Care Home: Borovere

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What the care home does well The home provides care in a well-maintained pleasant and welcoming environment by a well-managed supported, motivated, well-trained and qualified staff team who work in a manner that recognises resident`s need for personal privacy and dignity. Areas of particular note were the pre admission procedure the quality, quantity and choice of food available, which came in for particular praise from residents. What has improved since the last inspection? Requirements relating to the control of hot water have been complied with. Special beds have been purchased which assist staff when undertaking personal care of residents. An activities organiser has been employed. Steps have been taken to strengthen the management team by creating an assistant managers post. CARE HOMES FOR OLDER PEOPLE Borovere 10 Borovere Lane Alton Hampshire GU34 1PD Lead Inspector Peter J McNeillie Unannounced Inspection 27th June 2008 09:15 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 Borovere DS0000063367.V367643.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. Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Borovere Address 10 Borovere Lane Alton Hampshire GU34 1PD 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) 01420 85048 edye@greensleeves.org.uk www.greensleeves.org.uk Greensleeves Homes Trust Mrs Edith Wilson Johns Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th July 2006 Brief Description of the Service: Borovere Residential Care Home is owned and managed by Greensleeves Care Trust and is registered to provide personal care, support and accommodation for up to 30 older people. The home is located in the North Hampshire town of Alton and is situated in its own landscaped gardens with on site parking in a quiet residential area not far from the town centre, shops and other local facilities and within easy travelling distance of Basingstoke, Winchester and the M3 motorway. Accommodation is available in twenty-six single rooms and two double rooms that are only used to accommodate two people when a request is made for shared accommodation. Borovere DS0000063367.V367643.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 stars. This means the people who use this service experience good quality outcomes. This report was written after taking into consideration a number of sources of information and evidence including a site visit to the premises, previous reports, sampling residents, staff training and recruitment records and responses to an in house satisfaction survey by residents. We talked with residents, staff and management and received a response by the manager to a pre inspection Annual Quality Assurance Assessment. (AQAA). During this inspection which took place on 27/06/08 between the hours of 9.15 am and 1.15 pm during which all of the key standards for older persons and any previous requirements were inspected. The results and findings contained in this report will determine the frequency and type of future inspections. What the service does well: What has improved since the last inspection? Requirements relating to the control of hot water have been complied with. Special beds have been purchased which assist staff when undertaking personal care of residents. An activities organiser has been employed. Steps have been taken to strengthen the management team by creating an assistant managers post. Borovere DS0000063367.V367643.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. Borovere DS0000063367.V367643.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 Borovere DS0000063367.V367643.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): 3 and 6. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home has a system of assessing and identifying residents needs which ensures residents safety and that their assessed needs can be met. Intermediate care is not provided so this standard does not apply. Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 9 EVIDENCE: Samples of four resident’s pre admission assessments were viewed. These were produced in a very detailed format that took into consideration the needs, wishes, choices and aspirations as well as any present or potential risks. The assessments also confirmed that residents were only admitted in accordance with corporate pre admission policy and procedure set out in a care practice manual. The procedure requires that a detailed written assessment of need and risk by a member of the homes management team being carried out in consultation with the prospective resident. The procedure allows for a four-week trial admission followed by a review followed by a further two weeks and another review before a permanent place is offered. This procedure ensures both resident is happy with the placement and the home is sure they can meet the assessed needs. As part of the admission process management also liaise with external health and social care professionals regarding any care needs, risks, equipment and aids, that need to be taken into consideration when developing a plan of care. Records also confirmed ongoing assessments of need and risk for all residents are carried out on a regular basis and care plans (Section 7-11 of this report refers) updated to reflect any changes. Respite care is not available in the home. Borovere DS0000063367.V367643.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 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a well-developed system of planning and reviewing care, which reflects residents, wishes, and aspirations and ensures resident’s needs are met within a risk management policy involves residents and resident’s representatives or relatives in decisions that affect them. EVIDENCE: As part of our inspection plan, we viewed a random sample of four residents care plans. All of the care plans which were reviewed at least monthly were based on pre admission assessments to identify what help and support individuals needed and any attendant risks. (The previous section of this report; standards 1-6 refers). Some residents verbally confirmed they were consulted about and participated in the production of the plan, others could not remember. Records seen confirmed this. Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 11 All of the residents spoken with confirmed they were very satisfied with the care and support they received. They advised us they were contented, liked the staff and management and were treated with respect. They felt wanted and would recommend the home to anyone”. Individual residents and visiting relatives responses to our questions about how they were cared for, liked living in the home and the quality of the service included comments such as “ Could not have come to a better place”” I am very happy”,” Well satisfied ”,” Care is very good” “The staff are very kind and look after us all very well” “The best”. Resident also confirmed that their individual privacy was respected and that staff always knock on their bedroom door and wait before entering, a practice we observed during this visit. Resident’s right, and the opportunity to take risks is seen as fundamental. Residents were supported to make decisions for themselves within a risk assessment framework with the help of staff if required. This process identified individual risks and how they were to be managed. Staff who had a good understanding of the contents of the care plans and risk assessments and were able to explain how the care plan was put into day-today practice. Residents informed us were able to see the doctor of their choice or any other health and social care professional when they needed to. The records viewed indicated that apart from doctors, district nurses, physiotherapists, occupational therapists, other specialists had been consulted when required. Records were kept of appointments with GPs, dentist, optician, chiropodist and any other external health and social care professional and included details of any advice and treatment given. To ensure equality and diversity are promoted within the service the home informed us in their Annual Quality Assurance Assessment completed by the manager (AQAA) that: “There are policies and procedures in place throughout the organisation, allowing choice with respect for the individuals privacy. Staff training on these issues are discussed with attention given to the importance of the individual and is person centred.” Medication records confirmed all prescribed drugs, which are securely stored are dispensed by a pharmacist into a blister pack system. The pharmacist also visits at least every three months to audit the handling and storage of medication and staff training. Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 12 All medication is administered in accordance with a medication policy and procedure by staff all of whom have received training in the administration, recording and the security required when handling resident’s drugs and medication. All staff handling medication told us they were aware of and had read the procedure. The record of drugs and medicines administered to residents and unwanted drugs disposed of were complete and accurate. A procedure was in place to enable residents who wish to assume responsibility for their own medication. At the time of the inspection three residents were managing his or her own medication in accordance with a risk assessment. Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 13 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 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Family contacts and the provision of varied and nutritious meals were well managed and reflected residents interests and choices however the availability of social activities currently fails to meet the standard. Plans are in hand to overcome this deficiency EVIDENCE: Since the last inspection the person responsible for organising activities has left the home resulting in the activities programme being curtailed and whilst some activities do take place the current situation is described by the manager as “Ad hoc and far from satisfactory”. To overcome and improve the present situation an activities coordinator has been recruited and was due to commence work in the home within nine days of our visit. Residents spoken with confirmed the manager’s assessment of the situation and were anxious for better activities to be made available. Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 14 In view of the steps taken to date and the awareness in the home of the situation, a requirement is not being made on this occasion. The home has regular visits from local Church of England clergy who conduct services and communion in the home. The needs of members from any other faiths would be if required catered for but at the time of this visit no members from other faiths were residing in the home. During our visit we spoke with a visiting clergyman who informed us of local plans to improve the availability of religious services locally to members of all Christian denominations and possibly other faiths. Visitors are always welcome, and can share a meal in private if they wish all are encouraged to feel at home, and make drinks freely. Residents said they were fully consulted and were able to exercise choice in all aspects of their lives for example; when to get up and go to bed, mealtimes and where meals are taken, visiting times, the right to receive and converse with visitors and to make and receive telephone calls in private. The quality, quantity, presentation and choice of food served came in for particular praise from the residents. A written daily menu based on resident’s likes and dislikes was displayed. Vegetarian options are always available. Persons on special diets for religious or medical reasons can also be catered for, following individual written nutritional assessments, which are carried out, for all residents. We observed residents taking their mid day meal. This was conducted in a relaxed unhurried manner with staff available to give any resident assistance should they require it. Residents informed us meals could be taken in their own rooms if they wished. Tea and coffee making facilities were available to all residents and visitors at all times as was iced water and fruit squash. We observed staff encouraging residents to drink water to ensure they did not become de hydrated. Although a daily menu is displayed, we highlighted the need to ensure that the menu was displayed in format that all residents would understand. This had already been picked up by the manager who was in the process of addressing this issue as she and her staff are aware of how important this to for persons with dementia who may find the addition of pictures would be beneficial to them in understanding the daily menu and when making choices. Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 15 The manager gave a verbal undertaking he would look into the way menus were displayed in future. Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 16 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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The complaints procedure was satisfactory with evidence that residents feel their views will be acted upon in compliance with a previous requirement.The home has clear policies and procedures in place which ensures residents are protected from abuse. EVIDENCE: The complaints procedure, which is also included in the service users guide included information on how to contact The Commission for Social Care Inspection (CSCI), was seen, as was the record of complaints. C.S.C.I. have received no complaints about the service since the last inspection. All members of staff spoken with of stated they felt confident in discussing any concerns, complaints with management either in house or external on behalf of any resident. The homes corporate adult protection policy is works in tandem with the procedure produced by Hampshire County Council, which is based on National Guidelines and the document No Secrets and is designed to safeguard residents from abuse. Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 17 Management and staff who were spoken with confirmed they had all received training in recognising various types of abuse, this was confirmed by records viewed. All were able to demonstrate they knew the procedure to follow should they witness or suspect the abuse of any resident. Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 18 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 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A safe, well maintained, clean and suitably furnished home is provided for residents which meets their needs. EVIDENCE: All areas of the home were clean and free from unpleasant odours and obvious hazards. Residents confirmed the home is always clean and smells fresh. Furniture was comfortable, homely and in a good state of repair, in keeping with the décor and met resident’s individual and collective needs. All communal areas were accessible by residents including the well-tended established and safe garden. Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 19 Apart from personal mobility aids a number of communal aids had also been provided to assist residents, these included special beds, lifts, hoists, grab rails, and ramps. Residents commented how satisfied they were with their accommodation. There is a rolling programme of maintenance to ensure that the building is well maintained, decorated and kept safe for residents and staff. The manager informed us any new furnishings and decorations will take into consideration the particular environmental needs of persons with dementia. Since the last inspection, apart from day to day maintenance, safety to staff and residents has been improved by the purchase of special beds that can be raised and lowered and the homes fire safety arrangements have been upgraded creating more smoke free safe areas. Future plans include major structural changes to the first floor to eliminate stairs and produce a safer environment for residents. Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 20 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 and 30. Quality in this outcome area is good. Resident’s needs are met by sufficient numbers of well trained and supported staff who are recruited and selected using a procedure designed to protect all residents. EVIDENCE: The planned daily staffing levels for the home each day is: 8am–2pm or 8am4pm: The Manager, five carers (including a senior carer/shift leader) plus a chef and kitchen assistant, two cleaners, laundry assistant and an administrator. 2pm-8pm: The Manager (for part) plus three carers. 8pm-9pm two carers. 9pm to 8 am two waking night carers plus on call emergency arrangements. The daily staff rota confirmed these staffing levels. Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 21 At the time of this visit, in our view the number of management, care and support staff available met residents needs between the hours of 8am and 8pm, a view supported by the manager, staff and residents who informed us there were always enough staff on duty and they rarely had to wait for attention. However it is our view the number of care staff between 8pm and 10pm is likely to have a detrimental affect on residents choice, the quality of service, care and support they would receive. Staffing numbers could also compromise the health and safety of residents due to the absence of supervision brought about if two staff were required to assist the same resident. This matter is also commented on the Management and Administration (standards 31-38) section of this report. We viewed four staff recruitment and training files selected at random. All files viewed included evidence that staff are employed in accordance with a robust recruitment, equal opportunities and selection procedure, which is designed to protect residents. This involves the completion of an application form, the signing of a rehabilitation of offender’s declaration, an interview, and satisfactory Criminal Record Bureau (CRB) disclosure, Protection of Vulnerable Adults (POVA) and reference checks. Following their appointment, records seen confirmed that all staff are subject to an in house/corporate induction and compulsory training programme that include first aid, handling medication, food handling, moving and handling, POVA, infection control and dementia. All staff are expected to undertake a National Vocational Qualification N .V. Q.) Course. Information provided by the Registered Manager in the AQAA indicated that 58.8 of permanent staff has been trained to at least NVQ level two, with a further 17.7 currently on a course leading to a level two qualification. In addition 33 0f bank staff had been trained to NVQ level two resulting in a total of the 55 of the care staff currently trained to level two. Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 22 Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 23 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 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management of the home ensures the health, safety and welfare of residents and staff are promoted and the home is run in the best interests of the residents, whose views about living in the home are formally sought, however at times residents health and safety may be being compromised by staffing levels. EVIDENCE: The registered manager who has experience of managing resources for older persons for many years is a qualified Registered Nurse and has Registered Managers NVQ level four qualification. Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 24 In talking with staff we were satisfied that the home has a clearly defined management structure, staff were aware all of their responsibilities and the limits of their authority. The manager informed us that this structure is soon to be strengthened by the appointment of the newly created post of Deputy Manager. Staff described the management as approachable and accessible and willing to listen to any ideas they may have for the improvement of the service. As part of the homes quality monitoring system, residents and resident’s relatives/representatives and health /social care professionals are invited to participate in satisfaction surveys. The views expressed in the surveys are seen as key in highlighting areas that may require improvement or attention and the future development of this service. In her AQAA the manager identified that” There is a shortfall in our handling of Quality Assurance questionnaires although they are sent out the findings are not always fully collated and circulated so maybe the service user is unaware of any changes being made, they are discussed amongst staff. Questionnaires are sent to Residents, relatives & Friends and to other Stakeholders and professionals who come into the Home.” As the manager had identified shortcomings in this area and is taking steps to remedy this matter no requirement is being made on this occasion. An in house health and safety policy was in place to ensure the day-to-day safety of staff and residents. Procedures include, weekly health/ safety checks, the regular servicing of equipment, staff training in the techniques of moving and handling infection control, control of substances hazardous to health (C.O.S.H.H.) first aid, health and safety, reporting accidents, procedures to follow in the event of fire (including evacuation) and that all of the hot water supplies to baths were fitted with thermostatic controls set at 43 degrees centigrade and all radiators and hot pipes were covered to prevent a resident or staff being burnt in compliance with a requirement made at the last inspection. Despite the attention paid to health and safety issues residents safety in our view may be being compromised by the number of staff on duty as described in the staffing section of this report. Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 25 Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 26 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 27 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 OP27 Regulation 18(1)(a) Requirement A review of the number and deployment of staff must be undertaken and staffing adjusted to ensure sufficient trained and competent staff are available at all times to ensure residents needs can be met at all times. The health, safety and welfare of all residents must be protected at all times with particular reference to the number and deployment of staff employed between the hours of 8pm and 10pm Timescale for action 27/07/08 2 OP38 12(1)(a) (b) 27/07/08 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 Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Borovere DS0000063367.V367643.R01.S.doc Version 5.2 Page 29 - 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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