Inspection on 09/05/08 for Blackberry Hill

This inspection was carried out on 9th May 2008.

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

Blackberry Hill 14/09/06

Blackberry Hill 25/01/06

Blackberry Hill 08/08/05

Blackberry Hill 06/01/05

Blackberry Hill 22/07/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

Extracts from inspection reports are licensed from CQC, this page was updated on 27/09/2008.

CARE HOME ADULTS 18-65 Blackberry Hill Ansford Road Castle Cary Somerset BA7 7HG Lead Inspector Barbara Ludlow Unannounced Inspection 9th May 2008 12:50 Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 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 Blackberry Hill DS0000039173.V364082.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 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. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Blackberry Hill Address Ansford Road Castle Cary Somerset BA7 7HG 01963 350032 01963 350072 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) Home First & Foremost Ltd Mr Shaun Glenn Walker Care Home 10 Category(ies) of Learning disability (10) registration, with number of places Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One place in Room 7 may be used for a service user with a concurrent physical disability 14th September 2006 Date of last inspection Brief Description of the Service: Blackberry Hill is registered to provide residential services for up to 10 adults within the learning disability category of registration. The Registered Provider is Voyage, Home First & Foremost Ltd. Blackberry Hill opened in April 2003 following extensive refurbishment of the building. The home caters for young people who have complex needs and a high level of vulnerability. The accommodation is mainly on two floors with additional few steps on the first floor. There is a passenger lift although most people can use the stairs. Upstairs there are bedrooms and a conservatory lounge. Downstairs there is a dining room, living room and training kitchen; there is also a main kitchen where meals are prepared. Outside there is a parking area to the front of the property with garden areas to the side and back of the house. A previous garage has been converted and equipped to use as a sensory room. This room is also used for some therapies and for arts and crafts. Fees range from £ 1450.00 / per week but would be individually assessed packages of care. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. People who use the service experience excellent 3 Star outcomes in this area. We have made this judgement using available evidence including a visit to this service. This inspection was undertaken by B.Ludlow for CSCI. A site visit was made on 9th May 2008 but the inspection was held open for two weeks to allow the Annual Quality Audit Assessment which was not yet due to be returned, to be completed and sent to the commission. Comment cards were sent out to the relatives of people living at the home and these have been returned to CSCI, comment is included in the body of the report. At the ASR last year a good response was received from visiting professionals and no concerns have been raised with CSCI during the past year. The visit was well received and the deputy manager was on duty, the registered manager returned to the home mid afternoon after collecting a person who had been home to their family for a few days. Ten people were in residence at the home. All were seen during the visit including one person later in the day who had been unwell was not disturbed earlier in the day. One person was out shopping with staff at the start of the visit. A tour of the premises was made and people living at the home and staff were seen and spoken with. The home was clean, comfortable, well maintained and homely. A thematic probe by CSCI was undertaken as part of this inspection, looking at the protection of vulnerable people and at staff recruitment. Very positive findings were evidenced. Daily life at the service was observed. People looked relaxed and well cared for. Staff interactions were polite and helpful. Records were sampled and almost all were found to be up to date and complete. Care planning is person centred and was up to date. Staff supervision was up to date and thoroughly addressed. Feedback was given to the deputy at the conclusion of the visit. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 6 The inspector would like to thank the people living at Blackberry Hill, their relatives and staff working at the home for their cooperation with the inspection process. What the service does well: What has improved since the last inspection? The safeguarding issues raised at the last inspection have been addressed. The manager is actively trying to access more local banking for people in residence who require it. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 8 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 Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2, Quality in this outcome area is good Care plans were in place for people new to the service since the last inspection. The care plans were based on pre admission assessment of needs and aspiration. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two new admissions had been taken since the last inspection. The care plans were sampled and this included a detailed look at one new admission. The company have procedures where people are assessed in their present environment and are invited to visit and spend time at the home. This allows people to meet and get a feel for the place, the staff and the people in living at the home. Information was seen to be gathered from community health care professionals and family to explore whether or not needs can be met at the service. The appointment of a key worker from admission is helpful in supporting the person through the transition. Staff commenting to CSCI suggested that more information on new admissions to the home would be helpful. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good People have person centred care plans that are clear and about supporting their individual personal and social care needs. There is consultation on the care plan and a monthly review. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person had a care plan. The care plans have been changed with full implementation by the 1st May 2008. The inspector sampled the care plans for three individuals in detail. Each had a detailed support plan, which was reviewed with the person each month. There was evidence of key people being involved and agreeing to the care planning. A monthly summary was made available for the people close to one person and there was key worker contact where communication was difficult. Families commented to CSCI that they are kept up to date with their relative’s health and well being. Comment included that there is choice and that cultural Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 11 and gender needs are met, as are the varying levels of disability of people living at Blackberry Hill. Any restrictions on freedom of movement are recorded in the care plans with the individuals risk assessments. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good People are supported to enjoy an individual lifestyle in a group setting that meets their needs and aspirations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are a range of activities and outings that people can choose to attend. The premises have an activities room and snoozalum. All people are encouraged and offered opportunities to participate in a range of leisure and community based activities including horse riding, trampolining and swimming. Hydrotherapy facilities are used at a nearby school. Families responding to CSCI felt their relatives had access to a lot of social activity and opportunity. Staff commented that they have sufficient staff to meet the social care needs well of the people in their care. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 13 On the day of this unannounced inspection the manager was collecting one person from a short stay with their parents who had driven part of the journey to the home and the manager was rendezvousing with them at the M5. One person was out shopping and to lunch with staff. Other people were staying at the home to relax in their rooms or the communal areas. People were comfortable and staff interactions were seen to be kind and considerate Holiday plans had been made, two people were due to go to Dawlish and four people planned to go Exmoor and another two people to Alton Towers. One person experiencing their first holiday from the home will have extra staff support to ensure their safety and well being. Communication with families was discussed. The home has a web cam but on person found this distressing another was reported to be too restless to use it effectively. Families responded to CSCI that they would like the IT systems at the home to be used more to help them feel in touch with their relative and mentioned the web cam and e mail as contacts they would like more of. There has been an effort made by the manager to involve families more. A parents meeting is to be held later in the month and a newsletter has been started, to date one issue has been distributed. There was a Christmas party with families invited to the home; this was reported to be well supported. There has also been a sponsored mile for sports relief with parents being involved. Staff commented that they keep in touch with families and as key workers would write letters with the people they key work with. Families commented that communication with the home was very good and one said they are notified about every ‘bump, fit or fall’. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome area is good People living at Blackberry Hill looked well cared for and their health care needs were being addressed. Medication was safely stored and fairly well managed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All people living at the service were seen. All looked well cared for. The care plans that were sampled indicated that attention is paid to health status. One person has dietary monitoring that was detailed in their care plan, likes and dislikes were known and special requirements were clear. Staff were aware of weight and dietary intake impacting upon the persons well being. The care plan has a ‘my diet sheet’ for recording such information. A nutritional risk assessment tool is not used, this may be a helpful tool to use to inform and validate current good practice. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 15 Dental care was well managed those who needed a prompt had a dental chart in their bedroom. People living at the home all use the dental access centre in Yeovil. Medication records were examined. Staff signatures were recorded. The charts had photographic identification. There was also information for each person such as directions for taking the medication, the administration by spoon or syringe and their preferred drink to have with their medication. Two hand transcribed medications had only one signature where two is recommended for checking the accuracy of the entry and one chart had two administration gaps for skin cream application, no reason was indicated for non administration. This was discussed with the manager at the time of the inspection. There was, as recommended, a copy of the British National Formulary (BNF) available for reference for prescribed medication information. Professional feedback was very positive and praised staff for their professionalism, actively seeking training and for their keen liaison with health care professionals. It was heard that medication is safely and well managed. It was also heard that people have their privacy respected and always appear to be happy and well cared for. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good There have been no complaints raised since the last inspection. Staff demonstrated when asked, their awareness of abuse and the protection of vulnerable people in their care. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no complaints made to CSCI or the home in the twelve months between the service review in 2007 and this inspection. People who were asked if they felt able to raise a concern confirmed that they would. Not all the people in the home have the communication skills to respond to detailed questions and are more reliant upon staff to be alert to poor practice. CSCI are conducting a thematic probe and as part of this inspection staff and the manager were asked specific questions regarding the safeguarding of vulnerable people in their care. This included also questions about recruitment processes to check whether or not the home was working safely and in line with the expectations of the law under the Care Standards Act 2000, and the regulatory framework for care homes for younger adults. The inspector heard that the manager and deputy have attended Protection of Vulnerable Adults (POVA) training and the Investigators course which looks at Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 17 how to report and deal with concerns. The company has policies and procedures to follow and all staff have training on the ‘L Box’ computer training. The whistle blowing policy was seen and this was clear how staff coming forward would be protected for speaking up when they have concerns. The recruitment process was described in detail by the deputy manager and was verified by examination of the staff records, which were all satisfactory. Three staff were asked about their recruitment and knowledge of safeguarding people in their care. The information gathered demonstrated safe recruitment practice and a good of knowledge by staff of their responsibility towards the people they care for. Staff also demonstrated their awareness of the homes whistle blowing policy. Financial records were inspected for the three people who were case tracked at this inspection. There is a safe system in place. Storage facilities are secure and access is restricted. A daily check is made by a senior person and at the end of each month two people check and sign for the balances of all accounts. Any access to bank accounts requires two designated peoples signatures. Families commented that staff keep them informed and that any concerns receive a prompt response. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good Blackberry Hill provides a clean, safe and comfortable homely environment for the people living there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the premises was made and bedrooms were sampled. The home has comfortable communal rooms and a separate dining room. There is a training kitchen and a catering kitchen for food preparation, which was very clean and tidy. The house is homely yet spacious and well presented. Individual bedrooms and were personalised and very nicely furnished with ensuite facilities. One person choosing to have a Jacuzzi bath in their ensuite. An additional conservatory style lounge has been added on the first floor, a concern was raised that this may become very bright and hot in the summer. There are sufficient toilets. The laundry has a sluice cycle washing machine and large dryer. The home has good hand wash facilities for staff and the home presented as clean and hygienic. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 19 Staff are responsible for the cleaning of the house. Families commented that the house is always very clean. One person felt that some of the furniture was looking worn. There was comment from family’s staff and professional visitors that Blackberry Hill is homely and relaxed. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good The staff team were safely recruited and are well trained to support the people living at Blackberry Hill. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff were on duty in sufficient number to support the people in their care. Staff commented to CSCI that there are sufficient staff on duty in the daytime to meet the activities and outings. Each night there are two waking night staff with one sleeping night staff who is available if needed, one comment was that three waking staff would be helpful. Staff impressed as being interested and dedicated to providing a good standard of care and support to the people living at Blackberry Hill. Staff were asked about their recruitment. Recruitment records are held at the company head office, a list of verified information is signed by the administrator and the manager when the documents have been checked. The Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 21 recruitment processes lists for new staff were examined and this confirmed safe recruitment practice. All staff asked confirmed that their recruitment checks were carried out before they commenced working at the home. Enhanced Criminal record Bureau (CRB) checks had been undertaken and references were taken up including their most recent employer. One person did not have their photograph on file, it was considered to be mislaid as it was confirmed that the staff member had submitted it. Induction training is recorded in a booklet format and was evident on the staff files examined. Other training was seen to be recorded, this included first aid training and protection of vulnerable adults. Specialist learning disability training was recorded for one person. Staff responding to CSCI commented that they found the induction to be very good. Staff supervision records were examined. A chart is maintained in the office to prompt supervision review. Regular supervision records were seen on the staff files held at the home, supervision is carried out five times by year and appraisal is carried out annually, all are recorded and are stored securely. Staff received praise from relatives responding to CSCI for their caring skills, friendliness and professionalism. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,42 Quality in this outcome area is excellent The home is well managed and is run with the best interests of the people living there being paramount. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is well run; there is a pleasant and relaxed atmosphere. Both staff and relatives spoke of the home being well managed. Records were examined for maintenance of the premises, financial records, health and safety checks and fire alarm tests. Records were complete and safely stored. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 23 The service user guide was available in each bedroom and contains a contact alert card that the person can use if worried by anything at the home. Employers liability insurance was displayed. Some monthly regulation 26 visits by the provider have been sent to CSCI, this is no longer required unless requested. Policies and procedures were seen and it was noted that the missing person information is also held in the minibus. Activities are risk assessed. Wheelchairs have a weekly visual inspection; the inspector was informed that parents take responsibility for servicing personal wheelchairs. Portable equipment had been safety checked (PAT) and gas appliances had been inspected. The passenger lift had been serviced. A satisfactory environmental health inspection had last taken place in late May 2007. Water pipes are flushed regularly to prevent Legionella infection. Fire safety records were sampled. All weekly and monthly testing had been carried out on the alarm, emergency lighting and the fire extinguishers. Fire drills are held and all people are evacuated. Fire training is carried out every two months and all staff had received training in 2008. One named member of staff is responsible for the fire training. There is an emergency contingency plan where alternative temporary shelter can be accessed and emergency phone numbers are available to find immediate staff assistance. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 24 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 4 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 4 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 X 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 3 X 4 4 3 X X 4 X Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA20 YA20 Good Practice Recommendations Care should be taken to sign the MAR charts for the administration or non-administration of a prescription cream. Hand transcribed medication should checked and signed by a second person to validate the entry. Blackberry Hill DS0000039173.V364082.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Blackberry Hill DS0000039173.V364082.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. 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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