standard of hygiene at the home is good. Pressure relieving equipment is provided and, with good care practice, is successfully preventing pressure sores. Staff say that a hoist has, when necessary, been made available to assist them with moving immobile residents. Currently a resident, with no ability to stand or assist with movement, is being cared for in a low bed. Some equipment is available to move him, but this does not include a hoist. The current moving and handling practice for this one resident is posing a risk to staff and the resident alike. (See also Standard 38). Bath water was checked and proved to be extremely hot. This poses an unacceptable risk in a home where residents have dementia. Staff currently take and record the temperature when assisting a resident to bath. However, the bathing policy gives the impression that there is already a temperature control valve, which restricts the temperature; this is incorrect. The registered manager says that the necessary valves have already been purchased and will be fitted by mid February. Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 17, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers, knowledge and skill mix of staff are appropriate to meet the needs of current residents. Residents are protected by robust recruitment practice. EVIDENCE: A resident said: “I am very pleased with the level of attention I have received”. A district nurse said: “There are always plenty of staff in the home, plus a member of staff is allocated to go with me when I visit. The staff level of competence is good”. A visitor felt that there are enough staff, adding that staff always answer the door promptly. Staff themselves said they have enough staff allocated and there is little staff absence. Staff comments on training include: “We get a lot of opportunity for training and lots of staff go” and “Training is very good. Courses go on the board and you can go if you want”. The home reports that 50 of staff have achieved the National Vocational Qualification (NVQ) in care, which is a recognition of their level of competence. Recent training of staff includes, diabetes, infection control, continence care and care of the dying. Currently some staff (not involved in direct resident care) do not receive moving and handling training, but this training is already arranged. Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 18 The recruitment records of two recently appointed staff were examined. Records were clear and orderly with all necessary checks taken to ensure that staff employed are suitable to work with vulnerable adults. Staff are also given codes of the conduct expected of them. Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed with the wellbeing of residents in mind. The importance of health and safety are understood and managed but could this could be further improved. EVIDENCE: Residents consider the manager in high regard. A general practitioner said: A well run, caring and clean home”. A staff member said: “I have full support at all times from the owner and deputy manager”. Another said: We work well as a team”. Another: “We can always talk to our manager if any problems arise. They are always there to listen and help”. All survey responses from staff were positive. Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 20 Staff take a professional approach to their work. They demonstrate commitment, knowledge and a keenness to do their work well. All are very supportive of each other and committed to resident welfare. Residents, family, staff and others with involvement in the home, are given the opportunity to comment on the service, and influence what happens. There is also a regular external quality audit undertaken. These measures demonstrate an excellent approach to ensuring a quality service. Maintenance and servicing at the home appear to be satisfactory. Staff training is considered important and encouraged and includes health and safety. However, there continues to be a shortfall in how risk is assessed and managed. Bath water runs at an unsafe temperature, but has not been risk assessed or the risk reduced. (See also Standard 19). Staff are, in one case, having to move a resident in a way which poses a risk to him and themselves; moving and handling practice needs to be reviewed. Information about chemicals needs to be more readily available to staff, in case needed in an emergency. Risk assessment records were generally poor, although most actual risk was understood and well managed. Moving and handling, falls, nutritional assessment, and bathing assessment records must be improved. There has been an ongoing requirement to do this. Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 4 X 3 X X 2 Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 4 Requirement Timescale for action 31/01/07 2 OP3 14 3 OP7 15 The registered person shall compile in relation to the care home a written statement (the Statement of Purpose) which shall consist of: a) a statement of the aims and objectives of the care home b) a statement as to the facilities and services which are to be provided by the registered person for service users; and c) a statement as to the matters listed in Schedule 1 (This refers to inaccuracies in the current information provided) The Registered Manager must 31/01/07 write to the resident/relative to confirm in writing that they are able to meet those assessed needs. This requirement has been outstanding since May 2005. Comprehensive risk assessments 31/01/07 must be completed by the senior staff for each resident in keeping with the assessed needs as written in the care plan. DS0000003486.V295825.R01.S.doc Version 5.2 Underhill House Page 23 4 OP38 13 (5) 5 OP38 13 (4) (c) (On this occasion this refers to falls, moving and handling and nutritional assessment). This requirement has been outstanding since May 2005 The registered person shall make 31/01/07 suitable arrangements to provide a safe system for moving and handling residents. (This refers to the need for staff to manually move a non weight bearing resident from a low bed to a wheelchair) The registered person shall 14/02/07 ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. (This refers to: • Moving and handling of service users without the use of mechanical aids. • Prevention of scalds from hot bath water where there is no temperature control valve fitted.) 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 4 Refer to Standard OP2 OP18 OP22 OP26 Good Practice Recommendations The Service Contract should not give the impression that the home provides nursing care. It should be reviewed in line with Office of Fair Trading guidelines. The whistle-blowing policy should include the contact details for the Local Authority Adult Protection team. The home should have the equipment necessary to promote independence and well being, in this case a hoist. Infection control should be managed in line with Department of Health Infection Control Guidance for Care Homes June 2006. DS0000003486.V295825.R01.S.doc Version 5.2 Page 24 Underhill House 5 OP38 Information about chemicals used in the home should be readily available to staff in case of emergency. Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Underhill House DS0000003486.V295825.R01.S.doc Version 5.2 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. 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!