Inspection on 13/03/08 for Greenhill House

This is the latest available inspection report for this service, carried out on 13th March 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Greenhill House 27/01/06

Greenhill House 14/07/05

Greenhill House 12/01/05

Greenhill House 06/07/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Greenhill House Tweentown Cheddar Somerset BS27 3HY Lead Inspector Barbara Ludlow Unannounced Inspection 13th March 2008 10:40 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 Greenhill House DS0000015979.V358463.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. Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenhill House Address Tweentown Cheddar Somerset BS27 3HY 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) 01934 742280 01934 743476 avril.wright@somersetcare.co.uk Somerset Care Limited ** Post Vacant *** Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24/04/07 Brief Description of the Service: Greenhill House is located on the outskirts of the village of Cheddar, where there are a range of shops, banks, post office, churches and public houses. The home is registered with the Commission for Social Care Inspection (CSCI) to provide personal care for 26 people over the age of 65. Mrs L.Tungate is temporarily managing the home; the registered providers are Somerset Care Ltd. There are lawns at the front of the building and a patio area accessed through the homes conservatory. There are parking facilities at the side of the house. Greenhill House is a purpose built residential home providing accommodation on one floor. There are two lounges, a number of open plan sitting areas, a conservatory and a dining room. There are 22 single rooms and 2 double rooms. One single room has an ensuite facility. There are 7 communal toilets and 2 bathrooms fitted with bath hoists. All rooms are fitted with an emergency call system and individual bedrooms are fitted with locks. A pay phone is available for people to use and people in residence are able to have a private telephone in their room if they wish. The current fee range is £373 to £450 per week. Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Annual Quality Assurance Assessment was completed for the commission in February 2008. This inspection of the service follows the CSCI ‘Inspecting for Better Lives 2’ framework. The focus is on outcomes for service users and the quality of the service is measured under four general headings. These are; - excellent, good, adequate and poor for the seven chapter outcome groups and an overall quality rating is then calculated: : The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Questionnaires were sent by CSCI to people living at the service, relatives, visiting professionals and staff working at the home. Responses were received from one person in residence, six relatives, three visiting professionals and four staff. The analysis of their views of the service provision is incorporated in the inspection report. This inspection visit was undertaken over the period of one day by an inspector for CSCI and was well received at the home. Mrs L.Tungate, the Registered Manager from another Somerset Care Home, is temporarily managing the home. Mrs Tungate was available throughout the day to assist with the inspection process. The inspector met with people living at the home, their visitors and staff on duty throughout the day. A tour of the premises was made, communal rooms were seen and bedrooms were sampled. An invitation to lunch was made and lunch was taken in the dining room with people living at the home. Activities were observed and people attending the home for day care were seen and spoken with. Records were sampled, these included care plans, contracts, health and safety monitoring, staff recruitment and training files. The homes administrator gave her time to ensure access to records was possible at the inspection. Feedback was given to the manager at the end of the inspection day. The inspector would like to thank people seen for sharing their experience of the living at and of visiting the home. Thanks also to the manager and staff for their help and cooperation with the inspection process. Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The monitoring of personnel files and management of Criminal Record Bureau information should be improved. Correct information should be stored in the files. Capillary blood sugar monitoring by care staff should be carried out in line with the guidance from the Medical Devices Agency to reduce the risk to staff of needle stick injury from contaminated lancets. Staff need to use safer lancet holding devices such as the style that ejects the soiled lancet without direct contact. Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 7 Where fire alarm testing is usually carried out each week by designated staff. This should be monitored and delegated when holidays and sickness absence occur. 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. Greenhill House DS0000015979.V358463.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 Greenhill House DS0000015979.V358463.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): 3, NMS 6 does not apply. Quality in this outcome area is good People can make an informed choice of Greenhill House. There is information available about the home and pre admission assessment is carried out to ensure care needs can be met at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a statement of purpose and service user guide. At the last inspection it was reported that an information leaflet ‘Welcome to Somerset Care’ had been produced in Braille. One person who has moved into the home since the last inspection said they were pleased to have been able to take up a vacancy and found the staff ‘ever so kind’. The care plan showed that information regarding their transfer and Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 10 the community Single Assessment Process (SAP) document had been taken up to inform their assessment before admission. This information was on file. Their care plan was person centred and detailed. Contractual arrangements were sampled; the records were clear and satisfactory. Greenhill House DS0000015979.V358463.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 Quality in this outcome area is good Care plans are in place and detail relevant information for the individuals at the home. Medication was safely managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans were sampled. These were chosen to look at the process for care planning being developed from pre admission assessment, for the management of people with a chronic health condition and people with higher care needs. The care planning system has been developed to make it more person centred and the home will computerising records from April 2008. Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 12 Care plans contained moving and handling assessment. Nutritional risk is assessed. Pressure sore risk is assessed using the Waterlow score. Care plans are reviewed each month. There was monitoring of chronic illness such as diabetes. The inspector noted that the care staff are trained to undertake capillary blood sugar monitoring but were not using lancets recommended by the Medical Devices Agency (MHRA). The manager planned to address this with the local prescribing Doctor, after the inspection. Very positive feedback was heard from three visiting professionals, comment was made on the atmosphere, the ‘homely environment’ and staff being ‘helpful and caring’ and ‘confident’. The care given was praised and staff were described as ‘truly caring’ and ‘interested’. An ‘organised home’ with a ‘nice atmosphere’. Staff had been seen to ‘knock on bedroom doors before entering’. Under what do you think the service does well? one had written, ‘personal care’ and ‘care plans’ and another ‘respond respectfully to peoples needs’ and ‘willing to work with the health professionals to achieve the most appropriate care for individuals’. One relative said they felt the staff need to understand more about ‘anxiety’ and responding with understanding to someone who is anxious. One person spoken with said that staff are sympathetic and good, they also said their medication which has to be taken at set times, is delivered punctually. People looked well cared for and those spoken with confirmed that they are well cared for. All observed staff interactions between staff and people living at the home were friendly and helpful. Medication management was seen. The staff have received training in medications management and the systems in place were organised. Two medication rounds were briefly observed; these were both safely carried out. The medication administration records (MAR) were checked. One prescription was as directed by the doctor and the dose was not clearly indicated. The dose was recorded elsewhere and had been properly administered at all times. It is recommended that the doses prescribed be clearly recorded and countersigned on the MAR sheet. Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 13 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 Quality in this outcome area is good The home has a range of activities for people to join in with if they wish. Families and friends are made welcome. The food offered is good quality and appetising. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a notice board centrally placed between the entrance and the dining room; most people will walk past this each day. There were photos of recent events at the home such as a visiting band of musicians and Pancake Day. There was a birthday announcement and the menus for the day. On a table in the foyer there is a staff training book containing certified training undertaken by care staff working at the home. This is placed for people and their visitors to browse if they wish. Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 14 People were up and about at the start of the inspection and two day care people were chatting together with people in residence in one of the open seating areas at the front of the home. Visitors were spoken with as they arrived to visit someone celebrating a birthday. They said they are made welcome and were known to staff at the home. A tour of the premises was made and people were seen and chatted with. Activities took place in the lounge during the afternoon; it was a quiz game run by the activities coordinator and was well attended. People seemed to be happy and content living together at the home. Friendly chatting and respectful banter with staff was overheard. People living at the home expressed their appreciation of the care and attention they receive at the home from the staff team. People were asked about activities and said they have plenty to do. One person said they join in the exercise class and had attended the residents meeting commenting also that it was well supported by residents and families. People said their families and friends are welcomed and sometimes take them out. One visiting professional commented on the religious observation being supported. There is a service at the home each month. Both lunch and tea were observed being served. Meal times are unhurried, social occasions. The food is home cooked and served hot. People commented how much they enjoy their meals. The inspector was invited to stay to lunch; the meal of roast chicken, broccoli and cauliflower bake, vegetables and roast potatoes was nicely presented and delicious. Day care people said they particularly enjoyed lunch and commented that the cook knows everyone and comes to speak with them. The manager confirmed that the home has not yet adopted the corporate menus. These are being introduced by Somerset Care to ensure a well-balanced nutritional level is met in the daily menus. Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome area is good The home has a complaints procedure and invites concerns be raised via ‘Seeking your views’. The well being of people at the home is safeguarded through good practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no complaints made to the home or to CSCI since the last inspection. Staff recruitment files were sampled and there was evidence of Criminal Record Bureau (CRB) checks having been undertaken for staff employed at the home. Staff spoken with at the inspection confirmed having received induction training, which included abuse awareness. People living at the home who were asked said they would be able to raise any concerns or speak with the staff if unhappy. Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26 Quality in this outcome area is good The home is warm, clean and safely maintained. The responsibility for weekly fire safety testing needs to be reviewed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Greenhill House has a locked front door and visitors are asked to sign in on arrival. The hallway is bright and clean and there are open seating areas, which are well used. There are notice boards and photographs on display here for people and their visitors to see as they pass by towards the dining area and some bedrooms. Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 17 The home has a calm and welcoming atmosphere. There are views out onto the gardens that are used in warmer weather. There is a car parking area outside the dining room. The manager’s office has been relocated into a staff area. A tour of the premises was made, the communal areas were seen and the bedrooms sampled. The communal lounges are comfortably furnished. The dining room has been refurbished with new dining tables and chairs and some redecoration. Some new carpets have been laid. Some of the bedroom accommodation in this home is small. Bedrooms can be personalised and people were seen to have their personal belongings around them. The home is warm and clean throughout and was fresh smelling. The premises are well maintained. Two bedrooms were seen where the decoration looked ‘tired’ but was clean, the person in this room was happy with its condition. Staff have access to hand washing facilities throughout the home and to protective clothing such as gloves and aprons when needed. Hand cleanser is also available for hand hygiene. Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good The home has a sufficient staff number to meet the needs of the people living at the home. Staff have the skills and training to provide a safe care service. Recruitment is safely managed to protect people from the risk of harm or abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a staff team of 21 care and senior care staff, 15 have an National Vocational Qualification in care this equates to 81 which exceeds the National Minimum Standard, this was set for 2005. Staff on duty were spoken with at the inspection visit and 4 staff responded in writing on the comment cards returned to CSCI. Staff confirmed having recruitment checks before they started working at the home. Staff were positive in their appraisal of the home and the service they deliver saying that they work ‘hard’, ‘work well as a team’ and ‘provide a good level of care’. Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 19 This was reflected in the feedback from people who live at and use the service. Comment included that staff are ‘helpful’ and ‘kind’. Professional visitors had noticed that staff are helpful and professional and this was written on the feedback forms sent to the commission. Visitors found that staff make them welcome and mostly were happy with the care of their relatives and friends. Relatives said that ‘some staff are excellent’, ‘some not very understanding’. One person said that ‘on the odd occasion things are not relayed back to the person who needs to know first’. People commented on the environment being small rooms with no en suite facilities. Others said ‘excellent friendly home’,’ good staff’, and ‘good food’. Staff files were examined for four members of staff. Applications forms had been completed, CRB checks had been made and Protection of Vulnerable Adults (POVA) checks had been recorded. Health screening questionnaires had been completed and induction had been given or was in progress. Reviews and supervision records were seen. One person had a CRB returned for incomplete data and this had been filed away as if complete. The POVA first check was on file and the manager confirmed that the person had been employed with supervision during the their employment but had since left the home. This was brought to the attention of the manager at the inspection. CRB checks are stored securely between inspection visits when they can be sampled. The company record relevant information on a form to allow the original document to be shredded in line with Data protection. The information recorded on one format seen was the wrong; the CRB application form number had been recorded rather than the required disclosure number. Personnel files should be reviewed and the information vetted to ensure it is correctly recorded and is complete. The Friends and Relatives of Greenhill House do not have CRB checks. It was suggested that people in this group who may have one to one contact with people who live at the home, such as the mini bus drivers, should undergo CRB checks in their capacity as volunteers. This check is free for volunteers. There had been no staff agency used, staff had worked extra shifts were needed for cover. Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good The temporary management arrangement is working well. The home is well maintained. Records are safely and securely stored at all times. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a temporary manager from another home to provide some support to the staff team. The home was running well and with only minor anomalies at this inspection. The AQAA had been completed by the manager and was submitted to the commission, as required. Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 21 The manager, her administrator and senior staff team spent time with the inspector to ensure that any information required for the inspection could be accessed. This was most helpful. The home monitors quality on a day to day basis and gathers the views of people who are not happy via ‘Seeking your views’ and with an annual questionnaire. Positive feedback was reported. The feedback at this inspection was also very positive about the care service delivered at Greenhill House. People who live at Greenhill House can have small amounts of monies to a maximum of £50.00 can be safely held on their behalf. Two signatures are recorded where Money is taken out or added, onto the persons individual account sheet. The accounts are checked on a weekly basis. Extras at the home include newspapers, toiletries, chiropody and hairdressing. The hairdresser visits each week and a relatively small charge is made. Nametapes can be accessed for labelling laundry, there is a charge made for these. The home has a property book where anything other than money that is held is logged. Access to accounts and money is restricted. The home has a separate amenities account where fund raising money goes to pay for things such as entertainment and activities. Records were checked for maintenance. The records for fire alarm tests that are carried out on a weekly basis were seen. There were gaps for September 2007, two weeks tests were missing for December 2007, one entry possibly had a wrong date for February and no test had been carried out the week of the inspection. The alarm testing falls to one person, this should be a task that can be delegated, to ensure the teats are made when people are off work for holidays, training or illness. All other tests were carried out and the servicing was regular. Hoists had been services in line with LOLER for patient handling equipment. The homes specialist baths had all been serviced. The management is alerted to review the bath chair hoist in line with a very recent MHRA safety notice regarding changes to the use of bath hoist chairs, for safety reasons. Gas safety was inspected in January 2008. Kitchen equipment had been serviced. The nurse call system had been serviced in September 2007. The ‘sit on’ person weighing scales had been calibrated in February 2008 and wheelchairs in August 2007. The home has an appropriate waste collection contract. Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Greenhill House DS0000015979.V358463.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. 2. Standard OP9 OP29 Regulation 13(2) 19(5)(d) Requirement Medication doses prescribed must be fully recorded on the MAR charts. Recruitment files should be checked and the information recorded should be validated as correct and complete. Timescale for action 05/05/08 05/05/08 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 OP38 OP29 Good Practice Recommendations Weekly fire alarm tests should be carried out and the task delegated to more than one person to allow for cover during holidays and for any periods of illness. CRB checks for volunteers such as the ‘FROG’ drivers should be considered. Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South West Regional Office 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 Greenhill House DS0000015979.V358463.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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