CARE HOME ADULTS 18-65
Carrwood House 344 Grimesthorpe Road Sheffield South Yorkshire S4 7EW Lead Inspector
Janice Griffin Key Unannounced Inspection 26th August 2006 08:15 Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Carrwood House Address 344 Grimesthorpe Road Sheffield South Yorkshire S4 7EW 0114 243 9808 0114 261 8223 none 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) Mr Frederick Marshall Mrs Julie Marshall Ms Mabel Ann Hudson Care Home 16 Category(ies) of Learning disability (16) registration, with number of places Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 6th December 2005 Brief Description of the Service: Carrwood House is a registered care home offering personal care and support to adults (between the ages of 18 - 65 years) with learning difficulties and some service users with relating mental illness. The accommodation comprises of ground floor communal areas and first floor service user bedrooms, bathrooms and toilets. The philosophy of the home is to encourage service users to make choices, take risk as part of life style under supervision and build their self-esteem in a safe and caring environment. The gardens are landscaped and there are car-parking facilities. Copies of the last Commission for Social Care inspection report was available for service users and their families to read. The weekly fees range from: £450.76. This information was provided on the 24th July 2006. The home charges extra for chiropody, toiletries, clothing and holidays. Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced inspection undertaken by Janice Griffin and Debbie Foster it took place from 08:15 am to 13:00 pm. As part of the inspection process the inspectors spoke to ten service users, four staff and the manager on duty. The inspectors would like to thank service users, the staff and the manager on duty for their openness and for their commitment to the inspection process. The inspectors were pleased to note that all ten-service users spoke positively of the ongoing support provided by the staff. Observations confirmed that service users were extremely comfortable and at ease in the company of the staff whom they said were approachable, supportive and sensitive to their needs and feelings. A number of records were examined which included, the pre-inspection questionnaire completed by the manager, service users surveys, medication records, two-service users care plans, and three weeks menus and three weeks staff rotas. Records relating to service users finances, staff training and the homes quality assurance systems were also checked. Several areas of the building were also inspected. Feedback on the inspection was given to the manager on duty before the inspectors left the home. No complaints have been received about this home since the last inspection. What the service does well:
The environment is homely, friendly and welcoming. Clear information about contracts/terms and conditions, fees and extra charges was available in a format appropriate to each individual service user and their families. Staff interacted well with each service user and it was obvious from discussions with the service users that staff had developed positive relationships with them. Service users and the staff said the manager was committed to ensuring that the home provides a high standards of care they also spoke positively about the staff team and the care that they received. One commented that all the staff were “wonderful”. The appropriate systems were in place for the control and administration of medication and the homes systems were regularly checked by a local pharmacist. The staff said they were keen to ensure they meet the diverse needs of service users. The cook was familiar with the food likes and dislikes of service users. The inspectors observed the breakfast and lunch offered to service users the food provided was of good quality, well presented and a good choice of food was offered. Service users said they loved the food that was well cooked and that other choices were always provided if they wanted them. Documentation and discussion with three staff showed that they have had training in the specialist area of work that they work in. Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 6 What has improved since the last 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.
Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 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 the following standard(s): 1, 2 and 5. Quality in this outcome area is: adequate. This judgement has been made using available written evidence, discussion with ten service users, three staff and a visit to the home. There was a statement of purpose and a service user guide for the home. This enables the service users to make an informed choice of whether the homes services and facilities provided would meet their needs. An up to date contract/statement of terms and conditions had been provided to service users, but the contract of care did not give details of the number of the room to be occupied by the service users. This does not respect the rights of the service users. Needs assessments were not available in two service users files checked. This does not ensure that care needs can be met. Service users were able to have informal introductory visits to the home at the time of their admission. The service users confirmed that this helped them to get to know everyone at the home, which made them feel less anxious. EVIDENCE: The statement of purpose and service users guide had not been reviewed to include all of the required information. An up to date contract/statement of terms and conditions had been provided to service users and signed copies were retained on individual files. These clearly detailed the fees, including any extra charges, and the services and facilities
Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 9 provided by the home, however they did not state the number of the room to be occupied by the service user. The staff are qualified and skilled to meet the specialist needs of prospective service users. Detailed full needs assessments had not been completed by the referring social worker for all service users admitted to the home. Each service users had a care plan based on a Care Management Assessment, however the plan contained little information about the service users rehabilitation and therapeutic needs. Service users spoken to said at the time of their admission they were able to have informal introductory visits to the home and they had been provided with a contract containing the relevant information. Staff are prepared to visit the prospective service users at home to get to know them and answer any questions. Records checked and discussion with service users confirmed they had been involved in decisions regarding the arrangements. Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 10 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 the following standard(s): 6, 7 and 9. Quality in this outcome area is: adequate. This judgement has been made using available written evidence, discussion with ten service users, three staff and a visit to the home. Detailed care plans had been completed for each service user however the plans did not contain all of the required information and therefore it could not be confirmed that service users needs were being met. The risk assessments and care plans checked had not been reviewed regularly; some were not dated and therefore did not reflect the current needs of the service users. EVIDENCE: Service users had individual care plans, which contained some information about their physical care and support needs. Care plans checked did not set out in detail the action that was required by staff to ensure that all aspects of service users personal, social support, educational and healthcare needs should be met through planned intervention, rehabilitation and therapeutic programmes. The care plans checked had not been reviewed on a regular basis to reflect the service users changing needs and aspirations.
Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 11 Service users files contained risk assessments relating to some aspects of service users lives both inside and outside the home. They identified some individual risks that were presented to service users on a daily basis but not enough detail on the action required to reduce the risk and some documents were not dated. They had not been reviewed on a regular basis to promote the safety of service users. Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 12 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 the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is: adequate. This judgement has been made using available written evidence, discussion with ten service users, three staff and a visit to the home. Service users spoken to said there were little opportunity to develop their independent living skills as the home had very little equipment to support them. There were limited activity opportunities within the home. This does not allow the service users to develop some independence. Some opportunities were provided for service users to engage in activities within the local community. Some service users did not have a key to their bedroom doors. This does not promote the service users privacy. Service users were encouraged to eat a healthy and varied diet. Rules on smoking and alcohol use were clearly stated in the homes service users guide. This is good management practice. EVIDENCE: Service users said that they accessed activities within the community, which included gardening groups, day centres and visiting the cinema.
Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 13 Service users said that they enjoyed watching television and listening to music within the privacy of their own room. Several service users said that there were limited activities within the home. They said that they would like more opportunities to take part in activities within the home and felt that it would also serve as a good opportunity for service users to socialise more. The equipment they said they would like was, more variation with TV channels, more books, newspapers, the use of tea making facilities and the use of a computer. Service users were encouraged and supported to maintain positive relationships with their families and friends. Service users were offered and encouraged to eat a healthy diet. The cook was familiar with the dietary needs of service users. The inspectors observed the breakfast and lunch offered to service users the food provided was of good quality, served hot, well presented and a good choice of food was offered. Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 14 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 the following standard(s): 18, 19 and 20. Quality in this outcome area is: good. This judgement has been made using available written evidence, discussion with ten service users, three staff and a visit to the home. Specialist health, nursing and nutritional requirements and support were not clearly recorded in each service users care plan; the information did not give a comprehensive overview of the service users health care needs and furthermore the information did not act as an indicator of change in health requirements. This does not ensure that the staff can meet the service users health care needs. There was a medication policy and procedure to ensure that staff adhered to safe systems. This is good management practice. EVIDENCE: The staff had a good awareness of service users individual physical and emotional needs. Daily handovers were taking place on a daily basis, which enabled staff to discuss the needs of service users, to ensure that a consistent level of care could be offered. Within individuals care plans checked there was little or no evidence that regular health monitoring takes place. Records of healthcare appointments were maintained. However, there were little details to demonstrate the
Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 15 healthcare visits that service users had received and the treatment administered and any follow up action that was required to promote the health of service users. The routines within the home were flexible. Service users said that they were encouraged to spend their day as they wished and that the staff respected their choices. There was a medication policy and procedure to ensure that staff adhered to safe practices. Medication was checked on a sample basis. On the whole medication systems were good. Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 22 and 23. Quality in this outcome area is: good. This judgement has been made using available written evidence, discussions with ten service users, three staff and a visit to the home. The homes complaints procedure was clear, accessible and contained the necessary information. The complaints procedure was widely distributed and was highly visible within the home. This allows service users and their families a clear understanding of how to make a complaint. Service users were protected from abuse by the awareness of staff through training and the homes procedures. This protects the well being of service users. EVIDENCE: The complaints procedure was available for service users, visitors, relatives and staff. The staff confirmed that this would be available in alternative formats and languages should this be requested. The service users spoken to said that they knew that they could complain if they were not happy about anything and that they felt able to discuss any issues or concerns that they may have with the manager and staff. They also said that staff were always available and that they were encouraged to talk about anything that troubled them or caused them anxiety. Since the last inspection no complaints have been made about the homes. The home ensures through training, supervision, reviews and quality monitoring that the care staff fully comply with the policies and procedures provided in relation to protecting and safeguarding the rights of service users. Staff had been made aware of the action to take in dealing with third party information.
Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 24, 26, 27 and 30. Quality in this outcome area is: adequate. This judgement has been made after discussion with ten service users, and using available evidence including a visit to the home. The home was clean and smelt fresh. Some area around the home had damaged decoration; one shower room had a damaged door and some outside areas needed sweeping. This made the home look shabby in parts. The bedroom doors were fitted with locks, but some service users did not have a key. This does not promote the privacy of service users. A refuse bin was being used as an ashtray. This is dangerous practice. The string electric light cords were very dirty in some bathrooms and toilets. This is not hygienic. EVIDENCE: The service users said that the home was always clean, warm, well lit and there was always enough hot water. Some areas of the home had recently been redecorated but some areas (the flats) still had damaged decoration. The bedroom doors were fitted with suitable door locks and lockable facilities were provided in all the bedrooms. Some service users did not have a key to their room. The appropriate seating had been provided outside for those service users wishing to sit outdoors whenever the weather permitted.
Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 18 However parts of the garden needed weeding and a large quantity of cigarette ends were left discarded on the floor. Services users in the backyard were seen to be using a refuse bin, as an ashtray the bin was full of paper. Each area had a number of toilets and bathrooms, assisted showers were provided for those service users with mobility problems. Toilets were easily accessible as they were close to lounge and dining areas. One shower room had a damaged door and door lock. The string electric light cords were very dirty in some bathrooms and toilets. The home had a proactive infection control policy and they work closely with external specialists, e.g. the Health Authority, Environmental Health and their own staff to ensure infections are minimised. Clinical waste is properly managed and stored. Staff confirmed that they were provided with protective clothing if they needed it and that all the equipment was in good working order and that it had been serviced as required. Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 19 Staffing
The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, and 35. Quality in this outcome area is: good. This judgement has been made after discussion with ten service users, three staff and using available evidence including a visit to the home. Care staff had a range of skills and experience, which contributes to them being able to support the service users. This will ultimately benefit the health and welfare of the service users. The homes recruitment procedures could not be checked, as the records were not available. The home had a training and development plan and all staff had completed a range of training relevant to their role. This allows the staff to ensure they meet the individual assessed needs of service users service user. 75 of the staff team were qualified to NVQ level 2/3, this shows the providers commitment to staff development. EVIDENCE: The service users said that the staff worked very hard and described them as “very caring, kind and understanding”. Staff files were not available for inspection so the homes recruitment procedures could not be checked. Staff spoken to had an understanding of the home’s fire procedures; they had received training on moving and handling, fire, food safety and infection control. Files checked and discussions with three staff and the manager confirmed that all staff had completed detailed induction training. 75 of the staff team were qualified to NVQ level 2/3. Staff said that they had received
Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 20 training on caring for people with mental health problems. Staff were being formally supervised at the frequency required to fully ensure individual staff development and the monitoring of care practices. Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home
The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 and 42. Quality in these outcome areas is: good. This judgement has been made after discussion with ten service users, three staff and using available written evidence including a visit to the home. The service users, and three staff spoken to said the manager was approachable and very professional. Service users surveys are completed regularly, which ensures that the home is run in the best interest of service users. Records were in the main up to date and well ordered to ensure the best interests of service users, however some records were not available for inspection. A safe environment was not provided in all parts of the home. This doe not protect the health and welfare of the service users. EVIDENCE: The manager had a job description that clearly defined her roles and responsibilities and staff were aware of her role. The staff said she is committed to ensuring that the home provides a high standards of care, she completes regular internal audits on all aspects of the service provided by the
Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 22 home. Staff spoken to had an understanding of the home’s fire procedures; they had received training on moving and handling, fire, food safety and infection control. Service users said that they are actively consulted on how the service runs. Some policies and procedures were available and in formats to ensure the people who use the service are able to understand the information provided. No fire exits were blocked but a large quantity of lighters was noted on a windowsill, a risk assessment had not been completed. Accident records could not be checked, as they were not available for inspection. Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 3 2 2 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 X 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 2 12 2 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 3 3 3 X X X 2 2 X Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 24 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 2 3 YA5 YA6 YA9 Standard YA2 Regulation 14 16 15 Requirement New service users must only be admitted to the home on the basis of a full needs assessment. The contract of care must detail the number of room to be occupied by the service user. The service users care plan must include details of any rehabilitation; treatment and how care needs will be met. The plan must describe the facilities to be provided by the home and how the service will meet the current and changing needs of the service user. The care plans must be reviewed at least every six months. Risk assessments must be reviewed at least 6 monthly, dated and signed. The home must provide service users the opportunity to maintain and develop their social and independent living skills. Service users must be encouraged and supported to take part in valued and fulfilling activities. Service users must have access to, and be able to choose from a
DS0000002945.V303496.R01.S.doc Timescale for action 01/12/06 01/12/06 01/12/06 4 YA11 16 01/10/06 5 YA12 16 10/10/06 6 YA14 16 01/10/06 Carrwood House Version 5.2 Page 25 7 YA19 13 8 YA24 23 range of appropriate leisure activities. The service users healthcare needs must be assessed and recognised and procedures must be in place to address the needs. The areas with damaged decoration must be redecorated. The string electric light cords must be cleaned or replaced. 01/10/06 02/02/07 9 10 11 YA26 YA27 YA41 23 23 17 12 YA42 12 Service users must be provided with a key to their bedroom door. The damaged shower room door and door lock must be repaired. All records as detailed in the Standards and Regulations are at all times available for inspection by any person authorised by The Commission For Social Care Inspection to enter and inspect the home. Risk assessments must be produced for the safe storage and administration of hazardous substances. The bin use to discard old paper must not be used as an ashtray. 01/10/06 28/08/06 28/08/06 28/08/06 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 YA37 Good Practice Recommendations The manager should complete NVQ level 4 in care and management qualification. Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 Carrwood House DS0000002945.V303496.R01.S.doc Version 5.2 Page 27 - 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!
