Inspection on 15/01/08 for Walkden Manor

This inspection was carried out on 15th January 2008.

CSCI found this care home to be providing an Adequate service.

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

Walkden Manor 18/02/09

Walkden Manor 03/07/07

Walkden Manor 23/10/06

Walkden Manor 26/02/06

Walkden Manor 12/05/05

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Walkden Manor 41 Manchester Road Walkden Worsley Gtr Manchester M28 3WS Lead Inspector Elizabeth Holt Unannounced Inspection 15th and 16th January 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Walkden Manor DS0000062619.V355774.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. Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Walkden Manor Address 41 Manchester Road Walkden Worsley Gtr Manchester M28 3WS 0161 790 9951 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) Walkden Manor Care Home Ltd Mrs Sonia Jane Duffy Care Home 29 Category(ies) of Dementia (2), Old age, not falling within any registration, with number other category (29) of places Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of 29 older people (OP) requiring personal care only may be accommodated. Within the overall numbers two (2) service users who are currently accommodated are under the age of 65 and also have dementia (DE). If these service users leave the category will revert to OP. When either of the service users reach the age of 65 the category will be OP (DE). 3rd July 2007 Date of last inspection Brief Description of the Service: Walkden Manor is a residential care home situated in the centre of Walkden, Salford. The home provides personal care and support to older people. Bedrooms are situated on the ground and first floor of the accommodation with the laundry, office and main kitchen located in the basement. There is a large, flagged patio area to the rear of the home and a small car park situated at the side of the building. The weekly fees rang from £355.52 to £372.17 per week. Additional charges are made for hairdressing and for trips. Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This visit was the second key inspection conducted this year and focused on assessing progress made to address concerns identified at the earlier key inspection, which took place in July 2007. This key unannounced inspection, which included a site visit, took place over two days on Tuesday 15th January 2008 and Wednesday 16th January 2008. The manager of the home was not told beforehand of the inspection visit. All key inspection standards were assessed at the site visit and information was taken from various sources which included observing care practices and talking with residents who live at the home, visitors, members of the staff team, the manager and the home owner who was present during the course of the site visits. A partial tour of the building was conducted and a sample of care and staff records was looked at, including employment and training records, staff duty rotas and resident’s care plans. At the time of writing this report a concern/allegation has been reported of poor care practice under Salford Council’s adult safeguarding procedures. The manager has already carried out an internal investigation and the homes disciplinary procedures were followed. This has not yet been concluded fully. The term preferred by the people consulted during the visit was “residents”. This term is, therefore, used throughout the report when referring to those living at the home. The seven requirements made at the last inspection had been addressed. What the service does well: Prospective residents’ needs were assessed before they were admitted into the home. Throughout the two days of the visits the staff were seen to have good communication with the residents. One resident said, “The staff are kind and thoughtful, they look after me like my daughter would.” Staff demonstrated a good knowledge of residents’ needs and what they needed to do to make sure the needs were met. Staff members were seen to be patient and sensitive when supporting and helping residents. Residents liked their meals, and the cook knows the likes Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 6 and dislikes of the residents. She makes sure that the residents eat well and have a choice of what to eat. One resident said, “The food is always tasty and homely.” Meals served appeared to be nutritious, well balanced and nicely presented. There is a pleasant environment for the residents and three of the residents said they liked their bedrooms. The atmosphere in the home was friendly and relaxed and visitors said they were always made to feel welcome. The standard of cleaning was good and some of the residents agreed with this. The medication practices and procedures were good. What has improved since the last inspection? What they could do better: Care plans must be reviewed to make sure they include detail of the support required for the staff to support the resident’s according to their assessed needs. Appropriate risk assessments, particularly in relation to falls and personal health and safety must be provided to make sure residents’ needs are met. The ongoing recording and monitoring of resident’s weights in line with the risk assessments must be made to ensure appropriate action is taken to meet the healthcare needs of the residents. Recording in the care plans should include a body-mapping tool to ensure the staff record and report any marks or bruises and can monitor these. An approved fire safety risk assessment in line with the guidance must be in place to ensure the safety of all residents and staff. Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 7 The maintenance programme should continue to improve the environment for residents where damage from leaks had affected some of the residents’ bedrooms. 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 summary of this inspection report can be made available in other formats on request. Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 8 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 Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are given satisfactory information about the home and have their needs assessed before admission. EVIDENCE: An updated service user guide was in the foyer and contained information about the service. This contained the information required in the National Minimum Standards. Residents have an assessment of their needs carried out by the manager before admission. The assessment includes a visit to the person in their own home, or in hospital, by talking with the individual or with family members. Two residents were case tracked whose pre-admission assessments had been carried out since the last inspection. Assessments showed that a detailed assessment of needs had been carried out and this included the social and Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 10 cultural needs of the individuals. Staff spoken to felt the information they had about the individual residents on admission enabled them to meet their needs. One resident said, “I am liking it here, the staff are kind and helpful to me”. Walkden Manor does not provide intermediate care facilities. Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some shortfalls in the information provided in care plans and shortfalls in risk assessments may pose a risk to the health and welfare of the residents. EVIDENCE: Three residents were case tracked which included a resident with a dementia type illness. The care plans provided staff with information on the care needs of the residents but some further detail was needed to show the level of support to be provided by the staff and what the staff should look for in the event of there being any problems. For example, a care plan in relation to the care of a stoma, this should be expanded upon to include what care the staff would be looking for in the event of any problems arising and when they should report this. Some of the daily statements recorded showed a lack of detail. One statement was, “I noticed a couple of pressure sores on his right thigh”. A discussion highlighted the need to record this in more detail and/or to record that a referral was made immediately to the Community Nursing services. The daily Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 12 statement lacked detail as to how residents’ were supported with their hygiene needs and did not always reflect the care given. A recommendation was made for the need to make sure appropriate documentation is available for example, the use of a body-mapping tool to show any marks or bruises and particularly useful following a reassessment of a residents’ needs after a stay in hospital. A discussion with the manager showed that she had identified a training need for staff in wound care and its management and three staff had been booked on this course in March 2008. Comments made by residents indicated that they were happy with the care they received. One resident said, “The staff are thoughtful and kind, I can get up when I am ready and I do not feel rushed to get into bed at night. The staff explain clearly to me and they are very patient.” There was evidence in the care plans that residents and some relatives had been consulted about their care plan. One residents care plan showed they were assessed as being at risk of falling and at risk of self-neglect, however there were no problems identified to reflect these risk assessments. Another resident’s care plan and risk assessment was not clear in relation to pain management, however staff were seeking professional advice in relation to this resident’s needs. Failure of the staff to record the risk assessments appropriately may lead to residents’ needs not being appropriately met or managed. The records for some of the monitoring of the residents weight were discussed. Two residents cannot have their weight monitored, as the home does not have the appropriate equipment to accommodate these residents. This must be addressed as a matter of urgency to ensure the appropriate action can be taken if there is any significant weight loss. Staff must be reminded to the need to protect the dignity and privacy of the residents at all times. One resident wandered around in her underwear and used the bathroom with the door open. A discussion was held with the manager who said this resident could be challenging, however strategies must be put in place to maintain the dignity of this resident. Medication arrangements were safe and suitable, ensuring that residents have the correct medication administered by staff trained to do so. Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were provided with food, which they liked and had some opportunities to engage in the activities offered. EVIDENCE: Meal provision was good, with the cook having a very good knowledge of each resident’s preferences and dietary needs. The cook serves meals and clearly takes an interest in making sure that people eat well and have food presented in a palatable way. The meal on the day of the visit was a roast lamb dinner with vegetables, mint sauce, and a dessert of chocolate sponge and custard and diabetic fruit sponge and custard. Residents who expressed a view said the food was very good and there was always enough. Mealtimes were seen to be a sociable occasion in the two dining rooms and staff were seen supporting residents in an appropriate way. Residents spoken to were satisfied that they are able to exercise choice in their daily routines. One person said, “I love to have a lie in and enjoy a leisurely breakfast”. Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 14 Activities provided included outings, sing a longs and bingo. Residents were seen to be happy in their environment. Some residents chose to spend time in the privacy of their own bedroom and the staff respected this. One of the care workers had done the training to lead a movement to music workshop, which she planned to start in the next few weeks. A new widescreen television had been provided in the lounge and one of the residents said, “This is much better to watch Coronation Street now”. Care plans showed that some effort was made to find out the hobbies and interests of the residents. Residents were encouraged to maintain contact with family and friends; visitors were seen during the day and sometimes met privately with their relatives. Residents said their visitors were made welcome at the home and visitors spoken to confirmed this. One relative said, “My Dad is happy here and that is so important to me, he always looks clean and pleasantly dressed. I am always made to feel welcome when I visit.” Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents feel that issues they raise will be dealt with, and staff training arrangements seek to promote the protection of residents from abuse. EVIDENCE: Since the last inspection there have been no complaints or concerns raised with the Commission. A record of complaints and concerns was held by the home and a review of this highlighted a concern that should have referred as an adult safeguarding investigation. A discussion was held with the manager and action was taken to address this. From a review of the training records some staff had undertaken training in abuse awareness but the need for training in Adult safeguarding procedures was evident and the manager acted upon this immediately and arranged for training from Salford Council’s Safeguarding Adults team. Adult protection and whistle-blowing policies were in place and three staff said they were aware of these. Some staff spoken to were not clear of whom they should report an allegation to particularly if the manager was not present in the home. Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a homely environment; but some areas of the home were in need of maintenance to make the home free from risks to residents. EVIDENCE: A partial tour of the home showed that residents’ bedrooms and the lounges and dining rooms were pleasantly decorated. Bedrooms were personalised with photographs and ornaments. The hall and lounges had been newly carpeted and looked fresh, clean and bright. One resident said, “I like my bedroom it’s my home”. An immediate notice requirement for work to be carried was left following this inspection. This included the fire door at the rear of the premises, which did not close flush against its rebates and the radiator in this area, which did not Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 17 have any protector. There was a broken pane of glass in the “Old Smoke room” and a requirement for this glass to be replaced was made. Hand towels were being used in communal areas and there were no paper towels available. A discussion was held with the manager regarding the need for liquid soap and paper towels to be made available for staff and residents to minimise the risk of cross infection in the home. A maintenance programme was in place and this included the need to redecorate areas where damage from leaks had affected some of the residents’ bedrooms. Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The recruitment policies and procedures protected the safety and wellbeing of residents. EVIDENCE: The previous inspection report had highlighted the following shortfalls: improvements were required in the recording of the duty rotas to reflect the numbers and names of staff who were on duty, that several staff had not received refresher training in mandatory topics including health and safety, infection control, food hygiene and fire safety, and there was no training plan to show when training was due or had taken place. There were major shortfalls in recruitment practices identified in the staff files examined. During this visit the duty rotas were reviewed which clearly showed that the staff on duty reflected those present in the building. A recommendation was made to add the surnames of the staff on night duty. At the time of the visit there were 27 residents accommodated in the home including one resident in hospital. On the day of the visit the manager was on duty, four care workers, who were supported by a housekeeper, maintenance person and a cook. The staffing levels were appropriate to meet the needs of the residents. From observations made during the visit staff were available to meet the care needs of the residents. Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 19 Improvements have been made to the recruitment process since the last inspection. The staff files for three staff were looked at and were all found to contain a written application form, two written references and Criminal Records Bureau checks (CRB). The manager had introduced a series of questions to ask at the interview and notes were held of the responses made. A table of staff training had been developed and the manager had taken some action to arrange training to address the shortfalls. Courses had been arranged in abuse awareness, fire safety, wound care and infection control. Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Further work is needed to ensure the systems in place to monitor the care practices and record keeping is adequate, to ensure the health and welfare needs of the residents are met. EVIDENCE: Comments from the staff were positive in terms of the direction the manager is giving the home and relatives said the manager was approachable and listened to comments made. The manager has achieved NVQ4 and the Registered Manager’s Award. A discussion with the manager highlighted her enthusiasm for her role and to make improvements to the quality of life for the residents. Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 21 Since the last inspection the manager has made improvements in areas of recruitment, staff training and record keeping and this report has highlighted areas for further improvement needed in care planning, adult safeguarding and areas of the environment. The shortfalls identified highlight the need for the continued support and guidance needed to manage the home for the well being of the residents. The quality assurance system in place relies on written questionnaires and seeks the views of relatives, residents and professional bodies. The manager said there were plans to send this out soon and the results would be used to see the home’s success in meeting its aims and objectives. The Commission are notified under Regulation 37 of the Care Homes Regulations 2001 of some notifiable incidents/accidents that have taken place in the home. Accident records showed these were completed as necessary in an appropriate way. A look at the maintenance records showed that a record of the electrical periodic inspection had been carried out in March 2007. A look at the gas safety certificate showed these appliances were serviced and tested in the last twelve months. The fire safety risk assessment in line with the guidance must be validated to ensure the safety of all residents and staff. The home has a policy and procedure in place for the management of resident’s finances. It was pleasing to note that the statutory requirements made at the previous inspection had been addressed and the provider had forwarded a response to address the concerns raised. Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 22 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 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 X X X X 3 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 X 3 X 3 X X 2 Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Timescale for action 01/04/08 2. OP10 12(4)a 3. OP38 23(4) 4. OP19 23(2) An audit of the care plans must be carried out to ensure these accurately detail the actions needed by the staff to ensure all aspects of the health, personal and social care needs of the residents are met. The registered person must 13/02/08 make sure the care home is conducted in a manner, which respects the privacy and dignity of the residents. Resident’s must not be exposed to other residents, staff and visitors when using the bathroom. To make sure that staff know 26/02/08 what to do in the event of a fire, the fire safety risk assessment in line with the guidance must be validated to ensure the safety of all residents and staff. To make sure the environment is 17/02/08 safe for residents, the fire door at the rear of the premises, which did not close flush against its rebates and the radiator in this area, which did not have any protector must be addressed. The broken pane of DS0000062619.V355774.R01.S.doc Version 5.2 Walkden Manor Page 24 glass in the “Old Smoke room” must be replaced to prevent an accident. 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 OP7 OP8 Good Practice Recommendations Ensure a body-mapping tool is used to record any significant bruises/injuries so progress can be monitored. Daily entries must be linked to the care planned. To make sure the risk of cross infection to residents is minimal the use of hand towels in communal areas should be reviewed. Accurate weighing scales should be provided to make sure the recordings are accurate to monitor the resident’s weight. The manager should be supported and guided appropriately to manage the care home in the best interests of the residents. 3. OP31 Walkden Manor DS0000062619.V355774.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Central Registration 9th Floor Oakland House Talbot Road, Old Trafford Manchester M16 0PQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Walkden Manor DS0000062619.V355774.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!