Inspection on 10/05/06 for Carleton House

This inspection was carried out on 10th May 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Carleton House 11/09/07

Carleton House 14/02/06

Carleton House 29/09/05

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 Carleton House Rectory Road East Carleton Norwich Norfolk NR14 8HT Lead Inspector Ruth Hannent Unannounced Inspection 10th May 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Carleton House DS0000065207.V294644.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. Carleton House DS0000065207.V294644.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Carleton House Address Rectory Road East Carleton Norwich Norfolk NR14 8HT 01508 570451 01508 571358 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) Four Seasons Health Care (England) Limited (wholly owned subsidiary of Four Seasons Health Care Ltd) Position Vacant Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Carleton House DS0000065207.V294644.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th February 2006 Brief Description of the Service: This is a residential home for up to 27 older people. This original rectory is set in its own grounds with a large well-kept garden. It is situated in the small village of East Carleton with a once a week bus service. There is room to park a number of cars in the grounds. The accommodation is on the ground and first floor (accessed by a lift) with bedrooms on both floors. Fees per week range between £385 - £460 Email-carleton.house@fshc.co.uk Carleton House DS0000065207.V294644.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection, which took place with the new Manager over a period of seven hours. As part of the inspection, evidence of action taken from previous requirements were looked at. The pre-inspection questionnaire, comment cards from residents and relatives, rota’s and records were discussed. No complaints have been received since the last inspection and Four Seasons have not carried out a recorded visit as required by the Commission. Seen were personnel files, health and safety records, care plans, medication records, staff training information and the records for residents money. Time was spent talking to residents, staff and visitors. A meal was taken with residents and a tour of the building took place. Since the last inspection the Deputy Manager has been appointed as the Manager but is yet to be registered with the Commission. Although she has only been in post for four weeks the Home has started to improve and notable changes in both staff training and personnel files have taken place or are planned. What the service does well: What has improved since the last inspection? The Home has spent a period of time without a Manager, which has now been rectified and has the leadership in place to begin the development the Home has been missing while the post was vacant. Carleton House DS0000065207.V294644.R01.S.doc Version 5.1 Page 6 The staff training programme has started with many courses completed or booked in the near future. The meal service has improved so that residents have a choice and know what is on the menu prior to the meal served. The new Manager has already held a residents meeting and is about to hold a relatives meeting to aid the development and improvement of the service offered at Carleton House. 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. Carleton House DS0000065207.V294644.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 Carleton House DS0000065207.V294644.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): 3 and 5 The quality of this outcome area is adequate. This judgement has been made using available evidence, which included a visit to the Home. The potential residents are assessed but information is limited on the forms and it would be difficult to say if the needs could be met. Prospective residents and their families are invited to visit and assess the suitability of the Home. EVIDENCE: Two recently admitted residents both had an assessment forms completed. The information was very limited and the needs of each one, on meeting them and seeing and discussing the needs, was not reflected on the assessment. (Requirement) A long conversation was held with a relative who could not have praised highly enough the support, time and communication the Home had offered to him Carleton House DS0000065207.V294644.R01.S.doc Version 5.1 Page 9 and his family to ensure his parent would be cared for appropriately. This person had already experienced a Home elsewhere and had not been offered the understanding and support he had received at Carleton when making the choice of where to place his father. Carleton House DS0000065207.V294644.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 The quality of this outcome area is good. This judgement has been made using available evidence including a visit to the Home. The residents do have a care plan but health, personal and social need to show more detail for the individual. The resident’s health care needs are met appropriately. The medication procedures in the Home are appropriately followed and safe. Residents feel their right to privacy is upheld and that they are treated with respect. EVIDENCE: The residents have their care plans in their bedrooms, which although hold basic information are very limited in the details to person-centre the care required. In total three care plans were see. (Two being the care plans of the newest residents). The details on the assessment matched the needs written in the care plans but with the format used, information was difficult to find and Carleton House DS0000065207.V294644.R01.S.doc Version 5.1 Page 11 again was very limited. The daily records (case notes) have developed a little since the last inspection but to enable staff to develop their skills the information needs to reflect the day of the person as an individual. (Recommendation) The Home has a good rapport with the GP’s and District Nurses. This was evident on the day of the visit with the conversation held with the GP and the staff member showed that the medical needs of the resident being seen where carried out by the care staff. Staff record all the medical visits by highlighting the daily records which were seen and the action for staff to take recorded. The communication hand over book also draws the staff’s attention to the GP’s visit to ensure everyone is aware. The Home has a lockable medication trolley and issue the medication from a blister pack system. The trolley, when not in use is locked in a cupboard. It was noted on the day of the inspection that residents were receiving their medication quite late (this was due to an unforeseeable need of a resident). The Manager has a system that shows the medication was administered late to ensure the next dose is not delivered too early and the next staff member would follow this pattern. All the procedure is carried out and was seen as correct. The Home is about to move to the Boots system and all staff who administer medication will be fully trained. (Dates planned already and seen). Many residents were spoken to throughout the day and in total ten residents comment cards were received with everyone stating how kind and caring the staff are. It was noted during the visit that staff were courteous and always knocked on doors before entering. A resident who had only recently arrived stated how she really was not wanting to come into a Home at first but now wishes she had considered it earlier because “the Home has respected my rights and I am still independent”. Carleton House DS0000065207.V294644.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, and 15 The quality in this outcome area is adequate. This judgement has been made by using the evidence available and included a visit to the Home. The Home needs to improve the way they gain and write the information on peoples expectations and interests and then assist them to meet those expectations and interests. Residents are encouraged to remain in contact with family and friends. More effort needs to happen to ensure residents are able to make choice and have control over their lives. The meals are good with choice now evident and are enjoyed in nice surroundings. EVIDENCE: Although each resident has a key worker there was little evidence of the involvement with the resident of building the care plans. The first two care plans studied of the two people who had been admitted since Christmas had very little information of the recreational, religious, social or special interests that would stimulate the individual resident. Throughout the lunchtime meal an Carleton House DS0000065207.V294644.R01.S.doc Version 5.1 Page 13 animated conversation was held at the table with lots of past interests and lifestyles discussed. On reading the care plans none of this information is recorded yet it was very evident how much, if assisted with, these interests could still be pursued. (Recommendation) Prior to the inspection seven comment cards from relatives had been received at the commission with all seven stating they can visit and see their relative in private at anytime. Two visitors were in the building during the inspection and it was noticed the polite conversation held with staff and the comments given to the Inspector that the visitors are made welcome and questions are answered on asking. The manager is trying to encourage the local church to be more active within the Home by offering a lounge for visitors and residents to use. With the need to develop the care plans the standard on residents being assisted to exercise choice and control over their lives was difficult to assess. The residents spoken to gave clear pictures of what they would like to do with their lives but none of this is recorded. Yet throughout the day it was noted that residents were asked questions such as “where would you like to sit” or “would you like cream, ice cream or mousse”. A few residents have some control over their money but the majority have money held in the bank by Carleton House. This appears to suit most residents but with some who had not the capacity to understand, it was uncertain if choice was offered. The spending of the money such as paying for the Extend exercise class was taken out of the accounts of people who were in the lounge and appeared to take part but it was unclear if they were aware they were paying for the session. Families do receive a copy of the way the money is spent but this is after the event. (Recommendation). The lunchtime meal was taken in the dining area with the residents. Since the last inspection more effort has gone into providing choice. One resident was ‘overjoyed’ to have choice especially as she eats many of her meals in her room and before did not know what was on offer. The Manager is in the process of buying hard plastic menu covers so each week a menu can be available for all residents to see. The meal was sausages with vegetables or salad with ham, cheese or egg. The dessert was fruit flan with cream or ice cream or mousse. The conversation throughout the meal was showing how popular the meals were and how well the cook catered for them. One resident had decided to eat outside as the weather was hot and others were in the conservatory/dining room with the door open with a few remaining in the lounge or in the bedroom for their meal. It was a pleasant atmosphere with plenty of smiles and laughter. Carleton House DS0000065207.V294644.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 quality of this outcome area is good. This judgement has been made using available evidence including a visit to the Home. Residents and relatives are confident their concerns/complaints will be listened to. Residents are protected from abuse. EVIDENCE: The comment cards from both residents, families and friends all said they know who to complain to but had not had to complain. The Home has no records of complaints but the Manager is well aware of the procedure and the recording required if anyone wishes to show concern/complaint or allegation. At the last inspection none of the staff had received any training on adult abuse but the new manager has started them all on the pack produced for Four Seasons on the training required, she has also a date planned (seen in diary) when the Regional Manager and another Four Seasons manager will discuss the subject with the staff and ascertain the knowledge of the staff team. Policies and procedures on potential abuse are in the Home and have been seen on previous inspections. Carleton House DS0000065207.V294644.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 25 and 26 The quality of this outcome area is good. This judgement has been made using available evidence that included a visit to the Home. Residents do live in a safe well maintained Home. Residents are able to access safe and comfortable indoor and outdoor facilities. Residents live in safe and comfortable surroundings. The home is kept clean and hygienic. EVIDENCE: On the day of the Inspection visit the records were available for all the checks carried out by the maintenance officer. All records are current for fire alarms, hot water temperatures and legionella water checks. On walking the Home it was noted the fire extinguishers were in place and within date. Fire risk assessments were seen and a review date was noted as April 1006. A record Carleton House DS0000065207.V294644.R01.S.doc Version 5.1 Page 16 was also in place of the new smoke detector that had been replaced and dated the 28/03/06. There are two lounges that are used and allow residents to be quiet or participate in activities as they wish. The residents were spoken to in both areas with some reading, some chatting to staff and some having a nap. All appeared contented and happy with their home lounges and dining room, which is the conservatory attached to the one lounge. Although this is classed as the dining area residents spoken to said they could have their meal where they wished. The gardens are well kept with plenty of lawn areas and flower beds with sitting arrangements for residents. The Home still has the wired call bell system for some residents with the wire that can be seen as a trip hazard. The Home has tried to talk with these residents to make their bedrooms as safe as possible and have written risk assessments when the potential risk is apparent. Although the risk assessment was in place a record of the conversation was not evident and as this person has difficulty in remembering it would be useful to record conversations such as these and use it within the risk assessment recording. The Home has recently had the guttering cleared around the property and the plaster treated in one of the bedrooms that had a problem with damp and is now awaiting a new carpet. The freshly painted room was seen and will be ready for a new admission once the carpet is replaced. The radiators around the building are still in the process of being covered with guards. Some were still being constructed and were seen in the barn on the side of the property. This is part of the outstanding requirement and should be completed shortly. (Recommendation on past requirement). On walking the building it was noted to be clean and tidy. The laundry has two industrial tumble dryers and one industrial and one domestic washing machine. The room was in order and all the laundered items ready to go back to the individual rooms. The staff were all seen wearing the appropriate protective clothing when carrying out tasks that require protection and clinical waste was disposed of appropriately. Carleton House DS0000065207.V294644.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 The quality of this outcome is good. This judgement has been made by using available evidence including a visit to this service. Residents do have their needs met by suitable numbers of staff who have the skills to carry out the care required. The care team are slowly gaining a recognised qualification to ensure residents are in safe hands. The Home does need to ensure all records are stored to be in line with recruitment procedures and policy. The staff are working hard to develop their skills and training. EVIDENCE: The staff team within Carleton House are well established with a mixture of skills and abilities that complement one another. The rota on the staff notice board showed suitable numbers of staff on duty (although it was noted how highly dependent some of the residents were and required two staff for most tasks) no one appeared rushed and only one comment card received stated that more staff to aid stimulation would help to occupy residents more. The Home staff team work together and support the busy times of day regardless of job role such as the laundry staff member helping out at lunchtime. Evidence of the improvement in the skills was shown by the staff using Carleton House DS0000065207.V294644.R01.S.doc Version 5.1 Page 18 equipment now in place to transfer people who need assistance. This was carried out a number of times within the lounge using handling belts and the correct language used at each stage of the process to ensure the resident knew exactly what was happening. The Home has two staff with NVQ 2, four staff are half way through and two staff have NVQ 3. The Manager is keen to develop the staff team and is working closely with the staff to encourage all staff to gain the qualification. Since the last inspection and when the personnel files were looked at no new staff have been recruited and although the records have improved and are much tidier the files still have some items missing such as forms of identification and photographs. (Requirement) The training that has already taken place and the dates planned for the future show a great improvement in the development of the skills for staff and as mentioned previously the evidence of the recent moving and handling training was seen in the way residents were transferred. A distance learning programme was shared by a staff member and with the new Boots medication system about to commence a date for this training was seen in the diary. The Manager showed great enthusiasm to develop the staff team and also showed how the computer can be used to inform when a statutory training is due so as to not let a staff member be out of date with this training. Carleton House DS0000065207.V294644.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, 33, 35 and 38 The quality of this outcome area is adequate. This judgement has been made using available evidence including a visit to the Home. The residents live in a Home that is managed by a person who is fit to be in charge. The Home needs to develop a clear quality assessing procedure. Resident’s money is managed correctly but clearer understanding of what the money is used for needs to be recorded. The health, safety and welfare of residents and staff is promoted. EVIDENCE: Carleton House DS0000065207.V294644.R01.S.doc Version 5.1 Page 20 This Manager is very new in post but has worked at the Home for a number of years. The enthusiasm and effort already shown since being offered the position will hopefully continue. The Management qualification needs to be undertaken and the understanding of the National Minimum Standards to guide development of the role. The residents have already held a meeting with the manager and a planned similar event with the relatives is underway to work towards developing and improving the service. The need for a proper quality monitoring system needs to begin to aid aims and objectives for the future. (Requirement) The Administrator on the day of the inspection was able to show clear records of every transaction that occurred for each resident with signatures and double checks carried out by the Manager. One concern shared was the need to pay the person who had arrived and taken an extend class of which it was seen approximately ten residents took part. Some residents who were also in the lounge were not taking part and it was difficult to say who did and did not wish to pay for this event. Some record of how the resident has been asked should be held on file to confirm they wish to be involved especially when they are paying for it (Recommendation). The manager is working hard to ensure the health and safety of staff and residents is protected, by developing the training programme for staff (seen). Ensuring all records by the maintenance officer is up to date (seen). That equipment and the building is safe. The hot water was run in three sinks to test it was not too hot and it was noted that clinical waste was disposed of in the correct containers and a contract and notification from the disposal company was seen in the office. The dates for all other checks throughout the building were all recorded on the pre inspection questionnaire. The information required as stated for regulation 37 was not clearly understood and all records from now on must be sent to the commission. (Requirement) Carleton House DS0000065207.V294644.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 x x 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 2 X X 2 Carleton House DS0000065207.V294644.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP3 Regulation 14 Requirement Timescale for action 01/07/06 2 OP29 17 (sch 2) 3 OP33 24 4 OP38 37 It is a requirement that all potential residents are assessed fully to ensure the service available within the Home can meet the needs. It is a requirement that all 01/07/06 documents listed in schedule 2 are held in personnel files for all staff It is a requirement that the 01/09/06 Home has a quality checking system in place to monitor, review and improve the service It is a requirement that all issued 11/05/06 listed under regulation 37 be reported to the Commission 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 OP7 Good Practice Recommendations It is recommended that staff receive some form of training to enable them to record daily records that are appropriate DS0000065207.V294644.R01.S.doc Version 5.1 Page 23 Carleton House 2 OP12 3 4 OP14 OP25 and reflect the day of the individual resident. It is recommended that more information is gathered to ensure all areas of care including stimulation and interests are recorded and assistance given to residents to continue to enjoy these interests. It is recommended that residents/families are made aware of how the money of each resident may be spent before the event and that a record of this conversation is on file. It is recommended that the programme of placing guards on radiators is completed as soon as possible in compliance with previous requirements. Carleton House DS0000065207.V294644.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Carleton House DS0000065207.V294644.R01.S.doc Version 5.1 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!