Inspection on 21/02/06 for Cameron House

This inspection was carried out on 21st February 2006.

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

Other inspections for this house

Cameron House 22/05/07

Cameron House 18/07/06

Cameron House 06/07/05

Cameron House 14/02/05

Cameron House 23/08/04

Cameron House 25/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Cameron House Plumleys Pitsea Essex SS13 1NQ Lead Inspector Michelle Love Unannounced Inspection 21st & 22nd February 2006 08:30 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 Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cameron House Address Plumleys Pitsea Essex SS13 1NQ 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) 01268 556060 01268 556161 cameronhouse@ashbourne.co.uk Ashbourne (Eton) Limited Mrs Debbie Skeats Care Home 44 Category(ies) of Old age, not falling within any other category registration, with number (44) of places Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Cameron House provides care and accommodation for forty-four older people, it is not registered for people with dementia. It is a modern, purpose built home comprising of two floors with a passenger lift and stairs access to both floors. There are 42 single and 2 double bedrooms all with ensuite facilities. There is a dining room and separate sitting room on both floors. There is a range of bath and shower facilities and a separate hairdressing room. The home is situated in a residential area and is close to local shops in Basildon town centre. Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced inspection, which was conducted over two days and lasted nineteen hours. During the inspection a tour of the premises was conducted, records and documents relating to individual residents and staff working within the care home were examined. Additionally residents, relatives, care staff and the acting manager were spoken with as part of the inspection process. Discussion of the inspection findings took place with the acting manager and one of the registered providers senior manager’s. The home’s Operations Manager was unavailable at the time of the unannounced inspection. What the service does well: What has improved since the last inspection? Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 6 This was not possible to ascertain, as it was the inspector’s first visit to Cameron House and the newly appointed acting manager’s first inspection. 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. Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Both the Service Users Guide and Statement of Purpose needs to be reviewed to reflect the current provider. The home has a clear process and system for assessing prospective residents before admission. Residents are issued with a contract of residency following admission to the care home. Training records evidence shortfalls relating to mandatory/specialist training for some staff members. EVIDENCE: The home’s Statement of Purpose and Service Users Guide needs to be reviewed to reflect the current provider (Southerncross Healthcare) and not HighClear Homes Ltd. Of three care files inspected for the newest residents, only one pre admission assessment was available. It was unclear as to how the registered provider had made a decision that two prospective resident’s needs could be met without a formal assessment tool being completed. Information from resident’s placing authorities were readily available i.e. Community Care Assessments. No evidence was recorded relating to whether or not residents and/or their Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 9 representatives had visited the home prior to admission or undertaken a trial visit. At the time of the unannounced inspection, staff training records indicated that not all members of care staff have undertaken mandatory training/up to date refresher training and/or specialist training which meets the specific needs of residents and those conditions associated with older people. Following the inspection it was positive to note that the acting manager has speedily sought training for staff pertaining to fire awareness and protection of vulnerable adults/resident welfare. Standard 6 remains not applicable, as Cameron House does not provide intermediate care. Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10 and 11 The care planning processes within the home, were in general terms satisfactory. Resident’s healthcare needs are documented and well met by care staff. Residents feel that they are treated with respect and sensitively by staff. EVIDENCE: On inspection of five individual care plans, these were seen to be detailed and informative. Some inconsistencies were noted whereby certain elements of individual’s plan of care were detailed and comprehensive, whilst other elements lacked detail and clarity i.e. one care plan made reference to the resident experiencing `night tremors`. No information was recorded relating to how care staff provided support to the resident. Another resident’s care plan made reference to them needing to be weighed weekly. No evidence was available to indicate that care staff had followed the care plan. No formal assessments were available pertaining to falls, continence, nutrition and pressure sores. One person’s care plan relating to their mental health status detailed that they could exhibit aggressive/inappropriate behaviours, however information recorded was not specific e.g. specific nature of aggression, possible triggers and guidelines detailing staff’s interventions. Individual’s `life stories` were not completed for all residents. Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 11 One resident’s care plan made reference to them not being able to have grapefruit or grapefruit juice, however no members of staff when spoken to were able to provide evidence as to why this was. It was of concern during the inspection to note that one senior member of care staff failed to gather information from the hospital upon one resident’s return to Cameron House pertaining to new medication prescribed/new assessed care needs. The acting manager had to instruct the senior member of care staff to contact the hospital. Risk assessments were not devised for all areas of assessed risk i.e. one person’s care plan made reference to them being at risk of falling out of bed and having bed rails fitted and experiencing trouble with swallowing. No risk assessments were devised for the safe use of bed rails and the resident’s difficulties with swallowing/poor swallowing reflex. In general, care plans were seen to be reviewed, however for some moving and handling assessments it was unclear as to when these had been reviewed. Daily care records were in most cases written daily and after each shift, however some gaps were noted whereby records were not written after each shift and it was unclear as to how residents had spent their day/night and what staff interventions had been provided. Not all care plans had information recorded relating to resident’s wishes pertaining to funeral/terminal care arrangements. Accident records for residents were generally seen to be satisfactory. Some entries lacked detail and did not include the specific nature of the injury sustained, staff’s interventions or outcomes. The acting manager advised that the home has a very good working relationship with the GP’s and District Nurse team. A District Nurse expressed satisfaction during the inspection with the way in which their care plans and instructions are followed. The District Nurse stated that she is always made to feel welcome and that care staff/senior staff are very knowledgeable regarding existing residents. It was positive to note that no concerns were expressed and staff must be commended for their good care practices. Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 and 14 A range of `in house` and community based activities are provided for residents within the home. Residents are encouraged and empowered to maintain contact with family and friends. Additionally wherever possible residents are encouraged to exercise choice and independence based upon their capabilities. EVIDENCE: The home has an activities co-ordinator contracted for 25 hours per week (Monday to Friday). The number of hours provided is woefully inadequate to meet the numbers and needs of existing residents. The activities co-ordinator advised the inspector that despite being contracted for only 25 hours each week, additional hours are undertaken. Resident interests and hobbies are recorded within their individual plan of care. Activities undertaken are recorded within a folder. The range of activities provided to residents includes: collages and projects for local children’s groups, carpet bowls, dominoes, competitions, netball, card games, tea outings, themed social afternoons, armchair exercises, church and newspapers. In addition to an activities co-ordinator, the home has the services of a volunteer three afternoons each week. The activities co-ordinator is a member of NAPPA and has received specific training relating to activities for older people (November 2005). Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 13 From discussion with resident’s and care staff, routines within the home are flexible. Resident’s discussed that they are given choices relating to the time they get up/go to bed, whether they eat their meal in the main dining room or in their bedroom and whether they participate in activities or not. From observations during both days of inspection and from discussion with individual residents and care staff, it was clearly positive to note that rapport between care staff and residents is very good. Care staff demonstrated a good understanding and awareness of resident’s needs. Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The home has a complaints and adult abuse policy and procedure in place. Staff training has been provided in relation to protection of vulnerable adults procedures. EVIDENCE: The home’s complaints procedure was clearly displayed, however it made reference to the previous registered provider. During the inspection the complaints procedure was reviewed, by the acting manager and a new procedure devised and implemented. Since the last inspection the home has received four complaints. Three of the complaints were dated prior to the acting manager’s appointment to Cameron House. No information relating to the action taken and outcomes following the investigation were available for these three complaints. It was positive to note that the fourth complaint was dealt with appropriately by the acting manager and included the investigation, action taken and outcomes. At the time of the inspection no staff were noted to have protection of vulnerable adults/resident welfare training. It was positive to note that since the inspection the acting manager has attained the above training for staff. Additional training is required relating to how staff deal with those residents who exhibit challenging/inappropriate behaviours. Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 15 The home was observed to have a copy of Essex County Councils protection of vulnerable adults procedures. The home’s existing restraint and prevention of abuse policy was issued November 2000 and reviewed in 2001. The registered provider must ensure that an up to date policy and procedure is provided to Cameron House. Additionally the registered provider must ensure that blank `paperwork` for completion by care staff is readily available. Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Residents live in a homely, safe, well-maintained and safe environment. EVIDENCE: The home was observed to be clean, odour free, safe and well maintained. A random sample of individual resident’s bedrooms, were inspected and these were noted to be personalised and individualised. Of those resident’s spoken with, all were complimentary regarding the décor of the home and of their own individual space. No health and safety issues were highlighted at this inspection. Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Staffing levels within the home appear sufficient to meet the needs of current residents. Staff morale is quite low as a result of recent changes to the registered provider. Some gaps were observed pertaining to recruitment practices within the home. Additional staff training is required for staff in order to meet resident’s specialist needs. EVIDENCE: Four weeks staff rosters were requested however only one staff rota was available as the home’s wages were being collated at another care home and paperwork (rosters) were unavailable for inspection. The acting manager was advised, that this is unacceptable and in the future, photocopies of documentation should be retained by the care home. The acting manager advised the inspector that only one member of agency staff has been utilised in the last five weeks. Current staff vacancies include 3x night care staff to cover maternity leave, 42x care staff hours at weekends and 1x 18 hours for domestic cover. Since the last inspection, seven new members of staff have been recruited to Cameron House. Not all records as required by regulation were available and gaps were observed relating to no photographs for some members of staff, references not always from the last employer, no evidence of a Criminal Record Bureau check, no contract of employment, no job description, no health declaration for one member of staff and no proof of ID for one member of staff. It was unclear as to whether or not a Criminal Record Bureau check had been undertaken for the home’s volunteer. Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 18 Induction records evidenced that only some employees received a `basic orientation induction` on one day and completed training relating to food hygiene, health and hygiene, manual handling and fire awareness over one/two days. Training records for one member of staff indicated that their knowledge of fire awareness was very poor and limited despite having received training. Not all new employees had received mandatory training (fire awareness, first aid, infection control, protection of vulnerable adults, health and safety and food hygiene) and there was limited information to evidence specialist training undertaken. It was of concern to note that one senior member of staff who administers medication to residents, had no evidence on their training file to indicate that they had current medication training. A regulation 37 notification had been forwarded to the Commission for Social Care Inspection (dated September 2005), detailing that the senior member of staff in question had administered the wrong medication to a resident. No information was noted on their employment file to indicate that they were `shadowed` by a senior member of staff following the error or that they received additional training. On inspection of this person’s employment file, it was noted that there were discrepancies pertaining to their application form/dates actually employed/dates of references received and they received an induction from the then registered manager who was a relative. Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,34, 35, 36, 37 and 38 Although the acting manager is new in post, she appears committed and keen to ensure that Cameron House is run in line with Regulatory Requirements and National Minimum Standards for Older People. Resident’s monies have not been safeguarded and the home’s accounting procedures have been very poor. Staff supervision systems have been implemented. EVIDENCE: The acting manager has worked previously for another local corporate provider and has many years experience working with older people. The acting manager has attained NVQ Level 3 and has enrolled on the Registered Managers Award. The inspection highlighted that the acting manager is very keen and committed to ensuring that Cameron House meets regulatory requirements and recommendations in line with the Care Homes Regulations and National Minimum Standards for Older People. Staff equally showed a willingness to ensure that good practice is ensued at the care home and that residents receive the best care. Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 20 It was of major concern to find discrepancies and poor accounting procedures relating to individual resident’s monies. The inspector was advised that issues had been found pertaining to the home’s previous administrator and that following poor accounting procedures the company’s senior administrator had been requested to undertake an audit. The inspector found that the audit was of poor quality and discrepancies in the audit itself were evidenced. As a result of the above findings an Immediate Requirement Notice was issued whereby the registered provider was requested to undertake another audit (checking receipts against individual resident’s accounts), the senior administrator to forward her finance audit to the Commission, an action plan by the registered provider as to how risks to be minimised for the future to be devised and training to be provided to the home’s new administrator. An action plan by the registered provider was submitted and received at the Commission on 2nd March 2006. Since the appointment of a new acting manager, staff supervision sessions have been implemented. A number of records as required by regulation were inspected pertaining to the following: The home’s electrical safety installation certificate was seen as satisfactory. The gas safety certificate was out of date, however the acting manager and maintenance person advised that works are to be completed. A copy of the certificate to be forwarded to the Commission within 21 days. The record of fire drills evidenced that staff are currently receiving weekly practices. The passenger lift was last serviced 16.12.2005. Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 21 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 2 3 2 1 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X 3 1 3 3 3 Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 6(a) Requirement The registered person must revise and keep under review the Statement of Purpose and Service Users Guide. The registered person must ensure that all prospective residents are assessed prior to admission. The registered person must ensure that all staff receives training appropriate to the work they perform and the needs of residents. The registered person must ensure that detailed and comprehensive care plans are devised for all residents. The registered person must devise risk assessments for all areas of identified risk. The registered person must ensure that resident’s wishes are taken into account relating to funeral arrangements and terminal care and recorded. The registered person must ensure that sufficient staff hours are provided for residents to access a comprehensive activity DS0000018044.V286612.R01.S.doc Timescale for action 01/05/06 2. OP3 14 01/04/06 3. OP4 18(1)(c) (i) 01/08/06 4. OP7 15(1) 01/06/06 5. 6. OP7 OP11 13(4)(c) 12(2) 01/05/06 01/06/06 7. OP12 18(1)(a) 01/05/06 Cameron House Version 5.1 Page 23 8. OP16 22 9. OP18 13(6) 10. OP18 13(6) 11. 12. OP27 OP29 17(2),Sch 4(7) 17(2)&19, Sch 2 & 4 13. OP35 17(2),Sch 4(9) programme. The registered person must ensure that a record is kept of all complaints, the details of the investigation, actions taken and outcomes. The Registered Person must ensure that the homes policy on the protection of vulnerable adults is reviewed and up to date. (Previous timescale of 25/08/05 not met) The registered person must provide training to staff relating to dealing with resident’s aggression/inappropriate behaviours. The Registered Person must ensure a staff roster is available for inspection at all times. The registered person must ensure that all records as required by regulation are sought and available for inspection. The registered person must ensure that robust systems are in place for the accounting and safe keeping, of resident’s individual monies. 01/04/06 01/06/06 01/08/06 01/04/06 01/04/06 01/04/06 Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP5 OP7 OP7 OP8 OP31 OP38 Good Practice Recommendations Ensure that residents and/or their representatives are offered a trial visit and that this is recorded within individual care plans. Ensure that all elements of the care plan are reviewed. Ensure that daily care records are written daily and after every shift. Ensure that resident’s accident records are detailed and include information relating to the nature of the injury sustained, treatment provided and outcomes. The manager should attain NVQ Level 4. Provide the Commission for Social Care Inspection with a copy of the home’s gas safety certificate. Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Cameron House DS0000018044.V286612.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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