Care Home: Chadwick Lodge Residential Home

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What the care home does well Observation showed that the team are caring towards the residents and interact well with them. The staff team is stable and the level of experience with the resident group is good. The staff are improving at working in person centred ways and involving individuals. Residents spoken with were happy with the service provided. Residents stated, `the staff encourage me take responsibility for myself but help me when I need it`, `I think the staff are kind and caring.` ` The staff treat me with respect and will do anything if I ask.` What has improved since the last inspection? The number of staff with a NVQ (national vocational qualification) qualification has increased. Many of the requirements and recommendations from the last inspection have been achieved. The recruitment records now show that proper checks have been done for all staff. All training for staff in moving and handling has now been completed. The manager has updated the Statement of Purpose and Service Users Guide. All but one resident room have been redecorated. A new flat screen television has been purchased for the main lounge. New carpets in communal areas have been provided. New chairs for the main lounge are on order. The bathroom on the first floor has just been refurbished. There are on going plans to improve the environment both inside and outside of the home. What the care home could do better: The AQAA returned was not fully completed as could be, this was due to lack of information provided. As a consequence vital information has been lost and failed to form part of this report. This information may have benefited the overall quality of assessment by us for Chadwick Lodge. Monthly regulation 26 visits need to be undertaken and reported, with these reports on the premises. Quality Assurance information needs to be collated and results made available to all interested parties. Care plans and risk assessments for all residents need to be kept updated, when reviewed and put into place alongside individuals changing needs. CARE HOMES FOR OLDER PEOPLE Chadwick Lodge Residential Home Chadwick Lodge 8 Chadwick Road Westcliff-on-sea Essex SS0 8LS Lead Inspector Sarah Hannington Unannounced Inspection 17th April 2008 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000063515.V362152.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. DS0000063515.V362152.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chadwick Lodge Residential Home Address Chadwick Lodge 8 Chadwick Road Westcliff-on-sea Essex SS0 8LS 01702 331599 01702 331599 peter@more-care.com 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) More Care (Home Counties) Limited Mr Peter Roger Cordery Care Home 15 Category(ies) of Dementia - over 65 years of age (15), Old age, registration, with number not falling within any other category (15) of places DS0000063515.V362152.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Old age (over 65) not falling within any other category (OP) (15) Dementia - over 65 years of age (DE(E) (15) Age: Over 65 years of age Total number to be accommodated shall not exceed 15. Date of last inspection 12th April 2007 Brief Description of the Service: Chadwick Lodge provides personal care and accommodation for fifteen older people. The home is also registered to provide care for residents who have dementia. The building is a three story property with the second floor being private accommodation. Most accommodation is in single bedrooms, some of which have en suite facilities. The home has two shared bedrooms. There is spacious open plan communal accommodation. Chadwick Lodge has a large and pleasant garden which is well maintained. A minibus is available. The home is situated close to local transport links. Day care places are also offered at Chadwick Lodge. Separate accommodation is provided in the home’s grounds for day care. The facility does not currently fall within the remit of the inspection process. Previous inspection reports were not readily available for residents or visitors to the care home. The registered person said that this was available on request and held in the home’s office. It was agreed that copies of reports will now be made more freely available by being placed in the lobby area of the home. The current scale of charges as quoted in the home’s Pre Inspection Questionnaire and confirmed at the site visit are £390.45 as a contract price and £421.27 as a private rate. Additional charges to residents include chiropody and hairdressing. DS0000063515.V362152.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. The site visit took place over six hours and was carried out as part of the annual inspection programme for this home. This visit was conducted with assistance from the manager. As part of the process a number of records relating to residents, care staff and the general running of the home were examined. The site visit also focused on any requirements and recommendations from the last key inspection. Prior to this site visit CSCI (Commission for Social Care Inspection) sent out surveys to all interested parties, however at the time of writing this report only three have been returned, however these comments from relatives will form part of this report. A number of residents and staff were spoken with during the site inspection and a tour of the building was undertaken. Additionally the manager returned an (AQAA) Annual Quality Assurance Assessment form. This is a self-assessment that homes are required by law to complete, that asked how well the home is meeting the needs of the people who live at Chadwick Lodge. What the service does well: What has improved since the last inspection? The number of staff with a NVQ (national vocational qualification) qualification has increased. Many of the requirements and recommendations from the last inspection have been achieved. The recruitment records now show that proper checks have been done for all staff. All training for staff in moving and handling has now been completed. The manager has updated the Statement of DS0000063515.V362152.R01.S.doc Version 5.2 Page 6 Purpose and Service Users Guide. All but one resident room have been redecorated. A new flat screen television has been purchased for the main lounge. New carpets in communal areas have been provided. New chairs for the main lounge are on order. The bathroom on the first floor has just been refurbished. There are on going plans to improve the environment both inside and outside of the home. 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. DS0000063515.V362152.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 DS0000063515.V362152.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 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A robust assessment process reassures prospective residents that their needs could be met before they move to the home. EVIDENCE: The manager has recently reviewed and rewritten the Statement of Purpose and Service Users Guide. Both these pieces of documentation give clear details to prospective residents about what they can expect. Both the service users guide and statement of purpose give a clear account of any specialist services provided, the quality of accommodation, qualifications and experience of staff and how to make a complaint. All residents are given a copy of the guide before they visit. This was confirmed by people spoken with. The manager states on the AQAA that, ‘The home ensures that each Service User receives a pre-admission assessment and are offered a visit to the home before admission.’ DS0000063515.V362152.R01.S.doc Version 5.2 Page 9 A full needs assessment is undertaken before any resident is admitted. We looked at assessments carried out for two of the most recent residents admitted since the last site inspection. The assessments showed that some involvement with the individual and their family was part of this process. Additionally the assessments identified risks and an initial care plan was put into place. The manager confirmed that he does put into writing to the resident that the home is able to meet their needs. This was also supported by relatives spoken with who stated, ‘ We had a letter from the manager confirming that the home could meet the needs of my relative.’ however a copy of this should also be kept within the person’s file. The statement of purpose and service users guide state that, ‘A months trail period is always given before taking permanent residency, this gives the person time to get to know staff and adjust to new people and surroundings.’ Looking through the two most recently admitted residents’ files showed that a review had taken place since moving in. Recently admitted residents, other residents spoken with, and feedback from relatives confirmed that resident’s feel their needs are met by the manager and staff of the home. Intermediate care is not provided at Chadwick Lodge. DS0000063515.V362152.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. Staff may not always document the care given appropriately, however the care provided for all residents is good. EVIDENCE: The statement of purpose and service users guide states that, ‘Care plans are reviewed monthly. Any plan is developed with the involvement of the service user. We carry out risk assessments aiming to identify those at risk of pressure damage, falls and malnutrition. We aim to identify any health problems so that they can be dealt with from an early stage.’ In three out of the five care plans inspected there was sufficient evidence to show that a good standard of recording is in place and that residents are involved within this process. These care plans had been reviewed regularly at monthly intervals. In all care plans seen, information such as weight monitoring, fluid in takes, and falls and communication needs were included. In three of the care plans inspected, changes had been accurately recorded, risk assessments and care plans were changed accordingly and action had been taken as a result. However this was not consistently met in all care plans DS0000063515.V362152.R01.S.doc Version 5.2 Page 11 seen, for example, in one of the newest resident’s files, the sections ‘needs and preferences’, ‘Social and leisure interest’ or ‘involvement of this individual’ were not filled in. For another resident who had lived in the home for a couple of years, it was recorded in the monthly reviews that from the 13/1/8 until 13/4/8 no changes had taken place. As a result care plans and risk assessments had not been changed. However it was clearly noted throughout daily notes that there had been changes for this individual. All residents have had recent annual review, which included other professionals, the residents, their family and key worker. Medication training has taken place for all staff that administers medication. A Monitored medication dosage system is in place for each resident. Medication is stored in lockable cabinet/trolleys. The administration records were being maintained in accordance with agreed procedures. Record sheets had been signed for with no omissions or gaps. DS0000063515.V362152.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Opportunities for residents to receive activities, which are suited to their needs and wishes, are available. EVIDENCE: Throughout the day, care staff were seen to be initiating activities that stimulated and supported individuals emotional and physical needs. A number of activities are carried out on a daily basis, such as, reminiscence, chair based activities, dancing, a spelling quiz, bingo, drawing, painting, cards, reading and topical discussions. Occasional trips outside in the community are arranged and in the summer there is a lovely large garden that is used. On a Sunday Hymns and prayers are taken within the home for those who wish to take part. Additionally ministers do occasional visits and are more frequent if residents request this. One of the residents stated, ‘ If I want to have a minister visit then it will be arranged.’ The statement of purpose and service users guide state, ‘ service users may attend religious services either within or outside the home as they so desire. If required a private room will be made available for such meetings.’ DS0000063515.V362152.R01.S.doc Version 5.2 Page 13 Residents spoken with confirmed that their relatives and friends could visit when they chose to and that staff always encouraged them to keep contact. The manager states on the AQAA, statement of purpose and service users guide that, ‘ Family, friends and relatives are encouraged to visit regularly and maintain contact by letter or phone if not possible. We recognise the importance of social relations and are respectful of the individual’s privacy.’ A relative stated that, ‘we are welcomed anytime into Chadwick Lodge to visit our relative, the staff are very friendly.’ The home’s menus have recently been reviewed and there is a four weekly menu plan. On the day of inspection the food smelt good, and was appealing. Staff observed during the lunchtime period gave individuals a chance to be independent as much as possible by encouraging individuals to use cutlery themselves, rather than staff taking this over and using bowls instead of plates so that food would not spill over due to lack of coordination. Individuals were enabled to take their time and eat in an unrushed and relaxed environment. Residents stated ‘ the meals are cooked well.’ ‘I would not eat it if it wasn’t tasty.’ ‘ The food is lovely here.’ DS0000063515.V362152.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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by staff knowledge and training and a robust complaints procedure. EVIDENCE: The manager states on the AQAA that, ‘ we have a clear Complaints Procedure and each service user has been provided with a copy. Service users and relatives can be provided with Advocacy information.’ There have been no complaints received by the manager or made to CSCI or any other agency since the last inspection. The manager has a good complaints procedure in place. Three residents spoken with were aware of their rights and knew what they would do if they wanted to make a complaint. All commented that they would feel confident that the manager would follow these up to their satisfaction. All staff have attended safe guarding (protection of vulnerable adults) training. Staff spoken with had a good knowledge around these issues. One new member of staff spoken with about the induction package identified good training around safe guarding issues and demonstrated that they knew procedures well and how to contact outside agencies if need be. DS0000063515.V362152.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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People live in a clean safe environment. EVIDENCE: The manager states on the AQAA that, ‘We ensure that the environment is well maintained and offers service users a homely place in which to live in.’ Overall the home is comfortable and suitable for the needs of the present resident group. There is also a good cleaning programme in place. On the day of inspection the home was observed to be clean and all areas were odour free. Since the last inspection five bedrooms, two corridors, the entrance hall, stairways, lounge and dinning area have all been redecorated. The majority of residents’ felt great improvements had been made to the environment inside and outside of the home. Residents stated, ‘The manager has decorated my room and now it feels more like mine’ ‘ The home is getting better as it is gradually being re-decorated, I like it.’ DS0000063515.V362152.R01.S.doc Version 5.2 Page 16 The home is still being redecorated in many of the communal areas. As a result many surplus and old materials, for example, furniture not in use, chairs, wheelchairs, frames, fans and general materials are stored in many of the communal areas looked at, such as the room leading out to the garden and the main lounge. These all need to be cleared and free from clutter. This would improve the overall areas in question and safe guard the residents from any unnecessary hazards. Again the garden at the back had an unused fridge freezer, used paint cans and general bits and bobs strewn around. These need to be cleared. Additionally the garden needed a small bit of general upkeep to keep it neat, tidy and useable. DS0000063515.V362152.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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by good staff recruitment, induction and training. EVIDENCE: Chadwick Lodge provides 5 senior carers, 5 carer posts of which two are still vacancies, one cook and two housekeepers, again one being a vacancy. The statement of purpose and service users guide state, ‘All staff complete a skills for care induction course.’ The manager uses an induction training pack that is in line with Skills for Care standards. Documentation evidenced that topics such as safeguarding, health and safety and medication are some of the areas covered. Speaking with new staff about their induction they were able to give a good account of what they had learnt and the knowledge they had gained from this. The rota provided evidence that there are enough staff on duty and that agency is used on rare occasions. The manager has been active in recruiting for the last few posts that remain unfilled. The manager states on the AQAA that, ‘We ensure that all new staff undergo a robust recruitment process and they receive the relevant training.’ DS0000063515.V362152.R01.S.doc Version 5.2 Page 18 The personal files of three members of staff that have been employed since the last inspection were looked at in terms of their recruitment records. Application forms were completed, interviews were held, two references obtained, criminal records bureau checks undertaken and proof of ID and photograph kept. Contracts of conditions of service and job descriptions were issued to all new staff. The manager states on the AQAA that, ‘Staff training has increased. New staff induction package has been introduced. Staff have been encouraged to identify what training they need.’ We looked at a copy of the home’s training plan/training statistics for staff. Evidence suggested that 8 of the 10 care staff in post have attained fire safety training, 8 staff have attained training relating to food hygiene, 10 of the staff have received training relating to moving and handling and 2 of the staff have received training relating to nutrition. It is also an improvement that 8 of the staff have attended dementia awareness since the last inspection. There are still plans for the rest of the staff team to complete this later on in the year. Additionally one senior member of staff has completed the ‘train the trainer’ course so that they can train staff in moving and handling. The statement of purpose and service users guide states that, ‘The home insists that all care assistants hold a minimum of NVQ level 2 in care.’ Three of the senior carers have qualified in the NVQ 2 and one has completed the NVQ 3. Five other care staff are currently studying the NVQ 2. Staff spoken with confirmed that there are regular meetings, individual supervisions and hand over meetings (sharing of information) on each change over of shifts. Annual appraisals identified training needs. The manager states on the AQAA that, ‘All staff have supervision at least six times a year and an annual appraisal to identify learning needs.’ DS0000063515.V362152.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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is run in a way that protects and promotes the health, safety and welfare of the residents at Chadwick Lodge. EVIDENCE: The statement of purpose and service users guide state, ‘ The manager is a registered trainer with the Alzheimer’s Society and is currently working towards the NVQ4 and Registered Managers award.’ Overall the manager is knowledgeable, has good experience of the resident group he works with and is good in his role. There is clear accountability of roles amongst the team and he has provided a strong shift leader support system by having five seniors in post. The residents health, safety and welfare is protected as a result. DS0000063515.V362152.R01.S.doc Version 5.2 Page 20 Quality Assurance is still being further developed and information needs to be collated and made available to CSCI and all other interested parties. At present the organisiation is not carrying out regulation 26 monthly quality control visits. This needs to be implemented and for copies of these visits to be kept within the home. The manager states on the AQAA that, ‘We comply with various requirements – Health & Safety, Local Fire Service etc.’ All health and safety checks that were inspected are up to date. Within the fire records looked at and staff practice around fire evacuation drills were found to be to a good standard. No residents at the home manage their own finances, their families or the Local Authority supports this. DS0000063515.V362152.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 2 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 2 3 X X X X X 3 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 3 X 3 X 3 X 2 3 DS0000063515.V362152.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. 2 3 4 Refer to Standard OP19 OP33 OP37 OP37 Good Practice Recommendations Communal areas in need of repair, redecoration and to be kept free from clutter. Regular review of the quality of care provided at the home to be collated and kept on the premises and made available to CSCI and all other interested parties. That the annual AQAA is filled out fully so that CSCI can fully evaluate the quality of service provided as part of the inspection process. Regular monthly Regulation 26 monitoring visits of the home to be undertaken and that the reports are kept within the home and available for inspection. DS0000063515.V362152.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 DS0000063515.V362152.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. 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