Care Home: Roselands

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What the care home does well Residents are being provided with all the information they require with which to enable an informed choice as to where they would like to live. Residents are being provided with a copy of the home`s terms and conditions at the point of moving into the home. The home is able to demonstrate that residents` needs are being fully assessed, and that the range of needs presented is being sensitively and appropriately met. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 8Residents are having their health, personal and social care needs set out in a very comprehensive and detailed individual plan of care, with review taking place on a regular, monthly basis. The health care needs of residents are being fully met, with thorough and ongoing monitoring of individuals` health, sensory, and physical care needs. Residents are being well protected by the home`s medication policy and procedures. Accredited medication training has been extended to all care staff. Residents are being treated with respect in all aspects of their daily living, and are having their right to privacy upheld. The views and wishes of residents and their relatives, regarding the eventuality of their infirmity or death, are being respected. Residents are being provided with a full and varied range of opportunities for recreational and social activity that is in accord with their social, cultural and religious needs. There is full consultation with residents regarding their specific interests and choice of activities. Residents are being encouraged and assisted to maintain contact with their family and friends, and to access and maintain links with the local community. The home has an open door policy, with residents at the home being assured of privacy and respect when receiving visitors. Residents are being actively enabled to exercise choice and control in their day-to-day activities and routines, with appropriate support from staff being provided to help to facilitate this. Residents are receiving a wholesome and appealing diet in pleasant surroundings, and at times which are convenient to them. Individuals` personal and cultural tastes, preferences and dietary needs are being catered for. The home has an appropriate complaints policy and procedure in place. Clear information for raising complaints is made available, and residents and their relatives/friends are encouraged to raise any concerns they may have. The legal rights of residents within the home are being well protected and promoted. Residents are encouraged and assisted to vote if they wish. The home`s policies, procedures, practice and training evidence that residents are being protected from abuse and are living in a safe environment. Residents live in a safe, well-maintained environment, with access to safe and comfortable communal facilities.Residents` rooms are safe, comfortable and pleasantly decorated, reflecting residents` personal identities, and being suited to their individual needs. Residents are living in a home that presents as being clean, pleasant and hygienic. The home has the numbers and skill mix of staff sufficient to meet the needs presented by the home`s residents, and to ensure their safety. Staff are being provided with the necessary induction and training with which to competently perform their work duties Generally, residents are being protected by the home`s recruitment policy and procedures. The home is being managed in the best interests of the home`s residents. The management approach is evidenced to be open and enabling, and conducive to creating a positive and inclusive atmosphere in the home. Through the appropriate supervision, appraisal and support of staff, good practice is being promoted and the welfare and best interests of residents is being protected. The interests of residents are being safeguarded by the home`s record keeping, with records being kept secure, up to date and accurate. The home is consulting widely with residents, relatives and other stakeholders, and is evidencing the home`s ability to meet its aims and objectives. Residents` financial interests are being appropriately safeguarded. Generally, the health, safety and welfare of residents and staff are being appropriately promoted and protected. What has improved since the last inspection? The care manager has completed Croydon`s `Training for trainers` course for safeguarding adults. There has been an increase in the numbers of staff possessing NVQ qualifications in social care. There has been ongoing redecoration of the home, which has included recent refurbishment and redecoration of the home`s bathrooms and toilets, and a refurbishment of the kitchen at the end of 2007. There has also been recarpeting of hallways and corridors.0 What the care home could do better: The home needs to obtain an updated CRB certificate for one staff member. Staff files need to be divided into separate sections so as to improve access to information. Hot water temperatures need to be monitored on a more regular basis. CARE HOMES FOR OLDER PEOPLE Roselands 8-10 Stanford Road Norbury London SW16 4PY Lead Inspector Peter Stanley Unannounced Inspection 16th September 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 Roselands DS0000025830.V371864.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. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Roselands Address 8-10 Stanford Road Norbury London SW16 4PY 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) 020 8764 6045 NO FAX nhosanee@yahoo.co.uk Mr Nizam Hosanee Mrs Zeidah Bannon Hosanee Manager post vacant Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places Roselands DS0000025830.V371864.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: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 16 19th June 2006 Date of last inspection Brief Description of the Service: Roselands is a 16 bedded domestic-style building within a residential street, very closely situated to the busy Norbury High Road shopping area and to excellent transport links formed of a number of bus routes to Croydon, Brixton, Clapham and Central London and the railway link to Croydon, Thornton Heath and Central London. The home comprises two interconnected houses, with three floors being accessed via a passenger lift. Each floor provides a large lounge and dining area, residents move between these lounges, with the ground floor lounge providing the social focus of the home. The home provides bathrooms and toilets on each floor, or on half-landings between floors. The home aims to accommodate more able older people, and is not suitable for people who have a physical disability as the home is accessed from the front by a small number of stairs. Many of the home’s residents are able to manage their own care, with residents being encouraged and assisted to access local community facilities. The home has a large and pleasant garden, which is well maintained. Roselands DS0000025830.V371864.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 3 stars. This means the people who use this service experience excellent quality outcomes. This was a key inspection that was completed over one day. The inspection was assisted by the involvement of an expert by experience, and involved discussion with the deputy manager and person-in-charge, the home’s Care Manager, Hannah Oozeerally. The home’s registered provider and manager, Mr Hosanee, was not present. We spoke with a wide range of residents and with staff on duty, obtaining views about the home and the support provided. There have been two admissions within the last 12 months, both of which were case-tracked. We examined a wide range of documentation. This included staff rotas, staff and residents’ files, training records, accident and incident logs, medication records, and policies and procedures. Information was also available from the Annual Quality Assurance Audit, which is completed by the home’s providers. The evidence from this inspection indicates that Roselands offers a pleasant, well-maintained and homely environment in which to live, and that it is achieving high standards in the quality of care and support which it provides for residents. The evidence across all standards inspected is that the home is being well managed, and that there is a firm commitment to maintaining standards of good practice in all aspects of the home’s day-to-day operation. Discussion with residents indicated that the home and staff are positively regarded and that residents’ needs are being generally very well met. The home was observed to provide an open, friendly and inclusive environment for all its’ residents, with minority needs being identified and addressed. Positive comments were received regarding the choice and quality of food, the caring attitudes of staff, and the respect shown for individuals’ privacy and rights. There was evidence of a varied programme of activities and outings, and of a philosophy of care that encourages individuals’ to lead as independent and fulfilling lives as possible. There are links with the local community and the cultural, religious and spiritual needs of residents are respected. The varied ethnic diversity of the staff group, together with accredited training for staff in this area, reflects the home’s commitment to promoting equality and diversity. The home holds regular monthly staff and residents’ meetings, providing information, and consulting with residents regarding their individual and collective wishes. There is a notice board in the main reception area, which Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 6 publicises activities and outings and which keeps residents informed of any forthcoming events or visits by entertainers or other services. A mobile library visits monthly. There is a robust complaints policy and procedure in place, which is well publicised, and there is a complaints and suggestion book available for residents to fill in. No complaints have been recorded within the last 12 months. The home is evidenced to be providing a high standard of assessment and monitoring of residents’ care needs, with regular review of care plans and risk assessments. There is a comprehensive induction and staff training programme, with staff being actively encouraged to develop their skills and knowledge base, and to study for NVQ care qualifications. There is a rigorous system of staff supervision and appraisal in place, with attention being given to the development of good practice. The home has developed its quality assurance processes and completes regular annual surveys with residents, relatives, and visiting professionals. There are other regular contacts and checks that take place. An annual audit report summarises the findings from all sources of feedback, and a development plan links these to forward planning. From this inspection there is 1 requirement and 2 recommendations. An expert by experience participated in this inspection, and made the following observations regarding the home. The home consists of two interconnected houses with a number of stairs and corridors and is therefore only suitable for reasonably mobile and alert residents. I was asked by the CSCI Inspector to ascertain, as far as was possible, the residents’ views on the environment of the home, the care and support they receive, the quantity and quality of the food, opportunities to pursue areas of interest and whether staff treat them with respect and dignity. My first impressions were of a homely atmosphere though I personally found the décor old fashioned and in need of brightening up. However, I gained the impression that it was to the residents liking and likely to be the sort of decoration they were familiar with. There were a number of communal rooms, which were arranged in a homely style, allowing residents a choice of where to sit. The general atmosphere was calm and happy. Bedrooms, like the living areas were decorated and furnished in an old fashioned manner and I found some of them rather dark. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 7 I spoke to about 8 residents, some more articulate than others and asked how they liked living there. Less alert residents said it was alright but others were fulsome in their praise saying what a nice home it was, adding comments such as “they do a fantastic job” and “I’m very settled and happy living here.” Another resident said “The staff are lovely-we can’t say a bad word about any of them” and “they will do anything for you”. In particular, one lady pointed out that “Hannah (the care manager) couldn’t be lovelier. She looks after all the staff and makes sure they treat you well by setting a good example-she works very hard” I certainly observed this for myself and was extremely impressed by Hannah’s management style and attitude towards both the residents and her staff. Equally impressive was the relaxed and flexible attitude shown to meeting residents’ needs. For example, they can get up when they wish and eat in their rooms or in one of the dining rooms. This adds to the sense of being in a family home rather than an institution. No relatives or friends visited whilst I was there but residents told me they did have visitors. A number of people had gone out for the day and those who cannot go out unaccompanied are taken out by members of staff. Staff I observed were respectful and kind in their approach to residents and told me they enjoyed working in this home. Optional activities are organised by the staff though there is no specific activities manager in the home. I did wonder if residents would benefit from more organised sessions. I joined one group of residents for a pleasant lunch. We were assured that residents were given a choice of meals and all residents I spoke to told me the meals were very good. Second helpings were offered. Meals were plated in the kitchen and I felt it would have been nicer to see food put in dishes on the table, though in discussion with Hannah I could see the approach used was the most practical one given that there were 2 dining rooms and a number of residents eating in their own rooms and food needed to be kept warm. Overall, whilst I found the style of décor in this home very dated and potentially depressing, the level of care offered was clearly good and appreciated by the residents with staff showing obvious care and concern for their residents. What the service does well: Residents are being provided with all the information they require with which to enable an informed choice as to where they would like to live. Residents are being provided with a copy of the home’s terms and conditions at the point of moving into the home. The home is able to demonstrate that residents’ needs are being fully assessed, and that the range of needs presented is being sensitively and appropriately met. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 8 Residents are having their health, personal and social care needs set out in a very comprehensive and detailed individual plan of care, with review taking place on a regular, monthly basis. The health care needs of residents are being fully met, with thorough and ongoing monitoring of individuals’ health, sensory, and physical care needs. Residents are being well protected by the home’s medication policy and procedures. Accredited medication training has been extended to all care staff. Residents are being treated with respect in all aspects of their daily living, and are having their right to privacy upheld. The views and wishes of residents and their relatives, regarding the eventuality of their infirmity or death, are being respected. Residents are being provided with a full and varied range of opportunities for recreational and social activity that is in accord with their social, cultural and religious needs. There is full consultation with residents regarding their specific interests and choice of activities. Residents are being encouraged and assisted to maintain contact with their family and friends, and to access and maintain links with the local community. The home has an open door policy, with residents at the home being assured of privacy and respect when receiving visitors. Residents are being actively enabled to exercise choice and control in their day-to-day activities and routines, with appropriate support from staff being provided to help to facilitate this. Residents are receiving a wholesome and appealing diet in pleasant surroundings, and at times which are convenient to them. Individuals’ personal and cultural tastes, preferences and dietary needs are being catered for. The home has an appropriate complaints policy and procedure in place. Clear information for raising complaints is made available, and residents and their relatives/friends are encouraged to raise any concerns they may have. The legal rights of residents within the home are being well protected and promoted. Residents are encouraged and assisted to vote if they wish. The home’s policies, procedures, practice and training evidence that residents are being protected from abuse and are living in a safe environment. Residents live in a safe, well-maintained environment, with access to safe and comfortable communal facilities. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 9 Residents’ rooms are safe, comfortable and pleasantly decorated, reflecting residents’ personal identities, and being suited to their individual needs. Residents are living in a home that presents as being clean, pleasant and hygienic. The home has the numbers and skill mix of staff sufficient to meet the needs presented by the home’s residents, and to ensure their safety. Staff are being provided with the necessary induction and training with which to competently perform their work duties Generally, residents are being protected by the home’s recruitment policy and procedures. The home is being managed in the best interests of the home’s residents. The management approach is evidenced to be open and enabling, and conducive to creating a positive and inclusive atmosphere in the home. Through the appropriate supervision, appraisal and support of staff, good practice is being promoted and the welfare and best interests of residents is being protected. The interests of residents are being safeguarded by the home’s record keeping, with records being kept secure, up to date and accurate. The home is consulting widely with residents, relatives and other stakeholders, and is evidencing the home’s ability to meet its aims and objectives. Residents’ financial interests are being appropriately safeguarded. Generally, the health, safety and welfare of residents and staff are being appropriately promoted and protected. What has improved since the last inspection? The care manager has completed Croydon’s ‘Training for trainers’ course for safeguarding adults. There has been an increase in the numbers of staff possessing NVQ qualifications in social care. There has been ongoing redecoration of the home, which has included recent refurbishment and redecoration of the home’s bathrooms and toilets, and a refurbishment of the kitchen at the end of 2007. There has also been recarpeting of hallways and corridors. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 10 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. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 11 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 Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 12 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): 1 to 5 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents are being provided with all the information they require with which to enable an informed choice as to where they would like to live. Residents are being provided with a copy of the home’s terms and conditions at the point of moving into the home. The home is able to demonstrate that residents’ needs are being fully assessed, and that the range of needs presented is being sensitively and appropriately met. EVIDENCE: Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 13 The home has compiled a Statement of Purpose outlining the aims and objectives of the home, and the facilities and services it provides. The Statement of Purpose includes all the information detailed in Schedule 1 of the Care Homes Regulations (2001). An addendum to the Statement of Purpose gives updated details of the qualifications and experience of the home’s management and care staff. The home has a fairly comprehensive Service User’s Guide. This includes all the elements of regulation 5(1),(2)&(3), and is written in a clear and easily accessible format. A very comprehensive charter of residents’ rights complements this document. Both the Statement of Purpose and the Service User’s Guide have been reviewed within the last 12 months, and include feedback from Quality Assurance surveys. Following a referral to the home, a staff member will arrange to visit the person referred in their own home or current setting, so as to gain as full a picture as possible of their current needs and lifestyle. Prospective residents are then invited to visit the home and to meet residents and staff. They are then able, if they wish, to move in on a trial basis, so as to give time to settle in and make an informed choice. The Registered Provider is keen to ensure that any new residents are compatible with the existing resident group. The residents at this home tend to be very independent and relatively able. The Registered Provider aims to admit older adults who are fairly independent with their self-care, and whose needs are relatively low to medium dependency. The Statement Of Purpose states that the home is unable to offer placement to those who are wheelchair users, or to those who are mentally impaired or who have nursing needs. The home does not accept emergency admissions, and does not offer intermediate care. All residents are issued with a Placement Agreement, which clearly sets out the terms and conditions that apply to their placement in the home. This is written in plain English and is signed by the resident or his/her representative. Referring local authorities provide written contracts, which provide detailed information relating to the legal basis and terms on which the placement has been agreed with the home and the individual concerned. New residents are only admitted on the basis of a full assessment undertaken by a person who is suitably qualified to do so. This may involve a social services care manager and relevant professionals, in an initial care management assessment, and a thorough assessment and risk assessment by the home’s registered manager or care manager. The assessment fully involves the individual concerned, his/her relative or delegated representative, and any relevant professionals that have been party to the referral. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 14 The home has admitted two new residents within the last 12 months. The relevant residents’ files were examined. It was found that care management assessments, outlining the residents’ care needs, had been obtained from the referring local authority, and that assessments and risk assessments had been completed by the home. These included an ‘independence assessment’ and a ‘choice assessment’ which includes very detailed and comprehensive information regarding individual capabilities, and the person’s wishes and preferences in relation to their daily care, routines and activities. A sample of residents’ care plans were examined. These are reviewed on a regular monthly basis, and are formally reviewed and updated every 3 months. Records of the initial six-weekly and subsequent three-monthly reviews were also evidenced. Three monthly formal reviews are held to which the resident, his/her relatives/representatives, care manager and GP are invited. Views were elicited from a number of residents. Generally very favourable views were expressed regarding the home and the care and support provided by staff. The expert by experience spoke with about 8 residents, some more articulate than others and asked how they liked living there. Less alert residents said it was alright but others were fulsome in their praise saying what a nice home it was, adding comments such as “they do a fantastic job” and “I’m very settled and happy living here” another resident said “The staff are lovely-we can’t say a bad word about any of them” and “they will do anything for you”. The various assessments (including choice, independence and service users’ rights) and service user plans indicate that care and support needs are being very well assessed and met in this home, and that residents and their relatives are being fully involved in the assessment, review and care planning process. There is a comprehensive and ongoing programme of training for staff which is tailored to the care and support needs of this client group. Staff and training records indicate that the home has the requisite range of skills and abilities with which to meet the needs of the home’s residents. Views elicited from staff members indicate that staff are receiving good supervision, training and support in carrying out their duties, and that they derive considerable job satisfaction. There was evidence of good communication and rapport between the care manager, staff and residents, with evidence of staff being positively regarded and valued. Staff were observed to be caring and professional in their communication and interaction with residents. The expert by experience noted that staff “were respectful and kind in their approach to residents” and that they enjoyed working in this home. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 15 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 to 11 Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the visit to this service. Residents are having their health, personal and social care needs set out in a very comprehensive and detailed individual plan of care, with review taking place on a regular, monthly basis. The health care needs of residents are being fully met, with thorough and ongoing monitoring of individuals’ health, sensory, and physical care needs. Residents are being well protected by the home’s medication policy and procedures. Accredited medication training has been extended to all care staff. Residents are being treated with respect in all aspects of their daily living, and are having their right to privacy upheld. The views and wishes of residents and their relatives, regarding the eventuality of their infirmity or death, are being respected. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 16 EVIDENCE: Residents’ care plans are being compiled on the basis of the initial assessment prior to admission, on admission and during residency. Care plans are viewed by the home as being ‘living documents’. The care plans for two residents, admitted within the last 12 months, were examined. These evidenced the full involvement of the two residents, and their nearest relatives, in identifying their needs, wishes and preferences, and in drawing up their care plans. The home’s care plans are comprehensive and person centred, focussing on the individual’s physical, cultural, mental, emotional and spiritual needs and wishes, and how the home aims to meet these. Care plans are being reviewed on a regular, monthly basis, and are formally reviewed and updated every 3 months. All care plans are signed by the individual resident, with residents being given the choice as to whether they wish to be fully involved in drawing these up. All residents are registered with a local health centre, where residents have access to 3 GPs, a district nurse, and other health care professionals. Any resident wishing to retain his/her GP can do so if still living within the GP’s catchment area. There is a routine weekly GP visit to the home, with reviews and screening of residents’ physical health. Residents can either be visited at the home, or visit the health centre, and have the choice of being seen by a male or female GP. The home supports residents in accessing health care checks, treatment and hospital appointments. An NHS chiropodist visits once every three months, training in foot care having been provided to staff. The home uses a domiciliary dental practice, with visits by a dentist and a dental hygienist to the home taking place on a six-monthly basis. There are no specific health concerns or continence issues at present in the home. Nutritional assessments are undertaken, with nutritional assessments and plans, monthly weight charts and records of food consumed, being maintained. The home has appropriate policies and procedures in place for the administration and storage of medication. All medication is securely stored in a locked medication cabinet. No controlled drugs are administered or kept in the home. The care manager confirmed that all staff have received accredited medication training, and that they update their knowledge through a distance learning training module (NCFE). The home receives regular pharmacy visits, and has had a recent pharmacy inspection (on 16/7/08) and found to be satisfactory in its’ procedures. All medications are reviewed for each resident by their GP, and Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 17 appropriate records maintained. The home’s manager and care manager are both qualified nurses and maintain an overview of medication procedures and practice. The home has detailed and comprehensive policies and procedures in place which cover privacy, dignity and confidentiality. Residents are assisted to complete questionnaires in relation to their privacy and dignity, these fully exploring the expectations of each individual in relation to all aspects of their care. These include choice, independence, and the individual’s likes and dislikes. The questionnaires are used in the writing of service user plans and are reviewed annually. The review of these documents includes further discussion of residents’ rights and ensures that residents are made aware of the complaints procedure. Each resident completes a number of these questionnaires. These documents represent excellent examples of good practice and demonstrate a commitment to addressing the individual’s right to privacy and dignity. Issues of privacy and dignity are discussed on a regular basis at residents’ meetings. The expert by experience noted that she observed staff ‘being respectful and kind in their approach to residents’, and that there was ‘a relaxed and flexible attitude shown to meeting residents’ needs’. Residents’ care plans detail individual wishes and preferences in regard to their daily living and routines, and as to how they wish their care to be provided. From the discussion that took place with residents, it was apparent that residents feel that their privacy, dignity and rights are being respected in this home. Residents are able to see relatives or friends in privacy, a quiet upstairs lounge, or a small visitors room being available if required. A phone is available for private phone calls in the visitors’ room. Residents’ wishes regarding the eventuality of their infirmity or death are recorded on their files, with the nearest relative being involved, wherever possible, in this process. The religious, spiritual and humanitarian needs and wishes of each individual are respected and noted, together with detail of any wishes regarding practical issues and funeral arrangements. The home has a policy and procedure on ‘death and dying’; this was revised in January 2005. The home’s provider/manager has, as an accredited trainer in this area, provided training in bereavement and loss to staff at the home. From the feedback provided, this has proved beneficial in developing awareness of issues relating to bereavement and loss, and in enabling staff to develop insights and skills to assist in supporting residents when a death in the home, or family bereavement, occurs. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 18 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 to 15 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents are being provided with a full and varied range of opportunities for recreational and social activity that is in accord with their social, cultural and religious needs. There is full consultation with residents regarding their specific interests and choice of activities. Residents are being encouraged and assisted to maintain contact with their family and friends, and to access and maintain links with the local community. The home has an open door policy, with residents at the home being assured of privacy and respect when receiving visitors. Residents are being actively enabled to exercise choice and control in their day-to-day activities and routines, with appropriate support from staff being provided to help to facilitate this. Residents are receiving a wholesome and appealing diet in pleasant surroundings, and at times which are convenient to them. Individuals’ personal and cultural tastes, preferences and dietary needs are being catered for. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 19 EVIDENCE: The home offers a wide range of activities that all residents are given the option of participating in. These are publicised on the notice board in the home’s main reception area. The activities in the home are designed to reflect the interests and choices of the residents, each individual, on admission, being asked to provide information regarding their wishes and interests. Residents are regularly consulted by their key workers, and at residents’ meetings regarding their preferences regarding activities and outings. There is a regular activity programme, which includes music, games, quizzes, bingo, exercise, dancing and library visits. Staff were observed to be interacting in a positive way with residents and to be helping to create a friendly and stimulating environment. One staff member was facilitating a bingo session with three residents, whilst another staff member was engaging residents in conversation. There have been some new activities introduced within the last year, which include relaxation and yoga sessions. A mobile library visits monthly, with reading books and plays to listen to. The home could perhaps offer more in the way of structured activities. In this regard, the expert by experience made the following observations. “Optional activities are organised by the staff though there is no specific activities manager in the home. I did wonder if residents would benefit from more organised sessions.” Residents are encouraged to involve themselves in daily routines, including assisting with tidying their rooms, with laying table and food preparation, or assisting with daily trips to purchase fresh fruit and vegetables from local shops. Residents are encouraged to access facilities in the community, with key workers assisting individuals to access shops and parks where help is needed. Links with the local community are encouraged with residents being enabled to visit the library or cinema or to attend a social club or day centre. There is a local Darby and Joan club very close to the home, which residents can attend if they wish to do so. Residents are able to go out, to the shops or places of interest, or to visit friends. Views expressed indicate that, generally, residents are satisfied with the range of activities on offer, and that they feel able to exercise choice and control in their daily activities and routines. Independence in daily living is encouraged wherever possible and there is a strong enabling ethos within the home, with residents being encouraged to Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 20 develop their interests and skills, and to lead as fulfilling lives as possible. As detailed in their personal files, this is linked to very detailed and thorough monitoring of individuals’ wishes, preferences and needs. The home has an open door policy to visitors, and from the views expressed, relatives and other visitors are made to feel welcome at the home. Residents also indicate that their privacy is respected when they receive visitors. The expert by experience made the following observations. “No relatives or friends visited whilst I was there but residents told me they did have visitors. A number of people had gone out for the day and those who cannot go out unaccompanied are taken out by members of staff.” Residents at the home receive visits from clergymen of different denominations, with access to places of worship being arranged for those residents who wish to do so. The home provides occasional outings to places of interest, these being publicised on the notice board. These are usually for small groups of residents, including those who feel less able to go out on their own. The home also organises an annual day outing to the South coast, for a large group of residents, these trips having proved very popular. The home undertakes a questionnaire about choice with all residents. This is an extensive document covering a wide range of choice areas, information from which is integrated into the care plans. Most residents manage their own financial affairs. The home tries to ensure discussion of the individual’s choices, wishes and rights at formal reviews, with input, where required, from relatives and friends, and their care manager. Advocacy information is made available at the home. Food served in the home is evidenced to be of a high standard and served in large quantities. Residents have expressed favourable views regarding the quality and choice of food available. The menus are pre-planned and fully represent the preferences of residents. The range of food served is varied and nutritious. Lunch is the main meal, which includes a choice of main courses, with fresh vegetables, and a pudding for dessert being included. The evening meal is always soup and bread followed by a choice of snack meals such as fish cakes, scrambled eggs etc. Residents are able to help themselves to snacks in between meals. Fresh fruit is always provided with bowls of fruit being observed to be available in the communal lounges. The expert by experience made the following observations. “I joined one group of residents for a pleasant lunch. We were assured that residents were given a choice of meals and all residents I spoke to told me the Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 21 meals were very good. Second helpings were offered. Meals were plated in the kitchen and I felt it would have been nicer to see food put in dishes on the table, though in discussion with Hannah I could see the approach used was the most practical one given- that there were 2 dining rooms and a number of residents eating in their own rooms and food needed to be kept warm.” Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 22 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 to 18 Quality in this outcome area is excellent. This judgement has been made from evidence gathered both during and before the visit to this service. The home has an appropriate complaints policy and procedure in place. Clear information for raising complaints is made available, and residents and their relatives/friends are encouraged to raise any concerns they may have. The legal rights of residents within the home are being well protected and promoted. Residents are encouraged and assisted to vote if they wish. The home’s policies, procedures, practice and training evidence that residents are being protected from abuse and are living in a safe environment. EVIDENCE: The home’s philosophy is one of open-ness and transparency, where residents are encouraged to raise any concerns they may have, and for these to be addressed in an open and non-judgemental way. There have not been any complaints since the last inspection, and none during the last 12 months. The complaints procedure is simple and clear. This outlines the process for managing complains and for ensuring that these are dealt with promptly and effectively. Details of the complaints procedure are clearly displayed on the Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 23 residents’ notice board, and are included in the Service User Guide. They are also raised in residents’ meetings and in reviews. A complaints book at the home details the outcome of any complaint and what action (if any) was taken. Relatives, their relatives/representatives are encouraged to raise any concerns that may arise. Views expressed by residents indicate that there residents understand their rights in this area, and that they feel able to voice concerns if these arise. The home has a policy on rights. All residents are registered to vote and are supported where necessary to attend the polling station. While none of the current residents have requested advocacy services, the home holds information on advocacy services should these be required. Residents’ files include a “rights assessment” for each person. This has been designed to ensure that each resident is made aware of his or her rights and that the home has ascertained what this means for the individual. Vulnerable Adult Procedures for the protection of adults are in place, together with the local authority Safeguarding Adults Policy, a copy of which is available in the home. A whistle blowing policy is also in place. Clear guidance is provided to staff about these policies with staff being made aware of the nature of various forms of abuse and the procedures for reporting any suspicions initially to senior staff. The care manager has advised that there is discussion of adult abuse and adult protection procedures within residents’ meetings. Views expressed indicate that residents feel safe and secure living in this home. Staff are perceived as being caring and supportive, no concerns having been raised. No adult protection concerns have been recorded or notified to the Commission. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 24 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 to 26 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Residents live in a safe, well-maintained environment, with access to safe and comfortable communal facilities. Residents’ rooms are safe, comfortable and pleasantly decorated, reflecting residents’ personal identities, and being suited to their individual needs. Residents are living in a home that presents as being clean, pleasant and hygienic. EVIDENCE: Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 25 An inspection of the premises was completed. The home presents as safe and well maintained, with spacious communal areas, bedrooms, and garden. The home is laid out over three floors, accessed by lift or stairway. There is a small flight of stairs leading up to the front door. The home was found to be clean, tidy, and in a generally good decorative state throughout. Monthly checks by the management team identify any areas of redecoration required. There has been ongoing redecoration of the home, which has included recent refurbishment and redecoration of the home’s bathrooms and toilets, and a refurbishment of the kitchen at the end of 2007. There has also been recarpeting of hallways and corridors. There has been previous redecoration and re-carpeting (in 2006) of the ground floor lounge, reception area, corridors, stairways and some service users’ rooms. Residents are consulted about decisions relating to redecoration and refurbishment of the home, with the décor and furniture in residents’ rooms reflecting individual choices and preferences. Communal areas are also decorated to reflect residents’ wishes. A number of residents’ rooms were inspected. These were observed to be safe and fit for the purpose. Though not en suite, the rooms present as being pleasantly decorated and arranged, reflecting individual preferences and tastes. Residents are able to bring personal possessions and items of furniture with them to the home. Views expressed indicate that residents are generally happy with their rooms, and that these are meeting their needs. No concerns were expressed. Two residents share one room, both residents having previously indicated that they are happy with this arrangement. The expert by experience made the following observations. “My first impressions were of a homely atmosphere though I personally found the décor old fashioned and in need of brightening up. However, I gained the impression that it was to the residents liking and likely to be the sort of decoration they were familiar with. There were a number of communal rooms, which were arranged in a homely style, allowing residents a choice of where to sit. The general atmosphere was calm and happy. Bedrooms, like the living areas were decorated and furnished in an old fashioned manner and I found some of them rather dark.” Adaptations have been made to various areas of the environment to ensure the health and safety of the residents. One bathroom has an ambu-hoist and grab rails are in place in the other bathroom. The hoist is being serviced on a 3 monthly basis. Handrails are in place on the staircases. Any adaptations or specialist equipment that is needed for residents is assessed by an occupational therapist on an individual basis as and when needed. The home was found to be clean, pleasant and free from any offensive odours. The laundry is sited in the basement, well away from the kitchen. The home Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 26 has a contract for the collection of clinical waste. The washing machine has a sluice facility. Policies and procedures are in place to deal with the safe handling of clinical waste. All staff at the home are familiarised with the home’s infection control procedures, and have received approved infection control training Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 27 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 to 30 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home has the numbers and skill mix of staff sufficient to meet the needs presented by the home’s residents, and to ensure their safety. Generally, residents are being protected by the home’s recruitment policy and procedures. However, the home needs to obtain an updated CRB certificate for one staff member. Staff are being provided with the necessary induction and training with which to competently perform their work duties EVIDENCE: The home has sufficient staff with which to meet the needs of the residents. The staff duty rota evidenced that the person in charge and two carers are on duty throughout the day, with one waking staff member, and one sleep- in, at night. An additional care staff member is employed to work during the busiest time of each day. A cleaner is on shift daily. The home does not use any agency staff. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 28 The home has generally thorough recruitment procedures in place. Three new staff members have been recruited within the last 12 months. Inspection of the staff files indicated that, generally, employment and recruitment checks are being completed. However, the home needs to complete an up-to-date CRB check for one staff member, the CRB certificate providing outdated information. A requirement applies. File checks indicated that staff have evidence of qualifications and training, and that staff have completed an induction programme. Appraisals have been completed for all three staff. The home organises a comprehensive induction programme that is in line with Skills For Care training targets. The induction programme is ongoing over a period of six weeks, and comprises both training and observation. All staff have an individual development programme, with training being planned and individualised according to individually defined training and learning needs. The home’s care manager takes a lead role in this area. There is a comprehensive programme of staff training which includes training in health and safety, fire safety, first aid, food hygiene, basic infection control, health and safety, manual handling, medication, adult protection, risk assessment, and bereavement and loss. There is also training for staff in Equality and Diversity, with 3 staff (including the manager) having recently completed an NCFE distance-learning certificated course. Other recent training has included training in the Mental Capacity Act and DOH infection control training. Formal training and distance learning is supplemented by practical advice and information sessions from health care professionals. Issues pertaining to good practice and staff development are thoroughly discussed within staff meetings, as evidenced in the very detailed minutes that are recorded. The home has a good record in encouraging staff to study for National Vocational Qualifications (NVQ) in Social Care. 7 staff currently have an NVQ Level 2, 3 staff have an NVQ Level 3, and 1 an NVQ Level 4. 3 staff members are currently studying for an NVQ Level 3, and 3 are studying for an NVQ Level 2. Views expressed by staff members on this inspection indicated that staff are feeling generally well supported, and that they are receiving good training, supervision and encouragement to develop their skills and potential. Views expressed by residents regarding the quality of staff attitudes and support were generally very favourable. The expert by experience noted positive staff interaction with residents: Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 29 Residents commented that “they (the staff) do a fantastic job” and “I’m very settled and happy living here”. Another resident said “The staff are lovely-we can’t say a bad word about any of them” and “they will do anything for you”. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 30 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 to 38 Quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home is being managed in the best interests of the home’s residents. The management approach is evidenced to be open and enabling, and conducive to creating a positive and inclusive atmosphere in the home. Through the appropriate supervision, appraisal and support of staff, good practice is being promoted and the welfare and best interests of residents is being protected. The interests of residents are being safeguarded by the home’s record keeping, with records being kept secure, up to date and accurate. The home is consulting widely with residents, relatives and other stakeholders, and is evidencing the home’s ability to meet its aims and objectives. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 31 Residents’ financial interests are being appropriately safeguarded. Generally, the health, safety and welfare of residents and staff are being appropriately promoted and protected. However, hot water temperatures need to be monitored on a more regular basis. EVIDENCE: Both the home’s provider manager and deputy manager are very experienced in terms of their qualifications and background, and exemplify a very enlightened, caring and committed approach to managing the home. The Registered Provider is a Registered Mental Health Nurse, with extensive experience of managing wards in long stay psychiatric hospital and community mental health facilities. He has managed as owner/manager since 1994. The care manager is also a qualified nurse who has extensive experience of working with older people. Throughout this inspection, the care manager was able to demonstrate an in-depth knowledge and understanding of the physical, psychological, cultural and spiritual needs of older people, and a thorough knowledge of the relevant regulations and care standards that apply. These are routinely discussed within staff meetings, staff development being a high priority. There is a comprehensive programme of ongoing support and training for staff. The evidence across all standards inspected is that there is a firm commitment to maintaining standards of good practice in all aspects of the home’s day-today operation, and that the home provides an open, friendly and inclusive environment for its residents. As evidenced in key documents and policies, and observed in practice, this includes a strong commitment to promoting the welfare, independence and rights of the home’s residents. Very favourable views were expressed by residents and staff regarding the home and the way in which it is being run. Comments received from individual residents, regarding the manager and staff, were generally praiseworthy. No concerns were expressed. The care manager was observed to interact well with both staff and residents and to provide a positive model of care and support. The expert by experience made the following observations: In particular, one lady pointed out that “Hannah (the care manager) couldn’t be lovelier. She looks after all the staff and makes sure they treat you well by Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 32 setting a good example-she works very hard” I certainly observed this for myself and was extremely impressed by Hannah’s management style and attitude towards both the residents and her staff. Equally impressive was the relaxed and flexible attitude shown to meeting residents’ needs. The home has quality assurance processes in places, with regular canvassing of the views of residents, relatives and care professionals. Detailed questionnaires have been developed, and a quality assurance audit report completed. This provides a tabulated layout of the audit results and an evaluation of the feedback received. The home also completes an annual development plan, providing a link with the home’s forward planning. The views of relatives are regularly sought by means of telephone, invitations to reviews, and for some, regular visits to the home, where relatives are able to meet and talk directly with care staff and the manager. At the request of residents, ‘formal’ meetings are held on a regular, monthly basis. Where possible, residents are enabled to retain control over their finances, with all but four being independent in managing their own finances. The home maintains records of residents’ monies with all transactions being accounted for with a receipt and a signature. There are secure facilities for the safekeeping of monies kept on behalf of residents. The home does not act as an appointee for any residents, with either a relative or solicitor fulfilling this role where the person is unable to manage their own monies. Inspection of staff files evidenced that supervision of staff is being provided on a regular two-monthly basis. The home’s provider/manager and care manager undertake supervision and appraisal. A system of annual appraisal is in place, all staff having been appraised within the last 12 months. A wide range of the home’s records were examined during this inspection. These included staff and residents’ files, complaints, accidents/incidents logs, and records relating to the running and maintenance of the home. These were found to have been satisfactorily maintained, with residents’ best interests being protected. It is, however, recommended that staff files are structured into separate sections so as to facilitate easier access of information. The provider/manager and care manager are ensuring that all the home’s policies and procedures are being reviewed and updated on an annual basis, these having been most recently reviewed in April/May 2008. Key policies and procedures are discussed with staff and residents in their respective meetings. All health and safety checks were evidenced from records to have been completed. These include electrical installation and appliances, hoist and lift maintenance, gas, fire alarms/emergency lighting/call systems, water/ legionella, food hygiene and environmental health. Fridge and freezer records are being maintained on a daily basis. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 33 Thermostatic valves have been fitted to taps throughout the home. At the present time, checks on hot water temperatures for water temperatures throughout the home are being completed on a monthly basis. This is insufficient and needs to be done on a more regular weekly basis, so as to ensure that hot water temperatures are being maintained at a correct level. A requirement applies. The home’s boiler provides effective and efficient central heating and hot water supply for the home. A legionella inspection has been completed. Risk and fire risk assessments of the home are being updated on a 3 monthly basis. Risk assessments for individuals are in place for their protection. Approved fire training was last held in June 2005, with the home’s own fire safety training being updated on a 3 monthly basis. Records indicate that fire drills are being held on a monthly basis. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 34 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 4 3 4 4 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 9 3 10 4 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 4 17 4 18 4 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 4 28 4 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 4 3 3 Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 35 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 OP29 Regulation 19(1)(b) Schedule 2, No 7 Requirement To ensure the protection of residents, the home must obtain its’ own up-to-date CRB check for one new staff member. Timescale for action 31/10/08 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 Refer to Standard OP37 OP38 Good Practice Recommendations It is recommended that staff files are structured into separate sections so as to facilitate easier access of information. To ensure the safety of residents, hot water temperature checks should be completed on a more regular weekly basis. Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 36 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 Roselands DS0000025830.V371864.R01.S.doc Version 5.2 Page 37 - 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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