Inspection on 25/04/05 for Ashburnham Grove (75)

This inspection was carried out on 25th April 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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ashburnham Grove (75) 08/02/08

Ashburnham Grove (75) 12/10/06

Ashburnham Grove (75) 20/09/04

Ashburnham Grove (75) 05/05/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Ashburnham 75 Ashburnham Grove Greenwich London SE10 8HJ Lead Inspector Sue Grindlay Announced 25th April 2005 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. Ashburnham Version 1.10 Page 3 SERVICE INFORMATION Name of service Ashburnham Address 75 Ashburnham Grove Greenwich SE10 8HJ 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) 020 8692 5032 020 8692 4301 London Borough Greenwich Ms Lesley Milroy CRH 11 Category(ies) of LD 11 registration, with number of places Ashburnham Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: 1. Flats 1 and 2 are for Residents who require long term care. 2 Flat 3 is for Residents who require care of no more than 6 weeks and the one bed is then retained. Date of last inspection 20/9/04 Brief Description of the Service: Ashburnham Grove is a Home for younger adults with a learning disability, who are residents of the london Borough of Greenwich. The Home is situated in West Greenwich, within a conservation area known as the Ashburnham triangle. The Home is close to the centre of Greenwich and the station, park and Maritime Museum are close by. The Home accommodates six permanent residents within two flats, and five short-term or respite service users in an adjacent flat in the same buidling. One of the latter is currently deemed an emergency bed.All the bedrooms are single occupancy. Although the two groups are accommodated in the same building, and share the same staff group, they are separated by a door with a security code, and meet only in the lobby and in the shared garden. Up to forty service users take advantage of the respute facility for up to five weeks each year. Ashburnham Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place over six hours on a cold, wet spring day. Six staff were spoken with and five residents were seen during the course of the day. Most of the residents are non-verbal, but questionnaires were returned from eleven relatives, one service user and the general practitioner who attends the Home. In addition care plans, policies and documentation were viewed and a tour was made of the Home. What the service does well: What has improved since the last inspection? What they could do better: The Home is obliged to take residents who may not be appropriately placed. Training is insufficiently focussed and quality-monitoring systems are not in place to address the views of service users and their families. Records need to be reviewed and kept in good order. Ashburnham Version 1.10 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Ashburnham Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Ashburnham Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2, 3 and 4 Pressure on places means that residents may be admitted inappropriately with significant impact on other service users. EVIDENCE: One new resident has been admitted to the Home as he needs waking night support. Members of his family came to look at the Home prior to his admission, and an assessment of needs was made by the resident’s previous Home. There were contra-indications at the outset, for example this resident reacts better to male members of staff, and the staff group at Ashburnham is principally female. The Manager said that she has admitted only on trial, and there are signs that other residents may be adversely affected. This is being closely monitored. The emergency bed in the short-term unit is also filled now by an older gentleman whose adult placement recently broke down. He has poor health. In these two areas he is at odds with the majority of the short-term clients who are generally younger and more active. The fact that the emergency bed is occupied will also have a knock-on effect for residents expecting to come for respite, and there will need to be some negotiation over dates. The manager said that staff time is disproportionate for the short-term clients, at the expense of the permanent residents and this is therefore a requirement. Ashburnham Version 1.10 Page 9 Changes are planned to the way the Unit operates. Respite clients will transfer to a new unit at Kemsing road in the near future (one relative said that she was unhappy with the plan). The last meeting of respite care parents highlighted the fact that parents of Ashburnham respite clients had not been invited to visit the new unit. One staff member did not know about the proposal. Specialist input is given from psychiatric and psychological services in the borough, and a speech and language therapist is coming to a team meeting to advise on one resident who has difficulty in swallowing. Ashburnham Version 1.10 Page 10 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) 6,7,8 and 9 Care Plans and Risk Assessments are up to date and residents know that their needs will be met. EVIDENCE: Care Plans have been revised, using principles of person centred planning and are dated. Managers said that it was more difficult if clients were non-verbal, and they had tried to find ways of engaging and involving clients in the process. For example, one resident had been on a cruise the previous year, and they had used photographs to help her to decide whether she wanted to save up for another similar holiday or have a cheaper holiday this year (she opted to save for another cruise). Photographs of residents were on some files, and these were often sent in by parents who had received copies of updated care plans to check. Files were not indexed and it was hard to access particular sections, and this is a recommendation. Since the new resident has moved in, the lounge in Flat 2 has to be locked at night as this resident will wander at night and put the television on. It is Ashburnham Version 1.10 Page 11 acknowledged that this is now restricting the freedom of other residents and will inform a decision about the placement. Residents’ meetings are not held as it was found that key workers were putting their own views forward. Following the death of one resident last year, risk assessments have been made on all residents suffering from epilepsy, and all residents for the use of the stairs and these were seen on client files. Ashburnham Version 1.10 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 13,14,15 and 17 Service users have opportunities to go out and to maintain contact with their families, but activities are sometimes limited by staffing ratios. EVIDENCE: Activities are somewhat restricted and dependent upon sufficient staff cover. One residents went to a 60s revival show at Dartford. Another went to the cinema to see “Hitch” as she is a fan of Will Smith. A member of staff said that she takes her key client shopping or to the park. Two permanent residents have regular contact with their families. Residents sat down together for a meal at Easter, but generally each flat does its own catering. There was range of foodstuffs in each flat, and plenty of fruit in Flats 1 and 2. Flat 2 had a good range of salad items in the fridge. Menus for the day were on the wall, and meals reflected personal tastes and preferences. One of the chest freezers in the respite unit has been disposed of, and baskets have been ordered for the other to make it easier to reach food stuffs at the bottom. Ashburnham Version 1.10 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 and 21 Residents’ physical and emotional health needs are well met. EVIDENCE: One staff member said that her key client likes to look nice, and she takes her to have her hair cut, colours her hair for her and takes her shopping for clothes. The clothes in her wardrobe, and her room in general looked immaculately kept. Two other residents were in pyjamas and barefooted throughout the day, and staff said that this was their preferred attire. One said that she tried to help her client choose leisurewear that looked more like a tracksuit than pyjamas! One service user had had an epileptic fit the previous day and had bitten her tongue. Staff had taken her to hospital, and subsequently followed this up with a consultation with the GP. Advice to staff on monitoring the welfare of this resident was given at handover on the day of the inspection. Another resident with swallowing difficulties had Eating Guidelines in the front of his Care Plan, and the GP had endorsed these with a signature. Authorisation had also been sought appropriately to crush tablets for this resident. Members of staff had been asked to sign to say that they had read these guidelines, but only five out of thirteen staff had signed the sheet. The GP returned a questionnaire with positive feedback about the Home’s care and the liaison with herself. Ashburnham Version 1.10 Page 14 In the health section of one client file there was information about one resident who had undergone a scan to investigate a lump on her side. This had apparently revealed gallstones. There was also a letter on file for a gynaecological appointment, but staff did not know what this was for. It is recommended that this be clarified and the section on health contains a summary of this client’s health needs. None of the residents self-medicates and medication is checked at each handover. On this occasion there was an anomaly, whereby there was one tablet short, and this was reported immediately by the member of staff to the manager. Advice was given by the GP and the resident’s mother was informed. A notification of this incident was also sent appropriately to the Commission. The section on the Client record marked Allergies should record ‘None known’ rather than be left blank. Staff at the Home have suffered two bereavements in the past few months, and both were well-loved long-stay residents. The way the deaths were handled, and the support for staff at this time was discussed in detail during the inspection and is reflected in a score of standard exceeded this time. One of the residents was returned to the Home after a spell in hospital, and a ‘Best Interests’ meeting was held soon after his discharge to plan for his care. Extra staffing in the form of one to one waking night staff was put in place, and after his death one resident came to say goodbye. Other residents were informed, and managers were aware of the impact of these deaths on residents and staff alike. One staff member said that it had been a difficult time but “we all pulled together”. Bereavement counselling was offered to staff, and photographs of the two men were evident throughout the Home. Ashburnham Version 1.10 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 and 23 Residents’ welfare is safeguarded in the Home and complaints are investigated promptly. EVIDENCE: The complaints leaflet issued to residents at the home uses widget icons. Eight out of the eleven relatives who answered the questionnaire said that they knew how to make a complaint, but none of the eleven had done so. There were only two complaints logged at the Home since the last inspection and these referred to problems over items of clothing. The Assistant Manager said that often items are not labelled and this is usually the reason why items go astray. One complaint received at the Commission concerned the death of a resident. The borough had already conducted an internal investigation into the circumstances, and certain recommendations were made as a result. These have been implemented. There are clear policies in place for the protection of vulnerable adults, and there was some adult protection training in November. Staff spoke kindly to residents who wandered into the office during the course of the day (one sat in on the handover meeting) and were observed to take residents by the hand to lead them back into the building. Ashburnham Version 1.10 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,27,28 and 30 The Home is spacious, safe, comfortable and fairly well-maintained. EVIDENCE: A number of bits of refurbishment have been done since the last inspection. The kitchens in Flats 1 and 2 have both been painted, and the removal of the fly screen on the windows has brightened the rooms enormously. Two bathrooms have been retiled, and painted, and bright accessories purchased to make them more attractive. The tiles are plain white, and the Assistant manager said that they hoped to buy some transfers to break up the plain white surface and to improve the overall appearance. A tub of flowers was beside the front door, giving a fresh and welcoming look to the building. Client bedrooms are all large and are personalised with pictures, ornaments and photographs chosen by the residents. All were very neat and tidy. One resident had new curtains, and the staff member said that they had to introduce change gradually so that she did not become upset. This resident had many examples of her own artwork on display. One resident had a broken lampshade and this should be replaced without delay. Ashburnham Version 1.10 Page 17 Lockers in the laundry room are now designated for staff use. There was no hand wash in the kitchen of Flat 1 and no lid on the rubbish bin in Flat 3 (it had been broken the night before). Only one washing machine was in use on the day of the inspection, but this had not affected the routines of the Home. The Home was generally clean and tidy, and there were no unpleasant odours. Ashburnham Version 1.10 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 and 36 The staff team is well-motivated. Supervision and training must not be allowed to slip as they support staff development. EVIDENCE: Staff spoken to were enthusiastic about their work and considered that the Home was a good place to work. Comments like, “I enjoy working with clients” and a description of a resident as “almost like a brother”, demonstrate the warmth and motivation of staff. Several staff felt that the care offered was good, and this was confirmed by relatives who answered the questionnaire. All eleven said that they were satisfied with the care given. Personnel records now consist of a laminated sheet that has a photograph of the worker, details about them and a signature from a senior manager to say that their passport, birth certificate and criminal records bureau check has been approved. This information was not in place yet for three members of staff and these must be followed up as a matter or urgency. The rota was being done on the computer at the last inspection but was handwritten for the last three weeks, and consequently it was less easy to read. Nine out of eleven relatives felt that there were enough staff on duty, but one relative who said there were not enough staff commented that there was, “not enough help given for smaller things”, for example dressing and hair washing. Ashburnham Version 1.10 Page 19 Staff training is still lacking direction, with relevant specialist subjects such as challenging behaviour, autism and dementia either unavailable or “hard to get on”. One staff member said that she had never had First Aid training, and the managers said that First Aid training is to come on stream later this year. The requirements with regard to staff training under standards 33 and 35 are therefore restated. A number of staff have done their NVQ and one staff member said that it had given her confidence that she was “doing the right thing”. Several staff members said that the team works well together, although the manager said that pairing established staff members with newer staff had not worked very well. One staff member said, “there are a lot of good staff here. A lot of good people who go the extra [mile]”. An illustration of this is seeing something for a resident while not at work or spending free time taking a resident out. One manager admitted that supervision had ‘slipped’ in the last few months and this was confirmed by a staff member who said she had not had supervision this year. This is therefore a further requirement. Ashburnham Version 1.10 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 39, 41 and 42 The Home has a committed manager who places safety a high priority. Records, and record-keeping generally along with the development of a quality monitoring system is an area for improvement. EVIDENCE: The Manager and her deputy are both completing their NVQ this year, and their Assessor observed part of the discussion during the inspection as part of their assessment. They appear to work well together, and have complementary skills. Both are ‘hands on’ and both were responsive to clients during the inspection, seeing this as their primary role. Two staff members said that the manager is ‘approachable’. Regulation 26 reports were received at the Commission last year up until October. Further reports were available in the Home for subsequent months, and a copy should be sent to the Commission. A relatives survey last year yielded a poor return, and alternative ways of getting feedback from users and Ashburnham Version 1.10 Page 21 relatives should be explored. A brief questionnaire focussing on one aspect of the service could be completed at Respite meetings. It has been clear from this and other inspections that there is some conflict of interests between the permanent and the short-term or respite services, and this anomaly looks like being resolved to some degree when the spite service moves to the Kemsing road site. However, the issue of emergency placements destabilising permanent residents remains as two beds instead of one will now be designated as emergency beds. There seems to be some confusion in the minds of staff and relatives about the purpose of the changes, the benefits that will ensue, if any and certainly the timescale and it is recommended that decisions be made about this and all parties properly informed. The policies and procedures manual was very muddled. Policies were undated and were from different origins and filed in no particular order. It is recommended that these are reviewed, and updated as appropriate, and the file is indexed so that relevant policies can be accessed easily. They should be available for residents and for staffing an accessible form. Managers said that, although they are on the network for the borough, their computer is old and ‘temperamental’. In any modern business environment, it is essential to provide staff with functioning up to date equipment, and it is recommended that a new computer be purchased for managers to keep accurate and updated records. Health and safety issues are given a high profile at Ashburnham and the standard is exceeded on this inspection. A system for checking hot water temperatures has now been instigated. Fire call points are checked at 1-2 weekly intervals. A fire drill was completed on 20/4/05. This lists the names of all staff and residents and the evacuation time. A report on Food Standards and Health undertaken on 17/3/05 states, “Excellent standards being maintained. Keep up the good work”. Staff now have walkie-talkies for communicating with each other within the building. This ensures staff can be on hand to help with an emergency. Ashburnham Version 1.10 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 2 3 x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 4 x 3 3 x 3 Standard No 11 12 13 14 15 16 17 x x 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x 3 4 3 1 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 4 Standard No 37 38 39 40 41 42 43 Score 3 3 1 x 2 4 x Ashburnham Version 1.10 Page 23 yes 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 YA3 Regulation 14(1) Requirement The Registered person must ensure that residents are only admitted when their assessed needs can be fully met Handwash must be provided in the kitchen of all flats Updated First Aid training must be delivered to all staff(Previous timescale of 19 November 2004 not met) Personnel information, as listed in Schedule 4 including evidence of a satisfactory Criminal Records Bureau check must be available for all staff members Staff at the Home should receive training appropriate to the work that they are to perform (previous timescale of 19 November 2004 not met) Supervision for staff should take place at least six times a year Copies of Regulation 26 reports should be sent to the Commission Timescale for action 24 June 2005 Immediate 24 June 2005 24 June 2005 2. 3. YA30 YA33 13(4) 18(1)(a) 4. YA34 19(4)(b) 5. YA35 18(1) 24 June 2005 6. 7. YA36 YA39 18(2) 26(5)(a) 24 June 2005 Immediate Ashburnham Version 1.10 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard YA6 YA19 YA20 YA24 YA39 YA39 Good Practice Recommendations Care Plan files should be indexed so that appropriate sections can be easily accessed and information does not get lost. A health care summary for one resident with a consultant appointment should be made and be clearly visible on the file The section on the medication care for Allergies should read None known rather than be left blank The broken lampshade in Flat 1 should be replaced, and th rubbish bin in Flat 3 likewise A quality monitoring system should be devised to ensure that feedback is obtained from service users and their families Information concerning proposed changes to the service delivery, including options if any, timescale for change and benefits to current service users should be given to staff, service users and their families without delay Policies and Procedures of the Home (See Appendix 2 for list of policies) should be reviewed, dated and indexed, and should be available for staff and residents at all times 7. YA41 Ashburnham Version 1.10 Page 25 Commission for Social Care Inspection Riverhouse 1 Maidstone Road Sidcup kent DA14 5RH 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 Ashburnham Version 1.10 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!