Care Home: The Piers

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What the care home does well People who are considering moving into this service have an assessment of their needs and aspirations before they make a final decision. This means that they will know if the home is able to meet their individual needs before they decide. People are supported to make decisions and choices about their daily lives. Risk management is part of everyday life and enables people to have the kind of life they want to. People living at The Piers are able to participate in activities, which interest them and are important to them both with their family and friends and in the local community. People are supported to maintain the relationships, which are important to them. People were observed being given the respect they deserve in their own home. Information in individual files recognises the importance of ensuring people receive the support and care they need in the way they like and prefer. There is information in files which reflects that people living in the home are supported to have their physical and emotional needs met. Staff receive the training the need to ensure that they understand the importance of keeping people safe. The Piers is designed with the needs of the people who live there in mind and it provides a comfortable and safe home. The home is clean which means that people can enjoy their surroundings. People living in the home are supported by staff that have the skills to meet their individual needs. Recruitment practice is good and means that people are protected.The home is run by a manager who takes her responsibilities seriously and has enthusiasm for the job. The views of the people living in the home are seen as important and form part of the development of the service. Systems in place mean that the health, welfare and safety of people living and working in the home are protected. What has improved since the last inspection? This is a new service, which was first registered in March 2008. CARE HOME ADULTS 18-65 The Piers 166 Columbia Road Ensbury Park Bournemouth Dorset BH10 4DT Lead Inspector Tracey Cockburn Unannounced Inspection 30th July 2008 09:15 The Piers DS0000070797.V367504.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 Piers DS0000070797.V367504.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 Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Piers Address 166 Columbia Road Ensbury Park Bournemouth Dorset BH10 4DT TBC 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) Mrs Eve Mary Went t/a Harbour Care Mrs Nicola Elizabeth Levick Care Home 3 Category(ies) of Learning disability (3) registration, with number of places The Piers DS0000070797.V367504.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 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 3. New service registered with the commission in March 2008 Date of last inspection Brief Description of the Service: The Piers is owned by Harbour Care and is the 5th service to be opened by this registered provider in the past few years. The home is a detached bungalow in a residential area close to local amenities in a Bournemouth. The home is registered to provide care and support to 3 people whose primary care needs on admission are in relation to their learning disability. The home provides 3 spacious single bedrooms In addition, room 3 has an en-suite, which includes a “walk-in” shower, WC and wash-hand basin. There is a large bathroom which includes a bath, “walk-in” shower and disabled user “friendly” WC. A separate WC is located opposite for staff and visitors. The accommodation has been designed in consultation with an occupational therapist. The standard of decoration, floor coverings, fixtures and fittings and furniture is very high throughout the accommodation. The premises are designed for use by people who may have a physical disability. There is level access to all areas, which are suitable for use by wheel-chair users except the laundry/utility room, which is too narrow for such a purpose. The kitchen and visitors’ WC, whilst accessible, are not designed for use by a disabled person. The bathroom contains a WC, which is suitable for a wheelchair user. The weekly fees range from £1500 - £1900. Further information on fees and contracts can be found on the Office of Fair Trading website: www.oft.org.uk The Piers DS0000070797.V367504.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 This was a key inspection of a new service. It took place on a weekday and with no warning. At the time of the site visit there where two staff at work and two people who live in the service. The registered manager was also there. Care records, medication, training and individual assessments and care plans were seen. A tour of the home took place and two members of staff spoke about working in the home. The two people who live in the service were observed briefly during the day before they left for day activities and when they returned in the late afternoon. The service has not yet returned its annual quality assurance assessment. What the service does well: People who are considering moving into this service have an assessment of their needs and aspirations before they make a final decision. This means that they will know if the home is able to meet their individual needs before they decide. People are supported to make decisions and choices about their daily lives. Risk management is part of everyday life and enables people to have the kind of life they want to. People living at The Piers are able to participate in activities, which interest them and are important to them both with their family and friends and in the local community. People are supported to maintain the relationships, which are important to them. People were observed being given the respect they deserve in their own home. Information in individual files recognises the importance of ensuring people receive the support and care they need in the way they like and prefer. There is information in files which reflects that people living in the home are supported to have their physical and emotional needs met. Staff receive the training the need to ensure that they understand the importance of keeping people safe. The Piers is designed with the needs of the people who live there in mind and it provides a comfortable and safe home. The home is clean which means that people can enjoy their surroundings. People living in the home are supported by staff that have the skills to meet their individual needs. Recruitment practice is good and means that people are protected. The Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 6 The home is run by a manager who takes her responsibilities seriously and has enthusiasm for the job. The views of the people living in the home are seen as important and form part of the development of the service. Systems in place mean that the health, welfare and safety of people living and working in the home are protected. 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 Piers DS0000070797.V367504.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 Piers DS0000070797.V367504.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 good This judgement has been made using available evidence including a visit to this service. Systems are in place to assess someone’s needs before they move into the home and to consider the views of the other people who live there. EVIDENCE: Two care files were looked at as part of the site visit both contained detailed assessments. Each file also contained an individual profile, ‘my life so far’, care plan, risk assessment, medical summary, guidance on any medical condition they may have and how to support them, communication profile and goal plan. The care plan contained information in the original assessment. Any restriction on individual freedom and choices were also recorded. The Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Systems are in place to assess the changing needs and goals of people living in the home. People are supported to make decisions and take risks as part of their everyday life. EVIDENCE: The care plan for one person contained a very specific plan relating to their medical condition. This plan was completed with the learning disability community nurse. The care plans could be developed further to enable greater involvement of individual’s. The manager explained that this is her goal. During the inspection staff came back from a shopping trip with boards and various craft materials to create activity boards for each person, to be put up in their individual rooms and this would display information relating to their care and support and activities they participated in. The Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 10 There was evidence that care plans are reviewed, however one person was having some additional treatment from a district nurse. The care plan had not been updated with this information for staff. During the visit staff were observed helping people make choices in their daily lives, such as whether they wanted to watch the television while waiting for transport or whether they wanted to go and get ready to go out. There was information available for people on advocacy services. The communication book details when each person living in the home makes decisions about when they get up and what they do and what they eat. The two files seen both contained risk assessments covering all aspects of each person’s life including areas such as falling during transfer and use of the shower. The Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People are able to live the life they want to, participating in activities, which interest them within the local community. People are supported to maintain contact with family and friends. People living in the home are supported with a healthy diet. More care needs to be taken when recording what people eat to ensure that any concerns are clearly recorded and acted upon. EVIDENCE: All three people who live at The Piers attend day services during the week. During the inspection the activities record showed that people living in the home had done a variety of different activities including visiting Poole quay to see a motorbike rally, shopping at Castlepoint (a local shopping centre), visiting relatives, a trip to Portland Bill and going to Pontin’s on holiday. The Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 12 The manager explained that a member of staff is going with 1 person to a family event in another part of the country. This event has been identified as a goal and both staff and the manager were able to evidence that they had supported the individual to purchase items for the family event such as, a present and new clothes. It was clear from speaking with the manager that this event was very important to the individual. There was clear recording of individual preferences in each of the two care files seen. People have access to all areas of the home. There is a notice board in the hall, which has pictures of the people who live in the home and the people who work in the home. There is another notice board with pictures of the staff that are on duty and what the evening meal is. One person does not always eat meals and staff record when this happens. There was inconsistency in some of the recording, which made it difficult to know if they had eaten at all on three consecutive evenings. The manager said that if someone does not eat their evening meal or does not want it they are offered something to eat later. However this was not always recorded and on one occasion it looked like one person had not eaten anything from lunchtime until the following morning. Individual preferences with regard to different foods are clearly recorded. The manager said they are planning to take photographs of different meals to have on the board in the hall each day so that people know what they have having to eat. At the time of the inspection there was one person eating breakfast at the dining table and another person who had finished eating and was waiting to be taken to day activities. People are able to eat when they want. The person who was still eating breakfast was observed eating at his or her own pace, with a member of staff asking if they needed any support. A record is kept of each persons weight, however there was a gap of several months for one person with no explanation. Information is also kept of the meals that people eat each day but not record of the actual amount, which is relevant if someone is refusing food or skipping some meals. The Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 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 their personal care provided in the way they prefer. Their physical and emotional needs are identified and met. Policies, procedures and training are in place to ensure that people receiving medication are protected. Risk assessments and care plans on the delivery of medication need to be more robust to ensure that every consideration has been given to how someone is given medication and that it follows good practice guidance. EVIDENCE: Both files seen contained information on how each person preferred to be supported. There was detailed information in one persons file on how they communicate and how to interpret their expressions and movements. One file remained staff on how to ensure dignity for the individual when assisting them from their bedroom to the shower. Personal profiles set out when people like to get up and how they need to be supported to do this. The manager explained that people living in the home are assisted to choose their own clothes and she said that they had taken one person shopping for a suit for a very special family occasion. The Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 14 There are overhead tracking hoists in the home to support people easily around the home. Staff have received the training they need to do this safely. There was evidence in both file that people are supported to attend specialist appointments such as physiotherapy and with specialist consultants. The manager has a small staff team who provide consistency and continuity to the people who live there. Some of the staff have worked with people living in the home before and know them well. In both files there was evidence of people being able to access the healthcare support they need. One person had recently needed to see a healthcare professional and staff had clearly recorded their concerns and an appointment had been made and equipment ordered. Each person has a medication cabinet fixed to a wall in their room. The medication is in a monitored dosage system and there is a policy and procedure in place. All staff have received medication training and weekly audits are completed. A record is kept of all medicines received, administered and leaving the home. There is a protocol in place for people who take medication with them to any day activities. At times people are given medication in food; the manager has taken advice and guidance from both the GP and the pharmacist regarding this. However the care plan must be clearer and the manager needs to have the royal Pharmaceutical Society guidance on covert medication to ensure that best practice is being followed. The Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There is a complaints procedure in place. A user-friendly format would give the people living in the home confidence that their views would be listened to and acted upon. Safeguarding adults training for staff ensure that they understand the importance of protecting the people living in the home. EVIDENCE: There is a complaints procedure in place, which uses symbols. As The Piers is a small home further work could be done to ensure that each person living in the home had an individualised copy of the document, which met his or her individual communication needs. The manager said that there had been no complaints made to the home. All staff have received safeguarding adults training and the home has a policy in place. A new member of staff had completed the training in the last 4 weeks. There are body maps in each persons file for completion if any bruising or marks are noticed. The Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is excellent This judgement has been made using available evidence including a visit to this service. People live in an environment, which is homely and comfortable and meets their individual needs. The home is clean, this shows that care staff take pride in where they work and consider how the people who live there feel. EVIDENCE: The accommodation is on one level. The corridors are wide and the bedrooms are large. There is access to the garden through patio doors in the lounge. At the time of the visit there was a temporary ramp for wheelchair access to the garden. The manager explained that they are waiting for a permanent one to be fitted. The home is light and airy, with natural light. Each person’s bedroom is personalised with their possessions and decorated in their individual style. One person has a large double bed and another person has a high low bed, which gives greater flexibility in supporting someone to get in and out of bed. The home is set back from the busy road and reached by a short driveway. There is The Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 17 easy access to local shops and other amenities and the building is in keeping with others in the street. The home is accessible for people who use a wheelchair. The furnishings and fittings are very modern and of a very good quality. The manager was a little concerned as there are some scuffmarks on the walls from the wheelchairs. She is intending to repaint them herself as in her own words “they are a little scruffy”. The registered provider has a maintenance person who ensures that all work is completed. The home is very clean and there are no odours. There is a washing machine and dryer is a small utility room. All hazardous substances are kept securely locked. The home has an infection control policy and staff have had training. There are hand-washing facilities in the utility room and paper towels. The Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff are provided with the training they need to do the job well. Recruitment practice ensures that the people living in the home are supported and protected. Further training will enhance the skills that staff have and enable individual needs to be fully met. EVIDENCE: During the inspection there was limited observation of staff working with individual’s however one member of staff who had not been in post very long was seen with one of the people who live in the home, she was very respectful, clear on how she was supporting them and gave them her full attention. Staff who do not have experience of some of the conditions associated with learning disability are having training and the manager has organised training for the 20/08/08 in understanding autism. The file of a new member of staff was seen this contained 2 written references a Protection Of Vulnerable Adults (POVA) 1st check and a Criminal Records Bureau check both were completed and returned before the person started work. The Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 19 The files contained proof of identity and a copy of the company’s terms and conditions. They had also been issued with the company’s staff handbook. There was also evidence that they had been issued with the General social Care council code of conduct. New staff received structured induction training, which follows the skills for Care specifications. The manager has assessed the training needs of all the staff and has encouraged them to participate in National Vocational Qualifications. The manager said that she is developing the training for the home around the needs of the people living there. All staff have also completed training in understanding epilepsy. The Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,42 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. People who live in this home benefit from a manager who understands her role and is able to take into account people’s views of the home and use it to develop the service. Systems in the home protect the health, safety and welfare of the people living there. EVIDENCE: The manager has a good understanding of her role and responsibilities. The manager is undertaking the National Vocational Qualification expected of a registered manager. During the visit there was a staff team meeting taking place. There is a corporate quality assurance policy in place. All the results from surveys are centrally collated and a report is produced. There was evidence of The Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 21 some of the survey forms returned and the ones sent to people who use the service used symbols and pictures. The fire records for the service were seen and were up to date and accurately completed. At the time of the visit there had already been four fire drills were the home was evacuated two during the day and two at night. As the home has been open just under six months the certificates of servicing were all up to date and equipment brought into the home had been tested. At the beginning of the inspection there was a regulation 26 visit taking place by a senior manager in the company. The reports of these monthly visits were seen and provided a good record of action taken following each monthly visit. The Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 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 2 23 X ENVIRONMENT Standard No Score 24 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 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 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 2 X 3 X 3 X X 3 X The Piers DS0000070797.V367504.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. 1. Standard YA6 Regulation 15(1) Requirement The registered manager must ensure that care plans detail the changing needs of the individual especially with regard to any medical care that is being given. The registered manager must ensure that the correct current good practice is followed for the safe administration of all medicines. Timescale for action 30/09/08 2. YA20 13(2) 30/09/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA17 Good Practice Recommendations The registered manager should ensure that more consistent records are kept of people’s nutritional intake and their weight is recorded regularly and any gaps recorded. The registered manager should consider a more userfriendly format of the complaints procedure for the people who live in the home. This should be done in consultation with them. The registered manager should arrange for further training DS0000070797.V367504.R01.S.doc Version 5.2 Page 24 2. YA22 3. The Piers YA35 for staff to enhance their understanding of the needs of people with both physical and learning disabilities. The Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 25 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 Piers DS0000070797.V367504.R01.S.doc Version 5.2 Page 26 - 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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