Inspection on 15/11/06 for 27 Hamilton Road

This inspection was carried out on 15th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

27 Hamilton Road 05/11/08

27 Hamilton Road 22/11/05

27 Hamilton Road 07/06/05

27 Hamilton Road 05/01/05

27 Hamilton Road 27/07/04

Similar services:

21 High Street

Vale House

Chestnut Walk

The Old Vicarage

Cherwood House Care Centre

Ashley House

Ascot Nursing Home

Fountain View

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

CARE HOME ADULTS 18-65 27 Hamilton Road Reading Berkshire RG1 5RA Lead Inspector Julie Willis Unannounced Inspection 15th November 2006 09:20 DS0000011055.V314587.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000011055.V314587.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000011055.V314587.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 27 Hamilton Road Address Reading Berkshire RG1 5RA 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) 0118 935 1762 0118 9268214 Paramount Housing Association Limited Mrs Pauline Gregg Care Home 13 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (13) of places DS0000011055.V314587.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users not to be admitted who are over 65 years of age. Date of last inspection 22nd November 2005 Brief Description of the Service: 27, Hamilton Road is a care home providing personal care and accommodation for thirteen adults with mental disorders, excluding learning disability or dementia, three of whom are over sixty-five. Hamilton Road was the first care home opened by Paramount Housing Association in July 1988. It is a detached house built at the turn of the century, located on the east side of Reading close to Palmer Park. The area provides excellent facilities for all kinds of leisure pursuits and there are many local shopping amenities either within walking distance or on local bus routes. The house comprises three floors and a basement area, providing accommodation in the form of thirteen single bedrooms. Service users share bathrooms and toilets. Washbasins are provided in each room. The communal area is spacious and there is a large rear garden. The current fees for the home (as at November 2006) are £360 per week. There are no additional charges. DS0000011055.V314587.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 09:20am and was in the service for five hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the services and other people who responded to questionnaires that the Commission had sent out. The inspector had the opportunity to talk with 9 of the 13 users of the service individually or in small groups at the time of inspection. The residents thoughts, opinions and comments are reflected throughout this report. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. There were no requirements made at the previous inspection visit in November 2005 and no legal requirements made following this inspection. The CSCI are not aware of any complaints about the home in the past year. What the service does well: The home is clearly meeting the needs of its users. Service users confirmed that they are free to make their own decisions and to live as independently as possible. Staff are respectful and kind and it is clear that they have built a good understanding and trusting relationship with each resident. The written records are good and residents have a say about what is written about them. All information is clear and is written in a manner that residents understand. The service takes into account the specific religious and cultural needs of each resident and provides support as necessary. Residents enjoy active lifestyles and are free to come and go as they please. Limitations on freedom and choice are agreed mutually between the staff and residents. There are sufficient numbers of staff working at the home to meet the needs of the residents. Staff were professional and well trained and are offered training courses to further their knowledge and skills. Most of the staff have professional qualifications. Service users say that staff are kind, caring and easy to talk to. DS0000011055.V314587.R01.S.doc Version 5.2 Page 6 Service users have a say in the way the home is run and are regularly asked for their comments and suggestions. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. DS0000011055.V314587.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000011055.V314587.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality outcomes in this area are good. All service users are fully assessed prior to their admission to ensure the home will be able to effectively meet their need. This judgement is made using available evidence including a visit to the service. EVIDENCE: Examination of 3 service users files indicated that users were fully assessed prior to their placement in the home. The tools used for the purpose of assessment were comprehensive and holistic in content and involved the service user, their families and a multi-disciplinary team of professionals. The inspector spoke with the majority of users over the course of the inspection. All users confirmed that they had been involved with their admission to the home and had been fully consulted about living there. One of the most recently admitted users told the inspector “ he was really happy he had moved in and was glad to be there”. The user was complimentary about the quality of the staff and their caring attitudes. He said “ that staff were kind and helpful”. DS0000011055.V314587.R01.S.doc Version 5.2 Page 9 There was evidence in the files that information provided by Purchasers of the service had frequently been minimal in content and often provided the home with a limited medical and social history prior to a users admission. As a result the staff team have become highly skilled at building on the information received and over a period of time develop a personal history of each user, which is accurate, comprehensive and up-to-date. DS0000011055.V314587.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality outcomes in this area are excellent. The care plans were sufficiently detailed to enable staff to effectively meet service user need. Service users are encouraged and supported to make decisions in relation to their everyday lives. All risks to service users safety are fully assessed and guidelines are in place to reduce the risk identified. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Examination of 3 service user care plans evidenced that the records were upto-date and well documented. It was evident that the staff have tried to involve users in the care plan process from the outset and their input was clearly recorded in the service user files. The care plans were comprehensive and holistic in detail and provided sufficient information for staff to provide the DS0000011055.V314587.R01.S.doc Version 5.2 Page 11 appropriate care. Personal programs and goals had been jointly agreed between staff and users and appeared realistic and achievable. Discussions with service users confirmed that they had helped to write the care plans and had agreed the content with their key worker. One user said that they really liked their key worker and found them helpful. From examination of documentation and discussion with staff and service users it is clear that the home positively encourages users to develop independence and new skills. This has led to a degree of risk taking. The content of care plans evidences that users are supported to take risks as part of their everyday life style. These risks have been fully assessed and guidelines have been put in place to minimise the risk to users. Any limitation on freedom that results from the risk assessments have been agreed and set with the individual resident. There was evidence that users are supported to make decisions about their lives. Users decide when to visit town, how to get there, where to shop, go to the cinema, use local services and facilities or meets friends. A number of users regularly stay with their family for weekends. Users confirmed that they are encouraged to make choices and are supported in their decisions by the staff. All of the residents manage their own monies and financial affairs. One user told the inspector that he was accompanying another resident to the bank and building society in town on the morning of the inspection in order to pay bills and go Christmas shopping. The users choose where and when to go on their summer holidays. One service user has requested that they go to Weymouth and another has said that they would like to go to Dorset. Meetings take place with the users to ascertain their personal wishes and preferences in relation to all aspects of their lives. DS0000011055.V314587.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality outcomes in this area are excellent. Service users take part in activities that provide opportunity for personal, practical and emotional development. Service users are encouraged to be part of the local community and citizenship is encouraged and supported. Service users are provided with a menu that is nourishing, varied and meets their individual and cultural need. This judgement has been made using available evidence including a visit to the service EVIDENCE: All service users are provided with the opportunity to engage in activities that are stimulating and worthwhile. There was evidence in the daily records that users make good use of communal facilities including local restaurants, DS0000011055.V314587.R01.S.doc Version 5.2 Page 13 cinemas, sports facilities and public houses. All users use public transport or walk into town. Several users are in paid employment or are volunteers at local centres. One user told the inspector that they work at a local supermarket 20 hours per week, which they enjoy. The user said that they were particularly looking forward to the Christmas party in their works canteen. Another user volunteers at a local day centre run by Age Concern. It was evident that the users are positively encouraged to engage with the local community and are supported to learn new skills at local colleges and Adult Learning Centres. This was well documented in residents care plans. Service users are involved with the shopping, cooking, cleaning and laundry activities in the home and this is a well-documented part of each users care plan. Service users told the inspector that they help to prepare the evening meal which one user said that they particularly enjoyed and that they also do their own washing and cleaning. Service users told the inspector that they were free to see friends and to develop relationships. Users regularly have friends to visit them at home. Visitors are made welcome and offered appropriate hospitality. The home provides a nourishing menu, which meets the needs of users. Service users are provided with choice and variety and are regularly consulted about the menus. Service users told the inspector that they are supported to prepare the meals themselves. One user told the inspector that he thought the food was “very good with plenty of choice”. Users that require a special menu or reducing diet are provided with the necessary foodstuffs to maintain a healthy diet or achieve the necessary weight loss. One user is provided with food supplements as prescribed by their doctor. Care plans indicated that users weight is monitored routinely and a dietician is involved when needed. DS0000011055.V314587.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality outcomes in this area are good. Service users physical and personal support needs are well met and medication is dealt with safely and appropriately. This judgement has been made by using available evidence including a visit to the service. EVIDENCE: From examination of 3 service user care records it is evident that service users physical and personal care needs are well met by the home. All care and support provided is documented in the daily contact sheets. These records evidenced that all users are supported to remain as independent as possible in relation to their personal care. Users shower and bathe in privacy and are supported by staff only when necessary through ill health. Observation of staff and service user interaction demonstrated that care was provided in a manner, which maintained the users right to dignity, privacy, independence and choice. Service users confirmed that they have complete freedom to choose what they do and any restrictions have been agreed between the users and staff as part of their on-going care plan. DS0000011055.V314587.R01.S.doc Version 5.2 Page 15 Service users are supported to manage their own appointments with healthcare professionals and to attend these alone. Service users told the inspector they had caring doctors and nurses at their local surgery and were provided with routine treatments and health checks. Users do not self medicate at the home. The system adopted for the administration of medication is the monitored dosage system. This system reduces the likelihood of medication error and provides an accurate record of administration. All staff have been fully trained in safe administration and have been assessed by the Organisation as part of their formal training. The majority of the staff have completed the Intermediate certificate in the safe handling of medicines. DS0000011055.V314587.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality outcomes in this area are good. The home has a complaints procedure, which is clear and accessible. Service users views and comments are listened to and acted upon. Service users are protected from abuse and exploitation by well-trained and competent staff that demonstrate knowledge of the homes abuse of vulnerable adults and whistle-blowing policies. This judgement has been made using available evidence including a visit to the service. EVIDENCE: From examination of the complaint record it is evident that there have been no complaints recorded by the home or reported to the CSCI in the past year. Service users have access to the complaint procedure, which is explicit in their copy of the Service User Guide and readily available on the homes notice boards. Discussion with the Manager and staff indicated that feedback is actively sought from service users and their families on an on-going basis. Service users told the inspector that they were confident that if they had a complaint it would be dealt with effectively and in a timely fashion by management. Users confirmed that they are provided with the opportunity to express their views in the weekly residents meetings and at other times. The Manager operates an ‘open door’ policy where users are free to express their views openly. Users confirmed that they felt they could bring issues to management informally DS0000011055.V314587.R01.S.doc Version 5.2 Page 17 which would be dealt with before there was necessity to make a formal complaint. There was evidence in staff files that all staff receive training in the abuse of vulnerable adults as part of their formal induction and NVQ training in which it is a core module. Refresher training courses are also offered regularly. Service users confirm that they feel safe at the home and are well cared for by competent and caring staff. DS0000011055.V314587.R01.S.doc Version 5.2 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 the following standard(s): 24, 30 Quality outcomes in this area were good. Service users benefit from living in a comfortable, homely environment, which is clean and hygienic. This judgement has been made using available evidence including a visit to the service. EVIDENCE: A tour of the home evidenced that the home was clean and hygienic throughout. Communal areas were spacious, light and airy and pleasantly furnished and decorated. Staff are mindful of the need to involve users with the choice of decoration and furnishings in the home. Several users showed the inspector their bedrooms, which had been decorated to their particular colour choice and theme. Users told the inspector that they liked living at the home, which they said was “clean and comfortable”. DS0000011055.V314587.R01.S.doc Version 5.2 Page 19 Although all users are fully risk assessed in relation to bathing and showering independently there is a need to consider fitting thermostatic mixer valves to the baths and showers as the temperature of hot water available to users in baths and showers exceeded a safe temperature of 42°c. This could place service users at risk of scalding. The Service Manager confirmed at the time of this inspection that this issue would be addressed. DS0000011055.V314587.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 Quality in this outcome area was excellent. The service users benefit from being cared for by properly recruited and trained staff in sufficient numbers to effectively meet their needs. This judgement has been made using available evidence including a visit to the service. EVIDENCE: During the course of inspection the staff clearly demonstrated that they have the necessary skills and experience to effectively meet the needs of service users in their care. Staff on duty had a good understanding of the individual needs of users. There approach to managing care needs was consistent, professional and based on establishing and maintaining users independence and autonomy. Staff supported and enabled service users to maximise their quality of life, to take risks and to make appropriate decisions. The rosters evidenced that staffing levels were adequate and staff were flexibly deployed to meet the needs of the service users accommodated. Examination of the staff training files for 3 employees indicated that staff were appropriately recruited, inducted and trained. Staff interviewed appeared to have a good understanding of how their individual role benefits the work of the DS0000011055.V314587.R01.S.doc Version 5.2 Page 21 team and a thorough knowledge of the key values that underpin their work with service users. Staff are properly supervised and records indicated that the support offered in these sessions was frequent and appropriate. Staff confirm that they have the opportunity to express their opinions openly in staff meetings, supervision sessions and staff handovers. They say that they are provided with plenty of opportunity to express concerns, share information and to feel included and involved in the way the service is delivered. Staff are offered opportunities to gain professional qualifications to further enhance their knowledge and skills. Six staff had already achieved a National Vocational Qualification at Level 3 and 1 member of staff was due to start NVQ 4. Staff also hold a number of other qualifications including the Diploma in Psychiatry and Diploma in Criminology. There was evidence that all staff are provided with refresher training in core skills at regular intervals, including fire safety awareness, first aid, medication, POVA (protection of vulnerable adults), health & safety, first aid, manual handling and infection control to ensure service user safety. Service users were highly complimentary about the quality of staff at the home. They said they felt that “staff listened to what they had to say”, “were kind and caring” and supported them in their everyday lives. DS0000011055.V314587.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is good. The home is well run for the benefit of users by a competent manager and professional staff team. The home reviews its performance on an on-going basis, which seeks and focuses on the views of its users. Service users live in a safe environment. Risks to users safety are assessed and managed effectively. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The Homes Manager is knowledgeable, experienced and professional. Staff confirm that the Homes Manager demonstrates effective leadership skills and DS0000011055.V314587.R01.S.doc Version 5.2 Page 23 vision and is always keen to support individual members of staffs personal and professional development. The manager operates an ‘open door’ policy, which provides users with the opportunity to express their views openly on a daily basis. Quality assurance is monitored through weekly service user meetings, staff meetings, keyworker meetings and monthly auditing of the home by senior management. Annually the manager asks users to complete a satisfaction survey, which provides an overview of the quality of the home. Users confirm that they feel management is approachable and will listen to their views, comments and suggestions. Examination of a number of health & safety records indicated that all necessary checks and servicing of equipment is routinely undertaken to safeguard the health and welfare of users. Unnecessary risks to users are identified using a comprehensive risk assessment. So far as possible the risks are reduced or eliminated by putting in place effective guidelines, policies and procedures. DS0000011055.V314587.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 4 33 x 34 3 35 4 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 x 4 x LIFESTYLES Standard No Score 11 x 12 4 13 4 14 x 15 3 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 x x 3 x DS0000011055.V314587.R01.S.doc Version 5.2 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. 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 Refer to Standard YA42 Good Practice Recommendations The Proprietors should liaise with the Environmental Health Department regarding the temperature from hot water outlets. Consideration should be given to fitting thermostatic mixer valves to baths and showers. DS0000011055.V314587.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 DS0000011055.V314587.R01.S.doc Version 5.2 Page 27 - 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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