Care Home: St Mary`s House

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What the care home does well People are happy living at the home. There is a welcoming, family atmosphere. The Manager is involved in all areas of care. Staff are happy working at the home and are positive. People like the food, activities and the care they receive. What has improved since the last inspection? The Manager has improved areas of the building, staff training, policies and procedures and is constantly monitoring the quality of the service. What the care home could do better: The current medication procedure could put people living at home at risk and needs to be changed. There needs to be improvements in recording of staff training. The Manager needs to make sure all staff have regular recorded individual supervision meetings. CARE HOMES FOR OLDER PEOPLE St Mary`s House 71 Ormond Avenue Hampton Middlesex TW12 2RT Lead Inspector Sandy Patrick Unannounced Inspection 20th November 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 St Mary`s House DS0000017391.V373296.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. St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Mary`s House Address 71 Ormond Avenue Hampton Middlesex TW12 2RT 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 8979 2847 stmaryshouse@dial.pipex.com Ms Sylvia Warren Sylvia Warren Care Home 24 Category(ies) of Dementia - over 65 years of age (1), Old age, registration, with number not falling within any other category (24), of places Sensory impairment (24) St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One (1) place for a sevice user witth Dementia can be accommodated. Date of last inspection 22nd August 2006 Brief Description of the Service: St Marys House is registered to provide accommodation for 24 older people. The home is owned and managed by Mrs. S Warren who takes a pro-active dedicated and hands-on approach to care. Many of the staff have worked at the home for a number of years. The home is situated in a residential road which is tree-lined and attractive. The building is a substantial (extended), detached property with a well-kept garden. Fees range from £500.00 - £550.00 per week. St Mary`s House DS0000017391.V373296.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 stars. This means the people who use this service experience good quality outcomes. We visited St Mary’s House on 20th November 2008. This visit was unannounced. We met and spoke with the Manager/Owner, people living at the home, staff on duty and visitors. We asked the people who live at the home and staff to complete surveys for us about their experiences. 10 people who live at the home and 9 members of staff returned surveys to us. We looked at the environment, records and how people at the home were being supported and cared for. ‘I think the home does everything well.’ ‘There is a pleasant atmosphere and the place is always warm.’ ‘They make it as near to a family home as possible.’ ‘Excellent care.’ ‘It is lovely. I am very happy here.’ ‘I think that it is marvellous here.’ ‘You wont find anything wrong here.’ ‘I couldn’t be happier.’ ‘You are well looked after.’ What the service does well: People are happy living at the home. There is a welcoming, family atmosphere. The Manager is involved in all areas of care. Staff are happy working at the home and are positive. People like the food, activities and the care they receive. St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People have the information they need to help them make a decision about moving to the home. Their needs are assessed to make sure the home is the right place for them. EVIDENCE: There is a Welcome Pack, including the aims and objectives of the service, complaints procedure, terms and conditions and statement of rights. Copies of this are available in the main foyer and given to people who are interested in moving to the home. These are updated regularly. People told us that they had enough information to help them make a choice about moving to the home. People said that they had been given opportunities to visit and the Manager had visited them in their own homes. People told us that they had a contract for their place at the home. We saw evidence of thorough assessments and contracts. St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People are given the support and care they need to stay happy and healthy. The staff treat them with dignity and respect. Some medication practices are good and there are thorough assessments on staff, however the practices around administration potentially put people at risk and need to be changed. EVIDENCE: Everyone has their needs recorded in a care plan which is regularly reviewed and updated. Copies of these care plans are kept in each person’s room. We saw examples of some of the care plans. Care plans are well designed and give clear information. They are regularly reviewed and updated. Not all care plans had been signed by the person or their representative and should be. There was not a lot of information about people’s social needs and interests in care plans and this is an area which could be expanded so that they can be supported to meet their specific individual social needs as well as participating in group activities. Care plans should contain a photograph of the person to help new staff identify them. St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 10 We saw that some risk assessments were in place, however we saw that where some risks had been identified there was no recorded plan of how to manage these risks and there should be. There are good systems for recording daily needs and care given. People told us that they were consulted about the care that they wanted. They said that the staff listened to them and acted upon what they said. People told us that staff treated them with respect and dignity. People said that they had access to the health care services they needed and staff helped them to stay healthy. One person told us that they would like a change of doctor. The Manager told us that everyone is registered with a local doctor who visits the home each week and communicates well with staff to make sure people’s medical needs are met. Other health care professionals, such as the chiropodist visit when needed. A hairdresser visits the home each week. We saw that staff supporting people were kind, attentive and polite. We overheard staff commenting on people’s wellbeing and complimenting them on the way that they looked. We saw that one person was left waiting for the hairdresser for over an hour. The person told staff that they were not happy with this and did not know how long they would have to wait. The staff should try their best to keep people informed and offer them something to do or somewhere more comfortable to wait if they have to wait for a long time. There is a recorded medication procedure. All medication is stored securely. All staff are responsible for administering medication. They have been trained and are regularly assessed by the Manager. The Manager makes regular audits on the medication held and these are very good. The current system for administering medication means that staff dispense medication for more than one person and carry this around the home in open pots to people before administering it. This procedure creates a risk. Medication must be individually dispensed and administered to each person. The staff sign medication administration records when they dispense medication and not when they observe people taking this. Therefore they are falsely recording that they have witnessed administration. The Manager said that they amend these records if people do not take their medication for any reason. However, this system creates a risk and staff must only sign when they have witnessed administration of medication. We saw that two people had been given their medication to take but had not done this and the medication remained in open pots in their rooms. The staff explained that these people were able to choose when to take their St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 11 medication. However, there was no procedure for this and no risk assessment. Medication records indicated that staff had observed people taking this medicine. Risk assessments and clear procedures must be in place for any one who self medicates. People who self medication must understand that they are responsible for medication left with them and there should be a record to show that they accept this responsibility. St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 12 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People are supported to take part in a range of activities and to keep in touch with friends and family. They are able to choose from a range of freshly prepared food. EVIDENCE: People told us that they liked the organised activities at the home. There is at least one organised activity each day and regular visitor from entertainers. The Manager told us that families and friends were invited to regular special events and parties. We saw the staff supporting people with a game of bingo on the day of our visit. This appeared to be popular with the group. The Manager told us that activities were arranged at a time the people living at the home had chosen as the best time of the day for them. Activities are advertised on a notice board. The home has support from the local church who hold a regular service. Some people use the local community and local shops. St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 13 One person told us that the staff helped them to celebrate their birthdays with cake and a party. The staff and people living at the home have created a wonderful collection of memory books. These incorporate different people’s memories throughout their lives and pictures and photographs. The books are a lovely way to help everyone remember and understand about people’s lives before they moved to St Mary’s. There are also photo albums which show special events and activities at the home. There are a range of resources, such as games and books available for people to use as they wish. Some people said that there were very good activities and they enjoyed participating in these. One person told us that they wished there was more opportunities to socialise as they sometimes felt other people living at the home just socialised in small groups of friends. People told us that their visitors were made welcome and that their families and friends were informed about important events. People said that their families were able to continue to be involved in their care if they wanted. One person told us, ‘my family are always offered a tea or coffee’. Another person said, ‘visitors are made very welcome at the home’. One visitor told us, ‘our general impression is very good and we are glad to see no communal television in sitting rooms’. We saw people visiting throughout the day and being made welcome. We saw that there is a varied menu and that people are given a choice at mealtimes. The Manager told us that people were able to request certain dishes and that they catered for some specialist diets. People told us that they liked the food and felt that care was taken to prepare a range of home cooked food. All food is freshly prepared, including home made cakes and puddings. The atmosphere at mealtimes was relaxed and people were able to take their time. Some of the things people told us about food at the home were, ‘I very much like the meals’, ‘breakfast is very good’, ‘the food is gorgeous’ and ‘the cooking and food presentation is very good’. St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Procedures at the home are designed to keep people safe. EVIDENCE: People told us that they knew who to speak to if they had any concerns or wanted to make a complaint. The complaints procedure is given to everyone and is displayed around the home. There are procedures for abuse and whistle blowing and the staff have had training in these areas. There have not been any recorded complaints since the last inspection. St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 15 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People live in a well maintained and attractive building. EVIDENCE: People told us that they liked the home and the garden. They liked their rooms and were able to personalise these. People told us that the home was clean and fresh. ‘The home is always very clean’ said one person. The environment is well maintained and there is a programme of redecoration and refurbishment. The Manager told us that there were plans to create two new shower rooms and redecorate some bedrooms and corridors shortly after the inspection. Each person has their own room and some people have en suite facilities. People have personalised their rooms with their own belongings and furniture. There is a well kept garden and we saw people enjoying this during our visit. St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 16 Bedroom doors were not labelled with people’s names or signs that might help them to recognise their room. This may mean that it is hard for people who are confused to locate where their room is. The Manager should consult with people to ask them how they would like to identify their room, using labels, names, numbers, pictures or any other thing which is meaningful to them. We found that the home was generally clean throughout on the day of our visit. Some areas of the home had a slight odour. Some carpets were stained and would benefit from replacement. There were no paper towels in WCs. The Manager told us that the towels in these rooms were changed and washed daily. However, paper towels should be provided to reduce the risk of cross infection. All radiators in the home are thermostatically controlled so that individual rooms can be heated as people wish. There is a new call bell system and everyone has a call bell in their rooms. St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 17 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People are cared for by well trained, supported and experienced staff. EVIDENCE: People told us that they liked the staff and felt that they did a good job. Some of the things that they told us were, ‘the staff are very friendly’, ‘the staff are good’, ‘the staff give very good care’, ‘the staff are very kind’, ‘they are all very kind’ and ‘the patience of the carers is incredible’. Two people told us that they found the majority of staff very competent and did their jobs well but that one or two of them treated them in a way they did not like and sometimes told them what to do. Many of the staff have worked at the home for a long time. There is a good atmosphere amongst the staff team and they are supportive of each other. There is a low turn over of staff and those who contacted us said that they were happy working at the home. The staff told us that they had the information, training and support they needed to do their jobs. They told us that they felt the home treated people well and provided a caring and safe environment. They said that there was enough staff on duty to support people well. St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 18 Volunteers from the community and local schools provide regular support. We saw one such volunteer helping with afternoon tea and cakes. The Manager has written her own training and induction work books for staff. These are very comprehensive and have been used as examples of good practice by other local organisations. The Manager told us that the staff have recently been trained in dementia care. We saw records of regular staff meetings. We looked at a selection of staff files. These showed that people had been recruited appropriately with formal interviews, reference and criminal record checks. We saw contracts of employment. Some staff files did not have photographs and should have. We saw that some staff did not have regular supervision meetings with their manager. The Manager told us that people had informal support and the staff confirmed that they felt supported in their role. However, the Manager needs to make sure everyone has regular individual meetings to look at their job and the support they need. They should also have their performance appraised each year. Records of staff training did not show some of the regular training the Manager said that had attended. The Assistant Manager told us that she was creating a central training record for staff. It was difficult for us to judge whether people had had regular and up to date training in some areas, such as first aid, manual handling, fire safety and infection control. The Manager must make sure training records are up to date and that all staff have been appropriately trained and take part in regular training updates. St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 19 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): Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People live in a well managed service. EVIDENCE: The home is a family run business and the Owner has owned and managed the home for 26 years. Her daughter is the Assistant Manager. They are both at the home regularly and are involved in all aspects of the running of the home. The Manager demonstrated and excellent knowledge of the service and about individual people living and working there. She had a good rapport with people living at the home and staff. People told us that they liked the Manager and found her approachable and friendly. The Manager demonstrated a commitment to making changes we suggested. St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 20 The Manager is involved in local care home groups and a training and NVQ partnership board. The Manager and Assistant Manager are both qualified to NVQ Level 4. The Manager has been trained in managing people with dementia. Throughout the inspection, the Manager praised the work of the staff and spoke highly of them. The Manager makes spot checks at the home including night time checks to make sure people are receiving a good quality service all the time. There is a comprehensive range of policies and procedures. We saw that staff were informed of new policies and procedures and any changes. There are up to date clear records. People or their representatives manage their own finances and St Mary’s invoice them for any expenditure. There is an up to date fire risk assessment and evidence of regular checks on fire safety equipment. We found that not all fire doors closed automatically and fully and should do so. The Manager makes regular checks on the building and health and safety. These are not always recorded and should be to make sure any areas of risk are identified and acted upon. Tests on equipment and electrical safety are recorded. The Manager regularly talks to people who live at the home, visitors and staff. However, there are not systems for recording regular quality audits. Surveys asking people their views on the service were issued last year. The Manager should consider sending out further surveys to ask people what areas they think are good and what areas they would like to see changed. St Mary`s House DS0000017391.V373296.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 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 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 3 X N/A 3 3 2 St Mary`s House DS0000017391.V373296.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 OP7 Regulation 13 Requirement Timescale for action The Registered Person must 31/01/09 make sure that identified risks and action to help reduce risks are recorded in individual risk assessments. The Registered Person must 31/12/08 make sure each person’s medication is individually dispensed, administered and recorded. The Registered Person must 31/12/08 make sure staff sign medication records only after they have witnessed administration or non administration. 2 OP9 13 3 OP9 13 4 OP9 13 The Registered Person must 31/12/08 make sure there are recorded risk assessments for everyone who self medicates. The written procedure must clearly describe any practices St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 23 where people self medicate. People who self medicate must understand that they are responsible for medication left with them. There should be a record to show that they understand this. 5 OP26 13 The Registered Person must 31/12/08 make sure WCs are equipped with paper towels. The Registered Person must 28/02/09 make sure all staff have opportunities for regular recorded and planned formal supervision meetings. The Registered Person must 28/02/09 make sure all staff have been appropriately trained and have regular updates. There must be a clear record of all staff training. The Registered Person must 31/12/08 make sure checks on health and safety are recorded. The Registered Person make sure fire doors automatically. must 31/12/08 close 6 OP36 18 7 OP30 18 8 OP38 13 9 OP38 23 St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 24 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 Refer to Standard OP7 Good Practice Recommendations Care plans should be signed by the person they are about or their representative. Care plans should contain a photograph of the person. There should be more in depth information on people’s social needs so that the staff can help them meet their specific individual needs as well as part of a group. The Manager should make sure people are supported to change their GP if they wish to do so. The staff should make sure people who are waiting for the hairdresser are kept informed and are given opportunities to do something else or wait somewhere else if they wish. The Manager should consult with people to ask them how they would like to identify their room, using labels, names, numbers, pictures or any other thing which is meaningful to them. The Manager should make sure the home is free from odours and should consider replacing stained or damaged carpets. The Manager must make sure all staff listen to people who live at the home and do not tell them what to do. The Manager should consider recording a formal quality assurance plan and should offer stakeholders a new DS0000017391.V373296.R01.S.doc Version 5.2 Page 25 2 3 OP7 OP7 4 OP8 5 OP10 6 OP19 7 OP26 8 OP27 9 OP33 St Mary`s House opportunity to complete surveys and give their written views on the service. St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 26 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 St Mary`s House DS0000017391.V373296.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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