Inspection on 15/04/05 for 20 Windlesham Road

This inspection was carried out on 15th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

20 Windlesham Road 20/04/07

20 Windlesham Road 04/05/06

20 Windlesham Road 13/10/05

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 20 Windlesham Road 20 Windlesham Road Brighton East Sussex BN1 3AG Lead Inspector Jenny Blackwell Unannounced 15th April 2005 10:00 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 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 Stationary 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. 20 Windlesham Road Version 1.10 Page 3 SERVICE INFORMATION Name of service 20 Windlesham Road Address 20 Windlesham Road Brighton East Sussex BN1 3AG 01273 735322 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Brighton & Hove City Council Mrs Lillian Fafoutis Care Home 4 Category(ies) of Learning Disability (LD) registration, with number 4 of places 20 Windlesham Road Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1 The maximum number of individuals to be accommodated is five (4). 2 Individuals must be aged between eighteen (18) and sixty-five (65) years on admission. 3 Individuals with a learning disability only to be accommodated. Date of last inspection N/A Brief Description of the Service: The home is registered to support up to four adults who have a learning disability. The home is a detached three-storey building set in a residential part of Brighton. Although the home was not purpose built for people with disabilities some minor adaptations have been made to the home and one bedroom is on level access on the ground floor. The home is close to local shops, pubs and restaurants in Seven Dials. The home has its own vehicle which helps people to access their local community. 20 Windlesham Road Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this summary the people who live at the home will be referred to as people/person, and the people who work at the home as staff or by their job title. This was the first inspection of the home under the Care Standards Act and it was unannounced. The people who live at the home, some of the staff team, deputy and manager were present during the inspection. Time was spent with all of the four people who live at the home. The manager and deputy were spoken to individually and four staff were spoken to throughout the day. The day was arranged to fit around the activities organised for the day. As this was the first inspection for the home, four areas where prioritised. These were the admission of new people to the home, people’s involvement in decision making at the home, health care needs for the people who live at the home and the facilities around the house. These areas were prioritised because of issues raised during communications between the manager and the Commission and Regulation 26 reports from the reviewing officer for the service. What the service does well: The staff and people who live at the home have had a difficult time over the last few months getting used to a new person moving to the home and another moving on. During this time the staff have endeavoured to make the settling in period for the person go as smoothly as possible. This has been a challenge as the person has found the move to the home difficult and in addition has had health problems. However the staff have worked with the person, manager, health care professionals and the other people at the home in a professional and dedicated manner. Some staff were asked about their views on how the persons move went. They stated that although the initial move was difficult the staff team had worked well together and supported each other throughout. The manager and staff arranged daily activities with the people at the home and a daily shift planner was seen which detailed outings and activities for each individual. During the inspection all the people who live at the home were involved in a variety of activities. During the day the staff were seen to interact sensitively with the people and demonstrated a good knowledge of the support needs. 20 Windlesham Road Version 1.10 Page 6 The manager and deputy were able to show that they oversee the staff teams performance and conduct supervision and team meetings regularly. What has improved since the last inspection? What they could do better: The manager appears to have been under pressure from senior managers to have the new person move into the home quickly and the other person move out. Although social work assessments were in place for the new person to move in, little information was seen as to the compatibility between the new person and existing people living at the home and if the layout of the building was suitable. This was also the case for the person moving from the home. The process was rushed and appears to have contributed to the staffs difficulty in initially supporting the person and the other people at the home. The manager needs to ensure she adheres to the National Minimum Standards and Regulations when admitting new people to the home. The storage and administrating of medication was substandard. Medication stocks were found which needed returning to the pharmacist. In addition most people at the home had been prescribed “as and when” medication without clear information on why it was prescribed by the G.P. The staff gain peoples choices on what they want during the day verbally or they rely on acquired knowledge of them. There was little evidence of gaining peoples choices proactively by using tools such as photo menus, photo rota’s or objects of reference. Some areas of the home had restricted access such as the kitchen and dining room. This will need to be reviewed. 20 Windlesham Road Version 1.10 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. 20 Windlesham Road Version 1.10 Page 8 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 Standards Statutory Requirements Identified During the Inspection 20 Windlesham Road Version 1.10 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 4. The manager and staff have access to the appropriate documents and policies for new people moving to the home. However the recent procedure for a new person moving to the home was not managed well. EVIDENCE: A person has recently moved to the home and has had a difficult time in settling in. Her care plan was looked at and particular attention was paid to the assessment of her needs and the process of supporting her to move to the home. The assessment was detailed highlighting the person’s history and current health needs. However there was limited information about the wishes of the person or their representatives. In addition the impact on the move to the people who lived at the home did not appear to be assessed. The manager related that the process had been rushed due to external pressures and that she had not conducted a compatibility study with the other people at the home. During the inspection it was observed that the layout of the home contributed to conflicts between people who live at the home. It was deemed to be due to 20 Windlesham Road Version 1.10 Page 10 lack of passing space between the kitchen, lounge and the new persons bedroom. Some staff spoken to about this felt that the layout of the home meant that they had to “police” the movements of the people to ensure conflicts did not arise. It is required that the manager ensures a full and comprehensive assessment process is in place for all people who are to be admitted to the home. 20 Windlesham Road Version 1.10 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7 and 8. The persons individual care plans contained detailed information including likes and dislikes, activity arrangements and guidance on supporting people with personal care and health needs. Restriction on peoples movement around the home was not recorded. The staff and manager approach individuals sensitively and offer choice to people in their daily lives. Tools to support proactive choices such as pictorial, photos symbols and objects of reference are not used. EVIDENCE: Two care plans were viewed for two people. They contained photo’s of people and included information that describe a persons interest, likes, dislikes, family and friends connections, basic health and social care needs. Activitiy time tables were in the plans and were tailored to each person interest. The plans were drawn up from a variety of resources such as assessments, reviews and day centre information. The keyworkers and other staff contributed to the plans and care was taken in describing peoples support needs. During the inspection staff talked to the people at the home about what they would be doing that day. Not all the people who live at the home use words to 20 Windlesham Road Version 1.10 Page 12 communicate. Staff spoke with people and used some signing to enage the person attention. The staff were seen to ask people about their preferences for example choices between tea and coffee. One person was seen to approach a staff member take him by his hand and lead him to another area in the home for some personal support. The staff member responded promptly to this and appeared comfortable in allowing the person to lead him to communicate his needs. Two staff spoken to at the time had felt that the involvement of some of the people in decision making had changed due to the new person moving to the home and routines that had been working in the home previously had changed to adapt to the needs of the new person. During discussion at lunch with the people and staff, it was noted that the home did not use any additional communication aids such as photo rota boards, pictorial menus or day planners. The staff spoken to thought this was a good idea to introduce these tools and believed it may help to get people more involved in the planning of the day and to understand what was going to happen to them. It is required the manager ensures the people who live at the home make decisions in respect of their health and welfare and take their wishes and feelings into account. 20 Windlesham Road Version 1.10 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15,and 17. The manager and staff are commited to supporting each person with their daily interest. The home is concerned with the individual and does not group people together during activities for ease. People are supported to be part of the community. Staff generally do household task for people rather than with them and some enviromental restrictions are in place which need to be reviewed. Privacy is respected and staff freely engage with the people at the home rather than restrict conversation amoungst themselves. EVIDENCE: During the day people had a variety of activities. One person was going out on a train, another had been for a walk and one person was due to go out to recycle the homes bottles and papers. A written activities plan was up in the kitchen with planned activities for each person. The staff talked to had an understanding of what people enjoyed and what day they went out to particular activities. As in the previous section it was noted the planner was not in an accessible format. When asked one 20 Windlesham Road Version 1.10 Page 14 person was not able to say what had been planned for that day. There may have been a variety of reasons why the person was unable to say, but without the help of accessible information her understanding of what was happening that day was likely to be effected. The people use community facilities like swimming pools, restaurants and shops. As the home is set in a residential area people use the homes vehicles to travel further afield. Time was spent with one person as he was having some time away from the others in a small upstairs room, previously a bedroom. Whilst there he played music on a stereo, looked at some books and showed the inspector some of his personal belongings. As the move to the home of the new person had been quite difficult for some other people, staff are sensitive in supporting them to have some time away from each other. The staff have used some parts of the building well to achieve this. During the time spent at the home it was noted that some areas were resticted, for example a hatch was across the kitchen entrance which blocked people from entering and the dinning room doors had double handles on. Staff were seen to allow people acess to the kitchen to make tea. When this was raised with the deputy manager of the home she stated the staff team were aware of the restictions and are beginning to encourage access to these areas. It is required the manager undertakes a review of any restriction to areas of the home. 20 Windlesham Road Version 1.10 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 20. The medication procedure is clear and staff are trained in the administration of medication. However the the stock control, recording of errors and use of as and when drugs were poor. EVIDENCE: The medication system was checked with the manager present and although some information was good the overall management of the system was poor. When medication had been “spoilt” for example dropped, this had not been recorded. During a check of a persons prescribed drugs it was noted that a drug for light sedation was being used on an “as and when” bases to relax a person whilst a nursing procedure took place. The manager explained that this sedation had been requested by a community health care professional. Evidence was not available to demonstrate this decision to sedate the person had been taken lawfully. In addition sedative medication had been prescribed to each of the other people living at the home as an “as and when” option when people were attending medical appointment. When questioned the manager stated that people usually attended appointments without any difficulty. The manager was not sure as to why 20 Windlesham Road Version 1.10 Page 16 some people had been prescribed the medication and why it was not part of their care plan. The stocks of these drugs for each person were high and several packets were open at once. The manager was unable to confirm how many doses had been given and a tally of the drugs in stock had not been kept. It is required the manager reviews with medical professionals the use of medicines intended to sedate people. It is required that stocks of medication are stored, recorded and monitored correctly. It is required any “spoilt” medication is recorded in line with the homes policy. 20 Windlesham Road Version 1.10 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) On this occasion only part of 23 was inspected in relation to the previous section, standard 20. The manager and staff had not demonstrated the administration of the medication system protected the people at the home from the misuse of medicines. EVIDENCE: Due to the lack of control over the use of medicines to sedate people the manager and staff are unable to evidence that people are not being placed at risk of abuse. “As and when” medication when used to manage behaviours can be misused if staff do not have specific training on the appropriate use of the medication. The manager needs to ensure that robust monitoring procedures protect people from abuse. 20 Windlesham Road Version 1.10 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28,29 and 30. The house had minor adaptions in place to support people with disabilities. The house was well maintained and pleasantly decorated. Each person had their own bedrooms which were decorated to their individuals tastes. The bathroom facilities were adequate and the home was clean and well kept. The communal space between the lounge, kitchen and a downstairs bedroom was often busy causing raised anxieties when people were passing in the hallway. EVIDENCE: During a tour of the building it was noted the house was in a good state of repair and decoration. The shared spaces in the house were kept in good order and generally had a homely feel. As stated in a previous section the hatch in the kitchen and double doors on the dinning room door are the exception to this. Each person’s bedroom was individually decorated and contained personal items such as family photographs, TV’s and stereos. Time was spent with two people in their rooms. One person had recently moved to the home had her 20 Windlesham Road Version 1.10 Page 19 room decorated with the colours she had chosen. Another person was able to show where different things in his room were and was independent in his room. He indicated staff had fixed a door on his wardrobe and that he liked his room. On the day of the inspection he was supported to clean and tidy his room. Two bedrooms have en-suite facilities. The people and staff at the home have sufficient toilet and bathroom facilities, which were clean and tidy. The laundry facilities are suitable for the people needs and the staff handle washing appropriately. Those spoken to had good understanding of infection control procedures. All the people at the home use the communal areas. A room that used to be a bedroom is now used as a small second lounge. One person was using this space during the day to quietly listen to music and look at records. The staff were conscious about the people getting on top of each other during the day and sensitively encourage people to use different spaces around the home to relieve tensions. It was noted that particularly the hallway between the kitchen, lounge and a downstairs bedroom was a congested area. The new person to the home needed downstairs accommodation, however the positioning of that bedroom right by the thoroughfare of the home causes her and other people raised anxiety. During the day it was noted that including staff there could be four or five people in this area or passing through. This created an air of tension particularly at meal times. The staff spoken to were aware of the difficulties and were consciously trying to encourage people away from that area during meal times. It is required that the manager ensures the physical design and layout of the premises meet the needs of the people at the home. This may need to be a long term strategy for the manager and staff. Again this is an indication that a compatibility study, and environmental assessment were crucial in ensuring the persons move to the home was well managed. 20 Windlesham Road Version 1.10 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35,36 (in part) The staff were observed throught the inspection and asked about their induction to the home, and training. Staff demonstrated competence when supporting the people at the home and in particular had adapted well to the support needs of the new person. Agency staff needed closer supervision and support to ensure people who live at the home and the agency staff are not put at risk. EVIDENCE: The staff team working in the morning were made up of the deputy manager, two permanent support workers, a student nurse who was on a placement and a new agency worker who was on her first shift at the home. The staff were seen to approach the people sensitively and had knowledge on how they preferred to be supported. They staff commented on how difficult the introduction of the new person to the home had been. Stating the impact to the other people at the home had been significant. However their view was the team had pulled together and as they gradually got to know the person and now felt reasonable confident supporting her and the other people. 20 Windlesham Road Version 1.10 Page 21 The student nurse was asked about her induction to the home, which she felt had been good. She was able to shadow experienced staff and had access to information, which helped her to support the individuals. It was noted the agency member of staff was on her first shift at the home and had been given little induction. Although throughout the day she adapted well to the routines of the home at one stage she was allowed to deal with a difficult situation with a person that resulted in her being struck. She was supported well by the staff and manager once this situation had occurred however it is required that the manager ensures that people working in the home are appropriately supervised. It is also recommended that only experienced staff deal with potentially difficult situations with the people at the home. 20 Windlesham Road Version 1.10 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42. The manager demonstrated knowledge of monitoring health and safety issues at the home. Staff are trained in First aid, moving and handling and food hygiene. The home had appropriate fire protection proceedures. The home was generally a safe enviorment for the people who live and work in the home. EVIDENCE: Mainly a contractor appointed by the organisation carry out health and safety checks. They visit the home to undertake checks on the fire system, water temperatures and general repair issues. The inspector discussed with the manager the need for the registered person to be accountable for the monitoring of the checks in the house. She demonstrated that she was aware of when checks where due and what work was undertaken. It is recommended that the manager and staff establish some in house checks such as the water temperatures and fire alarm systems. 20 Windlesham Road Version 1.10 Page 23 During a tour of the premises the home was found to be in a good state of repair with appropriate fire and health and safety checks. One bathroom on an upper floor had hot water delivered at a temperature of 57 degrees centigrade. The manager confirmed that staff only used this bathroom. It is required that the manager ensures that people at the home are not at risk from scolding from the bath’s hot water supply. 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. Where there is no score against a standard it has not been looked at during this inspection. 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 1 x 2 x Standard No 22 23 ENVIRONMENT Score x 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 20 Windlesham Road Score 2 2 x Standard No 24 25 26 27 28 29 30 Version 1.10 Score 3 3 3 3 2 3 3 Page 24 9 10 LIFESTYLES x x Score STAFFING Standard No 11 12 13 14 15 16 17 x 3 3 x 3 2 2 Standard No 31 32 33 34 35 36 Score x x x x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x 1 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x 20 Windlesham Road Version 1.10 Page 25 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. 2. Standard 2 7 Regulation 14(1)(a,c) 12(2)(3) Requirement The manager shall not provide accomodation to a person without a full assessment. It is required the manager ensures the people who live at the home make decisions in respect of their health and welfare and take their wishes and feelings into account. It is required the manager undertakes a review of any restriction to areas of the home. It is required the manager reviews with medical professionals the use of medicines intended to sedate people. It is required that stocks of medication are stored, recorded and monitored correctly. It is required any “spoilt” medication is recorded in line with the homes policy. Timescale for action Immediate Immediate 3. 4. 16 20 12(2)(3) 23(2)(a) 13(2) 1st June 2005 Immediate 5. 20 13(2) Immediate 6. 24 23(2)(a) 7. 36 18(1)(d) (2) It is required the manager 1st October ensures the physical design and 2005 layout of the premises meet the needs of the people at the home. It is required the manager Immediate ensures that people working in the home are appropriately Version 1.10 Page 26 20 Windlesham Road supervised. 8. 42 13(4)(a)( b)(c) It is required the manager ensure that people at the home are not at risk from scolding from a bath’s hot water supply. Immediate RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations 20 Windlesham Road Version 1.10 Page 27 Commission for Social Care Inspection Ivy House, 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 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 20 Windlesham Road Version 1.10 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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