Care Home: The Moorings

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What the care home does well Relatives and friends of people living in the home are made welcome and there is good communication between the manager and visitors. Interactions between staff and people in the home are good. Staff are able to provide support for people in a way that meets their needs and wishes. They ensure the personal and healthcare needs of people living in the home are met and relevant healthcare professionals are consulted where appropriate. The Moorings provides a comfortable environment for people with ample communal areas and bedrooms that reflect individual tastes. What has improved since the last inspection? Some areas throughout the home have been redecorated and in general the premises look fresh and clean. Staff feel well supported by the new manager and are positive about the way she runs The Moorings. Staff are also complimentary about the quality of training available. What the care home could do better: Although there is an appropriate complaints procedure in place, it would be improved if minor concerns were also documented. The providers should ensure the new manager is registered with us at the Commission. Improvements to the environment should continue, particularly to the bath and shower rooms so that people living in the home benefit from a better bathing experience. The manager and the proprietors should continue to support the staff team to complete National Vocational Qualifications. CARE HOMES FOR OLDER PEOPLE The Moorings 167 Thorney Bay Road Canvey Island Essex SS8 0HN Lead Inspector Ray Finney Unannounced Inspection 26th November 2007 09:00 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 The Moorings DS0000015546.V355537.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. The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Moorings Address 167 Thorney Bay Road Canvey Island Essex SS8 0HN 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) 01268 514477 01268 514474 moorings@abc-care-solutions.co.uk Independent Homes Limited Manager post vacant Care Home 39 Category(ies) of Dementia - over 65 years of age (39), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (39) The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Excluding any person who is liable to be detained under the provision of the Mental Health Act 1983 2nd July 2007 Date of last inspection Brief Description of the Service: The Moorings provides purpose built accommodation for thirty-nine older people with dementia and mental disorders. The property is situated in a quiet residential area of Canvey Island close to the sea front and a few minutes drive from the town centre. The Moorings has 35 single and 2 shared bedrooms. Accommodation is provided on two floors, access to the first floor is by means of a passenger lift. People living in the home have access to a secure garden to the rear of the property and there are parking spaces for approximately twelve cars to the side of the building. The home charges between £474.00 and £635.00 a week for the service they provide. Other services such as hairdressing, chiropody and aromatherapy are available at an additional charge. This information was given to us in November 2007. Information about the home can be obtained by contacting the manager. Inspection reports are available from the home and from the CSCI website www.csci.org.uk The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was looked at when compiling this report. Documentary evidence was examined, such as menus, staff rotas, care plans and staff files. An Annual Quality Assurance Assessment (AQAA) with information about the home was completed earlier in the year, therefore a further AQAA was not requested before this inspection. However, information from the AQAA where relevant is reflected in this report. A visit to the home took place on 26th November 2007 and included a tour of the premises, discussions with people living in the home, the manager and the proprietor, members of staff and two visiting relatives. Observations of how members of staff interact and communicate with people living there have also been taken into account. On the day of the inspector’s visit the atmosphere in the home was relaxed and welcoming and the inspector was given every assistance from the manager, the proprietor and the staff team. What the service does well: What has improved since the last inspection? Some areas throughout the home have been redecorated and in general the premises look fresh and clean. Staff feel well supported by the new manager and are positive about the way she runs The Moorings. Staff are also complimentary about the quality of training available. The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 6 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. The Moorings DS0000015546.V355537.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 The Moorings DS0000015546.V355537.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): 1, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People choosing to live at The Moorings receive sufficient information about the home and may be confident their needs will be assessed before admission. EVIDENCE: The AQAA states that a new brochure is in place to provide information. The manager and proprietor explained that the Service User Guide was updated after the last inspection and is available for residents and their relatives. On a tour of the premises the Service User Guide was seen to be available in some individual rooms. As at the last inspection an appropriate pre-admission assessment process is in place. The AQAA states that all residents currently in the home have a completed pre-admission assessment and a hospital nursing needs assessment which are taken into consideration prior to admission. This is confirmed in the The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 9 sample of four care plans examined, which all contain a comprehensive preadmission assessment. The ‘Admission and Assessment of Need’ document covers a wide range of physical, psychological, social, healthcare and personal care needs. There is also a ‘Map of Life’ giving an overview of the individual’s history and life. National Minimum Standard 6 does not apply as The Moorings does not offer intermediate care. The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 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. People choosing to live at The Moorings can expect their care plans to detail their needs and how they are to be met and also to be supported to make decisions that respects their dignity and safety. There are policies and procedures in place to help staff ensure people are safely supported around medication. EVIDENCE: On the day of the inspection four care plans were examined. They are well organised and cover a wide range of needs, including personal care & well being, diet & weight, sight, hearing & communication, oral care, foot care, mobility & dexterity, falls, continence, mental state & cognition, social interests, hobbies, religious & cultural needs, personal safety, relationships & family involvement, social, medical & psychiatric history, normal daily routine, self-medication and managing finances. Any end of life issues or wishes are also documented. Two visiting relatives were spoken with on the day of the The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 11 inspection visit and both are complimentary about how their relatives are cared for. The proprietor demonstrated a new ‘Person Centred Care Plan’ format that they are in the process of introducing. Care plans in place identify the person’s specific needs, the desired outcome and an action plan or nurse intervention to achieve the outcome. Care plans examined use positive language and contain good details, particularly in the section on the resident’s daily routine. Staff spoken with on the day of the inspection were able to demonstrate an awareness of people’s needs and daily progress sheets are completed by staff. The AQAA states that there is “excellent liaison with external health care professionals”. Records examined confirm this with evidence of input from a range of healthcare professionals, including G.P., optician, hospital consultants and speech & language therapists. There are also individual risk assessments in place. Risk assessments examined cover manual handling, falls, nutrition, continence, sleep and a Waterlow Pressure Sore Assessment. The manager explained that she has used a range of measures to reduce the number of falls by those who are frail and at risk. These include ensuring good staffing levels and raising staff awareness. The manager produces a graph recording falls that is posted on the notice board in the nursing office so that there is a visual reminder to staff that falls prevention is a high priority. The current graph displayed on the board confirms that the number of falls has reduced. The use of bed rails was discussed with the manager, who demonstrates a good awareness of the risk of using bedrails in inappropriate cases. Few bed rails are used and then only after a risk assessment has been carried out. As at the last inspection, the home has an appropriate process in place for supporting people with medication. Storage of medication was examined and was found to be well organised, safe and secure. The medication Administration Record (MAR) sheets examined were completed appropriately and recording is carried out to a good standard. Staff spoken with are able to demonstrate a good awareness of appropriate storage and recording of controlled drugs. Observations of staff dispensing drugs demonstrated good practices. The AQAA states that they implement policies to ensure privacy and dignity at all times. Observations on the day of the inspection visit confirm that staff treat people living in the home with respect. One person spoken with said the staff are “very good” and two visiting relatives were also complimentary about the way their relatives are cared for. The Moorings DS0000015546.V355537.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): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in The Moorings have opportunities to participate in activities that are appropriate to their needs and they are supported to build and maintain relationships. People have a varied diet that they enjoy. EVIDENCE: The AQAA stares that they involve residents in activities appropriate to their abilities and they have assigned a member of staff as activities co-ordinator. They have reviewed activities assessments and keep a more detailed activity record for each individual resident. How activities are planned and provided was discussed with the proprietor and the manager. The provider explained that they have recently used the services of a consultant to advise on activities. They have prepared guidelines for staff on how to deliver a range of activities such as a variety of armchair exercises. The guidelines were examined and clearly show the aims of each activity such as to improve flexibility or to improve circulation and the method is clearly explained. The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 13 There are three communal lounges. The activities planner is displayed on the notice board and shows that one lounge is used for a range of structured group activities. On the morning of the inspection people were taking part in a music session. One person was observed to be taking particular pleasure in the activity and was laughing and joining in enthusiastically. The manager explained that the quiet lounge is used for more individual activities such as hand massage, which is popular with people in the home. One person spoken with said they enjoy spending time in their room watching television but there is plenty to do if they want to join in. A visiting relative said the whole family had visited the previous day for a birthday celebration. The relative had arranged with the manager to have a buffet laid on and this was enjoyed by all the family. The relative was very complimentary about the arrangements. Two relatives spoken with said that they are kept informed of anything relevant to their relative’s care. Both are confident that their views are listened to and they are consulted in all aspects of care. Meetings are held approximately monthly for relatives to discuss the service provided, one person said they regularly attend these meetings and another said that they attend sometimes and are happy with the service their relative is receiving and are confident that their opinions are listened to. Relatives and people living in the home who were spoken with are complimentary about the food. Lunch on the day of the inspection visit was lamb hotpot with bananas and cream for dessert. Menus show a good variety of traditional foods. The cook was able to demonstrate an awareness of people’s likes and dislikes and explained about what alternatives are available. Food storage is appropriate and a range of fresh and frozen foods, including fruit and vegetables was observed to be available. There are two sittings for meals so that people can receive the support they need. Two dining rooms are used, one for those who require more support and one for those who are more independent. Observations during the lunchtime meal confirm that staff support people appropriately and in a caring manner. The Moorings DS0000015546.V355537.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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use the service have access to an effective and understandable complaints procedure that ensures that they are listened to. People living in the home can expect that the procedures followed by staff would help to protect them. EVIDENCE: The Moorings has an appropriate complaints procedure in place that meets the requirements of the Care Homes Regulations 2001 and the National Minimum Standard for older people. The complaints procedure is prominently displayed on the notice board. Records examined show that no formal complaints have been recorded since the last inspection. There was a discussion with the manager and proprietor about recording minor concerns as well as issues that may be seen as complaints, as this is a way of demonstrating that they listen to people’s concerns and take appropriate action. Relatives spoken with are confident that any minor issue is dealt with promptly and to their satisfaction. The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 15 The service has a safeguarding policy and procedure in place that follows local guidelines relating to actions that should be taken when reporting allegations of abuse. The manager and proprietor are both able to demonstrate a good awareness of their responsibilities around safeguarding vulnerable adults. Records examined confirm that staff have received Protection of Vulnerable Adults (POVA) training. The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in The Moorings benefit from a comfortable environment that is well maintained and clean. EVIDENCE: On a tour of the premises it was observed that there is a good standard of cleanliness both in communal areas and in people’s individual rooms. The bathrooms are bright, airy and clean with appropriate flooring. Although a good standard of cleanliness was observed, the tiling in the bathrooms and showers would benefit from being re-grouted and in a few areas repairs to some of the tiling is needed. The AQAA states that they are currently undergoing a refurbishment and redecoration programme to improve the environment and facilities. Many areas of the premises have been redecorated in the past year and were The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 17 observed to be clean and bright; many of the rooms have new carpets. There are no offensive odours throughout the premises. A tour of the premises confirms that the laundry has non-permeable flooring to facilitate infection control. There are two large professional standard washing machines and a dryer. The laundry and sluice room are both kept clean and tidy. There is a bathroom and shower room on each floor, which have had new dispensers for hand washing liquid and hand sanitizer. Observations on the day of the inspection confirm that staff are provided with personal protective equipment, including gloves and aprons and they follow good practices around infection control measures such as hand washing. Records examined confirm that staff have received Infection Control training. The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in The Moorings benefit from a competent, well trained staff team who receive appropriate supervision. The recruitment procedure in the home provides the safeguards that ensure appropriate staff are employed. EVIDENCE: As at the last inspection, the home continues to use the Residential Forum tool to determine the number of staff required based on the dependency levels of people living in the home. Staff rotas examined show that there is a mixture of qualified nursing staff and care staff on every shift. Observations on day of the inspection visit confirm that the number of staff on duty were meeting the needs of people living in the home and staff were seen to spend time with people and to provide support in an unhurried manner. The staff team comprises of eight qualified nursing staff and seventeen care staff. Three members of staff have got a National Vocational Qualification (NVQ) at level 2 or above and a further four are in the process of completing the award. This is below the level of 50 of staff with NVQ as recommended in the National Minimum Standards. Efforts should continue to ensure further care staff are supported to obtain an NVQ qualification. The manager and The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 19 proprietor confirm that there have been a number of staff who have left in the past year but there is now a more stable staff team in place. Four staff files were examined at the inspection visit. At the front of the files there is a checklist of all the documents required by Regulation and examination of the files confirms that all the required documentation is in place. Staff files examined all contain recent photographs of the member of staff, a completed application form with employment history, proof of identity, two written references and a health declaration. Files relating to Registered Nurses contain proof of their registration with the Nursing and Midwifery Council. Evidence was seen that enhanced Criminal Record Bureau (CRB) checks are carried out before the member of staff commences employment. Staff training records were also examined. There is a staff training matrix in place showing evidence of up to date training in Protection of Vulnerable Adults (POVA), Infection Control, Health & Safety, Dementia Care, Challenging Behaviour, Fire Safety, Food Hygiene, Manual Handling (theory and practical) and Control of Substances Hazardous to Health (COSHH). Some staff have also completed training around continence promotion and record keeping. There is a register of all staff who have completed training and a plan of training for the next year. Each individual member of staff has an individual training record of training courses they have completed. Individual training records confirm that the range of in-house training identified in the staff training records is carried out. As with other homes run by the company, individual staff training records contain preparation sheets that staff complete before training to identify what they expect and require from the training. A range of completed worksheets are in place that demonstrate what each person has learned in the training session. Staff files examined contain a checklist of the issues covered during staff induction. A member of staff spoken with said that the home is “top grade for training”. The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Moorings is competently managed and run in the best interests of the people who live there. The health and safety of individuals living and working there is promoted and protected. EVIDENCE: The new manager is appropriately qualified to run the home and has a number of years experience in management. Staff spoken with confirm that they get “excellent support from the manager”. Discussions with the manager and proprietor confirm that they work together as a management team to develop the service. Now that the manager is established in post, the proprietors should ensure an application for registration with the Commission is submitted. The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 21 The manager and proprietor continue to develop the Quality Assurance process. The AQAA states that they have carried out a quality audit as a benchmark for future improvement and have written an action plan as a result of this. Records examined confirm that they have carried out a quality audit and developed an action plan. Regular meetings are held for residents and their relatives and minutes of these are available. Relatives and members of staff spoken with are confident that their views are listened to. No one living in The Moorings has the capacity to manage their own finances. Records examined contain evidence that finances are managed by relatives. Discussions with the manager around staff supervisions indicate that there is a supervision programme in place. Staff records examined confirm that staff are having regular supervisions and staff spoken with said that they feel well supported. Certificates relating to the annual maintenance of equipment to comply with health and safety regulations were examined. All documents were in date and satisfactory. The Moorings DS0000015546.V355537.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 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 23 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. Standard Regulation Requirement Timescale for action 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 OP16 Good Practice Recommendations Documenting minor concerns as well as complaints would demonstrate that the service listens to people and that even minor concerns are important. Refurbishing or replacing the tiling in the bathrooms and shower areas would improve people’s bathing experience. The management team should continue to support staff to achieve NVQ awards so that the recommended 50 of carers with the award is reached. OP19 OP28 The Moorings DS0000015546.V355537.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Colchester Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Moorings DS0000015546.V355537.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. 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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