Inspection on 21/12/05 for 3 Trinity Close

This inspection was carried out on 21st December 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

3 Trinity Close 18/04/07

3 Trinity Close 03/05/06

3 Trinity Close 07/09/05

3 Trinity Close 15/02/05

3 Trinity Close 12/05/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOME ADULTS 18-65 Trinity Close 3 Trinity Close Bath Bath & N E Somerset BA1 1US Lead Inspector David Smith Unannounced Inspection 21st December 2005 10:00 Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 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 Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 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. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Trinity Close Address 3 Trinity Close Bath Bath & N E Somerset BA1 1US 01225 443575 01225 443575 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) New Era Housing Association Limited Mr Paul Flett Care Home 5 Category(ies) of Learning disability (5), Physical disability (5) registration, with number of places Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 5 persons aged 18 - 65 years requiring personal care only 7th September 2005 Date of last inspection Brief Description of the Service: 3 Trinity Close is registered as a care home operated by New Era, an independent voluntary organisation, who are part of the New Dimensions group, to provide personal care for up to five people who have a learning and physical disability. The home is just a five-minute walk from the centre of Bath, where service users can benefit from ease of access to all the amenities offered within the city. The premises are part of a general needs housing scheme developed by Sanctuary Housing Association. Number 3 Trinity Close is a ground floor flat within a row of what looks like terrace houses. Accommodation is on one level and five single bedrooms are equipped with wash hand basins. Three bedrooms are equipped with ceiling track hoists and closomat toilet. One bathroom has an Aqua Nova bath with hoist and there is an additional shower room with toilet and wash hand basin. There is an enclosed rear patio garden, reached through the patio doors of the lounge/dining/kitchen area. This patio garden is also accessible to number 9 Trinity Close, which is an interconnecting property also overseen by New Era but currently not in use or registered as a part of 3 Trinity Close. 3 Trinity Close has its own leased mini bus enabling service users to access opportunities outside the city centre and the costs are supported by a contribution from service users mobility allowance. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection, which was carried out over one day. The inspector gathered information for this report from discussions with the two staff on duty, meeting service users, case tracking, inspection of care plans and other records, observing staff communicating and supporting service users and a tour of the home. What the service does well: What has improved since the last inspection? The home now has a homely remedies policy in place. All staff are aware of this and service users GPs have endorsed it. This policy is also evident in service users care plans. The lounge blind was clean and there was no condensation evident on the skylight window in the dining area. The compliment of staff has increased since the last inspection, with one new member of staff recruited. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 6 The tap/mixer valve on the bath has been replaced. This enables the water temperature to be regulated correctly and safely. Risk Assessments are now in place for the use of bedrails. The service users and their families have been included in the risk assessment process. 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. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 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 Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 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): 1 and 2. Service users are given the information they need about the home. Service user support is based on an assessment of their individual needs and goals. EVIDENCE: There is a comprehensive Service User Guide, which has been adapted to include picture symbols. This details the facilities, services and ethos of the home as well as the local structure of the New Era organisation. Service users care needs are assessed prior to entering the service and then translated into their care plan. The three care plans examined demonstrated this practice. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 9 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 and 9. The care plans examined provide good information on supporting each service user to achieve their personal goals. However, these need to be reviewed regularly and a clear record of the review process maintained to ensure service users changing needs/goals are clearly reflected. Service users are supported by an experienced staff team who involve them in decision-making processes. Staff also advocate appropriately for service users. Risk Assessments are in place for each service user and are reviewed regularly. This helps Service Users take risks whilst promoting their safety. EVIDENCE: Discussions between the inspector and the two members of staff on duty demonstrated they had an extremely good knowledge of both the history of Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 10 service users and their current support needs. This appears to be an important factor in supporting the service users who live here. Interactions between service users and staff were observed. These were conducted in a sensitive and respectful manner. Individual support needs and methods of communication were clearly known and acknowledged by staff. Staff actively offered choice and the inspector observed two service users choosing lunch. Three care plans were examined. These contained comprehensive support plans for each service user which keyworkers are required to regularly update and organise regular reviews. One care plan examined recorded the last review meeting as 24/10/04. It was not evident within the care plan that a further review meeting had taken place since this date although the staff members confirmed this had occurred. A clear record of each review must be maintained within each care plan to ensure the correct levels of support for each service user are clearly defined, updated and communicated. There are Risk Assessments in place for each service user. These are written from a person centred perspective. There is a clear system of assessment and review in place, which helps to ensure the safety of each service user. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 11 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, 14 and 15. Service users are supported by staff to use community facilities, enjoy holidays, visits to family and friends and visitors to the home are welcomed. The location of the service provides easy access to the facilities within Bath. Service users attend specialist day services as well as community-based resources. This is reflected in their care plans. The shortages within the staff team have led to a difficulty in carrying through goals identified in some individual care plans. It can also be difficult to provide sufficient support for all service users to enable them to access the community on an individual basis. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 12 EVIDENCE: Service users have their own weekly timetable of activities. These include attendance at specialist day services, hydrotherapy sessions, horse riding, Shiatsu sessions, lunches out, walks as well as activities provided within the home. Each service user has had a holiday this year, supported by members of the staff team. The proximity of the home to the centre of Bath provides a variety of local resources for the service users. One service user was observed spending time in his bedroom listening to music. He made a clear choice regarding the type of music he preferred and communicated this to staff. He clearly enjoyed this activity, singing along with the music. Another was offered and accepted the choice of accompanying member of staff to collect a housemate from their day service in Bathford. Staff did comment that at times staffing levels made it difficult to provide support for service users to access the community on an individual basis. One service user previously enjoyed trips on trains but due to staffing levels this is now not often possible. Also service users at times have to be supported in the community together, rather than individually. Service users will sometimes choose this option, and this is respected, but at other times this is solely due to staffing levels. Records examined confirmed these views. Service users are supported to maintain close contact with families and friends. Three regularly visit their families and one receives regular visits from his mother. There is a clear record kept within each care plan of family contact, including telephone calls made/received. One family has been actively involved in assessing the risks associated with bedrails being used for their relative. Correspondence from this family is extremely complimentary towards the care and support provided by the home for their relative. There is limited evidence that sensory stimulation is being explored within the home. It is recommended that this should form part of the plans to improve the environment for service users. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 13 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): 19 and 20. Service users care plans clearly reflect the levels of support they require in relation to their health and social care. This area is clearly monitored by staff and any concerns are acted upon. Experienced staff have a good knowledge of each service user and how to provide the support appropriate to them, however staffing levels are an issue where service users require the use of a hoist. The medication policy now includes homely remedies. This is incorporated into service user care plans. Staff re-dispense medication from the monitored dosage system when service users visit their families. This practice must cease, as staff should not re-dispense medication. EVIDENCE: The care plans examined showed service users are registered with a local GP, Dentist, Optician and Chiropodist. There are varying levels of support from other healthcare professionals from the Community Learning Disabilities Team such as Speech and Language Therapy, District Nurse, Physiotherapist and Dietician. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 14 Health care appointments/contact are well recorded by staff. Each service user has their own file where these records are stored. On the day of inspection one service user was unwell. The Duty GP had been called as a precaution. The inspector observed sensitive care and support being provided throughout the course of the day. This was particularly noted when the same service user had a seizure. The staff member clearly had a good understanding of the condition and the appropriate support required. The care plan was clearly followed and the seizure recorded as part of the monitoring and review process. The needs of two service users dictate that support is required with intimate personal care and hoists are used as part of this process. The care plans and associated Risk Assessments state that two staff assist with the hoisting process. This effectively leaves three service users without direct staff support for short periods of time. Staff on duty on the day of inspection concurred this was not satisfactory due to the vulnerability of the service users. The home should review staffing levels as previously mentioned in the body of this report. The home uses a monitored dosage system for medication. The administration records showed two staff sign for medication, there is a list of staff names and specimen signatures available, all medication has manufactures profiles in place, stock levels are clearly monitored and recorded and staff have attended training in using the Monitored Dosage system. The inspector noted that staff were re-dispensing medication when service users visited their families. This practice needs to cease. Medication must not be re-dispensed by staff. The complete medication pack dispensed by the pharmacy must be sent with the service user during family visits together with the appropriate administration records. A clear record of this practice must be kept by the home and guidelines form part of each service users care plan. The home should also consider whether the stock of rectal valium being maintained within the home is necessary. Some staff have received training to administer this medication to one service user, however current policy dictates that staff cannot administer this under any circumstances. This is only to be administered by a Paramedic from the Ambulance Service. It is recommended that the stock of this medication is removed from the home and returned to the dispensing pharmacy. Two service users require the use of bedrails. There were Risk Assessments in place and these are subject to regular review. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 15 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): 23 Arrangements for protecting service users from the risk of harm or abuse are in place. EVIDENCE: There have been no complaints recorded since the last inspection. The two staff on duty clearly described the procedures they would follow if they had any concerns regarding service users vulnerability or if felt they were at risk. The home has good policies and procedures in place. Staff have received training on Protection of Vulnerable Adults. Both Policies and training are extremely important as staff confirmed they would need to advocate for most service users should they wish to make a complaint or were at risk of harm or abuse. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 16 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, 25 and 30. Although the home was generally clean and tidy, several improvements are needed to maintain safety, comfort, ensure sufficient space and provide a more homely environment for the service users. EVIDENCE: The lounge/dining/kitchen area remains the focal point of the home. The home was generally clean and tidy on the day of inspection. Two service users use wheelchairs and this still presents difficulty in the limited clear space within the home. Staff also commented it was difficult to move the two adapted armchairs easily around the home due to the limited space available and the width of doorways. The skylight window and large blind in the lounge/dining area were both found to be clean on the day of inspection. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 17 Some kitchen worktops remain in a poor state and need replacing. The frontage to one of the kitchen drawers was missing and this needs to be replaced/restored. Several carpets are badly stained. These are in both communal areas and in two of the three service users bedroom the inspector was invited to view. Staff did comment that the carpets were cleaned with a ‘rug doctor’ machine, which the home has. This is evidently not effective and the carpets outside the shower room, in the lounge area, in the communal area outside the office and in two service users bedrooms should be replaced. Requirements were made at the last inspection to resolve the issues of the carpeting and kitchen worktops. Both remain outstanding. Enforcement action will be taken if these issues are not satisfactorily addressed within the timescales set out in this report. The lounge and dining area are in need of redecoration. Several area of paintwork in the lounge are worn or chipped. The wall in the dining area is badly discoloured. This appears to be caused by the venting for the radiator fixed to this wall. The laundry room was very hot and would be very uncomfortable for staff to spend time in. The Aqua bath has had a new mixer valve fitted. The temperature of the water was tested and found to be within correct limits. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 18 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 Staff are knowledgeable, motivated and work positively to support the service users. Staffing levels need to be reviewed and the home recruit for the vacant staff post to ensure service users are provided with consistent and appropriate levels of staff support. EVIDENCE: The home benefits from an experienced staff team. Several members of the team have worked at the home for a number of years and provide consistency and an excellent understanding of service users support needs. The two staff on duty were both confident in their role and helped the inspection process by explaining their knowledge of care plans and policies and providing records necessary for the inspection. The home does have one staff vacancy. At present this post is being covered by New Era Bank Staff and one staff member from another New Era home. The home needs to recruit to fill this vacant post. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 19 The home still does not employ waking night staff. There has been a Risk Assessment completed in this respect. It however remains unclear how one service user would summon support from staff during the night if they were in difficulty. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 20 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): 42 and 43 There are policies, procedures and regular checks in place to ensure the health and safety of service users is maintained. The home has been the subject of a recent service review. There now needs to be a clear plan of development, together with appropriate timescales to ensure the goals and support needs of service users are promoted. All COSHH products must be securely stored to ensure the safety of service users. EVIDENCE: There are clear recording systems in place to support the Health and Safety within the home. Records examined included fire alarm system checks, fire Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 21 fighting equipment checks, water temperature checks, servicing of gas appliances, portable appliance testing, servicing of the Aqua bath and hoisting equipment and accident reports. These checks had been conducted and recorded appropriately. The recent service review needs to lead to a clear plan of how the service is to be developed and improved. Staff spoken with remain unclear if the service will expand by incorporating the space of No.9 Trinity Close, which is immediately next door to No.3 and currently unoccupied, or whether the service will be relocated entirely. The issues relating to both staffing levels and the environment remain unresolved. These are central to the provision of a good quality and accountable service to the people who live at Trinity Close. On the day of inspection the cupboard containing the COSHH products was found to be unlocked, despite a padlock being available to secure the cupboard doors. COSSH products must be stored securely at all times to ensure service users are protected from possible harm. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X X X Standard No 22 23 Score X 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 X X X X 3 LIFESTYLES Standard No Score 11 X 12 X 13 2 14 2 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X 2 X X X X CONDUCT AND MANAGEMENT OF THE HOME X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Trinity Close Score X 2 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X 2 2 DS0000008190.V271226.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23.2.b Requirement a) Replace the stained corridor carpet, outside the homes shower room [this was a requirement at the last two inspections with an extended compliance date of 16/12/05] b) Replace dirty carpets in service users bedrooms. c) Replace kitchen worktops that are in poor condition. d) Redecorate the lounge/dining area. e) Replace carpets in the communal area outside the office. Ensure suitable staff are working 28/02/06 at the care home in such numbers to meet the needs of service users at all times. (This is to ensure there are sufficient extra staff to provide activity and also to review and provide waking night staff if it is DS0000008190.V271226.R01.S.doc Version 5.0 Page 24 Timescale for action 28/02/06 2. YA33 18.1.a Trinity Close necessary) 3. YA42 23. 2 Review the possibilities to improve the facilities at the home to: increase space; improve ventilation; improve the laundry. Provide CSCI with a copy of the outcome of this review. Ensure all service user care plans are reviewed regularly and a clear record maintained. Ensure staff do not re-dispense medication from monthly pharmacy supplies. Ensure all COSHH products are stored securely within the home. 28/02/06 4. 5. 6. YA 6 YA20 YA9 and YA42 15.2 13.2 13.4 21/12/05 21/12/05 21/12/05 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. 3. Refer to Standard YA19 YA24 YA20 Good Practice Recommendations Consider development of sensory possibilities to aid stimulation for residents, within 3 Trinity Close, when reviewing care plans. Review the possibilities to improve the facilities at the home to: increase space; improve ventilation; improve the laundry. Review the need to maintain a stock of rectal valium. Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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 Trinity Close DS0000008190.V271226.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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