Care Home: Northernhay

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What the care home does well The whole house is large and spacious, the communal areas are light and airy and were clean and tidy. It is decorated and arranged in a domestic style. Each of the bedrooms is individual to the person living there and is furnished as required. Records, Health and Safety checks, policies and procedures are up to date and are well ordered. The two people who replied to our survey said they liked living in the house and that the staff treated them well. One person refers to the other people living in the home and the staff as, "My Northernhay family." Five out of the six families returned the questionnaires we had sent them and they contained no criticisms, but a lot of praise. One person appreciated that staff always accompany them and their relative to hospital appointments. Another relative said that, "Northernhay does a very good job caring after the residents. We are very happy and satisfied that our relative loves returning there after a weekend spell away with us." What has improved since the last inspection? The garden is large and set out in an interesting style, there are French windows in the sitting room that open onto a ramp making it accessible to everyone. The home has employed a gardener who keeps it tidy. Since the last inspection volunteers from a local bank have built a sensory area in the garden. Parts of the home have been decorated and new curtains have been put up in the dinning room. CARE HOME ADULTS 18-65 Northernhay 11 Bickley Road Bromley Kent BR1 2ND Lead Inspector Ann Wiseman Key Unannounced Inspection 30th April 2008 10:00 Northernhay DS0000006958.V362272.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 Northernhay DS0000006958.V362272.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. Northernhay DS0000006958.V362272.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northernhay Address 11 Bickley Road Bromley Kent BR1 2ND 020 8295 3757 020 8467 7211 infonorthernhay@aol.com 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) Bromley Autistic Trust Anita Walters Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Northernhay DS0000006958.V362272.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 (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Learning disability - Code LD The maximum number of service users who can be accommodated is: 6 30th April 2007 Date of last inspection Brief Description of the Service: Northernhay is a large, detached Victorian house, which provides accommodation and care for six people with autism. Hyde Housing Association owns the building and the service provider is Bromley Autistic Trust, which also employs the staff. The house is spacious and has private and communal facilities to meet the needs of the people living in the home. There is a large enclosed back garden and some off street parking at the front. Northernhay is situated on a main road and bus route leading to Bromley town centre. For people with full mobility, it is within reasonable walking distance of a train station. The cost of living at Northernhay is £1097 a week and people living there contribute according to their accessed ability. Northernhay DS0000006958.V362272.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 this service experience good quality outcomes. This was an unannounced inspection and it consisted of two site visits, one started at 10am and lasted four hours and the second started at 2.45pm and finished at 6.20 in the evening after the people living at Northernhay had returned from their day centres. The home sent us their annual quality assurance assessment (AQAA) when we asked for it. It was clear and gave us all the information we asked for. The AQAA is a self-assessment that focuses on how well outcomes are being met for people using the service. It also gave us some numerical information about the service. Before we visited the house we had sent surveys to the people living in the home, their families and professionals connected to the service so they could comment on the quality of care offered at Northernhay. The response was good, two people returned their survey and five relatives replied. All of the comments were positive including one from the local GP. Questionnaires were also sent to the staff members but only one returned it. We spoke to another member of staff who was on duty when we arrived. During the inspection we were given a tour the house. We looked at the personal files of two people living in the home and two staff personnel files. We sampled a few of the health and safety records and we also examined the medication, its recording and how it is stored. A new manager has been appointed since the last inspection, she has just completed our registration process. The manager was available throughout both of our visits and was able to answer our questions and produced all the documents we requested. What the service does well: The whole house is large and spacious, the communal areas are light and airy and were clean and tidy. It is decorated and arranged in a domestic style. Each of the bedrooms is individual to the person living there and is furnished as required. Records, Health and Safety checks, policies and procedures are up to date and are well ordered. The two people who replied to our survey said they liked living in the house and that the staff treated them well. One person refers to the other people living in the home and the staff as, “My Northernhay family.” Northernhay DS0000006958.V362272.R01.S.doc Version 5.2 Page 6 Five out of the six families returned the questionnaires we had sent them and they contained no criticisms, but a lot of praise. One person appreciated that staff always accompany them and their relative to hospital appointments. Another relative said that, “Northernhay does a very good job caring after the residents. We are very happy and satisfied that our relative loves returning there after a weekend spell away with us.” 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. Northernhay DS0000006958.V362272.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 Northernhay DS0000006958.V362272.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): Key standard 2 was assessed during this visit. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People considering moving in to Northernhay will have their needs and aspirations assessed before being offered a place in the home. EVIDENCE: We examined two files of people living in the home on this occasion and evidence was seen that their needs and aspirations were assessed and continue to be reviewed. The home has policies and procedures in place regarding taking new people into the home and the Manager has assured us that the procedure will be followed when anyone new moves in but there have not been any new admissions for quite a while. Northernhay DS0000006958.V362272.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): Standards 6, 7, 9 and 10 were examined on this occasion. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People living in this home have individual care plans and are able to make decisions about their lives. Risk assessments are in place and information is stored appropriately. EVIDENCE: We examined two peoples files and found that the care plans are written in a away that made it easy to identify individual needs, but it have been two years since they have been updated and they will need to be done soon. The manager intends to review all of the files now that she has settled into her new post. People are supported to make decisions about the way they live, it is evident that they took an active part in developing their own care plan and have signed them to indicate they agree with them, people also signed the risk assessments and contracts. Northernhay DS0000006958.V362272.R01.S.doc Version 5.2 Page 10 They take part in house meetings, chose social activities and where they want to go on holiday which they do every year, four people had holidays abroad last year. Personal files also contained risk assessments that have been done to find ways to minimise the risks that people take in their everyday lives so that they could carry on doing the things they want to. The assessments were realistic and did not unduly restrict people and allowed them to take risks as part of an independent lifestyle. Files that contain personal information are stored in a filing cabinet in the office. We were assured that when not being used files are not left out for others to read and the office is kept locked when staff are busy elsewhere. The importance of keeping confidences is covered during the induction of new staff and both the staff member and the manager displayed respect in the way they spoke about the people living in the home. Northernhay DS0000006958.V362272.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): All of these standards were looked at during this inspection. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People that live in Northernhay have the opportunity to take part in a large number of social activities and are part of the local community. Family contacts are maintained and rights are respect. Meals are healthy and wholesome. EVIDENCE: People living in the home take part in the local community by shopping, eating out, going to shows and the cinema. They have their own minibus and people contribute to the cost of it out of their own money. More staff members have recently taken their driving assessment so they can drive the minibus. Alternatively people use public transport and some travel independently. Everyone is given opportunities to develop personally; one person is supported to attend a local church regularly and a volunteer comes to the home to help people with their numeracy and literacy skills. Two people attend the trusts Northernhay DS0000006958.V362272.R01.S.doc Version 5.2 Page 12 autistic specific day centre. Others take part in independent lifestyles training sessions or attend day centres run by the local authority. Family contact is supported and encouraged; there is a family support group that meet together at the house. Some people visit their families’ home for overnight and weekend stays. In discussion with staff is was evident that they understood the need to respect and uphold Peoples rights and that they support them to take responsibility by respecting others rights as well as their own. The manager told us that people participate in a number of household activities depending on their skills and ability. There is a schedule of chores in the kitchen. People preparing to live independently are being supported to plan and prepare their own meals. During the Inspection the evening meal was being prepared and it appeared and smelt appetising. The fridge and freezer contained ample quantities of good quality food and the menus that are written in consultation with the people living in the home were varied and interesting. An alternative meal is offered if requested. Northernhay DS0000006958.V362272.R01.S.doc Version 5.2 Page 13 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): All of these standards were judged on this occasion. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. This home provides personal care in the way people prefer to be care for and have their physical and emotional health needs are met. Medication is managed effectively but changes need to be made in the way people have their medication dispensed to they can take it away safely when away from home. The Trust is aware that they need to consider how it will care for people as they get older. EVIDENCE: Care Plans clearly show support needs and note preferences in the way people want to receive personal care. Evidence was noted in people’s files that show they receive appropriate medical treatment; there is evidence of hospital appointments, there are reports from doctors and other health service professionals including speech and language therapy, epilepsy specialist and psychiatric specialists from the Community Learning Disability team. The medication is stored in a cabinet that is kept locked and is secured to the wall, the home does not have any people who use any controlled drugs so does Northernhay DS0000006958.V362272.R01.S.doc Version 5.2 Page 14 not have a controlled drugs cabinet. In 2007 the law changed. Now all care homes, whether providing nursing or personal care, must keep controlled drugs in a controlled drugs cupboard, in the past homes not offering nursing care where not included in this act. We discussed the recent changes in legislation and because requirement 13 of the care homes regulations calls for arrangements to be made for the safekeeping of medication in the home it means that the home will now have to provide the appropriate storage for controlled drugs as set out in the Misuse of Drugs Act 1971 and it’s amendments. They will also have to develop policies and procedures in preparation of managing controlled drugs within the home if the need arises. We examined the medication and it’s records and they were in order apart from one area. We cannot give details of the issue involved in this report without disclosing the person’s identity. We discussed it with the manager and she has undertaken to deal with the situation. It is advisable that the doctor should review everyone’s medication regularly and discontinue those that are no longer necessary. The home is in the practice of re-dispensing medication for those people who are away from home when it should be taken. This is unsafe and not good practice. However there are exceptional circumstances when the practice of secondary dispensing may be acceptable and even necessary in social care. There needs to be a robust risk assessment and written procedure. Details should include, which staff are permitted to do this, what containers the medicines are to be put in, how the containers are to be labelled and what other information is to be given. A clear record should be kept of all staff involved in each stage of the procedure and the actions taken. When dispensing a prescription a pharmacist must include the following information on the medicine label that must also included on the container it is secondarily dispensed into. - name of the medicine and strength - dose, that is the number of tablets, capsules or volume of liquid - frequency, that is how often to take the dose - any special instructions, for example take with food - quantity supplied - date the medicine was dispensed - name of the person the medicine is prescribed for. We received feed back from a GP who has patients in this home and they said, “Staff are sensible and ask for appropriate advice, they take a certain level of responsibility which I to be commended.” The Trust is aware that the house may not be suitable for the people living there as they get older and develop age related illness and disabilities and are making plans to provide for them when the need arises. Northernhay DS0000006958.V362272.R01.S.doc Version 5.2 Page 15 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): Both of these key standards were examined during this visit. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Complaint procedures are in place and required Protection of Vulnerable Adult Training is given. EVIDENCE: The home has a complaints procedure that meets required regulations. Staff we spoke with were aware of the term whistle blowing and are also aware of the Trusts policy in relation to this. The Trust has developed procedures for the protection of vulnerable adults. We saw the complaints procedure posted in the front lobby and the complaints log was examined, its format meets requirement and shows that complaints received are dealt with appropriately. No complaints have been made directly to us regarding the care and service provided at Northernhay since the last inspection. The issue of how people’s finances are managed by the home were discussed during the last two inspections and was subject to a requirement at both. The practise of all monies belonging to people being paid directly to the Trust and held in a central account is still being used. This practice contravenes Regulation 20 of the Care Homes Regulations and is an offence under the act. Since further discussion with the manager during this inspection steps have been taken to setup separate bank accounts for all of the people living in the home in their own names at a local bank and will be completed in the near future. Northernhay DS0000006958.V362272.R01.S.doc Version 5.2 Page 16 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): Standards 24, 25 and 30 were assessed on this occasion. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. Northernhay is a homely, comfortable and safe environment. Bedrooms are individual to each person and the home is clean and hygienic. EVIDENCE: The house is accessible, safe and well maintained and provides the people living there with an environment that is homely and comfortable. There are personal items, photos and ornaments all around the house, the furniture is attractive and comfortable and the decoration is in a modern, domestic style that people living in the home have helped to choose. The large rear garden is easily accessed from the house and is well maintained and attractively landscaped, there is a BBQ and garden furniture available to enable al fresco eating in good weather. The building is maintained in a way that provides a safe environment. There are some minor repairs that need to be seen to, such as the sealant around the kitchen sink and work surfaces that needs to be replaced and the flooring Northernhay DS0000006958.V362272.R01.S.doc Version 5.2 Page 17 in the bathroom on the middle floor is worn and broken in places, it also needs replacing. The manager has undertaken to make sure the repairs are carried out. She has already made arrangements to replace the fridge that had a broken door seal. The home is kept clean and hygienic by staff, there is a domestic staff member three days a week and people are supported to keep their rooms clean and tidy. Northernhay DS0000006958.V362272.R01.S.doc Version 5.2 Page 18 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): Standards 32, 34, 35 and 36 were examined during this visit. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. People living in this home are supported by competent and qualified staff and are protected by the homes recruitment policies and procedures. The training offered is appropriate to the service offered. EVIDENCE: We examined two staff records including training records. They indicated that the required recruitment practices were carried out. The staff member we spoke to confirmed that she had given two referees and had a Criminal Records Bureau check done before she started work and had undergone the training that was recorded in her file. The trust have devised a joint training program with the local authority and the training records indicate that the home offers a full and varied training program that includes Health and Safety, First Aid, basic Food Hygiene, Person Centred Planning, Understanding Autism, Moving and Handling, personal Awareness, Medication and Protection of Vulnerable Adults. The manager and staff confirmed that supervision is offered regularly. Northernhay DS0000006958.V362272.R01.S.doc Version 5.2 Page 19 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): Key standards 37, 38, 39, 40 and 42 were judges on this occasion. People who use the service receive Good quality in this outcome area. This judgement has been made using available evidence including a visit to this service. The people living in this home benefit from a service that is well run and they can be confident that their views underpin the running of the home. Health and Safety safeguards are in place and checks are carried out regularly. EVIDENCE: The Registered Manager is knowledgeable; she shows a good understanding of this client group and their needs. The ethos of the home is geared toward empowering the people living in it. The home is well organised and people benefit from the calm and supportive atmosphere generated by the Manager and staff. Northernhay DS0000006958.V362272.R01.S.doc Version 5.2 Page 20 People and their relatives talk about Northernhay as being a good place to live, where “They select staff who love and care for the residents that they are responsible for.” One person wrote, “I would like to express my appreciation to all the staff for their care and understanding and kindness, both to my relative, and to myself.” The Doctor commented, “Staff demonstrate respect for the individual residents…… and residents are well cared for” The manager commented in the AQAA, “We listen to our residents and observe any changes in behaviour for those who have none verbal means of communication.” The AQAA says that the policies and procedures were reviewed and updated in 2007 and that the equipment is well maintained, the home have the necessary safety certificates. We sampled a few of the Health and Safety records during the inspection and they were found to be in order. The home gives annual quality assurance surveys to people, their families and also staff members. The information is collated in detail and the outcomes for each question is considered and compared with the previous years survey. The manager told us that the home receives regular visits from members of the service support committee, who provide feedback to the registered provider. People living in the home and their relatives meet with staff together throughout the year, which provides the opportunity for informal discussion regarding the service provided. The home keeps us informed of any significant incidents in the home and sends us copies of the provider report generated from inspections they carry out every month. In the past we have asked for these Regulation 26 reports to sent to us but this is no longer necessary and in future we will ask to see them when we visit the service. Northernhay DS0000006958.V362272.R01.S.doc Version 5.2 Page 21 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 4 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 LIFESTYLES Standard No Score 11 4 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 2 3 3 3 4 3 X 3 X Northernhay DS0000006958.V362272.R01.S.doc Version 5.2 Page 22 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 YA20 Regulation 13(2) Requirement Provision must be made for the safe storage of controlled drugs within the home that meets the required standard as set out in the Misuse of Drugs Act 1971 Medication must not be redispensed unless unavoidable. A robust risk assessment and written procedure must be developed and should include which staff are permitted to do this, what containers the medicines are to be put in, how the containers are to be labelled and what other information is to be given. Timescale for action 22/12/08 2. YA20 13(2) 23/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Northernhay DS0000006958.V362272.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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 Northernhay DS0000006958.V362272.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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