Care Home: Garthowen

What the care home does well The home continues to improve and provide a home for residents who are supported to gain everyday living skills. The staff team work well together in the interests of the residents and have a good knowledge of the particular needs of each individual resident. The staff team work actively to encourage residents to take assessed risks and to become more confident in decision-making. What has improved since the last inspection? The home has worked hard to improve the medication systems to ensure they are robust and safeguard the residents. The staff team receive regular training and the Manager is active in ensuring staff are up to date and have the necessary skills and knowledge to work effectively in the home. What the care home could do better: It is recognised that the Manager and staff team are working hard to address the ongoing environmental issues and that there is a plan in place to improve the environment. However, the maintenance work needs to be completed within a reasonable timescale. CARE HOME ADULTS 18-65 Garthowen 78 Barrowgate Road Chiswick London W4 4QP Lead Inspector Sarah Middleton Key Unannounced Inspection 30 September 2008 09:30 th Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 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 Garthowen DS0000022889.V363961.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 Adults 18-65. 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. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Garthowen Address 78 Barrowgate Road Chiswick London W4 4QP 0208 995 9702 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) garthowen@together-uk.org www.together-uk.org Together Working for Wellbeing Olufunmilayo Adetipe Eddo Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st October 2007 Brief Description of the Service: Garthowen is a detached, three storey building situated in a residential area in Chiswick, close to local facilities and transport. The home is registered for twelve residents with mental health problems. The London Borough of Hounslow is the main purchaser and has blocked purchased seven of the bed places. The home is owned and managed by Together Working For Wellbeing. The accommodation has nine single bedrooms on the first floor. There is a selfcontained flat on the ground floor and two flats on the second floor. Residents who are ready to move on to more independent living use the latter. Smoking is permitted in resident’s bedrooms and in the garden. The dining room can be used as a quiet area in between meals. There are no lifts in the building so it is only suitable for residents with good mobility. Residents are expected to participate in cooking, looking after their own laundry and helping with some domestic tasks around the home. After a settling in period, residents are expected to become more involved in some form of activity outside the house during the day. This is specified in their care plans. Key workers support residents to learn new skills and work in conjunction with other professionals in helping them to move on to independent living. Fees range from £702.42- £800 per resident, per week. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced inspection and took place between 9.30am-4.15pm. We viewed a variety of documentation, such as, a sample of residents’ files, staff files and maintenance records. Four residents, five relatives and one health professional completed postal surveys. We also spoke with four residents and two members of staff during the inspection visit. The Registered Manager (who will be referred to in this report as the Manager) completed an Annual Quality Assurance Assessment and this also informed the inspection process. The three previous requirements had been met. One new requirement was made at this inspection. All of the National Minimum Standards were assessed at this inspection visit. What the service does well: What has improved since the last inspection? The home has worked hard to improve the medication systems to ensure they are robust and safeguard the residents. The staff team receive regular training and the Manager is active in ensuring staff are up to date and have the necessary skills and knowledge to work effectively in the home. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are fully assessed prior to moving into the home. EVIDENCE: We viewed a sample of residents’ files and saw completed pre-admission assessments. These documents cover a range of subjects such as, their mental health needs, care needs and independent living skills. Two members of staff meet with the prospective resident and seek to gain information from them and professionals. All prospective residents are encouraged to meet the other residents and staff team and spend time in the home, including having overnight stays in the home. This also assists staff to begin completing a risk monitoring form and to consider the initial care plan. Once new residents have moved into the home they are assigned a keyworker who they meet on a regular basis. The recently admitted resident is on a six- week assessment to ensure the home is suitable to meet their particular needs. Overall the induction process is well planned out and the resident’s views are taken into account throughout this period. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that their care needs and presenting risks are recorded and their views are taken into consideration. Residents are supported to make daily decisions about their lives. EVIDENCE: We looked at two residents’ files and saw on both files there were detailed care plans. These covered the residents’ main care and health needs, along with how these needs were to be met. Cultural and religious needs are also considered and recorded. The files seen contained the resident’s life histories and had pen pictures of the resident. These gave a good overview of the resident’s character and needs. Throughout the documentation the resident had signed to demonstrate they were involved in the completion of these documents. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 10 The Annual Quality Assurance Assessment stated that residents are fully involved in the development of their care plans and risk assessments. This was confirmed when those residents spoken with all confirmed they were a part of their care plans and risk assessments. The residents also stated that they felt able to talk through with staff if they disagreed with an aspect of what was written about them. Care plans and risk assessments are reviewed on a regular basis and are updated when there is a change in needs. Evidence was seen that keyworkers meet with the residents on a regular basis and these meetings are recorded and signed by both the keyworker and resident. Residents spoken with commented positively on the support they receive from their keyworkers and other members of staff. Residents are encouraged to make choices about their lives. The impact of these choices, if significant, are talked through with a member of staff, to ensure the resident understands the consequences of the decisions they are making. Regular contact with health professionals and relatives ensure that the resident receives support from various people. The majority of residents manage their own finances and are encouraged to manage their own medication, (see further on in the report in relation to these areas). As noted earlier risk assessments were viewed and were very detailed. Members of staff consider historical risks along with presenting and potential current risks. Each resident presents with different risks and the Manager is mindful that those risks need to be assessed, recorded and reviewed to ensure all those in the home are safeguarded from potential harm. Plans would be put in place if a resident presented with a significant risk that needed closer monitoring. The resident would be fully aware of the procedures the staff team would be taking in order to minimise the presenting/potential risks. The staff team have worked hard to clearly record residents needs and risks and this has continued to improve. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents engage in activities and tasks both in the home and in the community. Residents are encouraged to maintain social relationships with friends and relatives. The residents’ rights and choices are promoted within the home. The meal provision offers residents well- balanced fresh meals on a daily basis. EVIDENCE: Residents spend their time in different ways. One resident we spoke with described doing voluntary work and commented positively on this experience. Other residents attend a drop in centre or take part in chores around the home. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 12 The staff team recognise that for some residents, being motivated to engage in regular activities can be stressful and staff work with each resident at a level the resident is comfortable with. The aim of residents living in the home is to gain daily living skills and confidence. The Annual Quality Assurance Assessment stated that staff assist residents to look for a placement that will meet the resident’s interests and needs. For some residents this is not always possible and placements are reviewed if residents do not engage with tasks around the home or go out into the community. Each morning there is a house meeting where chores and tasks are divided up between the residents. Once a month there is a community meeting whereby residents can choose group activities. Not all residents take part but a small group might play pool in the home, or have a movie night. Residents are supported to see friends and relatives. One resident sees their family on a weekly basis. Within reason, there are no restrictions to visiting times. Those residents asked confirmed they can lock their own bedrooms and receive their own personal mail. Staff were seen to interact with residents in a positive and professional manner. The kitchen was viewed which had very recently been updated. The kitchen now had new fitted units and flooring. This made the room more appealing to prepare and cook meals in. The kitchen is spacious and enables residents to cook meals for themselves or for the whole home. Residents are encouraged to prepare a meal for everyone each week. Those residents spoken with said they enjoyed making meals and that staff were there to assist them if they needed help. Menus were seen and overall they provide a variety of food that incorporates fresh produce. Some residents prefer takeaway food or eat outside of the home. Staff are conscious that it can be difficult to monitor what some of the residents eat. Some resident, who live in the small flats that are within the main part of the home, are encouraged to self-cater on certain days. This entails the resident shopping and preparing their own meals. Those residents asked said they enjoyed the food they eat in the home. We advised the Manager to replace the chopping boards as those seen were scratched. We acknowledged that they had been replaced recently, but they do need replacing when they become too marked. We were satisfied that staff would take action to replace these. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents receive personal support in their preferred way. Residents’ health needs are identified and were being met. Robust medication systems are in place to safeguard the residents. EVIDENCE: The majority of the residents are able to manage their own personal care needs. Staff on occasion might need to encourage residents to wash or change their clothes. Residents said they were able to get up and go to bed as and when they wanted to. Residents’ health needs are noted on their care plans. Appointment sheets were seen which record health visits and the outcome of these visits. All residents have a GP and see other health professionals either in the home or the community. Some residents choose to attend appointments without a member of staff and when this occurs, residents are expected to let staff know the outcome of these visits. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 14 A sample of medication was checked and counted. All those counted were correct at the time of the inspection. Evidence was seen that staff had attended training on medication and the Manager and senior staff had attended advanced medication training. Two members of staff handle medication and it is counted and checked on a daily basis. Evidence was seen of additional medication audits that are carried out on a weekly basis. There were no controlled drugs in the home at the time of the inspection. Some residents are able to self-medicate. When this has been assessed and discussed with the resident and other health professionals, such as a Psychiatrist, this is then introduced slowly. Risk assessments are completed and the resident starts by having three days supply of their medication. This is then increased so that eventually the resident has a month’s supply of their medication. One resident who has just started to self-medicate explained that they knew the medication had to be kept safely locked away in their bedroom. Staff also make spot checks on these medications to ensure the resident is taking the prescribed amount each day. Residents who are self-medicating are aware that this will be checked and we saw a consent form signed by a resident that agrees to their medication being checked by staff. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to make a complaint and can feel confident that this will be listened to and acted on. Systems are in place to safeguard residents from abuse. EVIDENCE: The home had received two complaints since the last inspection. These were seen and had been dealt with by the Manager. Those residents who completed a postal survey and those spoken with at the time of the inspection all stated that if they were unhappy they would talk with a member of staff. Staff were due to attend training on safeguarding issues on the 21/10/08. The Manager would also be attending training on safeguarding specifically for Managers. Those staff asked said they would report any safeguarding concerns to the Manager. We checked one resident’s personal money. This was correct at the time of the inspection. The other residents’ manage their own personal money. One resident explained how they preferred to be in charge of their own money as they could then budget each day. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are still ongoing maintenance jobs needing to be completed within the home. Overall the home is clean and welcoming. EVIDENCE: We carried out a tour of the home. There were still areas needing to be addressed that had been identified at the last inspection visit. Bedroom five had no light fitting attached to the ceiling light. The ground floor and top floor bath still needed re-enamelling or replacing. In addition, we also noticed that the seal around the first floor bathroom was mouldy and in need of replacing. The toilet holder in the small toilet on the first floor was broken. Although the larger jobs need attention, the Manager should consider having smaller jobs also completed. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 17 However, as noted earlier a new kitchen had been fitted and some bedrooms had been painted. The Annual Quality Assurance Assessment stated that there is a five-year maintenance programme in place. The Manager showed us a maintenance plan that outlined all the major works needing to be completed. The large lounge was next on the plan to be updated and re-furbished. The Manager was hopeful that work would continue to be completed in the home. Although it is acknowledged that the Manager has worked hard to ensure work has been carried out in the home, there continues to be work outstanding. Therefore a requirement was made for the maintenance work to be ongoing to ensure the home looks welcoming and appealing for those living in it. The home has a cleaner who works fifteen hours a week. The Manager is in the process of advertising for a caretaker who would work twenty-five hours a week and not only clean the home but also carry out the general maintenance of the home. Overall the home was clean and free from offensive odours. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34 & 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A competent and effective staff team support the residents. Residents are safeguarded by a robust recruitment procedure. A staff team who receive regular training opportunities support the residents. EVIDENCE: There are three seniors who work closely with the Manager. One senior recently left and the Manager had been successful in recently filling this position. We were informed that the home uses external agency staff on the rare occasions, when the existing staff team or relief members of staff cannot work in the home. Staff are supported to study for an NVQ level 3 and the majority of staff have either obtained or are in the process of obtaining this qualification. The staff team are a mix of experience, gender and cultural backgrounds, thus reflecting the mix of residents living in the home. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 19 Those staff asked said they felt the team worked well together and that communication was good. One member of staff explained that as soon as they come on shift they checked the communication book and diary to see what has occurred since they were last working in the home. Two staff employment files were viewed. These contained all the necessary documentation, such as Criminal Record Bureau Check, medical clearance and references. We viewed a sample of individual training records. We also viewed the training booklet where all the courses are listed for the year. Staff attend courses on core subjects such as fire awareness and food safety, along with more specialist courses relating to mental health, the mental capacity act and equality and diversity. Relief staff also attend training. New staff receive an induction into the home, where they spend time observing and reading relevant documents. They also receive an induction into working for the organisation. Overall the staff team were up to date with their training and the Manager was aware of when staff needed to attend training courses. Those staff asked said they were happy with the induction and training they had received. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a well run home. The home is reviewed and objectives set in the interests of the residents. The residents’ health and welfare is promoted by regular maintenance checks. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 21 EVIDENCE: The Manager has an NVQ level 4 in care and is registered to be an NVQ assessor. There are plans in place for the Manager to study for the Registered Managers Award. She has been working in the home for approximately two years and has worked hard, as reflected in the recent inspection reports, to make improvements to the home. Those staff asked commented positively on the Manager, stating she is supportive and approachable. The home has various systems in place to monitor the home and to involve and obtain the views of the residents and their relatives. The day before the inspection the home had held an annual review day. This day is open for residents, relatives and other professionals to come to the home and meet with the staff team, ask any questions they might have and for the home to gain the views of others. Surveys are also given to residents and the results are looked at the Provider’s head office and sent to the Manager of the home. We receive the monthly Regulation 26 reports, where the Area Manager visits the home and looks at a sample of records and speaks with residents and staff. There is a business plan in place and we viewed the 2007/08 quality assurance summary. This summary provides a pen picture of how the home operates and where there have been areas of improvement. The maintenance records were viewed. Servicing records such as testing for Legionella, fire equipment and Portable Appliance Tests were up to date. The Gas safety Record was recently out of date and subsequent to the inspection the Manager informed us that this had now been carried out and a certificate of evidence was now available. Fire drills had been held on a regular basis and a fire risk assessment was seen that had been completed in May 2008. As the fire Regulations had changed in 2007 the Manager was advised to ensure she was aware of this new legislation. Water temperatures are taken on a regular basis and general health and safety checks are carried out on a daily basis. Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 x 4 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23(2)(d) Requirement In order for the residents to live in a pleasant and welcoming home, the maintenance of the home must continue on an ongoing basis to ensure the work is carried out within a reasonable timescale. Timescale for action 02/03/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 24 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 Garthowen DS0000022889.V363961.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!