Inspection on 01/03/07 for Alison House

This inspection was carried out on 1st March 2007.

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

Alison House 18/02/09

Alison House 06/11/06

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Alison House 7 Newton Street Basford Stoke on Trent ST4 6JN Lead Inspector Sue Jordan Key Unannounced Inspection 1 March 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alison House Address 7 Newton Street Basford Stoke on Trent ST4 6JN 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) 0121 4513746 01782 717168 Mrs Shanti Odedra Mr Sunil Odedra Mrs Sharon Allen Care Home 24 Category(ies) of Dementia - over 65 years of age (12), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (6), Old age, not falling within any other category (24) Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6 November 2006 Brief Description of the Service: Alison House is situated in the Basford area of Newcastle Under Lyme. Alison House is registered as a residential care home for 30 older people. They are also registered to provide care to 6 people with dementia care needs and 6 with mental disorder. At the time of the inspection there were 23 people residing in the home. Alison House has had a new owner and acting manager since the last inspection. The manager was registered with the Commission for Social Care Inspection in January 2007. The home is on two levels and single bedrooms are available on both floors. Some of the bedrooms have en-suite facilities. There are a variety of communal spaces in the home: a large conservatory looking over a paved courtyard area at the back of the home and two lounges at the front. There is a separate dining room adjacent to the kitchen. The home provides home cooked meals, with a varied menu. The fees charged range from £304-£334 per week. Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place over five and a half hours. The methodologies used were scrutiny of three residents’ care records and the records for two new staff employed since the last inspection, including recruitment and training documents. Discussions were had with a number of the residents, a senior care worker, the manager and some staff. Observations were made of non-personal care tasks and daily routines, including the morning’s activities and the serving of lunch. The medication systems were thoroughly checked, including observation of administration. A random selection of the maintenance records was seen and a tour of the environment was taken. What the service does well: Prospective residents are provided with information about the Home and are able to visit before making a decision as to whether they wish to live there. Assessments are undertaken of all new residents and the manager obtains a professional assessment for those residents referred by the Local Authority. Care records are maintained for each resident, which are regularly reviewed. The care staff monitor the health of the residents and medical support is provided as required. Generally the medication systems are satisfactory. Administration is undertaken professionally and storage and record keeping robust. Staff are undertaking comprehensive training in medication procedures. The residents are treated kindly and sensitively by the staff. There is a range of activities available for the residents and relatives are welcomed into the Home. Good quality, home cooked meals are provided. Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 6 There have been no complaints made to the Commission for Social Care Inspection. There have been no Vulnerable Adults referrals. The staff team are well recruited and trained. There is a loyal, core group of staff that have worked at Alison House for many years. Appropriate checks are made of all potential staff. Health and Safety procedures, including fire safety remain a priority. What has improved since the last inspection? What they could do better: There are only two usable bathrooms in the Home. Now that the Home is at near full capacity, this must be increased. The information in the care records varies depending on the staff member completing them. The manager is going to monitor this and provide additional guidance at supervision, if required. The manager was advised that the medication administration records should include very clear, guidance for all drugs, as to when it should be given. Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are provided with information about the Home and are encouraged to visit before making a decision as to whether they wish to live there. Their needs are assessed, so that they can be confident that the Home can provide the required support. EVIDENCE: The Statement of Purpose and Service Users Guide have been updated to reflect the proprietor and management changes in Alison House. The care records of the last three residents admitted into the Home were checked. The manager received comprehensive assessments from the Local Authority prior to them coming to the Home. Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 10 The staff at the home complete ‘in-house’ assessments for the residents, including manual handling and falls, physical health, personal, oral, tissue viability, nutritional and mental health assessments. The quality of the assessments varied dependent on the staff member completing them and some were not dated. As a result, it is difficult to establish whether the assessments are being reviewed. The manager is recommended to monitor the completion of the care records and discuss with staff at supervision. Where possible potential residents are encouraged to visit Alison House before making a decision to come live there. Records are kept of all visits. Alison House does not provide intermediate care. Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The needs of the residents are detailed in their care records, ensuring that the staff know what support is required. The health of the residents is closely monitored and medication administered in a safe and professional manner. EVIDENCE: New care plan formats have been introduced and are now in place for all of the residents. The formats allow for more detailed information. However, as identified previously, the quality of the care plan information varies. Records are kept on a daily basis and the care plans are reviewed monthly. The phrase, “all care given” does not provide enough information as to the Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 12 support given to the residents and it is recommended that this information be extended. There is ample evidence within the care records that the residents’ health needs are monitored. All health and medical professional input is recorded in the care plans. The residents are weighed regularly and weights recorded. Alison House has recently had a change of pharmacist and is using a cassette system. The medication procedures were checked during this inspection and found to be generally satisfactory. Administration was carried out in a safe and professional manner. Administration directions for staff is generally clear and concise, however the manager must ensure that this is the case for all medication. For example, “when required” is not sufficient information. The manager should ask the prescriber to provide clear instructions to the pharmacist, which is then transferred to the medication recording sheets. If this is not possible, protocols should be developed and the general practitioner asked to sign them. Several staff are completing the ‘Safe Handling of Medicines’, distance learning training course and the staff were shown how to use the new cassette system by the pharmacist. The manager is recommended to develop a system of checking staffs’ on-going competency. It is recommended that this be undertaken twice a year. The staff were observed treating the residents with respect and dignity. One of the residents said that the staff at Alison House were kinder than in her last residential care home. A pleasant banter was observed between the manager, staff and the residents. New laundry systems have been introduced, with the marking of clothes and individual boxes. Residents are also provided with their own bedding, towels and flannels, which again are marked and returned to them after washing. All of the bedrooms are single occupancy and door locks are provided on the doors. Medical intervention is provided in private, either in the resident’s bedroom or in the ‘hairdressing’ room. Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are offered a range of activities in which they can join in. Good quality, home-cooked meals are provided. EVIDENCE: Alison House encourages a flexible approach and some of the residents were observed having their breakfast at 10:00am. The residents’ preferred routines are recorded in their care records. A new four weekly activities plan has been devised. Activities are available in the morning and in the afternoon. Staff are delegated to facilitate the activities at the beginning of their shift. The plan includes activities, which meet both mental and physical needs. One of the residents confirmed that activities take place on daily basis. At the time they were playing snakes and ladders with a staff member and she Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 14 laughingly said that they had done the conga that morning. Another resident said that she preferred not to join in, but liked to watch the others. Alison House has a key worker system in place and as part of this role; the staff undertake one-to-one activities with the residents. Time is specifically set aside and the staff record the activities completed, even if this is time spent chatting. More craft activities have been introduced, for example dried flower arrangements. One of the residents said that she goes to a local market with staff every week. A number of relatives were visiting during this inspection and are welcomed by the staff. The lunchtime menu is posted on a board in the dining room. A three-course meal is provided every lunchtime, which always includes an alternative of cold meat if the main meal is not wanted. A choice of a hot and cold meal is provided at teatime. Staff were observed asking the residents which meal they wanted to have and records are kept. There is a four weekly menu, which is changed depending on the season. Two of the residents spoken to said that the food was very good. Vegetables and sauces are taken to the tables separately to further encourage choice. A local greengrocer delivers fruit and vegetables and full fat milk is provided. At present there are four diabetic residents and they are given alternative deserts. Mid morning and afternoon drinks and biscuits are provided and a choice of milky drinks provided at suppertime. The staff report that the residents can have a snack at suppertime, if they wish. The manager reported that all staff have completed food and hygiene training. The staff avoid going into the kitchen and if they do, they wear protective clothing to avoid contamination. Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents are protected by robust recruitment and safe systems of working. EVIDENCE: At the last inspection it was identified that some of the residents and relatives did not know who to complain to, if they had concerns. As a result the manager has posted copies of the complaints procedure in strategic places in the Home. The manager has introduced a ‘hard backed’ book for the recording of complaints, as was previously recommended. There have been no complaints made to the Commission for Social Care Inspection since the last inspection in November 2006. Staff have received Protection of Vulnerable Adults training and appropriate checks are made for all potential staff members. There have been no Vulnerable Adults referrals. Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Improvements continue to be made to enhance the environment for the residents. EVIDENCE: Following the last inspection in November 2006, the manager sent a maintenance plan to the Commission for Social Care Inspection. A tour of the Home was undertaken and a number of improvements have been made, which together with those already made since the new owners purchased Alison House, have greatly enhanced the environment for the residents. Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 17 The work completed includes: New radiator covers. New carpets in some of the bedrooms. New nameplates on the bedroom doors. New liquid soap and paper towels dispensers in the communal bathrooms and toilets. New roller blinds throughout the Home. The bath panel in the downstairs bathroom has been repaired. Handrails have been fitted in the en-suite toilets. Many areas of the Home have been decorated. New light fittings have been provided in a number of areas. A new handy person has been employed. As a result of the above work, the Home is looking cleaner and fresher. There are only two ‘useable’ bathrooms in Alison House. There have been some new admissions at the Home and there are presently twenty-three residents. Another bathroom should be renovated to ensure a minimum ratio of one bathroom to eight residents. There are plans to improve the conservatory area. The manager is concerned that the glass roof means that it is too warm in the summer and too cold in the winter. She thinks that because of this the residents do not make the most of the space. A hand washbasin is still required in one of the communal toilets. Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A well-recruited and trained workforce supports the residents. EVIDENCE: The manager provided evidence that staffing levels are reviewed and provided dependent on the number and needs of the residents. The manager reported that there is normally four care staff on duty but that there were a number of staff on leave. The rotas confirmed this. The Home has had a shortage of night staff, however two people have recently been recruited. The manager reported that she intends to employ more staff for the afternoon shift. Two waking night staff are always provided. A new member of night staff will work alongside two colleagues for at least two weeks before being able to work as a member of the two-person team. A decision is made at supervision with the manager as to whether a third week is required. Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 19 New staff complete a comprehensive induction booklet, which can be cross referenced to a National Vocational Qualification. The training records were checked and courses have been attended in Health and Safety, Fire Safety, Protection of Vulnerable Adults, Manual Handling, First Aid and dementia. The records only detailed the training attended in 2006 and it was recommended that a matrix be developed, which will evidence all previous training that is still ‘in date’. For example, the manager reported that all staff have food and hygiene certificates and a number have received medication training but this is not recorded. Most of the staff have either achieved National Vocational Qualification 2 or above or they are undertaking the award. The recruitment files of the two most recent employees were checked. They provided evidence that robust recruitment procedures have been sustained. Protection of Vulnerable Adults and Criminal Records Bureau checks are made for all potential staff members. The staff spoken to confirmed that they are enjoying the new responsibilities given to them since the new manager came into post. Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents and staff benefit from sound managerial systems. EVIDENCE: The manager, Sharon Allen was registered with the Commission for Social Care Inspection in January 2007. She is presently undertaking the Registered Managers Award and hopes to be finished by summer 2007. She also has a personal interest in learning more about dementia. Mrs Allen was previously the deputy manager and has implemented many improvements since becoming the manager. These include a Quality Assurance system; new assessments and care plan formats, a staff supervision system, more regular Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 21 training including induction of new staff and more robust recruitment procedures. Staff have been given more responsibility pertinent to their roles and new staff are given the support of working alongside experienced care staff as mentors until they are ready to work unsupervised. These together with the environmental improvements made since the new owners purchased Alison House have improved the standards in the Home for the residents and the staff. Quality Assurance questionnaires are sent to the relatives, residents and staff on an annual basis. The manager also sends them to other professionals involved in the lives of the residents and replies have been received from the hairdresser and a district nurse. The manager monitors the reasons why residents leave Alison House and her analysis shows that this is normally due to the need for nursing care. She also undertakes an analysis of staff training, the Commission for Social Care Inspection reports and the reasons why staff leave the Home. Staff supervision systems are now up and running and there is evidence that all staff have received at least one one-to-one supervision with a member of the management team. Staff spoken to confirmed this and also that regular team meetings are held. This includes the whole staff team, or by shift. Staff handover pertinent information at every shift change. The manager is due to set up a monitoring system to check the quality of the information in the care records. The manager and the proprietor have drawn up a maintenance plan for the environment and a copy was sent to the Commission for Social Care Inspection, as required. An independent consultant undertakes monthly, unannounced visits and the reports are available to the Commission for Social Care Inspection. A random selection of the Health and Safety and maintenance records were checked at this inspection and provide evidence that Health and Safety is a priority in the Home. Generic risk assessments were reviewed at the end of 2006. The manager was reminded that a risk assessment should be completed for the handy person when undertaking any task, which may comprise his or the residents’ safety. It was recommended that the handy person receive instruction regarding risk assessment so that he can complete them prior to commencing a job. Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 22 Fire safety arrangements are robust, including regular testing of the systems, regular fire drills and the maintenance of fire fighting equipment. Individual fire risk assessments and evacuation plans have been developed for each resident. The manager holds some small amounts of residents’ money for safekeeping. The records were checked against one balance and found to be correct. All transactions are recorded and where possible signatures are obtained from the relatives or resident. Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP21 Regulation 23 (2j) Requirement The registered person must ensure that there are sufficient numbers of ‘usable’ bathrooms and wash hand basins in the Home. Timescale for action 01/05/07 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 OP7 Good Practice Recommendations The manager is recommended to monitor the completion of the care records and discuss with staff at supervision. It is recommended that the information in the daily care records be extended. The manager should ask the prescriber to provide clear administration instructions to the pharmacist, which is then transferred to the medication recording sheets. If this is not possible, protocols should be developed and the general practitioner asked to sign them. OP7 OP9 Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 25 4. OP9 The manager is recommended to develop a system of checking staffs’ on-going medication administration competency. It is recommended that this be undertaken twice a year. It is recommended that a training matrix be developed. Risk assessments should be undertaken for the jobs undertaken by the handy person, which may compromise the safety of residents and staff. 5. 6. OP30 OP38 Alison House DS0000067292.V332534.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Stafford Office Dyson Court Staffordshire Technology Park Beaconside Stafford ST18 0ES National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Alison House DS0000067292.V332534.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. 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