Inspection on 16/10/06 for Willow View

This inspection was carried out on 16th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Willow View 06/10/08

Willow View 09/10/07

Willow View 15/12/05

Willow View 04/07/05

Willow View 10/11/04

Willow View 13/05/04

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

CARE HOMES FOR OLDER PEOPLE Willow View 1 Norton Court 201 Norton Road Stockton-on-Tees TS20 2BL Lead Inspector Jane Bassett Key Unannounced Inspection 16th October 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Willow View Address 1 Norton Court 201 Norton Road Stockton-on-Tees TS20 2BL 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) 01642 550935 www.fshc.co.uk Tamaris Healthcare (England) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Care Home 35 Category(ies) of Dementia - over 65 years of age (35) registration, with number of places Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th December 2005 Brief Description of the Service: Willow View is a care home providing personal care for older people with dementia. The home is situated at Norton Court close to local shops, amenities and public transport. It is approximately two miles from Stockton town centre. The home is a two-storey purpose built building providing 35 single bedrooms all with en-suite toilet facilities. There are two lounges, one smokers lounge, two dining rooms and a garden area for residents to use. The home provides car parking for visitors. The home is currently without a registered manager and has been managed by a number of people covering this role. Information received by the inspector indicated fees charged by the home are £376 to £385 per week. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The key inspection was carried out over two visits to the home. The first was unannounced and was carried out by one regulatory inspector and one pharmacy inspector. The second visit was announced and was carried out by two regulatory inspectors. During the inspection the inspectors spoke to two residents, three family member, four staff members, the deputy manager and two peripatetic managers who were overseeing the running of the home at different times. A tour of the building took place. Documentation including plans of care and staff records were examined. The home submitted a pre inspection questionnaire. Three relative / visitor comment cards were received by CSCI. A total of eleven hours were spent at the home. What the service does well: What has improved since the last inspection? Following a number of incidents relating to the administration of medication the home has reviewed and altered the way in which it stores and administers medication. The company has recently introduced a new staff induction that incorporates the elements of the NVQ training and should meet current requirements. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for Standard 3 were looked at. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service consults the assessment information to see if they can meet the prospective residents needs before they make the decision to accept the application for admission. Evidence suggests that the prospective residents have a needs assessment carried out before they are admitted, however the consistency and quality of these varies. EVIDENCE: The inspector was told that a visit to the prospective resident is carried out to assess their needs and establish these can be met by the home. The file of one resident recently admitted was seen. This was found to include information obtained by the home, however this was limited. The file of another resident who had been at the home for a number of months was seen to contain a more comprehensive assessment. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 9 The inspector was told information is also received from the authority funding the placement. Evidence was seen in one file that confirmed this. The home does not offer intermediate care. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for Standards 7, 8, 9 & 10 were looked at. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Each resident has a care plan. The plan in most cases includes basic information and includes some risk assessment, however these plans are not always comprehensive. Plans of care and assessments are not always reviewed as required. The residents health is monitored and appropriate action taken. The home seeks advice on health care needs and acts appropriately. EVIDENCE: During the inspection 3 residents files were examined. These were found to contain assessments, including moving and handling, nutrition, continence, falls risk, pressure care, and dependency ratings. These were not always completed. Two of the files contained evidence that the residents were incontinent, however the assessments had not been completed. Another indicated the resident had a history of falls, the falls risk assessment was blank. Reviews of assessments and care plans had not always been carried out as identified. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 11 Plans of care seen did not always reflect the care to be given to identified needs. One file contained information that suggested the resident could exhibit aggression on intervention, there was no evidence of risk assessment or plan of care regarding this need. Another file indicated the resident may refuse medication, again there was no plan of care detailing how staff should manage the care. Plans seen contained limited detail as to the actions needed and the individual residents preferences in the management of care needs. Daily recordings are kept. Staff who spoke to the inspector were able to demonstrate through response to questions some understanding and knowledge of individuals needs and how these are met. Evidence seen indicated residents had access to health care services such as GP’s and district nurses. Records indicate the home seeks advice and acts appropriately in relation to health care needs. Comments received from families indicated that there had been a deterioration in the quality of care, however that has recently improved. Comments included ‘there was previously a sense of deterioration in atmosphere and staff attitude. This has now improved’ and ‘they do their job but attitude varies’. One family member who spoke to the inspector told her the majority of staff were always friendly and welcoming and would do what they could to help. It was seen at the time of the inspection that residents looked settled and comfortable in their surroundings. Residents appeared to be appropriately dressed with the exception of the ladies who were all seen to be bare legged without stockings or tights. Following a number of incidents relating to the administration of medication the home has reviewed and altered the way in which it stores and administers medication. The pharmacy inspector examined the medication and records for three residents. He identified no major concerns with the storage, receipt and disposal of medication. However it was noted record keeping should be improved further especially the detail recorded on the MAR sheets. It seen that on one sheet there were several doses of one medication not recorded, omission of details such as start date and inaccurate recording of amount received. Another residents daily care record sheet indicated the administration of a PRN medication, this was not recorded on the MAR sheet. MAR sheets seen contained insufficient detail to guide PRN medication, nor were there plans of care identifying how care staff deal with as required medication or refusal of medication. The inspector was told all staff who administer medication have received training with regard to safe handling of medication. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for Standards 12, 13, 14 & 15 were looked at. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has open visiting and families and friends can visit in residents own rooms or in the communal areas. Activities are limited. Residents are treated with respect. The home provides food that is of good quality and gives choices, however this could be enhanced by the improvement of the environment and surroundings. EVIDENCE: Whilst it was difficult to get feedback from the majority of residents due to their capabilities and frailty, it was noted that all appeared settled and comfortable in their surroundings. A good rapport was observed between staff and residents. Families who spoke to the inspector said they could visit at any time and had the opportunity to eat with their relative if they wished. Visitors confirmed they can meet residents in the privacy of their own room or in the communal areas. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 13 All spoke of the choice, quality and variety of food offered, however one family told the inspector despite staff being informed of requirements dietary needs were not always met. Concern was also raised that the time of the lunch had been altered without consultation. The lunch time meal was observed on the second day of inspection, this was seen to be nutritious and well cooked. However the surroundings could be enhanced with the provision of tablecloths and matching crockery. It was noted that cutlery in both dining rooms was in open canteen style racks. The first floor dining room contained open shelving where stacks of mixed crockery and food stocks such as cereals were stored. The environment would be enhanced with the provision of more appropriate storage. Discussion with families and staff indicated that social activities were limited. The home no longer has an activities coordinator and staff have recently had limited time to devote to activities. Staff spoke of spending some time with individual residents talking and reminiscing. Staff also were able to demonstrate through response to questions and observation, residents are given choice in activities of daily living and are treated with respect. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for Standards 16 & 18 were looked at. Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. Relatives and others associated with the service demonstrated a good understanding of how to make a complaint or raise a concern. The complaints procedure is available within the home. Staff have received training in relation to prevention of abuse and are aware of action to take. EVIDENCE: Information in the pre inspection questionnaire indicated the home has a policy and procedure in relation to the handling of complaints. The home has received three complaints in the last 12 months. Information given indicates that these complaints were substantiated. The home has made three Adult protection referrals. Comments received from families confirmed they were aware of how to raise concerns. One family spoke of raising a concern, they told the inspector that they were listened to and staff did what they could to rectify the issue. The information contained within the complaints procedure should be developed to include details of authorities funding the care of residents. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 15 Staff confirmed that they have received training with regard to the protection of vulnerable adults from abuse. All staff spoken to were aware of the actions that must be taken should a concern be identified and were able to demonstrate a commitment to protecting residents safety and wellbeing. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for Standards 19 & 26 were looked at. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There are sufficient bathrooms and toilets but some are not in good order or being used as stores. The home is not always clean. A number of fixtures and fittings need replacing and the décor requires upgrading. EVIDENCE: During the inspection resident’s bedrooms were seen to be personalised to taste with furniture, ornaments and pictures. On the day of the inspection a number of areas of concern in relation to the environment were identified. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 17 A number of bathrooms were being used to store equipment and documentation. The ground floor shower room continues to be out of use, concerns were raised at the previous inspection. The hydraulic chair in a bath on the first floor requires repair. A privacy curtain should be in place on the window contained in the bathroom door. The home was found to have only two working or accessible bathing facilities. Action was taken on the day of inspection to arrange removal of items stored in bathrooms. It was also noted that the bath had been replaced in the ground floor bathroom as required at previous inspection. External bolts must be removed from first floor bathroom and toilet doors. The activities / sensory room was no longer accessible to residents and being used as a storage area. The door to bedroom 5 was found to have the handle missing leaving a hole. Levels of cleanliness were seen to be poor in parts of the home. Cobwebs were observed in corridors and on window frames. The tables and chairs in the first floor dinning room were stained and dirty. Lounge and dining furniture were seen to be tired and worn looking. Wardrobes in residents bedrooms were untidy, clothes appeared to be stored in an untidy manner. Pillows on residents beds were seen to be thin and lumpy, quilts thin and worn, bedding to be worn and thin, curtains to have missing hooks and pelmets. The environment would be enhanced by the provision of curtains/ blinds to corridor windows and smokers lounge and programme of decoration. Families and staff who spoke to the inspector commented on the deterioration in the environment. The inspector was told that there had been issues in retaining domestic staff, however this has now been resolved by the recruitment of further staff. Comments received included ‘not kept clean as we would like, awful smell’. Information contained in the pre inspection questionnaire and evidence seen at the time of the inspection indicated fire equipment, , electrical equipment, passenger lift, and gas installation are checked and maintained as required. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for Standards 27, 28, 29 & 30 were looked at. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service has a recruitment procedure that is followed in practice. The service recognises the importance of training, however there were gaps. Staff should receive regular formal supervision to promote the safety and well being of the residents. Resident’s relatives were generally satisfied with the care, however there were concerns raised that on occasions the number of staff on duty was not sufficient to meet all needs. EVIDENCE: During the inspection files of two staff recently recruited were examined. These were found to contain the appropriate documentation, including an interview record sheet. However this did not identify the interviewer, this should be developed further to include the name and signature of the person carrying out the interview. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 19 A staffing rota seen at the time of the inspection indicated that the home currently was meeting the requirements of the staffing grid developed by Four Seasons Health Care as to the number of care staff. However it was noted that in the recent past there had been deficits in both care staffing and domestic staffing hours. Comments received from relatives both at the time of the inspection and within relative comment cards confirmed this. The peripatetic manager on duty informed the inspectors recruitment had taken place in relation to domestic staffing and there was to be further care staff recruitment. The company has recently introduced a new staff induction that incorporates the elements of the NVQ training and should meet current requirements. Information within the pre inspection questionnaire indicated staff have received training in fire safety, moving and handling, first aid and dementia awareness. The home has over 50 of care staff who have achieved NVQ level 2 or above. Information seen in staff files was limited. Staff who spoke to the inspector confirmed they had received training; staff also spoke of training with regard to infection control. Evidence seen indicated there is little formal staff supervision taking place. Staff who spoke to the inspector confirmed this, all commented on the frequent changes in management of the home. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Outcomes for Standards 31, 33, 35, 36 & 38 were looked at. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a policy that generally meets health and safety requirements and legislation. The peripatetic manager is aware of the areas where there is a need to make improvements and has an action plan for undertaking the work. EVIDENCE: The home has been without a Registered manager for a number of months and has had a series of people fulfilling this role. Evidence seen at the time of the inspection confirmed that lack of consistent leadership has resulted in a deterioration of the service provided. Concerns were raised by resident’s relatives about the poor communication and lack of consultation. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 21 The current peripatetic manager has arranged a meeting and written to all relatives to invite them to attend. There was little evidence of recent quality audits taking place. Information within the pre inspection questionnaire indicated that equipment such as passenger lift; and emergency lighting are maintained as required, fire drills, fire alarm tests and hot water temperatures are checked and recorded. During the inspection it was seen accidents are recorded appropriately. Work is outstanding in relation to the fire officers report regarding installation of self-closers and smoke seals to bedroom doors as identified at previous inspection. The home continues to use a joint bank account for the retention of resident’s personal allowances and maintain computerised records of individual accounts. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 2 X 3 Willow View DS0000000018.V315853.R01.S.doc Version 5.2 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 OP3 Regulation 14 Requirement All prospective service users must receive a comprehensive assessment of need that confirms the home can meet those needs prior to admission to the home. All assessments, risk assessments and plans of care must be reviewed as required to identify the current needs of the resident and how these are to be met. Medications must be recorded accurately and consistently. Action must be taken in relation to the following 1) The ground floor shower room that is currently out of use. 2) The broken bath in the first floor bathroom. 3) Storage facilities. 4) External bolts to bathroom and toilet doors. 5) The door to bedroom 5. 6) Dirty and stained furniture. The home must provide adequate bedding for all residents. DS0000000018.V315853.R01.S.doc Timescale for action 01/01/07 2 OP7 OP8 15 01/01/07 3 4 OP9 OP19 13 23 01/12/06 01/12/06 5 OP19 16 01/01/07 Willow View Version 5.2 Page 24 6 7 OP26 OP27 23 18 The home must be kept clean at all times. The home must consistently comply with an appropriate staffing ratio with regard to resident numbers, category and dependency levels. The provider must appoint an individual to the role of manager and make application to CSCI to register. The quality of care provided must be reviewed and necessary actions taken to improve. The home must comply with the fire inspection report to install self- closures and smoke seals to all bedroom doors. (Previous timescale of31/05/06 not met). 01/12/06 01/01/07 8 OP31 8 01/03/07 9 10 OP33 OP38 24 13 01/02/07 01/03/07 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 Refer to Standard OP10 OP12 OP15 Good Practice Recommendations Care staff should ensure female residents have access to their own tights/ stockings/ socks and are assisted to wear their own preferred garment. Daily activities are made available are flexible and varied to suit residents preferences and expectations. Residents should be offered a diet that meets their individual needs and requirements. Consideration should be given to improving and enhancing the dinning facilities. The Complaints policy and procedure should be developed to include details of all funding authorities. Consideration should be given to a programme of decoration and refurbishment to include lounge, bedroom furniture and curtains. DS0000000018.V315853.R01.S.doc Version 5.2 Page 25 4 5 OP16 OP19 Willow View 6 6 7 8 9 OP29 OP30 OP33 OP35 OP36 Curtains/ blinds should be provided to windows in corridors and smoking room. The recording of information received at interview should include the name and signature of the person carrying out the interview. A record of training should be maintained. Residents or their representatives should be consulted on services provided. Individual bank accounts to be obtained for residents. Staff should be appropriately supervised. Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Tees Valley Area Office Advance St. Marks Court Teesdale Stockton-on-Tees TS17 6QX National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Willow View DS0000000018.V315853.R01.S.doc Version 5.2 Page 27 - 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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