Care Home: Ixworth Court

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What the care home does well The home was clean, tidy and attractively decorated, each bedroom viewed reflected the individuality of the service users. Each of the three units were furnished to a good standard and were selfcontained with a separate kitchen, dining and sitting area. Residents can make drinks if they wish and the overall layout affords service users considerable privacy and independence. The home`s gardens and outdoor seating areas have been well tended and planned out. Care plans are maintained in resident`s rooms and are signed by residents. Some of the plans contain very detailed information about the resident`s life, which both the resident and their family have assisted with. These plans provide carers with information about the resident`s interests and lifestyle thereby enabling them to provide more individualised care. What has improved since the last inspection? In the AQAA the home told us that staff are clearer about their roles and responsibilities in the organisation of respite and transitional care. Key worker roles are now better defined. All residents have their medication stored in their bedroom, which should enable more people to retain control of this aspect of their care. A new garden patio area has been made at the side of the building, which is enclosed and allows residents to have the doors open in the warm weather. CARE HOMES FOR OLDER PEOPLE Ixworth Court Ixworth Court Thetford Road Ixworth Bury St Edmunds Suffolk IP31 2HD Lead Inspector Cecilia McKillop Unannounced Inspection 19th June 2008 09:00 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 DS0000037046.V366777.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. DS0000037046.V366777.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ixworth Court Address Ixworth Court Thetford Road Ixworth Bury St Edmunds Suffolk IP31 2HD 01359 230101 01359 232734 joanna.last@socserv.suffolkcc.gov.uk 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) Suffolk County Council Mrs Joanna Margaret Last Care Home 22 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (22) of places DS0000037046.V366777.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th June 2007 Brief Description of the Service: Ixworth Court is a purpose built home that provides well-furnished accommodation for 22 frail elderly, mixed gender and culture, residents. It is situated in Ixworth, which is a village with good community facilities approximately 10 miles from Bury St Edmunds. It is a single storey building separated into 2 units with surrounding safe gardens. Each unit consists of a comfortable lounge, dining room and kitchen area. All bedrooms are single with en-suite facilities. There are also assisted/communal bathrooms and additional toilet facilities. Ixworth court is owned and operated by Suffolk County Council. There is a day care centre within the building where social events are held and a small shop for the purchasing of every-day items. DS0000037046.V366777.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two stars. This means the people who use this service experience good outcomes. This report includes information gathered from a visit to the home on 19th June 2008, lasting just over six hours. During this visit time was spent with people who live and work in the home as well as the inspection of records and documents relating to the provision of care. A tour of the home was also undertaken. Information received by the Commission for Social Care Inspection since the last inspection was taken into account. This includes information contained in the Annual Quality Assurance Assessment, completed by the manager of the home and questionnaires completed by residents and staff. What the service does well: What has improved since the last inspection? In the AQAA the home told us that staff are clearer about their roles and responsibilities in the organisation of respite and transitional care. Key worker roles are now better defined. All residents have their medication stored in their bedroom, which should enable more people to retain control of this aspect of their care. A new garden patio area has been made at the side of the building, which is enclosed and allows residents to have the doors open in the warm weather. DS0000037046.V366777.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. DS0000037046.V366777.R01.S.doc Version 5.2 Page 7 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. DS0000037046.V366777.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 DS0000037046.V366777.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): 3,6 Quality in this outcome area is good. Prospective residents can expect that they will be provided with the information they need to make an informed choice about where to live, that they will have their needs assessed and met and that they will be provided with the opportunity to visit the home before they decide to move in. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The homes statement of purpose was found to comply with the standards and regulations at the last inspection. The document has been updated in line with management changes at the home and clearly outlines the facilities on offer. The home has a clear admission process, which is outlined in the homes statement of purpose. Prospective residents who plan to use the home for a period of respite attend the home for a pre stay visit. The homes policy is that prospective residents are invited to visit on as many occasions as they wish prior to admission to check the room and discuss any concerns. DS0000037046.V366777.R01.S.doc Version 5.2 Page 10 The inspector was informed that residents who are in hospital and unable to spend time in the home prior to their admission would be visited by the manager or a senior team leader. The community care assessment would be updated and changes noted to the prospective residents care needs. The inspector was shown a copy of a pre admission assessment checklist which identified people care needs however an examination of the files indicated that this was not being used routinely. DS0000037046.V366777.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. People who use this service can expect to have their care needs largely met. Better documentation however would ensure greater consistency. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During a tour of the building, it was observed that all residents have a copy of their individual care plans in their bedroom, which a number had signed. A sample of care plans were examined and it was noted that each plan had several elements including communication, being safe, personal care, dressing, eating and drinking, sleeping, mobility and recreation needs. All these care plans were clear and easily understood and covered day and night. Health records were in place clearly outlining when the residents had last seen the optician or chiropodist and guidance was available for staff on the persons care from a range of professionals including the speech and language therapist. DS0000037046.V366777.R01.S.doc Version 5.2 Page 12 There was evidence of ongoing monitoring and review and assessments were in place with regard to nutrition, medication administration, manual handling and pressure care. The manual handling assessments and subsequent guidance for one of the residents who had complex care needs was very comprehensive. Staff spoken with were knowledgeable about the people living in the home and their care needs. Residents have individual key workers who take a lead in updating their care plan. In the AQAA it is stated “ care plans are handed on to relevant staff at change over of shift to be altered to reflect any changes prior to it being replaced in residents room”. One of residents whose care was tracked was observed having difficulty eating and while there was a nutritional assessment in place it was in need of review. The assessment listed the residents preferred foods but did not detail any equipment that might assist or how staff should respond to the resident when they declined what was on offer. When the matter was drawn to a member of staffs attention a plate guard was obtained. There was no evidence on file of this resident being weighed for some time. Staff were observed interacting with residents in a warm and friendly way. In the unit, which cares for people with dementia, some excellent practice was observed. Staff knew the residents well and were very alert to their mood and behaviour. Residents who were interviewed as part of the inspection were positive about the care they receive at the home and reported that the routines were flexible and could be adapted to meet their needs. Feedback from the questionnaires was also positive. Comments included, “The care at Ixworth court is always very good” “ The staff at Ixworth court try and make all residents feel included in all that is happening and assist them in as far as it is possible and allowed” The inspector observed the end of the medication round and medication was observed being administered appropriately. Seniors carers are responsible for administering medication at the home. There have been a number of small changes to medication administration practices since the last inspection, with resident’s medication being stored in individual medical cupboards in their rooms. The cupboards were domestic in type and provided secure storage. One of the residents was on PRN medication and although the staff member was able to describe the process a copy of the guidance for staff to follow was not on the file or with the medication record. This was of concern however the inspector was informed that the resident had only been given the medication on three occasions in the last eight weeks. DS0000037046.V366777.R01.S.doc Version 5.2 Page 13 This would indicate that staff were considering the circumstances before administering the medication. A copy of the procedure for staff to follow before administering was subsequently forwarded to the Commission with an assurance from the manager that staff had been reminded to check and regularly review the procedure. DS0000037046.V366777.R01.S.doc Version 5.2 Page 14 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. Service users can expect that their social and recreational interests are met and that they are helped to exercise choice and control over their lives. Service users can expect that they receive a wholesome diet and that they maintain contact with others who are important to them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents who were interviewed as part of the inspection confirmed that they were able to maintain regular contact with family and friends and that their visitors were welcomed. A sample of care plans were examined as part of the inspection, some of the plans provided very detailed records about the residents life and activities that they enjoyed doing. The inspector was provided with details of some of the activities that have taken place over the last few months. Photographs were also on display of some of the events which included an Elvis night and a music afternoon. DS0000037046.V366777.R01.S.doc Version 5.2 Page 15 Staff organise two or thee events each month and in the week before the inspection there had been a residents birthday party. The manager said that each resident had recently been provided with a sunflower, which was placed in the garden, which it was hoped that they would take an interest in maintaining. In the AQAA reference is made to one resident who had been supported to maintain an interest in art and exhibit their work at a local art show. One of the team leaders has taken over resident’s activities as a responsibility. In the AQAA the home said that they are planning to encourage residents to become more involved and to develop contacts with the community learning and skills as well as exploring the benefits of music therapy. Resident’s bedrooms were viewed during a tour of the building. All bedrooms contained service users individual belongings including memorabilia and photographs. Some service users bedrooms contained their own furniture. The menu was on display and the main meal served on the day of the inspection was chicken curry. A number of residents had a baked potato with cheese and others an omelette as an alternative. Presentation was generally good although the omelette would have benefited from some garnish. Residents spoke positively about the food and the selection on offer. One resident was observed being fed by a member of staff and this was undertaken in a sensitive and unhurried manner. DS0000037046.V366777.R01.S.doc Version 5.2 Page 16 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. Residents can expect that any complaints will be handled properly and that they will receive protection from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure, which sits alongside the Suffolk County Council “Comments Compliments and Complaints” procedures. Details of the procedure are included in the statement of purpose and service users guide. CSCI and staff at the home have not received any complaints since the last inspection. The home has a policy on the protection of vulnerable adults and a whistleblowing policy. The manager was familiar with these procedures and said that all new staff undertakes training on safeguarding as part of their induction. The local coordinator was due to visit the home to talk with senior staff about their roles and responsibilities and it is planned that they will talk further to those staff that they manage. Staff spoken with as part of the inspection confirmed that they had received training in this area. In the AQAA the manager stated that it is planned that all staff will compete the skills for care knowledge set on “safeguarding” within the next year and there are plans to include information about safeguarding in the homes Statement of Purpose. DS0000037046.V366777.R01.S.doc Version 5.2 Page 17 DS0000037046.V366777.R01.S.doc Version 5.2 Page 18 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): 19,26 Quality in this outcome area is excellent. Residents who use this service can expect to find a comfortable clean and well maintained home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was in a good state of repair and there was evidence of ongoing maintenance. There are three units within the home and each have a communal kitchen, dining and lounge areas. The communal areas are comfortable, light and well furnished. The home has attractive garden areas with garden furniture where residents can sit if they choose. A new garden patio area has been made at the side of the building, which is enclosed and allows residents to have the doors open in the warm weather. Resident’s bedrooms have appropriate furnishings and fittings, including lockable storage areas, bedroom doors have locks, which service users may DS0000037046.V366777.R01.S.doc Version 5.2 Page 19 use if they choose to. Residents are asked prior to their admission what their colour choice is for their room. Rooms in one of the units willow have large en suite facilities comprising of a toilet, hand washbasin and shower. The home has a separate sluice room. There is a large laundry room, with two washing machines and a large dryer, the second laundry room provides storage for clean laundry until it is returned to service users and an ironing area. Disposable gloves, hand wash gel and disposable towels were available for staff use. The home was observed to be very clean and tidy and without any offensive odours. DS0000037046.V366777.R01.S.doc Version 5.2 Page 20 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. Residents can expect that staff that are trained and that there are adequate numbers of them available to meet their needs but they can be busy undertaking domestic duties in addition to care. The homes recruitment procedures will offer people living in the home some protection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During the waking day the home operates with a minimum of four carers and a senior team leader on duty, however on the afternoon of the inspection, one member of staff was off sick leaving three carers and one senior on duty. Two staff were located in the unit which cares for people with dementia and the staff were observed being attentive and kind. In the rest of the home staff were observed to be very busy undertaking both the provision of personal care as well as laundry tasks, which was time consuming as it was unclear who owned some of the items of clothing. One resident who had mobility difficulties was observed asking for assistance during the period that staff were distributing the laundry. The resident was unable to reach the bell, which was located on the wall and had to call out for assistance, which was not very dignified. Staff came to assist once the bell had rung. The manager reported that some of the issues on the day of the inspection were due to the fact that the home was operating with one member of staff off sick, which impacted on the availability of staff. DS0000037046.V366777.R01.S.doc Version 5.2 Page 21 Residents who were interviewed described the staff as “very nice ” and the feedback from the questionnaires was that residents receive the care that they need and staff listen and act on what they say. Only two members of staff returned a questionnaire, one reported that there was usually enough staff but the other said that sometimes they felt unable to give enough time to residents. The inspector was informed that cover is normally provided to cover staff leave but when staff report sick at short notice it was not always possible to get cover for sickness. The home had used agency staff in the months preceding the inspection but had recently appointed a number of night staff and at the time of the inspection the home was operating with a full compliment of staff. Examination of the staffing rota indicated that there were not excessive sickness levels. All newly appointed staff are provided with Skills for Care induction and in the AQAA the home manager indicated that the home has reached over the 50 target of care staff to achieve at least NVQ (National Vocational Qualification) level 2. On the day of the inspection the inspection was shown the skills for care knowledge sets, which staff were in the process of completing. Staff who were interviewed as part of the inspection confirmed that they had received training in a range of areas including dementia, infection control, manual handling, and protection of vulnerable adults. In the AQAA the home confirmed that all catering staff and care staff have received training in safe food handling. All the team leaders have undertaken first aid training and the mental capacity act. The recruitment records relating to two newly appointed members of staff were examined and there was evidence on the file of references, identity checks and criminal record bureau checks. In one of the examples however the professional reference related to a period of employment, which was four years old rather than a more recent period of work or work with vulnerable adults. The manager subsequently advised the inspector that there would be further discussions with the HR department regarding their responsibilities and a new reference had been requested. The manager also reported that there had been a recent policy change and all new appointments will have their referees contacted to verify the reference. DS0000037046.V366777.R01.S.doc Version 5.2 Page 22 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. People who use this service can expect that the home will be well managed and that their health and safety will be promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager was available on the day of the inspection and was positive and constructive throughout the process. Mrs Last has a background in nursing and has worked in care settings for older people for 15years. She is assisted in the day-to-day management of the home by a senior team leader and team leaders who cover both day and night shifts. Staff spoken with during the inspection reported that the homes management were approachable and that they met regularly with their manager for supervision. This was also confirmed in the questionnaires, which staff completed. DS0000037046.V366777.R01.S.doc Version 5.2 Page 23 The inspector was provided with details on the most recent Regulation 26 visit, which had taken place the week before the inspection. The visit had been undertaken by the residential quality advisor on behalf of the provider, the Local Authority. The advisor had spoken with residents and staff about the care provided and had prepared a detailed report. In the AQAA the homes manager reported that the resident’s views and those of relatives are sought through the admission and care planning process. The Home does not however seek formal feedback from residents or family though satisfaction questionnaires. The inspector was informed that residents are involved in menu planning and given the opportunity to comment on size of portion and choices. The carers also have regular unit meetings with residents and in the AQAA the homes manager outlined a number of changes that they had made to the service as a result of seeking resident’s views. Some of the changes included rearranging the sitting and dining areas, making an arts corner and changing the way that activities are organised. Residents are also now given the opportunity to move bedrooms when a vacancy occurs. The inspector was shown a folder, which on display in the entrance containing comments, from residents who had moved on and their families. There were a significant number of thank you letters from relatives who really appreciated the efforts of staff. The home has a system in place to safeguard finances, which they are storing on behalf of individual residents. The records relating to one resident was examined. Moneys were noted to be stored separately and a written record of transactions is maintained. Each month residents are provided with a statement of their account. Dates of servicing of equipment such as fire detection and hoists were provided to the Commission as part of the AQAA and evidenced that equipment was being regularly maintained. Staff receive training in areas which safeguard residents wellbeing such as food hygiene, manual handing and first aid. The water temperature in one of the bathrooms, was tested on the day of the inspection, and was found to be within the recommended level. Liquid soap and paper towels were available to assist with the control of infection. As outlined earlier in the report risk assessments were in place addressing such areas as manual handling. DS0000037046.V366777.R01.S.doc Version 5.2 Page 24 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 X X 3 X X 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 4 X X X X 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 DS0000037046.V366777.R01.S.doc Version 5.2 Page 25 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. 2 3 Refer to Standard OP8 Good Practice Recommendations Nutritional assessments should clearly outline the support the resident requires and how this will be monitored to ensure that the resident health is maintained. The homes management should expand the quality assurance systems in place to ensure that the home is run in the best interests of the people living there. Residents who are unable to reach the call bell should have a system to access staff, which preserves their dignity and ensures their wellbeing and safety. OP33 OP22 DS0000037046.V366777.R01.S.doc Version 5.2 Page 26 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 DS0000037046.V366777.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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