Care Home: Baytrees

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What the care home does well The needs of residents are being fully assessed before admission is agreed. Each resident participates in a full activities programme, which enables them to attend local day centres, college, community and leisure activities of their choice. The staff team have a clear sense of the needs of the residents and are committed to providing a good service. The manager/owner and the staff team meet monthly to review and discuss the on going needs of the residents and how this can be achieved. What has improved since the last inspection? Since the last inspection some care files have included sections relating to residents sexuality and religious preference and how this can be promoted and managed within the home. Residents signatures were seen on these forms demonstrating their involvement in the decision making process. What the care home could do better: Record keeping for all aspects of health and safety, care planning, risk assessments and policies were seen on care files. However, whilst it is noted that there was information available relating to residents needs, for some this was sparse, files were disordered and some records out of date. These related specifically to health reviews, action plans and risk assessments for individuals. Currently the care records available do not provide enough relevant and up to date information to substantiate the level of support given to the people who live at the home. A requirement has been made in respect of this. CARE HOME ADULTS 18-65 Baytrees The Street East Preston Littlehampton West Sussex BN16 1JD Lead Inspector Beth Tye Unannounced Inspection 20th November 2007 09:00 Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 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 Baytrees DS0000063705.V355828.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 Adults 18-65. 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. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Baytrees Address The Street East Preston Littlehampton West Sussex BN16 1JD 01903 770116 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) Mr Harry Parsad Purmessur Mrs Heywantee Purmessur Mr Harry Parsad Purmessur Care Home 9 Category(ies) of Learning disability (9), Learning disability over registration, with number 65 years of age (3) of places Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Up to 9 male and/or female service users in the category of learning disability (LD) may be admitted/accommodated. Up to 3 male and/or female service users in the category learning disability over the age of 65 years may be accomodated LD (E). The total of service users accomodated may not exceed 9. No service users over the age of 65 years may be admitted. Date of last inspection 30th April 2007 Brief Description of the Service: Baytrees is a fine old building in the village of East Preston, close to the local shops, and about a mile from the sea. Once a family home, it is now the home to nine residents, in the category of (YA) Young Adults, with a learning disability. Three of the residents however are over the age of 65 years. The accommodation consists of nine single bedrooms, all with en-suite facilities. There is a lounge and dining room, with a day centre, solely for the use of the people who live at Baytrees, in the garden of the home. The fees for the home range between £706 and £863 and are dependent on need and support. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on the 20th November 2007 and lasted approximately 4 hours. Prior to the inspection all relevant information and correspondence relating to the home was examined. This included a completed a detailed pre-inspection questionnaire sent by the manager sent prior to the last inspection in April 2007, all correspondence and notifications of significant incidents within the home. The manager/owner of the home was present throughout the inspection and was able to provide all information required. The inspector looked around the home and spoke with some residents and the staff in order to gain a sense of how the home is being run and how they experienced living and working at Baytrees. Two care plans were case tracked and new staff personnel files were examined alongside the homes records including, care files, rotas, staff personnel and training records, complaints, fire, incident and accident reports and all records relating to health and safety. Staff members were spoken with informally. They stated they enjoyed working in the home and felt the residents were well cared for. The observed interaction between staff and residents was relaxed and positive. Residents spoken with told the inspector that they were happy living at the home, that they liked their rooms and enjoyed the activities they were offered. This is the second inspection of 2006/2007. This is called a key inspection and will determine the frequency of visits/inspections hereafter What the service does well: The needs of residents are being fully assessed before admission is agreed. Each resident participates in a full activities programme, which enables them to attend local day centres, college, community and leisure activities of their choice. The staff team have a clear sense of the needs of the residents and are committed to providing a good service. The manager/owner and the staff team meet monthly to review and discuss the on going needs of the residents and how this can be achieved. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Prospective residents are provided with all the information needed to make an informed decision, prior to admission of the home. All residents have a needs assessment prior to admission, to ensure the home is suitable. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each resident is able to visit the home prior to admission. This gives them the opportunity to tour the home and meet other residents and staff, therefore contributing to a smooth transition process. There have been no new admissions since the last inspection. Two residents care plans were case tracked and all contained details of preadmission assessments. This information contributes to future care planning and ensures the home is able to fully meet the resident’s needs. The assessments seen contain information about the needs of the individuals and included areas such as personal care, mental health, mobility, communication, behavioural, emotional, daily living skills and relevant information. The inspector viewed an up to date Service Users Guide and Statement of Purpose. Prospective residents and their carers are provided with all relevant information to make an informed decision about the home. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 9 Residents have the opportunity to discuss their expectations and these are recorded as part of the assessment process. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Evidence of regular reviews to assess residents changing needs, was seen on individual care plans. Residents confirmed they were supported to make choices about their lives. Some risk assessments for individuals were found to be outdated and in need of reviewing and updating. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two residents care files were examined and case tracked. The care plans seen cover all aspects of the resident’s health, personal and social needs. Each file contains a plan of care for health, social and emotional need. They included evidence of monthly reviews by the manager (some of which were signed by the residents.) There were also records of key worker meetings and annual social services reviews. Risk assessments and behavioural plans, relevant to the individuals agreed limitations and behaviours were seen on some care files. It was noted that Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 11 some risk assessments were out of date and needed to be reviewed. Following discussion with the manager, he agreed to do this at the earliest opportunity to ensure residents were supported to live as independently as possible within agreed guidelines. Daily recording sheets for two residents were viewed. These detail any significant event, which needs to be handed over to other staff at shift change. In addition to care planning, this ensures consistency for residents in relation to their care needs on a day-to-day basis. Although most information and care records was held on file, some care files were disordered and needing updating. Clear and organised records provide staff with the opportunity to access information easily, as required. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good Weekly activity plans are held on individual care files. Each resident is encouraged to maintain relationships outside the home. Visitors to the home are welcome. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Discussion with staff and feedback from residents confirmed individuals are encouraged, to participate in social activities, both within the home and in the community. Records of activities are recorded in the individuals care plan and daily records, these include daily activities such as art, games, clubs, swimming, college, bowling, horse riding and gardening as well as visits to the cinema and shopping. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 13 Staff confirmed they often support service users in going to the pub, or to local areas of interest. Some risk assessments for individual activities were out of date or not completed. The manager agreed to review these and up date them where needed. Residents need to sign risk assessments to demonstrate their involvement in the process. The inspector was able to speak to the residents as a group during the visit. One resident recently celebrated her birthday and proudly showed off her balloons and flowers, which were on display in the home. Other residents talked about the photographs in the home, which showed them enjoying recent holidays and barbeques. This discussion took place whilst the residents participated in puzzles and drawing in the dining room with their mid morning coffee. The current manager confirmed the residents had enjoyed an annual holiday with staff. Last year six of the nine residents were supported to go to Euro Disney for a week to help one resident celebrate their 70th birthday. This was in addition to a week’s holiday for all to Butlins in Somerset. This year the residents have been to Hayling Island for a week. The manager explained that they choose holiday sites that have evening entertainment such as dancing and music as well as swimming and games. Since the last inspection residents care files now reflect residents cultural and sexual preferences. Guidelines have been included alongside this information to inform staff of action relating to individual needs and preferences. Each of the documents had been signed by the resident to demonstrate their involvement in the process. The inspector noted the visitors book detailed visits of family and friends to the home. One resident spoken to stated his mother visited regularly and he enjoyed home visits. Staff reported there are no restrictions on visiting, unless stated in an individuals care plan. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good Observation and feedback from staff demonstrated residents receive care and support in line with their assessed needs and personal preference. However health records need to be audited and updated to reflect current practice and daily action plans by staff in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care files of two residents were case tracked. Care plans included daily living and needs assessments, medication, diet and weight monitoring sheets, religious and cultural beliefs, dental and foot care, information on sexuality, communication, mobility and dexterity and risk assessments for personal safety which had been signed by the residents. Records are held on files detailing GP, chiropody, district nurse and dentists visit. Daily records of carers are up to date and specific to individuals, enabling good handovers for staff at each shift change. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 15 It was noted that the care plans had information about how the individual preferred their personal support to be given. These agreed guidelines are reviewed either monthly or as needs change, by the manager. Following the visit it was agreed the manager would include the resident in future monthly reviews and where possible obtain a signature on documents when changes were made. This would demonstrate the residents involvement whenever changes to their care plans occurred. One resident has diabetes and there was information about the condition and protocols for staff available in the care plan. There were also records of meetings with staff and district nurses about how the diabetes would be managed in the home. Although it was not clear if this information was up to date. The inspector concluded health information on the whole, was difficult to access as the files were muddled and some records were out of date. The manager agreed to audit the care files in order to ensure all information is up to date, in good order and more easily accessible to staff. During discussion with staff the information they gave confirmed that they are very aware of individual needs and how to provide appropriate care support. Monthly staff meetings with the manager support staff to provide appropriate care, as care practice is discussed and reflected on. Good care records in the home need to reflect the current health action plans and level of care that staff actually provide day to day. Policies and procedures relating to all aspects of healthcare and medication administration are in place and up to date. The homes training records showed that staff have completed medication training. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good People who use the service are protected through the complaints procedure and the staff’s knowledge and understanding of Adult protection issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Adult Protection policies and procedures are detailed and up to date. Staff will use these alongside County Procedures and guidelines, which are available in the staff office. The home has a detailed procedure for complaints, which is included in the Service Users Guide and Statement of Purpose, providing residents with clear information about how to complain. All complaints information is printed in a format suitable for residents to ensure they are clear about their rights within the home. The homes complaints log is supported by an up to date complaints policy and procedure. There have been no recorded complaints since the last inspection. Records viewed showed that residents have three monthly meetings, which provide them with a forum to talk about any issues of concern. In addition to this, the key worker system gives residents with the opportunity to talk on a one to one basis. Staff confirmed the manager/owner also speaks to the residents on a regular basis, to gain feedback about any issues arising in the home. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 17 Staff records reflected that they receive in house training for Working with Vulnerable Adults and Adult Protection. The last training was in August 2006 and is due again in early 2008. This ensures staff are able to meet residents needs appropriately, therefore reducing risk within the home. It also provides staff with clarity about reporting procedures, should suspicion of abuse arise. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good People who use the service have a pleasant and homely environment to live in. The home has had suitable adaptations to meet individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no changes to the homes environment since the last inspection. Staff support service users to decide on the colours of the lounges/dinning areas, all are very different in colour and furniture, suggesting that thought has been given to individuals needs and wishes. Bedrooms are brightly decorated and showed evidence of individual personalities with posters and the service users photographs on the walls, alongside other personal effects. The rooms were all single occupancy, all ensuite, and each with its own television and video. Service users are encouraged to furnish the room with personal belongings, furniture and pictures to make it feel like home. One individual’s room is Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 19 arranged in way that supported their decreasing sight and sensory equipment was in the room. Communal areas are spacious and homely. Residents were observed interacting in the dining room, whilst another resident chose to sit quietly in the lounge. All looked comfortable and relaxed in their surroundings. Care plans confirmed the environment had been assessed by community occupational therapists and adaptations had been fitted to communal areas and bedrooms according to individual needs assessments. The manager, to promote the safety and welfare of residents and staff, monitors health and safety records in the home monthly, The garden is well maintained and is accessible to residents. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good The staff numbers are sufficient to meet the assessed needs of residents. An induction and training programme for staff is provided by the home to ensure staff are trained and competent. Recruitment procedures and record keeping are robust to ensure that residents are in safe hands at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The duty rotas showed an adequate number of staff are on duty at all times. Rotas and staff spoken with confirmed the manager is most often surplus to staff and more staff are put on early mornings to support residents. Another member of staff commented the manager often stays on each evening to ensure the residents are home safely, following their daily activities. Domestic staff are employed to ensure that the standards relating to good food and cleanliness are adhered to. Staff and observations during the visit confirmed infection control procedures are adhered to and the use of colour coded bags; gloves and aprons are in use in the home. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 21 Staff members, who were spoken with in private, said that they found the manager/owners to be ‘supportive and helpful’. Both commented they would approach the manager to discuss any issues of concern. In addition the staff team meet once a month with the manager/owner to discuss changing needs of the residents and staff issues. There are four staff that have achieved NVQ 2, with three moving on to level 3, however the home has not yet achieved 50 of staff trained in NVQ. Records and certificates were available in respect of mandatory training in Manual Handling, Basic First Aid, Food Hygiene, Fire and Health and Safety. In addition, all staff members, who administer medication, have received the appropriate training. Since the last inspection two new members of staff have joined the home. Recruitment policies and procedures are in place to ensure staff employed by the home, have the necessary skills and experience to fulfil their roles. Completed induction books, CRB checks, terms and conditions and job descriptions were seen on file for new staff members. This ensures residents are protected by appropriate recruitment systems. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate People who live at the home may not always have their health, safety and welfare promoted due to the lack of up to date information on some care plans and risk assessments. This area of management must improve. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager, who is also the owner, has been at the home for two years. It was concluded from his interaction with staff and residents that there is a positive relationship at the home, with open communication, between the manager, staff and residents The inspector examined record keeping for all aspects of health and safety, care planning, risk assessments and policies. Whilst it is noted that there was information available on care files relating to residents needs some files were Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 23 disordered and records were out of date. These related to specific health reviews, action plans and risk assessments. The manager was spoken to during the visit and agreed to review the care files at the earliest opportunity. The current records do not provide enough relevant and up to date information to substantiate the level of support that the staff give people at the home. There have been no incidents or accidents recorded since the last inspection. Staff receive adequate training on health and safety issues, the inspector saw certificates for staff, confirming their attendance in moving and handling training, first aid, food hygiene and medication. The home has some risk assessments in place for the building and safe working practices for staff. However some of these need to be reviewed and updated. Certificates showed the maintenance of services within the home were up to date and Fire training, records and tests were seen to have taken place regularly. The staff members at Baytrees said that they enjoyed working at the home, and that they felt well supported by the manager. Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 2 33 3 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 3 3 3 X 3 2 X 3 Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 25 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA41 Regulation 17 Requirement The manager must ensure all care records and risk assessments are up to date and in good order. Timescale for action 31/01/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Baytrees DS0000063705.V355828.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Baytrees DS0000063705.V355828.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. 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