Inspection on 25/10/07 for Bay Tree The

This inspection was carried out on 25th October 2007.

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

Bay Tree The 01/12/08

Bay Tree The 01/11/06

Bay Tree The 17/11/05

Bay Tree The 05/05/05

Bay Tree The 24/02/05

Bay Tree The 27/09/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Bay Tree The Station Road Robin Hoods Bay North Yorkshire YO22 4RL Lead Inspector Karen Ritson Key Unannounced Inspection 25th October 2007 09:30 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 Bay Tree The DS0000007738.V349905.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. Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bay Tree The Address Station Road Robin Hoods Bay North Yorkshire YO22 4RL 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) 01947 880718 Mr Thomas Edward Dobson Mrs Jean Dobson Mr Thomas Edward Dobson Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 31st October 2006 Brief Description of the Service: The Bay Tree is a detached Victorian building set in its own ground in village of Robin Hoods Bay. There are three floors, with the residents occupying the first two floors and the proprietors the top floor. A shaft lift provides access to the first floor but due to the lay out of the building several bedrooms and one bathroom have restricted access due to there being two or three stairs. The Bay Tree is located close to all the village amenities although access to public transport is limited because of the location. The front garden is well maintained and is enclosed. Seating is provided for use by the residents if they want to. At the rear of the building there is a veranda for use by the residents. The home has a statement of purpose and service user guide, which provide information about the scope and nature of the care and facilities on offer. These, with CSCI reports, are available on request at the home. The fee charged is between £365 and £385 per week; however, this may vary with the degree of assessed need or if a service user occupies a double room as a single. Chiropody, hairdressing and newspapers are not included in this fee and these are charged at cost. This information was provided to CSCI on 18/09/2007. Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection for this service took 12 hours. This includes time spent gathering information and examining documentation before and after an unannounced site visit and in writing the report. The site visit took place on 25/10/07 between 9:30am and 13:00pm. Information for this inspection was gathered from the following: • • • • • • • • • • • A tour of the premises. Observations of care throughout the day of the site visit. Speaking with service users. Speaking with the manager. Speaking with staff. Case tracking service users on the day of the site visit. Looking at information provided by the home in a pre inspection questionnaire. Notifications sent to the commission from the home since the last inspection. Examining policies, procedures and records kept at the home. Examining information regarding the home on the file kept by CSCI. Considering comments made by relatives, health care and social services staff. All key standards were looked at during this inspection. The manager was not available on the day of the site visit, however, staff assisted with locating documentation and speaking with service users. The manager was telephoned after the site visit and added comments at this time. What the service does well: The Bay Tree offers comfortable care in a well-decorated and clean setting. People can visit the home before they make a decision about whether they want to move in, they are told about the home and what to expect by the manager. When someone is interested in becoming a resident, their care needs are thoroughly assessed by the home and a place is only offered if the home is sure the care needs can be met. A plan of care is written down for staff to follow which service users, relatives, and health care professionals are all consulted about. People are treated with Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 6 regard to their dignity and their personal care always happens in private. One relative said: ‘ The attitude of the staff is very good.’ The home employs an activities organiser who often carries out individual activities to cater for people’s particular interests. The meals are good, several service users, relatives and health care professionals made positive comments about the food. One service user said: ‘The meals are lovely.’ No service user or other person said they had ever had cause to complain but felt sure the home would put anything right straight away if there was a problem. All said the home manager was very approachable and easy to talk to. There are enough staff on duty, they are well trained and well recruited. All have a check against a list of those people who should not be employed to work with vulnerable adults. The service users are protected by the health and safety procedures in the home. What has improved since the last inspection? What they could do better: The home must amend medication practice to avoid the risk of errors in administration, which could have a detrimental effect on service users health. Infection control training should be recorded to evidence this has taken place. All staff should receive abuse awareness training in order to protect the welfare of service users. Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 8 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 Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 9 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): People who use the service experience good quality outcomes in this area. Service users have their needs assessed prior to admission, which ensures that their needs can be met. Standard 6 is not applicable. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The manager understands how important it is for prospective new service uses to have sufficient information to decide whether the home can meet their needs. The home invited each potential new resident to visit the home and to spend time there before making a decision. If they are unable to do so, the home will arrange for a home visit to discuss any queries. New residents receive a service users guide before admission, which explains the scope of care available in the home. Service users may register with a GP of their choice, subject to acceptance by the surgery if this means a change. Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 10 Each person receives a comprehensive assessment of care needs before admission. This ensures that the home has the information it needs before deciding if it can care for that person. A service user said: ‘They know me very well. I was asked if I wanted to come here and I said I’d give it a try. When (things changed for me) I asked if I could keep this room, as it just suits me fine. I was told I could stay in it as long as I like.’ Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 11 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. People who use the service experience adequate quality outcomes in this area. Service users receive the care they need, following well informed plans of care The principles of respect, dignity and privacy are put into practice. Service users are not fully protected by the medication procedure at the home. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Each service user has a plan of care based on the assessment. These receive a thorough review every month and changes are incorporated into the plan. The review looks at the key areas in the plan and is person centred in its approach. Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 12 A service user said she was regularly asked about the care she received and if everything was to her satisfaction. She said she felt her views were important to the manager and staff who were responsive to her needs. She said: ’I have only to pull that cord and someone is here straight away, and they’re always so glad to help you. They never make you feel it’s a chore which is so important when there are things you can’t do for yourself.’ Conversations observed between staff and service users showed that staff had a detailed knowledge of each persons care needs and that they were alert and responsive to any changes in a service users wellbeing. This ensures service users receive the care they need and is particularly important when service users have a limited capacity to express themselves clearly. There are a number of such service users living at The Bay Tree. Health care professional visits are recorded separately, which makes it easy to track the health care of each person. A GP said that the home worked very well with two of his patients who each presented challenges to providing good care. He said staff were very good at adopting the most appropriate approach to each individual. He added that the home always contact him if they are concerned about a residents health and they do this quickly giving good information. Another GP wrote: ‘Overall the care is to a high standard. The carers are compassionate to clients needs.’ Medication is administered from a trolley which is not accessible to all areas of the home. One member of staff puts the medication into pots whilst another member of staff goes to the service user and administers it. This is not an acceptable practice as it is produces the risk of administrative error. A procedure must be devised whereby the member of staff putting the medication into the pot is the one who immediately goes to the service user with it. It is this member of staff who should sign. The signature is to confirm medication has been given, not that it has been put into a pot correctly. Advice has been sought from the CSCI pharmacy inspector in order to clarify this requirement regarding medication. Throughout the site visit staff were observed treating service users with great respect, discretely and with regard to dignity. A service user said: ‘They are very good when they help you with a shower, I always feel all right because they make you feel comfortable about it.’ A relative also confirmed that his mother was treated well and her dignity was respected. Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 13 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 People who use the service experience good quality outcomes in this area. People who use services are able to make choices about their life style, and supported to develop their life skills. Social, cultural and recreational activities meet individual’s expectations. Service users receive a good diet. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: Service users are assisted to live their lives in the way they prefer. One service user enjoys spending time in her room where she receives her visitors, and is content with television and newspapers. Another service user said he was happier spending time in the lounge with others and enjoying a chat with staff and other service users. All service users have involvement from families and have the opportunity to go out if they wish. Staff were observed interacting with service users throughout the morning of the site visit, and this often initiated conversations between service users too. Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 14 The home employs an activities organiser who visits three times a week. Examples of activities are art, craft, exercises, chair netball, knitting, crosswords, jigsaws and dominoes. One service user said: ’ She gets us interested in things, otherwise we’d sit.’ A member of staff said: ‘Some of the residents won’t want to join in but that’s okay, it’s there for them if they want. Sometimes, those who aren’t keen decide to join in after all and say they’ve enjoyed it.’ The emphasis is upon each individual and what they prefer to do. Often the organiser will be assisting with several individual activities at one time. The home welcomes visitors at any reasonable time of day. A visitor wrote: ‘(Staff) are always pleasant to visitors.’ Service users can bring items from home with them on admission and an inventory is kept. Most spoken to said the food was very good. One service user said: ’You can’t fault it.’ A GP wrote: ‘Nice meals.’ And another GP wrote: The food is of a good standard.’ A midday meal was observed. The tables were set out attractively with flowers. The residents were offered Shepherds Pie and sprouts. The portions were good and the food was brought out hot. Some remembered being informed of the day’s choice in advance. Staff asked if residents were enjoying the meal and most agreed they were. The home can cater for specialist diets and if service users have particular likes or dislikes these are taken into consideration in planning menus. Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 15 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 People who use the service experience good quality outcomes in this area. People who use the service are able to express their concerns, and have access to a robust, effective complaints procedure, and are protected from abuse, and have their rights protected. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The home has a complaints policy and procedure. Service users said they could speak with staff or the manager if there was a problem. One service user said she was confident that the home would put anything right if there was a problem. She added. ‘Mr Dobson comes to see me every day to ask if everything is all right. I know he would do something about anything that was bothering me.’ Staff responded positively when asked about the way in which the home handles complaints. There have been no official complaints since the last key inspection, and all other problems are dealt with straight away by the manager. No member of staff could recall any such concerns. None of the relatives spoken to said they had cause to complain and none of the service users said there was ever anything to complain about. Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 16 The senior member of staff on duty has received abuse awareness training provided by an external trainer, but this was through another post. She was aware of the protection of vulnerable adults protocol and what she would do if there was suspected abuse within the home. Other staff were clearly aware of what would constitute abuse and had received training in the basics in their induction. However, these were not sure of the proper procedure for alerting about suspected abuse. They said they would go to a senior carer who would begin the process with the manager. The home is caring for vulnerable adults and should provide abuse awareness training for staff at all levels. The manager said he would plan for this training soon. One service user said: ‘I feel very safe here. All the staff know what they are doing and listen to what I want.’ A GP said: ’My advice is acted upon.’ Staff said they felt they could always ask if they felt unsure of a situation. This open communication helps to reduce the risk of unreported abuse. Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 17 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 and 26 People who use the service experience good quality outcomes in this area. Staff overcome the difficulties inherent in the building to ensure service users are as independent as possible. The home is well maintained, clean and provides a good laundry service. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The home is well decorated and homely. Service users rooms are decorated to their taste. Many rooms are personalised with pictures, photographs and items of service users own furniture. Although there are limitations inherent in the building, which can make it difficult for all service users to access all areas of the home, the manager and staff work hard to ensure that an atmosphere of inclusion is maintained. For example, those service users who find it difficult to Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 18 climb the two steps from the lounge into the dining room eat in the lounge. The rooms are open plan and service users are included in conversations. Whilst not ideal the home minimises the effect on service users. One service user sitting in the lounge at lunch time said: ‘I’m fine, they come and ask me what I want and talk to me.’ Because service users are encouraged to visit the home prior to admission they can see the way in which the home is laid out and can make an informed decision about whether the home is right for them. Where it has been possible for the home to provide adaptations these have been provided. There is a lift, a wheelchair accessible shower and grab rails where necessary. The home also has a second lounge which can be used by service users if they wish to be quiet or have visitors. The building complies with the local fire and environmental health departments. The laundry is situated away from the kitchen and meets the standard. Service users said they had no problem with the laundry provision. Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 19 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 People who use the service experience good quality outcomes in this area. Staff in the home are trained, skilled and in sufficient numbers to support the people who use the service, and to support the smooth running of the service. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The home has sufficient staffing for the needs of the residents. Service users said they received their care in an unhurried way and that staff had time to chat. One service user said: ‘They make me feel a part of things.’ There is a good skill mix of staff on duty each shift. There is always a senior carer on duty with other carers to assist. New or inexperienced carers always spend time shadowing more experienced staff until they feel confident to work Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 20 on their own. At these times such staff are not counted on the rota but are extra to requirements. Staff said they felt they had time to understand what was expected of them and that the senior carers were very open to being asked questions. Although less than 50 of staff have attained NVQ at level 2 or above, staff were enthusiastic about gaining this qualification and several were enrolled on a course of study. One relative said: ‘They know what they are doing. They provide excellent care and have a very good attitude.’ Staff are well recruited, they are interviewed, have references taken out and all checked files had a current Criminal Records Bureau check in place. Staff receive induction and foundation training. Although there was no formal infection control training recorded, staff reported that they were trained in infection control when they were shadowing senior staff. Observations on the day of the site visit showed that carers were using protective aprons and gloves when offering personal care and that there were liquid hand washing facilities available to control the risk of cross infection. When asked about infection control staff were aware of the correct procedure. Training in infection control should be recorded in order to fully evidence it has taken place. Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 21 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): 31,33,35 and 38 People who use the service experience good quality outcomes in this area. The management and administration of the home is based on openness and respect, there are effective quality assurance systems developed by a qualified, competent manager. Service users welfare is protected by good health and safety systems. We have made this judgment using a range of evidence, including a visit to this service. EVIDENCE: The proprietor/manager has many years of experience in managing the home. Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 22 Staff said they received good direction and support from the manager and that he would encourage and support them to begin training. The home has developed a new improved quality assurance questionnaire. These are sent out to service users, relatives and any others who visit the home. If any questionnaires raise issues which need to be addressed, the manager does this immediately, otherwise the results are fed back to staff in informal meetings. The manager said that any general improvements needing to be made following comments on surveys would be discussed and acted on. Staff said the home was always looking for ways to improve the service for each individual. This was done through the monthly care plan reviews for each person and through day-to-day observations of care. All surveys had positive comments and no complaints. Some examples were: I feel the staff at the Bay Tree do a good job and are always pleasant to visitors’ ‘I have always found the standard of care very high. The residents always appear to be settled and happy.’ One relative said: ’They go out of their way to make sure everything is done right for (my relative) they know what to do to keep things on an even keel. They really are excellent.’ The home does not handle service users finances. Health and safety is promoted through staff training, effective risk assessments, regular checks on electrical and gas systems and servicing of all equipment. Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X N/A X X 3 Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 Requirement Timescale for action 01/11/07 2 OP18 13 The person preparing medication must be the person who administers this to the service user. The use of a ‘runner ‘ is not acceptable. Staff must receive abuse 31/01/08 awareness training to protect service users welfare. 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 OP30 Good Practice Recommendations All staff training in infection control should be recorded in order to evidence it has taken place. Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Bay Tree The DS0000007738.V349905.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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