Inspection on 13/11/06 for Bank Close House

This inspection was carried out on 13th November 2006.

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

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

Other inspections for this house

Bank Close House 29/04/08

Bank Close House 15/05/07

Bank Close House 06/10/05

Bank Close House 04/05/05

Bank Close House 02/12/04

Bank Close House 28/07/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Bank Close House Hasland Road Hasland Chesterfield Derbyshire S41 ORZ Lead Inspector Ray Coonan Unannounced Inspection 13th November 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 Bank Close House DS0000019932.V316149.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. Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bank Close House Address Hasland Road Hasland Chesterfield Derbyshire S41 ORZ (01246) 208833 01246 208833 pat@bankclosehouse.totalserve.co.uk 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) Vital Balance Ltd Vacant Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Plus Three (3) Day Care Places Date of last inspection 6th October 2005 Brief Description of the Service: Bank Close House is a large converted 18th Century Georgian building situated close to the centre of Chesterfield. The home is registered to provide personal care for up to 27 residents. Accommodation is spread over two floors and includes 3 double rooms. The care home is a listed building, has retained many of its original features and is set within extensive grounds. There is a walled garden area accessible to residents. Several communal lounge areas are located on the ground floor and include a conservatory area. There are bathroom and toilet facilities on both floors. There is a stair lift and passenger lift at the Home and a resident call system throughout the building. At the time of this inspection visit fees at the Home ranged from £300 to £340.10. per week. Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection visit took place over a period of seven and a half hours on the 13th November. The inspection covered all key national minimum standards and also included a thematic enquiry as part of a national pilot scheme. This consisted of asking a number of set standardised questions to a sample of residents. The acting manager was informed of this process and the agreement of residents was sought before asking the questions about their care. The acting manager, Wendy Ward, was present throughout the visit and also the owners’ regional manager, Morag Dewar. There was also the opportunity to meet with several of the Home’s care staff on duty that day. A tour of the premises was undertaken and a range of documentation was examined, including individual care plans, staff files and rotas, training records, and relevant policies and procedures, including health and safety records. There were also discussions with several residents, either individually or in small groups during the visit. Several comment cards had been received from residents in response to a pre inspection survey, and these views were also in taken into account as part of the inspection process. What the service does well: What has improved since the last inspection? There have not been any major improvements in services since the last inspection and with the change of manager efforts have concentrated on maintaining service standards overall. The upgrading of some of the bathroom facilities has been completed. Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 6 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. The summary of this inspection report can be made available in other formats on request. Bank Close House DS0000019932.V316149.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 Bank Close House DS0000019932.V316149.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 3. Standard 6 is not applicable to the Home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information was available to prospective residents so that they could make appropriate choices about living at the Home. However, contracts were not immediately available so it was unclear as to whether residents had up to date information on the terms and conditions of their stay at the Home. Service users had satisfactory assessments before moving to the Home so that their care needs could be planned for and met. EVIDENCE: Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 9 Residents are issued with a service guide, which outlines services and resources at the home, including the complaints policy. It was noted that the fees quoted in the guide were not accurate. There was a total of seven residents privately funded and it was stated that all residents were given a contract either directly or through the funding local authority. Copies of contracts were not available as they were said to be in the process of being reviewed by the provider’s accountant and would then be sent out to residents and their families. It was explained that all residents have a family member as their financial agent, apart from one who has a solicitor involved, and information on any fee increases are sent out by letter a month in advance. Care files showed that a range of relevant assessment information on health, social and emotional needs are obtained from other agencies such as the health authority and social services before a resident is admitted. Several residents were not aware that they received a service user guide whilst others confirmed that they were given this information. A sample of three residents was spoken to in detail and two were aware of having received the service user guide whilst the third did not recollect having one. The same two residents were clear about being involved in the pre admission assessment process. They said that they had the opportunity to visit the Home and discuss the options with family members. They said that they were given satisfactory information about the Home and one also visited several other homes before making a final decision. They were also aware of having individual contracts and confirmed that letters were sent to their relatives about fee increases. The third resident was less clear about these matters and wasn’t sure about the admission process and about having a contract. Bank Close House DS0000019932.V316149.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Care planning systems were in a state of transition so that residents’ care assessments and needs were not always clearly set out. Residents said they were treated with respect but some aspects of the environment undermined their privacy. EVIDENCE: It was explained that care planning systems were in the process of changing so that new care plan formats can be introduced in order to bring documentation in line with other Home’s owned by the provider organisation. It is also intended that care plan information will be more accessible and streamlined. It was stated that this process had commenced in the past two months. Several Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 11 care plans were examined in detail and mostly were sparse and incomplete, though they all had good detail in daily communication sheets completed by staff. Some of the older plans were viewed and these contained much more information though important information such as risk assessments had yet to be transferred. There was information on the health care needs of residents and evidence of contact with community health services that included geriatrician and community nursing input. The home also had equipment for pressure relief such as special mattresses. Residents commented that staff were supportive and respectful in the way they went about their work. However, there were some environmental issues affecting privacy, which have been around for some considerable time and were referred to in the last inspection report. This concerns the fitting of locks on doors and though some doors may be listed there remain significant safety and privacy issues that have not been addressed and locks have not been fitted. On the first floor of the main block a bedroom adjoins a bathroom/toilet and there is no lock on the connecting door. Senior care staff administer medication, which was securely stored, including controlled drugs. Records were satisfactorily maintained though it was noted that the administration sheet for one resident did not have a photograph. The manager undertakes a regular audit of these arrangements. There was one resident administering their insulin, which was stored correctly at the right temperature. Bank Close House DS0000019932.V316149.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A stimulating activities programme has been developed at the Home, which is based on the expressed interests and preferences of residents. Catering is satisfactorily organised so that residents receive a balanced diet and their preferences are taken into account. EVIDENCE: The Home has a wide range of activities available to residents and the acting manager has had a lead role in the establishment of these programmes. Residents were positive about the recreational opportunities at the Home and Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 13 several talked enthusiastically about some of the outings. Residents also confirmed they were regularly consulted at the resident meetings. Apart from the trips out entertainers visited the Home and there were ongoing in house activities including craftwork and exercise sessions. There were no residents with specific cultural needs though any religious practice and contacts were maintained. Many residents mentioned regular contact with family and friends and the Home had organised a successful open day/garden fete in the summer. Residents were observed using different parts of the Home as they wished, including the garden, and there was no sense of undue emphasis on routines. One resident stated that that when she first came to the Home it did not feel like an institution and had a homely atmosphere. Residents also confirmed that menus and catering are discussed at their meetings. The menu for the day was displayed and menus were generally varied and nutritious. Lists of residents’ preferences were kept and dietary needs were assessed and catered for. Residents were positive about the overall standard of meals at the Home and confirmed that alternatives were available. Bank Close House DS0000019932.V316149.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The Home had satisfactory complaint procedures in place and accessible so that residents and/or their relatives concerns could be listened and responded to. Policies and staff training in protection and abuse were suitably maintained so that the safety of residents was enhanced. EVIDENCE: The Home’s complaints policy is contained in the service user guide and most residents were aware of this and knew who to raise any concerns with. Residents spoken to said they found the management at the Home approachable and that resident meetings were also used to bring up any issues. The Home had not had any major formal complaints since the last inspection and none had been sent to the Commission. Clear records of complaints and investigations were maintained. Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 15 The Home had relevant adult protection policies and procedures in place and there is access to Derbyshire inter agency guidance. Staff confirmed that they received specific awareness training in this area. Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24 and 26. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Home, whilst generally comfortable and clean, has several areas requiring improved maintenance so that residents can enjoy a fully safe environment that also meets their rights to privacy. EVIDENCE: Generally the Home was clean and odour free. Communal sitting areas were comfortably furnished and suitably decorated. It was noted that the carpet in the corridor area leading to the ground floor extension was damaged and Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 17 coming away. The grounds were well established and maintained with the walled garden area providing a safe and accessible outside facility, with several residents mentioning that they liked to use this area when the weather was fine. There were adequate bathroom and toilet facilities throughout the building and the upstairs bathroom in the main block has been significantly upgraded. It is this bathroom that does not have a door lock to the adjoining bedroom. As stated earlier in the report and in the Home’s previous report, there are privacy issues and also issues around fire safety, which were being discussed with the fire officer. However, there has not been a formal general hazard assessment of the premises, though the manager stated that a Fire Risk assessment of the Home is to take place in the near future. Many bedrooms were viewed during the visit and these were mostly comfortable and personalised by residents. There has not been any progress in providing bedroom door locks that comply with the relevant national minimum standards. There were several bedrooms that needed redecoration and attention to the plasterwork, such as number 16 in the stable block and numbers 8 and 3 in the main block. The furniture in Bedroom 22 in the Stable Block was worn and old with no lockable facility for personal valuables. It was noted that some beds, such as in number 2 in the stable Block, were in need of replacing. In many bedrooms, and bathroom areas, pipe work was in need of blocking in. There was no clear maintenance programme for the Home though the manager’s ongoing progress report did refer to some maintenance plans. The Home still has the cramped and compact laundry area and options for the relocation of this facility are still being considered. It was noted that a lot of residents’ clothing that had been laundered was hanging up in corridor areas outside their rooms waiting to be placed in their wardrobes and drawers. The bathroom in the ground floor extension did not have a toilet roll holder and a bar of soap had been left out, there not being a liquid soap dispenser. Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing levels were not always satisfactory, so that it was sometimes difficult to fully meet the needs of residents. There was not a fully organised approach to staff training so that the care of residents could be further enhanced. Poor past recruitment practices could potentially affect the safety of residents. EVIDENCE: From an examination of staffing rotas and discussions with the manager and care staff, it was evident that the Home has been struggling at times to maintain appropriate staffing levels and on the day of the inspection were one care staff down through sickness absence. The Home had 2 care staff vacancies and a degree of cover was provided from the existing staff group, though it was clear that the acting manager was also doing a lot of direct care shifts. There has not been any use of agency staff. Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 19 All staff had individual training files with records of courses attended, including induction training. However, the Home did not have any overall training plan or skills analysis regarding staff development and staff spoken to said that they were behind on ‘refresher’ training in basic mandatory care courses such as moving and handling, food hygiene and health and safety. It was stated that the majority of staff have completed NVQ training in care. Staff also had individual personnel files and several of these were viewed. The files for staff employed this year demonstrated that appropriate recruitment practices were followed with references taken up and criminal record checks obtained. A sample of files for longer established staff were less informative and in some cases there were no interview or application records, full references were not obtained and there was no evidence of criminal record clearance. It was stated that there were electronic records of CRB clearance for longer serving staff though these were not immediately available. Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Although the acting manager of the Home is very experienced her management role is not sufficiently protected and relevant training not undertaken so that service users do not live in a Home that fully meets its stated purpose and objectives. There are clear and well -established quality monitoring systems in place so that residents views on the service can be heard and responded to. Health and safety practices are generally well organised so that the interests of residents are mostly satisfactorily promoted in this respect, though formal risk assessments of the premises have not been undertaken. Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 21 EVIDENCE: The acting manager for the Home took up her responsibilities in January of this year. It was stated that the application for her registration was sent to the Commission during the week prior to this inspection visit though there is no record of this application having been received. The acting manager previously worked at the Home over a long period as a senior carer/supervisor. She has not as yet enrolled for NVQ level 4 training in care and management. The Home had systems in place for the individual supervision of staff and appraisal with recording processes. However, the manager stated that this is an area of management practice that has fallen behind lately. There is a sense that the Home are keen to have the views of residents and several mentioned their participation in regular meetings and that they readily express their views on such areas as menu planning and activities. Yearly resident satisfaction surveys are conducted and there is a summarised feedback published and made available to residents and other interested parties. Regular monthly monitoring visits are also made on behalf of the registered owners. The Home has relevant health and safety policies in place. Records of servicing of equipment and checking of utilities were seen and were up to date. Records for fire safety checks were seen and were satisfactory. However, as stated earlier in the report, hazard and fire risk assessments of the premises had not been carried out and the provision of staff training in safe working practices was not always up to date. Fire safety training was said to take place twice yearly but records were not immediately available, though staff spoken to confirmed that this took place. Bank Close House DS0000019932.V316149.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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 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 2 3 2 X 3 2 X 2 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X X 2 X 2 Bank Close House DS0000019932.V316149.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. 2. Standard OP1 OP2 Regulation 5 5 Requirement The service user guide must contain accurate information about accommodation fees. Copies of up to date contracts with terms and conditions in respect of accommodation for residents must be available for inspection The transfer of all care planning information to the new format and files must be completed. Specialist locks must be fitted on bathroom and bedroom doors, which are also fire exits in accordance with the advice of the Fire Officer. Previous timescale of 31/12/05 not met) A full hazard assessment of the premises must be made and an action plan established. A fire risk assessment for the Home must be undertaken A clear programme for the boxing in of pipe work in bedrooms and bathrooms must be developed with clear timescales for completion of the work. DS0000019932.V316149.R01.S.doc Timescale for action 31/12/06 31/12/06 3. 4. OP7 OP10 15 12 (4) (a) 31/01/07 15/01/07 5. 6. 7. OP19 OP19 OP19 13 (4) 23 (4) 13 (4) 31/01/07 31/01/07 31/01/07 Bank Close House Version 5.2 Page 24 8. OP24 12 (4) (a) Following consultation with individual residents, approved safety locks must be fitted to bedroom doors (and keys provided), where this is the wish of the resident. Previous timescale of 31/01/06 not met) A review of bedroom furnishing, fittings and decoration must be established together with a clear action plan for improvements. The Home must ensure that at all times there is sufficient staff working at the Home. All personnel files must be reviewed so that all staff have two written references and evidence that criminal record clearance has been obtained on all staff must be sent to The Commission. All staff must have up to date training in mandatory care courses. The registered providers must progress the registration of a manager who is to take up relevant training qualifications. All staff must receive regular individual supervision. 28/02/07 9. OP24 16 31/01/07 10. 11. OP27 OP29 18 19 31/12/06 31/01/07 12. 13. OP30 OP31 18 9 31/03/07 31/01/07 14. OP36 18 28/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP9 OP26 Good Practice Recommendations All medicine administration record sheets should have a photograph of the resident Individual bars of soap should not be left in bathroom areas and liquid soap dispensers should be available. Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 25 Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Bank Close House DS0000019932.V316149.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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