Inspection on 12/05/06 for Belper Views

This inspection was carried out on 12th May 2006.

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

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

Other inspections for this house

Belper Views 29/09/09

Belper Views 22/04/09

Belper Views 19/11/08

Belper Views 30/04/08

Belper Views 02/05/07

Belper Views 10/03/06

Belper Views 23/11/05

Belper Views 19/07/05

Belper Views 02/02/05

Belper Views 10/03/04

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 Belper Views 50/52 Holbrook Road Belper Derbyshire DE56 1PB Lead Inspector Brian Marks Key Unannounced Inspection 12th May 2006 09:00 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 Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 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. Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Belper Views Address 50/52 Holbrook Road Belper Derbyshire DE56 1PB 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) (01773) 829733 Mr Alan Kilkenny Mrs Susan Shirley Matthew Care Home 25 Category(ies) of Old age, not falling within any other category registration, with number (25) of places Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th March 2006 Brief Description of the Service: The home is a large detached brick building with its own large garden and patio area, set on a hill on the outskirts of Belper. The home offers access to a good range of community and leisure facilities, although there are no shopping facilities in the immediate area. The home offers accommodation for 25 older people in single rooms, some with en-suite facilities available, and has a good range of communal areas, offering a variety of spaces for residents and their visitors to use. Residents at the home are registered with 1 of 2 local Doctor’s practices and there is a small community hospital in the town. Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that took place at the home over a period of 7 hours. Additionally, time was spent in preparation for the visit, looking at previous inspection reports and other relevant documents and preparing a structured plan for the inspection. At the home, apart from examining documents, care files and records, time was spent speaking to the owner and registered manager and 5 of the staff working at the home during the visit. The care records of 4 people who use the service were examined in detail and these were interviewed along with 5 others and 2 visitors who were at the home during the morning. The last unannounced inspection of the home was carried out on 10 March 2006 when an immediate requirement notice was left for urgent attention to obtain new clearance by the Criminal Records Bureau in relation to 3 staff employed at the home. What the service does well: What has improved since the last inspection? What they could do better: Continued improvements in the standard of assessment and care planning documentation need to be made to increase staff working safely and consistently. Given the limitations of the current documentation, the purchase Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 Page 6 of a professionally developed system was discussed and strongly recommended. Urgent attention needs to be made to the process of applying for checks from the Criminal Records Bureau to make sure that only suitable people are appointed to work at the home, and an immediate requirement notice was left at the home to underline the urgency of this matter. Improvements in minor aspects of the medicines administration, staff training and staff supervision need to be made to ensure greater resident safety and consistency in staff working. 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. Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 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 Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 6 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. People do not come to live at the home without the care they need from the home, and its staff, being identified. However, this is not carried out in comprehensive ways and the documents prepared do not contain all the necessary information to ensure a safe and consistent service. EVIDENCE: As was noted in the reports of the last inspections, the service user files examined contain a range of information that had been prepared at the time of admission. Although the manager has continued to update and improve the standard of care records, it was agreed that she has gone as far as she can with the document formats currently in use at the home, due to their inbuilt limitations. Areas of particular concern and risk – (risk assessments) – had only been completed for some residents and these had not all been reviewed and evaluated at appropriate intervals to make sure that the information was accurate. Examples noted were general assessments in relation to nutritional and moving and handling needs. Whilst these assessments were linked to the daily care plan (see next section), in some cases the overall package of Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 Page 9 documents still lacked clarity and detail about how needs were to be met, and about how proper services were to be provided. The possibility of purchasing a complete system of care documentation was discussed with the home’s manager and proprietor and it was agreed that this would be given immediate serious consideration. During discussions with the manager about problems experienced with the increase in dependency of certain residents, she was able to explain how alternative services had been sought and how the home limits its service to people who don’t have advanced needs. Prospective service users can be reassured that only people who are appropriate for the home will be admitted. The home does not provide an intermediate care service so Standard 6 does not apply. Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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 the service. The care of all residents, including health care, is planned and given in ways that respect individuality and privacy, and the management of medicines is generally satisfactory. However, the care plan documents do not efficiently support care activities and resident welfare. EVIDENCE: All residents have their own file containing care records and care plans, and 4 files were looked at in detail during the inspection. As noted above, the current formats and structure of documents place limitations on the standard of care plans produced and this was again noted to be varied in the sample of files looked at and the requirement made at the last inspection remains. It was agreed by the home’s management that the style of current care plans does not encourage a comprehensive service being designed for each resident and that they do not describe clearly how different needs are to be met. As noted in the previous section the idea of the purchase of professionally produced sets of care documents was discussed with the proprietor and manager at this visit, and this will be given immediate serious consideration. Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 Page 11 Evidence from care records and from discussions with staff and residents, indicated that there is good and routine support from outside professionals in respect of the health needs of people living at the home. Generally the arrangements for receipt, storage and administration of medicines have been improved over the past year; in particular the standards of recording on the MAR sheets now ensure much safer practice although a number of handwritten entries and instructions had not been signed and dated by the person responsible. Records of the temperature of the small storage refrigerator were absent due to the lack of a maximum/minimum thermometer. These shortfalls may lead to unsafe conditions in the management of the residents’ medicines. Although some residents had their own telephones in their rooms, the proprietor has now provided a cell phone for everyone to use, so that residents do not block the office phone and a call line is always available to them. Discussions with residents and visitors indicated that care is always given in careful and sensitive ways by staff. They all reported that the staff were always very friendly and that their privacy was respected at all times. For example, one resident spoken to spends substantial amounts of time in her room and this presents no problems. Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 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 at least once during a 12 month period. 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 the service. Social life at the home had shown some improvements and there are always a good number of visitors to the home. Although, residents remained largely uninvolved in stimulating activities, they feel in control of their lives at the home and enjoy a satisfactory diet. EVIDENCE: The activities coordinator has continued to make an impact an impact on the amount of social and leisure time being spent with the residents, but the residents spoken to reported that when she is not on duty there is little in the way of structured activity at the home. They did say that staff are able to spend 1-to-1 time with them when they are free to do so and they are generally happy to be able to run their lives at the home as they please; a number were in their rooms listening to music or watching television during the visit. Additionally, those who are interested are now enjoying more regular visits of a local church group. One resident spoken to is supported to enjoy a particularly independent life and regularly travels into Belper and further afield around Derbyshire with his free bus pass. All residents spoken to have retained contact with their families and received visitors at the home on a regular basis. According to the residents, their routines were arranged Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 Page 13 according to their preferences and they all reported that they were free to use all the facilities of the home as they wished to. The new cook continues to make improvements in the home’s catering and all feedback from the residents was positive about the standard of meals served at the home. Storage arrangements in the kitchen have been changed and more space has been made available, with a different approach to purchasing food to make sure that excess stocks are not carried. The cook reported that he now uses increasing amounts of fresh ingredients, having changed some of the suppliers and the menus continue to reflect this. Written menus are now placed on each table in the dining room and a choice was available on the lunch menu on the day of the inspection. One resident also described how the cook will make special arrangements to cook food for him that he has purchased at the local supermarket. Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. 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 the service. The home has a procedure in place relating to making and managing complaints and in relation to the protection of vulnerable people. Residents and staff are made aware of their respective rights responsibilities in these areas. EVIDENCE: The copy of the complaints procedure is on display in the communal area and is included within the Service Users Guide, given to residents when they arrive at the home. The home has not had any formal complaints in the last 12 months but as there is no system in place for recording informal concerns and problems raised by residents on a day-to-day basis, the incidence of these cannot be commented on. Such a system will allow the proprietor and manager to be fully aware of how the home is operating and of any problems in the daily lives of residents, no matter how small they may appear to be. A complaint received by CSCI was discussed at the last inspection but this proved to be without foundation and was not taken further. The home has a detailed policy and procedure in relation to the protection of vulnerable adults, and this includes the local statutory procedure to be followed. Staff are given instruction at the time they join the home and also through other later training; not all had received this follow-up. There had been no incidents of use of the statutory procedures during the past 12 months but the manager has previous experience of the matter. Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The proprietor has continued to make improvements to facilities and the home is clean, hygienic and offers good standards of comfort to residents in the bedrooms, garden and communal areas. EVIDENCE: A tour of the building was made to look at selected bedrooms, bathrooms and to speak to residents and it was noted that the proprietor has continued to maintain a good standard in the physical environment of the home. The downstairs bathroom has been upgraded by the replacement of the ‘medi-bath’ with a standard modern one fitted with a manual hoist. Generally the standard of the bedrooms visited were satisfactory and the residents spoken to were complimentary about their individual arrangements. It was noted that the following areas need attention to improve resident comfort, welfare and safety: The carpet in the dining room is badly stained and showing signs of wear. There is an area of damaged plaster in the kitchen ceiling that has been caused by water leakage in the bathroom above. Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 Page 16 All bedroom doors have been supplied with resident names, to assist with orientation. The communal areas and bedrooms of the home were clean and tidy and free from odours at the time of this inspection and the residents spoken to had no complaints about the laundry service of the home; everybody observed in the home wore clean and well-presented clothing. The Fire and Environmental Health Officers visited the home last year and were satisfied with the standards of safety observed. Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Good levels of training have been provided to staff so that they work consistently and safely. Whilst recruitment of new staff has been carried out properly in the past, lack of recent experience has exposed serious flaws in the home’s systems and potentially the wrong people for the job may be employed. EVIDENCE: From examination of the staff roster, the numbers of staff regularly on duty is satisfactory and meets the previously agreed levels. Standards of cleanliness of the home and activities in the kitchen indicate that sufficient domestic and catering staff are employed to meet the needs of the registered numbers of residents. Records on staff files showed that 9 care staff had completed or were completing an NVQ qualification at a minimum of level 2, and the required target of 50 of staff having this has now been achieved, which is to be commended. Staff were observed with the residents during the inspection and interactions were seen to be warm and professional. At the last inspection an immediate requirement notice was left at the home requiring the home’s management to make urgent applications to obtain checks from the Criminal Records Bureau in respect of 3 recently employed staff. Examination of their records had indicated a failure to do so which has Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 Page 18 exposed serious weaknesses in the process followed for the recruitment of new staff. Since that time there seems to have been an administrative error on the part of the ‘umbrella organisation’ that handles these applications for the home and the applications sent by the manager have been lost. This has resulted in the potential recruitment of people who are not right for the job and, in order to make sure that the problem is urgently rectified, a further immediate requirement was left at the home at the end of the inspection. A previous examination of the files of all established staff indicated that the correct checks had been carried out for them. From the examination of staff records and discussion with the manager satisfactory levels of staff training in relation have been carried out in relation to the core health and safety activities, apart from instruction in relation to the control of infections and in the protection of vulnerable adults. The manager reported that following discussions with the National Training Council, she will be receiving assistance to plan and deliver a comprehensive training programme for staff. Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 35 and 36. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The manager has completed registration with CSCI and is due to commence on training for a suitable qualification. Systems for measuring the quality of services at the home have yet to be developed by the provider as have those for the formal support and monitoring of staff activities. EVIDENCE: The manager has completed registration with CSCI since the last inspection, and she is also due to commence on a Registered Manager’s training course with a local college; both of these are required by law. The manager continues to have a stabilising influence on the home and to update systems of administration. Previous examination of the system for managing of resident finances indicated that these were in order and all activities involved with looking after their Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 Page 20 money were properly carried out; there have been no changes to this system. However, discussion with staff and examination of records, indicated that although annual appraisals have been taking place, they had not been having regular 1-to-1 meetings with the home’s management. This will lead to a shortfall in systems for the formal support and monitoring of staff performance. Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 Page 21 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 2 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 3 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X X Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 Page 22 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. Standard OP3 Regulation 14(1-2) Requirement The needs of all residents must be fully assessed at the point of admission, and those needs must be recorded fully and kept under regular review. Comprehensive risk assessments of individual service users capabilities and needs must be recorded, and kept under regular review. Specific risk assessments that refer to resident preferences not to use footrests on their wheelchairs must be completed. (Previous timescale of 31/01/06 not met. Last timescale extended). Care plans must clearly show how service users needs are being met, including identified risks. They must be kept updated and regularly reviewed and must show the involvement of service users/relatives. (Previous timescale of 31/03/06 not met. Last timescale extended). All handwritten entries in the medicines record must be signed and dated by the responsible DS0000019936.V293104.R01.S.doc Timescale for action 31/10/06 2. OP7 15(2) 31/10/06 3. OP9 13(2) 30/06/06 Belper Views Version 5.1 Page 23 4. OP12 16(2) 5. OP19 16(2), 23(2) 6. OP22 23 7. OP29 19(5) Schedule 2 8. 9. OP30 OP33 18(1) 24(1) person. A thermometer that can read maximum and minimum temperatures must be provided and full records maintained. The registered person must consult with service users about activities and provide a structured programme of daily activities. The carpet in the dining room must either be cleaned to remove the visible stains or replaced. The ceiling in the kitchen must be repaired. The need for additional call points in the main lounge must be the subject of a risk assessment, which includes discussion with residents and their representatives. (Previous timescale of 31/01/06 not met). The registered person must ensure that no staff work unsupervised at the home until full checks have been received from the Criminal Records Bureau (CRB). Copies of the application forms to the CRB must be forwarded to the CSCI for examination and written proof of successful clearances under the POVA1st scheme must also be provided. All staff must receive appropriate training or instruction in infection control. The Registered Provider must carry out monthly monitoring visits in accordance with regulation 26 and retain a copy of written reports at the home for inspection. (Previous timescale of 31/12/05 DS0000019936.V293104.R01.S.doc 30/09/06 31/10/06 30/09/06 31/05/06 30/09/06 30/06/06 Belper Views Version 5.1 Page 24 10. OP36 18(2) not met). The registered person must ensure that there are systems in place to offer formal staff supervision and that these meetings are recorded. (Previous timescale of 30/06/06 extended). 30/09/06 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 OP10 OP16 Good Practice Recommendations The manager should make sure that residents and their families are aware of their access to the home’s cell phone. The complaints procedure should allow for recording of all concerns and problems, and for records to be stored confidentially. The displayed version should be suitable for people with a visual impairment. All staff should undertake regular update training in adult protection. The manager should monitor the impact on direct care of service users due to staff undertaking domestic and laundry duties, through Regulation 26 monitoring. The manager should obtain a greater understanding of the process of risk assessment through training activities and practical application around the home. 3. 4. OP18 OP27 5. OP38 Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Belper Views DS0000019936.V293104.R01.S.doc Version 5.1 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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