Inspection on 06/12/07 for Beech House

This inspection was carried out on 6th December 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

Beech House 15/10/08

Beech House 07/08/07

Beech House 30/10/06

Beech House 30/01/06

Beech House 22/06/05

Beech House 27/09/04

Beech House 02/08/04

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

CARE HOMES FOR OLDER PEOPLE Beech House 29 Great Bowden Road Market Harborough Leicestershire LE16 7DE Lead Inspector Keith Charlton Unannounced Inspection 6th December 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 Beech House DS0000001806.V355165.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. Beech House DS0000001806.V355165.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Beech House Address 29 Great Bowden Road Market Harborough Leicestershire LE16 7DE 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) 01858 464289 beech_house@harborough.uk.com Mr Keith Burrows Mrs Lesley Burrows Mrs Lesley Burrows Care Home 13 Category(ies) of Dementia - over 65 years of age (5), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (5), Old age, not falling within any other category (13) Beech House DS0000001806.V355165.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service User Numbers. No-one falling within categories DE(E) and MD(E) may be admitted into the home when there are 5 persons of categories/combined categories DE(E) and MD(E) already accommodated within the home. Date of last inspection 7th August 2007 Brief Description of the Service: Beech House is a residential home, which is registered to accommodate up to thirteen older people, including five within the category of mental disorder and dementia. Beech House is situated in a residential area, close to the Market Harborough town centre. The home is accessible by car or public transport. Parking is available to the front of the home. The home provides a large lounge to the front of the property and a dining room to the rear. There is a patio area to the rear of the home, which is accessible to residents using wheelchairs and walking aids. Bedrooms are located on the ground and first floor that is accessible by the stair lift or the passenger lift. Bath and toilet facilities are located close to the bedrooms. The weekly fees range from £380 to £420 - the Registered Provider provided this information on the day of the inspection. There are additional costs for individual expenditure such as hairdressing, dentist, optician and private chiropody. The home provides information to residents and prospective residents in the form of a Statement of Purpose that describes the services it offers, and a copy of the summary of the last Inspection Report. These are displayed in the hallway. Beech House DS0000001806.V355165.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of the inspections undertaken by the Commission for Social Care Inspection is upon outcomes for residents and their views of the service provided … The primary method of inspection used was ‘case tracking’ which involved selecting two residents and tracking the care they received through looking at their records, discussion, where possible, with them and care staff and observation of care practices. This was an unannounced Inspection, conducted with the Registered Provider. Planning for the Inspection included checking on the notifications of significant events sent to the Commission for Social Care Inspection and reading the last Inspection Report. There have been no complaints made to the Commission for Social Care Inspection since the last inspection. The Inspection took place between 9.40 and 13.15 and included a selected tour of the home, inspection of records and indirect observation of care practices. The Inspector spoke with seven residents (though this was limited for some owing to the difficulty with communicating with a number of residents with a high level of mental frailty) two staff members, two visitors and the Registered Provider, Mr. Keith Burrows. The inspection was completed the following day with the Registered Manager, Mrs. Lesley Burrows. What the service does well: Residents again said that staff were always very friendly and helpful towards them, that they were encouraged to retain their independence as much as possible, and reported that staff welcome visitors. Staff were observed to be friendly and positive towards residents. The inspector also observed a relaxed and friendly atmosphere in the home. Residents said they would feel confident to raise concerns if they ever had any and were satisfied that these would be listened to and acted on by staff and management. Residents said they liked staff spending time with them when they were able to do so. Relatives are told when their relative in care is not very well and are consulted over the support that is given. Beech House DS0000001806.V355165.R01.S.doc Version 5.2 Page 6 The home is clean, homely and comfortable for residents. Staff again thought they were valued and supported in the performance of their jobs by the Registered Manager and that staff training is encouraged in order to equip them to meet residents needs. Residents liked the food and said that portion sizes were good. The main meal included three vegetables plus potatoes, thereby offering healthy food choices. What has improved since the last inspection? What they could do better: The Registered Provider needs to ensure that the welfare of residents is further assured by keeping full Care Plans regarding residents needs, all staff reading residents Care Plans and having Plans agreed with residents/their representatives. It is recommended that residents personal choices of daily living are included in residents Care Plans to ensure their preferences are always followed. Beech House DS0000001806.V355165.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. Beech House DS0000001806.V355165.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 Beech House DS0000001806.V355165.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): 3.6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process is good and the pre-admission process ensures that most residents needs are met. EVIDENCE: Residents said they had been provided with a service users guide to the services the home offers and they have received contracts from the Registered Manager. The Statement of Purpose and the summary of the last Inspection Report are now displayed in the hallway to be easily noticed and accessible to current residents and their representatives. Beech House DS0000001806.V355165.R01.S.doc Version 5.2 Page 10 Residents said that they could visit the home if possible prior to their admission usually by way of a trial period, to give them a good idea of what services the home offers. A visitor said her relative had been able to visit the home and have a look around prior to admission. There was evidence of assessments undertaken by the Registered Manager available on the residents files examined by the inspector, which covered their needs, medical conditions etc. It covers important issues though not all National Minimum Standard issues are covered so the Registered Manager was again recommended to use the list of issues contained in National Minimum Standard to ensure that all relevant issues were included. The home does not offer intermediate care facilities. Beech House DS0000001806.V355165.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): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans describe identified care needs to ensure proper care is supplied by staff though they need to include all relevant information on residents needs. Medication systems are good in general. EVIDENCE: No residents asked knew they had a Care Plan and no Plan seen by the inspector had a signature of a resident/representative agreeing to its contents – this needs to be followed up. Care plans and risk assessments continue to be generally satisfactory. There is now a form to identify when health checks take place – dental, optical, hearing tests etc though this needs to be recorded so that these can be arranged at regular intervals. Beech House DS0000001806.V355165.R01.S.doc Version 5.2 Page 12 There was reference to the continence needs of a resident in a Care Plan, but this did not contain information regarding referral to the continence nurse to see if any action could be taken to help with this need or to establish what the need was as to what frequency the resident needed to go to the toilet, apart from ‘take to the toilet every four hours or when requested’, but no indication as to how to whether this had been assessed in detail. Other issues in Care Plans were blank. The Registered Manager said these issues would be followed up. Care plans are now reviewed on a monthly basis as per the National Minimum Standard. It is still recommended that there is a record of residents normal routines, capabilities/requirements, getting up and going to bed routines etc., as it was not certain that one resident who liked to stay in bed later than the normal getting up time was able to do so, and that all residents have full personal histories compiled so that they can be seen as individuals with a valued history (some but not all residents have these histories on file). A staff member said that she had not read all the residents Care Plans, though the other staff member said she had read all the Care Plans - this is needed so that there is full awareness of residents needs. Both the residents and the relatives spoken with said again said that staff were very kind and caring and that the standard of care was always of a high standard. The inspector noted that staff always addressed residents in a friendly manner. The relatives said that they were always made welcome. The inspector viewed accident records and found that staff usually call medical services if there has been a potentially serious injury, e.g. a head injury and accident records incidents supported this, except for one recent incident. The Registered Manager said this would always be carried out in the future. The medication system was inspected. The Registered Manager and staff confirmed that only senior staff issue medication and all had received training. Medication recording was complete. Medication is kept locked away though the medication trolley needs to be secured to the wall. Return of medication records were viewed and found to be satisfactory. Beech House DS0000001806.V355165.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): 12,13,14,15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have the opportunity to lead a full lifestyle and can usually exercise choice. Menu planning is thorough and residents are appreciative of the food. EVIDENCE: Residents again said that there were activities but would like more. There was discussion regarding having arts and crafts, raised beds for gardening etc. Some residents said that the lounge was too quiet on occasion and they would like to have music on at times. It was recommended that the Registered Manager speak to residents regarding what they would like to do and compile an Activities Programme based on residents choices. Beech House DS0000001806.V355165.R01.S.doc Version 5.2 Page 14 The inspector again recommended that the Registered Manager arrange training for a designated staff member on the provision of activities for residents with dementia, so as to offer more relevant activities. Residents again said that there were no rules that they knew of, e.g. they reported that there were no set going to bed and rising times though this was unclear for one resident who liked to stay in bed longer (see above) – all residents preferences need to be recorded in their Care Plans. Everyone thought the atmosphere of the home was friendly and relaxed. Inspection of residents accommodation again demonstrated that they were able to bring their personal possessions into the home. Both residents and the relatives spoken to said that visitors are always welcomed to the home and there were no restrictions on visiting. The visitors spoken with said that there were no problems with the care the staff provided and that any health concerns were reported to relatives when they arose. There were again positive views from residents regarding the food. Menus were inspected and found to have a proper choice with one resident currently enjoying the choice of a cooked breakfast. The food was tasted and was again found to have flavour with three vegetables served with mashed potato, followed by fruit and custard for dessert, thereby offering a healthy choice of diet. This is commended. Beech House DS0000001806.V355165.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): 16,18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident in the system of managing complaints. Staff have a generally good level of understanding regarding the prevention of abuse. Residents are properly protected from unsuitable staff as proper employment checks are in place. EVIDENCE: Residents again said that they thought that if there was a problem then they were confident that the Registered Manager would sort it out. One Complaints Procedure was generally satisfactory and now gives the complainant the opportunity to contact the Commission for Social Care Inspection at the initial stage, as per the National Minimum Standard. The Registered Manager is to add that the local Social Service Department is now the Lead Agency for complaints investigations. However the procedure in the Statement of Purpose is the old one and needs to be updated. Beech House DS0000001806.V355165.R01.S.doc Version 5.2 Page 16 Complaint records were inspected and no complaints had been recorded in the file since 2001. There have also been no complaints regarding the service since the Commission for Social Care Inspection was set up. This situation is commended. Policies and procedures for are in place for protecting Vulnerable Adults. Staff members spoken with were aware of the procedure and the agencies to contact if the in house arrangement failed. Staff commencing employment had statutory Criminal Records Bureau / Protection of Vulnerable Adults first checks in place to ensure residents are protected from unsuitable staff. Beech House DS0000001806.V355165.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): 19,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents see facilities as homely and clean. Odour control is of a very good standard. Maintenance needs to be swiftly carried out when necessary. EVIDENCE: Residents again said that they liked the facilities of the home and they could organise their bedrooms in the way they wanted. The inspector observed that bedrooms had been personalised and accommodated residents personal possessions. It was observed that all areas were generally well decorated and furnished, clean, tidy and well maintained. There is a plan to redecorate where paintwork Beech House DS0000001806.V355165.R01.S.doc Version 5.2 Page 18 had been damaged in skirting/doorways and the Registered Manager has stated this would be completed by the end of December 2007. There was one comment received that the corners of rooms were not always kept clean. The Registered Manager is to check this. There has been a suggestion in the past from residents that it would be nice to have the option of having a shower. The Registered Manager said that this is still being considered. It is again recommended that the Registered Manager investigate a signing system for residents with dementia, e.g. colour coding wc/bathroom doors, having pictures on bedroom doors, having a board to indicate date, weather etc, so as to provide more clarity for residents. It was indicated in the Annual Quality Assurance Assessment that the Registered Manager was looking into providing this. Beech House DS0000001806.V355165.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): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staffing levels meet residents needs. Recruitment processes have been strengthened to ensure the protection of residents from unsuitable staff. Staff training covers most essential care issues. EVIDENCE: The rota and the Registered Manager confirmed that there was normally a minimum of three care staff on duty during the morning and two on duty for the afternoon/evening period, and there is a staff member on duty during the night, seven days a week. Staffing levels have been increased on weekend mornings from the last inspection. Residents were again very happy with the staff team and said they are very helpful. Three staff files were inspected and contained the information required – references, identification and statutory Criminal Records Bureau checks. Beech House DS0000001806.V355165.R01.S.doc Version 5.2 Page 20 Staff files contained evidence of training and a Training Matrix has now been drawn up by the Registered Manager to cover training on essential care practices – food hygiene, health and safety, fire, moving and handling, first aid, infection control etc, though there is some outstanding training to be included on mental heath issues, dementia, training on residents health conditions – stroke, parkinsons disease, depression etc. Staff stated that there is encouragement to undertake National Vocational Qualification level 2 training. The last inspection ascertained the Registered Manager was meeting the National Minimum Standard of 50 of staff with National Vocational Qualification level 2 training, and also that two staff were due to start this training. The Registered Manager has obtained the Skills for Care induction programme to be used for new staff. A new staff member confirmed that this had been used during her induction. Beech House DS0000001806.V355165.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): 31,33,35,36,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are generally in place to protect the health and safety of residents. EVIDENCE: Residents and staff again said that they thought the Registered Manager the home was run in a positive and friendly manner and staff said they were supported in their jobs. There was evidence that staff are now receiving one to one supervision. The Registered Manager said this issue has been followed up. Beech House DS0000001806.V355165.R01.S.doc Version 5.2 Page 22 There was evidence of a recent Staff Meeting, which is useful to promote teamwork and consistency and ask staff if they would like to add items to the agenda. There are no Residents Meetings held. It was again recommended that residents / relatives meetings be held and recorded so that all concerned have the opportunity to air their views on the running of the home. The Registered Manager said this is to be arranged. A Quality Assurance system has now been put into place with Questionnaires supplied to residents to gauge their views as to the services the home provides with other interested parties supplied with questionnaires – GPs, District Nurses, relatives etc. It is recommended that an Action Plan be then drawn up to improve services and put into the Statement of Purpose. There is a Health and Safety folder with Risk Assessments for safe working practices with relevant issues covered - e.g. radiators with covers, the need for window restrictors, records of hoist maintenance and wheelchair servicing etc. The Registered Manager stated that she is currently following up the outstanding Requirement from the last Environmental Health Officers Report, which was available for inspection. The Registered Manager does not keep records of residents monies, as she stated that these are dealt with by residents or their relatives. Fire Precautions: System testing was on required weekly schedules for fire bell testing, regular fire drills had been carried out (though this needs to record all the staff that took part in the drill) and there was a completed fire risk assessment in place. Regular monthly checks are now carried out for emergency lighting. Staff members were asked about the fire procedure and were aware of what to do. Fire extinguishers and the fire alarm system had been serviced in 2007. The hot water temperature was checked and the temperature went down from 54.5c to an acceptable 43c, as per the National Minimum Standard, though this took three minutes to do so. The Registered Providers were asked to get a plumber in to change this as it could pose a risk to residents. They said this would be done as soon as possible. The Registered Manager agreed to introduce a weekly check on hot water temperatures to ensure any problems are quickly picked up and dealt with. Beech House DS0000001806.V355165.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 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 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 3 3 X 2 Beech House DS0000001806.V355165.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. Standard Regulation Requirement Timescale for action 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 OP3 Good Practice Recommendations That the home’s assessment form for prospective residents includes all issues contained in the National Minimum Standard. Care plans need to fully detail all care needs to include full care needs, residents preferences as to daily living, their personal histories, be read by staff and shared with the resident/representative. All potentially serious accidents need to be reported to Medical Services. The Registered Manager should set up an Activities Programme based on residents choices and ensure training for staff on providing activities for residents with dementia. DS0000001806.V355165.R01.S.doc Version 5.2 Page 25 2. OP7 3. 4. OP8 OP12 Beech House 5. OP19 It is recommended that damaged paintwork is attended to as soon as possible and that a shower is installed to provide choice of bathing facility for residents. The Registered Providers should ensure that all essential staff training is carried out. The Registered Providers should set up a system of regularly checking the hot water temperatures to ensure fuller protection from possible scalding. 6. 7. OP30 OP38 Beech House DS0000001806.V355165.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection East Midland Regional Office Unit 7 Interchange 25 Business Park Bostocks Lane Nottingham NG10 5QG 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 Beech House DS0000001806.V355165.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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