Inspection on 11/04/07 for Bungay House

This inspection was carried out on 11th April 2007.

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

The inspector 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

Bungay House 07/05/08

Bungay House 07/11/07

Similar services:

Chesham House

Argyll House

Dorset Lodge

Acacia House

Falcon House

Dial House Nursing Home

Cromwell Avenue (9)

Abbey Lodge

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

CARE HOMES FOR OLDER PEOPLE Bungay House 8 Yarmouth Road Broome Bungay Norfolk NR35 2PE Lead Inspector Mrs Marilyn Fellingham Unannounced Inspection 11th April 2007 09:30 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 Bungay House DS0000067514.V337758.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. Bungay House DS0000067514.V337758.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Bungay House Address 8 Yarmouth Road Broome Bungay Norfolk NR35 2PE 01986 895270 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) Bungay House Ltd Ms Sally Ann Gravestock Care Home 12 Category(ies) of Dementia (12), Mental disorder, excluding registration, with number learning disability or dementia (12) of places Bungay House DS0000067514.V337758.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The 12 Mentally Disordered people may be admitted if 50 years of age or older. Key Inspection 02/05/06 Random Inspection 30/11/06 Date of last inspection Brief Description of the Service: Bungay House is situated in the village of Broome on the border of Suffolk and Norfolk. The entrance to the home is signposted from the road. The home can accommodate 12 people aged over 50 years with either mental health illness or dementia. There are 2 double and 8 single rooms on the ground and first floor, none of these rooms have en-suite facilities. There is a separate dining room, sitting room and a small area that can be used as a quiet area or for activities. There is a pleasant small courtyard garden to the front of the premises with a large covered area for those residents who wish to smoke. There is limited parking to the side of the home. The home is supported by the local GP surgery and other professional agencies. The range of fees charged are £398.07 to 620 per week. Bungay House DS0000067514.V337758.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over eight hours. Opportunity was taken to interview the manager, staff members and some service users. No written comments were received from the service users or their relatives as the provider had refused to distribute them. The focus of the inspection was to ascertain if the repeated legal requirements had been complied with and also to inspect the other key standards. What the service does well: What has improved since the last inspection? The unsafe smoking shed has been removed and a new safe area has been provided for those service users who wish to smoke. Some areas have undergone some refurbishment with redecorating of four bedrooms and re carpeting of two. Bungay House DS0000067514.V337758.R01.S.doc Version 5.2 Page 6 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. Bungay House DS0000067514.V337758.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 Bungay House DS0000067514.V337758.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The admission process has improved, however formal records are needed for the pre admission assessment. EVIDENCE: Residents are no longer admitted for rehabilitation, this was confirmed by the manager at the Key inspection and information in admission notes and contracts. It was noted however by the Inspector that a format is not used for the pre admission assessment and the records were made on ‘scrappy’ pieces of paper. The admission notes indicated that latest service user who had been admitted to the home was given the opportunity to visit on a number of occassions so that they were able to ‘test drive’ the home also the notes indicated whether Bungay House DS0000067514.V337758.R01.S.doc Version 5.2 Page 9 the prospective service user would mix well with the other residents. A trial period was also given for this new person to be admitted to the home. Bungay House DS0000067514.V337758.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Service users health care needs are not clearly set out and there is no evidence of review or change of care to meet the differing needs. The staff and the manager continue to have a good understanding of the needs of the people in their care. Poorly completed medication records and lack of staff training in relation to the administration of medication could put the service users at risk. EVIDENCE: The Inspector examined three care plans, the manager explained that the home was introducing new paperwork in order to enhance the care planning system; she went on to say that the new format should ensure that there are Bungay House DS0000067514.V337758.R01.S.doc Version 5.2 Page 11 clear records for meeting the service users needs and review of those needs. Examination of the three care plans revealed that the service user’s needs have not yet been clearly set out and they lacked any record for frequent review. One persons file indicated that they had a history of seizures but there was no plan of care in place to meet this need. This person was also being cared for in bed but no skin integrity assessments had been carried out. The second persons file revealed that they were susceptible to falls, and no risk assessment was in place and there was no evidence of review or auditing of the falls. The third persons daily records confirmed that they had a problem taking tablets and spat them out, there was no plan of care in place to establish a safe way for ensuring this person continued to take their medication which was a vital part of their overall therapy. It is disappointing to see that although after four requirements having been made during four inspections the legal requirements have not been met and the care plans do not show any evidence of frequent review nor do they set out any clear needs relating to all areas of personal, health and social care. It is evident after discussion with staff and the manager that the manger does not consider she has sufficient supernumerary hours to enable her to meet these requirements. This will be discussed further under the appropriate standard. Discussion with staff members showed they still have the knowledge of the service users needs, however there are no records in place to support this. This ultimately will have an impact on the safe delivery of care to the service users. The staff were observed to be patient and kind when interacting with the service users. Discussion with service users revealed that they felt that they were well looked after and that their needs were met. One service user commented that they liked working in the kitchen but the Provider had prevented them from doing this because he felt there was a risk of infection; however the inspector noted that carers working on the floor and carrying out tasks related to giving personal care to the residents were then expected to prepare meals in the kitchen. This will be discussed further under the appropriate standard. For this particular resident a spell in the kitchen could be seen as part of their therapeutic care. Bungay House DS0000067514.V337758.R01.S.doc Version 5.2 Page 12 The medication records varied in their quality and there were no records for receipt of medication into the home. One record showed that the medication had not always been given at the prescribed time and lacked information why the medicine had not been given. One persons record was most muddled with no clear entry for the prescribed medication, it in fact had three entries for the same medication. This practice and the lack of suitable recording have the potential to place the service users at risk. The Inspector found other anomalies in relation to what medication had been recorded as given or not given as the case may be. It was difficult for the Inspector to audit the medication as records for receipt of medication did not exist. Staff records indicated that they had had no recent training in the administration of medication. One service user was prescribed Clozaril, but triangulation of case notes revealed that there were no care needs recorded for this complex medication. Bungay House DS0000067514.V337758.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A very limited range of activities within the home means that service users do not have the opportunities to participate in physical, therapeutic and stimulating activities to promote if possible recovery of their mental health problems. EVIDENCE: Activities are not advertised anywhere in the home for residents information. Care plans have no record of any involvement or any participation in activities although the daily notes indicate spasmodically when a resident has made a visit outside the home. Discussion with the service users and staff indicate that very little opportunities are offered to meet the social needs of the service users. Staff members and the manager believe that most of the time staffing issues prevent any form of socialisation with the service users taking place; the staff explained that they Bungay House DS0000067514.V337758.R01.S.doc Version 5.2 Page 14 are not able to spend time with the service users to do any forms of activities for them because they are busy providing for their physical and mental health needs. The poor quality of care plans meant that it was difficult to establish whether the number of staff scheduled on the roster were sufficient to meet service user’s needs. The issue of staffing will be discussed under the appropriate standard. Whilst the Inspector was at the home the manager took a resident out to visit a friend. This is not always possible because the manager is mostly the only driver on duty, and she also has to pick up prescriptions from the local chemist if needed. This activity then reduces the staffing notice and also makes the manager unavailable to perform in her role as manager. This will be discussed more fully under the appropriate standard. One member of staff commented that the service users just sit in the lounge doing nothing because there is never enough staff on duty. The general consensus of the staff spoken to was that the residents did not go out enough. One service user commented to the Inspector that they did not go out enough and would love to go to the library. Another service user stated that they would like to play the piano but unfortunately it needed re tuning. During the inspection process it was noted that fish and chips had been purchased and delivered from a local fish and chip shop for the residents and this happens on a weekly basis. Those residents spoken to enjoyed this weekly treat. At the weekends there is very little time given over to attending to the social needs of the residents especially as quite often the carers also have to prepare lunch for the residents as well as meeting their physical needs. Service users stated that the food was satisfactory. Although the menus were varied, they lacked imagination but mostly appeared nutritious. Observation once again showed that food stocks were low and staff indicated that since the provider became responsible for getting the food order and delivering it to the home they constantly ran out of items, especially tea, coffee and sugar. Bungay House DS0000067514.V337758.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for dealing with complaints are satisfactory. Service users feel safe and that their concerns are listened to by the staff, but not the provider. Service users are protected from abuse. EVIDENCE: A complaints procedure is available to all service users and included in the service users guide. Because of the nature of some of the service users mental health status it was noted by the Inspector that some may not feel or be able to air their concerns; however the Inspector did observe that the staff seemed to be most supportive to the residents and in discussion with staff noted that they appreciated the need for being an advocate in some circumstances. Those residents that were able to discuss with the Inspector assured her that they knew how to air their concerns and who to go to. They also felt that the staff listened to them, although one service user felt that although the staff listened to them and dealt with their concerns the provider did not. The Bungay House DS0000067514.V337758.R01.S.doc Version 5.2 Page 16 Inspector was given an example of one resident wanting a light that could be switched on from the bedside and this, although promised, had not been done. The residents say the staff are wonderful and they have no concerns. All the staff spoken to and the manager confirmed that they had had training in issues related to the protection of vulnerable adults; some staff had also attended sessions on dealing with aggression. Residents meetings were now held on a regular basis, minutes were seen for these and confirmed by the manager, however it was recognised that not all the residents wanted to or were able to attend these meetings. Bungay House DS0000067514.V337758.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. There has been a minimal amount of refurbishment. A number of repeated requirements and environmental hazards result in service users living in unsafe and not very comfortable surroundings. EVIDENCE: A tour of the premises was undertaken by the Inspector. It was noted that Rooms 9,7,2 and 1 had been re decorated and a new carpet laid in Room 7 and 9. The lavatory and bathroom upstairs has also been re decorated. Bungay House DS0000067514.V337758.R01.S.doc Version 5.2 Page 18 Many of the curtains in service user’s rooms were found to be hanging off their hooks, were very old and in some cases almost threadbare so that they let the light in. All the communal wash rooms including the staff lavatory had bars of soap and terry towels in place. These are considered a hazard and could lead to the spread of infection; this is important as two service users have MRSA (though neither acquired this infection within Bungay House) and all procedures related to the Universal Precautions should be put in place. It was noted that the bins in use for disposal of contaminated articles did not have pedals, these are a hazard and not aid the control of infection. The washing machine that deals with all the resident’s laundry does still not have suitable temperature adjustments or sluicing arrangements for dealing with contaminated linen. Staff are expected to sluice soiled linen by hand. The requirement made at the last inspection is therefore not considered met. The bedroom doors now have locks fitted but these can only be locked from the inside and afford no protection from anyone wishing to enter once the resident has left the room, this does have issues related to resident’s privacy and confidentiality. The smoking shed has been removed and replaced with an open building where residents who wish to can smoke in safety. The front garden looked very tidy with some plants being provided by a visitor. The back garden was very untidy and although not used by the residents needs to be dealt with The food requirements that arose from the Environmental Health Officer’s visit have still not been complied with. The requirement made at the last inspection is therefore not considered met. Bungay House DS0000067514.V337758.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement is made using available evidence and a visit to this service. Staff are unable to meet service user’s needs. Additional training has equipped the staff with the necessary skills to meet the service users needs. EVIDENCE: Discussion with the manager, staff and examination of duty rosters led the Inspector to believe that the provider continues to operate close to minimum staffing levels. This does not allow for the dependency levels of the service users to be taken into consideration or their need for social and physical stimulation. The manager constantly spends time working shift duties as a carer. This does not enable her to perfect her role as manager and make improvements in record keeping, care planning and other managerial duties. It was also noted by the Inspector that the manager does not possess a job description. The carers are expected to carry out a number of domestic duties as well as performing their caring duties. Bungay House DS0000067514.V337758.R01.S.doc Version 5.2 Page 20 The duty rosters show that staffing levels fall below the Residential Forum which is considered appropriate by the Commission. The requirement made at the last inspection is therefore not considered met. Although the provider insists that he carries out some of the administration work in the home the manager disputes this. The Environmental Health Officers report was missing from the file and it would appear that the provider has taken it away. As other paperwork was also seemingly missing, this situation makes it very difficult for the manager to totally fulfil her role. The manager is quite often involved with activities outside the home as highlighted earlier in this report and therefore is unable to carry out the management duties. Staffing records were seen and discussion with the staff and the manager confirmed that training is good and that the staff have received training in many of the areas applicable to the service users under their care. The manager was unable to present any evidence that the overseas staff had obtained or were in receipt of NVQ level two and therefore the standard for 50 of staff to be qualified cannot once again be verified. The records for the induction of new staff are scant and do not appear to be in line with the Common Induction Standards. Bungay House DS0000067514.V337758.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Although the manager has a good understanding of her role she still is not fulfilling the role satisfactorily. Repeated requirements in relation to infection control once more puts the staff and residents at risk. EVIDENCE: The manager states that she has NVQ level 4, however no documents were available to support this; she did say that she was about to start the RMA. Bungay House DS0000067514.V337758.R01.S.doc Version 5.2 Page 22 Although reports have been received from the provider’s visits they are still uninformative and do not entirely meet with the regulations The water system has now been examined for legionella by an expert. The manager believes that she has very little time to monitor the quality of the services offered by the home and no system is in place to do this. The manager participates actively in many of the care shifts and does not spend sufficient time on her duties as a manager and in particular implement changes that are necessary to meet the Care Home Regulations. These duties include supervision of staff, record keeping, developing systems for monitoring the quality of care and maintaining care plans and ensuring that these are reviewed on a regular basis. According to the owner of Bungay House, the manager has twenty-four hours allocated each week to carry out her management tasks. Providing these hours are not encroached upon to cover, for example, staff absences, there should be evidence of improved record keeping. Bungay House DS0000067514.V337758.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 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 1 14 1 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 1 1 x x x 1 1 2 STAFFING Standard No Score 27 1 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 1 x x 2 2 2 Bungay House DS0000067514.V337758.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 Regulation 15 Requirement Outstanding requirement for more than four inspections The registered persons must review the content of all care plans on at least a monthly basis, or more frequently when needs change Outstanding requirement for last two inspections The registered persons must ensure that the care plans for each resident clearly set out a full range of needs in all areas of personal, health and social care. Outstanding requirement The registered persons must act upon the most recent environmental health officer’s report. Outstanding requirement The registered persons must review laundry arrangement with advice regarding infection control from an appropriate source. Arrangements must be adequate to control the spread of infection DS0000067514.V337758.R01.S.doc Timescale for action 12/04/07 2. OP7 14, 15 12/04/07 3. OP19 OP38 16.2.j &`23.5 12/04/07 4. OP26 13.3 12/04/07 Bungay House Version 5.2 Page 25 in the home. 5. OP27 12, 18 Outstanding requirement The registered persons must review staffing levels and ancillary staffing levels to ensure these are adequate to meet the needs of increasingly dependent residents. Levels must be adequate to allow the manager to fulfil the full range of her responsibilities. All areas of the home must be free from sources of infection to ensure the safety of those working and living at the home. When medication is being administered to people who use the service it must be clearly recorded. This will ensure correct levels of medication are being given. Medicine received into the home must be recorded so that audit trails may be carried out. All staff must receive regular formal supervision. The home must instigate a system for monitoring the quality of the services it provides to ensure that the home is run in the best interests of it residents 12/04/07 6. OP19 23 13 27/05/07 7. OP9 13.2 27/05/07 8. 9. 10. OP9 OP36 OP33 13 (2) 18 24 (1) 27/05/07 27/08/07 27/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Bungay House DS0000067514.V337758.R01.S.doc Version 5.2 Page 26 1. OP3 The manager must ensure that she keeps good informative assessment records using a formal approach. Consideration must be given to the use of paper towels and liquid soap in all communal wash facilities, this will aid the control of infection. It is considered best practice to use pedal bins for disposing of all clinical waste, thus reducing the spread of infection. 2. OP19 3. OP19 Bungay House DS0000067514.V337758.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Bungay House DS0000067514.V337758.R01.S.doc Version 5.2 Page 28 - 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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