Inspection on 01/08/06 for Ancaster Court

This inspection was carried out on 1st August 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Ancaster Court 29/09/08

Ancaster Court 02/10/07

Ancaster Court 24/08/05

Ancaster Court 08/04/05

Ancaster Court 17/11/04

Ancaster Court 01/04/04

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

CARE HOMES FOR OLDER PEOPLE Ancaster Court 24 Hastings Road Bexhill On Sea East Sussex TN40 2HH Lead Inspector Melanie Freeman Key Unannounced Inspection 10:00 1 and 8th August 2006 st 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 Ancaster Court DS0000013953.V305243.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. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Ancaster Court Address 24 Hastings Road Bexhill On Sea East Sussex TN40 2HH 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) 01424-213532 01424-221925 sowerby@bupa.com www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Alison Sowerby Care Home 51 Category(ies) of Old age, not falling within any other category registration, with number (51) of places Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The maximum number of service users to be accommodated is fifty one (51). That the care home can provide nursing/residential care to older people aged sixty five (65) or over on admission The service can provide up to fifty one (51) nursing places and three (3) social care places. That the home can admit one named service user under the age of sixty five (65) years on admission. 24th August 2005 Date of last inspection Brief Description of the Service: Ancaster Court has 51 registered beds that can be used to provide general nursing care and admits people who are privately funded and those who are funded by Social Services. Ancaster Court is owned and managed by BUPA Care Homes Ltd. The bedrooms are found on three floors and a passenger lift provides level access throughout the home. 4 of the bedrooms can be used for sharing and 16 have en-suite facilities. Ancaster Court is a Victorian building that has been converted and adapted to its present use. It is located in a residential area approximately 1/2 mile from Bexhill town centre, seafront and mainline train station. The home has a garden to the rear of the property where residents can sit weather permitting. There is parking to the front of the home for approximately 15 vehicles. The home’s fees as from 01 July 2006 range between £450-£825 per person per week depending on the room to be occupied and the care needs of the individual. Additional costs are charged for chiropody, hairdressing, newspapers and magazines. The homes literature states that the Philosophy of the home is simple and believes that each individual should be treated as a unique independent person with a right to privacy and freedom of choice. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001 often use the term ‘service user’ to describe those living in care home settings. For the purpose of this report those living at Ancaster Court Care Home will be referred to as ‘residents’. This was a key inspection that included an unannounced visit to the home and a follow up visit made to the home by appointment. Contact was also made with resident’s representatives and visiting health and social care professionals following the visits to the home. The unannounced visit included a meeting with the registered manager who facilitated the inspection process and received the inspector’s feedback at the end of the inspection. On the day of the home visit the inspector spent most of her time meeting with residents and their visitors, and observing practice in the home. A tour of the premises was undertaken and a range of documentation was reviewed including the homes statement of purpose and service users guide, care plans, duty rotas, medication records, and recruitment files. The care documentation pertaining to three residents was reviewed in depth along with a number of policies and procedures and records relating to health and safety. The inspector was able to eat a mid-day meal with the residents in the communal dining room during the unannounced visit. In addition service users surveys were given to 10 residents or their representatives and 10 staff surveys were left in the home for staff to return. The inspector received 7 surveys from residents or their representatives, no staff surveys were returned. The information contained in the returned surveys has been incorporated into this report. What the service does well: A good level of information is provided to residents prior to their admission and all residents are assessed prior to admission. The care documentation gives a good framework for care. All feedback received from residents and relatives was positive about the care provided by the home and the staff working in the home. Although the home is large the individual and communal space provided is homely and well maintained. Visiting is encouraged and the home works hard on maintaining links with the community. The provision of activities and entertainment now provides a varied and much enjoyed provision. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 6 There is a well-developed system to promote and protect the health and safety of residents and staff. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 7 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 Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are provided with information about the home in order to make an informed choice about whether to live at the home. The pre-admission assessment procedures ensure residents admitted can have their care needs met within the home. EVIDENCE: The statement of purpose, service users guide and a copy of the last inspection report is available in the downstairs lounge area. Although the terms and conditions of residency were not displayed within this documentation during the first home visit, this shortfall was rectified by the home manager by the second visit. The home also has a full brochure that is provided to prospective residents and their representatives and this contains useful information. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 9 Contact with residents, relatives and social care professionals confirmed that the contract arrangements are clear and that the admission process was completed in a professional and efficient way. Those residents that are funded privately have a copy of the contract agreement, those funded by Social Services are not currently provided with a copy of the contract agreement and the home manager is looking at ways to ensure all residents have relevant information about the home and what facilities and services are available. All residents prior to any admission being agreed are fully assessed by the home manager or the head of care. The quality of these assessments were reviewed and identified that although they are full and used to ensure that any new admissions to the home is suitable they do not demonstrate a multidisciplinary approach to all the care needs of the identified individual care needs. It was also noted that the pre-admission assessments are not always dated or signed. These areas were discussed with the home manager during the inspection visit. Intermediate or rehabilitative care is not provided at Ancaster Court Nursing Home. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Generally care plans provide a good framework for the delivery of care, however these need to provide clear guidance to care staff on all the care needs of residents and how these are to be met. Procedures and practice in the home on the whole allow for the safe administration of medicines however further improved practice is needed in respect of pain management. The privacy and dignity of residents are well promoted. EVIDENCE: The care documentation pertaining to six residents was reviewed as part of the inspection process. This demonstrated a systematic approach to the planning of care that included a full assessment of individual needs and the use of individual risk assessment, that included the risk of developing pressure area damage, the risks associated with moving residents and an nutritional assessment. The care plans give a good framework for care however it was noted that not all the changing needs of residents are fully documented. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 11 An example of this is a resident’s problems with a painful shoulder and another resident with specific nutritional needs not being identified within their care plans. The inspector was also concerned to note that although a pre-admission assessment completed on a new resident identified the need for a specialist mattress to prevent pressure area damage, this specialist equipment was not provided before the admission and was not available for over 24 hours after admission. During the inspection visit it was noted that residents who have varying needs and dependencies were receiving appropriate nursing and personal care tailored to meet their care needs, with the support of appropriate equipment as required. All care staff spoken to had a good understanding of residents needs and demonstrated a sympathetic and kind approach which, respected their dignity and privacy. When reviewing the care for one resident it was apparent that the procedure for monitoring and dealing with resident’s experience of pain was not well managed. This resident had requested stronger painkillers and although these were dispensed via the GP, he was not receiving this medication despite still being in pain. This concern was identified to the head of care who ensured that this resident received the stronger painkiller. This resident was seen again at the follow up visit and there was no evidence to confirm that the resident’s pain was being monitored. A visiting relative was concerned that the pain was persisting and requested a visit from the GP. The facilities for the storage and administration of medicines are good and promote safe practice in the home. The inspector was able to observe a member of staff completing a medicines round and this found to be completed in a safe manner. Medicine records were found to be accurate and up to date however it was noted that staff had hand written medicines onto the MAR chart when they were no longer prescribed. Although this medicine had not been given, the risk was present. Feedback provided within the surveys and contact during the visit to the service confirmed a satisfaction with the care and services provided at Ancaster Court and this included meeting with ten visiting relatives. Their comments included ‘I am more than happy with the care’, ‘I am very satisfied with the care provided’. Visitors including professionals spoken to praised the home and the way the privacy and dignity of residents is respected. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The homes activities and entertainment is well managed and ensures a varied provision. Meals provided for residents are good and meal times are well managed. Residents are able to make a range of choices about their lives as well as maintaining links with friends and relatives. EVIDENCE: Feedback from resident’s visitors and staff was positive about the improved activities and entertainment. There are two people working in the home to provide appropriate and varied activities and they work hard to provide choice and time to those residents not wanting to or unable to participate in groups. The home has been doing ‘speciality days’ that include themed food and the next arranged is to be a Caribbean day. On the day of the inspection visit the inspector noted that residents were enjoying a visit from a volunteer who brings her dog to meet with residents and library service that comes to the home on a fortnightly basis. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 13 Visiting is encouraged and visitors spoken to including professionals confirmed that they were always welcomed by friendly staff and feel able to visit whenever they want to. The home has recently held a dog show that was very well supported by the local community and enjoyed by residents. Residents have access to the home’s mobile phone or they can have their own separate telephone line. During the inspection residents spoken said that they were able to choose how they spent their day and could go to bed and get up when they wanted. The inspector noted that many of the residents went to bed early and the home manager advised that this was at their request. Discussion took place around the need to record these choices in the care documentation. During the inspection it was noted that residents are able to personalise their own rooms, some looking very individual. The inspector ate a midday meal with the residents in the ground floor dining room. The meal provided was found to be well presented and to have a good taste. The staff member working in the dining room during the mealtime was very supportive to residents and encouraged resident interaction and independence. Residents and visitors complimented the food and there is recognition that the provision has been improved with a stable catering management being established. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures and practices in the home ensure that complaints made are managed appropriately, with residents and representatives being confident that they are listened to and responded to. Procedures and practice in the home ensure that adult protection issues are responded to when identified. EVIDENCE: The home has a detailed and clear complaints procedure in place. It gives clear guidance with regard to how a complaint can be made and how the complainant can expect it to be dealt with. The complaints procedure is available in the homes brochure and visitors felt confident that if they raised a concern this would be listened to and responded to appropriately. There were records in the home that confirmed that any concerns raised are investigated and responded to effectively. Procedures are in place for the protection of vulnerable adults and the homes manager and deputy clearly have a good understanding of adult protection issues within the home and external influences. The manager has involved social services in any adult protection concern as appropriate. Regular staff training on adult protection issues is being established. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Ancaster Court provides residents with a comfortable environment that is well decorated. The home is clean and well maintained. EVIDENCE: Ancaster Court is a converted premise that has been adapted to its present use as a care home. The home is well maintained and there was evidence that ongoing redecoration and refurbishment is routinely progressed throughout the home. The home has 43 single rooms and 4 shared rooms and these are used flexibly to meet resident’s needs. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 16 There is a lounge, dining room and sun lounge on the ground floor, and an additional lounge/dining room on the second floor, these areas are used by all residents as there is level access to all areas of the home and a passenger lift serves all floors. Ancaster Court has attractive gardens and access to these is provided with a ramp, however discussion with residents inferred that they would enjoy more access to this area with a carer in attendance. The standard of cleaning has improved since the last inspection and it was noted that good standards of infection control are being followed with appropriate equipment and clothing being used. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing numbers and skill mix provides a competent staff team that can meet residents health and personal care needs. The homes recruitment procedures followed were found to be robust. EVIDENCE: Ancaster Court has resident accommodation on three floors and each floor is staffed separately although the home manager advised that most staff are moved around the home to ensure equity of care and integration of staff. Residents visitors and staff spoken to said that there was enough staff to meet the needs of residents and allowed for some time to spend individual time with residents. Staffing levels observed during the site visits were found to be appropriate to meet the needs of residents with a registered nurse allocated to each floor, and records held by the home confirmed that these levels are maintained over the week. The feedback received from residents, relatives and care professionals as part of this inspection was on the whole positive and comments received about staff included ‘I have been impressed with how they have met one residents needs’, Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 18 ‘the home provides appropriate care and the staff are cheerful and friendly’, ‘I cannot fault the staff and I am well looked after’. The recruitment practice and records were inspected for four staff members and were found to be comprehensive and clear. The home has developed a training matrix, and this is proving effective in identifying training patterns and training needed. Although a wide range of training is arranged and there is a system to ensure everyone completes the necessary training this needs to be fully established to ensure and evidence that all staff have the necessary training to meet the needs of all residents. The inspector was advised that 75 of care staff have now completed the required National Vocational Qualification at level 2 or above in care. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed in a way that allows the home to meet its stated purpose. Quality assurance measures allow for residents and representatives views to be taken in to account and responded to. Systems are in place to ensure resident’s monies and health and safety issues are well managed. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 20 EVIDENCE: The registered home manager is a registered nurse with appropriate management qualifications, and has managed this home for four years. She is supported in her role by four heads of departments that include a registered nurse who is head of care, a maintenance manager, an administrator and a catering manager. This recently fully established supportive management structure has enabled the manager to focus on staff training and taking an active role in the care provision to residents. The home manager has a very good working relationship with her senior staff and a supportive team spirit was noted. Staff spoken to confirmed that the home manager and head of care have regular contact with staff and residents, reviewing the care provided in the home and readily available for support to staff and visitors. Residents and visitors questionnaires are completed on an annual basis these are audited by head office with a report going to the home manager. The last report was very positive this is available to people at request and although the manager responds to the any area that can be further improved this is not reported on. The home holds 3 monthly resident meetings, and the feedback from these is recorded within the minutes that are shared with all interested parties. A newsletter is also provided quarterly, which is an excellent vehicle for sharing of information. Internal company quality assurance audits are also used and evaluated. All service users have the opportunity to manage their own money and a locked facility is provided in each room. There are strict procedures in place regarding the documentation of ‘pocket money’ and receipts are required for every transaction and records seen at the time of this visit were accurate and up to date. All relatives spoken to said that they were aware of all the costs and were happy with the arrangements. There is evidence that the home is managed in a way that ensures as far as is reasonably practicable the health, safety and welfare of residents and staff. All records seen in respect of health and safety in the home were full and accurate. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 21 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 2 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 3 X X X X X 3 STAFFING Standard No Score 27 3 28 4 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 Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 22 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 OP8 Regulation 14(2) Requirement That all the care needs of residents are clearly documented in the care plans, and those residents who experience pain have this monitored and evaluated to ensure that any pain is minimised as far as possible. That the medicine charts are only used to record medicines that are prescribed and that painkillers used are closely monitored. That clear guidance is in place for all medicines that are prescribed on an ‘as required’ basis. Timescale for action 01/09/06 2. OP9 13(2) 01/09/06 3. OP9 13(2) 01/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 23 1. OP22 2. 3. OP20 OP35 That an assessment of the premises and facilities should be undertaken by a qualified Occupational Therapist, to advise on the suitability of disability equipment and environmental adaptations. That the use of the garden is increased for those residents wanting more time in the garden. That when money is accepted from relatives by the homes staff on behalf of a resident’s that a receipt is given. Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Ancaster Court DS0000013953.V305243.R01.S.doc Version 5.2 Page 25 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!