Inspection on 16/05/06 for Brook House

This inspection was carried out on 16th May 2006.

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

The inspector 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

Brook House 02/05/07

Brook House 24/05/05

Brook House 24/01/05

Brook House 14/09/04

Brook House 05/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Brook House 45 Seymour Street Cambridge CB1 3DJ Lead Inspector Matthew Bentley Unannounced Inspection 16th May 2006 12:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Brook House Address 45 Seymour Street Cambridge CB1 3DJ 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) 01223 247864 01223 213055 Brook Healthcare Ltd Care Home 33 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (33) of places Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th January 2006 Brief Description of the Service: Brook House provides care, support and accommodation for a maximum of thirty-three people, including up to eight who have a diagnosed dementia. The home is close to a popular shopping area of Cambridge; accommodation is on two levels, the upper floor being accessed by the stairs or shaft lift. All rooms are for single occupancy and are arranged in flats, each having dining areas, sitting rooms and a kitchenette. A day centre operates within the home, which some of the residents choose to use. Staff support is provided 24 hours a day and an on-call manager is always available. The home has two cats, which provide company and interest for residents who are fond of animals. Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took 3 hours and took place 16th May 2006 between 12.30 and 17.05. The inspection was carried out by one inspector who spoke to a number of service users, the acting manager, and the service manager and staff members. The inspection also included reading documents and a tour of the building; a number of CSCI questionnaires were also given either to residents or, when more appropriate, to their relatives; the responses have been used to provide further evidence of how the home is performing. Residents were all complementary about the home, comments made include “I can’t fault the home” and “its lovely, the staff will help at any time”. Comments made in the questionnaire sent out as part of the home’s own quality assurance processes were very positive; comments included “its absolutely perfect, there are no faults whatever” and “it’s wonderful”. Charges at the home range from £350.00 to £500.00 per week depending on the level and the facilities required. What the service does well: What has improved since the last inspection? Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 6 Information in care plans is being developed and work has been done to ensure that plans reflect current need and provide guidance to staff about, not only what residents need help with, but also what they can do for themselves. An activities coordinator has been appointed, though her input has been lessened by having to cover shifts in the kitchen. 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. Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4, & 5 Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. Documents outlining the services and facilities the home provides contain sufficient detail so that potential service users have full and up to date information about the service. The home takes suitable steps to ensure that potential service user’s needs are fully assessed prior to moving in to the home, and an appropriate length of time is offered as a trial period, so that residents, relatives, and other people involved can be sure of the suitability of the home. EVIDENCE: The home has a service user guide, which can be given to people who are interested in using the service; the guide includes information to let people interested in the home know about what services and facilities they can expect if they decide to take up a place. Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 9 When a referral is made to the home, a senior member of staff visits the person concerned and meets with family members and any professionals who may be involved, so that as much information about the person’s needs as possible is obtained. Resident’s files contain the information that has been gathered on each person’s needs, including pre-admission assessments carried out in hospital, and the details of the person’s social histories, hobbies and interests. A ‘care diary’ is also sent to relatives or other significant people, in which they are invited to document details of individual likes or dislikes, life histories, any things that may upset the person concerned, and conversely, anything that may make them happy or help them relax. Discussions with the acting manager and staff members indicates that staff are suitably experienced and competent and have a good level of knowledge about the general needs of older people, and the people living at the home specifically, though as noted elsewhere, the way on which some people were being helped to eat needs improving. Aids and adaptations, including rails and hoists, are provided to help staff meet needs and allow them to move about the home freely. The home’s admission policy encourages people who are interested in the home (and their families if appropriate) to visit before making a decision about whether they think it may be suitable. New residents are given a three-month trial period to see whether the home is meeting their needs and whether they want to stay there permanently. The home does not provide intermediate care so standard 6 is not applicable. Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. Care Plans outline what help each person needs and how that assistance should be given so that staff can be clear about what help they should provide. Arrangements are in place to ensure each service user receives input from relevant professionals to ensure that health needs are met. Policies and procedures are in place to ensure that personal care is given sensitively so that individual’s dignity and privacy are maintained. Procedures for managing service users’ medication are satisfactory and are being properly followed, so that medication is safely administered. Service users’ wishes with regard to death and dying are properly recorded so that appropriate arrangements can be made. EVIDENCE: Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 11 The care plans relating to the newest resident and the one who has lived at the home for many years were seen, and showed the action required to meet their assessed health, personal, and social care needs including hobbies, interests, personal histories and likes and dislikes. The system of care planning is in the process of being changed to include more detail about what residents can do for themselves so that individuals’ skills are maintained, and the care plans that have been completed have detailed information about the individual needs and abilities. Since the last inspection care plans have been reviewed every month, and the acting manager is intending to put into the compilation and reviewing of the plans, especially with regard to residents for whom they act as ‘key-worker’. The manager said that working relationships with the GPs, District Nurses, and other people working in the health service professionals are good, and arrangements have been made for individuals to receive regular dental and eyesight checks. Private chiropody services are available to people who need them. The home uses a pre-dispensed monitored dosage system for administering medication, and the local pharmacist provides training and advice. Records’ relating to the management of medication, and the local pharmacist provides training and advice. Records relating to the management were examined and were found to be in order, and the member of staff responsible for medication on one of the units confirmed that she has been given enough training to give out medication safely. Residents spoken to confirmed that they felt their privacy and dignity are respected and staff use the name they prefer, though most are on their first term names. Care staff were seen talking with service users whilst helping them walk from one place to another and with a variety of other tasks; the way they spoke was respectful and polite. Contact has been made with relatives asking for information about individual wishes around death and dying; where responses have been made, the information is included in the care plans though, understandably, some people did not want to consider the matter. Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, & 15 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to the service. The range and frequency of activities is adequate, though it is likely to be limited by the fact that the activities coordinator is currently being asked to spend time preparing meals. Staff provides appropriate support to facilitate contact with family and friends, and residents are encouraged to make choices about their lives and are encouraged to maintain their independence. Dietary needs are well catered for, with a balanced and varied selection of food available to meet residents’ individual tastes and choices, however, storage arrangements need to be improved, as do the way in which food is prepared, and the way in which staff provide assistance to residents who need help to eat so that individuals are helped to eat in an appropriate manner. EVIDENCE: A range of activities has been arranged including bingo three times a week, card games, and outside musical entertainers. Responses to the CSCI questionnaire indicate that residents feel that there is sufficient activities Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 13 provided, though the person employed to coordinate and facilitate the activities is currently spending time working in the kitchen; this was commented on by a number of residents and one said that they would like more activities. The home has a day centre, which means that there is plenty of space for, as many residents can get involved in organised activities and entertainment as they wish. The home encourages people to have visitors at reasonable times and residents confirmed that they were able to see their visitors in private if they choose; this was further backed up by the responses to the CSCI’s questionnaires, some of which were completed by relatives. Residents spoken to said that they were able to choose what time they get up and go to bed, and how they spend their days. A number of opened items of food were being stored in the fridge in the main kitchen however, there was no indication of when food was opened so staff would not know how long it would be safe for residents to eat; a requirement has been made about this. Residents generally said that the food was good and an alternative was offered if they didn’t like the main meal, however, a number said there was often too much on the plate, which put them off eating, and some commented that the sausages served for lunch on the day of inspection were cooked in the oven and were too hard to eat. The acting manager said that she would discuss with the kitchen staff, how to make meals more suitable for older people who may have difficulty cutting up and chewing and she would also ensure that food stored is properly labelled; a requirement has been made about this. Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. The home’s systems for dealing with complaints are satisfactory so that anyone wishing to make a complaint can be given accurate information about who to contact and what they can expect to happen. The arrangements for ensuing the protection of service users from neglect or harm are satisfactory so that, as far as possible, service users are protected from abuse, neglect, or mistreatment. EVIDENCE: The home has a complaints procedure to tell people how to make a complaint about the service; these are included in the service user guide and are displayed on the notice board in the entrance. No complaints have been made since the last inspection and a number of compliments, both verbal and written have been made; a sample of the latter are included in the summary of the report. The home has an adult protection policy to guide the staff in dealing with allegations of abuse or mistreatment; a whistle blowing policy aimed at encouraging staff to voice any concerns they may have, is also in place. The majority of staff has had the County Council’s training in its adult protection procedures, and staffs spoken to were clear about the need to make sure residents are protected from mistreatment. Responses to the questionnaire Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 15 sent out by the CSCI indicated that residents and relatives would feel able to talk to the acting manager if they had any concerns about residents’ welfare. Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 16 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, 20 22, 23, 24, 25, & 26 Quality in this outcome is good. This judgement has been made using available evidence including a visit to the service. The home is suitable for the needs of those living there, and sufficient equipment is provided so that service users’ independence is maximised. The home is clean and hygienic and there are no unpleasant odours. EVIDENCE: The home is close to a popular shopping area of Cambridge. Accommodation is on two floors; access to the upper floor is gained using the stairs or a shaft lift, and the building is fitted with aids and adaptations to meet the needs of older people. Whilst the building would not meet some of the new standards relating to, for instance, en suite facilities, the home is well maintained and has a homely, calm and pleasant atmosphere. Residents have access to a range of communal space and when asked, all said they were happy with these areas. Observation and discussions with staff Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 17 indicate that there is sufficient equipment and adaptations for staff to adequately, and safely, meet the needs of the current service users. Bedrooms are well maintained, tidy and clean. Furniture appears it be comfortable and appropriate to the needs of older people, and there is evidence that residents are able to bring with them personal items and items of furniture, provided they meet safety standards. One of the bedrooms had a linoleum floor rather than carpet; the acting manager said that this was due to the needs of the previous occupant and there was no reason why carpet should not be fitted. In the week following the inspection, it was confirmed that carpet had been fitted in the room concerned. The home has laundry facilities which are sited so that soiled linen and other items do not need to be carried through areas where food is prepared, stored cooked or eaten. The home was clean and free from unpleasant smells. There is a need for dementia care training to take place as that is one of the specialist services that the home offers; a requirement has been made about this. The deputy manager said that all staff now have the National Vocational Qualification (NVQ) at level 2 or an equivalent. Files relating to one of the newer members of staff were inspected and contained the information required to meet relevant standard, including references, and proof of identity. Criminal Records Bureau (CRB) checks have been applied for, however, a member of staff had begun working in the home (with supervision) before her check had been returned. The acting manager agreed that if this was necessary to ensure that home was properly staffed, the commission would be consulted, as the CRB guidelines state that staff in care homes should only be appointed without a check being received only in exceptional circumstances. Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 30 Quality in this outcome is adequate. This judgement has been made using available evidence including a visit to the service. Staff remain clear about their roles and were trained and experienced in most areas of their work, so that they can meet most residents’ needs. Staff need training in the care of people with dementia to ensure they have the skills and understanding to provide this specialist care. EVIDENCE: Staffing was adequate on the day of the inspection and rotas demonstrated consistent staffing levels. Staff were well presented and were courteous, welcoming and helpful. Service user comment cards stated that there were always enough staff available and that ‘staff are good workers and help residents in every way possible. It was noted that staff knocked on residents’ doors before entering. A keyworker system is in place. There is a need for dementia care training to take place, as that is one of the specialist services that the home offers. A requirement has been made about this. The deputy manager said that all staff now have the National Vocational Qualification (NVQ) at level 2 or an equivalent. Files relating to one of the newer members of staff were inspected and contained the information required to meet the relevant standard, including references and proof of identity. Criminal Records Bureau (CRB) checks have Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 19 been applied for, however, a member of staff had begun working in the home (with supervision) before her check had been returned. The acting manager agreed that in future, if this was necessary to ensure that the home was adequately staffed, the Commission would be consulted, as the CRB guidelines state that staff in care homes should only commence employment without a full check being received in exceptional circumstances. Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 20 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, 32, 33, 35, 36, 37 & 38 The outcome is adequate. The home needs to have a registered manager so that all management tasks are fully carried out. Residents’ financial interests are protected by the home’s policy of not getting involved in their personal finances. EVIDENCE: The home has been without a registered manager since January2006. The deputy manager is acting as managing the home adequately, however, a requirement has been made that an application to register a manager is submitted to the commission. Following the inspection, the acting manager was able to inform the commission that a manager had been appointed and Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 21 was due to start work on 1st June; a requirement that an application is made to register the person concerned has been made. Residents are expected to look after their own money or, if they are unable, relatives or other representatives will be asked to help them. The home has systems in place to ensure that residents’ and their relatives or other visitors are consulted regularly about standards of care within the home. This includes the acting manager making sure that she has regular contact with residents, holding relatives and residents’ meetings, and sending out questionnaires (a sample of the responses to which are included in the summary of this report). The acting manager is supervising staff, and it is likely that she will have some involvement in the task when a permanent manager is in post. However, she has not had formal training in giving supervision, and a requirement this is provided has been made. Staff has received training in health and safety matters such as first aid and moving and handling, however, as noted elsewhere in the report, food was being stored without being labelled or dated so staff would not know when it needs to be thrown away. The door to the laundry which, due to the presence of hazardous chemicals. Should be locked, was found to be open; a requirement has been made about this. In addition it was noted that there were no separate hand-washing facilities in the laundry area, meaning that staff could not properly clean their hands after handling soiled laundry. The manager was able to confirm that a suitable washbasin was fitted a few days after inspection. File records were seen and shown that some faults had been noted, however, no action appeared to have been taken; a requirement has been made about this, however, the acting manager gave an assurance that the engineers would be called immediately to rectify any problems. Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 22 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 3 X 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 X 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 3 x 3 3 3 2 Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 23 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. 2. Standard OP15 OP30 Regulation 16(2) (i) 19(5) (b) Requirement Food must be properly stored at all times. Staff working with people who have dementia must be provided with training in the needs of the specific user group An application to register a manager must be submitted to CSCI. All staff who have responsibility for the supervision of staff must be provided with suitable training. Timescale for action 16/05/06 31/07/06 3. OP31 9 31/07/06 4. OP36 19 (5) (b) 16/05/06 5. OP38 6. OP38 23 (4) (iv) Arrangements must be made to ensure that fire safety equipment is tested and any action required is taken to remedy any faults. 13 (4) (a) Areas in which hazardous chemicals are kept must be kept locked when unattended. 16/05/06 16/05/06 Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP15 Good Practice Recommendations It is recommended that specialist is sought with regard to improving the preparation and serving of meals. Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB1 5XE 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 Brook House DS0000015239.V292373.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!