Care Home: Dawes House

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What the care home does well One of the staff commented that for residents, Dawes House: "...meets their needs to live a better and fulfilling life...". Another commented that: "...the home is a good place to work...". The service benefits from a committed and caring management team who are aware of improvements needed at the service and are setting good standards of care. This is reflected in the genuine caring approach of the staff. What has improved since the last inspection? At the previous inspection there had been nine areas where the home had to improve. The home has taken action on most of these areas, which represents a positive response to the findings of the previous inspections, and good developments to the service. In particular, the home has worked hard to develop care plans that are more person-centred and provide good information about the individual needs of each resident. CARE HOMES FOR OLDER PEOPLE Dawes House 6 Bramlands Close London SW11 2NS Lead Inspector Louise Phillips Key Unannounced Inspection 12th May 2008 10:35a 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 Dawes House DS0000010185.V363991.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. Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dawes House Address 6 Bramlands Close London SW11 2NS 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) 020-7223-5002 020 7223 3957 locardiam@servitehouses.org.uk Servite Houses Manager post vacant Care Home 29 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (6), Old age, of places not falling within any other category (29) Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th October 2007 Brief Description of the Service: Dawes House is a care home providing personal care for 29 older people, including up to six people with a mental disorder, excluding dementia. The service is owned and managed by Servite Houses. The home is situated on a residential estate and is within easy reach of Clapham shopping centre. There is good access to public transport links and the home is located very close to Clapham Junction railway station. Dawes House is a purpose-built two storey building divided into three units. Each unit has it’s own lounge, kitchen/dining area, quiet lounge, bathrooms and toilets. The two floors are served by a lift. Residents are able to utilise the large communal lounge on the ground floor and the secluded garden adjacent to this. The most recent CSCI inspection report and information about the service are available in the reception area of the home. The fees charged by the home are: £485.85 per week for those residents funded by Wandsworth local authority £538.58 for privately funded residents. Dawes House DS0000010185.V363991.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 inspection took place over one day by one inspector. Time was spent talking to four staff, three residents and viewing paperwork. A tour of the premises was carried out and care records were inspected. Information has also been gained from the inspection record for the home, the Annual Quality Assurance Assessment (AQAA), that the manager completed and surveys received from two residents, seven staff, two relatives/ advocates of residents and two health/ social care professionals involved with the service. What the service does well: What has improved since the last inspection? What they could do better: Areas where the home could be doing better are highlighted in the report and were discussed with the manager during the inspection. These include improvements to the environment, catering and activities provided. Please contact the provider for advice of actions taken in response to this Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 6 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. Dawes House DS0000010185.V363991.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 Dawes House DS0000010185.V363991.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 good. The residents are appropriately assessed prior to moving to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care files provide information about the referral and care management assessments that are obtained from the social workers helping to place new a resident at the service. Prospective residents to Dawes House are appropriately assessed by the manager, or assistant manager, and a care worker from the home, to ensure that the service is able to meet their needs. The assessment information is then used to form the basis of the care plans for the resident once they move to the home. They are invited to visit the home to meet staff and residents and look at the service provided. Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 9 Residents move in for an initial trial period of six weeks. Prior to the end of the six weeks a review meeting is held between the resident, their relative, social worker and manager of the home to review their stay and for the resident to decide if they want to stay. Intermediate care is not provided by the home. Dawes House DS0000010185.V363991.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 and 11 Quality in this outcome area is good. The residents’ needs are met through improved care planning that takes into account individual needs and preferences. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents living at Dawes House say that they feel they get good care and support. Relatives also say this, adding that they believe the home is able to meet the differing needs of the residents and that staff keep them informed of important issues affecting their relative. The relatives further say that the home gets medical support when their relative needs it, with one saying that: “…we were very grateful that my (relative) was referred at once to hospital…”. Similarly, feedback from health and social care professionals involved with the service is that they feel the home contact them when necessary, and that staff seek and utilise the advice that they give. One professional commented that: Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 11 “…as far as I am aware, the clients are well cared for and we are called in appropriately…”. One resident discussed openly with the inspector the help they receive with personal care. They said that this is carried out with respect to their privacy and in a way they like. During the inspection staff were seen to knock at bedroom and bathroom doors before entering. A member of staff showed the inspector the new care plan formats that are in the process of being introduced at the home, where since April 2008 all the care plans are being updated to the new format. They were enthusiastic about the use of these, highlighting a number of improvements that had been made to make them easier to use and access information. The improvements include compiling a summary of all relevant information on one sheet, and a new ‘core care needs’ tick box list, that the staff said made it “…much easier to see the residents needs…”. They discussed that by identifying the core needs of the residents, it enabled them to focus on specific outcomes. Examples of this include particular areas of risk or challenging behaviour, diabetes or pressure areas. The new moving and handling assessment and review formats allow for much more detailed information. These, along with the care plans are reviewed monthly, along with the care plans. The care plans are in a good format, and it is much easier to identify relevant information about the care planned for each resident. Care plans are now more individualised and specific to each resident’s needs and preferences regarding personal care, communication and diet. Feedback from staff is that they are confident that they have the right information to enable them to meet the needs of the residents. Staff said that although the residents are involved in their care planning, they and their and relatives are reluctant to sign their care plans. It is recommended that where this occurs a note of this is made on the care plan. Some further work is needed to ensure that resident’s wishes in the event of their death are recorded, as in the care files the phrase “…family will deal with…” does not adequately address this, and more information is needed about eg. who the resident would like to be contacted, specific religious observances, etc. Improvements have been made to the medication procedures at the home, with staff holding the keys to the medicine cabinet on them at all times. The medication was looked at on two units and found to be well-managed and stored appropriately, apart from one discrepancy noted where, on Edinburgh unit, a staff member had signed the medicine chart to say that an evening Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 12 dose of medication had been given to a resident, where it was observed that this was still in the ‘NOMAD’ medication box. Dawes House DS0000010185.V363991.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 adequate. Residents have the opportunity to be involved in some in-house activities. Improvements are needed to the catering arrangements at the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: “…My son can visit anytime…”, “…there are sometimes activities I can take part in…”. These were comments from residents who say that they enjoy living at Dawes House, and like the relaxed atmosphere that enables them to spend their time as they wish. The home is still without an activity co-ordinator, but the manager said they are looking to recruit one soon for 20 hours a week. He described that care staff are involved in running activities for the residents, and that each day throughout the week there is a different activity that occurs, such as ‘news discussion’ on Tuesday afternoons, a film on a Wednesday and bingo on a Thursday morning. Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 14 A requirement has been restated from the previous inspection, for the service to ensure that staffing levels are increased to enable more outside, and oneto-one activities to occur with residents. The manager said that he is currently making contact with some local voluntary organisations, to come and spend time reading to residents and taking them out. Activities involving residents are recorded in one file, that provides more details about what activity took place and which residents were involved. It is not clear if the kitchenettes on each unit are being used for baking activities with residents, and this should be encouraged, with appropriate risk assessments being carried out. Lunch was observed being served on Edinburgh unit. The food looked nutritious and appetising, with good portion sizes and plenty of cold drinks available to accompany this. However, one resident was heard saying that the meat was “…too tough…” to eat, and it was observed that another resident also did not eat their portion of meat. Feedback from residents is that they sometimes like the meals provided. A staff member highlighted that they feel there should be more culturally appropriate meals for the Spanish and Chinese residents currently living at the home. It was noted that there were no menus on the table for residents to know or choose what they would like for lunch. Also, whilst still at the dinner table, having just finished their lunch, residents were asked by the staff what they would like to eat for their supper. It is recommended that this information be sought sometime later in the afternoon, at a more appropriate interval from residents having just eaten their lunch. Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 15 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. There are systems in place to minimise risks to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has a complaints procedure that is provided in the Service Users Guide and Statement of Purpose for the home. Feedback from residents is that they know how to make a complaint if there was something they were not happy about. There is a computerised system for the logging of complaints, along with records of actions taken and any correspondence relating to these. There have been no complaints received by the service since the last inspection. Survey responses from staff demonstrated that they have a good awareness of how to deal with a complaint should they receive this, where they feedback that they would refer to the complaint procedure and direct the complainant to more senior staff in the service. All staff have received recent training in abuse awareness and safeguarding adults, so to minimise risks to residents. Two staff also spoke about how they Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 16 are encouraged by the manager to report any safeguarding issues immediately. Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 17 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 adequate. The environment is welcoming and relaxed, however improvements need to be made to ensure the safety of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents comment that the home is fresh and clean, yet relatives feel that more attention should be paid to the environment. One relative commented that there should be “…more care with quality of accommodation…eg. my (relative) has a TV which never works, a wardrobe with a loose hinge…”, where another stated that “…a constant check on facilities would be an improvement…”. Staff also say that the environment needs improving, saying that an improvement would be to “…refurbish or demolish the building…”. Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 18 A tour of the home was carried out, and a number of improvements were observed to have been made since the last inspection. These include new décor in York unit, clean carpets and redecorated communal area in Edinburgh unit, and the fire exit door on Richmond unit being made easier to open. However, the new flooring on York unit was observed to be creased and bumpy, therefore a potential trip hazard, and in need of replacing. Edinburgh unit still needs the hole in the skirting board beneath the oven to be made good and Richmond unit continues to need repairs made to the fire escape steps that lead down to the pavement. It was also noted that the windows on Edinburgh unit were open wide, without window restrictors in use. Requirements have been made to address these areas. Following concerns raised at a previous inspection, the home should consider installing closed circuit television (CCTV) outside the fire exit on Richmond Unit to increase the safety of the residents. Consideration should also be given to linking the opening of all fire exits to the alarm system. Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 19 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. The service provides training so that residents receive a good level of care, and recruitment procedures protect the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Dawes House has a consistent staff team, most who have worked at the home for a number of years and have a good understanding of the needs of the residents. Staff feedback that they are confident that the service they provide promotes the well-being of the residents. Relatives comment that they feel the staff have the right skills and experience for their role. The home holds recruitment information on each member of staff. The staff files are well organised and contain relevant information such as proof of identification, correspondence relating to offer of job, Criminal Records Bureau check, two references and record of the interview of staff. All new staff receive an induction to the service which covers areas such as fire safety, first aid and communication. Staff who responded to the survey say that they received a very good induction that prepared them well for their work. Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 20 Staff also said that they get enough training to support them in their role. With one commenting that there is: “…lots of training to support, motivate and empower staff in my organisation…” Training records indicate that staff receive training in the Mental Capacity Act, health and safety awareness, fire safety, infection control, medication awareness, manual handling, food safety and first aid. Most staff have achieved their NVQ level 2 in Care. In looking at staffing levels, the feedback from residents is that staff are ‘sometimes’ available when they need them. Staff feedback indicates that they feel there is not enough staff to do the job properly, with one saying “…in order to give quality care one person cannot give 10 or 9 people time a resident may wish to take, sometimes they may want to talk to you. I have to keep rushing to complete my work…”, where another simply said “…we need more staff…”. One other staff member did say that at present there is enough staff, but this is because the home is not full, as there are currently five vacancies for residents at the service. The home must keep the staffing levels under review and increase where necessary to ensure the needs of the residents are met at all times. Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 21 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, 32, 33, 35, 36 and 38 Quality in this outcome area is good. There is a committed management team at the home who are progressing the service for the benefit of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: “…The management has been very supportive and always encourages me to ask questions and report any mistakes as soon as possible…”, “…the manager and the deputy manager are very supportive …”. These are comments from two staff who work at Dawes House. Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 22 Since February 2008 a new, permanent manager has been employed at the service, and there is a new assistant manager, who was previously a senior carer at the home. The manager has achieved the NVQ level 4 in Management and Registered Managers Award and is in the process of registering with the CSCI to become the Registered Manager of Dawes House. Staff feedback that they are very positive about the new management team, and that they convey a supportive and open approach. Staff feel there is good communication, and that they are informed of relevant issues that affect them and the residents. Staff are positive about the changes, but a number also comment that they would like to feel more valued and rewarded for their work, where one stated that: “…the service could do better by recognising the good work staff do by giving them award, yearly, to motivate them…”. Quality assurance is carried out by the service through annual questionnaires sent to relatives for feedback on various aspects of the care, service and accommodation. Visits by the registered provider are also conducted monthly. The manager explained that he is also trying to promote an ‘open door’ approach to seeking feedback about the service, through a weekly ‘meet the manager’ morning and regular residents meeting. Every two months one-to-one supervision of care staff is carried out by the senior carers, who are supervised by the manager or assistant manager. Records of supervision sessions are held in the staff files. The home holds a personal allowance for each resident that is funded by themselves, their family or through social services. This money is used for when a resident wants to go shopping or use the hairdresser, etc. The service maintains records to demonstrate that appropriate health and safety checks are carried out on the fire system and equipment, electrical installation, gas safety and Portable Appliance Testing, etc. Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 23 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 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 3 3 X 3 3 X 3 Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13(2) Requirement The Registered Persons must ensure that all medication is given as prescribed, and signed for appropriately on the MAR chart. Where this has not been given, appropriate records must be maintained. The Registered Persons must ensure that staffing levels are increased to enable more outside, and one-to-one activities to occur with residents. (Previous timescale not met) The Registered Persons must ensure that: - the hole in the skirting board beneath the oven on Edinburgh unit must be made good. - the broken step on the fire escape that leads down to the pavement from Richmond unit needs repairing. (Previous timescale not met for those above) - window restrictors must be used on all windows throughout Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 25 Timescale for action 30/06/08 2. OP14 18 30/06/08 3. OP19 23(2)(b), (4)(b), 13 30/06/08 the home. - the flooring in the hallways on York unit must be replaced. 4. OP27 18(1)(a) The Registered Persons must 30/06/08 ensure that staffing levels are kept under review to ensure there are appropriate numbers of staff on duty to meet the needs of the residents. 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 OP7 Good Practice Recommendations The Registered Persons should ensure that where the resident or relative declines to sign the care plan, a note of this is made on the care plan. The Registered Persons should ensure that each resident’s wishes in the event of their death are recorded. The Registered Persons should ensure than a more accessible format of menu is used, other than just written, and that this is displayed on the tables at mealtimes. The Registered Persons should ensure that more culturally appropriate meals provided to cater for the different cultures of residents living at the home. The Registered Persons should ensure that residents requests for their supper is obtained at a later time in the afternoon, other than when they have just finished their lunch. The Registered Persons should consider making better use of the kitchenettes on each unit, with more individual meals prepared there, with the involvement of residents, or them being used for baking sessions with residents. DS0000010185.V363991.R01.S.doc Version 5.2 Page 26 2. OP11 3. OP15 4. OP15 5. OP15 6. OP15 Dawes House 7. 8. OP15 OP19 The Registered Persons should ensure that the food provided is properly prepared for residents to consume. The Registered Persons should consider installing closed circuit television (CCTV) outside the fire exit on Richmond Unit to increase the safety of the residents. Consideration should also be given to linking the opening of all fire exits to the alarm system. Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Dawes House DS0000010185.V363991.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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