Care Home: Neville Grange Resource Centre

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What the care home does well The interaction between staff and residents` was good with a balanced mix within the staff team, which benefits them. The manager has a good knowledge of each resident and uses his professional experience to relate to the people in his care in a relaxed and friendly manner. Residents` are treated as individuals and encouraged to maintain their interests and skills for as long as possible. The home provides a secure environment with minimum restriction of movement around the building. The staff are good at responding properly to residents questions and behaviours. The home provides a good standard of care to residents in a comfortable and well-maintained home. It is decorated and furnished to a good standard.Residents` said that the home was always clean tidy and did not smell. They said that the food was good. Visitors said that they could visit the home at any time, and that they were made welcome, and were offered refreshments by staff. This makes it a pleasant, comfortable and homely place to live. Relationships between staff and residents` were warm and friendly. Residents` said that they were happy with the care provided and that the staff were kind and caring. They said that they could choose how and where to spend to their time and whether or not they want to join in with the planned social activities, or in the activities arranged in the day care area. The home has an activities organiser and a good range of activities is provided. The activity organiser also spends one to one time with residents talking about their past lives and finding out what they would like to do. Information about the services provided by the home is available in the foyer of the home, and lets residents` and their relatives decide if the home will be suitable for them. Senior staff visit prospective residents whenever possible to assess their needs to make sure that the home and staff team will be able to meet them. The manager is very keen on making sure there are no residents admitted to the home with needs the home cannot meet. What has improved since the last inspection? A planning application has been made to provide a shower. Staffing levels have improved. All the statutory requirements from the last visit have been met. What the care home could do better: All hand written entries onto MAR charts should be signed by the person making the entry. The manager could make sure all staff who have not received training in the safe administration of medicines have the opportunity to do so, and that this is certificated. CARE HOMES FOR OLDER PEOPLE Neville Grange Resource Centre Queens Road Saltaire Shipley BD18 4SJ Lead Inspector Pamela Cunningham Key Unannounced Inspection 14th December 2007 11:00 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 Neville Grange Resource Centre DS0000033532.V357320.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. Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Neville Grange Resource Centre Address Queens Road Saltaire Shipley BD18 4SJ 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) 01274 593399 City of Bradford Metropolitan District Council Department of Social Services Mr Roy Wilks Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability (2) of places Neville Grange Resource Centre DS0000033532.V357320.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 service users 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, Physical disability - Code PD. The maximum number of service users who can be accommodated is : 33 12th December 2006 2. Date of last inspection Brief Description of the Service: Neville Grange is owned and run by the local authority. The home looks after older people who need care for long or short periods of time. There are also rooms for people who book regular respite periods of stay or those who need to be looked after following hospital treatment (intermediate care) and who intend to move back home. Linked to the home is a day centre. This is run independently from the care home. However some of the residents do use the facilities. Neville Grange is registered provide care for up to 35 older people. It is in the village of Saltaire, also known as a world heritage site. There are a lot of shops nearby. There is also a post office, a number of churches, restaurants and pubs. The home is near to a main bus route. There is limited parking in the grounds of the home, otherwise on street parking is available. Information about the home is provided in a statement of purpose and service user guide. Both these documents were reviewed and updated in September 2005. The current fees charged are from £98.93 and £435.68 per week. There are additional charges for hairdressing; newspapers and chiropody. This information was provided by the home during this visit. Fees are reviewed in April every year. Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One visit was made on 12th December 2007. The home did not know that this was going to happen. Feedback was given to the manager during and at the end of the visit. The purpose of the visit was to make sure the home was being managed for the benefit and well being of the residents. Before visiting the home the inspector asked for information from the manager (the AQAA – Annual quality Assurance Assessment) which asks about what policies and procedures are in place and when they were last reviewed, when maintenance and safety checks were carried out and by who, staff details and training provided. Comment cards were sent to the homes of certain residents, their relatives and other visitors to find out what their views of the home were. The views of doctors and district nurses who visit the home were also asked for. At the time of writing this report two relatives, one doctor’s response, and one care co-ordinators response had been returned. In order to find out how well staff knew residents, care plans were looked at during the visit and residents, visitors and staff were spoken to. Other records in the home were looked at such as staff files, training records and complaints received. What the service does well: The interaction between staff and residents’ was good with a balanced mix within the staff team, which benefits them. The manager has a good knowledge of each resident and uses his professional experience to relate to the people in his care in a relaxed and friendly manner. Residents’ are treated as individuals and encouraged to maintain their interests and skills for as long as possible. The home provides a secure environment with minimum restriction of movement around the building. The staff are good at responding properly to residents questions and behaviours. The home provides a good standard of care to residents in a comfortable and well-maintained home. It is decorated and furnished to a good standard. Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 6 Residents’ said that the home was always clean tidy and did not smell. They said that the food was good. Visitors said that they could visit the home at any time, and that they were made welcome, and were offered refreshments by staff. This makes it a pleasant, comfortable and homely place to live. Relationships between staff and residents’ were warm and friendly. Residents’ said that they were happy with the care provided and that the staff were kind and caring. They said that they could choose how and where to spend to their time and whether or not they want to join in with the planned social activities, or in the activities arranged in the day care area. The home has an activities organiser and a good range of activities is provided. The activity organiser also spends one to one time with residents talking about their past lives and finding out what they would like to do. Information about the services provided by the home is available in the foyer of the home, and lets residents’ and their relatives decide if the home will be suitable for them. Senior staff visit prospective residents whenever possible to assess their needs to make sure that the home and staff team will be able to meet them. The manager is very keen on making sure there are no residents admitted to the home with needs the home cannot meet. What has improved since the last inspection? What they could do better: All hand written entries onto MAR charts should be signed by the person making the entry. The manager could make sure all staff who have not received training in the safe administration of medicines have the opportunity to do so, and that this is certificated. Neville Grange Resource Centre DS0000033532.V357320.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. Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5 and 6 Quality in this outcome area is excellent. This judgement has been made using a range of available evidence including a visit to this service. Residents and their relatives have enough information about the home to decide if it will meet their needs. EVIDENCE: People spoken to during the visit said they felt that they had been provided with enough information to help them make an informed decision to move into the home. Copies of contracts were seen in individual care records, with the exception of those who receive respite or short stay care. Trial visits are also encouraged if at all possible. The pre admission assessments seen for a sample of residents continue to be good with information seen setting out the reason the person was coming into the home, and a brief history and what staff needed to do to meet their needs. Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 10 People continue to have their needs assessed following admission, to identify any improvement or deterioration in their general or mental heath. Once a resident has been admitted to the home a further more detailed assessment of their needs is carried out. Information from surveys sent out to people living in the home and their relatives said: • They had been given enough information about the home and the services it provided and any questions asked were answered. • Contracts for services provided were in place, except for those who were respite or short stay. • They were satisfied with the services provided and felt that their or their relatives’ needs were being met. • The services provided were efficient yet homely and one person said ‘I always have a laugh.’ Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using a range of available evidence including a visit to this service. Staff show a good awareness of residents’ needs and there is good communication amongst them. Care records provide evidence that residents’ needs are met. Residents are treated with dignity and their privacy is maintained at all times. EVIDENCE: Each person admitted to Neville Grange has a written plan of care to provide staff with information about how the person wishes to live their life and what support is needed from staff to achieve that goal. Four plans were looked at in detail and two of the people who were permanent residents were spoken to. They contained all the information about the needs of the person. They were informative, clear and easy for staff to understand and regularly reviewed. Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 12 Where risks to the person were identified, they were discussed with them, and a plan of action agreed with staff. Risks relating to smoking cigarettes in the home was regularly updated and reviewed with the resident, to minimise the risk of a fire in the home. The care plan for somebody recently admitted to the home for a short period of time was looked at. It showed that a copy of the local authority assessment of needs had been obtained. This information was used to make sure the home would be able to meet the person’s needs before agreeing to their admission. The care plan of a person who had been admitted in an emergency was looked at, and they were spoken to. They said they had been asked ‘all manner of questions when they came in’ which they found reassuring as they felt the staff were doing their best to get to know them. Information from health and social care professionals said that assessments of peoples needs carried out by the home were ‘accurate and helped to make sure the right service was planned and given to people, and that the staff worked closely with them.’ Risk assessments around nutrition, falling, and the risk of developing pressure sores, and moving and handling were seen. Appropriate actions are taken and advice is sought if people are identified as being at risk. For example: Where people are identified as at risk of developing pressure sores appropriate action is taken to minimise the risk and obtain specialist pressure relieving equipment. The physiotherapists on the rehab unit do the assessments, and the community nursing services provide the necessary equipment. The manager said that if people are at risk of falling action will be taken to reduce the risk and he would contact specialist falls prevention team to contact for support and advice. Most people living in the home who are on regular medication are helped by carers. The manager said they have now found a new provider for medication training, and all staff are to be trained. Currently the people who have already had the appropriate training give the medication. The medication system was checked and safe procedures were identified, however, hand written entries on MAR charts should be signed by the person making the entry. Neville Grange Resource Centre DS0000033532.V357320.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): All standards were assessed. Quality in this outcome area is good. This judgement has been made using a range of available evidence including a visit to this service. People can exercise choice and control over their lives and maintain contact with family, friends and the local community. EVIDENCE: Care plans included what residents liked to do with their leisure time. Information received from one relatives comment card said that they did not always feel that there were enough activities in the home, but talking to some of the people who live there, they said they were happy with the entertainment programme and that they could also join in with the activities in the day centre if they liked. The home employs an activity organiser who looks at ways of involving residents in both large and small group activities. Trips out are organised, monthly entertainers and in-house bingo and quizzes are examples of activities and stimulation provided. The Christmas party and dinner was taking place in the day centre on the day of the inspection and a singer had been especially booked for this occasion. Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 14 People spoken to said that relatives are welcome at the home and are able to visit at any time. Those visitors spoken to repeated this view. People spoken to also said they were happy with the arrangements about going to bed and getting up. Those residents who are able to self-care said they were left to make their own decisions about this. Those needing assistance do seem to have some choice. Residents spoke in positive terms about the food provided at all mealtimes. The cook takes a pride in her work and makes sure the menus reflect the preferences of people living there. The meal at lunchtime looked hot, tasty and well presented. People were seen enjoying their meal. Staff eat with residents in each of the four dining rooms. People are given their post unopened therefore respecting their privacy. Staff said they know which residents need help and were seen to offer an appropriate level of assistance. There were plenty of newspapers and magazines around for residents to read and keep up to date on current affairs. One resident, who stays at the home regularly one week out of six said the staff continue to make sure her visits are planned properly and that she had everything she needed to make her feel at home. Including bringing pet parrot, with her. She was very clear about what her stay involved and she said she wouldn’t continue to stay at Neville Grange if it wasn’t ‘just right’. A new Mercedes ‘sprint’ bus has been provided for the peoples benefit since the last inspection Neville Grange Resource Centre DS0000033532.V357320.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 a range of available evidence including a visit to this service. People feel safe living in the home and know who to talk to if the have any concerns. EVIDENCE: There has been one complaint since the last inspection. This was regarding care practices and one particular member of staff. The complaint was upheld. The complaint procedure is displayed in the entrance hall to the home. All staff spoken to said they were familiar with the process and comments by relatives on comment cards confirmed they were aware of it and knew who to complain to if they were unhappy in any way. Residents were asked what they would do if they were unhappy. They said they would speak to a member of staff or their relative. The home has appropriate policies and procedures in place to deal with complaints and adult protection and the action taken. Staff have received training in adult protection and there is a whistle blowing procedure in place. Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 16 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, 23, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using a range of available evidence including a visit to this service. Neville Grange is well presented and residents are comfortable living there. EVIDENCE: Not all areas of the home used by residents were visited during the inspection, but those that were confirmed bedrooms and communal areas have good quality furniture, which is suitable for its use. Rooms have equipment, which helps people to keep their independence, and all areas were free from clutter and odour free. There are no en suite facilities, so all residents use communal bathrooms and toilets. Some residents have tea and coffee making facilities in their rooms. The quality of bed linen seen was good. Residents spoken to who were receiving short stay care said most of the time they were re admitted into the same room, which was reassuring for them. Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 17 The industrial kitchen is well equipped. It was very clean and well ordered. The cook said all the equipment was working. She showed me the records she keeps and they were recorded consistently and clearly. A recent Environmental Health visit identified no concerns. Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 18 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): All standards were assessed. Quality in this outcome area is good. This judgement has been made using a range of available evidence including a visit to this service. Staff are trained and competent to meet the needs of the residents. There are good recruitment procedures in place to protect the residents. EVIDENCE: Staff spoken to said they were proud to work at a care home with a stable staff team. They said this meant they could always trust that the people were care for by staff that knew them well and knew how they wanted to be treated. Staff said they worked as a team to make sure the home was kept running and that they helped each other. Some have been at the home quite a long tome. This is good for people living in the home because it helps to maintain consistency and continuity of care as well good relationships. On the day of the visit there ware enough staff on duty to meet the needs of the people living there. Duty rotas confirmed this. However comments made on a comment card by one relative said she thought recently there seemed to be quick turn over of staff. ‘We were used to seeing familiar staff members Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 19 who knew my relatives needs and had time to chat. The staff we see now have to check the records for my mothers details.’ The manager said that they now had a good team including enough cleaning staff. Two recruitment files were looked at. They were both complete with all security checks such as POVA (protection of vulnerable adults) and CRB (criminal records bureau checks.) There was also evidence of satisfactory references and records that formal supervision is taking place. They were also complete with photographs as identification. Training is seen as important and staff have access to relevant courses. Those spoken to felt they were given plenty of training opportunities. Information from the AQAA said that from twenty-four care staff, nineteen have achieved NVQ level 2 or higher, and that three are undertaking level 2. NVQ Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 20 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, 32, 33, 35, 36 and 38 Quality in this outcome area is good. This judgement has been made using a range of available evidence including a visit to this service. The home is run and managed in the best interests of people living there. EVIDENCE: The manager has many years experience working with older people, has worked at Neville Grange many years and has the necessary qualification to carry out his job properly. Staff and residents spoken to all feel he offers them good support and is ready to listen to ideas they may have. Staff said Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 21 there were clear management structures in place and they were given proper leadership and guidance. The responsible person carries out monthly visits to the home as required. Reports are made available to the CSCI. These visits are to make sure the home is being run properly and are called Regulation 26 visits, and one was taking place on the day of my visit. The views of residents and their families are regularly sought about the care provided at Neville Grange, and these are publicised. Bradford Social Services is responsible for keeping some residents personal monies if they are not able to do this for themselves or do not have a relative to do it. An Agreement with CSCI continues about how this money is administrated and the manager continues to follow these guidelines. The records seen make it possible for all transactions to be audited and the senior staff have to reconcile all the monies used and provide written proof. This makes sure residents affairs are kept in order and they are safeguarded. Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 22 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 4 4 4 4 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 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP21 Good Practice Recommendations All hand written entries on MAR charts should be signed by the person making the entry. The registered person should consider providing a shower for residents. Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Neville Grange Resource Centre DS0000033532.V357320.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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