Care Home: Green Gables

What the care home does well This is a well-managed service, which is run in the best interests of people who live in the home People are treated with respect and dignity. The atmosphere in the home is warm and friendly with cheerful and relaxed staff who are focussed on meeting people`s needs. People are fully assessed before admission and confirmation given that the home can meet their needs. Relatives said there is always a good atmosphere in the home and staff are very helpful.They also said that their relatives get a good standard of care and had no concerns about the care given. People said their care needs were discussed with them and overall they felt that they were well cared for. What has improved since the last inspection? Since the last inspection the home has reassessed their medication procedures to make sure they are in accordance with the Royal Pharmaceutical Society Guidelines. The manager has recognise the more work needs to be done for this and had put systems in place to address this, for example, two member of staff will be undertaking a training course, that would provide them with knowledge, how to meet people`s social needs, especially those with dementia. Since the last inspection, a bedroom and the communal sitting rooms have been redecorated and one window replaced. What the care home could do better: Privacy in those bedrooms with linking door; the manager told us that he had consulted with the fire service and is now looking into putting an appropriate lock that would not compromise fire safety. Care plans should include information about end of life care; this was discussed with the manager who said he is now looking at this to make sure people have the end of life care they want. Medication from the blister pack must be given directly to the person it is prescribed for, so that the staff can be sure that people are receiving the correct medication. All new staff employed must have a CRB check carried out by the home, to make that they are suitable to work with people who live in the home. CARE HOMES FOR OLDER PEOPLE Green Gables Green Gables 2 Woodside Road Low Moor Bradford West Yorkshire BD12 0TX Lead Inspector Valerie Francis Key Unannounced Inspection 09:30 14th August 2008 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 Green Gables DS0000001280.V364657.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. Green Gables DS0000001280.V364657.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Green Gables Address Green Gables 2 Woodside Road Low Moor Bradford West Yorkshire BD12 0TX 01274 676231 F-P1274 676231 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) R & N Partners Mr Ian Helstrip Care Home 11 Category(ies) of Dementia (2), Old age, not falling within any registration, with number other category (10), Physical disability (1) of places Green Gables DS0000001280.V364657.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th August 2007 Brief Description of the Service: Green Gables is situated in the Low Moor area of Bradford on a bus route into the city. The stone built detached house, standing in a large garden with a small area for off road parking, is indistinguishable from other houses in the area. Several local shops are within walking distance of the home. All but one of the rooms is shared and none have en suite facilities. One of the shared rooms is on the ground- floor; a stair lift provides access to the first floor rooms. People are encouraged to bring some small personal possessions into the home. At the time of writing this report fees charged for the care provided were between £354.27 to £ 398.88 per week. Extra charges are made for the following - private chiropody, hairdressing, newspapers and periodicals. Information about the home and the services provided are available from the home in the Statement of Purpose and Service User Guide. Green Gables DS0000001280.V364657.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 **two star. This means the people who use this service experience good quality outcomes. This report is based on information gathered in a number of ways. • • • A review of the information held on the home’s file since its last inspection. Information sent to us by the registered provider in a document called the Annual Quality Assurance Assessment (AQAA) We left surveys at the home for people who live at the home, their relatives and for staff. Three surveys were sent back by relatives, four came back from people who live at the home. We got one survey back from a member of staff. An unannounced visit to the home. This visit included a tour of the premises and talking to people who live at the home, their friends/relatives, staff and management. We also looked at menus, staff rotas and people’s care plans and watched staff looking after people over lunchtime and throughout the day. • The information we received helped us to form a judgment about the quality of care people who live at the home receive. In each of the sections in the main report we look at whether the quality of care is poor, adequate, good or excellent. What the service does well: This is a well-managed service, which is run in the best interests of people who live in the home People are treated with respect and dignity. The atmosphere in the home is warm and friendly with cheerful and relaxed staff who are focussed on meeting people’s needs. People are fully assessed before admission and confirmation given that the home can meet their needs. Relatives said there is always a good atmosphere in the home and staff are very helpful. Green Gables DS0000001280.V364657.R01.S.doc Version 5.2 Page 6 They also said that their relatives get a good standard of care and had no concerns about the care given. People said their care needs were discussed with them and overall they felt that they were well cared for. 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. Green Gables DS0000001280.V364657.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 Green Gables DS0000001280.V364657.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 and 3. (6 this standard is not applicable to this service.) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are assessed before admission and are encouraged to visit the home and/or have a trial stay before making a final decision to move in. EVIDENCE: We were told in the AQAA that people who want to move in the home are given a copy of the statement of purpose that gives them information about the home. One relative said. “The manager went through all the aspects of the home with me and my mum.” We saw detailed pre-admission assessments in people’s care records. Other assessments done by social care professionals were also available. The manager said during the assessment process he also considers the suitability of the home for new people and takes into account the needs of people already living there. Green Gables DS0000001280.V364657.R01.S.doc Version 5.2 Page 9 People and/or their representatives are encouraged to visit the home before making a decision about admission. People can stay for a trial period to make sure the home is suitable for them. Likewise if the home has any worries about whether they can meet the needs of the person they will offer admission for a trial period. We were told that during the trial period a full assessment including a risk assessment is carried out. To make sure the home can meet people’s assessed needs. Green Gables DS0000001280.V364657.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s health and personal care needs are met in a way that respects their privacy and dignity and takes account of their wishes. People are not protected by the home’s practises for administering medication. EVIDENCE: The AQAA told us that people’s care plan is based on their assessment information. We looked at the care plans for three people. The care plans give staff clear information on how to meet people’s personal and health care needs. They include information on what people can do for themselves. There are memory diaries, which give staff some information about people’s life history. However, there were no care plans to show how people’s social care needs will be met. Green Gables DS0000001280.V364657.R01.S.doc Version 5.2 Page 11 There were gaps in people’s care plans, for example risk assessments for falls are carried out and although there was a falls diary in place, there was no plan of action to show staff how to manage or minimise the risk. Nutritional risk assessments are carried out, but there was no guidance for staff to follow to manage any identified risk, so that they could seek advice from the GP or dietician. The timescales and systems for checking and recording people’s weights does not fit with what it says in people’s care plans. The manager told us that they have recently started to update care plans on a new format and they are now produced on a computer. The manager also told us he sits down with people and/or their relatives, to discuss their plans and make any changes to take account of their views. Staff told us that they get detailed information about people and are able to read care plans to find out more about an individual’s needs. They also said “the care plans are updated when needs change and are looked at on a monthly basis.” A recommendation was made at the last inspection, for people’s care plan to have information on how they wished to be cared for at the end of their life. This is to make sure that people get the care they want. . Relatives told us that their relatives get the care that they need and are informed of any changes in the care. One person who lives at the home said. “The staff are very good, they look after me well.” People’s information showed that they have access to health care professionals, which include their GP, dentists, district nurses and chiropodist. Medicines are managed safely, by staff who have had training on handling of medication. The manager told us that he has carried out medicine training with some new members of staff. We were told if anyone wanted to manage their own medication a risk assessment would be done. The home now uses a blister pack system for medications. However, we saw that medicines were being removed from the blister pack and put in pots with people’s names. This is known as secondary dispensing and is poor practice, which could result in people receiving the wrong medication. Medication from the blister pack must be given directly to the person it is prescribed for so that the staff can be sure that people are receiving the correct medication. Green Gables DS0000001280.V364657.R01.S.doc Version 5.2 Page 12 We saw that information about people’s personal care was displayed on the home’s notice board. This practice compromises people’s privacy and dignity. However throughout the inspection we also saw that people were treated with respect and they are encouraged to be as independent as possible. The atmosphere in the home is relaxed and it was evident that there are good relationships between people and staff. Green Gables DS0000001280.V364657.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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are supported to have control over their lives and are encouraged to maintain their life skills and independence. Effort needs to continue to make sure that people have the opportunity to take part in varied social activities that reflect their needs, preferences, and abilities. EVIDENCE: We were told in the AQAA, that the routines of the home are flexible, and are determined by the needs and wishes of people living in the home, and not those of the staff. During the visit an external activity organiser visited the home involving people in activities such as music, gentle exercise and ball games. After lunch we saw staff having discussions with some people about a television programme, people’s relatives and friends also visited them. Green Gables DS0000001280.V364657.R01.S.doc Version 5.2 Page 14 We saw that staff spent time speaking to people, making sure no one was left out, by involving everyone in conversations. We saw an activity plan displayed on the notice board near the back door, this may not be accessible to everyone. People had memory diaries, which has information about people’s life history. This information could be used in people’s care plans, to make sure all people’s social needs are identified and there is a plan in place to support them to carry out any social activity they want to pursue. The manager said he was aware that more needs to be done to make sure people’s social care needs are met. We were told that there is a plan to improve this by sending to two members of staff on a training course for stimulation and mental health stimulation, to make sure that everyone’s needs are met, including people with dementia. People told us that they could go to their rooms if they wish and they could take part in any activities they wanted. Visiting relatives said “staff spend time speaking to people, and my mother has made friends since she moved into the home.” During lunchtime we saw people being offered a choice of main course and puddings. The meals were nicely presented and people said “the food is very good.” One relative said her mother had put weight on since she moved in the home and the food always smelt and look good. We saw that people were offered second helpings of food. Staff gave people time to eat their meals; people were given juice or water with their meals. People were also offered a hot drink after their meal. We spoke to the cook about people’s weight and their nutritional needs. It was clear from her answers that she knew what to do to improve people’s weight and how to cater for people who had a problem with swallowing or choking. Green Gables DS0000001280.V364657.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 People who use the service experience good outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People and their relatives know that their complaints will be taken seriously and acted upon. EVIDENCE: The AQAA told us that the home has a robust complaint procedure that they follow. We saw that the home’s complaints’ procedure was displayed in the home, but the address for the Commission needs updating. People said they were confident that they could speak to any member of staff about any worries or complaints they may have. Relatives said they knew how and who to complain to, and they were sure any complaint made to the manager would be dealt with. The home has not had any complaints since the last inspection and none have been referred to us. Not all staff have had training on adult protection, those who had received the training were quite clear what to do in the event of an issue arising. All staff Green Gables DS0000001280.V364657.R01.S.doc Version 5.2 Page 16 should have adult protection training so that they are clear about what procedures to follow if abuse is suspected or reported. The home has a whistle blowing policy. When this was discussed with staff who were not aware of the policy, but knew in principal what to do if an issue around adult protection was brought to their attention. Green Gables DS0000001280.V364657.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 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home provides a comfortable, pleasant, and safe place for people to live. EVIDENCE: The home told us in the AQAA that they maintain the environment so that it is safe, clean and free from odours. The equipment and adaptations are suitable for the people living there. There is a programme for replacement and redecorating in place so that people live in an environment that is comfortable and pleasant and well equipped to meet their needs. The home has three communal sitting rooms. One is the designated dining room. All the communal sitting areas had recently been redecorated and carpets are well maintained. Green Gables DS0000001280.V364657.R01.S.doc Version 5.2 Page 18 There is a stair lift to the first floor. We were told that the stair lift had recently been replaced, to meet the needs of people, by giving them access to another two steps on the ground floor. One window has been replaced in the home’s programme for the replacements of windows. We saw that people had taken the opportunity to personalise their bedrooms with fitments and memorabilia from their life before coming to live in the home. The issue with privacy to the bedrooms that have adjoining doors, which are fire doors, to the next rooms, is still not resolved. The manager told us that he had spoken to Bradford fire service about suitable locks for these doors, and he now looking for an appropriate locking system that do not compromise fire safety. Some areas in the home were showing signs of wear and tear for example some tiles, to wash hand basins in bedrooms, communal bathrooms and toilets, needed grouting. The sink in one bedroom needed replacing as it was showing signs of wear and tear and the sink and taps were badly stained. We saw one bedroom that had recently been redecorated. Most of the recommendations made by West Yorkshire fire service have been carried out. Green Gables DS0000001280.V364657.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 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are enough staff available to meet people’s needs. Staff are supported in developing the skills and knowledge they need to meet people’s care needs. EVIDENCE: The AQAA told us that the home has a stable staff team who is well trained. Information seen, showed that 70 of care staff have achieved an NVQ (National Vocational Qualification) at level 2 or above. We saw the duty rota, which showed that are two staff and a senior staff on duty during the morning and two care staff during the evening. At night there is a waking staff member and a sleeping staff available to people. At nights there is one waking member of staff and one sleeping-in who is available for assistance if needed. Although at the time of this visit the staffing arrangement at nights, appeared to be appropriate for the current group of people living in the home. This arrangement must be kept under continual review to make sure that in an event of a fire, the staff available is appropriate to comply with fire safety, and there are enough staff to meet any change in people’s needs. Green Gables DS0000001280.V364657.R01.S.doc Version 5.2 Page 20 The home employs two cooks to cover the catering duties. One relative told us “staff are always friendly and always on hand to see to my mother.” Staff told us. “The staffing level at times is ok but they should try not to admit so many people who are dependent.” Overall people said they were happy with the care they get at the home. We looked at three staff files, two showed that the required checks had been made and were recorded on the files. However, we saw that the home had not carried out a CRB check for one staff; there was a copy of a result of a CRB check that had been made by their previous employer. The manager said he was not aware that CRB checks were not transferable from one employer to another. This practice means that the home cannot be sure that the staff it employs are safe to work with older people. There is ongoing training for staff, most of which is provided in house by the manager. The home has its own induction checklist and new care staff undertake the Skills for Care Induction standards. These are nationally recognised standards designed to make sure that new care staff are helped to get the knowledge and skills needed for their work. Staff said that they had received induction training; one member of staff said they felt that they had been given too much information in such a short period of time. We saw records that staff have had training on moving and handling, infection control and health and safety. The home has a training programme, which also covers areas such as fire safety training and training for staff on dementia and adult protection. Green Gables DS0000001280.V364657.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 35 and 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is well managed; the interests of people are safeguarded. EVIDENCE: The manager has many years of caring and management for older people. He undertakes various training courses to make sure he has up to date information and training about the people in his care. It was not clear at the start of the visit who was responsible in the absence of the manager; the senior care worker notified the manager who came and facilitated in the inspection process. It is clear that the manager is committed to making sure that the home is run in the best interests of the people who live there. People and their relatives Green Gables DS0000001280.V364657.R01.S.doc Version 5.2 Page 22 have confidence in the management team. Relatives said “we can always talk to the manager.” The manager told us that they do not manage anybody’s money. However, if this was needed there were systems in place to make sure people’s monies are safe, with a record kept of all transaction. People said they were happy with the home and the manager. The home sends out quality monitoring questionnaires at least three times a year. However there are no systems in place for people to get a copy of the outcome. We saw evidence that staff have one to one supervision with the manager. The manager told us these meetings take place at least six times a year. Staff said that they get regular support from the manager. We saw records that showed that equipment and installations are checked and serviced at the required intervals. The fire alarm system is tested weekly. Green Gables DS0000001280.V364657.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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Green Gables DS0000001280.V364657.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 2. Standard OP9 Regulation 13 Requirement Medication from the blister pack must be given directly to the person it is prescribed for, so that the staff can be sure that people are receiving the correct medication. All new staff employed must have a CRB check carried out by the home, to make that they are suitable to work with people who live in the home. Timescale for action 30/09/08 2. OP29 19 30/10/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP7 OP8 Good Practice Recommendations People should have a care plan in place for any Nutritional and falls risks identified. This is so that staff understand and are aware of people’s nutritional needs. People’s weight should be regularly monitored, to make sure that any issues with weight loss, can be identified and referred to the GP or dietician for support and advice. Green Gables DS0000001280.V364657.R01.S.doc Version 5.2 Page 25 3. 4. OP10 OP30 People’s information must not be available in a public place, which means that their privacy and their dignity can be compromised. All staff must have training in safe guarding adults, so that they are clear on the action they should take if abuse was either witnessed or suspected. Green Gables DS0000001280.V364657.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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 Green Gables DS0000001280.V364657.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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