Care Home: Sunny Fields

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What the care home does well The service provides a safe and comfortable environment in which to live. The bedrooms are well personalised and contain a range of equipment including televisions and music centres. The care plans are written with input from the service user, wherever possible, relatives, care manager and key-workers. They are comprehensive and give good guidance to staff.There is a range of activities undertaken and the home is aware of individual likes and dislikes and ensures these are met. The food offered is of good quality and food stocks are good, this enables service users to have lots of choices over food and drinks. Service users are involved where possible in choosing their daily activities, they include going out Horse Riding, pub lunches and drinks, cafes, daily walks and drives out in the company car. One service user often chooses to stay in their room and if they choose to go out it is on a 1-1 basis. All service users are registered with a local Doctor, Optician and Dentist. A Chiropodist visits on a regular basis. Service users wishes regarding illness and death are recorded. What has improved since the last inspection? The home has purchased a new table and chairs for the dining area, a new sofa, new flooring in the hall and a new industrial washing machine and tumble dryer. They hope to create a patio at the top of the garden for service users to enjoy. What the care home could do better: Although the provider is confident the home has a written medication policy the staff in the home on the day of the inspection were unable to produce it. Some concern was raised over the administration of some of the liquid medication and it could not be confirmed if staff were following the written procedures or not. The home was asked to submit a copy of the medication policy and procedure and to ensure staff are familiar with its contents. Discussion with the provider after the inspection confirmed they were aware of the issue with the staff group regarding a shortage of senior staff. This has meant that senior staff are working excessively long shifts. The provider confirmed they are currently advertising for staff and hope to appoint soon. The laundry floor and walls should be covered with a finish that is impermeable and easy to clean. CARE HOME ADULTS 18-65 Sunny Fields 241 Queenborough Road Halfway Sheerness Kent ME12 3EW Lead Inspector Sue McGrath Unannounced Inspection 3rd March 2008 09:30 Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sunny Fields Address 241 Queenborough Road Halfway Sheerness Kent ME12 3EW 01795 661064 01795 661064 forwardcare@yahoo.co.uk 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) Forward Care (Residential) Ltd Mr Brian John Lawrence Welsh Gary Greening Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th January 2007 Brief Description of the Service: Sunny Fields is a small home for four people with a learning disability who need a lot of staff attention. Service users are cared for on an individual basis and each has varied choice of daily activities that they can enjoy. The home had a friendly and welcoming feel and is well maintained, as are the gardens to the rear of the home. A hen house has been built at the far end of the garden and service uses enjoy feeding the chickens. The Home is situated on the Isle of Sheppey, near Queensborough and Sheerness. There is off road parking available at the front of the home and there is a main bus route running past the home. The fees range from £1,500 to 2,500 per week. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that took place on 3rd March 2008 and was conducted by Sue McGrath, Regulation Inspector for the Commission for Social Care Inspection. The key inspections for care home services are part of the methodology for The Commission For Social Care Inspection, whereby the home provides information through a questionnaire process and further feedback is gained through surveys sent to service users and relatives and information provided from professionals associated with the home, wherever possible. The actual date of the site visit is unannounced. At the site visit, service users and staff were spoken to, records were viewed and a tour of the environment was undertaken. Judgements have been made based on records viewed, observations and verbal responses given by those people who were spoken with. These judgements have been made using the Key Lines of Regulatory Assessment (KLORA), which are guidelines that enable the CSCI to be able to make an informed decision about outcome areas. Further information can be found on the CSCI website with regards to information on KLORA’s and (Annual Quality Assurance Assessment) AQAA’s. No requirements were made at the last inspection. One was made at this inspection. Overall this was a positive inspection with generally good outcomes for service users. The inspector on leaving the home was satisfied that residents were both safe and well cared for and wishes to thank the manager and her staff for their assistance and hospitality. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. What the service does well: The service provides a safe and comfortable environment in which to live. The bedrooms are well personalised and contain a range of equipment including televisions and music centres. The care plans are written with input from the service user, wherever possible, relatives, care manager and key-workers. They are comprehensive and give good guidance to staff. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 6 There is a range of activities undertaken and the home is aware of individual likes and dislikes and ensures these are met. The food offered is of good quality and food stocks are good, this enables service users to have lots of choices over food and drinks. Service users are involved where possible in choosing their daily activities, they include going out Horse Riding, pub lunches and drinks, cafes, daily walks and drives out in the company car. One service user often chooses to stay in their room and if they choose to go out it is on a 1-1 basis. All service users are registered with a local Doctor, Optician and Dentist. A Chiropodist visits on a regular basis. Service users wishes regarding illness and death are recorded. 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. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ individual needs are continually assessed ensuring any changes can be well managed. Service users’ have a written Statement of Terms and Conditions. EVIDENCE: The home continues to offer accommodation to four service users who have lived at the home for several years. There are no plans for any new admissions but if a vacancy arose the home would follow their procedures that included an assessment of needs being carried out prior to any placement being agreed. Part of this admission procedure would encourage any prospective residents to visit the home prior to admission, to view the home and meet with the current service users. Overnight or longer stays would be dependant on whether the prospective service user wish to do so. Ongoing assessments ensure changing needs continue to be met. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users have clear and in-depth care plans that identify their individual needs and give clear guidance to staff. Service users are enabled to take reasonable risks within the homes risk assessment management strategies. EVIDENCE: The care plans were viewed and were found to contain a high level of information regarding the care required, in depth behavioural plans and risk assessments. It was clear from the records that these plans were regularly updated and reviewed to reflect any of the changing needs of the service users. Daily notes were timed, dated and signed by staff and contained relevant and precise information. All service users had identified key workers who worked closely with the individual service users to develop a professional relationship and to offer a personalised service. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 10 Service users, wherever possible, were involved in the day to day running of the home and in their choice of clothes, food and activities. The management team is aware that not all service users enjoy group activities and evidence was seen that they are treated as individuals with individual needs. Some prefer to have activities and daily outing whilst others prefer to stay in the home. The home endeavours to work with families and other social care professionals but always to the benefit of the service users. The issue mentioned in the last report regarding difficulties between a service user’s relatives and the home are still continuing but all parties recognise the issues and mediation is being sought to resolve the issue. Risk assessments are undertaken for a variety of activities both in and outside the house. The home is aware that they need to support service users to take some risks as part of an independent lifestyle where possible. Evidence was seen during the day and staff confirmed their understanding of the appropriateness of confidentiality and of their legal requirements. Service users can be confident that confidentiality will be maintained and their records and personal information are securely stored in a safe environment. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 14, 16 and 17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users benefit from having the opportunity for personal development with their daily living skills and have appropriate level of leisure activities. Service users benefit from the appetising meals and a balanced diet offered by the home. EVIDENCE: All of the service users had daily activities charts, which indicated their chosen activity for the day. One of the service users preferred to remain in the home but some recent improvements have included encouraging him to leave the home and he now regularly attends an outside hairdresser. This process may be slow but the results have been positive. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 12 Activities include trips out in the homes car, visits to the local shops, meals out at different cafes and fast food restaurants. Regular visits are made to the local park and some like to go horse riding. Most of the residents maintain contact with their families and the home will provide transport where possible to enable this to happen. The ongoing issue with one service user and his family visits continues and as stated earlier in the report, mediation is being sought to resolve the issue. The menus were seen to be varied and balanced. There was a four-week rota, so the menus were changed to ensure plenty of variety. Staff said they were fully aware of the service users likes and dislikes and they take their preferences into account when developing the menus. There was a wide variety of food seen in the home including fresh fruit and vegetables. Friday night was take away night, when service users could decide which type to have. Evidence was seen that fruit juices, tea and coffee were freely available. The staff on duty prepare and cook the meals and all have completed a relevant food hygiene course. Where possible service users are encouraged to help and one is able to make his own drinks with a small amount of assistance. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users can be confident that they will receive personal support in the way they prefer and their health care needs will be well met. Service users can be confident that their physical and emotional health needs will be met. EVIDENCE: Each service user has their own routine that is set out in the individual’s care plan and have been agreed at reviews with family and care managers. Whilst service users are registered with local Doctors and Dentist, due to the severe learning disabilities, the Doctor usually visits service user at the house. Notes are well maintained on the outcome of these meetings and consultations. None of the service users have the capacity to self administer their own medication so the home continues to manage the safe administration of the medications. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 14 The senior member of staff on duty explained that the senior staff member administers the drugs and the supplies are sourced from a local Pharmacist. The local Pharmacist conducted a half days training session and some staff had also completed a further course. The inspector was unable to ascertain whether the home had a written medication policy and a requirement will be made to ensure the home has a written procedure and a copy is sent to the Commission. The staff must be made aware of the policy and its contents. The administration of medication was observed and some concerns were raised over the practise used. The home is strongly advised to ensure that only one service users medication is dispensed at a time, as it was noted that several pots of liquid were given out on a tray at the same time. The pots were not all for the same service user. Several names were seen written on the card tray used. This practise has the potential to put service users at risk of being given the wrong medication. The Mar sheets were viewed and no errors were found. There was evidence that all of the drugs were counted in and out and the senior member of staff confirmed the manager undertakes a regular audit to ensure the medication is correct. The home is strongly advised to obtain a copy of The Royal Pharmaceutical Society of Great Britain guidelines called ‘The Handling of Medicines in Social Care’. Further advise is also available on the Commissions website. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users can be confident that their views will be listened to and acted on. Service users are protected from abuse by the home’s procedures and policies in this area. EVIDENCE: The home has a clear and effective complaints system in place and ensures complaints are dealt with promptly and effectively. Neither the home nor the Commission has received any complaints since the last inspection. The home also has a Safe Guarding Vulnerable Adults policy and staff are aware of the importance of protecting vulnerable adults. Staff have received recent training in Abuse of Adults with Learning Difficulties, Challenging Behaviour and Non Abusive Psychological and Physical Intervention (NAPPI). The home prefers to use de-escalation techniques and these are usually adequate to calm any situation and NAPPI is not actually used. Staff have recently undergone training on the new Mental Capacity Act. It is noted that the home does not report many incidents as required to do so under Regulation 37 and advice was given to revisit this regulation and look at the new guidance on the Commissions website. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Service users live in a homely, comfortable and safe environment that is clean and tidy. Service users toilets and bathrooms provide sufficient privacy to meet needs. Shared spaces complement service users individual space. EVIDENCE: The home was found to be clean and tidy on the day of the inspection. All of the rooms were well presented and well personalised. New furniture had been purchased for the dining room and some new carpets had been fitted. The laundry was situated in the garage and contained an industrial washing machine and a tumble dryer. Consideration must be given to ensuring the laundry floor and walls are impermeable and readily cleanable. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 17 The kitchen was clean and held all of the required records. The fridges and freezers were well stocked. The home had one bathroom on the lower floor, which was shared by all service users. The upstairs bedrooms had en-suite facilities. All of the radiators were guarded and the upstairs windows had the required opening restrictors. There was pleasant conservatory to the rear of the home with some furniture in. The conservatory led to a large garden, which backed onto a field. There were five steps leading up to the garden with a handrail for service users to use if necessary. Garden furniture and a Bar-b-Que were seen in the garden. The home is planning to build a patio at the top of the garden for service users to enjoy. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live in the home benefit from the support of carefully selected and well trained staff who understand their needs. EVIDENCE: Staff files were viewed and contained the necessary information and documentation as set out in Schedule 2 of the Care Standards Act 2001. Staff spoken with were aware of their responsibilities and confirmed they had been given job descriptions. Training remains a priority within the service and staff have received mandatory plus specialist training in the last year. Of the six permanent members of staff, two have completed a National Vocational Qualification (NVQ) in care at level 2 or above and 4 are working towards their award. When completed this means that 100 of staff will be qualified. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 19 Induction training meets the national minimum standard for this service. Evidence was seen of the completed induction programme in staff files. One issue of concern was the length of the shift patterns, particularly for senior staff. It appeared to be regular practise for senior staff to work 8am to 8pm one day, followed by a second 8am-8pm day with a sleeping in on call, followed by a further 8am to 8 pm shift. This means they are in the home for twelve hours followed by thirty-six continuous hours. They then have only two days off before this pattern is repeated. The management must review this situation, as this is not taking either the health and safety of the residents or the staff into account. The main problem seems to be a lack of senior staff and the home needs to be looking to employ another senior staff member. Staff cannot be as effective at the end of such a long shift and with the category of service users at this home, this has the potential to put them at risk. Staff confirmed they received regular supervision sessions and that staff meetings were also regular. Key worker meetings also take place. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from living in a well run, well managed home. EVIDENCE: The registered manager is not based at Sunny Fields but is a Director of the company and is based at another of the homes within the group. He does visit the home on a regular basis but the deputy manager manages the home on a day-to-day basis. The Commission considers the main role of the registered manager to be the day to day running of the home and the provider is advised to look at this role and reconsider its approach. The deputy manager is undertaking the necessary qualifications. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 21 Staff confirmed she is approachable and accessible and manages the home well. Service users meetings are not held as the formal setting would not benefit the service users, however monthly key-worker meetings address this issue and their individual views are then put forward. Staff are very proactive in ensuring the service users are well supported and their best interests are promoted. Service users health, safety and welfare is promoted with regular checks carried out around the home, these are recorded. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 3 30 X STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 X 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 X X X 3 X Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 23 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA20 Regulation 13(2) Requirement The registered person must ensure that the home has a written medication policy and that staff are familiar with the contents. A copy to be sent to the Commission. Timescale for action 01/04/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard YA33 YA30 YA20 Good Practice Recommendations It is recommended that the home considers the length of continuous shift pattern that staff work to ensure they are effective at all times. It is recommended that the laundry floor and walls be covered with an impermeable material to ensure they can be kept clean. It is recommended that the home obtain a copy of the Royal Pharmaceutical Societies guidelines for ‘The Handling of Medicines in Social Care’. Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Sunny Fields DS0000042841.V359467.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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