Inspection on 10/10/05 for 39 Hawthorne Grove

This inspection was carried out on 10th October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

39 Hawthorne Grove 07/03/08

39 Hawthorne Grove 31/08/06

39 Hawthorne Grove 18/04/05

39 Hawthorne Grove 22/11/04

39 Hawthorne Grove 27/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Hawthorne Grove (39) 39 Hawthorne Grove Trowbridge Wiltshire BA14 0JF Lead Inspector Sally Walker Unannounced 10 October 2005 th 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. Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hawthorne Grove (39) Address 39 Hawthorne Grove Trowbridge Wiltshire BA14 0JF 01225 767441 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) Milbury Care Services Limited Miss Adele Lena Caroline Flegg Care Home 3 Category(ies) of LD Learning Disability (3) registration, with number PD Physical Disability (3) of places SI Sensory Impairment (3) Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th April 2005 Brief Description of the Service: 39 Hawthorne Grove is run by Milbury Care Services Limited which has a regional office in Henley Oxfordshire and runs other care homes in Wiltshire. The home is located in a residential area of Trowbridge and the property is owned by the West Wiltshire Housing Association. The home is a detached bungalow that does not stand out from the adjacent properties. The statement of purpose says that the home is the residents permanent home for as long as it is appropriate to their needs. Residents receive personal care and support throughout the day from a permanent staff team, with two staff sleeping in at night and a minimum of 2 staff during the day. Each resident has their own single bedroom, one of which has its own ensuite facilities. There is a large sitting room, also used for staff sleeping arrangements, a domestic kitchen with dining area, separate toilet, separate toilet, separate bathroom and office with staff sleeping arrangements. Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced inspection took place between 9.20am and 2.30pm. A senior support worker was assisting a resident with treatment from the district nurse, one resident was attending a day service and the other resident had gone for a walk with a member of staff. Miss Adele Flegg was at the other home which she manages and came to the home later. Mrs Jane Yates, Care Services Manager, came to the home to undertake the yearly audit. The care records, fire records, staff communication book, menus and residents cash records were examined. What the service does well: What has improved since the last inspection? What they could do better: If the care plans accompanied the daily notes, staff would be in a better position to ensure that they were following the guidance of the care plans rather than relying on memory. Records should ideally reflect the experience and training of staff and their understanding of working with people with learning disabilities who often have complex care needs. The organisation needs to be more proactive in its negotiations with the housing association that owns the property to ensure that works needing to be carried out for the safety of residents are completed. Hawthorne Grove (39) Version 1.40 Page 6 D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc 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. Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 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 standard(s) 5 The home could not provide evidence that residents’ families or representatives had yet agreed the contract. Residents or their representatives had not necessarily been involved in drawing up the contracts as they were standard to Millbury Care Services. EVIDENCE: The recommendation that both parties sign the contract and that residents or their representatives were given a copy was in progress. There were copies of the Millbury standard contract signed by the keyworker and Miss Flegg on file. Miss Flegg said that copies had been sent to residents’ families but had not been returned for various reasons. Mrs Yates said that the placing agencies contracts were held at the company head office. Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 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 standard(s) 6 & 7 Care plans are more detailed with good information about residents’ preferences in provision of personal care. However there is little evidence that they are directing the care. Significant work is being done to support residents with improved communication and therefore decision making but this is not supported by the records. EVIDENCE: Much work has gone into addressing the requirement that the care plans were filled out in full detailing all aspects of residents often complex care needs. Care plans now show good detail of personal care giving, social support and communication. The daily report format had been changed to show which aspects of the care plan were the focus, for example, personal care, communication and activities. It was clear from talking to a member of staff that residents were being encouraged to communicate and make choices but this was not always reflected in the daily report which generally reported on what residents had done during the day or what staff had observed. Discussions were held about what constituted evidence of staff intervention and how significant events should be recorded. There is still some work to be done to show evidence that the care plans are directing the care. It was clear from talking to a member of staff that some excellent work had been done in enabling a resident with communication and decision making but the care plan Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 Page 10 and daily reports did not necessarily reflect this. The staff records show that staff have much experience in working with people with learning difficulties and have been well trained in relevant subjects. However the daily reports do not necessarily reflect this with staff only recording events that they have observed. Discussion was held about how this might be achieved. The inspector advised that the care plans would ideally need to accompany the daily reports so staff can refer to the purpose of the plans to evaluate whether and how needs are being met. One member of staff had developed a communication book with photographs and Makaton signs for residents and staff to aid communication. The member of staff described a significant breakthrough in communication with one resident who had previously been deemed as not able to make certain choices. None of this work was taken up in the care plan and there was no evidence that other staff were using this innovative tool. The monthly summary sheets showed review of the care and identified some goals for residents. Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 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 standard(s) 13, 16 & 17 Residents have good access to the locality and its facilities. The home is in a residential community. Emphasis is put on residents referred individual routines. A good range of healthy food is on offer. EVIDENCE: Residents could access some of the local day services on a sessional basis. One of the staff said they were looking at extending the activities residents were involved in as day services were reduced and all the college courses were now full. Efforts are made to encourage residents to get out and about and use local facilities; some of the activities on offer were the cinema, skittles, swimming, relaxation sessions, trips to the local pubs and a yearly holiday. Special day trips or weekends away were organised for those residents who may not be able to cope with any length of time away in a different environment. The home has a vehicle which is wheelchair accessible. Residents preferred daily routines are clearly documented. Staff were heard to talk with residents; to greet them, explain what was happening and not talk exclusively with each other. Residents were not always directly involved in household tasks but would be present when food preparation or laundry was being done. A member of staff gave examples of when residents were involved in some housekeeping. Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 Page 12 Staff were recording what residents were eating at each meal to monitor nutrition. There was sufficient fresh produce in the fridge for the next few days’ meals and for any packed lunches that residents may take to day services. There were also snacks and treats. Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 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 standard(s) 18 & 20 Personal support is provided in the way that residents prefer. Residents have good access to healthcare and specialist services. Medication storage does not now intrude on residents’ living space. EVIDENCE: The care plans were much improved with a detailed section on preferred routines for the giving of personal care, meals and support with moving. There was guidance to staff on what residents liked or disliked in terms of food and how staff worked with them. There was specific guidance on what communication means and the use of Makaton or objects of reference. The requirement that recommended action and advice from healthcare professionals was included in the care plans had not been actioned. This related to an assessment by a physiotherapist regarding bathing and use of a wheelchair. Some guidance was noted in the risk assessments but not in the care plan. Miss Flegg could not find the original letter from the physiotherapist although other information was on file. Miss Flegg said that residents had good access to the consultant psychiatrist with regard to reviewing medication. Residents would also be referred to other healthcare specialists, for example, the hearing and vision team. Records were kept of the outcome of health appointments. There were individual risk assessments on certain activities which residents may be involved in, for example, bathing. Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 Page 14 The medication was now being administered from a locked medicine cabinet and not from a filing cabinet in the kitchen as before. This is less intrusive on residents’ living space. The requirement that staff were regularly trained in the administration and control of medication had been actioned with staff having undergone recent training and certificates on file. Staff were checking received medication and signing the medication administration record as confirmation. The inspector advised that a copy of the organisation’s policy for the safe administration of medication should be kept in the medication administration file for staff reference. Also that handwritten entries on the medication administration record where medication is changed or newly prescribed, should be witnessed, dated and signed by 2 staff. The inspector advised that the medication policy should be clearer about residents’ compliance in taking medication or difficulties in swallowing tablets together with a rationale for seeking alternative forms of medication. Tablets must not be automatically crushed as it could render the medication unlicensed or harm the resident by destroying protective coatings on tablets. Drugs can be prescribed in a variety of mediums and the prescriber should be asked about supplying these alternatives. Any unusual methods of administering medication indicated by a prescriber must be accompanied by their written confirmation for the protection of the residents and indeed the staff who administer. A nurse employed by the organisation’s training department was training staff in the administration of rectal diazepam and staff had been given competency certificates. Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 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 standard(s) 23 These standards were not inspected in any great detail. However independent advocacy services now protect residents. EVIDENCE: The requirement that any advocacy services were agreed with the resident’s placing agency and that there were no conflict of interests for the protection of residents had been resolved. This related to a member of staff’s partner who was due to be an advocate for one resident. The care manager had referred the resident to an advocacy service and advised that the partner should act as a befriender. The befriender would be subject to Criminal Records Bureau checks. Systems were in place for regular audit of residents’ finances to ensure that they are protected from abuse. Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 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 standard(s) 24 Residents benefit from living in a house in a residential area with their own single bedrooms. Little action has been taken to make sure outstanding works are undertaken by the owners of the property. EVIDENCE: The requirement that an action plan was submitted to the Commission regarding the works to be carried out to meet the requirements of the Environmental Health Department has not been actioned. This related to the provision of a second sink in the kitchen for hand washing and removal of the stench pipe in the conservatory. Mrs Yates described her various meetings with and letters to the housing association who had agreed to carry out the works but had not done so. The other outstanding requirement that all the radiators would be fitted with guards to ensure guaranteed low surface temperature for the protection of residents was also awaiting action from the housing association. Mrs Yates said she was taking legal advice as this had been outstanding for over a year and residents were at risk if they fell against the radiators. She agreed to inform the Commission by 10th November 2005 of her progress in getting the all of the works completed. One of the staff said that some work had been done, for example, the bathroom flooring replaced. She went on to say that requests had been made for the gravel area in the back garden needed to be replaced so that it was wheelchair accessible. The Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 Page 17 pond had been filled in as a safety measure. The member of staff said that the television aerial also needed attention as the picture received was poor. The home was keeping a record of all the checks and maintenance of fire protection systems and regular instruction to staff. The environmental risk assessments had been reviewed and updated in June 2005 and all staff were expected to sign up to them. Contractual arrangements were in place for the safe disposal of any clinical waste. The home was given a copy of the latest guidance to care homes on infection control published by the Health Protection Agency. Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Residents are supported by a stable group of staff who are well known to them. Staff are well trained and experienced but this is not always evident from the care records. EVIDENCE: The staffing rota showed a minimum of 2 staff through out the waking day and 2 staff sleeping in at night. Staff are involved in food preparation and cleaning as well as caring. Regular staff meetings were held with minutes kept. Staff received regular supervision with a plan for regular session seen. Miss Flegg showed the inspector a blank copy of the format for recording the agenda, discussion and action plan. As a matter of good practice it was noted that the staff communication book was for organisation purposes only and gave no confidential information about residents. Staff had access to the training programme provided by the organisation both nationally and more local courses. Relevant core subject were: promoting independence, moving and handling, epilepsy, first aid, food hygiene, health and safety, protection of vulnerable adults, non-violent interventions with behaviours, medication and care planning. All of the staff had attained the Learning Disability Award Framework training. Some staff were trained in communication and infection control. One staff held NVQ Levels 2 and 3, one was undertaking Level 3 and 4 staff were doing Level 2. Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 Page 19 Mrs Yates said that there was only a 13 hours post vacant and these shifts were being covered by either the home’s own staff or a bank of staff working between 5 of the organisation’s homes in this locality. She went on to say that the staff were working better as a team and less agency staff were being used. Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 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 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) 41 &42 The home is run in the best interests of the residents. Residents are placed at risk by failure to secure agreement from the owners of the property for outstanding safety works. Records do not always show evidence of the good levels of support provided. EVIDENCE: The home appeared to be much more organised and many of the requirements were being addressed. There is still some work to be done on recording how the care is provided with more detail on interventions rather than just observations. The format had been changed to highlight which areas of the care plan were the focus. The daily reports do not necessarily show staff’s skills or the high levels of training and experience of working with people with learning disabilities. Staff were required to complete the organisation’s regular checks of all equipment, vehicle, wheelchairs, water temperature and other items in the home. Hawthorne Grove (39) Version 1.40 Page 21 D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc There were better systems in place to ensure the security of any residents money with regular checks on balances against the amount and any purchases. Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 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 x x x x 2 Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x x Standard No 11 12 13 14 15 16 17 x x 3 x x 3 3 Standard No 31 32 33 34 35 36 Score x x x x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hawthorne Grove (39) Score 3 x 3 x Standard No 37 38 39 40 41 42 43 Score x x x x 2 3 x D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 Page 23 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. Standard YA 6 Regulation 15 Requirement The registered person must supply the Commission with an action plan giving dates for the works to be carried out to meet the requirements of the Environmental Health Officers report. (Outstanding from 18th April 2005 and not actioned at 10th October 2005. Mrs Yates, Operations Manager said that she was still negotiating with the housing association for completion of the work). The person registered must provide the Commission with an action plan showing the dates when the radiators will be fitted with guards to ensure low surface temperatures. (Outstanding since 18th April 2005. Again Mrs Yates said that she was still awaiting confirmation that the housing association would carry out the work). The person registered must ensure that the daily reporting on meeting residents care needs is related to the guidance given in the care plans. (In progress at 10th October. The format had Timescale for action 30th November 2005 2. YA 42 13(4) 30th November 2005 3. YA 41 17 10th October 2005 Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 Page 24 been changed with sections for personal care, communication, choice, activities and other aspects). Records do not necessarily show how the care was provided. 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 YA 20 Good Practice Recommendations The person registered should ensure that all handwritten entries on the medication administration record where medication is changed or stopped are witnessed, dated and signed by 2 staff. The person registered should ensure that the care plans are kept with the daily records so that staff are aware of residents current needs rather than relying on memory. The person registered should ensure that the medication policy is clear that medication is not crushed potentially rendering it unlicenced. Alternative mediums should be sought from the prescriber. Where unusual methods of administration are directed by the prescriber, the home should seek written confirmation of this. 2. 3. YA 41 YA 20 Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 Page 25 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire, SN15 2BB 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 Hawthorne Grove (39) D51_D01_S36132_HawthorneGrove(39)_V247011_101005_Stage4.doc Version 1.40 Page 26 - 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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