Care Home: Highgrove

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What the care home does well The registered manager and staff group have responded well to the requirements set at the last key inspection. Highgrove continues to provide easy access to a variety of communal areas. Bedrooms are comfortably furnished and suit the needs of their occupants. It is evident that people who use the service have brought items of furniture, photographs, ornaments and pictures with them to make their rooms more "homely" and, as a result, bedrooms are highly personalised. A system is in place for dealing with any complaints, people who use the service expressed a degree of confidence that complaints would be listened to and dealt with appropriately. All spoken to were able to identify the registered manager. Staff are on duty throughout the day and night in numbers that are sufficient to ensure the safety of residents in the home and staff training is provided to a satisfactory level. Staff are safely recruited into positions at Highgrove, the process ensures that all relevant checks are carried out with regard to a potential employees suitability. What has improved since the last inspection? The management and staff have made good progress in addressing the shortfalls noted in the previous inspection. The initial assessment and care planning process has been reviewed and people who live at the service now have their needs suitably documented. The management has now established a system for reviewing and improving the quality of care in the home. Written additions to the medication administration record are now signed, the controlled drug cabinet is now secured to the wall. An appointed person who is qualified in first aid is on duty at all times to ensure people receive prompt attention when required, infection control issues have improved. The management arrangements have been formalised and an application for a joint management of the home has now been made. What the care home could do better: The administration of medication via the per required needs route needs to be better regulated to ensure the protection of all those who require assistance. How people are assisted at dinner could be better managed to ensure that people who use the service have a positive experience. The management need to ensure that they have good documentation with regards to the fitness of agency staff. It would benefit those who use the service if staff had regular managed supervision. CARE HOMES FOR OLDER PEOPLE Highgrove Stapehill Road Stapehill Wimborne Dorset BH21 7NF Lead Inspector John Hurley Unannounced Inspection 15th September 2008 10:00 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 Highgrove DS0000061344.V368444.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. Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Highgrove Address Stapehill Road Stapehill Wimborne Dorset BH21 7NF 01202 875614 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) Samily Care Ltd Manager post vacant Care Home 21 Category(ies) of Old age, not falling within any other category registration, with number (21) of places Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th March 2008 Brief Description of the Service: Highgrove has been operational as a care home since 1991, the present owners Mr & Mrs Bleach have been registered since June 2004 under the company name of Samily Care Ltd. The registered manager post is currently vacant. The home is registered to accommodate 21 older persons for personal care only. The property is a large Victorian house that has been extended and is set in large, well-maintained gardens. The front of the home provides off road parking for several cars. Highgrove is in Stapehill between the towns of Ferndown and Wimborne and is a short walk from the local bus route and post office. Accommodation is provided on ground and first floor levels, the first floor is accessible by a central stairway, there is no lift. Catering and laundry services are provided. The current level of fees for personal care and services and accommodation at Highgrove is between £420 and £520. Highgrove DS0000061344.V368444.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 the second unannounced key inspection of Highgrove Care Home for the inspection year 2008/9. The inspection process followed the Commission for Social Care Inspection Inspecting for Better Lives methodology. The unannounced inspection lasted eight hours. The views of the people who use the service and people important to them were sought by way of questionnaires and conversation during the inspection; where appropriate their comments are included in this report. The inspector toured the building, spoke with the management and staff on duty and spoke privately with people who use the service on both an individual and group basis. They also spoke with a number of visiting relatives and joined the resident group for lunch. The inspector sampled the documentation relating to the individuals who reside at the home along with records relating to staff and other documents required by regulation. What the service does well: The registered manager and staff group have responded well to the requirements set at the last key inspection. Highgrove continues to provide easy access to a variety of communal areas. Bedrooms are comfortably furnished and suit the needs of their occupants. It is evident that people who use the service have brought items of furniture, photographs, ornaments and pictures with them to make their rooms more homely and, as a result, bedrooms are highly personalised. A system is in place for dealing with any complaints, people who use the service expressed a degree of confidence that complaints would be listened to and dealt with appropriately. All spoken to were able to identify the registered manager. Staff are on duty throughout the day and night in numbers that are sufficient to ensure the safety of residents in the home and staff training is provided to a satisfactory level. Staff are safely recruited into positions at Highgrove, the process ensures that all relevant checks are carried out with regard to a potential employees suitability. Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Highgrove DS0000061344.V368444.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 Highgrove DS0000061344.V368444.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): 1,3,6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The management carry out an initial assessment of need to ensure that they can fully meet the needs of the prospective resident. Intermediate care is not a feature of this service EVIDENCE: The inspector reviewed the Statement of Purpose and Service user guide and found that they gave a good account of the services on offer at Highgrove. The manager generally ensures that arrangements are made to carry out an assessment of need, which in the main is completed prior to any person moving into the home. With the introduction of new assessment documentation the gaps in the process that were found at the last inspection have now been addressed. Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 9 The inspector was informed that no new individuals had taken up permanent residency but the management had recently assessed the suitability of a person to come to the Highgrove on a respite basis. The documents sampled were in-depth and explored all areas of the persons well being including areas such as their social and emotional needs. The documents also demonstrated that the individual and people important to them had been consulted about the respite admission. At previous inspections it has been established through discussion with the people who use the service that prospective residents and their families are invited to visit the home prior to admission to establish if the home would suit their needs. The manager informed the inspector that the home does not offer intermediate care. Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans illustrate people’s needs enabling staff to meet them Staff treat residents with respect and dignity, promoting residents’ feelings of worth as valued members of the household. The home has systems in place for managing residents’ medicines but some aspects need improving to protect residents. EVIDENCE: The inspector looked at the care planning documentation. All but one of the current resident group have had their needs reassessed by the management and an initial care plan regenerated. The details on file now include information about the person from a social prospective identifying their likes and interests. The management informed the inspector of the forthcoming plans to get more Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 11 social history relating to the individual from the person themselves and people important to them. Issues relating to the individuals medical needs such as the condition of peoples skin in relation to pressure ulcers are now being fully assessed. The results of assessments are being recorded and action taken to ensure a proactive stance to care is made. Daily fluid and food intake charts are regularly maintained where appropriate. Records now evidence visits by doctors and other health care professionals. The observations in relation to the care planning represent a good response to the requirements set at previous inspections. Now that they have a care plan to work with the management informed the inspector that they can now begin to review the plans and are planning to hold formal reviews for all residents where, if appropriate, other people important to the resident can comment and agree the plans made on their behalf. Improvements had been made to medication practices following the last inspection. Medication was stored securely, a controlled drugs cabinet is now securely bolted to a solid wall. A medication policy was available to all staff who administer medication and they had signed a copy of this. Medication changes were recorded on a sheet at the front of the medication administration record file and all residents were identified with photographs. Medication administration records had been correctly completed. The controlled drugs were briefly audited and found to be correct. Weekly medicine audits continue to ensure that all medicines in the home are accounted for. Staff were observed administering medicines in a safe and caring manner. One area in relation to medication that needs improvement is relating to Per Required Needs medication as there was no recorded rationale for administration via this route for example, pain killers were often prescribed and dispensed for pain relief but there was no associated documentation to described what type of pain or its location. This may lead to staff dispensing medication for pain that has yet to be diagnosed for example originally given for back pain but as staff do not have guidance individuals may be asking or taking pain relief for pains in the legs. The management of the home acknowledged the inspectors observations relating to this matter. The inspector talked with some of the people who use the service and visiting relatives. These people expressed how much they appreciated the care staff and that they considered that they were treated with respect and dignity. It was clear from observation and the time spent with those who use the service that they feel comfortable and at ease with staff. Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 12 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. The pace of life appears to suit the resident’s expectations and aspirations. Visitors are welcomed and individuals are assisted with maintaining contact with relatives and friends. The food is home cooked and offers a balanced diet to those who live at Highgrove. EVIDENCE: People who use the service were observed in a number of different locations. They choose when to get up and when to retire. They have free access to their bedroom and communal facilities. Those who use the service are able to meet privately with visitors either in their rooms or in a designated lounge. Those who were spoken with indicated that they were happy with their life in the home and confirmed having freedom of movement and that staff support them in following their preferred lifestyle. Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 13 The inspector discussed with the individuals how they spend their day and what activities were available. It was established that some afternoons there are activities, some are enjoyed others are not, but in the main all considered there was some thing to do if you wished too. Two visiting relatives expressed satisfaction with the many aspects of “home” life but both identified social stimulation as a shortfall that they wished could be addressed. As reported in the personal care section of this report there is some recognition that the home needs to be more to identify social histories and personal interests in order to be able to plan activities based on individual’s aspirations and interests. Visitors were observed entering or leaving the home. All visitors were warmly welcomed. People’s records and the visitor’s book in the entrance hall demonstrate contact with family and friends as well as visits by professionals. The menu of the day was displayed there was a good choice of main and sweet dishes, both for lunch and tea. Meal choices included special diets. The majority of the meals were served at in the dinning room; some individuals were assisted to eat in the main lounge. The inspector observed the staff who were assisting people and noticed that they did not stay with the person they were assisting for the mealtime period often getting up to help others or to go to the main kitchen. Some more thought was given to how people are assisted at this time to reflect a more person centred approach. Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 14 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. Policies and procedures are in place to protect the residents living at the home To ensure that any incidents will be managed appropriately staff training in adult protection needs to continue. EVIDENCE: The people who the inspector spoke with informed them that they felt able to complain and said they would have no concerns complaining to any staff member should they have need to. They felt that the management and staff are very approachable and will deal with any issues, no matter how minor, there and then if they could. The management also confirmed that an adult protection policy is in place with procedures detailed for contacting the appropriate authorities should any concerns or allegations be made and that this had not changed since the last inspection Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 15 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): 19,22,23,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from comfortable, safe and well maintained surroundings. Resident can personalise their private space and contribute to the décor of communal areas. Residents benefit from a home that is generally maintained in a clean and tidy condition. EVIDENCE: There is evidence of investment around the home with general maintenance, decoration and refurbishment and residents live in comfortable, warm surroundings with a domestic, homely feel. Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 16 The home’s laundry provides adequate facilities. A review of soiled linen storage in the home has been made since the last inspection and new containers introduced so that soiled linen does not pose an infection control issue. The staff toilet that had been leaking at the last inspection has been repaired. The inspector toured the premises accompanied when they first entered the home inspecting a number of communal areas. They found that the home was generally clean in all areas observed. It was noted that all toilet and bathrooms were found to be clean and hygienic. The grounds of the building were not inspected on this occasion. Bedrooms are situated on the ground and first floors. There is no passenger lift at present or stair lift so the first floor rooms are only suitable for those who can easily climb the stairs. There is a dining room, large lounge and also a large conservatory all of which are well furnished and equipped. Aids and equipment are available for residents who may have disabilities, to help promote independence. People informed the inspector that they are able to bring personal possessions with them into the home. The inspector looked at a sample of the bedrooms used by people who use the service and found that they had been personalised with pictures, furniture and photographs to reflect the individuals taste. People said they enjoyed living at the home and found it to be warm and comfortable. Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 17 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. The staff team are knowledgeable with regards to the people who use the service needs. There are sufficient staff on the rota to meet the current needs of the people who live there. EVIDENCE: The inspector talked with the staff on duty who were knowledgeable with regards to how to meet the needs of the people who live in the home. Residents confirmed that the staff meet their individual needs in a way that suites them. They further commented that if they use the call system a member of staff would attend to them without too much delay. The staff files that were sampled contained sufficient detail with which to establish the prospective employees suitability for the job, but if the home uses agency staff they need to evidence that they have been supplied with sufficient information to establish the temporary staffs fitness to work at the home. The management acknowledged this point. Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 18 The files sampled continue to indicate that staff have undertaken mandatory training in areas such as Moving and Handling, Food Hygiene, Infection Control and general vulnerable adults issues. Some staff have also attended various day courses and are undertaking the NVQ Award in Care at varying levels. There is evidence that staff have a formal induction into the home and its care practices. Staff stated that they enjoyed working at the home, and received appropriate support. Through discussion with the staff group and by observing the people who use the service it is reasonably clear that the staff team have empathy for the people who live at the home. The training matrix supplied by the management of the home indicates that staff have been trained in areas such as food hygiene, first aid, Health and Safety. The rota supplied also indicated that a member of staff who has been trained with regards to first aid is always on duty. The matrix supplied indicated a need for some staff to have training in fire safety, infection control and working with people with dementia. The management reassured the inspector that his would be addressed shortly. Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 19 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. The management team at the service provide good leadership. The staff team would benefit from formal supervision to improve the outcomes for those who use the service. EVIDENCE: Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 20 The management and staff group have responded well to the requirements set at the last key inspection. The designated manager has been in post for some time now and it would appear that the lack of positive leadership has now been addressed. At the time of the inspection the designated manager had yet to have made a formal application to become registered. The designated manager explained that they had been collecting the information required and was about to go to the local offices of the Commission to present this documentation. Evidence was available to support these representations. The records at the home have been updated and kept in good order. Records inspected included care records, the complaints log, accidents, medication, staff files, rotas and the fire logbook, training records, safety checks and maintenance. A tour of the premises found a safe and comfortable home free from obvious hazards. Fire safety equipment has been serviced and tested as required. Equipment servicing records have been appropriately maintained. At previous inspections the lack of a quality assurance process’ have caused concern, this has now been addressed and evidence was available that demonstrated people are being consulted about the homes operation. It would be helpful if the management made a statement available to those who have been consulted with regards to the outcome of this work. The feedback from the people who use the service confirmed that they continue to feel a sense of belonging living at the home and gave examples of how staff do that little bit extra to help out. They informed the inspector that they can raise issues with the management, can identify who the manager is and are confident that issues are dealt with promptly and effectively. The inspector looked at the staff files to establish the frequency of formal staff supervision and found this was erratic. The manager acknowledged that more time needs to be allocated to ensuring staff have the opportunities to discuss their own development and work. This is the second time this has been brought to the managements attention. Given the improvements in areas such as care needs assessments and reviews further time to comply with this requirement will be given. The manager informed the inspector that the home holds small amounts of cash for the residents for small items such as toiletries, beverages when outside of the home etc. Examination of records relating to the handling of resident’s money showed these to be in order. Records were held relating to the income, receipt and balances held and any purchases made on behalf of the resident. Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 21 All substances that could be potentially hazardous to health are handled and stored safely. The records relating to what is on the premises is general kept in good order but some recent purchases need to be included on the product sheets. Highgrove DS0000061344.V368444.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 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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 x x 3 3 x 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 3 x 3 x 3 x x 3 Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 23 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 OP29 Regulation 19 Requirement The management must ensure that the fitness of agency staff is suitably documented at the home. The management must ensure that there is a recorded rationale for the administration of medication via the Per Required needs route Timescale for action 21/10/08 2 OP9 13(2) 21/10/08 Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 24 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 OP20 Good Practice Recommendations It is recommended that access to the rear garden through the patio doors is assessed and advice sought on control measures that could be used to reduce risks associated with the two steps into the garden. This recommendation will be further discussed at the next inspection. It is recommended that more thought is given as to how people are supported at meal times to ensure that a more person centred approach is adopted. It is recommended that the management ensure that staff are formally supervised at least six times per year 2 3 OP15 OP36 Highgrove DS0000061344.V368444.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Highgrove DS0000061344.V368444.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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