Inspection on 07/07/06 for Applewood Care Home

This inspection was carried out on 7th July 2006.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Applewood Care Home 24/10/08

Applewood Care Home 27/02/06

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Applewood Care Home Coopers Lane Bramley Basingstoke Hampshire RG26 5BZ Lead Inspector Mrs Michelle Presdee Unannounced Inspection 7th July 2006 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 Applewood Care Home DS0000064903.V298206.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. Applewood Care Home DS0000064903.V298206.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Applewood Care Home Address Coopers Lane Bramley Basingstoke Hampshire RG26 5BZ 01730 895485 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) Milkwood Residential Care Ltd Natalie Betsworth Care Home 19 Category(ies) of Dementia - over 65 years of age (9), Old age, registration, with number not falling within any other category (19) of places Applewood Care Home DS0000064903.V298206.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th February 2006 Brief Description of the Service: Applewood is a large detached property situated in a quiet residential area in the village of Bramley, Hampshire. The home provides care and accommodation for nineteen older persons, nine of whom may have dementia. Accommodation is provided over two floors with a passenger lift and stair chair lift allowing residents access to each floor. There are two communal lounges, a conservatory where a dining area is situated and there is also a small sitting room that can be used as a quiet room or for residents to entertain their visitors. The home has pleasant gardens where seating is provided for residents and their visitors. The fees for the home range from £319.00 to £500.00 per week, with extra being charged for hairdressing and chiropody. The home’s ownership changed in December 2005 and it is now registered with Milkwood Care Ltd, an organisation that owns a number of care homes in the South of England and in Wales. Applewood Care Home DS0000064903.V298206.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this unannounced inspection the majority of the 14 service users being accommodated were spoken with, as were three members of staff and two visitors. All spoken with had praise for the home and felt the manager was doing a good job and was approachable. The registered manager and one of the organisations directors assisted the inspector. During the inspection, a tour of the building was undertaken. The inspector was advised whilst there has been improvements to the decor of the home further improvements are planned, which would bring all service users rooms to the same standard. Assessments, care plans, policies, procedures, staffing records, safety certificates and other relevant paperwork were looked at during the day. The home is currently undergoing major change to the layout of the home. A new kitchen has been fitted which the inspector was informed should be operational in the week following the inspection. The conservatory that acted as the dining room has been knocked down and another one is being built. All steps were being taken to ensure the service users safety and to minimise the disruption to service users. In doing these changes the home has lost one bedroom and a room, which was used as a visitor’s room. The inspector advised all changes, which, affect the number of bedrooms, must be discussed and agreed with the Commission for Social Care Inspection (CSCI). The home is also planning an extension and building another twenty rooms. What the service does well: The home has a friendly and relaxed atmosphere. One service user stated, “we are just like one big family, we all including the staff look after each other”. Assessments and care plans are detailed and give staff good, clear information to ensure service users needs are met. The home tries to meet service users social needs on an individual basis and has a daily social activity, which service users can join in if they want. Training is well promoted in the home and staff are encouraged to undertake training. Staff felt they received good and regular training to enable them to do their job. Applewood Care Home DS0000064903.V298206.R01.S.doc Version 5.2 Page 6 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. Applewood Care Home DS0000064903.V298206.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 Applewood Care Home DS0000064903.V298206.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process provides sufficient information for care staff to meet all service users needs. The home does not provide intermediate care. EVIDENCE: The assessments of two service users were viewed. It was clear a full assessment is completed. The registered manager had a good process, which is followed for all new service users. As soon as an enquiry is made into the home an initial enquiry form is started which starts to build information on the service user. The manager would visit a service user before they moved into the home to gain information on the service user. The views of others involved in the care of the service user are sought and recorded. The service user is then invited to the home for a day or for a respite period. The needs of the service user are discussed with staff members and a decision is made if the home and staff can meet their needs. The home is going to introduce including Applewood Care Home DS0000064903.V298206.R01.S.doc Version 5.2 Page 9 the service user views on the assessment. Assessments seen gave detailed all of a service users needs including social and recreational needs, night and day needs, risk assessments and handling assessments. The home does not provide intermediate care. Applewood Care Home DS0000064903.V298206.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans give sufficient information to identify service users needs and show how the needs are to be met by care staff. The medication procedure is followed, ensuring service users safety. The core values are promoted in the home ensuring service users are treated with respect and their right to privacy is respected. EVIDENCE: Care plans seen on the day indicated service users have a plan of care, which meets all their needs. Care plans were split between night and day. Each area looked at stated the needs, the preferences, the objective, the action and by whom. Care plans recorded information on what the service user liked to be called, information on their family life, working life and what they enjoy doing. Daily notes were maintained giving an on-going picture of the service user. Applewood Care Home DS0000064903.V298206.R01.S.doc Version 5.2 Page 11 Reviews were held on a monthly basis and all changes were recorded. On the day of the inspection a review was being held on a service user who had been in the home for over two years; other agencies and family members had been invited. The inspector was advised the home is currently trying to get the service user and family members involved in the monthly review. Two visitors spoken to felt they were kept well informed on their relatives care and progress and felt their needs were well met in the home. The home has a range of health professionals calling into the home and the manager explained the home has a good relationship with the district nurses and community psychiatric nurses. All health needs are recorded and all visits by professionals are recorded in the care plan. The home has a dentist, optician and chiropodist who will call into the home. The home has a clear medication policy, which is displayed in the home. Care staff involved with the medication have received training from the pharmacist and are undertaking a 16-week course on the safe handling of medication. The inspector was advised two people check medication when it enters the home and it is always stored in a locked cupboard. Medication was checked on the day and it was found accurate records were maintained which corresponded with the medication held. Medication is given to a service user, the record is signed and then medication is given to the next service user. Temazepam was being used in the home; this was being stored appropriately as a controlled medication but was only being signed for by one staff member. The manager explained there were plans to change this to two members of staff when staff have finished their training. The home is also planning on creating a medication room with the new planned changes. Discussions were held on the need to ensure when medication has changed or been stopped on the instructions of the doctor these instructions are recorded. From observations on the day and from discussions with service users and visitors it was clear service users are treated with respect. Staff were observed talking and aiding service users in a friendly and caring manner. Service users spoken to stated care staff were always helpful and did respect their privacy. All bedrooms and bathrooms were fitted with locks. Applewood Care Home DS0000064903.V298206.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, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a variety of social activities, giving service users the choice to join in when they wish. Visitors are made welcome to the home. A varied menu with a choice and good quality food is served to service users. EVIDENCE: Service users spoken to on the day of the inspection felt the home matched their expectations. All service users spoken to felt the home offered adequate social and leisure activities. A list is displayed on a weekly basis and service users are free to join in if they wish. Activities include karaoke, arts and crafts, movement and exercise, bingo, outside entertainers, hairdressing, manicures and music and videos. One service user attends church on a regular basis and a religious service is provided in the home on a monthly basis. The organisation has a mini-bus, which has been used more regularly recently due to the building work, which has limited service users access to the garden. Signs in the home state visitors are welcome at any time. This information is recorded in the service users guide. Visitors and service users confirmed Applewood Care Home DS0000064903.V298206.R01.S.doc Version 5.2 Page 13 visitors can call at any time and will always be made welcome. Service users also spoke of their enjoyment of going out with their relatives and friends. A five- week menu was seen demonstrating meals were varied and nutritious. Wine is offered with Sunday lunch and sherry is offered to celebrate birthdays. The menu for the day is displayed in the home. On the day of the inspection fish and chips with peas and sweet corn was served for lunch with home baked bakewell tart and ice cream for pudding. Service user spoken to enjoyed their meals and confirmed they could always have an alternative if they did not like the main dish on offer. The cook confirmed all choices are recorded. The cook confirmed there are no restrictions on the budget for food and good quality food is purchased. Fresh vegetables are served on most days with puddings being home baked. A cook is on duty seven days a week working from 8.00am until 2.00pm. Whilst the new conservatory is being built, which will act as the dining room service users are eating their meals on tables, which are put in front of them at meal times. None of the service users spoken to on the day found this a problem and were looking forward to the new conservatory being finished. Applewood Care Home DS0000064903.V298206.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, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users felt confident their complaints would be listened to and acted upon. Service users are protected from abuse and staff benefit from regular training. EVIDENCE: The home has a complaints procedure, which details all the necessary names, addresses, telephone numbers and timescales. The procedure is displayed in the home and in included in the service user guide. The home records all complaints made to them and states what action has been taken and what the final outcome was. Records seen demonstrated the home takes all complaints seriously and acts upon them. Two visitors to the home stated they would first complain to the manager who they felt would deal with their complaint. They did know about contacting CSCI if they were not satisfied. Service users stated they had confidence if they spoke to the manager, their complaints would be dealt with. The home has a policy and information file on abuse. This included information on types of abuse it contained a whistle-blowing policy, the document “No Secrets” and Hampshire’s Adult protection Policy and Procedures. Staff spoken to were aware of abuse and the different types of abuse and were also aware of what to do if they suspected abuse in the home. Staff received training on Applewood Care Home DS0000064903.V298206.R01.S.doc Version 5.2 Page 15 abuse in May and more training has been arranged for October. Applewood Care Home DS0000064903.V298206.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a clean, safe, pleasant environment for the enjoyment of service users, which is improving and will continue to improve. EVIDENCE: At the time of the inspection the home was having building work both inside and outside. All necessary steps were being taken to minimise the risk to service users. Health and safety signs were being displayed. Pressure mats were placed on external doors, which triggered the alarm if a service user went outdoors. It was noted some sheds were left open in the garden, which should be kept locked just in case a service user did gain access. Service users whilst the building works are being undertaken are not allowed to access the garden. The inspector was advised service users and visitors had been informed of this Applewood Care Home DS0000064903.V298206.R01.S.doc Version 5.2 Page 17 prior to it happening. The mini-bus has been used to take service users out and the inspector was advised most service users have relatives who take them out. Whilst walking around the home and looking in service users bedrooms it was noted not all windows open fully and the majority were wedged open with sticks. Window restrictors had not been fitted. It was noted on three glass panes the glass had cracked. It was agreed a risk assessment would be completed in these areas and the windows would be fixed to ensure there was no broken glass, windows opened and closed freely and window restrictors would be fitted where necessary. The home has been improved, it’s general décor, hallway, landing and stairs have been re-painted. A new kitchen room has been created. Some bedrooms have been re-carpeted and re-painted. A new carpet within the following week was going to be fitted to the main staircase and landing. A new stair lift had been fitted. The home has a passenger lift, and the inspector was advised the plans include installing a new passenger lift. A new alarm system has been fitted, which allows service user to have the alarm on their bed or chair without a lead. Pressure mats can also be used with the alarm. The home uses these at night; they are placed outside a service user’s bedroom, who may have particular problems with wandering. If the service user does come out of their room an alarm is triggered, which means night staff can go straight to the service user and make sure they are all right. The inspector was advised when the extension is finished all the home will be brought up to the same standard. On the day of the inspection the home was clean and tidy. The cleaner advised on a daily basis she shampoos’s at least one carpet, to keep the home clean. The home had a friendly atmosphere and service users had personalised their own rooms. Service users spoken to, liked their rooms. One service user commented, “It is like home from Home, we are all one family here and we look after each other”. Applewood Care Home DS0000064903.V298206.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users needs are met by the number of staff on duty, who receives adequate training to do their jobs. The lack of good recruitment procedures could put service users at risk. EVIDENCE: The duty rota was seen, which indicated there was adequate staffing levels with a mix of experienced staff. The home usually has three carers on duty until teatime and then two carers until 8.00pm. The home has two members of staff working a waking night duty. A cleaner works in the home five days a week and the cooking duties are covered seven days a week. From discussions with care staff and service users it was clear the home is able to meet the needs of service users with the existing staffing levels. Two members of staff currently have a National Vocational Qualification (NVQ) Level 2. Two members of staff are currently undertaking a NVQ Level 2 and three members of staff are hoping to start soon. The staffing records of the last two members of staff to join the home were looked at. Both had a written application form, forms of identification, criminal record bureau checks had been obtained, interview notes had been recorded, but neither files had any written references. One reference had been returned Applewood Care Home DS0000064903.V298206.R01.S.doc Version 5.2 Page 19 stating they were unable to give a reference. Discussions were held on the need to ensure all references are received before a member of staff works in the home; verbal references are satisfactory if followed by a written reference. Training records are maintained for each member of staff and training is encouraged by the home. Recent training undertaken by staff includes medication, dementia, infection control, fire training, first aid, health and safety and basic food hygiene. Staff spoken to felt training had increased and improved since the new registration. Observations and discussions with staff demonstrated they had a good awareness of the needs of their service users. The manager is hoping to attend a course on the new common induction standards. Applewood Care Home DS0000064903.V298206.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 at least once during a 12 month period. 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 home is well managed and the manager has a clear direction for the future. Service users views contribute in the development of the home. Service users finances are protected and the health and safety procedures in the home ensure service users are protected. EVIDENCE: The registered manager has been in post or 18 months. She is currently undertaking a Registered Managers Award, which she is due to complete in September. Service users spoken to were full of praise for her and were in no Applewood Care Home DS0000064903.V298206.R01.S.doc Version 5.2 Page 21 doubt they could talk to her if there was a problem. Staff also felt the manager was doing a good job and appreciated her open style of management. The home has and is going through substantial change. The manager explained they are trying to do this at a pace, which suits the service users. The home only has fourteen service users at present so staff can spend extra time with service users and offer reassurance. Service users meetings have been held so all are kept informed of the planned changes. Relative and visitor meetings have been held to ensure they are aware of the planned changes. Staff meetings are held and the minutes are available if anyone wishes to read them. The home has an open approach the service user guide and the last inspection report are kept in the entrance and visitors are encouraged to read and make comments. The home does not become involved in any of the service users finances. The inspector was advised the home does not manage the personal allowance for any service users. Whilst touring the building it was noted all hazardous substances such as cleaning fluids were stored securely. The kitchen although soon to be closed was kept clean. Food was being stored appropriately and temperatures of the fridge and freezers were being recorded daily. The laundry room, which is going to be replaced under the new building work, was well organised and clean. The flooring is not suitable but the room will soon be replaced. Records demonstrated staff receives adequate sessions on fire training in a twelve-month period. Necessary checks are carried out on the fire equipment and are recorded on a weekly basis. It was suggested these should be split up so it was possible to record individually when each check was being made and on what for example, break glass points, emergency lighting and fire extinguishers. Certificates were seen which demonstrated the fire alarm, fire extinguishers and emergency lighting are serviced regularly. Dates were also sent to the commission stating when equipment in the home had been serviced. Applewood Care Home DS0000064903.V298206.R01.S.doc Version 5.2 Page 22 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 X X 3 X X 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 2 X X X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Applewood Care Home DS0000064903.V298206.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP29 Regulation 18 Requirement The registered manager must ensure that all the information required in Schedule 2 of the Care Homes Regulations including references are obtained for all staff members before they commence work at the home. The Commission must be kept informed in writing of any change, which affects the registration of the home. All windows in the home must open and close freely. Window restrictors should be fitted where identified through the risk assessments. Timescale for action 30/09/06 2 OP1 39 (h) 30/09/06 3 OP25) 23 (2) (h) 30/09/06 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 Applewood Care Home DS0000064903.V298206.R01.S.doc Version 5.2 Page 24 Applewood Care Home DS0000064903.V298206.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline Blechynden Terrace Southampton SO15 1GW 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 Applewood Care Home DS0000064903.V298206.R01.S.doc Version 5.2 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. 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!