Inspection on 20/09/06 for Bilton Court

This inspection was carried out on 20th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Bilton Court 11/03/09

Bilton Court 25/02/08

Bilton Court 28/02/07

Bilton Court 17/10/05

Bilton Court 04/11/04

Bilton Court 19/05/04

Bilton Court 23/01/04

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 Bilton Court Windermere Drive Queensway Wellingborough Northants NN8 3FR Lead Inspector Ms Sarah Jenkins Unannounced Inspection 20th September 2006 08:00 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 Bilton Court DS0000012708.V311553.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. Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bilton Court Address Windermere Drive Queensway Wellingborough Northants NN8 3FR 01933 401613 01933 401615 jane.ross@anchor.org.uk www.anchor.org.uk Anchor Trust 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) Mrs Elizabeth Jane Ross Care Home 48 Category(ies) of Dementia - over 65 years of age (7), Old age, registration, with number not falling within any other category (48), of places Physical disability over 65 years of age (24) Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The total number of service users must not exceed 48 No service users with a physical disability over the age of 65 PD(E) may be admitted to the home when there are already 24 service users accommodated within the home No service users with Dementia over the age of 65 (DE(E) may be admitted into the home where there are already 7 service users in the home 17th October 2005 3. Date of last inspection Brief Description of the Service: Bilton Court is a care home providing personal care and accommodation to forty eight older people twenty four who may have a physical disability and seven who may have a dementia related illness. Bilton Court is operated by Anchor Homes, which is part of Anchor Trust. It is situated on a residential estate on the outskirts of Wellingborough with public transport to and from the town centre. The home has single bedroom accommodation with en-suite facilities for all service users on two floors. A passenger lift provides access to the first floor. There are four separate units within the home each unit having a communal lounge/dining room. There are pleasant grounds surrounding the home, which are accessible to all service users. Information about the home can be obtained from Anchor Homes in the form of a Service Users Guide and a Statement of Purpose. The weekly fee is £420 with some additional costs such as hairdressing, chiropody and holidays. Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Inspection (CSCI) is upon outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting 3 service users and tracking the care they receive through meeting with the service users, a review of their records, discussions with the care staff and observation of care practices. The Inspector visited during the morning to observe practices by staff and to meet with service users. Some service users have mild dementia conditions and thereby communication can be difficult. Establishing Service Users choices and informed decisions is dependant to some extent upon the consistency of staff, service users relationships with staff, and the quality of communication. Feedback obtained from Service Users in this report was in part through observations of their relationships with staff, and also through interpretations of their general levels of happiness with their routines. The Inspector spent 3 hours preparing for the inspection through a review of its history and the Pre-inspection information provided by the home. Six General Practitioner surgeries returned feedback questionnaires and these expressed generally satisfactory views of the home. No feedback forms were received from service users or relatives. The Inspector met with a visiting District Nurse at the inspection, but there was no input to the inspection from other visitors. What the service does well: The premises are purpose built and with bedrooms and communal areas on each floor and a passenger lift. There is good access for wheelchair users to all parts of the home including the garden. The standard of the meals is good and menus are varied with a choice provided. Catering Staff are keen to provide meals to suit the individual’s requirements. The Staff on duty on the day of the inspection were observed to be caring and anxious to do their best to meet the needs of Residents. Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are admitted appropriately and sufficient information is available at the time of admission to produce reasonable care plans. EVIDENCE: Information is available for service users and a suitable assessment process is carried out prior to admission. Staff and service users described flexible and welcoming admission arrangements which were conducive to service users finding Bilton Court an acceptable placement. Service users who spoke about the admission procedure did not necessarily feel they had been properly informed about everything throughout, but this appeared to be largely due to concerns that their relatives had not handled the situation well. There may be a place for multidisciplinary support for relatives to ensure communication with prospective service users is the best possible to ensure a good outcome. Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 9 Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users needs are only being met to a minimal level and some risk is evident EVIDENCE: Service users care plans are of a poor quality and sometimes, essential information on service users physical, mental, emotional and social needs, is missing. Care plans are not being reviewed promptly or consistently. Risk assessments and up to date Moving and Handling assessments are missing. Staff are not always following the Moving and Handling assessments that are on file and that they have been trained in. From discussions with service users and staff, and a review of records it was evident that Service users health and welfare needs are not always being properly met. A service user with mental health needs was referred to openly both in her presence and privately as a “whittler”, and although this was intended as banter and a jest, and the service user took it in that spirit, it reflected the way in which service users needs for interaction are not always Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 11 recognized as part of their welfare needs, and their dignity thereby compromised. One service user said to the inspector that she felt very lonely, only had brief interaction with staff in passing and needed her room door open to watch the “comings and goings” as she felt that this was the only contact she had. Some service users had been identified as having mental health needs, but it was unclear how these were being met. The inspector had an opportunity to meet with a visiting District Nurse who praised the responses and assistance that she had from staff and felt that they were excellent in supporting her in her duties. The health information gathered in the assessment process on one service user had not been transferred to the care plan and this had resulted in there being no regular routine to check the catheter and thus essential catheter care being delayed. The service user had had to call staff on the call system to get the bag emptied. This presented a risk to the service users wellbeing. Concerns about service users care plans were raised in the inspection of May 2005 and a requirement was made. Some improvements were noted in the follow up visit of November 2005, but it was also stated that continuing development of care plans was required. It appears that this improvement has dropped off. The Registered Manager informed the Inspector that new care plan formats are to be introduced throughout the organization and this is seen as a positive response to the issues, but the proper introduction of these, including staff training, will obviously take time, and there is an need to resolve current problems to ensure service users safety in the meantime. The Inspector observed the administration of medicines during the breakfast time medication “round” and saw that the properly trained senior staff member was following procedures. However, the staff member was interrupted half way through preparing a service users medication, by a staff members need to access a urine sample bottle that was locked away. The Registered Manager agreed that there was no need for these bottles to be locked away as they did not contain preserving chemicals. This interruption in the medication administration process presented a risk to service users as the medicines were left in an unmarked pot (although properly secure) while the staff member attended to something else, thereby increasing the risk of human error. A medicine that had been prescribed for a service user for PRN (as required) use only had been used every night for at least a month. The instruction on the Medication Administration Sheets sheet was not the instruction that the Community Psychiatric Nurse had given for its usage. Staff had not noticed this error. There was no evidence of the regular administration of creams prescribed for another service user. This lack of management overview of medications presents a risk to service users. Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 12 The home has a good call system with service users carrying their call alarm buttons on their person, however service users consistently felt that there was a slow response to their calls for assistance. Several service users said that they had raised their concerns about this and been told that the delays were due to staff shortages. The Inspector confirmed that there were very long delays in calls being answered, up to 8 minutes observed and 18 minutes evidenced on the call printout record. These delays were due to staff being very busy at the time of the inspection. One record on the print out of call responses seemed to indicate that the bell had been silenced but that staff had failed to go straight to the room after silencing it. Service users were sympathetic to staff, acknowledging that they were very busy and that they did the best that they could in the circumstances, but they also felt that the slow response compromised their dignity. Two service users felt sufficiently strongly about it to share with the inspector, the sensitive information that they had soiled themselves on occasions due to the long waits. Bilton Court DS0000012708.V311553.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some service users are happy with the levels of suitable activity. Others are not and would benefit from much more social interaction, including increased interaction with staff EVIDENCE: Some service users have recently enjoyed a holiday away from the home, supported by staff. Various activities are advertised around the home and some service users engage in these and enjoy them. There is a part time activities coordinator who works exclusively providing activities. She was on duty and the Inspector observed that some service users were enjoying a game. The activities coordinator organizes a number of volunteers who are properly police checked, and assist her with her work. She felt more volunteers were needed to provide a better service to all service users. Some service users did not feel that they benefited from enough activity and there was talk of boredom and inactivity from several people. Some service users made negative comments such as that they were “fed up” or that they Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 14 “have to put up with it” or that they “make the best of it”. Some service users were reluctant to loose the contact established with the Inspector in the course of conversation and they expressed pleasure at having the chance to “just sit and chat” with someone. They felt that staff did not have this time, and described feelings of isolation. The Inspector met with most staff on duty on the morning and afternoon shifts, either privately, or briefly and informally. About 50 of the staff who spoke with the inspector felt that some service users needs in this area were not being properly met due to staff lack of time. The inspector observed that staff tried to be sensitive to service users, but that verbal contact was often rushed and gave the impression to service users that staff were in a hurry. Hospitality is offered to service users visitors who are encouraged to keep contact. Some service users said that they were enabled to access the local community through the help of their relatives and visitors. Generally meals and menus are well matched to service users needs and wishes. The chef continuously reviews provision through personal contact with service users and a comments book. Cultural diversity in taste and religious needs is recognized and responded to. Service users comments about the food at the home were generally very positive, and service users were observed to be enjoying their food, including a cooked breakfast. Bilton Court DS0000012708.V311553.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 inspected at least once during a 12 month period. 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. Complaints at the home are responded to and generally the response includes change where needed. This has not been the case in respect of service users concerns about staffing. EVIDENCE: Staff have all received training on Protection of Vulnerable Adults, and during the inspection and in discussion, showed themselves to care for service users, and to be alert to issues of protection. A recent concern raised by staff about the practice of other staff has been investigated by the Registered Manager and is thought to reflect training issues. Additional training is being provided to some staff as a result of this. The same concern has recently been sent on to Commission for Social Care Inspection and has now been referred to the Registered Owner for further investigation. There is evidence that the Registered Manager investigates and responds to complaints within the timescales. She was concerned that she has been unable to respond to a recently raised anonymous concern about food, put in the suggestions box, as it was too generalized to act upon. Advice is given that some service users felt that the concerns that they had raised about the delays in staff responding to their calls were said to be due to Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 16 staff shortages. They said that this situation had not improved despite being told of the reason. Bilton Court DS0000012708.V311553.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 at least once during a 12 month period. 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. The environment is conducive to service users happiness and wellbeing subject to adequate staffing for the layout of the home. EVIDENCE: The environment of the home is very good, and if fully staffed would be most conducive to service users happiness and wellbeing. The home is well maintained, clean bright and airy. The division of the home into 4 separate living areas, each including dining space, a lounge area and a kitchenette creates a homely atmosphere even though the capacity of the home is fairly large. Recent improvements have included new decoration and furniture and the widening of the garden path to ease access by wheelchair users. Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 18 Service users have been enabled to furnish their rooms and to personalize their space and expressed general content with this. The home was very clean and hygienic throughout and there were no malodorous areas. Service users expressed full content with the cleaning. Bilton Court DS0000012708.V311553.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,29,30, Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing of the home is poor at times. Staff training is not always translated into good practice. EVIDENCE: Care staffing ratios vary throughout the day, and from day to day. There was general consensus from most staff that when the numbers of staff are at the higher level, (i.e. one senior and six carers in the morning, and one Senior with five carers in the afternoon), staffing is adequate. At the lower level service users needs cannot be properly met. Service users made comments such as “they’re always very busy, but they do the best they can”, and “there are not enough of them, they can’t do it all”. One service user did not wish to comment on their own behalf but advised the inspector to see for herself and ask around saying that there are “lots of moans from people about staffing”. Staff training is implemented but is not always followed through into their practice, for example Moving and Handling instructions are not always being properly followed putting service users at risk. Staff are not properly maintaining Service users records and care plans. Supervision on shift is reported to be limited due to the pressure of work for the senior on duty. Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 20 There has been recognition from the organization that staffing levels day and night need to be improved and recruitment is in process with consideration being given to changes in organization of staff, and a “twilight” shift. Recruitment is professionally undertaken and managed and new staff feel that they are well supported and trained, shadowing more experienced carers on each different unit before working on their own on the units The problem of staff shortfalls appears to have gone on for some time. It is important that an increased level of staffing is implemented as soon as possible and thereafter maintained. . Bilton Court DS0000012708.V311553.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,36,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Management of the home is generally enabling and responsive, but improvements in staff organization and management must be implemented. EVIDENCE: The Registered Manager has improved the general running of the home since her appointment, and staff and service users find her approachable and generally responsive. Her interactions with service users were seen to be warm and sympathetic and she is well experienced and qualified for her role. She is fully supported by her Deputy. Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 22 Quality Audit systems are in place, although these were not sampled at this Inspection. The Inspector was informed that there is a regular review of responses to questionnaires, with the aim of improving services. Staff supervision, both formal and informal is inadequate. For example a staff member had been asked to draw up a care plan for a new service user and this had not been done in the time given for it. Staff were also failing to implement some of their training and the levels of senior supervision on shift were not picking this up as a problem. Formal supervision of staff was not happening. Generally, Health and Safety issues are properly addressed. Advise was given at the time of the inspection to ensure the security of the front door through meeting unknown visitors promptly, rather than letting them into the building, and ensuring that first floor windows are secured to a safe opening gap at all times. Bilton Court DS0000012708.V311553.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 1 8 1 9 1 10 2 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 1 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x x x x 1 x 3 Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 24 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. 1 Standard OP7 OP8 Regulation 12 Requirement Up to date care plans must be in place. They must contain specific information regarding service users individual needs including health care needs, and must be used to guide the actions of the staff. Medication, including prescribed creams, must be administered in accordance with the instructions from the service users General Practitioner or Community Psychiatric Nurse. Staffing levels must be maintained at a level which fully meets the needs of Residents. The quality of care at the home must be regularly reviewed through the proper supervision of staff. Timescale for action 21/10/06 2 OP9 13 27/09/06 3 4 OP27 OP36 18, 24 21/10/06 21/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 25 No. 1 Refer to Standard OP9 Good Practice Recommendations The procedure for the administration of medication should be reviewed. Staff administering medication should be dealing with that task exclusively unless a major emergency occurs. Service users dignity should be protected, through staff training and supervision as necessary. Service users should be assessed in relation to their social and emotional needs and should be enabled to increase their social contact as necessary. These needs and the ways in which they are to be met should be detailed on care plans. Supervision of staff practice should include observations of performance in relation to the training that they have received. 2 3 OP10 OP12 4 OP30 Bilton Court DS0000012708.V311553.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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 Bilton Court DS0000012708.V311553.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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