Care Home: Belmont House, Bodmin

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What the care home does well Belmont House provides a friendly and homely atmosphere for the residents. People are always assessed before moving in to ensure that the home can meet their needs. Staffing levels and skill mix are sufficient enough to meet the needs of the current residents. Nursing and care staff are trained in person centred care of older people with dementia. The manager responds to people`s comments or concerns and makes himself available to the residents and nursing, care and ancillary staff as necessary. What has improved since the last inspection? The care plans and any forms used to document details about residents such as fluid balance charts are completed accurately and in a timely fashion.The complaints procedure is in the Statement of Purpose given to all residents and /or their relatives to keep and all contracts have the complaints procedure included in them. Staff attend external safeguarding training as well as have in house updates as required. There is a robust recruitment procedure in place. What the care home could do better: The manager should try to complete a registered managers` course (or equivalent) as soon as possible. A review of the cleaning schedules should ensure that there are no cobwebs or dirty windowsills in the home. The provider should consider fitting a mechanical sluice as nursing care is provided. CARE HOMES FOR OLDER PEOPLE Belmont House, Bodmin Love Lane Bodmin Cornwall PL31 2BL Lead Inspector Mandy Norton Key Unannounced Inspection 11:00 9th October 2008 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 Belmont House, Bodmin DS0000038589.V368852.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. Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Belmont House, Bodmin Address Love Lane Bodmin Cornwall PL31 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) 01208 75057 01208 78836 belmont@almondsburycare.com www.almondsburycare.com Almondsbury Care Limited Mr Paul Seels Care Home 40 Category(ies) of Dementia (40), Mental disorder, excluding registration, with number learning disability or dementia (40) of places Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia - excluding learning disability or mental disorder - Code DE 2. Mental disorder excluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is 40. 1st November 2006 Date of last inspection Brief Description of the Service: Belmont House is a large mature property with a purpose built extension on the outskirts of Bodmin. The home is situated in a pleasant residential area and provides nursing care for older people with a dementia or a mental disorder. The grounds include gardens with a patio area. Car parking is available in the grounds of the home. Accommodation is spread over three floors with an inter-connecting shaft lift available. The top floor of the home provides bedroom accommodation only. The ground and first floor have bedrooms and communal areas. Security in the home is supported by the use of key pads which allow the people freedom of movement on each floor of the home. Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced inspection took place from 11 am until 4.05 pm on the 9th October 2008. The inspection was conducted with the manager and deputy manager. A tour of the home was carried out and a number of the people who live at the home and /or their relatives were spoken to and observed. Care staff were also observed and spoken to during the inspection. Information taken from these observations and conversations and the Annual Quality Assurance Assessment (AQAA) (a self - assessment document required to be completed and submitted to the Commission annually) submitted prior to the inspection is included in this report. There were 38 people living at the home on the day of the inspection. What the service does well: What has improved since the last inspection? The care plans and any forms used to document details about residents such as fluid balance charts are completed accurately and in a timely fashion. Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 Page 6 The complaints procedure is in the Statement of Purpose given to all residents and /or their relatives to keep and all contracts have the complaints procedure included in them. Staff attend external safeguarding training as well as have in house updates as required. There is a robust recruitment procedure in place. 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. Belmont House, Bodmin DS0000038589.V368852.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 Belmont House, Bodmin DS0000038589.V368852.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): 1&3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service (and their relatives or representatives) have information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that people’s diverse needs are identified and planned for before they move to the home. The home is not registered to provide intermediate care. EVIDENCE: An up to date Statement of Purpose is available in the entrance foyer and is given to representatives of the Service User or the person themselves as appropriate. A copy of the previous report was clearly displayed in the entrance foyer. The home also has a website for people to visit www.almondsburycare.com that provides useful information about what the Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 Page 9 service offers, a brochure to download and a link to the Commission for Social Care Inspection (CSCI) where previous reports can be viewed. The manager said himself or the deputy manager visit people in their current setting (where possible) to assess their needs prior to them moving into the home. The information gathered during the assessment forms the basis of the care plan when they move in. A completed pre admission form examined had relevant information about the person and their needs. A contract examined contained information about fees and terms and conditions of residency. The manager said that everybody is issued with a contract once the initial settling in period is over. Belmont House, Bodmin DS0000038589.V368852.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): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will be always be fully met. EVIDENCE: Care plans seen had a lot of relevant information about the individual and their health and personal care needs. They were up to date and had been regularly reviewed. The nursing and care staff complete daily records about a person’s welfare and detail what personal care activities have been completed during each shift. The plans seen had information about visits made by health care professionals such as GP’s, dentists and opticians. A tour of the home showed that equipment necessary for the promotion of tissue viability and prevention and treatment of pressure sores was available and the manager said that he felt they had enough equipment to meet people’s current needs. Many beds are adjustable and a number have specialist pressure relieving mattresses on them. Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 Page 11 The home uses a blister pack system for administration of medicines (as part of the contract with the suppling pharmacy advice is given and a 6 monthly audit of procedures is carried out) they are stored in a locked trolley kept in the treatment room. The drugs fridge has its temperature measured and recorded daily as required. Medication administration records seen were fully completed. The home uses a contractor to remove unwanted or unused medicines as legislation requires. The AQAA states that ‘The home’s policies and procedures have been amended to reflect the guidance issued by the Royal Pharmacuetical Society guidance Handling of Medicines in Social Care 2007 and The Administration of Medicines in Care Homes 2007. Staff were heard interacting with people living in the home appropriately and providing support and help in a discreet manner. People spoken to said that the staff are very kind and treat their relative and themsleves very well. Doors to people’s rooms and bathrooms were shut when personal care was taking place. It was recommended the toilet and bathroom doors have signs put on them to identify what room it is for people who may be able to move around the home independently. Belmont House, Bodmin DS0000038589.V368852.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): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Activities within the home mean that people have opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed making them an enjoyable, social occasion for people. EVIDENCE: The manager said that there is not formal activities programme as routines and activities are person centred and group activities do not always meet these needs. He said there are enough staff to be able to ensure people are given individual attention and they have a person dedicated to co-ordinating activities.Staff and visitors (who are welcome at all times) were seen engaging with individuals throughout the day. The website says that a minibus can be arranged for outings as necessary and that the home can cater for all religions. One lounge had a TV in it and all rooms TV points if people want one of their own. The AQAA does state that a better structure is needed for activities Part of the care plan includes information about hobbies and interests so that the nursing and care staff have an idea of what interested people in the past. Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 Page 13 There is access to a mature and secure garden and patio area, where seating is provided and people can spend time outside if they wish. The garden was in need of some attention, but the poor weather over the Summer has meant little has been able to be done to keep on top of it. Consideration should be given to providing raised flower beds and more seating within the garden as it could be a real asset to the home and enjoyed by more people more regularly. The manager and the AQAA says that feedback from Most people have their meals in the dining rooms where there are staff available to assist people as required. All meals eaten are recorded, along with drinks taken, in some cases, in order to confirm that people are having a well balanced diet. The manager said the chef is experienced in cooking for the current client group and is always consulted about dietary and nutritional planning and is viewed as a vital member of the team. It was noted that a number of people were wearing bibs during their meal. The manager said this is only when a need is identified and will ensure that if one is to be used the reasons why are detailed in the individuals care plan. Part of a mealtime was observed and staff were seen encouraging and helping people in a discreet and suitable manner. Belmont House, Bodmin DS0000038589.V368852.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): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Formal complaints and safeguarding policies and procedures are in place and are available to all staff at all times. All staff have safeguarding training. This means that people who live at the home are adequately safeguarded. EVIDENCE: The complaints procedure was seen displayed at the front entrance and is in the Service Users Guide which is also avalable in the front entrance and given to people and /or their relatives as required. It is comprehensive and gives options of who to contact and timescales for responses to be made. There have been no complaints made to the Commission in the last 12 months and the home have had one complaint and one safeguarding referral made. These have been resolved to a satisfactory conclusion. The manager said that any issues bought up either through daily contact with residents and/or their representatives, or as feedback from the quality assurance surveys are dealt with immediately and any required actions are detailed in the care plans.Staff files examined showed that staff have attended local adult protection (safeguarding) training and continue to have in house training on the subject regularly. Staff members on their induction and studying for a National Vocational Qualification (NVQ) level 2 or 3 also have information about safeguarding. Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 24, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ongoing maintenance, refurbishment and redecoration means that people have a homely, comfortable and safe environment in which to live. The home is generally clean and hygienic meaning people are safe and their welfare is considered. EVIDENCE: The home presents as welcoming and homely. The manager said that the home has recently been redecorated throughout and some faciliites upgraded. During a tour of the home people’s rooms seen were personalised with furniture, ornaments and photographs that they had bought in with them. There are 24 single rooms and eight double rooms some of which have ensuite facilities. There is a call bell system throughout the house and a shaft lift allowing access to all floors. Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 Page 16 Communal space consists of 2 lounges and a dining room. There are toilets and bath/shower rooms, with adaptations designed to meet the needs of the current residents, throughout the home accessible to everybody. The manager said that hand rails have been fitted throughout the home following a suggestion made by a relative.The home was generally clean but there were some cobwebs noted and a number of windowsills needed cleaning. Relatives spoken to said that they were happy with the quality of the rooms. The recently refurbished laundry is suitable and has hand - washing facilities. It is in a building to the main house and it was advised that some means of communication to the main house is installed in case the laundry assisstant needs to call for assisstance at any time.The policies and procedures around infection control are available to staff at all times and are reviewed annually. There is no mechanical sluice in the home. Locks on doors and lockable space in rooms is not appropriate for most of the client group however if (following a risk assessment) somebody wants a lock fitted or lockable sace in their room then this can be done on an individual basis. The garden is accessible to the current client group by way of a ramp. There is seating available and the garden is secure. The manager said that more can be made of the garden area so that people can enjoy being outdoors more often than they currently do. The main office is the only room where private interviews and sensitive discussions can take place. The home would benefit form an area/room away from the office where such meetings can take place. Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The providers show a responsible attitude and continue to implement changes and improvements in order to keep improving quality and outcomes for people living in the home. The staffing levels are satisfactory therefore people’s needs are being met at all times. The robust recruitment process means that people are being looked after by staff who are suitable and trained to do their job. EVIDENCE: Nursing and care staff are supported by activity, domestic, laundry, catering and maintenance staff. The manager said that an administrator has just been recruited who will be working 16 hours a week. There is a trained nurse, usually an RMN, on duty 24 hours a day. The manager said that the staffing levels are fine for the amount of people they look after (38 on the day of the inspection). He stated in the AQAA that staffing levels and skill mix are determined by the manager who takes into consideration the needs of the residents. Relatives spoken to said that the staff are always very attentive and they do not have to wait long for support or help when they need it. Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 Page 18 Three staff files were examined and contained all the information required including an application form (which asks for employment history), 2 written references, a Criminal Records Bureau (CRB) check and interview records. (The manager was reminded to make a note of the CRB check number before destroying original copies). The files also included evidence of appraisals and supervision sessions and contracts of employment .The training files seen contained certificates for numerous courses and study days (completed in house and with outside training providers) including; person centred dementia care, health and safety, fire safety, safeguarding and manual handling. The manager said that most care staff have achieved a level 2 NVQ in care and that many staff have achieved level 3 and above. Trained nurses are all registered with the Nursing and Midwifery Council (NMC) and undertake training appropriate to their area of care in order to remain up to date about good practice. The manager said that the trained staff meet regularly to discuss articles in journals and recent training undertaken with each other to help with continued development. New staff complete an induction period which includes principles of care and safe working practices. They are provided with a mentor to help support them through their induction. The manager has commented in the AQAA that the induction process could be better structured to ensure time limits for induction process are met. he goes on to state that staff are given the opportunity through supervision (one to one sessions or group sessions) to express their training and development needs. Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems/procedures the provider and manager have implemented are designed to meet the needs of the service as they strive to improve the service the home offers to the people that live there. The attitude around health and safety shown by the providers, care and ancillary staff means that people live in a safe and well maintained environment. EVIDENCE: The manager is a Registered Mental Nurse (RMN) with 25 years experience 20 of which have been with care of the elderly with dementia, he has been at Belmont for 15 years. He has not yet achieved a Registered Managers Award Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 Page 20 and level 4, although he has signed up twice and each time the training establishement has ceased operating. He said he is trying to locate a local training provider and will sign up again. The deputy manager has got a Registered Managers Award. There are clear lines of accountability within the home, this was demonstrated with ongoing activity during the inspection. The manager said that a representaitve from Almondsbury Care visits the home at least monthly and are very supportive and good to work with. There is a formal quality assurance/ audit system in place based on seeking the views of the residents (when possible) and /or their representatives and other stakeholders such as pharmacists, GP and social services. A number of the most recently completed satisfaction questionnaires (September 2008) were seen during the inspection and were very positive. A GP wrote that the home provides an excellent level of care. It was recommended that any actions taken as a result of commnets made on the questionnaires should be noted on the form and dated and signed as well as noted on the care plan as currently happens. The manager siad that recently as a result of feedback from a relative hand rails have been fitted throughout the home. The AQAA states that staff have Good Practice handbooks and easy access to all relevant documents and that these are often discussed at staff meetings and dduirng training. The manager goes on to say that the views of both staff and residents are listened to and valued. The manager described the procedures in place for dealing with people’s money. He said that they try not to be involved in people’s personal allowances if possible. For those they do manage individual records are kept of income, and outgoings and receipts are kept. The money is kept securely in individual named draws in a wall mounted organiser (this was noted as god practice) and is accessible to people when they want it. Staff files examined had evidence of some supervision (one to one) and appraisal sessions being carried out. All records seen were well constructed, up to date and stored securely.Staff files and training records seen showed that statutory training takes place as required. This includes fire safety, food hygiene, moving and handling and first aid. A selection of routine servicing and maintenance documents were seen confirming that people’s health and safety is promoted and protected. There were some cobwebs noted in high areas within the home and a number of windowsills that needed cleaning. The manager was told and said he would review the cleaning schedules to ensure these areas were attended to in the future. The maintenance man is responsible for ensuring that ongoing/routine inhouse and garden maintenance is carried out . He is supported by the maintenance teams supplied by Almondsbury Care who also carry out any major work required. A selection of general and individual risk assessments and the fire log- book were examined and found to be up to date. Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 Page 21 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 X X 3 3 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 3 3 Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP26 Good Practice Recommendations It is recommended that the manager reviews the cleaning schedules to ensure high areas prone to cobwebs are cleaned and that all windowsills are cleaned regularly. It is recommended that the provider considers installing sluicing disinfector as nursing care is provided. It is recommended that the manager to obtain a management qualification as soon as is possible. 2. OP31 Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Belmont House, Bodmin DS0000038589.V368852.R01.S.doc Version 5.2 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. 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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