CARE HOME ADULTS 18-65
Bunyan Lodge 66/68 Kimbolton Road Bedford Bedfordshire MK40 2NZ Lead Inspector
Katrina Derbyshire Unannounced Inspection 4th June 2007 13:05 Bunyan Lodge DS0000014994.V334616.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 Bunyan Lodge DS0000014994.V334616.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. Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Bunyan Lodge Address 66/68 Kimbolton Road Bedford Bedfordshire MK40 2NZ 01234 346146 01234 342557 HQ 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) Apex Care Homes Limited Mrs Marilyn Dorling Care Home 15 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (15), Mental Disorder, excluding of places learning disability or dementia - over 65 years of age (15) Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 4th December 2006 Brief Description of the Service: Apex Care Homes LTD owns Bunyan Lodge residential care home. The home provides care to fifteen people with mental health needs. The accommodation consists of two Victorian semi-detached houses, dining room, office and a kitchen. The basement has a games room, laundry, and storeroom. The home has fifteen single rooms, which are located on the first and second floors, with shaft lift access. The home has a smoking room for people living there who wish to smoke. The rear of the house has an attractive garden and a patio area. The front of the house has a small driveway with limited parking facilities. The home is situated in a residential area close to the town centre with its amenities and good bus and train services. The manager at the home provided the following information on charges on 4th June 2007. The fees for this home vary from £578.31 per week, to £650.00 per week, depending on the funding source and assessed need of the person. Additional charges are made for hairdressing, barber services, holidays, toiletries and newspapers. Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This visit was to undertake a key inspection. This unannounced inspection was carried out on 4th June 2007. During the inspection several areas of the home were visited and the inspector spent time with some of the people who live at the home in the communal areas. The care of three people was examined by looking at their records and interviewing them and staff who look after them, alongside speaking with other people that live at the home. Information from the home, through written evidence in the form of a Annual Quality Assurance Assessment has also been used to assess the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit. Observations of care practice and communication between the people living at the home and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well:
When a person feels they may wish to move into the home, staff carry out an assessment of their needs. This information is then used by the manager at the home to see if staff have the skills and experience to provide care for that person. The assessment for someone who had recently moved into the home was of a good standard. The staff member had made sure that they had found out about their individual needs including what they liked to eat and what time they liked to get up in the morning. This means staff at the home have very clear information to make a decision on whether they will be able to meet that persons needs. The way that the staff at the home support people living at the home to access healthcare is good. Each person has a health plan, this is where an assessment of their health care needs has been done and Doctors and Nurses have been involved. Where a need has been identified the staff have supported the people to then have those needs met. This means that people benefit from the specialist support available to improve their level of health. When staff are recruited to care homes there are safety checks that need to be done, this helps to protect the people living at the home. Management must make sure for example, that they receive at least two references and carry out
Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 6 a check known as a Criminal Records Bureau check, this helps them to decide if the person is going to be suitable to work with people who perhaps live in a care home. This had been done, all staff before being allowed to work had these checks made about them. What has improved since the last inspection? What they could do better:
The owner had made praiseworthy efforts to look at ways to change practices to make things better for the people living at the home, through spending a lot of time speaking with them and arranging for specialists to visit and show how things could improve for example. However there is still a need to constantly
Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 7 look at practices in the home and further changes are still needed. When we visited people were queuing outside a medical room before their evening meal to receive their medication. This should not happen, people must be offered medication individually. People must not receive care and support in a collective way, this must always be carried out according to the individual needs of the person. Documents known as care plans used to show staff how they should support people had been re written since the last inspection. They were greatly improved and gave better guidance to staff, however further development is still needed. The manager and staff must make sure that there is a plan in place for each assessed need to make sure that people receive continuity of care. 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. Bunyan Lodge DS0000014994.V334616.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 Bunyan Lodge DS0000014994.V334616.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): 1&2 People who use this service experience Good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Admissions to the home continue to be planned and give sufficient information for people to make an informed choice. EVIDENCE: Examination of care records was undertaken. As previously assessed of those files seen two people had lived at the home for several years therefore their assessment information was not able to be fully assessed. However the third care record examined was of someone recently admitted to the home. The assessment information in place was noted to provide sufficient information, to ascertain if the home would be able to meet the their needs. The individual likes and dislikes of the person had been detailed alongside the history of the person and the reason for their admission. In addition supplementary information was also seen, this had been provided by the placing authority and showed the assessment of needs as carried out by the relevant Social services Department. A copy of the homes statement of purpose was examined. Information within the document included the qualifications and experience of the manager, peoples rights including the provision of a lockable facility in the home, how to
Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 10 make a complaint and the services that the home would provide. This document was seen to be available in the home with access for the people living there and staff. Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 11 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 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Opportunities for people to make decisions about their lives have improved and make people feel in control of their own lives. EVIDENCE: Care plans were detailed and written on individual sheets for most of the assessed needs of each person. One person for example needed assistance in relation to the management of their epilepsy. This was detailed within their plan of care. Guidance to staff showed what they should do and the support that they should offer this person concerning their daily life, accessing medical assistance and providing emotional support. Through discussion with staff they showed a good level of knowledge of the content of the care plans, demonstrating that these documents were used by the staff team to ensure consistency in the care offered. However for one person who needed assistance with the management of their diabetes and support in maintaining
Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 12 personal relationships with their family, there was no plan in place to advise staff how they should provide support with this. Risks to people were discussed as part of their care planning review and these had been undertaken within the past 6 months; these documents showed that the person, staff and a representative were given the opportunity to review the care services at the home and for the person to be involved in planning their care. If it had been identified that the person needed encouragement and support with independence this was documented. People living at the home through discussion confirmed that they liked there and felt their privacy was respected. One person spoke of recent changes and said “we get asked about things more”. Management had sought the services of an advocacy group for those people who did not have any other representation. In addition literature was seen to be on display throughout the home entitled ‘Your Say’. This sought representatives for the people living there to be part of running the home whilst speaking up for the other people living there. Other documents were seen to have been revised, assessments now being written in a way that was more respectful to the person. It was also noted that changes had taken place so the freedom of movement for people was no longer restricted. The keypad entry system was not in use, only at night for security purposes. Changes were also acknowledged of the attempts that had been made to provide a more person centred approach. Entries previously used including encourage top follow the daily routines had stopped. New people moving into the home were not encouraged to join the evening walk. Documents that described varying activities undertaken were seen. The activity had been described and it gave clear guidance on the required support needed for each person, so that any risk associated with that activity would be reduced. Risk assessments were also in place on individual files relating to fire safety associated with smoking, and the physical support required by the person. Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 13 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 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People living at the home have a good level of access to local facilities so benefit from being part of the community and having their social needs met. EVIDENCE: Previous practices called “institutional practices” by a professional at the last inspection had virtually all ceased. The inspector did observe at this visit people queuing however for their medication, this was discussed with the owner and manager at that time and a requirement has been made. As previously reported photographic evidence was seen on display boards in the home to show that people had been on an annual holiday in the summer to the Isle of Wight. Documents were seen and people confirmed that they
Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 14 attended varying day care resources in which they had opportunities to participate in educational and social activities. People through discussion confirmed that they feel that the staff have developed good links with the local community on their behalf. Documentary evidence was seen that showed people used local community facilities including, shops, parks, pictures and pubs. People living at the home had a good level of knowledge of the resources available to them including advocacy support and transport links. Several people spoke of personal relationships that they were able to maintain whilst living in the home. They spoke of the importance of these relationships to their overall feeling of well being, and confirmed that the staff at the home supported them in maintaining them. Other people through discussion also spoke of the staff assisting them in keeping contact with family and friends if they wanted to. The practice of where everyone had to sign and collect their post from the office had ceased. It was also noted that the way minutes were written following meetings held with people living at the home were now written in a supportive manner. The owner of the home was seeking to establish a representative group and had named this ‘Your say’. Posters and flyers had been produced to advertise this to ensure people living at the home were involved with the running of it. A choice of meals was available, and menus are displayed within the home. All people said that they enjoyed the meals in the home. People also confirmed that they were able to make themselves drinks and snacks and now had a greater access to the kitchen area. Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 15 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. This judgement has been made using available evidence including a visit to this service. The support available to people in gaining access to healthcare is good with people living at the home benefiting from specialist medical advice and attention. EVIDENCE: Records from the local PCT were in place to demonstrate that people had attended medical appointments, for example an eye test. Staff confirmed that they would support people at the home to access any medical treatment that they needed and would escort them if needed. Medication was noted to be locked in a safe storage facility. Records of medication ordered, received and administered were clear and gave sufficient information to carry out an audit. Training records and staff confirmed that they had received training in the safe administration of medication. People living at the home said that staff helped them if they needed it. Care documents gave clear guidance in how staff should provide the individual
Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 16 personal care support, and it described that they must uphold the privacy and dignity of the people at the home. Permission to enter a room was seen to be sought at this inspection by staff, only when permission was granted did they enter the personal space of the people at the home. As previously reported people spoken with again confirmed that they chose their own clothes and would go into town to the shops when they needed new items; receipts to support this were seen. Everyone’s personal appearance was seen to be clean and their clothing individual. The practice of people having their nails cut on a Sunday and cleaning their shoes together had now ceased. Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 17 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. This judgement has been made using available evidence including a visit to this service. The complaints policy is clear so people at the home know how to make a complaint and that they will be responded to. EVIDENCE: The complaints procedure gave simple guidance in how people could raise a concern. Feedback from people living at the home indicated that they would feel confident in raising a concern or complaint and to whom they could complain to. A concern rose initially to the Commission for Social Care Inspection since the last inspection had been responded to by the owner of the home. Feedback from the complainant confirmed that they found her response to be receptive and professional. A copy of the local guidance in Safeguarding adults was noted to be in place alongside a procedure on abuse. This described the types of abuse and what staff must do if they suspect any abuse of someone living at the home. Training records and staff through discussion confirmed that they had received training in this area. As reported at the previous inspection four referrals had been made under the local Protection of Vulnerable Adults concerning the home prior to that time. The co ordination of these referrals have now concluded, recommendations for changes in care practice had been carried out by the manager and staff at the home. A joint decision between Health and Social services, that no placements
Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 18 would be made at the home until the conclusion of their investigation had been lifted. Acknowledgement is given to the owner that during this time she informed all other placing authorities of the ceasing of placements and reasons why, this demonstrated an honesty that is commendable. Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 19 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 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The standard of décor, furnishings and fittings in this home are very good creating a pleasant and homely environment for people to live in. EVIDENCE: The accommodation was provided over three floors and accessed via a passenger lift. The location and layout of the home was noted to be suitable for its purpose. Furnishings and fittings were domestic and of a very good standard. The communal areas in the home were clean and tidy and residents rooms contained personal items, which reflected their individual personalities. The communal areas of the home were clean and free from offensive odours at the time of inspection as were individual rooms seen by the inspector. Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 20 Policies were in place regarding infection control and staff were seen to be using protective clothing. Hand washing facilities were sited in the areas where waste was being handled. Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 21 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 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The systems in place for the recruitment of staff and vetting of prospective employees are robust and of a good standard and protect people. EVIDENCE: As previously reported staff training records still show that staff at the home had undertaken all mandatory training including fire safety and moving and handling. The records supplied by the home also show all staff had attended courses in understanding mental health needs. Guidance from specialists employed by the company on a consultancy basis had also been followed by staff. Staff files examined on this visit contained the information listed in schedule 2 and 4. The home had obtained in all circumstances all matters in relation to this standard. Criminal Record Bureau checks had been received prior to the employment of an employee. Staff confirmed that they had been issued copies of the codes of conduct and practices set by the General Social Care Council. All further recruitment checks had also been undertaken.
Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 22 Observation undertaken on the inspection showed staff to support people in a supportive manner. Staff gave a full explanation to any action that they were taking and engaged in conversation with the people at the home throughout the visit. On interviewing one staff member they demonstrated a good understanding of the needs of the people at the home relating to their cultural, physical, social and emotional needs. People at the home several times said that they liked the staff and described them as “alright”. Observation of interaction between staff and people living at the home showed that a good amount of conversation took place between them. Staff spoken with confirmed that many changes had taken place, they felt that people were seen and treated as individuals and that staff meetings held now concentrated on improving the standards of care. Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 23 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, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and safety systems are sufficient to provide an environment for people at the home, which reduce the risks associated with this area. EVIDENCE: Written information submitted by the home show that the Registered manager has held her position at the home for almost 14 years. The manager is a qualified general and mental health nurse and completed her Registered Managers award in 2003. Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 24 A requirement was made at the previous inspection that the owners of the home in conjunction with the manager embark upon further training to ensure that care delivery in the home was based on current best practice. The inspector was advised that the manager is to attend further training in the year. However with the efforts made and literature sought and consultancy used the practices in the home have changed enormously since December 2006. The manager through discussion demonstrated that she now endeavoured to ensure people took risks and were given a choice in their daily lives. The home carries out consultation with the people in different forms. More formal methods such as residents meetings had taken place and minutes were available for inspection. In addition questionnaires had been given to all residents to feedback to the home how they felt about living there. Analysis of this information had also been undertaken, evidence of this was seen. As previously assessed Health and safety systems at the home were seen to be carried out in accordance with the guidance within the homes policy. The most recent fire and environmental health inspection reports show that the home had met the standards in these areas. In addition cleaning products were seen to be locked away, risk assessments had been undertaken for areas and activities in the home. Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 25 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 3 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 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 26 NO 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 YA6 Regulation 12 & 15 Requirement Care plans must be in place for all assessed needs so staff know the support that needs to be provided to meet the needs of the people living at the home. Timescale for action 31/08/07 2. YA16 12 & 13 The practice of people queuing 31/07/07 for medication at teatime must cease so people are treated in a person centred approach to meet their individual needs. 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 Bunyan Lodge DS0000014994.V334616.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Bedfordshire & Luton Area Office Clifton House 4a Goldington Road Bedford MK40 3NF 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 Bunyan Lodge DS0000014994.V334616.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. 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!
