Care Home: Hilbre Court

What the care home does well Hilbre Court has a homely, welcoming atmosphere and provides a comfortable, well-maintained environment for the people who live there, who are well cared for. The manager, who also owns the home, has a hands-on approach, supported by the manager of her other nearby home. Staff show respect for residents and the new activities organiser is putting a varied programme of activities into place. Relatives who sent us survey forms praised the quality of care given to their relatives who live in the home. One said that `the home provides a happy, relaxed and stimulating environment coupled with care`. Another said that `it feels more like a home than an institution`. The menu is varied and nutritious and the meal we observed during the visit was appetising and well presented. What has improved since the last inspection? The recording of the administration of medication has been improved and an approved cabinet for the storage of controlled drugs is in place. The main lounge has been refurnished. A full training programme is in preparation by the manager of Hilbre House, who is assisting with certain aspects of the home`s management. The cook has started to use the food safety programme Safer Food, Better Business to ensure that food is stored and prepared safely. The Hilbre Care Support Group inspects the home regularly and is providing written reports to the owner setting out work that is needed. What the care home could do better: Some minor repairs are needed including the repositioning of the pull cords to several alarms in bedrooms to make sure that people can readily call for help when it is needed. Staff supervision needs to be fully recorded. Although people are assessed before they move into the home this is not always fully recorded. CARE HOMES FOR OLDER PEOPLE Hilbre Court 2 Barton Road Hoylake Wirral CH47 1HH Lead Inspector Peter Cresswell Key Unannounced Inspection 7th January 2009 09:40 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 Hilbre Court DS0000018895.V365178.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. Hilbre Court DS0000018895.V365178.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hilbre Court Address 2 Barton Road Hoylake Wirral CH47 1HH 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) 0151 632 2220 0151 632 4773 Mrs Delrose Haynes-McManus vacant Care Home 17 Category(ies) of Dementia - over 65 years of age (17) registration, with number of places Hilbre Court DS0000018895.V365178.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following categories of service only. Care home only - code PC, to people of the following gender:- Either. Whose primary care needs on admission to the home are within the following categories: Dementia over 65 years of age - Code DE (E) The maximum number of people who can be accommodated is: 17 Date of last inspection 20th June 2007 Brief Description of the Service: Hilbre Court is a large detached property with a pleasant, secluded garden at the rear. The seafront is a short walk from the home with public transport and shops in Hoylake town centre a little further away but still within walking distance. The home provides care and personal support for seventeen older persons with dementia. There are eleven single rooms and three that can be shared, all of them with an en-suite toilet facility. There is a passenger lift to the first floor. On the ground floor there are two lounges and a separate dining room. Three of the bedrooms are in a new extension to the building. This has allowed an increase in the number of people who can be cared for and this has been registered by the Commission for Social Care Inspection since the last inspection. The home is currently managed by its owner, Mrs Haynes-McManus. Fees for Hilbre Court range from £395 to £550 a week. Hilbre Court DS0000018895.V365178.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 inspection included a visit to the home. We did not tell anyone at the home that we were going to visit. We talked to the owner (who is managing the home), other members of staff on duty at the time, some of the people who live there and the representative of the relatives support group (‘Hilbre Care Support Group’. We also talked to the manager of the owner’s other (nearby) home, who provides some management support at Hilbre Court. We looked at records, including case files, care plans, safety records and information about staff. Some staff records are kept at the owner’s headquarters. The owner completed an Annual Quality Assurance Assessment (AQAA) for the Commission before the inspection. The AQAA provides us with information about the home as well as the provider’s own assessment of how the home is performing. We distributed a number of survey forms for relatives earlier in the year and received several back. We also distributed some survey forms during our visit. What the service does well: What has improved since the last inspection? The recording of the administration of medication has been improved and an approved cabinet for the storage of controlled drugs is in place. The main lounge has been refurnished. A full training programme is in preparation by the manager of Hilbre House, who is assisting with certain aspects of the Hilbre Court DS0000018895.V365178.R01.S.doc Version 5.2 Page 6 home’s management. The cook has started to use the food safety programme Safer Food, Better Business to ensure that food is stored and prepared safely. The Hilbre Care Support Group inspects the home regularly and is providing written reports to the owner setting out work that is needed. 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. Hilbre Court DS0000018895.V365178.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 Hilbre Court DS0000018895.V365178.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, 4, 5. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are assessed before they are admitted, so that the service can meet their needs, though the recording could be improved. The statement of purpose and service user guide give prospective residents and their relatives information about the home. EVIDENCE: The home has a statement of purpose but the service user guide is in the form of a contract and is referred to as such in paragraph 18 of the guide. The service user guide is intended to give essential information about the home to people who live at the home and those who are considering moving in. The guide we were shown when we visited the home did not cover all of the areas needed and it has since been revised. We looked at the files for the people most recently admitted to the home. One had full assessment documents from a local authority social worker but the other person had been admitted as an emergency and there was no pre admission assessment on file. The owner said that she had made an assessment before agreeing to this admission but it was not available in the home. A copy of the assessment was sent to us some weeks after we visited, having been kept at the owner’s other home. Assessments should be signed by the person who makes them and kept on file Hilbre Court DS0000018895.V365178.R01.S.doc Version 5.2 Page 9 in the home. Relatives and prospective residents are encouraged to visit the home before they make a decision on whether to move in. Hilbre Court does not provide intermediate care so Standard 6 does not apply. Hilbre Court DS0000018895.V365178.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 set out how the home meets people’s needs. Residents’ interests are protected by the efficient storage and administration of medication, though some minor changes are needed. EVIDENCE: The home has a computerised care management recording system that provides for detailed care plans and daily recording. It flags up when reviews are necessary. Care staff enter daily reports at the PC terminal and they cannot be altered retrospectively. We looked at daily reports for three people and they were quite detailed, describing how people’s needs had been met during the day. The care plans were detailed, covering areas such as ‘Personal safety and well being’, ‘Oral Health’, ‘Mental Health’ and ‘Communication’. They had been prepared within a month of the person being admitted to the home. Reviews are carried out monthly by key workers and were being recorded. More extensive reviews are carried out every six months and these involve the resident, where possible, and relatives. The home has introduced a key worker system since we last visited. We looked at the medication for three residents. Most medication is provided in a monitored dosage system, where the pharmacist puts tablets in dedicated Hilbre Court DS0000018895.V365178.R01.S.doc Version 5.2 Page 11 blister packs for each resident. The administration of the medication was accurately recorded. Creams and eye drops are signed and dated by staff when they are opened. There were some manual entries on the Medication Administration Record (MAR) sheets that are normally pre printed by the dispensing pharmacist. These were not signed; when handwritten entries of any sort are made on a MAR sheet by a responsible person they should be signed by the person making them and countersigned by another member of staff. Since we last visited the owner has purchased an approved Controlled Drugs cabinet. It should only be used for drugs which are listed as controlled. The administration of these drugs is recorded in a CD register and each episode is counter-signed by a second member of staff. For several inspections we have raised the need to make screens available in all shared rooms to ensure that personal care could be provided in private. Although there is a lightweight screen available it is currently stored in the garage. The owner told us that staff are told that under no circumstances should personal care be provided in the sight of other residents. It would still be preferable for portable screens to be readily available. Hilbre Court DS0000018895.V365178.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. Friends and relatives are made welcome in the home, so people living at Hilbre Court can remain in touch with friends and family if they want to. People can take part in a range of social activities organised by the activities organiser. A varied, well-cooked menu is provided, ensuring that people receive a balanced, nutritious diet EVIDENCE: The activities co-ordinator who was in post at the last inspection has left but has been replaced by a worker from an agency, who works two days a week at the home. There was some evidence of the activities he organises in the home but activities as a whole are not well recorded. In the AQAA the owner said that over the next twelve months she is looking to organise more trips out. The group owns some vehicles which are used to take individuals and small groups of people out. We saw staff spending time talking to residents and helping them to play games in the lounges and the dining room. There is a section in the care plan for ‘Social interests’ though it was not always extensive. One relative told us that her relative who lives in the home ‘has full freedom to express her religious faith’. Family and friends are encouraged to visit people in the home and several visited whilst we were there. They were made welcome and seemed to know the staff well. Two relatives told us that they do not have any concerns about Hilbre Court DS0000018895.V365178.R01.S.doc Version 5.2 Page 13 the care of their relatives who live at Hilbre Court. Each resident has a telephone in their room to help them maintain contact with friends and relatives. Relatives who returned survey forms said that they were welcome in the home. One said: ‘Visitors are welcome anytime without prior notice and are offered tea or coffee’. A five-week menu was displayed and contained a varied and nutritious menu. We observed lunchtime and the meal was appetising and well presented. It included fresh vegetables which had been prepared in the home and are purchased from a local farm shop. Lunch was unhurried and staff helped people discreetly if they needed help. There was a choice of four homemade sweets, as there is every day. There is a new cook at Hilbre Court and she showed great enthusiasm for providing fresh, appetising food for the people who live in the home. Hilbre Court DS0000018895.V365178.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, 17, 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure to ensure that residents and other people can complain if they wish to. Staff are trained in safeguarding adults so they are aware of how to protect people from abuse. EVIDENCE: Hilbre Court has an appropriate complaints procedure. There was a copy of the Wirral inter agency procedures on the Protection Of Vulnerable Adults (No Secrets) in the home. Most staff have now been trained in the safeguarding of adults and further training is planned via Wirral Borough Council. Hilbre Court DS0000018895.V365178.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, 20, 21, 22, 23, 24, 25, 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, comfortable, well maintained and well furnished. EVIDENCE: Hilbre Court has a homely atmosphere. The new extension that provides three extra single en suite bedrooms is now open. The building was clean, well maintained and odour free. The larger lounge is less used by the residents, partly because the smaller lounge overlooks the large, attractive back garden and main corridor. Residents who sit there can see outside and also look at the comings and goings in the corridor and front door. Both lounges are well furnished and the main lounge has been refurnished with comfortable conservatory-style cane furniture. The leather sofas in the large lounge are particularly attractive but are very deep and we observed that they are not easy for a frail resident to use – this should be borne in mind when new furniture is bought in the future. Bedrooms are well furnished, spacious and clean, though one or two items need to be replaced. These have been itemised through the Hilbre Care Hilbre Court DS0000018895.V365178.R01.S.doc Version 5.2 Page 16 Support Group’s regular inspections and are due to be dealt with via the normal maintenance programme. The ceiling and wall in an upstairs room is still badly stained. This was caused by a leak in the roof which has been repaired but has been in place for some time now and does need to be made good and redecorated. One wardrobe needed to be fixed to the wall to prevent the possibility of it being pulled over. Some of the bedrooms are personalised to reflect the tastes of the residents. Two have French windows leading on to the grounds and one of these is generally used by residents who are especially frail. All of the bedrooms have ensuite toilet facilities. Three bedrooms are available for sharing, though only two were actually shared at the time of the inspection. It is the owner’s policy that people should only share if they have clearly expressed a willingness to do so, though these wishes are not well documented. It would be preferable for people to only share if they have expressed a particular desire to share (such as partners or married couples). The home has an alarm call system but in two rooms the pull cord was not accessible as it fell behind a wardrobe. In another room the cord was at the far end of the room from the bed and was completely inaccessible. These had also been identified in the Support Group’s inspection last October and the cords must be made accessible as soon as possible. Hilbre Court DS0000018895.V365178.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. Staff are appropriately checked before they start work, helping to ensure that residents are not at risk from unsuitable staff. Staff are receiving regular training to help ensure their competence. It is not evident that there are always enough care staff on duty. EVIDENCE: The rota for Hilbre Court provides for three care staff (including the manager or senior carer) to be on duty between 8am and 6pm, after 6pm there are only two carers on duty. There is also a cleaner/housekeeper on the rota as well as a full time cook as well as an activities organiser. Two staff may always be not sufficient for this number of residents so the situation should remain under constant review, based on the residents’ assessed needs. Relatives who returned survey forms to us praised the care given by staff. One said: ‘The staff are extremely good at dealing with the elderly (confused) residents.’ Another said that ‘the care given to my (relative) is excellent’. New staff receive induction training and staff have attended a range of other courses. Recent training has included ‘Principles of risk assessment’, First Aid’, ‘Food safety in catering’ and ‘Principles of infection control’. More than 50 of staff have qualifications that are equal or above NVQ2 and several of them are qualified nurses from abroad. A number of staff are now studying for NVQs and one care assistant is studying for NVQ4. National Vocational Qualifications (NVQs) are the accepted qualifications in care homes. Training is being coordinated by the manager of the owner’s other home as most staff work in Hilbre Court DS0000018895.V365178.R01.S.doc Version 5.2 Page 18 both homes, and he is preparing a full training programme. All care staff have had training in moving and handling and staff have been issued with guidance on the subject from Cheshire and Wirral NHS Trust. However, some of the training is not up to date and additional training is being arranged. We looked at the recruitment files for staff recruited since the last inspection and all of the appropriate checks had been carried out, ensuring that residents are not put at risk. Hilbre Court DS0000018895.V365178.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 36, 38.Quality in this outcome area is good. Relatives are involved in monitoring standards in the home to help ensure quality standards. Health and welfare is protected but must always be recorded. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The former registered manager has left since the last inspection. The owner, Mrs Haynes McManus, is currently managing the home but she is considering the appointment of a registered manager in the not too distant future. We spoke to a relative who has formed the ‘Hilbre Care Support Group’, in effect a relatives support group. The group carries out regular physical inspections of the home and takes part in meetings to represent the interests of the people living in the homes. The group has the potential to be a powerful quality assurance tool to develop and preserve quality care for the people who live in the home. In view of the fact that most staff work across both homes one to one supervision is carried out by the manager of the other home. Ideally this task Hilbre Court DS0000018895.V365178.R01.S.doc Version 5.2 Page 20 would at least be shared by the manager of Hilbre Court, should take place every two months and be recorded. The home does not deal with people’s personal finances. Fire safety checks are carried out and the names of staff who have received recent fire safety training is recorded. The owner said that she has obtained up to date gas and electrical safety inspection certificates and copies were sent to us following the inspection. There is still some confusion about electrical safety certificates as the certificate for Hilbre Court states that it needs to be renewed within twelve months, which is unusual. The owner needs to clarify this situation with her electrical contractor and make sure that certificates are unambiguous in terms of when they should be renewed. The dry food stores are well organised and regularly rotated by the cook. Fresh vegetables are kept in a secure container outside. The cook carries out the required safety checks, using the Environmental Health Agency’s programme Safer Food, Better Business. Dirty linen has to be taken through the dining room to get to the laundry. This arrangement is not ideal and, as pointed out in June 2006, there should be a written risk assessment as to when and how this is done. There is a wideranging heath and safety risk assessment governing laundry but it does not cover this particular point, though we have no reason to believe that this practice continues. The manager and the owner said that staff were aware of the correct procedure, namely that laundry should only be taken through the dining area outside of mealtimes and in a container. Hilbre Court DS0000018895.V365178.R01.S.doc Version 5.2 Page 21 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 2 3 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 3 18 3 2 3 3 3 3 3 3 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 3 X 3 Hilbre Court DS0000018895.V365178.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14(1) Requirement Timescale for action 01/04/09 2. OP19 23(2) People shall not be admitted to the home until they have been assessed by a suitably qualified person and the registered person has obtained a copy of the assessment. All parts of the home must be 01/04/09 kept in a good state of repair so the damage caused by the leak in the identified bedrooms must be made good; the identified wardrobe should be fixed to the wall and all alarm bell cords must be made accessible to residents. 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 If handwritten entries are made on medication administration record sheets they need to be signed by the DS0000018895.V365178.R01.S.doc Version 5.2 Page 23 Hilbre Court 2. 3. 4. 5. 6. OP24 OP24 OP30 OP36 OP38 person making the entry and countersigned. Privacy screens should be made available in shared bedrooms. People should only share a bedroom if they have made a positive choice to share with one another. Training in moving and handling should be regularly renewed. The manager should keep a written record of one to one staff supervision. The Registered Manager should record a risk assessment on the transport of dirty laundry through the dining room to the laundry. Hilbre Court DS0000018895.V365178.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Regional Contact Team Unit 1, 3rd Floor Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries.northwest@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 Hilbre Court DS0000018895.V365178.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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