Care Home: Maybank House

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What the care home does well What has improved since the last inspection? Improvements have continued to be made to the premises including the redecoration of a number of bedrooms. One lounge had been refurbished including having a new carpet and window fitted and, at the time of our visit, new armchairs were due to be delivered. The kitchen area was undergoing refurbishment and a new roof had been fitted to the main part of the property. A suitable smoking area, complete with shelter has been provided for staff to the rear of the home. What the care home could do better: Information in care plans and risk assessments could be better recorded so that they clearly detail the way in which help and support should be offered to the individual resident. There is a need to bring training records up to date to ensure all staff have the opportunity to attend training that is appropriate to the jobs they do. CARE HOMES FOR OLDER PEOPLE Maybank House 588 Altrincham Road Brooklands Manchester M23 9JH Lead Inspector John Oliver Unannounced Inspection 22 & 29 January 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Maybank House DS0000066423.V351274.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. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Maybank House Address 588 Altrincham Road Brooklands Manchester M23 9JH 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) 0161 998 6566 0161 946 0429 maybankhouse@aol.com Maybank House Limited Lorraine Mary Quinn Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only: Code PC, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category: Code OP The maximum number of people who can be accommodated is: 25. Date of last inspection 3rd January 2007 Brief Description of the Service: Maybank House is a care home providing personal care and accommodation for 25 residents who are 65 years and over. At the time of this inspection visit all residents living in the home were female. The Registered Manager had recently left the home and the owner, Mrs Philomena Gibson was covering the post until a new manager is registered with the Commission for Social Care Inspection. The home is a two-storey detached building comprising of 19 single bedrooms, 3 double bedrooms and 3 lounges. There is a passenger lift available to the second floor and the home is located close to bus and train routes and within easy access of local shops and amenities. Parking space is available at the front and the side of the home. There are gardens to the side and rear of the house and the current range of fees charged for the service is between £378:54 and £390:00 per week. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use the service experience good quality outcomes. This inspection was undertaken as part of a key inspection, which includes an analysis of any information received by us (the Commission for Social Care Inspection) in relation to the home prior to the site visit. This visit, which the home did not know was going to happen, took place over the course of 5 hours on Tuesday 22nd January 2008 and 2 hours on Monday 29th January 2008. During the course of the site visit we spent time talking to residents, the Responsible Individual (owner) and staff on duty to find out their view of the home. Before the site visit we sent the manager of the home an Annual Quality Assurance Assessment (AQAA) document for them to complete and return to us with information about the service they provide. This was returned before the visit took place and contained information that helped us to assess the service being offered by the home. We also spent time examining various files and written information and spent some time looking around the building. What the service does well: The atmosphere in the home was warm, welcoming and very friendly. People living in the home said that they enjoyed living there and that they were well looked after and staff were very good. People living in the home are given opportunities to spend time socialising on a daily basis during various activity sessions that are held. Residents spoken to confirmed that activities took place on a daily basis and that they found them enjoyable. Watching staff interacting with residents demonstrated that good relationships had been developed and that staff respected the privacy and dignity of individual residents. One resident told us, “The staff always take me to my room and close the door afterwards – I like my privacy”. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents receive a full assessment of their needs prior to admission into the home. EVIDENCE: Since the last inspection visit the service user guide and statement of purpose have been reviewed and updated to provide prospective residents with good information about the home. As the registered manager has left her employment with the home since these documents were reviewed this will need to be done again to ensure all information is correct. We saw that a new resident was due to be admitted on the day we visited the home and we also saw that a pre-admission assessment had been carried out for this person. The family had visited the home twice following visits to a number of other homes in the area. The manager told us that any prospective resident always received a pre-admission assessment prior to moving in the home to ensure that the home could meet their individual assessed needs. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 9 The manager and a senior carer have the responsibility for carrying out these assessments. On the second day of our visit we spoke with the newly admitted resident who said she was ‘very happy’ with the way the admission to the home had taken place and said ‘I like it here, everyone is very good – I’ve already made some friends – the food is lovely and so are the staff – I know I will be happy here’. We also examined the files of two other recently admitted residents and both had pre-admission assessments on file including assessments carried out by other healthcare professionals. The manager confirmed that the home did not offer an Intermediate Care service. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans were in place that detailed the needs of the individual resident and supporting policies and procedures were in place to ensure the safe handling and administration of medication in the home. EVIDENCE: We saw that the home uses a professionally developed care planning system and we examined two files of people recently admitted to the home and saw that they both contained appropriate care plans. Although care plans had been completed information needed to be further developed to make sure that care staff are very clear about how they should support an individual resident. For example, one care plan stated ‘One carer to assist with daily dressing’. No clear details had been included as to what the level of assistance was required and lack of such detail could place the resident at risk of their needs not being fully met or their independence being compromised. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 11 We saw that care plans were being checked on a monthly basis and would be updated if required. Risk assessments were also included, but again, needed further information in order to detail how risk would be managed. For example, one resident was identified as being at risk from falls. There was no further information to inform staff how this risk was to be managed and lack of such detail could place the resident at risk of inappropriate support being offered. Details were kept of visits made by other healthcare professionals such as doctors, district nurses, opticians and chiropodist. We were able to check that information about such visits had also been included in the daily notes recorded on each resident. This is good practice as it keeps all staff informed about individual residents health needs and how they are being met on a dayto-day basis. Medication in the home is managed using a Monitored Dosage System that is provided by Boots Chemist. The manager told us that all staff with the responsibility for administering medication had received appropriate training and, at the time of this visit, no resident was self-administering medication. We saw that all medication is kept within a locked ‘work station’ (small office) and the actual medication is kept within a locked, wall mounted, metal cabinet. Medication Administration Records (MAR) all contained a photograph of the individual resident to aid identification and specimen signatures were seen of those staff with the responsibility for the administration of medication. A copy of the medication policy and other guidelines for the safe administration of medication were also in the front of the MAR file. Medication is prescribed on a monthly basis and deliveries are made to the home on a weekly basis by the supplying pharmacy. This means that large stocks of medication are not held within the home. An extra member of staff is put on duty the day medication is delivered to ensure that the person dealing with this can do so undisturbed. This is good practice and should help minimise the risk of errors occurring. We randomly checked the medication of a number of residents and the majority of these were found to be correct with appropriate signatures in place. We did see that two residents who had run out of stock of paracetamol had been administered some from stock that was awaiting return to the pharmacy. Following a discussion with the manager and a senior carer a telephone call was made to the pharmacist to ask that paracetamol be put in the monitored dosage system to reduce the risk of no stock being available and from errors occurring. One resident was being administered a Controlled Drug and the balance and records were checked and found to be correct. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 12 We spoke to a number of residents about medication and were told “I always get my medication when I should” and “The staff are very good – they make sure I take my medication”. Watching staff interacting with residents during our visit demonstrated that good relationships had been developed and that staff respected the privacy and dignity of individual residents and one resident told us, ‘the staff always take me to my room and close the door afterwards – I like my privacy’. We were told by one member of staff, “We certainly respect their (residents) dignity and privacy, for example, going to their bedrooms, closing the door and always remembering confidentiality”. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 13 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily routines in the home demonstrated that residents were encouraged to maintain control over their lives, were encouraged to maintain contact with the community and are provided with a wholesome and well balanced diet. EVIDENCE: The home has a varied activity programme in place and one member of the staff team has overall responsibility for arranging activities on a day-to-day basis. Staff told us that lots of activities take place throughout the week and comments included, “residents usually enjoy the games – such a lot going on for them”. Residents spoken to were very happy with the activities provided by the home. On the second day of our visit the activities in the afternoon were called ‘Table Games’. When we asked a number of residents what this meant they were able to tell us that different games are played on each table in the dining room. We saw that most residents joined in the activities and staff were seen to be gently encouraging people to enjoy themselves whilst participating. Games consisted of things such as ‘snap’, whist, dominoes and jigsaws. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 14 Whilst activities were taking place the chef was talking on a one to one basis with other residents about their likes and dislikes and was updating his information on each resident. This will help to make sure that residents get offered the things they like. Menus are planned over a four weekly cycle and discussion with the chef confirmed that he offers choice to individual residents on a daily basis and that records and samples are kept of food prepared. We observed a main meal being served and saw that staff discreetly helped those residents who required it. We also noted that during the meal times televisions and radios were switched off, unless a resident was watching or listening to them, to make sure people had a chance to socialise without any distraction. Residents told us, “Meals are really good here”, “You get asked what you want” and “The food is lovely”. No restrictions are placed on anyone visiting the home, unless agreed with a resident, and staff were seen to make those people visiting very welcome. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 15 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Policies, procedures and training were in place for staff to support residents to raise any issues of concern and to protect residents from neglect and abuse. EVIDENCE: We saw that information about how to make a complaint was displayed in the hallway of the home and was also available in the service user guide. Since our last visit to the home in January 2007 the manager told us there had been two complaints made and we saw that both complaints appeared to have been satisfactorily dealt with although the system being used to record complaints could be further improved. Information regarding complaints was recorded in a book with no particular format in place and a number of pages had become loose. This made it difficult to follow the details of the complaints, which could result it some details being missed. We spoke to a number of residents and staff about the complaints procedure in the home and all were clear about what to do should they have a complaint or a concern and staff were also aware that there was a whistle blowing policy and procedure available. Residents spoken to told us “I would go and see the manager”, “I would tell one of the girls” and “I would tell my daughter and she would go to the office”. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 16 A number of staff had received in-house training in the Protection of Vulnerable Adults and, in most instances, were aware of the procedures to follow should an allegation of abuse be made. It would be good if refresher training in this subject could be arranged to ensure that all staff have a clear understanding of what to do should an allegation be made. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 17 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 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The premises were homely, clean and well maintained. This enabled residents to live in pleasant surroundings appropriate to their needs. EVIDENCE: We found the home to be clean, tidy and free from any unpleasant odours. Those bedrooms viewed were appropriately furnished and were personalised to varying degrees. A number of bedrooms had been redecorated since the last inspection and each door had a lock that could be overridden in the event of an emergency. This helped to maintain the privacy and dignity of residents when in their rooms. Lounge areas were comfortably furnished and the layout was appropriate so that people could see and talk to each other. One lounge had been redecorated, re-carpeted and had a new window fitted. The manager told us that new armchairs had also been ordered and would be delivered very soon. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 18 Since our last inspection visit the manager has also purchased a new large screen television that has enabled more residents to be able to watch TV in comfort. The main bathroom has a bath that is suitable for use by those with mobility difficulties and this bathroom has been extremely well decorated and furnished to meet the needs of those people who use it. The manager told us that all hot water taps have temperature control valves fitted to reduce the risk to residents from water being too hot and the maintenance person carries out a monthly check of water temperatures to further reduce the risk. During this visit we saw the maintenance person carrying out routine tasks to help maintain the property and to keep it in a good state of repair. The garden areas of the home were well maintained and since our last inspection visit a new roof has been fitted to the main part of the property. A suitable smoking area, complete with shelter has been provided for staff to the rear of the home. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 19 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 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient numbers of staff are employed in the home and effective recruitment and training processes are available to ensure that skilled and competent staff members are employed to work in the home. EVIDENCE: The manager told us that no new staff had been employed to work in the home since our last inspection visit and this was also confirmed by the those staff we spoke to. It was also confirmed by the manager that all staff working in the home have a Criminal Record Bureau (CRB) disclosure in place. We saw that staffing rotas indicated that sufficient numbers of staff were employed to work in the home and we saw from direct observation and discussion with staff that the number and skill mix of staff met the current needs of those people living in the home. Over 50 of care staff hold a National Vocational Qualification (NVQ) at level 2 in care and two senior care staff also confirmed that they hold a National Vocational Qualification (NVQ) at level 3. Training records were in place for all staff but these had not been reviewed or updated for over twelve months so it was difficult to assess what training each member of staff had completed. We saw lots of training certificates belonging to staff displayed in the hallway and along the corridors of the home. Many of these certificates dated back a Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 20 number of years and an assessment of whether staff need updated training should be carried out. Staff told us, “There are always at least 4 carers on duty plus the manager – if we are short staffed, which is not very often, the manager will work with us as well” and “We usually get a lot of training but that has slipped a bit this year with having 2 new managers who have both left”. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 21 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents living in the home benefit from having the support of a management team with skills to provide a good quality service and procedures in place to promote their interests and well being. EVIDENCE: The registered manager has recently left her employment at the home and the Responsible Individual, Mrs Philomena Gibson, was managing the service. Discussion with Mrs Gibson confirmed that it was her intention to put forward an experienced senior carer for registration with the Commission for Social Care Inspection as registered manager of the home. The manager told us that she regularly seeks the views of residents and their families/relatives about the home by using a questionnaire. Once these Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 22 questionnaires are returned, the findings would then be analysed and any necessary follow up action would be taken. We saw that the manager only dealt with small amounts of money on behalf of some residents. This is where money has been left at the home by relatives or friends to enable a resident to see the hairdresser or buy sweets, newspapers or magazines and we saw that appropriate records and receipts were kept. Health and safety policies and procedures were in place with safety notices posted appropriately throughout the building. A recent visit by the Greater Manchester Fire Service had resulted in a new fire risk assessment being developed for the premises. The manager should contact the local Fire Officer to ensure that this fire risk assessment is appropriate and meets their requirements. The manager told us within the Annual Quality Assurance Assessment (AQAA) returned to us that the maintenance and servicing of equipment used in the home had been carried out and a random selection taken from the service records during our visit indicated that all servicing and maintenance of equipment was up to date. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 23 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 3 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 Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 24 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. 1. Standard OP31 Regulation 8&9 Requirement An application for a manager to be registered with the Commission for Social Care Inspection must be made. Timescale for action 30/05/08 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 4 5 Refer to Standard OP1 OP7 OP7 OP16 OP18 Good Practice Recommendations It is recommended that the Service User Guide and Statement of Purpose be reviewed and updated. It is strongly recommended that care plans clearly detail the way in which help and support should be offered to the individual resident. It is strongly recommended that risk assessments clearly detail the way in which identified risks are to be appropriately managed. It is strongly recommended that an appropriate system be developed into which full details of any complaints can be recorded. It is strongly recommended that all staff receive appropriate training in the Protection of Vulnerable Adults (POVA). DS0000066423.V351274.R01.S.doc Version 5.2 Page 25 Maybank House 6 OP30 7 OP38 It is recommended that all staff training files be brought up to date and refresher training be arranged for all staff where necessary for example, moving and handling. It is also recommended that all out of date training certificates be removed from display. It is strongly recommended that contact be made with the local Fire Officer to make sure that the newly drafted fire risk assessment for the premises is appropriate. Maybank House DS0000066423.V351274.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Maybank House DS0000066423.V351274.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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