Care Home: Englishcombe House

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What the care home does well The home was found to be clean, warm and free from unpleasant odour. Staff were cheerful and interacting with residents in a positive, caring and sensitive manner. Residents were calm relaxed and looked well cared for. The home continues to provide effective care by ensuring that prospective residents are appropriately assessed before admission to determine that their needs can be met Residents are protected by a robust complaints procedure and the home would ensure that any complaints are thoroughly investigated and all required action implemented. The home ensures that there are adequate numbers of staff to meet the residents` needs. The home ensures that aids and equipment are provided in sufficient quantity to assist staff with meeting the needs of residents. What has improved since the last inspection? The home provides meaningful activities for all the residents based on individual capabilities. Residents and representatives are involved in the development and review of care plans wherever possible. Suitable environmental signs enabling residents to gain their independence have been provided. What the care home could do better: Ensure the contact details for the Commission are updated in the service user guide and complain procedure. Food diaries should be maintained for those at risk nutritionally. That written interview notes should be retained. CARE HOMES FOR OLDER PEOPLE Englishcombe House 33 Englishcombe Lane Bath Bath & N E Somerset BA2 2EE Lead Inspector Andrew Pollard Unannounced Inspection 17th September 2007 09:30 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 Englishcombe House DS0000046576.V345318.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. Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Englishcombe House Address 33 Englishcombe Lane Bath Bath & N E Somerset BA2 2EE 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) 01225 428369 englishcombehouse@btconnect.com Cedar Care Homes Limited Mrs Jayne Mpe Phamotse-Ncube Care Home 20 Category(ies) of Dementia (20), Dementia - over 65 years of age registration, with number (20) of places Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate people with dementia aged 50 years and over Date of last inspection 23rd August 2006 Brief Description of the Service: Englishcombe House is a home registered for twenty people aged 50 years and over with dementia. The home is situated in a south-western suburb of Bath with easy access to the city centre by car or bus, and panoramic views over the city from the front of the building. The home is a converted older property, providing mostly single bedroom accommodation. There is one double bedroom and one en-suite room. Resident’s accommodation is on 3 floors with communal space on the ground and first floors. There is a passenger lift providing access to all areas. The home has a front garden with patio area and a terraced rear garden offering a safe wandering environment for residents. The manager, Ms. Jane Ncube, has been in post since December 2005. Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the report following the announced inspection of Englishcombe House, which was conducted on 17th October. The building, rooms and facilities were inspected. A range of records relating to the day-to-day running and management of the Home were inspected. A selection of resident’s care records and care plans were reviewed. Tour of premises was conducted. General feedback was given to the manager on the day of inspection. No surveys were returned, however reference is made in places to a quality review survey conducted by Cedar Care or entries in the visitor’s book and contained in letters from relatives. Residents and staff interaction were seen to be positive and caring upholding the dignity of the residents. The relatives spoken with on the day praised the staff and quality of care no complaints were made. What the service does well: The home was found to be clean, warm and free from unpleasant odour. Staff were cheerful and interacting with residents in a positive, caring and sensitive manner. Residents were calm relaxed and looked well cared for. The home continues to provide effective care by ensuring that prospective residents are appropriately assessed before admission to determine that their needs can be met Residents are protected by a robust complaints procedure and the home would ensure that any complaints are thoroughly investigated and all required action implemented. The home ensures that there are adequate numbers of staff to meet the residents’ needs. The home ensures that aids and equipment are provided in sufficient quantity to assist staff with meeting the needs of residents. Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Englishcombe House DS0000046576.V345318.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 Englishcombe House DS0000046576.V345318.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): 1,2,3,4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective clients and their families are given relevant information in written or verbal form about the home. Contracts and terms and conditions of services are provided to all clients. The assessment procedure is well managed and a thorough assessment of prospective residents needs is carried out. EVIDENCE: A statement of purpose and a home guide plus additional helpful information is made available at the initial stage of enquiry to prospective residents/families. This provides good information about the services and facilities available and includes the terms and conditions. Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 9 The manager accepts that the annual review of the Statement of Purpose and Service User guide is due and that the commissions contact details need to be up dated. The home has an admission procedure and pre-admission assessments cover the activities of daily living, care needs and personal history. All residents have handling and risk assessments. Resident’s assessment records showed assessment of the person’s physical and mental needs had been carried out. Progress has been made in developing social care assessment assisted by the recent appointment of an activities organiser. The prospective resident/relatives are involved where possible in the assessment and all information is used to determine the suitability of the placement. The manager or care co-ordinator conduct assessments and obtain information and care plans from other professionals for example, social workers, district nurses and hospital staff. All residents or their representative have contracts and written terms and conditions. Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Comprehensive and clearly written care plans are in place. The staff provide a high standard of personal care to maintain residents’ health and well-being and dignity. Proper arrangements are in place for residents to access primary healthcare services. The staff properly store, administer and record medication on behalf of residents. Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 11 EVIDENCE: The care co-ordinators and or manager write care plans. A wide range of elements are covered in addition to personal care, including mobility, nutrition, challenging behaviour and depression. Risk assessments in respect of manual handling needs had been completed and supported with an action plan, which details safe systems of work. People’s religious practices and rituals are enquired about and supported where applicable. There is no one of other than Christian faith backgrounds in the home at present. Individualised planned care is detailed in residents’ files for health and personal needs. Social engagement and needs are being assessed on an individual basis by the new activity organiser. The elements of the care plan have monthly evaluations recorded and updates as required. Where possible families or advocates sign consents for care and care reviews. There is evidence that residents received visits from the chiropodist and optician. Residents tend to use their own dentist or alternatively arrangements can be made with a local dentist in Bath. A private Chiropodist visits the home every six to eight weeks. Appropriate continence products are being used following resident’s assessment. Residents are able to retain their own General Practitioner if he/she is willing to visit the home or alternatively the manager will assist with registering residents with a local GP. District Nursing services are sought through the GP practice. Consultants Dr Jelly and Dr Duvall visit the home from time to time and carry out drug reviews. Medication procedures and practices in the Home were reviewed, and the Home operates a safe system of storage, administration and recording of medication. Residents’ weight gain or loss is monitored if there is a concern about a resident’s appetite/nutrition. It is hoped that a sling weighing device can be purchased for residents unable to use normal scales. At present such residents have body measurements taken, which is an imprecise way to assess weight changes. In this event it is suggested that a food diary also be kept to review the at risk resident’s nutritional as well as calorie intake. Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 12 The home presented a calm and supportive environment. The staff resident interactions were friendly and courteous. Residents were at ease with the carers and visitors spoken with confirmed this was the norm for Englishcombe. Comments from relatives included: “The care and attention given to my relative is really good” and “People are extremely well cared for”. Throughout the inspection it was observed how the management and staff treat all residents with respect and dignity and encourage independence. Englishcombe House DS0000046576.V345318.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): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A range of social and recreational activities is arranged that seek to enhance the quality of life for the residents. Resident’s families are involved and informed of issues related to their relatives and are able to maintain close contact with families and friends. The food is of a high standard and provides a balanced diet for residents. EVIDENCE: Residents can have visitors at any time of the day, and are able to choose whom they see and do not see. A lot of effort is made to support residents to exercise choice in their day-today lives for example in the one to one discussions with the activity coordinator or picture book menu choice. Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 14 The first floor lounge is used as an alternative to the main communal area on the ground floor. Dining tables are available in both lounges. Many have good support from their relatives who are often consulted over decision-making regarding key events, etc. Residents are supported in their wishes to rise and retire at various times The home has a new qualified activities person who is working 20 hours a week to enhance the social activities for the residents. The aim is to provide accessible, meaningful and fun activities for the residents. There is more effort being made to offer social engagement with some residents on a one to one basis if they do not enjoy group activities. A programme of events was on display and relatives are always welcome to be involved if they wish. One relative stated that, “The staff are very welcoming and try and keep the people happy”. The residents were engaged in various activities throughout the day including a sing along and exercise class. Residents obviously enjoyed this. A relative stated that the residents benefit from services run by the local church including Holy Communion for residents each monthly. At present there are no residents with particular cultural needs. The menu offers two choices for the main meal or an individual choice can be catered for. The menu is nutritionally well balanced and varied. Residents are asked their wishes and if helpful can use a picture menu. Relatives spoken with stated that the food was good and their relative enjoyed their meals. The kitchen looked clean and appropriately equipped. The residents in this home have a deteriorating and variable condition of dementia. They will for the greater part rely on the advocacy role of the home’s staff or their relatives to interpret their care needs. This relies heavily on the observational skills of the staff, especially for residents who are unable to express themselves. From observation of interactions, there was evidence that staff have the skills and confidence to observe and interpret the needs of residents when necessary. Englishcombe House DS0000046576.V345318.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): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are robust and comprehensive policies in place to protect residents investigate complaints. Proper arrangements and policies are in place to protect residents from abuse. There are good arrangements in place for staff training and awareness of Protection Of Vulnerable Adults matters. EVIDENCE: I was advised that the home has had one complaint since the last inspection, which was properly managed and resolved. There were a number of complimentary letters and cards. Evidence gathered during the inspection confirmed that any concerns raised by residents / family are acknowledged and actions taken quickly to resolve issues. Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 16 The Commission has not received any complaints. As previously mentioned the contact details for the Commission require updating in the complain procedure. The home has written procedures for whistle blowing, management of aggression, abuse, bullying and management of residents’ money/valuables. The ‘No Secrets’ document was also available. Englishcombe House has a policy on the protection of residents and follows the inter-agency procedure for the protection of vulnerable adults in Bath and North East Somerset, however there is a more recent version now available, which the manager is going to download. All staff complete a DVD and workbook on adult protection as part of induction. Latterly staff are trained in ‘Averter’s awareness of abuse’ and senior staff are trained to ‘Investigator’ level. It is important that staff to have a heightened awareness of their adult protection responsibilities, due to the vulnerability of the residents living at Englishcombe. It was suggested that the manager acquire a copy of the mental Capacity Act code of practice when it is published. Englishcombe House DS0000046576.V345318.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): 20,21,22,24,25,26, Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of furnishing and décor in bedrooms and communal areas is good. The Home is safe, well maintained, and suitable for the needs of residents both internally and externally. The standard of cleanliness is high. Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 18 EVIDENCE: No changes had occurred in relation to the home’s suitability for its stated purpose on the provision of care for the residents. The home was found clean, warm, well lit and free from unpleasant odours. The residents were found sitting in the communal areas and appeared relaxed in their homely environment. There has been progress to promote resident orientation within the homes environment with suitable signs to maximise residents’ independence and promote orientation. Some photographs have been obtained from family members to place on bedroom doors. Residents’ bedrooms looked homely and were personalised with residents’ personal possessions and small items of furniture. The laundry room was well organised to manage a large selection of bed linen and towels for the residents use. Personal clothing is attended to with care. This was evident from the neat personal appearance of all the residents on the day of inspection. In consultation with Dementia Voice the home provided sensory gardens for the pleasure of the residents. Englishcombe House DS0000046576.V345318.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): 27,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The recruitment procedures and records are in good order. The home is well staffed with appropriately trained and experienced staff for the number of residents. Good progress is being made training care staff for the benefit of residents. EVIDENCE: On weekdays in the daytime there are generally 5 staff working including the manager. There are adequate staffing arrangements for housekeeping, laundry catering and maintenance. There are no staff vacancies at present. Relatives spoken with stated that staff attended to residents promptly and a caring manner when they needed help. The manager intends to reintroduce a key working system to enhance the resident/staff relationship. Staff spoken with had high morale and enjoyed their work. Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 20 Staff training records showed that the home invests in the training of its staff to ensure that staff are aware of their roles and responsibilities and that a high standard of care is maintained. Records showed that staff have attended training on Health & Safety, fire safety updates and other relevant courses including manual handling, basic food hygiene, fire safety, first aid and protection of vulnerable adults. Other training is currently being planned and will further support the staff in providing for the needs of the residents’. Cedar Care Group’s training manager supports this. The manager maintains a training overview matrix to cover Induction, foundation, NVQ, mandatory and specialist aspects of staff training such as dementia care and mental health training to ensure that all staff have the appropriate experience to work in this care home continues to be maintained. Cedar Care has been accredited as an NVQ training centre to provide level 2 and 3 training for all care staff. Recent staff recruitment showed that all statutory requirements in relation to the protection of residents were met. The Home’s recruitment procedure is detailed and robust. However it was suggested that written interview notes should be retained. CRB (criminal records) and POVA (protection of vulnerable adults) checks have been undertaken. At present no renewals are carried out. It is acceptable for the counter signatory to provide a CRB log of all satisfactory disclosures to the home manager. Englishcombe House DS0000046576.V345318.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): 31,33,34,35,36,37,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well managed and run taking into account the views and wishes of the relatives and residents and as they are able. There are good arrangements in place to maintain and service the equipment and facilities in the home. The Responsible individual does not write Regulation 26 reports. Staff supervision is taking place. The Home protects the health and safety of residents and staff. Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 22 EVIDENCE: The Manager has the required qualifications and experience and is competent to run the home. Mrs Ncube is on target to complete her Registered Manager’s Award and NVQ Level 4 award by the end of 2007. Evidence gathered throughout the inspection site visit showed that she communicates a clear sense of leadership and is aware of her responsibilities. Relatives confirmed that they see her regularly and she is approachable and helpful. The senior management completes regulation 26 inspections and reports From observation and from discussion with staff and visitors, there is clear evidence of good leadership and support by management. The home maintains a log of all chiropody care received and hairdressing, which is sent to the companies finance department who in turn send a monthly invoice to the residents’ significant other. One family visitor stated that they were happy with this system. Resident’s money held for safe keeping is properly managed and clear records maintained. Regular supervision is maintained with supervision sessions for care staff at least 4 times per year and the records of these are maintained in the staff files. The manager conducts an annual audit to assess the satisfaction of residents/relatives with regards to the service and care that the home provides. This information is obtained through questionnaires and completed by residents and relatives. A survey has recently been carries out collated and showed positive outcomes. Surveys stated that, “the staff work hard to please the residents”. Other comments included, “The whole team are of a caring nature” and “Staff are friendly, approachable and respectful”. Senior staff meetings continue to be held on a monthly basis for the organisation with care meetings every other month. This aims to measure the success in meeting the aims, objectives and the statement of purpose of the home. Minutes were looked at from the last two residents and family meetings, which were informative. The contents of the minutes showed a wide variety of topics discussed. The certificate of registration and a current insurance certificate were displayed. Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 23 The home employs a maintenance man. Records showed that relevant inspections and maintenance has been carried out at the required intervals for the fire alarms and equipment, gas and electrical services, hoists and lift. Baths have thermostatic mixer valves and the monitoring hot water temperatures take place. The fire logbook was up to date and in order. Staff fire safety drills and training are taking place at the required intervals. Accidents were noted to be properly recorded and reviewed as required as are notifications made under Regulation 37. All residents have risk assessments including tools for assessing falls and falls prevention The home has appropriate moving and handling and pressure relieving equipment and that staff have attended updates on handling residents. Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 2 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X 3 3 3 X 3 3 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 3 3 3 Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 25 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. 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. Refer to Standard OP1 OP15 OP29 Good Practice Recommendations Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Regional Office 4th Floor, Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Englishcombe House DS0000046576.V345318.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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