Inspection on 23/06/05 for Burnt Ash Hill, 94

This inspection was carried out on 23rd June 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Burnt Ash Hill, 94 28/02/07

Burnt Ash Hill, 94 19/01/06

Burnt Ash Hill, 94 31/03/05

Burnt Ash Hill, 94 14/06/04

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Edenvale

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Chatsworth Care - Dawson House

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Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 94 Burnt Ash Hill London SE12 0HT Lead Inspector Rossella Volpi Unannounced 23 June, 2005 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 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 Stationary 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. 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service 94 Burnt Ash Hill Address London SE12 0HT Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8851 3824 Aurora Charity Mrs Comfort Amoateng CRH care home PC care home only 6 Category(ies) of LD learning disability registration, with number PD physical disabiilty of places 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: This home is registered for 6 people with a learning disability of whom 2 are over 65 years Date of last inspection 31 March, 2005 Brief Description of the Service: Burnt Ash Hill offers a care home to a maximum of six women and men with learning disabilities, who might also have other support needs. The overall aim is that of providing a service driven by the needs, abilities and aspirations of the service users. The home declares its core values to be: individual approaches, equal opportunities, inclusion and shared values. Burnt Ash Hill aims to achieve this by basing the service on a thorough assessment of needs, delivered in collaboration with external agencies. Staff would seek to advance the rights to privacy, dignity, independence, security, civil rights, choice and fulfilment in all aspects of their work and of the environment. The provider is an organisation named: ‘The Aurora Charity’, which also runs other homes. A chief executive and a service manager, to whom all the staff are ultimately accountable, direct the service. The day-to-day running of the home is delegated to a care manager. The registered care manager is now on extended leave and an acting manager has been appointed. The premises are a large house, adapted to meet the needs of the residents group. All residents have their own bedroom. The ground floor is fully accessible to people using wheelchairs. The area is residential; it is served by public transport and has a selection of local shops. 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and consisted of one visit conducted on 23 June 2005, during the afternoon. The findings were informed by general observations, discussion with all the residents, discussion with the members of staff present, a tour of the premises conducted by two residents and inspection of records. Not all core standards were inspected on this occasion, but it is intended that, during the course of the inspection year (April 2005 to March 2006) all core standards would be inspected. What the service does well: What has improved since the last inspection? What they could do better: 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 6 While the home strived to provide same gender care, this was not always possible. The staffing levels were such that, at times, only one member of staff was on duty. When the carer on duty was a man, he might be required to support a woman with intimate care. The provider needed to carefully consider this arrangement in relation to their policy on safer working practices. The provider needed to carefully assess again staffing levels (or the way staff were deployed) to ensure that residents would consistently benefit from personal support when they needed it. There were times, such as some evening or some bank holidays or weekend days, when only one member of staff would be on duty, although all the residents were at home. This impinged on the activities and support that could be provided. The garden furniture was not adequate to ensure both comfort and protection from the sun. One of the residents’ rooms was too hot and needed to be better ventilated; however the staff on duty said that she would rectify that immediately. 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. 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The home was committed to a full assessment of residents’ needs and aspirations. This would therefore enable appropriate care and support, to meet residents’ individual needs. EVIDENCE: No new resident had come to live at the home since 1998. The policy of the organisation in relation to any future admissions was that prospective residents would need to receive a full assessment, by the appropriate professionals. Only then the home would confirm the offer of a place, if the home could meet the identified needs and aspirations. All residents had a care plan. 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 Residents participated in the day-to-day running of the home. They were supported in making both major decisions and everyday choices and guided into responsible risk taking. Therefore, they had the opportunity to take control of their lives and their environment. EVIDENCE: Discussion with the residents (both in a group and individually) and with staff showed that residents made decisions about their lives. Residents spoke of the means used to elicit their views and to inform management decisions. These included house meetings, consultation on a day-to-day basis, involvement in their own reviews and in the development of the service users’ guide or other documents. An independent advocate helped in the carrying out of annual surveys. Residents stated that staff supported and guided them with clear information and discussion of possible consequences of different course of actions. 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 10 A discussion with a senior carer was held during the inspection regarding risk taking. The home gave due emphasis to responsible risk taking, recognising it as essential to a fulfilling life. The staff team would carefully consider with each resident the risks identified and the strategies to minimise them. The carer confirmed that no resident was ever left in the home without staff in attendance and that senior management had given clear instructions regarding this, following the issues raised at the two previous inspections. A CSCI’s concern, which remained regarding the deployment of staff, is discussed below under the sections on lifestyle and personal support). 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 15, 16, 17 Residents were supported in maintaining independence, family links and relationships. Staff endeavoured to ensure that residents could enjoy healthy meals, had opportunities for education and training, work, leisure activities and had a real say about the running of the home. This enabled residents to achieve a fulfilling lifestyle, but staffing issues would impinge on this if not resolved. EVIDENCE: Residents spoke of the range of activities they pursued in the local community and expressed satisfaction with the support and information they received. They discussed their jobs and education classes with pride. Staff confirmed that the home arranged a variety of outings and that these, including the cost of lunch, would be funded by the provider both for residents and the staff accompanying them. Residents said that contacts with friends and family were facilitated. They also said that staff or other professionals advised them regarding the intimate personal relationships that they developed with adults of their choice. 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 12 Residents said that they were treated with respect and their privacy was upheld. They took responsibility, usually with support, for cooking and other household tasks of their choice. Two of the residents spoke about the menus, which they found satisfactory. The home had advised the residents of the recent food scares; the residents had then changed the arrangements for meals to include more home cooking, to ensure healthier ingredients. On the day of inspection, the evening meal started as a relaxed and calm period with most of the residents and the carer on duty sitting and eating together and discussing various matters. This was disrupted, however, when the carer had to leave the table to attend to another resident who got distressed in the garden. To properly support all residents there should have been a minimum of two members of staff. Furthermore, so as not to leave the residents at the table unsupported for too long, the carer could not spend enough time with the distressed resident in the garden. Discussion with staff and residents indicated that this was not an isolated incident. The inspection of staff rotas showed that there were several occasions when only one member of staff would be on duty, even though most of the residents were present. There had been weekend days when residents who could not go out unaccompanied had to stay at home, because there was only one member of staff on duty. Both residents and staff considered that a minimum of two staff should be at the home at busy times, such as the late afternoon / evening, between 8 and 9-30 in the morning and at weekends, when most of the residents are not away. Comparison of staff rotas with the logbook demonstrated that this was not consistently achieved. These issues are even more directly relevant to the areas discussed below, relating to personal support and safer working practices. However, if not resolved, they could affect the positive outcomes in this area of the service also and could negatively affect the scoring of the standards inspected. This is because appropriate staffing levels underpin the capability of a service to support residents in maintaining a fulfilling life and the quality of every-day experiences. On this occasion, the related standards in this area continue to be assessed as met, with the exception of the one on meals and mealtimes, which is assessed as almost met, because of the disruption. 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19, 20 Health care needs were assessed, recognised and acted upon to ensure residents’ well-being. The way intimate care was delivered at times was not always consistent with safer working practices’ principles. EVIDENCE: Residents considered that their health needs were met. The care plans and discussion with staff demonstrated appropriate liaison with health care professionals, including the GP, optician, chiropodist and therapists such as occupational and speech and language. A clear record of medications was kept and the two residents, with whom their files were inspected, confirmed that they received them as stated on the record. From direct observation and from what residents said, residents were treated with respect and staff were attentive, subject to enough staff being available. However the issues discussed above, regarding staffing levels, are also relevant to the area of personal support. Furthermore, at the inspection of June 2004, it was raised that while the home strived to provide same gender care, this was not always possible. The staffing levels were such that, at times, only one member of staff was on duty. When the carer on duty was a man, he might be required to support a woman, with intimate care. The provider was required to carefully consider this arrangement in relation to their policy on 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 14 safer working practices. This would be not only for the protection of residents, but also to protect staff from false allegations. The findings of this inspection, based on discussion with staff and residents and inspection of rotas, demonstrated that the above situation had continued. It was also of concern that this was in contrast with the assurances received at the last inspection. That was an unannounced visit conducted in March 2005. At the time there was only one man (staff member) on duty at the home. Two residents were present, both being women and one of whom requiring, at times, help with intimate care. The home said at the time that the staffing and residents mix found on that day was a rare occurrence, as management had acted on the concerns raised by the Commission. This will now be followed up with management. The previous requirement (amended) is repeated. It is debatable whether standard 18, which is not met, should continue to be given a score of 2 (minor shortfall) or of 1 (major shortfall). It was not clear from the discussion with staff or from inspection of records, what the assessment of management had been in relation to the issues discussed above and of previous requirements. A score of 2 has been given, because of the assurances of the senior member of staff on the day. The member of staff assured that she would relate the concerns immediately to the manager and change the rotas. Obviously that would only be a short-term solution, pending a thorough management review of the staffing levels against each resident’s needs, behaviour, actions, aspirations and the ethos of the home. 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Residents felt safe at the home and able to speak to staff or external people. This made them confident that their views would be considered, any concern acted upon and that the staff team took seriously their responsibilities in preventing abuse, neglect and self-harm. EVIDENCE: Residents said that they felt safe at the home and that they would be able to raise issues of concern with staff, external management, other professionals or their families or friends. The home had recently drafted a new adult protection procedure to ensure that staff at the home would be clear of the actions expected in case of allegations or suspicion of abuse and their roles and responsibilities. Elsewhere in this report concerns are raised regarding how staffing issues affected the support to residents. The senior member of staff, with whom this was discussed, assured that residents’ safety was not compromised, because of the degree of independence of some of the residents, the expertise of staff and the back up systems put in place by management. 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25, 26, 27, 28, 30 The home offered single, comfortable bedrooms and shared facilities, which were well maintained, clean and personalised. Attempts had been made to embellish the environment so as to create a homely feel for the residents. Garden furniture was not adequate to ensure both comfort and protection from the sun. EVIDENCE: The two residents who conducted the tour of the house were satisfied with the premises and all residents confirmed that, most of the time, they found them comfortable and meeting their needs. One resident said that her room was very hot that day. She showed how the window could not be opened enough to enable a sufficient breeze and there was no electric fan to move the air. The carer on duty at the time took immediate action to resolve this. Another resident pointed out that there was a lack of garden furniture and of sun umbrellas and, because of the lack of shade, his skin had become affected by the sun that day. The carer said that the concerns would be related to senior management to be rectified in the following couple of days. 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 17 The home had re-located, during the previous two years. The premises had been adapted to meet the changing needs of the residents. The ground floor was accessible to people using wheelchairs and all bedrooms were single. The premises were clean, the bedrooms were personalised. Four of the bedrooms had en suite facilities and the two ground floor bedrooms shared an adapted bathroom with an assisted bath. The home had a laundry room, which housed washing machines with programming facilities to meet disinfection standards. The home had an infection control policy. Residents and staff said that they had received information or training about safety and food hygiene. 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 18 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 35 Residents benefited from a staff team who was clear about their roles and responsibilities and who received regular training. This would enable staff to appropriately support the residents’ group, subject to adequate staffing levels being maintained. It was not evident that staffing levels consistently supported residents’ personal needs. EVIDENCE: Discussion with the senior staff on duty confirmed that she had received a job description and was clear about her responsibilities. This was also consistent with what other staff had said previously. The organisation had taken steps to ensure that at least 50 of care staff in the home would achieve a care national vocational qualification (NVQ 2 or 3) by the end of 2005. The record of the mandatory and other training was not available on the day. However the staff member confirmed that a range of appropriate training had been made available to her and her colleagues, including a set of training on specific topics that had been identified as mandatory by the provider for all care staff. This related to safety and welfare of staff and residents. The concerns regarding staffing levels, on occasions, in relation to individual support and safer working practices, have been discussed above in the report. 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 19 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 42 The health and safety of residents and staff was ensured, as far as it was reasonably practicable. EVIDENCE: The home had a policy on health and safety. Regular risk assessments, (including fire), were conducted. The member of staff interviewed said that she had attended mandatory health and safety training, which included moving and handling and fire safety. Fire drills were conducted. Fire extinguishers were checked annually by an external contractor (last check having been in May 2005). The gas and electrical installation had been checked by an appropriate contractor when the home opened in October 2003 and there was a follow up gas safety record in November 2005. The fire prevention officer had visited the home, during the previous year and made some recommendations, which, the provider had said, had been acted upon. 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 20 Some other issues and requirements regarding safer working practices in relation to care and staffing are discussed in the report under the more directly relevant areas. 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 21 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 2 x 3 Standard No 11 12 13 14 15 16 17 x 2 3 x 3 3 2 Standard No 31 32 33 34 35 36 Score 3 x 2 x 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 94 Burnt Ash Hill Score 2 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 22 yes 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 17 Regulation 18 (a) Requirement The registered provider must ensure that residents receive adequate support so that they can enjoy relaxed and unrushed mealtimes. The registered provider must: - Conduct a thorough review of the staffing levels against each resident’s needs, behaviour, actions, aspirations and the ethos of the home. - Prepare a statement of what they consider minimum suitable staffing levels. - Ensure that at all times suitably skilled staff are working at the home in such numbers as are appropriate for the health, welfare and support needs of residents. - Ensure that staffing levels are consistent with an assessment of safer working practices for residents and staff. (Part of this requirement was imposed before. The previous timescale of 1 June 2005 was not met) The registered provider must ensure that garden furniture is Timescale for action 1 September 2005 1 November 2005 2. 18 and 33 18 (a) 12 (1) (a) (b) 3. 28 23 (2) 1 August 2005 Page 23 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 adequate to ensure both comfort and protection from the sun. 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 33 Good Practice Recommendations That a minimum of two staff are on duty to support residents at busy times. This would include the late afternoon/evening, when residents are getting ready to go out in the morning and weekend days, (if most residents are not away). 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection 46 Loman Street London SE1 0EH 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 94 Burnt Ash Hill G52-G02 S53308 BurntAshHill V184908 230605 stage 4.doc Version 1.40 Page 25 - 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!