Care Home: L and S Care

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What the care home does well Staff have got to know the people living in the home well and respond well to individuals` non verbal communication. The people living in the home are supported with daily living skills in the home and out in the local community. People have an active lifestyle with plenty of choices to occupy their time. The quality of the food is good and mealtimes are flexible. Other professionals have been involved in the support of individuals and the manager and staff team have followed advice given. The home was found to be clean in all areas and has a relaxed and welcoming atmosphere. There is sufficient communal space in the home and privacy is respected. What has improved since the last inspection? There have been some improvements to the building. Some parts of home have been decorated following a maintenance plan of re-decoration. Two bedrooms have been decorated and the bathroom was partly decorated at the time of the visit. There is a new cooker hob which staff were pleased about because it had been broken for a while. The manager makes sure that all staff have a safety checks before they start work and that the staff files contain records required by the care home regulations as part of recruitment. A training plan has been set up to update staff on the training required by regulations to maintain a safe home and also includes courses to support the development of individuals. There are some gaps in the training needed and refreshers for staff who have attended some time ago. What the care home could do better: Support plans need to be more person centred. It may be useful to introduce pictures and/or photos to the support plans to make them more user friendly to the people living in the home. Health action plans could be introduced as part of the plan, again using the pictures and simplified words to increase awareness of their own health and healthy living. The requirement made at the last visit has been continued. The service provider and manager are not able to be proactive with regard to the environment and are reliant on the landlord to respond to repairs needed. An agreement needs to be reached to determine who is responsible for what so that an effective maintenance plan can be put into place. A requirement has been made for this. The NVQ training needs to continue for other members of the staff team to assist in updating knowledge and skills and to meet the workforce target. Staff have had some training in supporting challenging behaviour. This needs to be developed and refresher training offered to staff who trained several years ago. The behaviour intervention policy needs to be revised to reflect actual practice in the home. A requirement has been made to provide necessary training to the staff and to amend the behaviour intervention policy. CARE HOME ADULTS 18-65 L and S Care L and S Care 3 York Terrace Birchington Kent CT7 9AZ Lead Inspector Julie Sumner Key Unannounced Inspection 22nd November 2007 09:45 L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 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 L and S Care DS0000059423.V352612.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 Adults 18-65. 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. L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service L and S Care Address L and S Care 3 York Terrace Birchington Kent CT7 9AZ 01843 843486 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) lscare@hotmail.co.uk Miss Linda Ann Wright Post Vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st August 2006 Brief Description of the Service: 3 York Terrace provides residential care for 3 people who require varying degrees of assistance because of their learning disability. Whilst the home does not claim to provide specialist services, it has access to all necessary specialist services within the community. The home comprises a semi-detached property in a residential area of Birchington and is within a short distance rail and bus services, health centres, shops and churches, a library and a concert hall. The fees for support from the home are set during the assessment period and are very individual to the needs of each person, depending on the level of support required and the staffing numbers provided. A guide to average fees for a year range from a minimum of around £11000 to a maximum of around £15000 or more depending on the support needs as stated. L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is based on information received about L & S care including an annual quality assurance assessment completed by the manager and two unannounced site visits to the home lasting around 3 ½ hours each. The manager was in the home on the arranged second visit. Information was gathered for this inspection in a variety of ways both prior to and during this visit to the home. Time was spent the people living in L & S care whilst they carried on with their usual routines for this day and one person talked a little, answering some questions about his lifestyle. General observations were made during the morning of how people are supported, particularly with reference to people with limited verbal communication skills. The staff spoke about their role in the home. There was a tour of the building and various records were inspected. There was good progress on meeting requirements set following the last inspection visit. The manager is in the process of implementing developments to the service provided. 4 requirements have been made as a result of this visit. What the service does well: Staff have got to know the people living in the home well and respond well to individuals’ non verbal communication. The people living in the home are supported with daily living skills in the home and out in the local community. People have an active lifestyle with plenty of choices to occupy their time. The quality of the food is good and mealtimes are flexible. Other professionals have been involved in the support of individuals and the manager and staff team have followed advice given. The home was found to be clean in all areas and has a relaxed and welcoming atmosphere. There is sufficient communal space in the home and privacy is respected. L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Support plans need to be more person centred. It may be useful to introduce pictures and/or photos to the support plans to make them more user friendly to the people living in the home. Health action plans could be introduced as part of the plan, again using the pictures and simplified words to increase awareness of their own health and healthy living. The requirement made at the last visit has been continued. The service provider and manager are not able to be proactive with regard to the environment and are reliant on the landlord to respond to repairs needed. An agreement needs to be reached to determine who is responsible for what so that an effective maintenance plan can be put into place. A requirement has been made for this. The NVQ training needs to continue for other members of the staff team to assist in updating knowledge and skills and to meet the workforce target. Staff have had some training in supporting challenging behaviour. This needs to be developed and refresher training offered to staff who trained several years ago. The behaviour intervention policy needs to be revised to reflect actual practice in the home. A requirement has been made to provide necessary training to the staff and to amend the behaviour intervention policy. L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken. EVIDENCE: There have been no new admissions and the three men who live in the home have lived there for some time. Staff said that assessments were carried out when they first moved in. A sample of support plans were viewed and discussed. L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. Each person has a support plan and changing the design to suit each person would encourage his involvement in it. Risk assessments could be developed so that whilst addressing the safety issues they mainly focus on developing skills and improving quality of life. EVIDENCE: A sample of support plans were viewed and discussed. The plans have been reviewed and individual needs reassessed as part of the review process. Plans identify areas of need systematically with some guidelines for staff of how to support. The staff said people living in the home are asked about what they would like to do and their views are taken into account when planning their support. The format of the support plans is not accessible for the people living in the home and their involvement is very limited. In discussion with staff at least one person living in the home would be able to understand the planning of support if modified. Pictures and photos and picking out specific tasks to L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 11 concentrate on would be useful to assist with this and help develop individual skills. A recommendation has been made for this. One person spoke a little about his lifestyle and in this conversation indicated that he does get to choose how he spends his time and how he likes to be supported by staff. People living in the home were observed taking the lead in activities, for example, if they want a hot drink they go into the kitchen and pick a cup up. Staff respond and they are assisted to make a drink. A sample of risk assessments were read and discussed with the manager. There are guidelines for staff to support individuals in a variety of activities. There was a debate with the manager about the health and safety focus on the risk assessments. The manager was aware of providing positive support for the activities individuals participate in and said that this would be reflected more when the risk assessments are reviewed. L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people who live in the home are involved in a variety of activities and have the opportunity to maintain important family relationships. Individuals are involved in the domestic routines of the house. EVIDENCE: Each person is supported by a member of staff and is able to choose from a variety of activities to occupy him throughout the day. There are activity plans in each person’s folder and there are daily household activities on the notice board in the kitchen. These were viewed and discussed with the staff present. During the visits each person went out. At the beginning of the visit individuals were carrying out household tasks and getting ready to go out. There were contact details of families in the support plans. Staff said that families are involved with the support of individuals and visit regularly. Families are asked for their views of the home as part of the quality assurance L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 13 monitoring and some of these records were viewed. Relatives said that the home is welcoming and gave positive feedback about the service. Individuals were observed moving around the home freely. All evidence prior to the visit indicates that mealtimes are flexible and the food provided is good. One person also confirmed this during the visit. There are records of the food eaten and menus are planned. L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Support is given to each person in a way that suits the individual and healthcare needs are appropriately met. The development of health action plans will enhance the healthcare support given and focus on possible developments in individual support. EVIDENCE: There are guidelines in the support plans about how to support individuals with personal care. There are notes in the support plans related to support of individual health. Health is monitored through observation regarding food that is eaten, weight charts and behaviour patterns. There was a discussion with the manager and the staff about introducing health action plans. The manager said she would pursue this. There were discussions about the involvement of health care professionals when the need has arisen with individuals. The community learning disability team have been involved in bereavement support and the physiotherapist has assisted with the support of one person with some exercises to maintain his mobility. The manager explained that none of these L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 15 services are as accessible now and in some cases cannot be accessed directly, needing GP referral. Medication storage and administration was observed and discussed with the staff in the home during the first visit. Medication is kept to a minimum in the home. The manager confirmed that all staff who administer medication have received training. Some training certificates were seen to confirm this. L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people involved in the service say that they are happy with the service provision and know how to make a complaint. Staff working at the service know when incidents need external input and are confident in the manager to carry this out. EVIDENCE: The home has a complaints procedure and adult protection procedure with guidance for staff and whistle blowing policy displayed. The feedback from the quality monitoring and a brief conversation with one of the people living in the home confirmed that people are able to air their views and know who to speak to if they have a concern. There is a policy that has been designed for staff with guidance on how to respond to incidents of challenging behaviour. The policy stated that as a last resort staff should restrain individuals. None of the staff have received training in restraint. The manager said that this was because it was not necessary to restrain. This needs to be clarified in the risk assessments for each individual. The policy needs amending to reflect actual practice in the home. A requirement has been made for this. The staff member spoken to on the first visit had attended adult protection training and was confident of what to do if there was a suspicion of abuse. The training matrix indicated that three staff had attended this training and others had covered it in the induction but were booked to attend this training. L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 17 The manager stated in the AQAA that it was planned for all staff to attend this training in the next 12 months. Individual financial procedures were discussed and a sample of records and receipts were checked. The financial procedures have been amended following the previous inspection visit. Two members of staff sign for any transaction made on behalf of a person living in the home. The security of individual money was discussed with the manger and she said she would review this. L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides a clean physical environment that meets the specific needs of the people who live there. Due to the current lease arrangement maintenance tends to reactive rather than proactive. EVIDENCE: A tour of the home took place with one of the staff. The home has a selfcontained basement flat and both this and the main building were viewed. The home is privately rented. The member of staff explained that the property is leased and there is sometimes difficulty in having areas of the home repaired and maintained. Some repairs have been carried out and parts of the home have been decorated. This includes the lounge, dining room and the bathroom has been started. The kitchen hob has recently been replaced and some of the windows have been double-glazed. A requirement was made at the last inspection visit for a doorframe that contains a number of sections of glass to be made safe with a protective film and this has been done. L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 19 The home was clean and there are cleaning schedules in place. The people living in the home take part in some of the cleaning in the home. The home organises infection control training and infection control measures have been incorporated in a homely way. L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience adequate outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager is aware that there are some gaps in the training programme and plans to deal with this. The service is also able to recognise when additional training is needed but is not always in a position to provide this training. EVIDENCE: The staffing level has been set so that each person living in the home has the support of one member of staff during the day. This was observed on both visits. Five staff in the team have achieved NVQ level 2 and there was some discussion about training the rest of the team to achieve the workforce target. The manager is aware of the need to make sure that all staff have POVA checks prior to working in the home and a CRB check. Evidence of these checks was seen in the staff files viewed. One person’s CRB was still being processed but a POVA was evident. 2 references had been taken for all sampled and ID checks had been carried out with copies kept in the files. There was evidence of a selection process that included an interview. L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 21 The home have recently changed the staff induction and now purchase a pack that is in line with the common induction standards when new staff are employed. The training matrix showed that training is ongoing and is being planned. Not all staff have up to date mandatory training but courses are booked when they become available. The manager has recently booked some communication skills training. The manager has also introduced competency monitoring. 2 questionnaires were viewed monitoring a staff member’s skills in challenging behaviour and awareness of the mental incapacity act. There was a discussion about what training staff have and the skills needed to support people with challenging behaviour. All staff have attended a one day training course in challenging behaviour in learning disability. The home have had the support of the local community challenging behaviour team who have devised programmes of behaviour support and staff training. The manager said that staff use the techniques they have been taught and complete the reports when there is an incident. However, this training was some time ago and the newer staff have not received it. It was agreed that all the staff now need refresher training and the new staff need training in addition to the current course which offers a good introduction. A requirement has been made for the manager to make sure that the people living in the home are supported safely and the staff working in the home have the necessary skills to do this. L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): People who use the service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager has the required qualifications, is competent to run the home and knows where improvements need to be made to develop the service. The service works in partnership with families of people who live there and professionals. EVIDENCE: The manager has RMA and level 4 NVQ and has several years experience in supporting adults with learning disabilities. The quality assurance monitoring in the home has been developed. Surveys are sent out to staff, relatives and visiting professionals. The information from the surveys is collated and the manager reviews the service and plans priorities for improvement. There is no written development plan at present L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 23 but the manager said she will design one using the feedback as a basis and including the areas that have been discussed during the inspection visits. One of the staff said the service owner visits informally to see how everyone is. The manager said the owner carries out the monthly unannounced inspection visits required under regulation 26. The reports from these visits are not currently kept in the home and this was discussed with the manager who said she would discuss it with the owner. The manager said she carries out a health and safety audit and the record for this is in the home. The manager works 4 days in office and one day on shift and she said she works random times in the home, rather than fixed hours, to maintain staff consistency. Some of the maintenance checks for the home have recently been carried out including the gas safety check and portable appliance testing. Fire safety checks are carried out in the home and equipment is serviced by an external company. The service provider rents the home from a private landlord and there are negotiations about who is responsible for some of the environmental checks and maintenance including the electrical hardwiring, which has not been tested recently. A requirement has been made to decide who is responsible for the safety of the building and make sure that servicing and maintenance takes place at the recommended times. L and S Care DS0000059423.V352612.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 Adults 18-65 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 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 2 33 x 34 3 35 2 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 2 x L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 25 yes 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 YA6 Regulation 14, 15 Requirement To develop a record that evidences the goals that have been achieved to date and to support the development of new aspirations. This needs to be developed in a person centred way. Timescale for action 31/03/08 2. YA23 12 3. YA35 12 4. YA42 23 The manager needs to risk 31/01/08 assess individuals to make sure that interventions are safe. The behaviour intervention policy needs to be amended to reflect actual practice in the home and if restraint is not to be used it must not be included in the policy. Make all necessary training 30/04/08 available to provide staff with the skills to support the assessed needs of the people living in the home and for safe working practices. The provider must make sure 31/01/08 that all servicing is carried out within the required timescales. This is with particular reference to the electrical hardwiring servicing. L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 26 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 L and S Care DS0000059423.V352612.R01.S.doc Version 5.2 Page 28 - 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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