Inspection on 19/09/05 for Berkeley House

This inspection was carried out on 19th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 17 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Berkeley House 01/06/06

Berkeley House 16/05/05

Berkeley House 10/12/04

Berkeley House 17/05/04

Berkeley House 15/04/03

Similar services:

Thorndene

Insight - Eastchurch

Southfields

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33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Berkeley House Lynsted Lane Lynsted Sittingbourne Kent ME9 0RL Lead Inspector Lucy Ansell Unannounced Inspection 19th September 2005 9:30 Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 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 Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 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 Adults 18-65. 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. Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Berkeley House Address Lynsted Lane Lynsted Sittingbourne Kent ME9 0RL 01795 522540 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) The Regard Partnership Limited Vacant Care Home 23 Category(ies) of Learning disability (23) registration, with number of places Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16 May 2005 Brief Description of the Service: Berkeley House is a registered care home for 23 adults with learning disabilities. It is one of a group of homes owned and managed by The Regard Partnership. The home is situated in the village of Lynsted, roughly one mile south from the A2 at Teynham. The service is provided in three separate listed buildings set in large grounds. The Granary provides accommodation for four service users. The Windmill has five service users. The main house, The Bakery, has twelve service users. The Granary and The Windmill are self-contained and are staffed independently from the main house. Some areas of the grounds are shared by all three homes although The Granary has independent access and an area of dedicated garden.The home has two vehicles that are used as required to provide transport to local services and amenities. Teynham is on a bus route and has a main line railway station. Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection on the 19th September 2005 carried out by two inspectors Lucy Ansell and Anne Butts. The purpose of the inspection was an additional visit with the focus on looking at the progress made of all the outstanding requirements. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. Some Standards were not inspected in full and the last report should be read in conjunction to obtain a full picture. The home’s area manager and deputy manager have been in position for only two months and this inspection was to help them identify what works still needed to be carried out and in what order of priority. What the service does well: What has improved since the last inspection? What they could do better: The home still needs to concentrate on improving on all requirements until the home is at a level where all these are met. The home’s announced inspection later in the year will look at all requirements in more depth. Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 6 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. Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3 Prospective residents and their relatives do not have the relevant information required to make an informed choice about the home. Residents cannot be confident that all of their assessed needs can be met until new assessment procedures are in place. EVIDENCE: The manager has revised the Statement of Purpose and each house has its own separate one. There were pieces of information missing that need to be added: number and size of rooms, complaints procedure to be expanded on, a chart to include the hierarchy of the staff and management structure, expand on current activities offered both in and outside the home. Every resident now has a service user guide kept on their file which they have gone through with their key worker and signed. The manager is currently looking at the home’s capacity to meet the assessed needs of all residents in the home by re-assessing all residents. It is the intention of the home to provide a written agreement for all residents confirming that they can meet their needs based on current best practice. This will then be kept on file. Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8 and 9 The home is working towards care plans being comprehensive enough to ensure residents’ care needs are identified and met. Residents are supported to make decisions and choices. Residents are well supported to take risks as part of an independent lifestyle. EVIDENCE: The care plan for one resident that had been reviewed and rewritten was looked at and scrutinised. It was felt that this care plan was too large and all the information contained within would take too long to read and so would not be effective as a working tool. The manager is looking at having a pull out section, which encompasses all the key documents. The model shown to the inspector was a very good example. The staff have all received training in Person Centred Planning and the awareness and motivation this has given staff is tangible. If residents are able to write and comprehend they are encouraged to add input to their own care plans. On a long-term the manager would like for all the residents as able to decide their own aims and goals in the care plan. At this time there was no monthly reviews started as the revision of care plan is still in its infancy. Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 10 Staff need to be evidencing they are offering choices to the residents and care plans must clearly represent that independence is being maintained. The use of symbols and makaton signs through out the care plans is good practice and needs to extend to the action plan / pull out section. It was noted that pen pictures of the residents were written in the positive and the risk assessments held on file were excellent although not used company wide. The weighting on the assessments, of the probability of risk made it less subjective and more informative. To help eliminate any confusion the action plan does not need to be separate but used to complete the care plan. The residents are now involved in key working sessions as well as house meetings. The resident’s feel they are more involved and consulted on aspects of the home that concerns them. Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13 and 16. Residents are being encouraged to make choices about all aspects of their daily lives, through the support of a range of activities in the home and local community. Residents’ opportunities for personal development are improving with chances to maintain and develop independent living skills. Residents benefit from being treated with respect and dignity and their independence is being promoted. EVIDENCE: The care plans and direct observation evidenced that residents are now being encouraged to learn, maintain and develop practical life skills to the best of their abilities. Residents spoken to on the day attend college and have work placements; one has found employment through Skillnet and is really well supported by the staff there. Staff are facilitating independent travel within the local community this has been worked on in stages and he is being shown how to manage the risks. Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 12 The other residents attend The Resource Centre based in the grounds open daily and in the evenings. It was apparent through discussion with the staff working there that the programme lacked creativity and records of participation by residents were not evidenced. However it appeared resident’s had some control over the activities and they could choose as to whether they wanted to participate or not. Many residents attended an evening class there on basic maths and English, and the home is looking to expand this to include money management and kitchen skills. The residents accessed the local community to do their shopping, go to the local shopping centre, and use the cinema, pubs and restaurants. The residents are now going out on activities with the staff or their key workers. Evidence needs to be seen in the care plans of a range of leisure activities that they choose to participate in. The manager needs to ensure risk assessments have been undertaken to assist staff in supporting residents maintains appropriate personal relationships. Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 19 The residents benefit from staff who are aware of how to give personal support. Whilst the residents benefit from having their immediate health care needs met, longer term healthcare needs still need to be addressed. EVIDENCE: It was evident from speaking to the managers and looking through the documentation that they are much more aware of the needs of their residents. The manager indicated that all support offered was aimed to maximise the resident’s independence. The manager described how routines of the home were flexible to suit the needs and wishes of the residents; this was backed up by the documentation. No residents were seen still in bed many had gone out or were going out and the day was planned around their wishes. The health needs of residents are well met with evidence of good multidisciplinary working now being requested on a regular basis. Some of the residents are very independent with their personal care needs so are offered guidance and supervision, and other residents who needs more assistance, are offered this in as sensitively way as possible by the same sex carers. Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 14 The home promotes and maintains residents health through supporting and facilitating medical appointments as required. The Manager stated that all service users are registered with a GP of their choice. Care plans showed that speech and language assessments are being asked for residents as required, also physiotherapist and Occupational therapists reviews. There was also clear evidence of medication reviews happening and optician and dentist appointments. The managers and staff were observed indirectly throughout the inspection, and were seen to interact in a positive and respectful manner with clear affection and genuine regard from both parties. One resident gave positive feedback during the inspection about the new approach of the home, commenting, “I love it here”. Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Whilst the home has a robust complaints procedure the residents’ pictorial format needs revising. The home is working towards ensuring all residents are protected from abuse, neglect and self-harm. EVIDENCE: The home’s complaints procedure was seen. This evidenced a fairly robust policy that included all necessary information and time scales. The inspectors were shown the residents’ complaints procedure which is on display in the main entrance hall, this is in a service user-friendly format using pictures and simple words. However the pictures had very confusing meanings and are not considered acceptable by the inspectors or the homes managers. The residents are speaking out more about their concerns and are able to approach the staff; the home must ensure it is clear on what constitutes a complaint and how to let residents know the outcomes of their concerns. The inspector viewed and discussed copies of the Home’s Policy for the Protection of Service Users and staff “Whistle blowing” procedure. These include procedures for the reporting of suspicion or evidence of abuse with a format for the recording of any allegations and action to be taken. The Manager who is responsible for training informed the inspector that most of the staff had now received training in Adult protection. We discussed the need to have all staff suitably trained including the domestic staff. Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 16 It was recommended that the home gain awareness with regard to the Medway & Swale Adult Protection Protocols. The home was also requested to ensure that it is aware of the POVA (Protection Of Vulnerable Adults) procedures. Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,28,29 and 30 Residents will benefit from living in a safe, well maintained and homely environment when the full refurbishment programme has been completed. Whilst service users have the benefit of living in a clean and odour free home further consideration will need to be given to the standards of cleaning once the refurbishment work has been completed. EVIDENCE: The home is carrying out major refurbishment and redecoration both inside and out. Whilst the decorators are there it is not possible to gain a true reflection of the cleaning however mouldy tiles were still evident in one of the bathrooms, smeared and sticky marks on doors and mirrored doors. A new cleaner is starting and a cleaning matrix needs to be in place to ensure it is clean and the finish is good. We walked around all the houses and looked at the previous report to ensure all issues hi-lighted had been addressed. The refurbishment programme for the smaller units, The Granary and The Windmill, has nearly been completed. The Bakery (which is the largest unit) is still in working progress. Overall the quality of furnishing and fittings has improved and furniture had been replaced were it was broken or worn; most of the rooms had been painted and were Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 18 reasonably fresh and clean. There was a faint smell in a couple of the bedrooms and the flooring is being changed to help address this. All rooms had the required furniture and residents had made decisions on whether they had a bedside light or not. There is currently one communal area in the Bakery that is the lounge/diner. There was enough seating for all service users however this was because the home is not full. Soft furnishings had all been washed or replaced however the sofas did look quite worn and uncomfortable. Dining tables and chairs that had been encrusted with old food had all been stripped and sanded down. A second room is being converted into a quiet living room so that residents may have a choice. Berkeley House has ducks in the garden which are contained in a small pen. It is recommended that consideration might be given to offering the birds a more natural but secure habitat within the grounds of the garden. All garden furniture has been cleaned of duck faeces and residents at the time of the inspection were seen to be sitting outside for their lunch enjoying the sunshine. The home is aware when finished all redecoration to ask the Environmental Health Officer to visit. Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,33,34 and 36 The safety of residents is maintained by the newly formed staff team and the home’s robust recruitment practices. EVIDENCE: The staff observed on the day of inspection appeared knowledgeable about the residents they were working with. This was evident from the positive relationships, which had been formed between staff and residents. One residents were quoted as saying “Friendly and nice staff ”. From discussion with one resident at the home the primary focus was on developing a tailor made service to enable this man to develop his independence and his living skills. Evidence was seen that the daily routines of the home now focussed more on the choice and freedom of the individual service users. The home has implemented training for all staff and hopes to have all staff trained to the required standards by the end of the year. The home has employed many new staff and staffing is now at full capacity. Evidence was seen of supervision notes and induction booklets. The managers had been through the staff files and highlighted all the information that was missing then notified staff to bring this in. The staff files are greatly improved and evidence was seen of a checklist on the computer to mark off all info as received to ensure the CRB’s stay current. Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 38 The care of residents is being enhanced by the recent introduction of improved management practices EVIDENCE: At present the dynamic leadership from the area leader is driving the advancements in care planning, good practice and policies and procedures. The approach of transparency and honesty enables trust and leading by example. The new manager when she starts will need to ensure that the momentum of good practice and good care continues. The residents and staff at the home appeared to be working in partnership and a good feeling was present in the home. The homes management is good at present but not stable or settled. Senior management needs to guarantee that the service users health, welfare and best interests stay at the forefront of this homes management structure. Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x 3 x x Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 2 2 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x 2 x 2 2 2 LIFESTYLES Standard No Score 11 x 12 2 13 2 14 x 15 x 16 2 17 Standard No 31 32 33 34 35 36 Score x 2 2 2 x 3 CONDUCT AND MANAGEMENT OF THE HOME x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Berkeley House Score 3 2 x x Standard No 37 38 39 40 41 42 43 Score 3 3 X x x x x DS0000023892.V251342.R01.S.doc Version 5.0 Page 22 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 17 Standard YA38 Regulation 24(1) Requirement The management approach of the home creates an open, positive and inclusive atmosphere. The registered person operates a thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. The home has an effective staff team with sufficient numbers and complementary skills to support service users’ assessed needs at all times. Staff numbers/hours relating to the needs of service users are based on guidance recommended by the Department of Health. Staff have the competencies and qualities required to meet service users’ needs and achieve Sector Skills Council workforce strategy targets within the required time-scales. The premises are kept clean, hygienic and free from offensive odours throughout and systems are in place to control the spread of infection, in accordance with relevant legislation, published DS0000023892.V251342.R01.S.doc Timescale for action 30/11/05 16 YA34 19 (9) 30/11/05 15 YA33 18(1) 30/11/05 14 YA32 18(1) 30/11/05 13 YA30 23(2) 16(2)(J) 30/11/05 Berkeley House Version 5.0 Page 23 12 YA29 23(2)(n) 11 YA23 13(6) 10 YA22 22(2) 9 YA19 12 1(a) 8 YA18 12(2) 7 YA16 12(4) 6 YA13 16 (2) professional guidance and the purpose of the home The registered person ensures the provision of environmental adaptations and disability equipment necessary to meet the home’s stated purpose and the individually assessed needs of all service users. The registered person ensures that service users are safeguarded from physical, financial or material, psychological or sexual abuse, neglect, discriminatory abuse or self harm, or inhuman or degrading treatment, through deliberate intent, negligence or ignorance, in accordance with written policy. The registered person ensures that there is a clear and effective complaints procedure, which includes the stages of, and timescales for, the process and that service users know how and to whom to complain. The registered person ensures that the healthcare needs of service users are assessed and recognised and that procedures are in place to address them. Staff provide sensitive and flexible personal support and nursing care to maximise service users’ privacy, dignity, independence and control over their lives. The daily routines and house rules promote independence, individual choice and freedom of movement, subject to restrictions agreed in the individual Plan and Contract Staff support service users to become part of, and participate in, the local community in accordance with assessed needs DS0000023892.V251342.R01.S.doc 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 30/11/05 Berkeley House Version 5.0 Page 24 and the individual Plans. 5 YA12 16 2(n) Staff help service users to find and keep appropriate jobs, continue their education or training, and / or take part in valued and fulfilling activities. The registered manager ensures that service users are offered opportunities to participate in the day to day running of the home and to contribute to the development and review of policies, procedures and services. Staff respect service users’ right to make decisions, and that right is limited only through the assessment process, involving the service user, and as recorded in the individual Service User Plan. The registered manager develops and agrees with each service user an individual Plan which may include treatment and rehabilitation, describing the services and facilities to be provided by the home, and how these services will meet current and changing needs and aspirations and achieve goals. To ensure statement of purpose contains all required information. 30/11/05 4 YA8 12(3) 30/11/05 3 YA7 12(2) 30/11/05 2 YA6 15(1) 30/11/05 1 YA1 4(1) 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Berkeley House DS0000023892.V251342.R01.S.doc Version 5.0 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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