Care Home: Z & M Care

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What the care home does well The home prepares care plans, which assists staff in monitoring resident`s healthcare needs and providing consistent and appropriate care. Staff are trained and well supported. The home provides a comfortable, homely, clean environment. New staff have the proper checks before they are allowed to work with residents. Staff told us the procedures they take to make sure they and residents are protected from cross infection. This tells us that the home have a good induction and training process. Visitors have told us that they are made to feel welcome. What has improved since the last inspection? New formats have been prepared for person centred care plans and risk assessments. What the care home could do better: Provide information for residents in a pictorial or other more easily understood format. Make sure that medication is stored securely and appropriately in a cupboard designed for this special use. Ensure that there are no potential hazards around the home, for example from cleaning materials. Continue with programme of refurbishment and re-decoration. Ensure that staff receive training in any specialist conditions affecting residents, for example, diabetes. CARE HOME ADULTS 18-65 Z & M Care 12 Lyndhurst Road Hove East Sussex BN3 6FA Lead Inspector Mrs Sue Gaskell Unannounced Inspection 18th March 2008 09:30 Z & M Care DS0000014112.V359553.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 Z & M Care DS0000014112.V359553.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. Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Z & M Care Address 12 Lyndhurst Road Hove East Sussex BN3 6FA 01273 323814 01273 748172 Lyndhurstcarehomes@hotmail.com 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) Z & M Care Limited Mrs Zara Fatemeh Moussavi Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is seven (7). Service users must be aged between eighteen (18) and sixty-five (65) years on admission. Only service users with a learning disability to be accommodated. That the home may admit one named service user who is over the age of sixty-five (65) years. Date of last inspection Brief Description of the Service: This report has been written for the Younger Adults home of Z&M Care. This home is registered for seven residents with learning disabilities between the ages of 18-65 years; it is adjacent to the larger home that provides care for thirty-seven residents in the older people category (over 60 years) of which 20 have learning disabilities. The homes are integral but are run separately and inspected independently. The home is part of an Edwardian terrace that has been extended and renovated to accommodate service users in both homes. It is in a residential road, near to the busy Seven Dials area of the city that has facilities for shopping including a bank and a post office. The home is also close to both Brighton and Hove mainline stations and local buses stop nearby for all parts of the city. Parking is available in the roads near to the home and is either resident only parking or via a meter system for 4 hours at any one time. The home has a parking bay outside for resident transport. The area is well serviced for parks, churches, pubs and leisure activities including the Sussex County Cricket Ground. The home states that its ethos is to promote independence in a caring and homely atmosphere. The fees range from £360 - £685 per week. Previous reports can be obtained from the home. Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 18th March between 9:30am and 3:55pm. This time was divided between the sister home mentioned above, as the management systems are very similar, and are owned and run by the same provider. There were 7 residents in the home and no vacancies. We spoke with 2 residents, the registered manager, deputy manager, and the care manager. We toured the building and looked at all communal areas. One resident showed us her bedroom. The inspection process also consisted of information collected before and during the visit to the home, and feedback from two residents’ relatives and two local care Managers after the site visit finished. We also saw and assessed other information such as general assessments, risk assessments and care plans, medication records, the duty rota and staff recruitment and training records. We used the AQAA for information – this is the Annual Quality Assurance Assessment, and is a legal document that the home need to complete each year. This was provided when we asked for it, and was completed to a good standard. There were no outstanding requirements from the previous inspection and one requirement was made following this inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. What the service does well: The home prepares care plans, which assists staff in monitoring resident’s healthcare needs and providing consistent and appropriate care. Staff are trained and well supported. The home provides a comfortable, homely, clean environment. Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 6 New staff have the proper checks before they are allowed to work with residents. Staff told us the procedures they take to make sure they and residents are protected from cross infection. This tells us that the home have a good induction and training process. Visitors have told us that they are made to feel welcome. 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. Z & M Care DS0000014112.V359553.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 Z & M Care DS0000014112.V359553.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): 1&2 People who use the service experience good outcomes in this area. The statement of purpose, service user guide and individual statement of terms and conditions, clearly says what service will be offered. Prospective residents can be confident that their needs will be assessed and can be met This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s Statement of Purpose and Service User Guide are reviewed and amended regularly and provide residents, prospective residents and their relatives with information about the home. The home is still working on the pictorial format which was discussed at the previous inspection. No new residents have been admitted since the last inspection and most of the residents have lived in the home for many years. However, the records indicate that there would be an appropriate referrals procedure and that an assessment would be carried out prior to admission. Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 9 Prospective residents would be given the opportunity to visit the home prior to admission. Z & M Care DS0000014112.V359553.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 People who use the service experience good outcomes in this area. The care plans are easy to use and descriptive. Residents’ choices are respected and their decision-making is well supported. Residents are supported in taking risks in the daily and social activities that form part of an independent lifestyle. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The care plans of the four residents were examined in detail. The files include residents’ personal profiles, mobility, dietary and other assessments and the resident’s likes and dislikes. There are also some guidelines on how the home will assist residents in achieving their short and longer term goals. Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 11 Residents have key workers who monitor their individual needs and activities. The records showed that the care plans are updated following the reviews or as and when their care needs change. The care manager, who is responsible to the registered manager, referred to preparing person centred care plans where the residents have been encouraged to participate as much as possible. Risk assessments are in place and the AQAA has told us that staff support residents to review these each month. There is no standard format for risk assessment, as the home aims to develop each one with a person centred approach in a way that is right for the individual. Staff confirmed that issues relating to confidentiality are addressed during the induction period. All records are stored in a lockable office and there was no public display of confidential or personal information. Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 People who use the service experience good outcomes in this area. Daily life meets the residents’ lifestyle preferences and expectations. Residents have regular contact with their families and friends. Residents receive a nourishing and balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The residents in the home have been together for many years and are used to living together as a family. Two residents said that they like living in the home. Most of the residents attend the day centre for five days of the week. Some residents have attended college courses and there is a computer in the sun Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 13 room of the older people’s home for use by residents of both homes. Residents also enjoy going shopping or out to pubs. One resident who prefers not to go out spends much of his time in the next-door home for older people. One resident’s relative said that the home has been able to make allowances for that resident as his or her needs have changed. There is evidence in the residents’ daily records to show that families, and other visitors are encouraged and welcomed. Two of the residents’ relatives were full of praise. They said the staff are helpful and easy to talk to, and that they always make time for them when they visit. Residents have individual bank accounts which are regularly audited, with appropriate receipts and records kept. Staff signatures are required for monies taken out when residents spend money on social activities such as going to the pub. Residents are part of the local community. They are encouraged to shop and bank locally and use public transport. A member of staff said that meals provided are mainly based on residents’ choices, but staff also take into account the need for a reasonably balanced diet. Residents help prepare and cook their meals. The store cupboard contained a range of food including fresh fruit and vegetables. The staff said that there are no residents at present with different ethnic or cultural needs, as the current residents tend to come from the local communities. Residents are supported in attending any church services of their choice. The home has a policy in place regarding personal relationships and the deputy manager said that residents would be supported with this or with any other personal needs. Z & M Care DS0000014112.V359553.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 People who use the service experience good outcomes in this area. Residents’ choices over their care are respected. Residents’ care plans are reviewed and their health care needs are met. Residents are protected by the home’s policies and procedures for administering their medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the residents were seen to be relaxed and comfortable interacting with staff. Residents care plans and daily records include guidelines on providing support and monitoring health care and social care needs. There is regular input from a variety of healthcare professionals. Two relatives said that residents are also referred for specialist help if they have other Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 15 individual health care needs. The home keeps good records of GP’s and community nurses’ visits etc, together with any subsequent advice. The manager and all members of staff showed a high level of awareness of residents’ needs and referred to a variety of issues, such as the importance of ensuring that residents’ needs are treated with sensitivity and that the care is consistent. Two professional from the local care management team said that there are no concerns or issues with the home and that the home keeps them informed of any particular needs or developments. The home has sound medication procedures. Staff confirmed that only when trained may they administer medication. They said that all staff are required to read the procedures stored in the medication file. Residents have direct support from staff for medication storage. Staff administer this from a central cupboard. There are no assessments in place to see if residents, with support, could take a bigger role in this process. The medication records are clear and current and there is a system for the receipt and disposal of medication. However the medication is stored in a communal area in a cupboard that is not purpose built and does not have a lock built into it. The manager said that this will be reviewed. Z & M Care DS0000014112.V359553.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 People who use the service experience good outcomes in this area. Residents can be confident their complaints will be listened to and dealt with appropriately and that they will be protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents are given as much information as possible on the home’s complaints procedure which is included in the service user guide. The home has safeguarding adults procedures in place and has a copy of the East Sussex County Council procedures displayed in the office. Staff confirmed that they have received training on recognising and reporting any form of abuse as part of either safeguarding adults or other training sessions. Staff said that they have attended training sessions on how to intervene appropriately in difficult situations. The home has sound recruitment procedures in place and staff said that they had not been able to start work until CRB, POVA, references and other checks had been completed. Staff said that they are aware of the home’s “whistle blowing procedures. Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, & 30 People who use the service experience adequate outcomes in this area. Residents live in a clean, comfortable environment but there is still a need to improve furnishing and decoration and to ensure that there are no safety issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We were shown around the premises by the Deputy Manager and were also shown some of the individual rooms by residents. The home is run separately and independently from the adjacent home belonging to Z&M Care, which are physically linked. Shared facilities are limited to the fire routes and systems. The building is on three levels. All residents are in single room accommodation, and rooms are fitted with alarm call buttons. All bedrooms and living areas are furnished and decorated to a reasonable standard, and contained the type of furniture and equipment necessary to Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 18 provide a homely environment. Beds and bedding are of a reasonable standard. The resident’s rooms are personalised with their own pictures, ornaments and equipment. Although some new carpets and furnishings have been provided recently, there are areas of carpet on the second floor which require cleaning or replacement. There is an on-going programme for re-decoration and refurbishment. The manager has made clear in the AQAA that these matters are planned for and will be improved on a rolling basis. Some of the bedroom doors have a lock that is of a type not recommended as it has a “snib” button. This can act as a ‘dead-lock’ which staff would not be able to over-ride in the event of an emergency. The manager said that this would be attended to very quickly. All of the radiators have been fitted with protective covers and windows are fitted with restrictors. There is one window without a restrictor and the deputy manager said that this would be attended to immediately. All areas were seen to be clean and hygienic. However, the shower cubicle in the first floor bathroom is heavily marked and worn and requires attention. At the time of the inspection there were some cleaning materials, including bleach, which were stored in an unlocked cupboard underneath the kitchen sink. This should be locked away to protect residents who may need additional support when using these products. There is a small but well-maintained garden and patio which is used by the residents. Staff said that residents do use the garden sometimes. Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 19 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 People who use the service experience good outcomes in this area. Staffing numbers are adequate to meet the daily needs of the residents. Residents are protected and supported by the home’s recruitment and induction training procedures. Residents benefit from a well trained and supported staff team. This judgement has been made using available evidence including a visit to this service. EVIDENCE: At the time of the inspection there were two staff on duty. There were also the registered manager, deputy manager, cook, two domestic assistants and a maintenance person in the adjoining home for older people. This staffing level appears adequate to meet the current number of residents’ needs (i.e. 7 residents) in terms of their daily care and the home’s domestic needs. We looked at four staff files. They all contained evidence of work references, Criminal Records Bureau (CRB) and other checks, such as Protection of Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 20 Vulnerable Adults register (POVA). Whilst there is a turnover of staff, there is a core group of staff who have worked in the home for some while. Two recently employed members of staff confirmed that staff must complete application forms, and that they cannot start work until the home has obtained references, CRB and POVA checks, and evidence of their identity. The home also verifies the working permits of staff recruited from overseas. Staff confirmed that there is induction training and regular formal or informal supervision. The AQAA confirmed that there is a proactive approach to safeguarding people through solid, consistent recruitment processes. The care manager, who manages the day-to-day running of this side of the home, said that all of the staff have either achieved or are undertaking their NVQ’s – a nationally recognised care qualification. The care manager has completed NVQ training to Level 4 and has commenced the Registered Managers Award (RMA). The training programme since the last inspection has included dementia awareness, health and safety, safeguarding adults and infection control. Although there is a resident in the home with diabetes there has not been any formal training provided in diabetes awareness. This could put the person at risk if staff needed to support her or him in an emergency situation. . Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 21 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 People who use the service experience good outcomes in this area. The current management arrangements ensure that the home is being run in a way which benefits residents and staff. The record keeping, and health and safety systems are sufficient to safeguard residents’ welfare, rights and best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager, although already professionally qualified, has also completed her Registered Manager’s Award. The deputy manager has completed NVQ level 3, and is working towards level 4. The care manager has Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 22 completed NVQ training to Level 4 and has commenced the Registered Managers Award (RMA). The management of the home and completion of records are generally of a good standard. One member of staff said that morale in the home is good and that the owner/manager and deputy manager are supportive. Quality assurance is carried out through regularly reviewing policies and procedures, and through obtaining feedback from quality assurance surveys. Staff said that residents’ views and feelings are regularly questioned and monitored, either through talking to them, observing them to see whether or not they appear happy. The manager said that any feedback from residents and/or their families or advocates is acted upon. One Care Manager, who has reviewed clients in the home also confirmed this. The layout of the home is such that residents must access the dining room by walking through the kitchen, but there did not appear to be a risk assessment specifically for this. There were no obvious safety hazards around the home, and there was evidence to show that health and safety issues are taken seriously e.g. staff showed an awareness of infection control procedures, and fire safety procedures. Accident records are collected and risk assessments for residents and the environment have been carried out. The home employs a part time maintenance man. The deputy manager has responsibility for routine testing of equipment and ensures that regular weekly tests are carried out and recorded. Staff have had fire safety training and there are regular fire drills. There are current certificates to show that regular checks e.g. gas and electricity, are carried out. Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 23 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 3 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 3 23 3 ENVIRONMENT Standard No Score 24 2 25 2 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 4 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 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 3 3 3 X 3 X 3 X X 3 X Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 24 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 YA24 Regulation 13(4)(a) Requirement To protect residents potentially hazardous chemicals stored around the home must be locked away when not in use e.g. cleaning materials. To protect individuals, staff must receive training in any specialist conditions affecting residents, e.g. diabetes. Timescale for action 22/03/08 2 YA35 18(c)(i) 01/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA1 YA20 Good Practice Recommendations Provide information for residents in a pictorial or other more easily understood format. Ensure that medication is stored securely and appropriately. Assess individuals to see if they are able to take a role in medication management. Continue with programme of refurbishment and redecoration. 3 YA25 Z & M Care DS0000014112.V359553.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Z & M Care DS0000014112.V359553.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. 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