Inspection on 07/09/05 for Wardley Street

This inspection was carried out on 7th September 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 9 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wardley Street 05/06/07

Wardley Street 11/07/06

Wardley Street 24/05/05

Wardley Street 25/01/05

Wardley Street 31/08/04

Wardley Street 24/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Wardley Street 2 Wardley Street London SW18 4LU Lead Inspector Sharon Newman Unannounced 7 September 2005 09:50 th 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. Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Wardley Street Address 2, Wardley Street London SW18 4LU 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) 020 8875 1293/133 Odyssey Care Solutions for Today Ms Comfort Bonti Care home only (PC) 7 Category(ies) of Physical disability over 65 years of age (PD(E)) registration, with number Learning disability (LD) of places Physical disability (PD) Learning disability over 65 years of age (LD(E)) Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th May 2005 Brief Description of the Service: The home is located in Wandsworth, in a small cul-de-sac off the main road from Wandsworth to Tooting. It is situated across the main road from a day service run by The London Borough of Wandsworth, close to local shops, post office, public transport, pubs, and other amenities. Wandle Housing Association owns the building and Odyssey Care Solutions for Today, a charitable organisation manage the home. It is registered to provide care for up to seven service users with learning disabilities. The home is a purpose-built three-storey building. There is no passenger lift. All bedrooms are single including two which are wheelchair accessible and these are on the ground floor, both with en-suite facilities. The home has an open plan lounge/dining room and a patio garden to the rear. Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 7th September 2005 and was conducted by one Regulation Inspector. There are currently seven residents living at the home, The inspector was able to talk to two residents who were at the home on the day of inspection, and two staff members who were on duty. Documentation sampled included care plans, medication records and health and safety information. A tour was also taken of the premises. Staff spoken to expressed concerns about one part time and one full time post which are vacant at present. They felt it affected the residents and led to a lack of continuity of care. The home needs to ensure that there are sufficient numbers of experienced and trained staff on duty at the home at all times. Staff on duty were helpful, open and welcoming throughout the inspection visit. This home continues to provide a pleasant relaxed atmosphere for residents and those spoken to indicated they were happy. Staff spoke highly of the manager and were positive about the support offered to them by the manager at the home. What the service does well: Staff continue to maintain a good rapport with the residents and have a good knowledge of their individual needs. Residents’ needs, likes and dislikes are well known by staff. Residents independence and choice is respected and promoted at this home. The manager provides good support for staff and helps to promote a relaxed atmosphere. There is a varied programme of activities and residents are encouraged to take part in local community work projects and attend local day centres. There are very good community links at this home, some of which are provided by the Community Assist Team (CAT). The members of this team visit the home and work with residents in the community setting helping them to become more independent. On the day of the inspection a member of the CAT team took one resident bowling in the morning and another resident to the cinema in the afternoon. The resident who had been bowling expressed their happiness at taking part in this activity. Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? 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. Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.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 Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.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, 3, 5. This home continues to ensure that there are appropriate procedures for the assessment and admission of residents. A thorough assessment process ensures an effective care planning process can develop from the information obtained. Residents are consulted about moving to the home. EVIDENCE: A Statement of Purpose is in place and states that it ‘offers a men with a learning disability’. It contains information supporting service users, care plans, personal care, hobbies ‘Service Users Guide’ is available to residents and contains a Statement of Purpose. service to seven about: staffing, and interests. A summary of the Contracts were seen to be in place for the two residents whose documentation was sampled at this inspection visit. Full and detailed assessments were in place in each of the two residents files seen. The staff on duty demonstrated that they were aware of individual residents needs, likes and dislikes. Two residents indicated they were happy living at this home. Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.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’ choice continues to be respected and they are well supported by staff in achieving independent living skills. As stated in the previous inspection report a more user-friendly care planning format would be of benefit to staff and service users. EVIDENCE: Two care plans were sampled at this inspection visit and the contents were found to vary regarding content and review. Two folders are in place for each resident and contain a large amount of information about the residents. This information includes: personal details, photographs of the residents, life histories, medical and health details, financial information and risk assessments. Service summaries are also available within this documentation. A maintenance plan folder is in place and contains daily information about all the residents. Some of the information within this documentation was seen to require review. A service summary had a review date of 06/05/05 but there was no evidence of a review. Another service summary did not have a date of review. A life history in one file had not been completed and an application and assessment package had only basic details and contained one-word answers to the Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.doc Version 1.40 Page 10 questions. Many of the risk assessments were detailed and addressed issues such as community safety, overtrusting and limited communication. However, some were seen to require review to demonstrate that these risks have been reconsidered and are still valid. Care plans and risk assessments need to be of sufficient detail and kept up-to-date to indicate that residents’ needs are regularly assessed. A staff member discussed the issues involved when drawing up a risk assessment and stressed the importance of being realistic when drawing up this documentation. Staff continue to state that they do not find the care plan documentation userfriendly. It certainly appears to contain much information that could be streamlined and archived. The care planning documentation should be less wieldy and more understandable to ensure ease of use by staff. Additionally as stated in the last inspection report all care staff should receive individual training regarding care planning. However it is noted that staff within the home have begun the process of archiving some of the care planning documentation. A staff member stated that resident’s choice is well respected at this home. One resident was seen to exercise choice about deciding to have a lie-in on the day of inspection. Another resident chose to go to the cinema in the afternoon. Residents were seen to access all communal areas. There is a key worker system in place to help ensure some degree of continuity of care for residents. Residents have a monthly report compiled by their key worker which contains information about health, relationships, family and friends, success and achievements and activities. Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.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) 11, 12, 13, 14, 16 Links with the community remain good and these support and enrich resident’s social and educational opportunities. The home provides a very good environment for residents to develop their social skills. Staff encourage and support them to be as independent as possible. EVIDENCE: A staff member reported that they felt residents’ choice regarding activities is very much respected at this home. If a resident does not wish to participate in any activity they can choose not to. One resident was participating in a local community work project during the last inspection visit. However, he felt this did not suit him and has chosen not to go any more. This choice was seen to be respected by the home and staff are supporting this resident to find a more suitable work placement with the involvement of social care professionals. One resident reported that they had been bowling that morning and expressed how much they enjoy participating in this activity. A member of the Community Assist Team had accompanied this resident and was seen to be taking another resident to the cinema in the afternoon. Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.doc Version 1.40 Page 12 Evidence was seen of a variety of options for service users as regards leisure activities. Many of the residents were out participating in activities at local day centres during the inspection visit. Other activities enjoyed by residents include: going to the pub, cinema, walks and shopping. There is a television, music centre and video available for the use of residents in the lounge/dining area. Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.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) 19, 20, 21 The health and emotional needs of residents are well met and there is evidence of multi-disciplinary working with health and social care professionals. However, omissions in the administration records regarding recording of allergies could compromise residents safety as could lack of staff training in this area. EVIDENCE: Documentary evidence was seen of health and social care input from professionals including: hospital health professionals, dentists, social workers and chiropodists. A staff member reported that healthcare appointments are made for residents whenever required. There is a medication policy in place in the home and the medication cupboard was locked securely at the time of inspection. A staff signature list is also in place. The allergies section had been left blank within two Medication Administration Records (MAR), this must be completed for all residents. If they are not known to have any allergies then this must be recorded. There has been an improvement in the administration recording and no omissions were seen relating to this in the MAR sheets. Photographs of the residents were seen to be attached to the MAR sheets to allow easy identification. Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.doc Version 1.40 Page 14 A staff member reported that they have not received medication training for some considerable time. All staff must receive up-to-date accredited training in this area. A policy regarding the dying and death of a resident is in place at the home. Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.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 Policies and procedures are in place to protect residents from abuse and harm. Staff promote an open and approachable atmosphere at this home. EVIDENCE: A complaints policy is available at the home and is also available in a pictorial format. Wandsworth’s Protection of Vulnerable Adults procedures are followed at this home and a copy of this procedure was available at the home. An organisational abuse and a Whistle blowing policy were also seen to be in place. A staff member spoken to at this inspection visit was aware of the importance of these procedures and had a very good knowledge of the appropriate action to take if abuse was suspected. They gave example of different types of abuse and stated they would not hesitate to act on a resident’s behalf. Risk assessments are in place in residents’ files, although attention needs to be given to ensuring these are all regularly reviewed. Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.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, 25, 27, 28, 30 The standard of the environment within this home is good, providing service users with an attractive and homely place to live. The home is clean and hygienic. Resident’s bedrooms are comfortable and suit their needs. EVIDENCE: The home is purpose built for residents with a learning disability and promotes a homely and relaxed atmosphere. The kitchen is large and light and was clean at the time of inspection. The communal lounge/dining area is spacious, clean and bright and the furniture is attractive and solid. There is a small garden and patio area to the rear of the house for the use of residents. Issues raised in the last inspection report, including the presence of a mattress and bed base in the garden and a leaking radiator have now been addressed. Storage of items in the communal hallways has improved but some items remain on the top floor landing. Appropriate space needs to be found for items not currently in use. Any broken items must be repaired or disposed of. There is an area of scuffed paintwork in the lounge area which needs to be addressed. However, it is recognised that overall this area is very well Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.doc Version 1.40 Page 17 decorated and some wear and tear is bound to occur in a home of this size catering to residents with different levels of independence. Bedrooms were seen to be clean, well decorated and personalised to individual residents taste. There are two wheelchair accessible bedrooms on the ground floor which are spacious and bright. All bathrooms and WC’s seen at the time of inspection were clean and meet residents needs. The home was clean and hygienic and free from offensive odours at the time of inspection. Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.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, 36 Staff remain committed to delivering good standards of care and supporting residents to meet their goals. Staff are well supported by the manager and the standard of care also remains good. However as reported previously, improvements can be made regarding training to ensure all staff have up-todate knowledge in areas such as moving and handling, first aid and food hygiene. Lack of staff continuity caused by staff vacancies has the potential to affect residents adversely. EVIDENCE: Staff demonstrated a good rapport with the residents during the inspection visit and were able to discuss in detail each residents’ likes and dislikes. Regular staff meetings take place and are fully minuted, issues discussed at the last one included: health and safety, the importance of updating staff training, care plans and staffing issues. Staff raised concerns during the inspection visit that there are currently one full time and one part time staffing vacancies at the home. They felt this was affecting continuity of care for the residents who need a stable environment. The home must ensure that there are appropriate numbers of trained, experienced and regular staff on duty at all times. A staff member also Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.doc Version 1.40 Page 19 commented that they did not feel valued by the organisation. However, they said they felt supported by the manager at the home. The frequency of staff supervision has improved and a supervision chart displayed on the office wall indicates that staff are now receiving one-to-one supervision at least six times a year. Two staff spoken to stated they receive regular supervision. One staff member stated they were completing the Learning Disability Award Framework foundation course and found this training helpful. Although it is acknowledged that staff training in mandatory areas is taking place, evidence could not be seen on the day of inspection that all staff are upto-date in moving and handling, first aid, food hygiene and abuse awareness. A training log for all members of staff would be useful and would help to demonstrate what training courses staff have attended. Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.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) 37, 39, 42 The home is appropriately managed and the manager is experienced. The manager continues to provide good leadership to staff. The home has still not implemented a quality assurance system this would ensure the views of the residents and their family members are sought. EVIDENCE: The manager was not on duty at the time of inspection but was spoken to at the last inspection visit. She is experienced and staff on duty stated she is supportive and approachable. A business plan was seen to be available at the home for the years 2004 – 2007. Although hot water temperatures are tested weekly, some bath temperatures remain higher than is recommended. One bath temperature was found to be 46.1 degrees centigrade and another was 47.3 degrees centigrade. Temperatures must not rise above 43 degrees centigrade. Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.doc Version 1.40 Page 21 An up-to-date gas safety certificate needs to be obtained, as the copy at the home is out of date. An up-to-date legionella testing certificate and portable appliance testing certificate are now in place. Other records relating to health and safety such as first aid box checks and a fire protection service certificate were found to be in good order. As reported in the last inspection report a formal quality assurance programme is not in place at the home yet this needs to be in place to ensure the views of the residents and other interested parties are sought. Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 x 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 3 3 x 3 x Standard No 31 32 33 34 35 36 Score x 2 3 x 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Wardley Street Score x 3 2 3 Standard No 37 38 39 40 41 42 43 Score 3 x 2 x x 2 x G54-G04 S10236 Wardley V246367 070905 Stage 4.doc Version 1.40 Page 23 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 YA6 Regulation 15 (1) (2) Requirement The Registered Person must ensure that: 1. Information in the care plans is kept under review and up-todate. 2. The Registered Person should ensure that files are archived and remove any inappropriate documentation. 3. Risk assessments are subject to the same review as the care plans. The Registered Person must ensure that the allergy section on the administration record is completed for all service users. The Registered Person must ensure that all staff receive regular accredited medication training. The Registered Person must ensure that all maintainence issues outlined in Standard 24 of this report are addressed. The Registered Person must ensure that adequate numbers of appropriately trained staff are on duty at all times to ensure the needs of the service users Timescale for action 01/11/05 2. YA9 13 (2) 01/10/05 3. YA9 13 (2) 01/11/05 4. YA24 23(2)(b) & (d) 18 (1) (a) 12 (1) (a) 12 (5) (a) 01/12/05 5. YA32 01/10/05 Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.doc Version 1.40 Page 24 are met. 6. YA35 18 (1) The Registered Person should ensure that staff training is upto-date. Refresher training must be provided for staff as required with regard to care planning, Abuse, Manual Handling, First Aid and Food Hygiene. The Registered Person must ensure that a formal system for reviewing the quality of care in the home is fully implemented. (Previous timescale of 01/08/05 not met) The Registered Person must ensure that hot water temperatures are tested weekly particularly with regard to service users safety and full body immersion - and these must not rise above 43 degrees centigrade. The Registered Person must obtain an up-to-date Gas Safety Certificate. 01/11/05 7. YA39 24 (1) (2) (3) 01/01/06 8. YA42 13 (4) 01/10/05 9. YA42 13 (4) 01/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Wardley Street G54-G04 S10236 Wardley V246367 070905 Stage 4.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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