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. The AQAA has told us that a resident who`s first language is not English has been provided with satalite TV to access programmes in her or his mothertongue. Relatives and staff who share the language in common have translated documentation relating to the home, such as the statement of purpose and service user guide. What has improved since the last inspection? New walk in showers have been provided and the bathroom has been refurbished. Some parts of the home have been re-decorated. CARE HOMES FOR OLDER PEOPLE Z & M Care 8 Lyndhurst Road Hove East Sussex BN3 6FA Lead Inspector Mrs Sue Gaskell Unannounced Inspection 18th March 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Z & M Care Address 8 Lyndhurst Road Hove East Sussex BN3 6FA 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) 01273 323814 01273 748172 Lyndhurstcarehomes@hotmail.com Z & M Care Limited Mrs Zara Fatemeh Moussavi Care Home 37 Category(ies) of Learning disability (20), Old age, not falling registration, with number within any other category (37) of places Z & M Care DS0000014211.V359554.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 thirtyseven (37). Service users accommodated will be older people of which twenty (20) may have a learning disability. Service users will be aged sixty (60) years and over on admission. That the home may admit one named service user who is under the age of sixty-five (65) years of age. Date of last inspection Brief Description of the Service: Z&M Care older peoples unit is registered for 37 residents, 20 of whom have a learning disability. Z&M Care also have an adjacent and integral group home, which is registered for 7 adults (18-65) years with a learning disability. They are inspected as separate homes, this report if for the home for 37 Older People aged over 65 years. The home is part of an Edwardian terrace that has been extended to meet the needs of its residents. It is situated in a residential road near to the busy Seven Dials area of Brighton and Hove City that has facilities for shopping, including a bank and post office, cafes and a restaurant. The home is close to both Brighton and Hove mainline stations. Parking is available in the roads near to the home and is either resident parking only or via a meter system. Public transport is available locally to all parts of the city. The area is well served for parks, churches, pubs and leisure activities including the Sussex County Cricket Ground. The main ethos of the home is to provide the residents with a homely environment and to promote independence. The fees range from £360 - £1052 per week. Previous inspection reports can be obtained from the home. Z & M Care DS0000014211.V359554.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. The home currently has one vacancy. We spoke with 4 residents, the registered manager, deputy manager, and the care manager. We toured the building and looked at all communal areas. One resident showed us his or 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 saw other information, including 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 no requirements 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 DS0000014211.V359554.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. The AQAA has told us that a resident who’s first language is not English has been provided with satalite TV to access programmes in her or his mothertongue. Relatives and staff who share the language in common have translated documentation relating to the home, such as the statement of purpose and service user guide. What has improved since the last inspection? What they could do better: Ensure that daily reports are factual and informative. Ensure that medication is stored securely and appropriately. Ensure that there are no potential hazards around the home, for example from unrestricted windows or wardrobes. Continue with programme of refurbishment and re-decoration. Ensure that staff receive training in any specialist conditions affecting residents, for example, diabetes. Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 7 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 DS0000014211.V359554.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People who use the service experience good outcomes in this area. The statement of purpose and service user guide says what service will be offered. Prospective residents can be confident that their needs can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 10 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 provider supports a resident whose first language is not English through direct translation with these documents, but they are currently not in a printed format in this language. Six care plan files were examined, including three referring to residents who have been admitted recently or since the last inspection. All files inspected include basic pre-admission assessments carried out by the home, some with supporting information from health care professionals or care managers. Several residents and/or their relatives confirmed that the residents had visited the home prior to admission and that the manager had also visited them in their own homes or in hospital. Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience good outcomes in this area. 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, but the current storage arrangements could compromise security and confidentiality. Residents are treated with respect. This judgement has been made using available evidence including a visit to this service. Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 12 EVIDENCE: Each resident has a care plan that includes personal and healthcare needs, likes and dislikes, moving and handling assessments and some risk assessments. 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. Although there are daily records on each resident, the majority of the entries were not specific, for example they stated “no problems” or “ Mrs X is OK today” and they provided little information on what the residents have actually done during the day. Residents have access to local health care services. The local District Nurses, Diabetic Nurse or specialist nurses call regularly. Residents are able to choose their own GP and all have access to dentists, opticians and other community services. Residents’ healthcare needs are generally monitored and appropriate action taken. The manager said that she seek professional advice on health care issues. There is also evidence in the care plan of monitoring residents’ health care needs and general well being, for example some residents are weighed weekly. The home has a medication policy which is accessible to staff. The medication records are up to date for each resident. There are appropriate records for the receipt, administration and disposal of medication. The medication is currently stored in a cupboard which also contains gas and electricity equipment and it is sometimes necessary for people unconnected with the home to have access to this cupboard. Therefore the manager will need to ensure that security and confidentiality can be maintained at all times when access is required. The home has prepared risk assessments for residents who have expressed a wish to look after their own medication. Risk and other assessments take place through the care planning system to find out which residents may take a role in managing their own medication. The records showed that medication is administered by staff who have been trained to do this task. Staff members confirmed that only staff who have attended this training can administer medication. Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 13 Staff spoke of the need to treat residents with respect and to consider dignity when delivering personal care and staff were seen to assist residents with great sensitivity. Two residents said that they like living care in the home and two residents’ relatives said that the care is good. Local care managers who have visited residents in the home said that there are no issues regarding the home and that they consider the care to be good. Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 People who use the service experience good outcomes in this area. Residents’ lifestyle preferences and expectations are generally met. 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: Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 15 The care plans contain a list of residents’ needs, likes and dislikes and preferences. There was evidence in the residents’ daily records to show that families, and other visitors are encouraged and welcomed. We also spoke with two relatives who visit on a very regular basis. They all said that they are always made to feel welcome and offered refreshments and meals. Staff said that residents generally get up and go to bed at the time they choose although this is not always possible if they require assistance. One member of staff said that they try to bear in mind which residents like to get up early and who like to stay in bed later. They try to plan around meeting preference when supporting those residents who require a greater degree of assistance. One resident said that generally people who live in the home can do what they please. Seating in the dining room is available but meals can also be taken in the lounge, or in bedrooms, if this is preferred. The food served on the day of the inspection appeared appetising and wholesome and the residents said that it tasted good. The manager said that meals provided are mainly based on what residents like, but the home also takes into account the need for a reasonably balanced diet. One person said that there generally is not a choice as such but that residents could have an omelette or sandwich as an alternative. The AQAA told us that there is a programme of activities that is tailored to meet the interests of both individuals and groups, and that suggestions for changes come about through residents meetings. It did not specify what these activities were, but were later told by the manager that they were extensive. We found during the visit that activities for residents on the day included bingo or armchair exercises, which staff help facilitate. The home keeps a record of the activities carried out by residents. The manager said that the home is not involved in all residents’ finances as they are dealt with either by families or the local authority finances officers. We were shown the records and receipts, which are kept wherever the home assists residents. The manager and deputy manager said that there is only one resident at present from a different ethnic or cultural background but that person has no special religious needs. Other residents who have expressed interest have been supported to follow their religious beliefs. The manager also said that Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 16 residents would be supported with personal relationships whatever their gender or choice of lifestyle. Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good outcomes in this area. Residents can be confident that 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: The majority of staff have undertaken training in the area of ‘safeguarding adults’ either through attending a specific training course or/and as part of NVQ training – a nationally recognised care qualification. The AQAA told us that this is also part of the induction programme. Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 18 The member of staff spoken to showed a good awareness of safeguarding adults issues and were aware of the home’s “whistle blowing” procedures. The home has information on the East Sussex County Council safeguarding adults policies and procedures. The home has a complaints procedure with an appropriate recording system. There is a complaints form but this is not translated for people whose first language is not English. The owner / manager has verbally translated this for the individual. The AQAA tells us that the home recognises that they could produce this information in ‘easy read’, using symbols and also in other languages. They tell us that they plan to do this in the next 12 months. Relatives said that they would feel comfortable mentioning any problems to the manager or and one relative said that they were sure that any issues would be resolved speedily and without fuss. Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience good outcomes in this area. Residents live in a comfortable, safe, clean environment. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 20 The building is on three levels but the lift only goes from the ground to first floor. There is no access to the top floor other than by stairs, therefore this part of the home is not suitable for people with impaired mobility. However, all residents currently living on the second floor have full access and free mobility. The owner / manager has told us, in the AQAA, that they have submitted plans to extend the lift provision, so as residents needs change, the building will be ready to respond. There have been difficulties obtaining this, and the owner is therefore considering a suitable alternative so the second floor becomes more accessible. There are interconnecting corridors to the home next door, which is registered for people with a learning disability. The home has an alarm call system. Two walk in showers and one new bath have been installed since the last inspection. There are some shared rooms. One shared room has curtain style screening between the beds to give some privacy. Another room currently has no curtain but there is a mobile “hospital style” folding screen. We advised the manager to prepare a risk assessment for the use of this screen as the style of it makes it unstable. All bedrooms and living areas are furnished and decorated to a reasonable standard, and contained the type of furniture and equipment necessary to provide a homely environment. Beds and bedding are of a good standard. The resident’s rooms are personalised with their own pictures, ornaments and flowers. New carpets and furnishings have been provided recently. There is an ongoing programme for re-decoration and refurbishment. The AQAA tells us that the communal areas and bathrooms have been reviewed and improved and that residents are consulted about decorative changes. There is a ‘green’ awareness, the owner hopes to improve the home’s recycling record. 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 areas were seen to be clean and hygienic. 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 DS0000014211.V359554.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience excellent 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 very 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 a range of care staff, managers and support from domestic staff. This staffing level appears adequate to meet the current number of residents’ needs (i.e. 37 residents) in terms of their daily care and the home’s domestic needs. Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 22 We looked at four staff files. They all contained evidence of work references, Criminal Records Bureau (CRB) and other checks, such as Protection of 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 manager said that all of the staff have either achieved or are undertaking their NVQ’s. The AQAA tells us that 100 of existing staff at that time (January 2008) held an NVQ award. The training programme since the last inspection has included dementia awareness, health and safety, safeguarding adults and infection control. There are four residents in the home with diabetes, whom the manager confirmed shortly after the site visit receive support from staff who have had specific training. The information stated that this is provided on a regular, rolling basis by a qualified nurse care manager. The AQAA went on to show that training was provided around the assessed needs of service users. The manager clearly noted that areas more specific to supporting people, such as sexuality and dementia awareness for people who have learning disabilities was something they aim to improve on. However, the emphasis on training and development is excellent and the AQAA and previous inspections clearly show continued commitment in this area. Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, & 38 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. Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 24 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 resident 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 deputy manager said that residents can access the garden through the laundry room but we did not see a risk assessment specifically for this. We were assured that the annual health and safety risk assessment took this route into account. This was specially reviewed when the smoking area was relocated to the outside of the home. There were no obvious safety hazards around the home, and there was evidence to show that health and safety issues are taken seriously for example 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 person. 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, for example gas, electricity, are carried out. Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP19 Good Practice Recommendations Ensure that medication is stored securely and appropriately. Ensure that there are no potential hazards around the home, eg from unrestricted windows or wardrobes. Z & M Care DS0000014211.V359554.R01.S.doc Version 5.2 Page 27 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 DS0000014211.V359554.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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