Care Home: Mandela House

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What the care home does well The Home provides comfortable and homely accommodation for the tenants The Home is well managed by the new manager who tenants and staff find approachable. The care plans and risk assessments are detailed and contain good information for staff about how to meet tenants needs. The views of the tenants are sought in a variety of ways. The tenants take part in a lot of activities, both educational and leisure. The staff receive good training and support to help them carry out their roles effectively. What has improved since the last inspection? The home has a new person managing the service at present who has many years experience and worked for the company for 20 years. The ethos was clear that tenants come first and each one is supported as an individual. The environment has developed with some rooms being made into flats and allowing tenants more independent living. The numbers who can be accommodated have reduced to 6 from 8 to allow this to happen. The home has a good quality assessment process that helps build the development plan for the service. What the care home could do better: This is an old Victorian building that has been adapted for this service and although the flats have been made to the best in the template of the building some bathrooms could have been planned better. Some of the individual ensuites have very small cloakroom sized basins that do not allow for a good wash/shave without water going everywhere. This was particularly noted in flat 2. CARE HOME ADULTS 18-65 Mandela House 13 Vicarage Road Cromer Norfolk NR27 9DQ Lead Inspector Ruth Hannent Unannounced Inspection 13th January 2009 10:00 Mandela House DS0000027484.V373645.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 Mandela House DS0000027484.V373645.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. Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mandela House Address 13 Vicarage Road Cromer Norfolk NR27 9DQ 01263 514747 01603 279529 m.jeesal@virgin.net www.jeesal.org Jeesal Residential Care Services Limited Mrs Sally Subramaniam Vacant Care Home 8 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) Category(ies) of Learning disability (8) registration, with number of places Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th February 2007 Brief Description of the Service: Mandela House is a large terraced house in the town of Cromer. It is located in a residential area which is close to the town centre and to the seafront. The Home is registered to provide a service for up to eight adults with a learning disability. The Home is owned and managed by Jeesal Residential Care Services Ltd. The accommodation is on three floors and there is no passenger lift. The service users all have a single bedroom with some having their own individual flat. The Home has a small garden to the rear. The fees for this service range from £978 to £1961 according to need. Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit to this home took place on the 13th January 2009 over a three hour period with time spent talking to tenants and staff, looking at records held in the home and observation taken through the tour of the building. The home had previously completed an Annual Quality Assurance Assessment document (AQAA) that has been used as part of the evidence for this report. 4 residents were able to give a picture of the service they receive and 4 staff members told the inspector how the company support and provide training for the service to be offered to tenants correctly. Many comments made and the records seen show a quality service is provided to the tenants who live at Mandela House. The home has been rated as a 2 star, good service. What the service does well: What has improved since the last inspection? The home has a new person managing the service at present who has many years experience and worked for the company for 20 years. The ethos was clear that tenants come first and each one is supported as an individual. The environment has developed with some rooms being made into flats and allowing tenants more independent living. The numbers who can be accommodated have reduced to 6 from 8 to allow this to happen. Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 6 The home has a good quality assessment process that helps build the development plan for the service. 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. Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 7 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 Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 8 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Potential tenants needs are assessed to ensure the service can meet the individuals requirements. EVIDENCE: The home has recently accepted new tenants into the home who have settled and were appropriately assessed to ensure suitability. The systems are in place and formats are available to ensure that all the correct questions are answered as part of the assessment process. The staff told us that recently one resident did need to move on as the service offered at this home did not suit the individual. Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Tenants do have a plan of their needs that is reviewed and reflects their changing needs and planned goals. Tenants are encouraged and do make decisions that will enhance their lives. Tenants are supported to take risks to enable them to lead an independent lifestyle when possible. EVIDENCE: One of the care plans was looked at during this visit. This contains a great deal of information about the needs of the tenant and guidance for staff about how to meet these needs. The manager said that they have recently reviewed the format of the care plans and have made some changes so that there is now a shorter version which contains the necessary day to day information which is important for staff to know. These care plans are kept in the Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 10 individuals flat so that the tenants have access to them with any detailed information stored in the sleep in/office room on the first floor. The new versions of the care plan was seen for one of the tenants and this contains updated care plans and risk assessments. These also contained “pen pictures” for each of the tenants. The care plans contain monthly reviews which have been produced using words and symbols to make it easier for the tenants to understand. This is good practice. It was evident that the individuals are involved in the reviews as they had been signed by the tenant and one tenant talked about his review meeting. The care plans contain detailed risk assessments which cover a range of issues relevant to each tenant. There is guidance for staff with regard to identified risks. It was also noted that the risk assessments had been updated and reviewed on a regular basis. The tenants are supported to make their own decisions about issues. Tenants and staff gave examples of how this is put into practice. Staff, recognise the importance of effective communication and how improvements in this area can enable tenants to make more choices. The Home now has a communication board with details of the daily activities for each tenant and also a board with information about which staff are on duty, on holiday or training. Not only was the name of the staff member displayed but also the photo of the person. The home does use pictures for most of the communication that suits the individual person with many examples seen when walking around the building. The home gives a service that is varied and allows choices that suit the individual lifestyles. The tenants talked about what and when they do different things from college to visiting clubs to holidays to using webcams to talk to family members. Many and varied risk assessments were seen to show that the risk for any activity had been thoroughly considered and minimised where possible to allow a full and as much as possible an independent lifestyle. Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Tenants do take part in activities that are appropriate for the individual. Tenants do take part in the local community. Tenants do keep in contact and visit their families and friends. The right are respected and responsibilities recognised in the tenants daily lives. The meals are enjoyed by the tenants and healthy eating is encouraged. EVIDENCE: All of the tenants spoken to state that there are lots of things to do. The communication boards in the individual areas shows what each tenant has planned for that day although staff said that they are also given the choice on Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 12 each day in case they have changed their mind about what they had planned to do. The care plans contain information about the individuals likes and dislikes with regard to activities, both educational and leisure. It was noted that one care plan stated and written by a tenant that ‘I need you to let me have time to tell you what I want to do’. This was also evident when talking to this person and how time was offered to allow an answer. Tenants are very busy during the week with attendance at a range of day services, adult education classes, horticulture and more leisure style activities such as going for walks, shopping and meals out. One comment was ‘I really enjoy pub night on a Friday’. Staff said that the staffing levels are adequate to enable tenants to attend the activities of their choosing. They said that tenants rarely choose to go out in the evenings during the week as they have been busy during the day. At weekends the activities are much more leisure based, such as going to the pub, out for meals, to the cinema. Some tenants visit relatives at weekends. The Home has 2 vehicles for the tenants use, a people carrier and a car. The home is also situated within walking distance of the town of Cromer and its facilities with a variety of things available to occupy the tenants.. One tenant talked with excitement about the important evening cup match that was being played at Norwich City and that he was attending the match. ‘I am really looking forward to it. I am sure they will win’. The staff are aware of the rights of the tenants and recognise the need to respect that it is the tenants home and to support them to make choices about how they spend their time. A tenants meeting is now a more informal discussion rather than a formal meeting with minutes taken. The new manager plans to make some meetings more formal so minutes can evidence the ‘homes meeting’. The tenants make their own choices about meals. One of the tenants said that they enjoy their meals and that they choose what to have. Staff said that there can be occasions when different meals are being prepared at different times according to the activities the individuals have planned for the day. During this visit tenants who could, had prepared a sandwich for lunch and had a yoghurt for a sweet. There was displayed in each area the tea for that evening with pizza being a favourite. Fruit was seen available in fruit bowls as and when required. The manager did explain how they try to encourage healthy eating with the tenant by fruit and vegetables being readily available. Tenants are involved in the household tasks such as shopping, cooking, laundry and clearing up after meals. Some of the tenants make their own Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 13 drinks and snacks, depending on the outcome of risk assessments. One tenant was pleased to tell us of the way he had cleaned his flat that morning. Mandela House DS0000027484.V373645.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Tenants do receive support in a way that is preferred and required. The healthcare needs of each person is met appropriately. Medication is managed and administered safely. EVIDENCE: The care plans contain detailed information relating to the personal and healthcare needs of the tenants. Records of appointments are kept and care plans updated as necessary following any changes to the tenants needs. The staff were in the process of a handover during this visit and showed the us the communication book which records day to day reports and visits planned to the doctor or dentist etc. The manager stated they have a good relationship with the local GP and that tenants all have a annual check up. The Community Nurse visits the home every two weeks to administer an injection and tenants visit the consults as an when planned. Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 15 Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 16 The staff are aware of the personal care needs of the tenants. Tenants said that they can get up and go to bed when they want to and one resident said that they can have a lie in at weekends if they want. Tenants are clearly encouraged to develop their own sense of style with regard to clothes and hairstyles. The medication system was seen. Each tenant has their own safe in their own room for their own medication. The MAR charts are held in the sleep in room in a locked cabinet. Medication is stored appropriately and records are kept of receipt of medication into the Home and of the administration. Staff said that they adhere to the Homes policy. All staff have received medication training. The manager has also just set up a system where tenants out on a daily basis have a copy of their MAR sheet sent to the day place for the staff to record that the medication has been taken correctly. This sheet is then returned to Mandela House at the end of the month. Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Tenants views are listened to and would be acted upon. Tenants are protect from abuse. EVIDENCE: The home has a complaints procedure and tenants spoken to know who to tell if they are unhappy with anything. The company has a standard procedure for dealing with complaints. The home has not received any complaints and the tenants reported they have nothing to complain about and are happy with their lives at Mandela House. Nothing has been sent to the Commission in the form a complaint and staff spoken to said anyone involved with the home would be able to complain and that it would be treated seriously and acted upon. Staff do have training on the protection of vulnerable adults. The training programme includes this subject regularly to ensure all staff are up to date. Dates of who attend which date were seen. Recruitment procedures are carried out correctly to ensure staff employed are suitable. Mandela House DS0000027484.V373645.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): Quality in this outcome area is Good This judgement has been made using available evidence including a visit to this service. Tenants live in a comfortable and safe environment. The home is clean and hygienic safeguarding the tenants from infection. EVIDENCE: The home has changed the environment since the last inspection to offer more people a flat rather than just a room. Each one that has been converted has a lounge, dining room, kitchenette, bedroom and an en-suite. Where three tenants have not got complete flats and extra lounge is available on the top floor which is comfortable and nicely furnished. The different flats seen were all very personalised. One person is an avid Norwich City supporter and has his room decorated and soft furnished in the Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 19 team colours. Another person likes super heroes and has posters and bed linen of these characters. Although each flat has an en-suite the hand wash basins in some of the areas are too small with limited room to get two hands in, so to shave or have a good wash would be difficult. It will be a recommendation that the small sinks are replaced. Two different taps were hand tested in two different bedrooms and both ran at a temperature that was suitable. The outside area at the back is small but the tenants have begun working on a small vegetable plot to grow there own vegetables and new furniture for the better weather is to be purchased to make sitting in the courtyard more comfortable. Throughout the home there were no unpleasant odours and all areas appeared clean and tidy. Tenants are obviously proud of their flats with comments to us such as ‘Do you like my flat, I do’ and ‘Come and visit anytime as I am proud of my home. Each one has a front door knocker and a letter box is attached to the wall by the side of this door for their individual post. Mandela House DS0000027484.V373645.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): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Tenants are supported by competent and qualified staff. Recruitment procedures are robust to ensure tenants are protected. Training is in place to ensure tenants are cared for by appropriately trained staff. Staff are offered regular supervision to ensure they are well supported. EVIDENCE: On the day of this visit 4 staff were spoken to. Each one of them has worked at the home for a number of years apart from one who has been at the home for about 10 months. The staff told us of the support and encouragement they receive to develop and train to be able to deliver a suitable care support service. The new member of staff spoken to talked of her induction and the training given. Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 21 Out of 10 staff members 6 have an NVQ2 qualification, with some also having NVQ 3. At the end of January the latest staff members are signed on to the next NVQ 2 course. The personnel files are held in a locked cabinet in the sleep in office room. 2 were picked at random to look at. The manager informed us that the company had recently carried out an audit on the personnel files. On looking at these 2 files all relevant paperwork was in place and included application, CRB, 2 references and forms of identification such as driving licences and passports. On the day of this visit 2 staff members were away training on a course that is recognised as suitable in ways to appropriately manage behaviour that may challenge the service. The training matrix for the staff was seen with dates in red of staff who need to be updated and the planned dates for that training. The staff spoken to felt the training was very good and that courses were running all the time. With only 6 residents in total the staff ratio to tenants is commended. Time is spent with individual tenants to help them lead a full life and key workers work well to build the personal plans with the individual to ensure goals are achieved. On the morning of this inspection one staff member was having her one to one session with the manager. On talking to all the staff regular meetings are held and one to ones take place approximately every two months. Mandela House DS0000027484.V373645.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Tenants do benefit from a well run home. Tenants can be confident that monitoring of the quality of the service will assist with the development of the home. The health, welfare and safety of the tenants is promoted and protected. EVIDENCE: The home manager has changed and although not registered has been at the home for the last 6 months with improvements noted and mentioned by the staff and tenants. This person is managing a small home within the company close by and hopes to register for the two homes. This needs to be decided by Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 23 the registration team within the Commission and contact with the department needs to be made. This person is qualified with a Registered Managers Award and holds an NVQ 3 certificate. The National Minimum Standards do ask for NVQ 4 and completing this level will need to be discussed. Throughout the visit, led by this manager, it was evident that the home is run in a competent and professional manner with a clear understanding of what the tenants require. The staff all stated how easy it is to talk to this manager and felt the home had improved over the last few months. During this visit the manager showed us the 2008 quality review results with a comprehensive document created ranging from the comments received to the outcomes to be planned to achieve. To date the development plan from this review is yet to be drawn up but is planned by the manager very shortly. In the office cabinet there are records of all appliances that have been serviced, and visits from other statutory bodies. Seen were the gas safety certificate 16/09/08, environmental health report with a clear certificate given in 2007 and a visit from the fire department 12/08. The fire extinguishers had all been serviced at the same time as the December visit. COSHH procedures were in place and chemicals were locked away. The home has not reported any accidents or incidents and tenants risk assessments are in place. Mandela House DS0000027484.V373645.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 3 ENVIRONMENT Standard No Score 24 3 25 x 26 3 27 3 28 3 29 N/A 30 3 STAFFING Standard No Score 31 3 32 3 33 4 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 X X 3 x Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 25 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. 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 Refer to Standard YA27 Good Practice Recommendations It is recommended that the hand wash sinks in the individual bathrooms are of a suitable size. It is recommended that the home contact the Commissions registration department to clarify if two homes can be managed by one registered manager. YA37 Mandela House DS0000027484.V373645.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 Mandela House DS0000027484.V373645.R01.S.doc Version 5.2 Page 27 Mandela House DS0000027484.V373645.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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