Care Home: The Lodge, Plymouth

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What the care home does well The Lodge and Plymouth Highbury Trust provide the people living at the home with a good choice of daytime activities and several short break holidays a year supported by caring staff team. This service provides people living at the home with a regular upgraded and homely caring environment. What has improved since the last inspection? The new furniture provided in the lounge area is of a high standard and designed to meet the needs of the people living at the home. The homes AQAA states, "New three-piece suite purchased for the home" and "New washing machine and tumble drier purchased for the laundry". CARE HOME ADULTS 18-65 The Lodge, Plymouth The Highbury Centre 207 Outland Road Plymouth Devon PL2 3PF Lead Inspector Kim Fowler Unannounced Inspection 10th January 2008 10:00 The Lodge, Plymouth DS0000003445.V357253.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 The Lodge, Plymouth DS0000003445.V357253.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. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Lodge, Plymouth Address The Highbury Centre 207 Outland Road Plymouth Devon PL2 3PF 01752 773333 01752 796299 admin@plymouthhighburytrust.org.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) Plymouth Highbury Trust Vacant Care Home 3 Category(ies) of Learning disability (3) registration, with number of places The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users with a learning disability some of whom may have a physical disability Age 18-65yrs Date of last inspection 18th January 2007 Brief Description of the Service: The Lodge is a care home providing personal care and accommodation for three people with learning disabilities. It is owned by the Plymouth Highbury Trust, which is a voluntary organisation, affiliated to the Royal Mencap Society. This home is located in the residential area of Peverell, close to shops, pubs, the post office and other amenities. The home was opened in 1995 and consists of a two-storey building situated on the site of the Plymouth Mencap Society, where there is also another care home and a day centre owned and managed by the Society. All the home’s bedrooms are single, on the 1st floor and none of them have en suite facilities. On the ground floor there are separate lounge and dining rooms. The home has an attractive patio and garden accessible to all the service users, shared with the other facilities on the site. The home is staffed 24 hours a day and has sleep in staff at night. The current fees range from £345 to £1248. The Lodge, Plymouth DS0000003445.V357253.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. The unannounced inspection took place over 1 day. And the new Manager was available during the afternoon of the inspection to assist the inspector with changes made within the home. A full tour of the building was undertaken and the inspector spoke to all 3 of the service users. The staff that were on duty at the time were spoken with. Documentation relating to the care planning process and the management of the home were examined. Any comments are discussed in the relevant section of the report. What the service does well: What has improved since the last inspection? What they could do better: The new manager needs to complete the Registration process with the Commission. Please contact the provider for advice of actions taken in response to this The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 6 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. The Lodge, Plymouth DS0000003445.V357253.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 The Lodge, Plymouth DS0000003445.V357253.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): 2/3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective new admission can be assured that the home will complete a detailed assessment that will assist staff to meet their individual needs. EVIDENCE: The home has had no new admissions for a number of years. The home has a pre-admission procedure in place should the need arise. And discussion with the manager provided evidence that he was aware of the admission process. The homes AQAA returned to the Commission states, “We have available a Statement of Purpose and a Service Users Guide”. All 3 files for the people living at the home were examined as part of this inspection. One file examined held a local authority assessment and care plan in place. All files contained information that details the needs of people living at the home. However the files used by staff on day-to-day bases require updating. The new manager who has only been in post for a short time is aware of the updating required and has arranged a meeting with the placing authority to carry out a review for one person this week to start this process. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 9 This updated information would enable agency staff and regular staff to be aware of the changing needs of people living at the home. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 10 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home are encouraged and supported to make decisions about their own lives to maintain their independence. All care plan updated would enable staff to meet the changing needs of people living at the home. EVIDENCE: Each person living at the home has a care plan in place and each holds information on meeting the needs of people living at the home. These care plans show a breakdown of the services and facilities provided by the home. These plans provide staff with the information on how to care for each person and should ensure continuity in care and been completed to enable staff to carry out their duties. Any aspects of health, personal and social needs should also be recorded. However as previously stated under standard 2 these plans all require updating. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 11 Some files contained a Care Manager’s assessment and a care plan review form and were signed and dated by people living at the home. However these required updating. The manager stated that this updating process has started and one review is booked for tomorrow and others will follow shortly. The homes AQAA records, “ Residents files are continually updated with their changing needs and aspirations”. It goes onto states under what they could do better, “Access Person Centred Planning for our residents” and “To have Health Action Plans in place”. All files held information on specialist input to individuals. The reports held included reports from SALT (Speech and Language Therapist), dementia screening, challenging behaviour service and hospital appointments. One staff member spoken with confirmed that a key worker system was in place and that they escort people to appointments when possible. Some recorded information held on all files showed when staff attended hospital appointment, the treatment carried out and any follow up information needed to provide care to person living at the home. Some appointment visits had not been completed with the follow up with treatment provided and the outcome of these appointments. Observation during the inspection showed that one person living at the home accessing the community when they wish. Other people were attending a local social club. From discussion with the manager and staff it was clear they encourage people to make every day decisions about their own lives. One staff member was observed discussing with one person living at the home what and were to go on a trip out that day and another staff member was observed asking someone if they wished to attend the social club. The risk assessments held on individual files cover all aspects of the individual’s life. These included outside activities like walking and swimming. All file showed evidence that they had completed risk assessments however the manager stated that these required some updating to meet the changing needs of people living at the home. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 12 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): 12/13/15/16/17. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People living at the home can be confident that the home will provide support for them to access the local community, many leisure activities and regular short break holidays. The staff and menu confirm the home provides good quality, wholesome and a choice of food in this home. EVIDENCE: All three people living at the home are encouraged to attend a variety of activities. One person is waiting to hear a start date for a craft session. Some people attended a local social club, horse riding session and art and craft sessions. Each file holds activities lists on were and what session each person attends daily. All three people access the community regularly, some with staff support and one independently. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 13 Two people living at the home were able to say that they had visited and stayed with family members over the Christmas period. These two people were also able to state that they had gone to Minehead and Lyme Regis for their holidays last year. Each file holds information on family involvement. The manager and staff confirmed that all the people living in the home have a front door key and staff were observed knocking to gain access to the home. Staff were also observed knocking on individuals bedroom doors to gain access to their rooms. Two people were spoken with about the food and one was able to say “its alright”. The manager stated that the homes menus are currently under review and they plan a new 6 weekly menu and have discussed with individuals living at the home their preferences to go onto the new menu. The AQAA states, “The menus are provided in picture format”. Several staff and the new manager confirmed that the home prepares all meals on site and the each person is involved with the preparation and cooking when possible. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 14 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): 18/19/20/21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recorded information showed that this home provides good personal support to each person living at the home promoting privacy and dignity at all times. Access to health care is maintained to promote the wellbeing all the people living at the home. EVIDENCE: Recorded into one care plan was that one person living in the home recently saw a physiotherapist and specialist equipment was then provided. The manager confirmed that were possible each person living at the home is able to choose who works with them and all rooms are single to allow all personal support to be carried out in private. Evidence was recorded that one person living at the home had been referred to the Challenging Behaviour service and guideline were now in place to assist the staff and support the person requiring this input. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 15 One person has specialist equipment in place to alert staff to any overnight seizures thus allowing staff to assist them as quickly as possible. Other equipment available included a wheelchair for outside use and hearing aids. One person is able to self-administer their diabetic medication. A risk assessment is held on file detailing the procedure for this person and staff’s involvement and includes blood sugar testing. These procedures outline any risk to both staff and the person receiving this input and includes information on needle stick injuries. The staff spoken with confirmed that they had received training on emergency medication and insulin administration from the previous Registered Manager and the new manager in post. The new manager said they had been in contact with the diabetic clinic to arrange further training for staff. Records showed that the home has a clear audit trail of all emergency medication, with staff signing and checking the medication when it has left and is returned to the building. The home has a recording sheet for staff to check and sign emergency medication at each handover. This record also showed a well-documented record of when the emergency medication is administered and included the time, dose and outcome for the person receiving the medication. The manager confirmed that the local pharmacist had recently carried out a audit of the home medication system and had made one recommendation which the home has already carried out One staff member was spoken with about the handling of controlled drugs, administration of medication and the homes medication procedure. It was clear from this discussion that the staff member was fully aware of the Polices and Procedures within the home. All three files held details on their and their family’s wishes on their death and included details of funeral arrangements. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 16 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): 22/23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at The Lodge can be confident that any complaints or concerns raised will be listened to, acted upon and well managed by the home, which protects the welfare of the all. EVIDENCE: The home has a complaints procedure in place and this is displayed in the main entrance hall. The manager stated that this procedure in available in sign and requires some updating. The home has the use of a local advocacy service if required and one person living at the home made use of this service last year to assist them in their decision making. Neither the home nor the Commission has received any complaints for this service. The manager stated that most staff have completed the local Adult Protection training and one staff was able to confirm this. The staff files examined held certificates in place of this course having been completed. The homes AQAA states, “Staffing training on the Protection of Vulnerable Adults is in place and staff are aware of the procedure for adult protection”. One newer member of staff said they hope to complete this course soon but from discussion with this staff member showed that they had a good knowledge and understanding of this procedure. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 17 The money held for all the people living at the home was checked and found to be correct with excellent systems in place. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 18 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): 24/30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living at this home benefit from a homely, comfortable, clean and well-maintained building that is appropriate to meet their needs. EVIDENCE: A full tour of the premises confirmed that this home is clean, comfortable and bright environment. It is suitable to meet the needs of the people currently living at the home. Plymouth Highbury Trust the company that own The Lodge employs a maintenance person to carry out day-to-day repairs. The home has a system in place that enables the staff to record any repairs required. Outside contractors are used when required for major repairs or ongoing upgrading. A tour of the premises showed that all bedrooms were single rooms and each bedroom was decorated too individual needs to meet and reflect the The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 19 personality of the occupant, with many personal possessions. All furnishings are of good quality. The tour confirmed that the home was clean, hygienic and free from odours. The manager confirmed that the home had recently purchased new lounge furniture and plan to redecorate the lounge area. The laundry facilities are sufficient to meet the needs of the people living at the home and the home was found to be clean, hygienic and odour free. The homes AQAA returned to the Commission states, “We have a schedules plan for re-decoration of all rooms”. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 20 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): 32/34/35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a caring staff team who understand the needs of people living in the home. Updating staff training regularly would ensure that the assessed needs of the people living at the home are met. EVIDENCE: Several staff on duty during the inspection were spoken with during this inspection. It was clear from these discussions that the staff had developed a good relationship with the people living at the home. This was also evident through observation throughout the inspection. One staff was able to confirm that they had completed their NVQ training and the AQAA records that the home has over 50 of staff trained to NVQ level 2 or above. The manager made the inspector aware that some training is now due for updating and is in the process of arranging dates for staff. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 21 One staff confirmed that staff meetings were held and this ensures that all staff are involved in the planning and monitoring of all aspects of the home. A recent training session provided assistance to staff on managing behaviour difficulties displayed by one person living at the home. Some staff files examined showed that staff had all relevant employment checks. And these checks were undertaken prior to employment for the safeguarding of service users. This included Criminal Record Bureau (CRB) checks. However examination of two staff files for staff members now employed at The Lodge but also employed elsewhere in the service showed these files did not contain all documents as required. The manager stated that he had spoken to the manager of the other services employing these staff member and they had confirmed that all relevant information had been obtained. These files were available for examination if required. It was agreed with the manager to obtain photocopies of all documents to keep in the homes files and sign a declaration stating he had seen the original documents. One staff confirmed that they had undergone a probation period and staff Induction. This Induction is completed before the end of the probation period and ensures the staff are aware of the needs of the people living in the home. The staff confirmed that the home provides regular training. This included mandatory training in Fire Safety, First Aid and Health and Safety. Staff files showed certificates of completed training and these were completed recently. Courses booked for future dates included Challenging Behaviour and Epilepsy. Three staff members were spoken with and all stated that they had been provided training and agreed with the manager that this was now due for updating. Of the staff spoken with one commented on the lack of regular staff recently and others commented on the use of agency workers. One stated that they had worked extra hours to cover staff shortages and that the use of agency and extra hours had put the home under some strain. The manager confirmed that one new staff member was due to start work soon and that one part time staff was due to commence full time hours next week. The manager and the staff spoken with felt this would benefit the home, the rest of the staff team and in particular provide continuity for the people living in the home. All three staff agreed that the home had a good supportive staff team. One said, “It’s a great team to work with”. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 22 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): 37/39/42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Lodge would benefit from having a manager Registered with the Commission to ensure the home is managed for the best outcomes for the people who live there. EVIDENCE: The home has a new manager in place and Neil Ochiltree is waiting for the Registration process to be completed by the Commission. Mr. Ochiltree is planning to start the NVQ 4 and Registered Managers qualification when he becomes Registered. The AQAA provides further evidence that the manager has “A total of 11 years experience in caring for adults with a learning disability and 3 years in a senior post”. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 23 All staff spoken with and some of the people living at the home who were able to agreed that the new manager was approachable. The manager stated he is aware that the quality assurance system requires some updating. However a local advocacy is available when needed. All the people living at the home are invited to attend the regular staff meeting and as the home is only 3 bedded the staff speak to the people living at the home on a one to one bases everyday. Sampling of servicing records indicated that equipment is serviced regularly and maintained in good working order, this included the fire alarm system. And certificates were available on all Health and Safety equipment having been checked regularly. The fire protection system was regually checked and recorded details of evacualtion and drills having atken place were well documented. Maintenance checks are being carried out. Staff are receiving appropriate fire protection training to ensure they have the skills to deal with emergencies. Gas and electrical appliances were being routinely serviced and checked. Good health and safety practice reduce any unreasonable risk, affecting service users or staff, to an acceptable level. All staff have completed manadatory training in Fire safety, First Aid and food hygenie certificates. Good health and safety practices reduce any unreasonable risk, affecting residents or staff, to an acceptable level. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 4 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X 3 X X 3 X The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 25 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. Standard Regulation Requirement Timescale for action The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 26 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 YA6 YA37 Good Practice Recommendations All care plans should be updated to ensure the staff are able to meet the needs of people living at the home. The manager should complete the Registration process with the Commission. This would ensure the home is managed for the best outcomes of the people who live there. The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Colston 33 33 Colston Avenue Bristol BS1 4UA 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 The Lodge, Plymouth DS0000003445.V357253.R01.S.doc Version 5.2 Page 28 - 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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