Inspection on 25/01/06 for Wear Court

This inspection was carried out on 25th January 2006.

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

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

Other inspections for this house

Wear Court 27/05/10

Wear Court 17/05/10

Wear Court 16/03/10

Wear Court 18/02/10

Wear Court 11/12/09

Wear Court 30/07/09

Wear Court 01/08/08

Wear Court 08/11/07

Wear Court 01/12/06

Wear Court 13/09/05

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

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

CARE HOMES FOR OLDER PEOPLE Wear Court Rock Lodge Road Roker Sunderland SR6 9NX Lead Inspector Mrs P A Worley Unannounced Inspection 25th January 2006 11:00 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 Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 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. Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Wear Court Address Rock Lodge Road Roker Sunderland SR6 9NX 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) 0191 5496441 0191 5485305 Moorlands Care Homes (N.E.) Limited Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th September 2005 Brief Description of the Service: Wear Court Nursing Home provides nursing and personal care for 30 older people. The home is situated in a residential area of Sunderland approximately 50 metres from the sea front and within easy reach of public transport facilities. The three-storey house was originally a residential dwelling and was converted to a care home in 1993. There is a passenger lift, which provides access to most areas of the home. A stair lift provides access to several bedrooms on the first floor that are inaccessible via the passenger lift. There are twenty-seven bedrooms, four of which are double and are currently used as single rooms. Eight single and two double rooms have en-suite toilet facilities however, some are not of a suitable size to allow access for wheelchair users or people with mobility difficulties. Corridors and door widths are wide enough to allow access for wheelchair users. The laundry, kitchen, dining room and lounge areas are all on the ground floor with the majority of bedrooms on the upper floors. There is a conservatory to the rear of the building, which overlooks the private and mature gardens. Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day by one Inspector. Time was spent talking with residents and staff. Three visitors who attended during the inspection were also spoken with. Inspection of a sample of records was undertaken that included care plans, medication records, complaints records, staff files and residents personal allowance records. Time was also spent looking around the building to check the facilities and equipment available for service users and the general maintenance and safety of the Home. A new Manager has started work at the Home since the last inspection. She has spent time assessing the care and service provided by the Home and has identified the priority areas that need improvement and development. All but one of the requirements from the last inspection have been dealt with, the outstanding requirement is concerned with the decoration and refurbishment of the Home. However the timescale set by the Commission for this has not yet been reached. The recommendation to improve the presentation of the information ‘package’ about the Home, for service users, has not yet been dealt with. What the service does well: What has improved since the last inspection? A new Manager has been appointed and was said by residents to be “tremendously helpful”, very friendly and approachable” and very nice, seems to be getting things done”. Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 Page 6 Whilst little progress has taken place with the decorating and provision of new furniture and furnishings, one lounge has been decorated and two sets of new curtains have been provided in two lounges. 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. Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 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 Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 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 & 3. The Home’s Statement of Purpose and Service Users Guide do not yet provide the up to date information about the changes in the Home. The Service Users Guide is not available with the up to date information to enable potential service users to make an informed choice about whether to move into the Home. And, the information has not yet been given to current service users. Service users have their needs assessed and identified by appropriate persons prior to and on admission to the Home, and the Home confirms that their needs can be met before being admitted. Intermediate care is not provided by the Home (Standard 6). EVIDENCE: The Home’s Statement of Purpose and Service User Guide had been amended at the last inspection to reflect the new owner and Responsible Individual for the Home. They need to be further amended to include information about the new Manager and any other changes that have taken place. They had been prepared in large print but still have not yet been produced in a more userfriendly and interesting format suitable for service users. Individual copies are still not available to potential and current service users. Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 Page 9 Inspection of service users care files showed that Care Managers, and the Home, carry out appropriate assessments prior to a service user moving into the Home, Subsequent assessments are carried on admission and as necessary for individuals’. Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 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. Residents appeared well and spoke of staff meeting their health and personal needs. Service user’s care plans are in place but still do not fully reflect and document all their observed needs and the effectiveness of the care given. This can limit the guidance available regarding care practice and consistency. The systems in place for dealing with medicines are satisfactory but the medicine administration records are not and therefore do not ensure that resident’s medication needs are met. Staff at the home support residents with their social, health and personal care needs in a way that treats them with respect and generally promotes their rights and dignity. EVIDENCE: A sample of residents’ care plans was looked at. Appropriate assessments were in place and plans of care drawn up from the assessment of known needs. However, not all were fully completed, and dated and signed, which does not therefore give adequate and accurate information. Health and other care related risk assessments were evident and input of GP’s and other Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 Page 11 professional, for example the nutritionist. Daily and weekly progress statements are written and monthly evaluations carried out. However, the statements often indicated that the care needed was carried out rather than how effective the plan of care was. The statements were therefore ‘monitoring’ and not evaluating the care. The Manager is currently introducing a new care plan format and the process of transferring residents care records onto this system has only just begun. Discussion took place with the Manager and a Registered General Nurse (RGN) who was present, about how the quality of the documentation could be improved and of the opportunity for the new recording format to assist with this. In conversation with the Manager, nurses and other staff, they displayed a good knowledge of individual residents and their needs, including health care needs. They were able to say how those needs would be met and how identified risks were managed. Residents who were spoken with described how their health care needs were met. One resident said, “they look after my health care very well”, and a relative who visits daily said, “ my mother’s health needs are well catered for, I have no worries”. A policy/procedure is available for staff guidance on the control of medicines in the Home. A twenty-eight day cycle monitored dosage system (MDS) is used. Medicines received are checked, signed and dated on receipt however, balances of tablets carried forward from the previous month were not stated, dated or signed in most cases. Some hand written transcribed instructions on the Medicine Administration Records (MAR) medicines did not have signatures, or were specific about quantities or dosages. The codes used to explain why medicines were not given were variable in how they were used and the recordings on the MAR sheets were generally inconsistent by nursing staff. On receipt of the original prescriptions, staff currently write down the medicines prescribed. It was recommended that a photocopy of the original prescription be taken as a more reliable way of keeping a record of medicines prescribed for individuals. An appropriate service contract is in place for the disposal of medicines including controlled drugs. An audit trail of some medicines in stock against the MAR sheets was satisfactory. Residents described how staff maintained their privacy and dignity. They also confirmed that they were treated respectfully and in a kind manner by all members of staff, especially when personal care was being carried out, such as bathing. Staff were observed to treat residents, when carrying out care procedures and in general conversation, in a sensitive and respectful manner. Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 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. Residents are offered opportunities, and are encouraged, to participate in social activities, as and when they choose, although the variety of choices offered by the Home are limited at present. Links with families, friends and the community are maintained and encouraged and service users are supported in making choices about their daily lives. EVIDENCE: There is no specific Activities Co-ordinator employed at present, the function of arranging activities and social events falls to care staff. The Manager indicated that she would be looking to appoint a specific person for this post. A number of residents who were spoken with said they were able, and happy to provide their own entertainment with activities such as cards, games, watching television, reading and chatting. Some residents said that the staff often walked with them down to the seafront, and they also spoke of having entertainers in the Home and of going out with relatives. Some residents spoke of activities and that they preferred or just having a quiet time watching television or just chatting. A number of residents remained in their own rooms pursuing interests of their choice. Residents who prefer this life style said staff respected their wishes to spend time as they wished. They also confirmed that they choose what time they wish to retire Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 Page 13 and rise, have baths, and where they spend their time, and staff supported them in this. Visitors are welcome at any time and this was observed during the inspection, as visitors came and went at times to suit the residents and themselves. Residents and relatives confirmed that there were no restrictions on visiting and that they were able to receive visitors in private if they wished. Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 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. The Home has a satisfactory complaints procedure, which ensures that complaints are handled objectively, and residents and relatives indicated that their concerns are listened to, taken seriously and acted upon. EVIDENCE: A satisfactory complaints procedure is in place and is also available in residents’ bedrooms. The Manager indicated however, that the procedure would be reviewed along the general review of all policies and procedures in the Home, in due course. A suitable format is available in a hard-back book to record complaints, with appropriate headings, but no complaints have recently been made. Day to day concerns or comments are dealt with as they occur and are not recorded as complaints, but where relevant are recorded in individuals’ care files. It was recommended to the Manager that these be recorded as a register to assist with the monitoring of complaints as part of the quality monitoring of the service in the Home. No complaints about the Home have been received into the Commission. Audits and monitoring of complaints are to be included in a quality assurance system to be developed by the Manager. Residents, who were spoken to, said they knew who they could go to if they had a complaint to make and felt confident the Manager and staff would deal with them appropriately. Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 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): 19. Limited progress or improvements have been made to the maintenance, decoration or refurbishment of the Home. The poor quality of the décor, furnishings places residents and visitors at risk as the Home does not provide them with a safe, comfortable or pleasing environment in which to live or visit. EVIDENCE: Since the last inspection, very little progress has been made with the planned, major refurbishments of the Home. Although the timescale set by the Commission at the last inspection has not been reached, the Provider had offered timescales in his action plan but these have not been met. Only one lounge has been decorated, and light bulbs replaced in the chandelier where there were none at the last inspection, and new curtains have been provided in two lounges. One vacant bedroom was in the process of being decorated at the time of the inspection. All other areas of the Home remain in need of major maintenance, decoration, and furniture replacements, where appropriate. The worn, dirty and unsightly armchairs are still in the lounges Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 Page 16 and although some have been covered with ‘throws’, remain a potential health and safety hazard to residents, as they cannot be effectively cleaned. The wallpaper is coming off the walls in many places and the wooden furniture is in need of painting or re-varnishing. The paintwork in a number of toilets and bathrooms needs renewing and the general poor state of the paintwork throughout does not enable effective cleaning to take place and is therefore a control of infection risk. The lighting level at one end of the dining room is still dim and no evidence was available that the lux lighting levels had been checked as required from the last inspection. The dining room furniture is not of a design suited to the needs of frail older people or staff assisting them. In one residents bedroom the french windows are in need of maintenance as they do not open easily. The step leading from them to the outside is too steep for an older person or anyone requiring assistance, to use. This is potentially dangerous and also restricts the ability for this resident to go outside the room, as the resident indicated a wish to do in warmer weather. Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 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): 28, 29 & 30. The nursing staff, and a good level of care staff are appropriately qualified, and have received training in relation to the safety and care of residents living in the Home in order to meet their needs. The procedures for the recruitment of staff provide the safeguards to offer protection to people living in the Home. EVIDENCE: Ten of the thirteen care staff are qualified at NVQ Level 2, one is currently doing the training and the other two are still to commence the training to achieve the qualification. The Manager has assessed the training needs of staff and has developed an up to date training programme to include health and safety, moving and handling, fire safety, infection control, and protection of vulnerable adults. This training is scheduled to commence in early February and run through until April when all staff should have attended. Training in food hygiene and handling for all staff has commenced. Training in clinical issues such as tissue viability, wound management and pressure and leg ulcer prevention will commence in June and will be taken up by nursing and care staff. All care staff are scheduled to do first aid training commencing in April and it was recommended that nursing staff also do this training. In the afternoon of the inspection an in-house training session for care staff took place on Diabetes. Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 Page 18 Only one member of staff has recently commenced work in the Home. The staff file was inspected and contained the appropriate application, qualification checks and information and security clearance checks from the Criminal Records Bureau (CRB), and two references. Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 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, 33, 35 & 38. The Manager has an appropriate qualification and the experience to manage the Home, but needs to gain a further qualification in management, and apply to the Commission for registration as manager. No systems to are in place to determine the quality of the service provided by the Home, and ensure that it is run in the best interests of the residents. An adequate system is in place and functions satisfactorily, to safeguard service user’s personal allowances. Records are clear and adequately documented. Staff follow safe working procedures in most cases but some fire prevention and accident prevention practices and facilities do not fully promote and protect service users’ health, welfare and safety. EVIDENCE: Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 Page 20 The new Manager has been in post for eight weeks. She is a Registered General Nurse (RGN) and has many years of varied nursing experiences. She has had experience as a Deputy Manager in two nursing homes and has a good awareness of the responsibilities of running and managing a care home. She is currently making enquiries about attending an appropriate training course for the Registered Managers Award qualification. And, an application must be made to the Commission to become registered manager. Since commencement in post, the Manager has been making assessments of the care and service provided to residents, and other issues such as the environment of the Home. She has prioritised the areas of most need within her area of responsibility, and some are mentioned in other sections of the report. Staff, residents and relatives who were asked said she was very approachable, helpful and had settled into the home well. Comments received included: “we’re doing some good training now”, “she’s made a big difference” and “ we see her all the time”. There are currently no formal or structured quality assurance systems in the Home to monitor its service provision. The Manager has indicated that she has already identified some audit formats and will be introducing some systems in the near future. Inspection of residents’ personal allowances that are held by the Home was made. All personal allowance monies are brought into the home for residents by their relatives and signed receipts are issued to them, with copies kept. Each resident has an individual record sheet for all transactions and monies are kept in individual containers. Individual receipts for each resident are obtained from the hairdresser, however these are not signed, and also the chiropodist. Although an audit of two residents’ monies and records could be successfully carried out, it was suggested that the receipts be numbered and recorded as such on the individual records, to assist with audits. Although staff have received training in health and safety, and practices in this area were generally satisfactory, the practice of leaving keys in the doors of rooms where potentially hazardous items are kept, must not take place as this poses an accident hazard to residents. Some equipment failures were also presenting potential hazardous risks. For example, a ‘Dorgard’ self-closure device in one residents room did not work but was still in place and the door was choked open: the door handle was broken and did not function on a frequently used toilet door, a mechanical extractor fan in another toilet was extremely noisy and malfunctioning and a wardrobe and glass cabinet in one resident’s room needed to be secured to the wall to prevent an accident if pulled or fallen over. A number of other Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 Page 21 maintenance issues were identified that posed potential health and safety risks within the premises and these were identified to the Manager. Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 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 2 X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 1 X X X X X 2 2 STAFFING Standard No Score 27 X 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X 3 X X 2 Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 Page 23 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, 5 & 6 Requirement The Home’s Statement of Purpose and Service Users Guide must be up to date, prepared in a format suitable for service users and available to them. Service users care plans must be accurate and reflect all needs and how effectively they are met. Medicine Administration Records (MAR) must contain clear, accurate and consistent records of medicines at all times All matters concerned with the safe environment, décor and furnishings must be addressed within a planned programme. The Manager must apply to the Commission for Registered Manager status. The Manager must ensure that all areas of potential hazard to residents are kept locked and the keys removed. Timescale for action 28/02/06 2. OP7 15 31/03/06 3. OP9 13 (2) 25/01/06 4. OP19 23(2)(b) 31/03/06 5. OP31 8 14/02/06 6. OP38 13 (4) 25/01/06 Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 Page 24 7. OP38 23(2)(c) (4)(c)(i) Fire door self-closure devices must be maintained in working order, and wedges must not be used to prop open fire doors. 25/02/06 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 OP33 Good Practice Recommendations The development of quality assurance systems should be pursued in order to monitor the services provided by the Home. Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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 Wear Court DS0000064820.V267865.R01.S.doc Version 5.1 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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