Care Home: Greenbanks

What the care home does well "I have nothing but the utmost admiration for this place" was the comment of one relative about Greenbanks and one resident thought that "I am very lucky to have come here" The standard of care observed throughout this visit was good and this was confirmed by positive comments made by people living in the home in their responses to the surveys and also in conversations on the day.Comments on the day from staff indicate that they feel well-supported by the new home manager and that a good programme of training is provided for them which helps them maintain their skills and in turn supports people living in the home by ensuring they are cared for by staff with the necessary skills and experience to do so. One staff member commented in their survey response "I believe in all the home is a very good home" The standard of records seen on the day, including care plans and those for medication were good and again help to support the good standard of care provided for people living in the home. What has improved since the last inspection? The impact of the new manager has been seen as positive by both staff and people living in the home and Runwood Homes provide robust support through, for example, their quality assurance manager and also in the specialist training support they provide in, for example, dementia care. Requirements made in respect of the environment following the previous inspection have been addressed and overall the home now provides a pleasant environment for those people who live and work there. Dementia care in the home has been enhanced by the use of `memory boxes` for those people who live with dementia, this helps staff to know something of their history, interests and personalities and to use this as they seek to provide person centred care for them. What the care home could do better: Some of the staff surveys indicate that staff can be under pressure at some key times and that in the past communication within the home has not been good. Communication is one of the areas identified for improvement in the home`s AQAA. Some concern over the food budget was raised by one member of staff although overall comments about food from people living in the home were satisfactory. The home recognise in their AQAA that there is more work that needs to be done as they seek to implement activity based care. CARE HOMES FOR OLDER PEOPLE Greenbanks Greenbanks Road Watford Hertfordshire WD17 4JP Lead Inspector Jeffrey Orange Unannounced Inspection 7th May 2008 08:15 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 Greenbanks DS0000019414.V363845.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. Greenbanks DS0000019414.V363845.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenbanks Address Greenbanks Road Watford Hertfordshire WD17 4JP 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) 01923 255 160 01923 255 170 www.runwoodhomecare.com Runwood Homes Plc Vacant Care Home 66 Category(ies) of Dementia (66), Old age, not falling within any registration, with number other category (66), Physical disability over 65 of places years of age (66) Greenbanks DS0000019414.V363845.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: There are none Date of last inspection 8th May 2007 Brief Description of the Service: Greenbanks is a care home providing personal care and accommodation for 66 older people, who may also have a physical disability or dementia. It has been owned and operated by Runwood Homes plc, since 1999 (and was previously operated by Hertfordshire County Council. The home consists of a purpose built two-storey building that is divided into four units, each with its own name and identity. It is situated in a residential area on the outskirts of Watford. There is a parade of shops relatively close by, the town centre with shops, library and access to public transport, is about a mile away. It is next to a day centre that is also owned by Runwood Homes. All the homes bedrooms are single and have en-suite facilities. There is a passenger lift. The home has attractive grounds that are fully accessible for the service users and provide pleasant outlooks from the home and a stimulating and safe outside environment. The fee range for the home is between £420-673 per week. Additional charges are made for hairdressing, personal toiletries, newspapers and chiropody and dental services where these are not provided free under the National Health Service. Information about the home, including fees is contained in the Service User’s Guide and Statement of Purpose, copies of which are available from the home. The latest report on the home by the Commission for Social Care Inspection (CSCI) is also available in the home. Greenbanks DS0000019414.V363845.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 unannounced inspection began early in the morning and provided an opportunity to observe the routine of the home as people living there were helped to prepare for the day. During the inspection visit conversations were held with people living in the home as well as members of the staff team, the home’s manager and with senior Runwood Homes managers responsible for quality assurance and dementia care training. Key records, including those for staff recruitment, training, care planning, medication and financial records for people living in the home were inspected and the physical environment of the home was assessed. Prior to the visit a series of surveys to both staff and people living in the home were sent out and those that were returned have been noted and summarised and have been used in drawing up this report. This report also draws on comments from information made in the home’s annual quality assurance assessment (AQAA) that was received by the CSCI the day after this visit. (The AQAA is a self-assessment that focuses on how well care outcomes are being achieved for people living in Greenbanks, it also contains some useful statistical information about the home) As part of a national piece of work by the CSCI on safeguarding vulnerable adults, specific questions were asked of a sample of people living in the home, staff and the home’s manager and their answers will inform the national statistical and quality analysis of safeguarding processes. What the service does well: “I have nothing but the utmost admiration for this place” was the comment of one relative about Greenbanks and one resident thought that “I am very lucky to have come here” The standard of care observed throughout this visit was good and this was confirmed by positive comments made by people living in the home in their responses to the surveys and also in conversations on the day. Greenbanks DS0000019414.V363845.R01.S.doc Version 5.2 Page 6 Comments on the day from staff indicate that they feel well-supported by the new home manager and that a good programme of training is provided for them which helps them maintain their skills and in turn supports people living in the home by ensuring they are cared for by staff with the necessary skills and experience to do so. One staff member commented in their survey response “I believe in all the home is a very good home” The standard of records seen on the day, including care plans and those for medication were good and again help to support the good standard of care provided for people living in the home. What has improved since the last inspection? What they could do better: Some of the staff surveys indicate that staff can be under pressure at some key times and that in the past communication within the home has not been good. Communication is one of the areas identified for improvement in the home’s AQAA. Some concern over the food budget was raised by one member of staff although overall comments about food from people living in the home were satisfactory. The home recognise in their AQAA that there is more work that needs to be done as they seek to implement activity based care. Greenbanks DS0000019414.V363845.R01.S.doc Version 5.2 Page 7 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. Greenbanks DS0000019414.V363845.R01.S.doc Version 5.2 Page 8 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 Greenbanks DS0000019414.V363845.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5 (Standard 6 does not apply to Greenbanks) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering Greenbanks as their home can be confident that they have the necessary information to enable them to make a well informed decision. Assessments made before admission provide assurance to people considering Greenbanks as their home, or as home for someone they are responsible for, that only people whose care needs are understood and can be fully met will be admitted. EVIDENCE: Surveys received from people currently living in the home indicated that they felt they received sufficient information about the home before they moved in and that the information received had been borne out by their experience since they moved into the home. Relatives and people living in the home spoken to on the day of this inspection confirmed that they had opportunity to visit the home prior to admission in Greenbanks DS0000019414.V363845.R01.S.doc Version 5.2 Page 10 order to help them decide if it was somewhere they thought they could be happy and well cared for. Care plans for people recently admitted to the home were seen to contain a detailed assessment of need and how these were to be met. People living in the home or those responsible for them were involved in the assessment process, which should provide confidence in its accuracy and thoroughness. Greenbanks DS0000019414.V363845.R01.S.doc Version 5.2 Page 11 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. People using this service can be assured that they will receive effective personal and healthcare support that respects them as an individual, with their personal healthcare needs clearly recorded, reviewed and updated in their person centred care plan. People living in the home are protected by an effective and robust medication process that ensures that they receive the support they need with their medication in order to maintain their wellbeing. EVIDENCE: A community nurse commented that “The home works well with us” and paid tribute to the work of the care staff. A doctor was visiting the home on the day of the inspection and all the care plans seen included ample evidence of the involvement of a range of healthcare services, which should provide confidence that people living in the Greenbanks DS0000019414.V363845.R01.S.doc Version 5.2 Page 12 home have ready access to the healthcare services they need to promote and maintain their good health. People spoken to on the day of the inspection and comments received by way of returned surveys were all positive about the way that care is received in terms of preserving rights and dignity. 100 of surveys returned agreed that care staff listen and act on what people living in the home say. One person indicated that she had retained her own chiropodist when she moved into the home, which is positive and indicates that people are able to choose healthcare practitioners where that is possible. Medication records were spot-checked and found to be accurate. Details of the home’s weekly pharmacy audit were seen. This is very comprehensive and covers tidiness and hygiene as well as accuracy of records. This provides people using the service with confidence that the administration of their medication is accurate and well managed. The controlled drugs cupboard should be checked against the requirements of the Misuse of Drugs and Misuse of Drugs (Safe Custody)(Amendment) Regulations 2007 to ensure that it complies with it and offers adequate security from controlled drugs being misappropriated or misused. Guidance is available on the Internet. Greenbanks DS0000019414.V363845.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. People living in Greenbanks can be confident that they will be able to be involved in meaningful activities of their choice, reflecting wherever possible their personal tastes and preferences. People living with dementia are increasingly receiving individual care by staff on a one to one basis, reflecting their personal history and assessed needs. EVIDENCE: “We have some fine old laughs” was the comment of one person living in the home and the majority of those people who returned surveys also indicated that there were always or usually activities arranged by the home that they could take part in. On the day of the inspection there was a cookery session in the afternoon to which several people living in the home spoken to were looking forward. Because it was a fine day some people indicated they would be sitting out in the gardens around the home, which include a sensory garden. The home also has a multi-sensory room which is intended in particular for people living with Greenbanks DS0000019414.V363845.R01.S.doc Version 5.2 Page 14 dementia as it offers an environment designed specifically to stimulate the physical senses such as touch and sight. The home’s principal activities organiser is currently off sick and it has been decided to introduce ‘activity based care’ and enhance the one to one activity sessions on offer to people living in the home, particularly those living with dementia. Staff have been provided with dementia care training, although a few of the survey returns indicate that some staff feel they have insufficient time and skill to carry out the additional work as well as they would like to. The activities programme is augmented by some people living in the home being able to help with, for example setting the table or ‘assisting’ the domestic staff. This provides a sense of purpose and worth for the individuals concerned as well perhaps as some useful practical assistance to staff. Some staff surveys raised concerns about the intervals between meals and the restrictions of the home’s budget for food, which led it was said to some staff having to provide tea bags and milk on occasions at weekends. The surveys returned by people living in the home were on the contrary mostly positive about the food with most indicating that they usually like the meals. Others spoken to on the day said “The food is lovely” or “The food is good” although one person spoken to did indicate that they didn’t care for the food all that much and complained that it was not always possible to get a small portion. There were several visitors to the home during this visit and those spoken to were very positive about the home and their welcome from the manager and staff. People spoken to who live in the home confirmed that they are able to keep in touch with family and friends and that they can have visitors readily. Breakfast was observed on the Hazlemere unit and people living in the home were asked what they would like for breakfast, whether they would like toast or not and if their food was hot enough. As well as this choice being given at the time, people living in the home confirmed that the home’s menu provides them with a reasonable choice, with alternatives to the main menu available on request. Greenbanks DS0000019414.V363845.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. People living in this service can be assured that they will be protected from abuse and that they will be listened to if they raise any concerns or make a complaint about any aspect of their care. EVIDENCE: As part of the national thematic probe on safeguarding being carried out by the CSCI, staff, managers and people living in the home were asked about their knowledge of safeguarding issues and if they felt safe and protected in the home. All staff spoken to were aware of the different kinds of abuse and had a good understanding of the home’s policies and procedures for safeguarding people who live in the home from abuse. People living in the home said that they felt safe and well cared for. “The staff are wonderful, nothing is too much trouble, I only have to ask” was one comment recorded. Training records and staff spoken to show that staff are given the knowledge and skills they need to be able to recognise abuse if they see it and what to do if it is seen or suspected. This can provide people living in the home, and those responsible for them with confidence that any abuse will be recognised and appropriate action taken to deal with it. People living in the home indicated that they felt comfortable with expressing their views and that they would have no hesitation in approaching the manager Greenbanks DS0000019414.V363845.R01.S.doc Version 5.2 Page 16 or their key worker if they did want to raise any concerns or make a formal complaint. All but one of the surveys returned indicated that the people completing them knew how to make a complaint. There is material about advocacy services available to people living in the home available, which means that independent assistance can be provided to people living in the home if they feel that they need it or have no one else to act on their behalf. One complaint has been copied to us and a copy of the home’s reply has also been seen. The outcome of this complaint has not yet been determined, however it has been dealt with so far in line with the home’s complaints policy and procedure and within the timescale set out in it. Greenbanks DS0000019414.V363845.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, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a safe, clean and well-maintained environment for those who live and work there and people who live in the home can be assured that they can personalise their rooms to reflect their own tastes and personalities. EVIDENCE: There was only one area of the home that had any unpleasant odour on the day of the inspection although this was being attended to by the domestic staff. Those rooms seen, with the permission of the people whose rooms they were, showed evidence of personalisation with pieces of furniture, equipment, pictures and ornaments that reflected their life history, interests and personalities. Greenbanks DS0000019414.V363845.R01.S.doc Version 5.2 Page 18 There has been a programme of decoration since the last inspection drew attention to some shortcomings and the home’s AQAA states that this is to continue. This means that the decorative order of the home should be maintained and enhanced for the people who live and work in it. The improvement of signage on the dementia units is included in the planned schedule of work and once fully completed should provide assistance to those in the home who live with dementia by identifying key areas and facilities of the home. A record of maintenance undertaken on key pieces of equipment has been provided by the home and should ensure that people who use the home’s equipment or rely on its safety and reliability can be confident and reassured that it is safe and well maintained. Greenbanks DS0000019414.V363845.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 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home can be assured that they will be supported by appropriate numbers of skilled and trained staff who have been robustly recruited to ensure that people living in the home are kept safe and their needs are met. EVIDENCE: The recruitment files for recently engaged staff were seen and included all the pre-employment checks required to ensure as far as possible that only suitable people are employed in the home in any capacity and this should afford protection to people living in the home. Training records were seen and are clear and comprehensive. They should provide people living in the home with confidence that staff are given the skills they need to appropriately meet their needs. 56 of staff have now achieved NVQ 2 in care and staff have received specific training in the provision of care for people living with dementia. This should enhance the care experience for people in the home that live with dementia. Although staff surveys suggest that the home is sometimes short-staffed, the rotas seen and the staffing numbers present on the day appeared to be Greenbanks DS0000019414.V363845.R01.S.doc Version 5.2 Page 20 adequate to meet the care needs of people living in the home in a timely and appropriate way. Of the surveys received from people living in the home 40 said that staff were always available when they needed them and 60 said that was usually the case. “The staff are wonderful” and “They tell me it’s no bother to help me” were only some of the very positive comments made about the care experience for people living in Greenbanks. Greenbanks DS0000019414.V363845.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 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who live and work in this service can have confidence that it is well managed and that their health, safety and wellbeing are promoted and protected. EVIDENCE: Although the newly appointed manager has not yet been registered with the CSCI she has previously been registered in respect of another care service and has the appropriate qualifications and experience to manage this service. (Subject to satisfactory completion of the registration process with the CSCI). It is understood that an application for registration as manager of Greenbanks has been made to the CSCI since this inspection visit. Greenbanks DS0000019414.V363845.R01.S.doc Version 5.2 Page 22 Staff spoken to and people who live in the home were generally very positive about the new manager and her team. “The duty manager and deputy manager are very good” The AQAA contains clear, relevant information and is supported by a wide range of evidence that supports claims made in it. It is realistic and acknowledges those areas of the home’s operation that can be improved and sets out how this will be achieved. There are appropriate risk assessments in place and records of maintenance provided in the AQAA indicate that equipment is regularly tested for safety, this should provide people that live and work in the home with confidence that it is a safe environment and that risks to their health and safety are recognised and minimised where they cannot be eradicated altogether. The home has a well developed quality assurance process which takes full account of the views and best interests of people living in the home. “We had some papers sent round to find out what we think” as one person living in the home said. The system for the recording of financial transactions carried out on behalf of people living in the home was examined and found to be robust and well audited and provides people who rely on the home in this way with confidence that their financial interests are being protected. Greenbanks DS0000019414.V363845.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 3 N/A 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 Greenbanks DS0000019414.V363845.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. 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 Refer to Standard OP9 Good Practice Recommendations To ensure the security of any controlled drugs in use in the home, the construction and fixing of the controlled drug cabinet currently in use should be checked to make sure it complies with the requirements of the Misuse of Drugs and Misuse of Drugs (Safe Custody)(Amendment) Regulations 2007. If it does not, action should be taken to replace it with a storage cabinet that does. Greenbanks DS0000019414.V363845.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenbanks DS0000019414.V363845.R01.S.doc Version 5.2 Page 26 - 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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