Inspection on 05/05/05 for Arundel House

This inspection was carried out on 5th May 2005.

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

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

Other inspections for this house

Arundel House 08/11/07

Arundel House 24/05/06

Arundel House 18/10/05

Arundel House 19/10/04

Arundel House 12/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Arundel House 117 Torquay Road Paignton Devon TQ3 2SF Lead Inspector Michelle Finniear Announced 05/05/05 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Arundel House Address 117 Torquay Road, Paignton, Devon, TQ3 2SF Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 551450 01803 551450 Mrs Anne Morrison Mrs Anne Morrison Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19/10/04 Brief Description of the Service: Arundel is a terraced three-storey building. The property is situated on the level, within easy walking distance of all local facilities and Paignton town centre. The home caters for adults with learning difficulties, with or without a physical disability, and to this end the home benefits from the provision of some specifically designed bedrooms, which provide suitable accommodation for wheelchair users. Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was planned in advance with the home, and took place over eight hours on a Tuesday in May 2005. Before this inspection the home owner, Mrs Morrison, completed a questionnaire, and six relatives completed comment cards which were returned to The Commission. Comment cards were also returned by all the residents, some of whom had needed support from staff to fill them in. At the inspection, a tour was made of the home, records inspected and six service users were spoken to. Seven relatives also attended and were spoken to, along with several members of staff on duty during the day. What the service does well: The home is a comfortable, relaxed and positive environment which has retained the feel of a domestic house as far as possible. Residents spoken to liked the accommodation in which they lived, and had been able to make their rooms very personal to them. All residents have their own rooms, all of which have ensuite facilities, and some of which include lounges as well as bedroom areas. Rooms are bright, airy and well decorated, and rooms for people who use a wheelchair are all on the ground floor. Good relationships were observed between staff and residents, and residents follow interesting and meaningful activities of their choice, have goals set in care plans to which they contribute, and have opportunities to have a say in the way in which the home is run. The medication systems at Arundel house are well-managed, promoting good health for service users. The home has excellent systems to make sure the home is a good place to live in with relatives, residents and other stakeholders being regularly consulted about the service and encouraged to make suggestions. Relatives interviewed made comments such as “a truly excellent place” and indicated that their relative was “very happy here”, that the home was “a pleasure to go in”, and Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 6 that “Arundel House continues to offer ***** a high quality of care both physical and emotional”. What has improved since the last inspection? What they could do better: The home needs to obtain copies of the General Social Care Council codes of conduct and practice for care staff and give this to each member of staff. One relative commented that the way they were received at the home by some of the younger staff on occasion could be better, and this comment was passed to the owner to be addressed. Other relatives interviewed did not confirm this view. Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 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. Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,4 Arundel house has a comprehensive statement of purpose and service user guide providing service users and prospective service users with full details of the services the home provides and enabling an informed decision about admission to the home. Comprehensive assessments undertaken prior to admission ensure the home is appropriate to meet the needs of the potential service user. EVIDENCE: Arundel house has provided a comprehensive statement of purpose, which is partly available in a REBUS format, to meet the needs of the Ladies and gentlemen who live at the home. The statement of purpose was last updated 2 1/2 months ago, so contains current information about the home. All of the Ladies and gentlemen living at the home have received a copy of this documentation, which ensures that they have individual access to such information as the complaints procedure. Arundel house has an admission process and policy, which was seen and found to be comprehensive, involving a full process of assessment and consultation with the service user prior to admission. This means that both parties are able to ensure that the home is the right place and that the persons needs can be met. This process was examined in relation to the most recent admission to the home, and an admission made within the preceding year, and in both instances files contained comprehensive pre-admission assessments and Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 10 reviews of the placement, including plans of care needs by Social Services. Later during the inspection discussion was held with one service user and a relative in relation to the admission process which was found to support and confirm the information held on file. Both the service user and relative indicated they had a full involvement throughout the process of admission. Files evidenced that the admission process followed had involved a series of trial visits over several weeks. People already living at the home were also involved in the process to ensure compatibility. Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,9,10 Arundel house has a clear and consistent system for the planning of care, to ensure staff have the information to satisfactorily deliver care to service users in the way in which they have indicated they wish it to be delivered. EVIDENCE: Plans for four service users were inspected, and were found to be comprehensive, accessible, individualised and drawn up with the involvement of the service user or their family/supporters. This was later confirmed with service users. One relative commented in a comment card that “All the right plans and programmes ensure that this home is a very happy place” and that “Constant effort is made to improve…..the package of care”. Plans could show definite links to the assessment process and reviews that had been undertaken, including development from the single care management assessment completed by social services at the point of the initial admission. This ensures that plans are kept up to date and reflect the changing needs of the service users. The level of detail and positive service user focus were commendable. Plans seen were later related to the service user and care practices observed during the course of the inspection and were found to accurately reflect the needs and wishes of the service users concerned. Plans Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 12 contained full risk assessments on all aspects of care needs and activities of daily living, which are reflected in an individual lifestyle agreement. Plans are reviewed with Key workers approximately every eight weeks. The service user involvement in this process is acknowledged and recorded on the plan, and ensures that plans remain up to date and accurate. Minutes of service user meetings were seen, which demonstrated how service users make decisions about their lives as well as in the information recorded within their lifestyle plans. Individual recording in the care plans reflects choices service users have made on a daily basis, including meals and activities. The home has a policy on information management and confidentiality, which ensures that service users know that information given in confidence will not be shared against the service users wishes other than in very specific circumstances. Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 17 Dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: Arundel house has a dedicated cook for the majority of the week and a series of menus, developed in consultation with service users reflecting their wishes and choices. A choice of salad or a main meal is available every day, with the main meal being taken in the evening, and service users have a choice of a dessert or yoghurt and fruit. Packed lunches are provided for many service users out at day opportunity resources. At the time of the inspection the home was catering for service users who are diabetic, and evidence was seen of special dietary products and low sugar alternatives, presented in ways to minimise differences and not discriminate as far as possible. All service users completed comment cards indicating their satisfaction with the meals served, and this was confirmed in later discussion with six service users. Service users also confirmed they assisted staff with shopping for food and in making choices on meals to be served. Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20 The medication systems at Arundel house are well-managed, promoting good health for service users. Service users physical and emotional health needs are assessed and addressed appropriately, ensuring their optimal health. EVIDENCE: Arundel house uses a monitored dosage system of medication. This means that medication is a blister packed from the pharmacy, reducing the possibility of errors in administration and ensuring the home can clearly see when medication has being administered. Evidence was seen of Staff having received training in the administration of medication, including medication to be given in an emergency via an invasive procedure. Full records were seen of medication for service users, and the home has a policy on display for the administration of homely remedies. Safe storage is provided and the home currently does not deal with any controlled drugs. At the time of the inspection two service users needed oxygen, delivered through a nasal catheter. Discussion was held in relation to the storage and use of oxygen, which is fully detailed in a risk assessment and in the respective service user plans. Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 15 Service users are supported and facilitated to manage their own health care needs wherever possible, and their wishes regarding their healthcare were seen to be recorded in each service users Lifestyle plan. Each service user receives regular health checks, which are detailed in their care plan, and this includes such preventative health care screening such as mammography and hearing tests where appropriate. This means service users are having their rights of access to Healthcare supported and their health is being maximised. Routine healthcare needs such as optical tests and podiatry services are recorded and planned in service user files, so that appointments do not get missed. Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Arundel house has a satisfactory complaints system which ensures service users have opportunities to air their views. Arrangements for protecting service users from abuse and neglect are satisfactory. EVIDENCE: Arundel house has a complaints procedure which has been given to all service users and was seen on display within the home. The procedure is available in formats which mean that all service users will be able to understand the process, or have had it explained to them and this is recorded. Service users who completed comment cards indicated they would know who to speak to if they were unhappy with the home or their care, and this was confirmed in conversation with six service users. Discussion with relatives who attended the inspection, and those who completed comment cards indicated an understanding of the homes complaints process except for one person. The administrator confirmed that a copy of the complaints process was sent out to all relatives recently as a part of the quality assurance process. No complaints have been received by CSCI since the last inspection. Adult protection training has been given to staff in relation to the homes own policy which is linked to the locally issued alerters guidance. Staff training records evidenced an understanding of the issues involved in Adult protection and the home has a full policy and procedure for adult protection including information on Service user rights and a whistleblowing policy which was seen. Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,27,28,29,30 Arundel house provides a comfortable, homely and safe environment for service users and their visitors. The overall quality of furnishings and fittings is of a high standard. EVIDENCE: A tour of the premises evidence that the accommodation in is provided to a high standard with rooms which are bright, cheerful, airy and clean. The lounge has recently been refurbished and at the time of the inspection the other first floor shower room is in the process of having an assisted bath fitted, meaning service users will all have access to specialist bathing facilities. All bedrooms seen had ensuite facilities, and some have an integral lounge area, making bed-sitting rooms, which was commendable. All were of a good decorative standard, and were clean, warm and comfortable. Comments made by relatives about the environment were favourable including “constant effort is made to improve the building” and service users confirmed these views in conversation. Service users bedrooms have locks fitted to which they have keys, so they can choose to maintain their privacy. Some had locked their rooms when they were out for the day. Rooms are personalised and individual reflecting service users Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 18 recorded interests and tastes. Service users were observed using the communal areas on their return from day activities to chat with friends and the relatives that had come to participate in the inspection. Specialist equipment is available as needed, and was seen to include specialist bathing facilities, rails, shower seats, raised toilet seats and magnetic door opening devices. Environmental adaptation assessments were seen to have been addressed, ensuring the accommodation is suitably adapted for the people who live there. A laundry is provided, with machines capable of achieving a sluicing cycle, tumble dryers and provision for the disposal of clinical waste. Clear policies and evidence of staff training was seen for the control of infection at the home, including occupational health provision. This means that service users and staff are protected from any risk of cross infection. Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35, 36 Arundel house has carried out a full process of recruitment and vetting of staff ensuring service users are protected. Staff are well trained and supported and have a good understanding of service users support needs. EVIDENCE: The owner of Arundel house could evidence person specifications and job descriptions for each grade of staff within the home, which were seen during this inspection. Copies of the General Social Care Council code of conduct have not yet been issued to all members of staff. Each member of staff receives a comprehensive induction and foundation inhouse training package, which the provider stated is comparable to National training Organisation training targets. Evidence could be seen in three individual staff members files of completion of this documentation, which will ensure staff understand their role and the work they are expected to carry out, so protecting service users. Additional staff are training towards NVQ’s in care, although currently only one staff member has achieved this award. The Deputy manager is undertaking an NVQ level 4. The proprietor and administrator are undertaking the registered managers award. 10 staff currently hold a first aid certificate. Additional training recorded in staff files or certificated evidence that staff since the last inspection have received training in first aid, epilepsy, Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 20 moving and handling, infection control, fire safety and prevention, fire or equipment, fire drills, health and safety, food hygiene, responding and reporting abuse, and NVQ training. This programme of staff training will ensure that members of staff can assess and meet the needs of service users confidently and competently and is commendable. Staff receive regular support and supervision to ensure their work performance is satisfactory and their professional development is facilitated through the identification of training needs. This means service users at the home receive support from staff who have good understanding of the their support needs, communicate well within the home, and will follow through the homes overall philosophy of care. Supervision records seen in staff files indicated supervision is given approximately every eight weeks to all grades of staff. The home is developing a mentoring system which should increase protection for service users through ensuring all staff have a full induction process, individually tailored to their needs. Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 39, 40, 41, 42, 43 Arundel house has good systems for reviewing its performance through a comprehensive quality assurance programme, ensuring the views of service users, relatives and staff are taken into account. There are comprehensive systems for ensuring the health and safety and welfare of service users, including appropriate systems for financial management. Recording systems and policies in use provide protection and consistency of care for service users. EVIDENCE: Arundel house has a comprehensive quality assurance and quality monitoring system, based on seeking the views of service users and other stakeholders through a series of four questionnaires, last issued in June 2004. The results of the questionnaires have been analysed and included in the annual development plan for the home, which was seen at this inspection along with a sample of questionnaires that had been returned. This process ensures the home remains responsive to the service user group, acknowledging and acting upon their wishes and suggestions, and was commendable. Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 22 A set of comprehensive policies and procedures covering all topics required for current legislation or professional standards is available within the home. Policies and procedures sampled during the course of this inspection were appropriate and relevant to the environment and service user group and will assist in providing care and that is consistent in addressing the needs of service users. Action is taken to address the health, safety and welfare of service users and staff at the home, via training, provision of equipment, assessment of risk, environmental adaptation or environmental assessment. Comprehensive risk assessments were seen for all areas of practice for staff, in relation to care needs, and in relation to the environment. Arundel House has automatic water temperature regulation and hot surface protection on a risk assessed basis to protect service users at risk from scalding or other injury. Workplace precautions were in evidence in relation to a pregnancy risk assessment which was seen for a member of staff, and there is a weekly audit and maintenance plan, which was also seen, in relation to the provision and use of work equipment. Individual protective equipment such as aprons gloves and masks were available and seen within the home. The homes accident book was seen, which was indexed for audit purposes. All the above areas should ensure that service users health and safety and welfare is protected and enhanced at the home. Examination was made of the homes systems for managing service user finances, where a full accounting system demonstrated service user money held in trust by the home. Evidence of insurance cover was seen. Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 4 x 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 4 3 x 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 4 x x 4 3 3 3 Standard No 11 12 13 14 15 16 17 x x x x x x 3 Standard No 31 32 33 34 35 36 Score 2 3 3 3 4 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Arundel House Score x 3 3 x Standard No 37 38 39 40 41 42 43 Score x x 4 3 3 3 3 D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 24 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 31 Regulation 18 (4) Requirement The registered provider must make arrangements to supply to members of care staff a copy of the General Social Care Council Codes of Conduct. Timescale for action By 20/8/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard Good Practice Recommendations Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Arundel House D54-D07 S18318 Arundel House V215887 050505 Stage 4.doc Version 1.30 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!