Inspection on 12/07/05 for Wellfield House

This inspection was carried out on 12th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Wellfield House 21/01/09

Wellfield House 15/01/08

Wellfield House 24/04/06

Wellfield House 13/11/05

Wellfield House 06/12/04

Wellfield House 28/06/04

Wellfield House 24/11/03

Wellfield House 06/08/03

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 Wellfield House 38/42 Athol Road Whalley Range Manchester M16 8QN Lead Inspector Les Hardy Unannounced 12 July 2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Wellfield House Address 38/42 Athol Road Whalley Range Manchester M16 8QN 0161 881 9700 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) Welfield Estates Limited Responsible Individual- Mr Joseph Heifetz Bernadette ORourke Care home only (PC) 23 Category(ies) of Old age, not falling within any other category registration, with number (OP) (23) of places Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 Personal care only is provided for a maximum of 23 older people. 2 Staffing at the home must comply at all times with the minimum levels set out in the Residential Forum Guidelines for staffing in Care Homes for Older People. 3 Staffing levels must be regularly assessed depending on service users assessed needs. 4 The service should, at all times, employ a suitably qualified and experienced Manager who is registered with the CSCI. Date of last inspection 6 December 2004 Brief Description of the Service: Wellfield house is a care home that provides accommodation and personal care only for up to 23 older people aged 65 years and over The home was originally four terraced properties, which have been converted into one detached property. The accommodation for residents is provided on two floors accessed via a passenger lift and stairwells. The kitchen, laundry and storerooms are situated in the basement of the building with the main office on the second floor. There are fifteen single rooms and four shared rooms. The home has an enclosed garden at the rear of the property with seating available. Residents are able to access the garden via steps or ramps. The home is located to the south of the city centre in a quiet residential area within walking distance of the local shops. Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection, which was unannounced, was carried out by 2 inspectors on a Tuesday morning, started at 6.30 am and lasted for 7.5 hours. During the inspection, 10 residents, 6 staff and one health care professional were spoken with. The inspectors looked around the building, including the laundry and kitchen area. They also looked at all types of care records and admission procedures. Employment practices were reviewed. It was of concern that the majority of the requirements from the last inspection report had not been complied with. Failure to comply with these requirements meant that the care and safety of residents in the home, and in some cases staff as well was being compromised. This was of great concern to CSCI so immediately after this inspection the Proprietor and Area Manager for the home group were required to attend a meeting at which ongoing concerns and lack of action on these was discussed. An action plan was formulated and will be monitored. Failure to address the issue could result in further enforcement action by CSCI. During this inspection only a selection of key National Minimum Standards were assessed therefore to gain the full picture of how the home meets the needs of residents, this report should be read with the previous and any future reports. What the service does well: What has improved since the last inspection? What they could do better: How the home is managed must be reviewed. This is fundamental to the service and care provided to the residents. Without this improvement the homes practices andsystems will continue to fail residents. Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 6 The home need to develop systems for developing assessments including those for risk for residents and then developing care plans that describe how these needs will be met. Systems for the total management of medication must also be developed and implemented. The home must develop recruitment procedures that do not put residents at risk from the employment of inappropriate staff. Complaints procedures must be tightened. Specialist aids and adaptations available in the home must be available to be used and used appropriately. Lifting procedures that put residents and staff at risk must not be used. A review of how infection control in the home could be improved is needed. 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. Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 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 standard(s) 3 and 5 The non-assessment of residents prior to admission meant that the home was unaware of the residents’ needs, which meant that they could not be sure that they could meet these. EVIDENCE: There was no written evidence that residents were assessed by someone from the home prior to admission. One resident had an assessment undertaken by the referring social worker, another had not. A requirement had been made in the previous inspection report that the home must be able to demonstrate that the needs of residents could be met by the home. This requirement is reiterated. It was not clear if the home offered visits prior to admission, or residents were admitted for a trial to ensure that the home could offer appropriate care. Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7, 8 and 9 The general poor care planning meant that residents were at risk of not receiving the care they needed. Poor risk assessments put residents at risk, and in one case actual practice put both residents and staff at risk of injury. The methods for receiving and returning drugs to and from the pharmacy, together with the storage of medication in an open container in the Kitchen refrigerator could put residents at risk. EVIDENCE: There was evidence that some residents had had limited care planning undertaken but where this was over a year old no new plans were found and there was no evidence that the old plans had been reviewed. Some residents did not appear to have had any care plans written by staff at Wellfield House. There was also evidence that some limited risk assessments had been undertaken, but these were limited in detailing the risks to residents. Requirements had been made in the last inspection report regarding care planning and assessments particularly nutritional assessment, these are reiterated. In regard to moving and handling some guidance was given in the plan, which in one case was confirmed by the manager to be different from that actually Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 10 used in practice, the practice being to use a lift banned in the Back Pain Association and Royal College of Nursing’s lifting manual. The daily records for residents written by day staff during the preceding month were not available, the manager stated a resident could have removed them as they were kept in an open office. Other records were kept in an open corridor, which was said to be a non-resident area, but could be easily accessed by them. Records must be kept secure to prevent inappropriate access to confidential information. Records available including up to date night records were brief and contained repeated similar phrases such as “good night,” “slept well” and “care as planned.” It is important to be more descriptive and record what the resident actually did. This will enable staff to build a picture of the resident and to be able to demonstrate changes in condition to others such as G P’s and social Workers. The recording of the administration of medication was thorough and showed that medications were either recorded as given or if they were omitted a reason was shown. One resident was found to have been left tablets to take; staff must supervise the taking of these. Prescriptions from the residents General Practitioner went directly to the Pharmacy. These must go first to the home were the back must be signed either by the resident or a member of staff acting as their agent. A copy should then be taken and kept by the home. This will then be used to check that the right medication has been dispensed, the delivery and check being recorded in the space on the Medicine Administration Chart. The Royal Pharmaceutical Society of Great Britain recommends this procedure and the home must ensure compliance, as this will ensure that the medication received in the home is that which has been prescribed and ensure that residents are not given drugs dispensed in error. A written record must be kept of medicines returned to the Pharmacy. Medicines, which needed refrigeration, were kept in an open container in the kitchen fridge. This included an anti-biotic syrup, eye drops and insulin, including on phial in an injection pen. These items must be kept in a locked container to prevent unauthorised access or use. Eye drops did not have a pharmacy label on the actual bottle, only on the box. The home must ensure that drops have a pharmacy label on the actual container as required by The Royal Pharmacy Society of Great Britain. This will ensure that residents are given drops prescribed and dispensed for them and not given someone else’s, even if it is the same drug, because bottles are accidentally put in the box with another residents name on it, or the box is lost. Staff were recording on the box the date it was opened. Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 11 A requirement had been made in the last inspection report regarding the management of medicines. This is reiterated. Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 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 standard(s) 12 and 15 Little organised activities making the home an appropriate environment for residents who prefer to sit and talk, read or watch television. The food available was satisfactory but did not fully meet the needs of residents from ethnic minorities. EVIDENCE: Residents were able to freely move around the home spending time in a number of lounges, the garden area or their own rooms as they wished. The home organised most activities on a one to one basis, according to the manager, but little evidence of this was seen. The activities list on a notice board mentioned 2 organised weekly activities, which included hairdressing. Televisions in communal lounges were noted to be on throughout the inspection. Residents were generally complementary about the food but some residents of African Caribbean background felt that their needs were not fully catered for. The chef did say that he attempted to meet these needs but it required that the manager should work with the 2 chefs to address this need. Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 13 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 standard(s) 16 and 18 The home did not have a robust system for recording and dealing with complaints. The lack of appropriate recruitment/vetting procedures when employing new staff could leave residents vulnerable if unsuitable staff were employed. EVIDENCE: The home had a procedure and book for recording complaints. This book contained little detail of investigation and outcome, and the manager stated that a recent complaint had not been recorded. The requirement on this matter made in previous reports is reiterated. Staff spoken to were aware of the action to be taken in the event of observing or suspecting adult abuse. New staff were being employed without Criminal Records Bureau (CRB) disclosure including Protection of Vulnerable Adults (POVA) checks being undertaken. This must be undertaken for all new staff with at least a PVOA being obtained if shortages of staff dictate before commencement and a requirement is made on this. Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19, 22, 24 and 26 There were a number of risks to residents’ health and safety identified during the inspection which must be attended to prevent injury or infection risk. EVIDENCE: The home was odour free. Since the last inspection 4 bedrooms have been redecorated and the registered manager spoke of plans to decorate more shortly The home had specialist equipment used to assist in bathing and moving and handling. Two bath hoists that had been serviced on the previous day did not work. The manager stated that they needed to be charged. Specialist equipment for moving and handling was not seen to be used as the manager stated that residents did not like it. Staff stated that they had had moving and handling training but were seen to be using lifts banned by the recognised authorities on the subject (see comment on standard 7). This could put not only residents, but also staff, at risk of serious injury. Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 15 A requirement was made in the last inspection report for all wheelchairs to have the footplates fitted, wheelchairs were still found to not have these fitted putting the residents at risk of injury. Wheelchairs were also dirty with a lot of food stains on them. A regular cleaning programme should be in place. Rooms were appropriately decorated and residents were able to bring their own furniture. Radiators were protected to prevent accidental injury but 2 had the thermostatic valve missing. The outside temperature was 27 C. One occupied bedroom were a valve was missing meant the radiator was on making not only the room very hot, but also the protective cover on the radiator. A requirement has been made for all valves to be in place The home had a laundry in the basement. The provider must ensure that this equipment meets the required infection control standards for thermal disinfection of clothing. Dirty laundry was seen to be place on the carpet in corridors, this presents an infection risk and must not occur. Dirty laundry must not pass food storage areas in the basement. Requirements are made on laundry handling. Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The home recruitment practices could put residents at risk from the employment of inappropriate staff. Staff training undertaken was not planned to met residents needs. EVIDENCE: Though the home was staffed appropriately on the day of the inspection mechanisms need to be in place to link dependency as shown in care plans to actual staffing. This will ensure that residents are not put at risk. A letter in one residents file stated that they should receive extra care. There was no evidence of this occurring. Requirements were made in the last inspection report regarding inappropriate recruitment practices. These include not taking up references for new employees and undertaking CRB and POVA checks. It is of concern that these have not been actioned since that report. (see comments on standard 18) which could put residents at risk..The requirements from the last report are reiterated. Staff stated that they access training and evidence of this was seen. No induction programme or individual training plans were available. The requirement for an induction programme is reiterated from the previous inspection report. Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 36 37and 38 The home was not effectively managed. This put residents at risk. Care records were not securely kept. Wedged open fire doors could put residents at risk in the event of a fire. EVIDENCE: The manager of the home was on the premises for long periods of time and staff clearly saw that they had to consult her about actions that they took. The manager needs to look at how she manages the home in conjunction with the provider as there appeared to be an over reliance on her. This means that she is not able to give time for staff development or general planning and review of care and work practices. During the inspection the manager appeared to spend her time delivering hands on care and the requirement from previous reports that she has time for management and planning is reiterated. This would help to overcome some of the deficits highlighted in this report. Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 18 Regulation 26 reports are not currently being submitted to CSCI. Undertaken visits leading to this report would help the Registered Person monitor the home effectively. Requirements were made in the last report regarding the recording of staff supervision. Supervision of staff is important to ensure that care practices are monitored and staff can review how they deliver care to ensure that it is appropriate for residents needs. Formal recorded supervision was still not occurring and the requirement is reiterated. As stated previously daily statements relating to residents were unavailable. Care records were stored on a corridor shelf on the 2nd floor which puts residents confidentiality at risk. These must be kept secure and a requirement is made. Some corridor doors were held open by a device that allowed them to close when the fire alarm was activated. Other corridor and bedroom doors were wedged open with various items including wheelchair footplates, which meant that they would stay open in the event of the fire alarm being activated. Previous requirements had been made on this matter, as this practice is dangerous and could result in the least residents inhaling smoke in the event of a fire. Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 1 x 2 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION 2 x x 1 x 3 x 2 STAFFING Standard No Score 27 2 28 x 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 1 x 1 2 x x 2 1 2 Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 20 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 5 Regulation 12 Requirement The home must demonstrate that the needs of the residents at the home could be met by complying with registration and having the appropriate number of staff with the skills and experience to meet service users needs (Previous date of 28/02/2005 not met) The manager must ensure that residents have an up to date care plan, which are reviewed monthly, and are involved in the planning and review of the care plans. Risk assessments for all service users must be undertaken. Previous date of 28/02/2005 not met.) The methods of obtaining prescriptions, receiving drugs into and out of the home, and security of drugs in the fridge must be altered as required in this report. A record of all complaints made must be maintained and include any details of investigations and any action taken. (Previous date of 28/02/2005 not met) F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Timescale for action 10/10/05 2. 7 14 01/10/05 3. 9 134 01/10/05 4. 16 4 01/10/05 Wellfield House Version 1.40 Page 21 5. 22 13 6. 7. 8. 22 13 27 1317 26 27 9. 29 19 10. 30 18 11. 32 9 Wheelchairs and hoists in the home must be kept clean and ready for use as needed and must be used instead of current dangerous manual handling practices. Wheelchairs must not be used without being fitted with footplates. Laundry equipment must be capable of sluicing foul items and of thermal disinfection. Staffing levels at the home must be in accordance with the residential forum guidance on staffing within care homes as identified in the homes conditions of registration. The service provider must a) ensure two references are obtained for all new staff prior to commencement of employment b) obtain CRB and POVA checks on all staff. c) Staff files must contain all information as required under Schedule 2 of the Care Home Regulations 2001.(Previous date of 28/02/05 not met). Induction training must be given to all staff that meets the National Training Organisation workforce training targets (Previous date of 28/02/05 not met). The managers’ hours must include time for management planning and practice (previous date of 28/02/05 not met). The provider must submit Regulation 26 visits to the Commission for Social Care Inspection on a monthly basis (Previous date of 28/02/05 not met). 01/10/05 01/10/05 01/10/05 01/10/05 01/10/05 01/10/05 01/10/05 12. 33 26 01/10/05 Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 22 13. 36 18 14. 15. 16. 17 38 15 37 23 16 Staff members must receive 01/10/05 individual supervision at least 6 times per year. A record of these sessions must be maintained. (Previous date of 28/02/05 not met All records must be kept securely 01/10/05 All fire doors and bedroom doors must not be wedged open. The availability of food for residents from minority ethnic groups must be reviewed by the Manager and chef 01/10/05 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. 2. 3. 4. Refer to Standard 28 Good Practice Recommendations A minimum of 50 of care staff must be trained to NVQ level II by the end of 2005. Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection 9th Floor, Oakland House Talbot Road Manchester M16 0PQ 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 Wellfield House F55 F05 s42777 Wellfield House V237758 D120705 Stage 4.doc Version 1.40 Page 24 - 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. 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