Care Home: The Old Vicarage [Blakeney]

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What the care home does well The home listens to the residents and wherever possible will meet their needs/wishes. This is done by staff that were seen to give time to residents, and the time given was in a calm and dignified way even when the behaviour of some residents may have been seen as challenging. The introduction of more precise care plans has started and this should result in residents having more specific objectives, which can be measured by staff. The development of the coach house will provide opportunities for greater independence and the provision of dedicated staff will ensure support is available.The regular staff and resident meetings ensures there is good communication throughout the home and allows everyone to take part in shaping the care practices. The relationship between residents and staff was seen as good with staff being approachable and having a real interest in the residents. The residents are also enjoying continuity and consistency from a settled staff group. What has improved since the last inspection? The introduction of regular meetings of staff/residents. The review of care planning and the introduction of new and more specific plan of care. The careful distribution of staff to ensure minimum standards are maintained. The introduction of "healthy eating" for the main meal. What the care home could do better: The complaints procedure may not be understood by all residents and could be adapted to resolve this problem. Ensure that all admissions, to include transfer between homes have an assessment of need before any admission. CARE HOME ADULTS 18-65 The Old Vicarage The Old Vicarage Church Square Blakeney Nr Lydney Gloucestershire GL15 4DS Lead Inspector Mr Tim Cotterell Unannounced Inspection 23 and 24th June 2008 10:00 rd The Old Vicarage DS0000016626.V360713.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 Old Vicarage DS0000016626.V360713.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 Old Vicarage DS0000016626.V360713.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Vicarage Address 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) The Old Vicarage Church Square Blakeney Nr Lydney Gloucestershire GL15 4DS 01594 517098 Stepping Stones Resettlement Unit Limited Mr Hanif Mohamed Patel Care Home 13 Category(ies) of Learning disability (13) registration, with number of places The Old Vicarage DS0000016626.V360713.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 13. 17th May 2007 Date of last inspection Brief Description of the Service: The Old Vicarage is owned by Stepping Stones Resettlement Unit Ltd, which owns four other homes in the area. The organisation has been awarded the ISO 9002 award and has retained the award in subsequent years. The Old Vicarage is a Grade 2 listed building and provides residential care for 13 people with a learning disability and a history of challenging behaviour. The accommodation is provided in the main house, the nearby Coach House and in a self contained flat. The main house accommodates eight people over three floors. All have single rooms with en suite facilities. Four people live in the Coach House across the courtyard. They have single rooms with the use of a bathroom and a shower room. One person lives in the flat. To the rear of the properties are well maintained gardens. At the front of the main house there is a garden overlooking the village. Weekly charges of the home range from £1062 to £1319. The Old Vicarage DS0000016626.V360713.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 star. This means the people who use this service experience good quality outcomes. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. The inspection was undertaken over two days, one whole day followed by an afternoon to ensure we (the Commission) saw all residents. The home has a new manager and she was transferred from another home in the group in May 2008. She was present throughout the inspection and was able to provide the information required and was helpful during the visits. The inspection consisted of looking at the accommodation, talking to five care staff, seeing all of the residents and looking at the following records; care plans, medication, personal monies and healthcare profiles The Annual Quality Assurance Assessment was not received in time for the inspection, it would have been helpful if this had been submitted within the extended time scale. The failure to return to us the completed residents/relatives/staff surveys has meant that any comments they may have had are not included in the report. We found the home to be organised with staff clear about their responsibilities. Residents were welcomed when they returned to the home from day activities and there was a pleasant atmosphere in the home. What the service does well: The home listens to the residents and wherever possible will meet their needs/wishes. This is done by staff that were seen to give time to residents, and the time given was in a calm and dignified way even when the behaviour of some residents may have been seen as challenging. The introduction of more precise care plans has started and this should result in residents having more specific objectives, which can be measured by staff. The development of the coach house will provide opportunities for greater independence and the provision of dedicated staff will ensure support is available. The Old Vicarage DS0000016626.V360713.R01.S.doc Version 5.2 Page 6 The regular staff and resident meetings ensures there is good communication throughout the home and allows everyone to take part in shaping the care practices. The relationship between residents and staff was seen as good with staff being approachable and having a real interest in the residents. The residents are also enjoying continuity and consistency from a settled staff group. 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. The Old Vicarage DS0000016626.V360713.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 Old Vicarage DS0000016626.V360713.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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A more individualised service would be provided if all residents have a formal assessment of need before admission. EVIDENCE: The acting manager was not sure if the home had an assessment format for new admissions, but it is likely that the model used at Stepping Stones Care Home would be used. It is essential that all new admissions have a comprehensive assessment and that the home feels able to meet the identified needs. The new registered manager of the home must also be involved in the assessment process to ensure that the needs of the potential residents can be met and are in line with the Statement of Purpose. On the first day of the inspection one resident had been transferred to the home from another home in the group. The transfer had taken some time and enabled everyone to confirm that the move was in the best interests of the resident. It was evident after talking to the resident that he had made a positive choice about the move. The Old Vicarage DS0000016626.V360713.R01.S.doc Version 5.2 Page 9 Although it will be mentioned under care planning it is recommended that the initial assessment of need is reviewed to ensure any changes are recognised and met. The Old Vicarage DS0000016626.V360713.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 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The old care plans seen were out of date and there was no evidence of any review. The new care plans being introduced have measurable objectives and will provide a more precise picture of the needs of the residents. All plans of care should be based on a formal assessment and reviewed. EVIDENCE: Three care plans were seen and the issues discussed at length with the manager. All of the care plans seen were not up to date and the last entry in two were dated 2006. It is appreciated that the home keeps daily and monthly records and that this information included matters relating to the plan of care, however, it was difficult for us to determine what progress had been made and we did not see any meaningful evidence of a review. The manager had already identified care planning as something which needed addressing and had completed three new plans of care, which indicated the aim and the measurable objective. It is recommended that the first step could be a new assessment of need or a review of the old one this would then identify areas of The Old Vicarage DS0000016626.V360713.R01.S.doc Version 5.2 Page 11 need. A plan of care could then be completed and reviewed. The new plans were written in a way, which was simple but effective and were seen by us as user friendly. The completion of the new plans should give residents a clear direction and staff measurable goals to achieve. The use of advocates was discussed and the introduction of the Mental Capacity Act. Residents are able to make decisions about their lives and staff were seen as good listeners if guidance and support was seen as appropriate. Responsible risk taking is encouraged and a recent social event provided evidence of the unobtrusive support provided where individuals residents made choices about what they did but where the home felt that some support was appropriate. The Old Vicarage DS0000016626.V360713.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, & 17Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy a range of activities and their comments confirmed that they felt they were in line with their needs and wishes. EVIDENCE: Residents are not involved in any formal supported employment but this option was discussed, and the role of Gloucestershire Industrial Services in the process of supporting people in employment. The day care services at Stepping Stones provide numerous recreational activities and residents who we spoke to say they enjoyed going. A number of residents also attend a college in the Forest of Dean. The manager is aware of the desirability of integration in the local community and will be looking at ways of achieving this. She is arranging bus passes for some residents and this will allow greater choice and flexibility. The Old Vicarage DS0000016626.V360713.R01.S.doc Version 5.2 Page 13 Staff were aware of the leisure opportunities locally and residents enjoy trips out. Residents are also encouraged to consider the places they would like to go for their annual holidays. The staff provide support between families and residents, and the forthcoming visit home for one resident indicated that staff provided appropriate guidance. The Old Vicarage DS0000016626.V360713.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home supports residents in a manner that suits their wishes. Healthcare needs are met by the services in the community and with support residents are able to enjoy all of the services provided Residents are encouraged to manage their own medicines. EVIDENCE: Residents confirmed that they receive the support they need in a manner that meets their wishes. The times of getting up and going to bed are flexible and subject to safety issues determined by the residents. The physical needs are met by the resources in the community and we saw evidence of the treatment received. Residents are encouraged to take an interest in their physical wellbeing and are supported by staff if this is needed. All residents are registered with the local doctors surgery and staff are also able to seek advice at any time. The specialist services include the Community The Old Vicarage DS0000016626.V360713.R01.S.doc Version 5.2 Page 15 Learning Disability Team and at the time of the inspection they were supporting three of the residents. We inspected the medication records and saw that there was a record of the receipt and administration of medication. If medicines were administered as “as and when required” there was a written protocol and one was examined. The administration of any emergency medicines e.g. for epilepsy, should only be administered by staff who have been trained by the district nurse who would have administered the medication. The coach house, which accommodated up to four residents, will soon be providing support to enable the residents who live there to have greater independence in their lives. It is anticipated that the residents will become responsible for many aspects of their day-to-day lives e.g. cooking, laundry and personal care and to achieve this the coach house will have dedicated members of care staff. It is recommended that any plan for greater independence is formally recorded in the individual’s care plan. It is also worth considering amending the Statement of Purpose to reflect the proposed development. The Old Vicarage DS0000016626.V360713.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. Residents’ views are seen as important in respect of the day-to-day practices in the home and it was evident that the manager intends running the home for the wellbeing of the residents. The protection of vulnerable adults may be improved if staff are updated in the identification of abuse. EVIDENCE: The home has introduced residents meetings and it is planned that they will be held on a regular basis. The views of the residents are, wherever possible, sought and they are able to comment on and influence most of the day-to-day practices in the home. It was unfortunate that the resident’s surveys provided by the Commission were not returned to us before the inspection. We felt that the home was listening to residents and providing an environment, which supported them where necessary. Three residents personal monies records were seen, the records included a record of the receipts and expenditures. The main incomes for residents were their personal allowances and Disability Living Allowances. Some of the staff seen had a good understanding on how abuse occurs, however, some staff are to be updated on the Identification of Abuse and the dates and staff will be determined when the manager has compiled new staff training profiles. The Old Vicarage DS0000016626.V360713.R01.S.doc Version 5.2 Page 17 The Old Vicarage DS0000016626.V360713.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 adequate. This judgement has been made using available evidence including a visit to this service. The refurbishment of the communal areas will improve the physical environment and provide residents with a pleasant and comfortable home. The home was found to be clean and organised. EVIDENCE: We looked at the accommodation with the manager. All of the communal rooms were seen and a number of bedrooms were selected randomly. The communal area, with particular reference to the lounge and dining rooms are in need of refurbishment as some of the plaster is damaged and the wallpaper/paint needs attention. This area had already been identified by the manager and during the inspection the work was being looked at by an external contractor. The furniture in these rooms was seen as worn and we were advised that the suites would be replaced. The bedrooms seen were seen by us as homely and reflected the interests of the individual resident. The The Old Vicarage DS0000016626.V360713.R01.S.doc Version 5.2 Page 19 outside areas are extensive and well kept and provide a pleasant alternative in the summer months. We also visited the coach house. The bedrooms have appropriate furniture and are in good decorative condition. We were advised that some of the lounge furniture is to be replaced. The home was found to be clean and odour free. The Old Vicarage DS0000016626.V360713.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 are good. This judgement has been made using available evidence including a visit to this service. The home is staffed by a manager and care staff that are competent and are good listeners. Staff support and guidance is always available for residents and provided in a calm and professional manner. EVIDENCE: The home has a new manager and a proposal to register her with the Commission will be sent to us soon. The staffing position has improved considerably since the last inspection. The home now has one care vacancy and has employed a cleaner. The new manager confirmed that during most of the waking day there are five carers. After 17:00 this reduces to three. At night there is a waking carer. We noted the number of residents, the layout of the building and the philosophy of the home and feel that three carers should be the minimum number of carers on duty during the waking day. The Old Vicarage DS0000016626.V360713.R01.S.doc Version 5.2 Page 21 All new staff have an induction and this process is being reviewed. Training is encouraged and staff undertake the induction and foundation modules (Learning and Disability Framework Training) followed by NVQ studies. The manager meets the staff monthly and they saw this as useful and allowing them to raise matters of interest, it also permitted the manager to ensure that staff are updated on procedures and practices within the home All of the care staff on duty during the inspection, with one exception, were seen and spoken to individually. They had a good knowledge of the residents and of their disabilities. A number of staff records were inspected and the following observations are made. In one case it was unclear where the reference came from. In another the applicant had worked in a care home but no reference was asked for as a care home that was not included in the person’s CV as an employer had supplied one. In this case the dates of employment were imprecise (starting and leaving dates). This information is important, as it would be necessary to make further enquiries about employment if there were gaps. We would also refer you to the Regulations in respect of appointments, specifically the circumstances when you need to enquire from a previous employer (in addition to any references) where the applicant has worked in another home with vulnerable adults. The Old Vicarage DS0000016626.V360713.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 new manager has already identified many areas that require attention and we felt that her appointment will improve the quality of life for the residents. The views of the residents are always considered and wherever possible form part of the homes practices. The current review of the health and safety assessment of the home will ensure residents are protected EVIDENCE: The home now has a new manager and we were informed that the company who carry on the business at the Old Vicarage would be proposing this person as the new registered manager. The manager has completed NVQ 3 and hopes to undertake NVQ 4 (Care) and the Registered Managers Award. We felt that The Old Vicarage DS0000016626.V360713.R01.S.doc Version 5.2 Page 23 the new manager was making great efforts to provide a flexible and individual service to the residents and had already identified areas that need attention e.g. the introduction of care plans and replacement of some communal furniture. Supervision of the home is provided by the clinical director of Stepping Stones Resettlement Ltd and he is already providing support through regular meetings with the new manager. Whilst we did not have the benefit of any completed surveys from the residents it was evident that the home is listening to their views and subject to any safety issues would introduce their wishes/needs into the day-to-day practices of the home. The Health and Safety issues are dealt with centrally (from Stepping Stones) and during the inspection we were advised that the risk assessment for the building is being reviewed. The fire officer had recently visited and was satisfied with the current procedures. The home has acquired a DVD in respect of fire safety issues and staff have access to this. There is a record of the fire checks and instructions to staff, and night staff have been included. The last Regulation 26 report, which refers to visits to the home by a representative of the provider, was dated April 2008. It is a requirement that the visits are undertaken monthly and a report written. There were no Regulation 37 notices; they inform us of any events of significance in the home. However, there was an event, which referred to a staff member in the home. This was reported to us through Stepping Stones. It was appreciated that the matter was investigated and is still ongoing. It is essential that matters relating to the Old Vicarage are reported to us by Regulation 37. The Old Vicarage DS0000016626.V360713.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 2 3 X 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 2 25 X 26 x 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 x 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Version 5.2 Page 25 The Old Vicarage DS0000016626.V360713.R01.S.doc 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 YA6 Regulation 15 Requirement The registered person must ensure that all care plans are updated. The registered person must ensure that all staff are trained/updated in the identification of abuse. The registered person must ensure that all residents have an assessment of need before admission. Timescale for action 30/09/08 2. YA23 13 31/10/08 3. YA2 14 30/06/08 4. YA24 23 The registered person must 30/11/08 ensure that the communal rooms on the ground floor are refurbished to include the replacement of the existing suites. The registered person must submit an application for the manager to be registered. The registered person must ensure that 26 visits are carried out in accordance with the Regulation. 30/08/08 5. YA37 8 6. YA39 26 30/06/08 The Old Vicarage DS0000016626.V360713.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. Refer to Standard YA23 Good Practice Recommendations The home should consider including planned and unplanned physical intervention strategies to form part of the plan of care. The home should review the complaints procedure with the objective of making it more user friendly. 2. YA22 The Old Vicarage DS0000016626.V360713.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West 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 Old Vicarage DS0000016626.V360713.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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