Inspection on 23/06/05 for Cedar Court

This inspection was carried out on 23rd June 2005.

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

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

Other inspections for this house

Cedar Court 11/10/06

Cedar Court 05/01/06

Cedar Court 03/02/05

Cedar Court 08/06/04

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

CARE HOMES FOR OLDER PEOPLE Cedar Court Lensbury Way Abbey Wood London SE2 9TA Lead Inspector Maria Kinson Unannounced 23 June 2005 10:15am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Cedar Court Address Lensbury Way Abbey Wood London SE2 9TA 020 8311 1163 020 8311 1193 cedarcourt@schealthcare.co.uk Southern Cross Healthcare Services Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Kim Madeline Brown Care Home 47 Category(ies) of Dementia (47) registration, with number of places Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 03 February 2005 Brief Description of the Service: Cedar Court is a purpose built home, which was originally registered in 1996. In 1997 the home was taken over by Southern Cross Healthcare Ltd and was registered for 47 mentally infirm people. At that time, 10 places provided nursing care. On the 4 March 1999, the registration was changed and the home now provides 47 residential places for older people with dementia. The home is located a short distance from Abbey Wood station, bus routes and shops. It has 41 single and 3 double bedrooms. The home is on two floors and has a sitting room and dining room on each floor. There are additional communal rooms on each floor. From the ground floor service users have access to the garden, which is enclosed. On the ground floor there are offices, a laundry, kitchen and storage rooms. Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place on 23.06.05 between 10.15am and 17.35pm. The inspector undertook a partial tour of the home including the kitchen, laundry, two bedrooms and communal areas. A selection of documentation was examined including the homes Service User Guide, care, medication and staff recruitment records. During the course of the inspection the inspector spoke with three residents, two sets of visitors and one health care professional. Written feedback was received from two relatives and three health care professionals. What the service does well: This home provides good care for people with dementia. The Statement of Purpose and Service User Guide provide comprehensive information about the home for prospective residents and their relatives. Detailed information was obtained about resident’s needs and preferences, so that appropriate care could be provided on admission to the home. Staff worked in partnership with other health and social care professionals to ensure that resident’s health and social care needs were met. Staff addressed residents in a respectful manner and showed concern for resident’s welfare. One resident told her relative “We are so lucky to live here”. The home provides a regular and varied programme of activities in the home and community. Staff arranged unusual and interesting trips such as wine tasting and everyday type activities such as going to the hairdressers or local pop in parlour for a cup of tea. Relatives were encouraged to visit and spend time with residents in their room or the communal areas. The choice and quality of food provided in the home was good. One relative told the inspector “residents get real food, meat and two vegetables, what older people know and recognise”. Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 6 The manager of the home has worked in the home for several years. The manager works hard to support residents, staff and relatives and keeps up to date with best practice in dementia care. The home has a stable team of staff who were familiar with resident’s individual needs and provide good continuity of care. Staff had a good understanding of the needs of people with dementia and managed challenging behaviour appropriately. Staff kept information simple to counteract the difficulties that residents were experiencing communicating and understanding information. Staff maintained some degree of routine in the home but were flexible when residents requested food and drink at unusual times of the day. Access to vocational and ongoing training for staff was good. Staff received good supervision and support from the manager and senior staff. What has improved since the last inspection? What they could do better: Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 7 The management of medication was mostly good but staff must ensure that medication is stored at an appropriate temperature and that the information on the medication administration sheet matches the information on the medication pack. Recruitment practices were mostly good but some of the older files did not include adequate documentation. 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. Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 9 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 standard(s) 1, 3 and 4 (standard 6 does not apply to this home) Residents were provided with comprehensive written information about the service. Staff had sufficient information to meet resident’s health and welfare needs on admission to the home. This home has a competent team of staff who work hard to make all aspects of daily living understandable for residents with dementia. EVIDENCE: The home provides comprehensive information for prospective and existing residents. The Statement of Purpose and Service Users Guide were displayed in the reception area. Since the last inspection the Service Users Guide had been updated to include information about the terms and conditions of occupancy, a sample contract and details of the managers experience and qualifications. Information was easy to read and well presented. The care records for two residents were examined. Staff had assessed resident’s health and welfare needs prior to admission and had developed a draft care. Additional information was obtained from the local authority and carers or relatives where possible. Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 10 This home is registered to care for people with dementia. The manager and staff had attended specialist training about dementia and challenging behaviour. Staff recognised the difficulties that residents had communicating and understanding information and took action to simplify and help residents in this respect. The inspector observed many signs of well- being such as social interaction, expressing personal choice, humour and helpfulness amongst residents. Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 11 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 standard(s) 7, 8, 9 and 10 The care planning system provides staff with adequate information to meet resident’s health and welfare needs. The management of medication was mostly good but staff must ensure that potential risks are addressed promptly and that medication is stored at an appropriate temperature. Personal support was provided in a way that promoted and protected resident’s privacy and dignity. EVIDENCE: Two sets of care records were examined. Staff undertook a thorough assessment of resident’s health, personal and social care needs. A specialist assessment was used to assess the impact that dementia was having on the resident’s ability to communicate and understand information and whether there were any behavioural issues. Staff tried to establish resident’s individual preferences, preferred routines and likes or dislikes. Staff used all of this information to develop an individual care plan for each resident. Issues that were recognised as a potential risk for older people such as the development of pressure sores, poor nutrition and difficulty moving were assessed separately. Care plans were reviewed regularly and reflected resident needs. Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 12 Residents were not always able to provide information or answer questions about the home and their circumstances. Staff prompted residents if it became apparent that they were having difficulty by reminding them about the places they had travelled to, their occupation and about their family background. It was evident that staff spent time getting to know each resident as a person. See standard 4. Staff distracted residents when they became physically or verbally aggressive and did not challenge residents even when they were talking about issues that were unlikely to have occurred. Staff had a good understanding of the needs of people with dementia and spent time reassuring and comforting anxious residents. Access to community health care services was satisfactory. The inspector obtained written and verbal feedback from four health care professionals that were in regular contact with the home. Three of the four respondents were satisfied with the care provided in the home and indicated that staff worked in partnership with their team. Comments included “This home is good, the staff genuinely care about residents and are interested in their welfare. There is always something going on, staff talk to residents. I can tell the residents are happy. Staff treat residents as individuals.” “I judge all homes by the standard of care that I have witnessed here”. “This home is brilliant”. “Staff are approachable and address concerns promptly”. One health care professional said that the home was sometimes malodorous and staff did not always provide adequate support. Team Leaders were responsible for monitoring care practices on each floor. This included ensuring that residents had adequate fluids and that continence needs were met. Residents that remained in their rooms were checked regularly and more regular checks were carried out when residents were unwell. Two medication charts were examined. The management of medication was good overall but one issue identified at the previous inspection had not been addressed. This issue relates to one resident who was prescribed a variable dose of anti-coagulant medication. The instructions on the medication chart and in the anticoagulant book were different. There was no evidence to suggest that the resident was receiving incorrect amounts of medication but this was a potential risk. A staff member said that the excess medication was being thrown away but there were no records of this. The temperature in the medication room and drugs refrigerator was too warm for the storage of medication. See requirement 1. Records of receipt and administration of medication were good and storage facilities were clean and spacious. None of the residents were prescribed night sedation. The effort made by staff and other healthcare professionals to avoid the use of hypnotic medication is commended. Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 13 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 standard(s) 12, 13, 14 and 15 Social activities were well managed and provide daily variation and interest for residents. Relatives were satisfied with the visiting arrangements and indicated that they were made welcome by staff. A good selection of food was provided in the home to meet resident’s nutritional needs and tastes. EVIDENCE: Senior staff were responsible for arranging and facilitating the homes activity programme. All staff were responsible for supporting and encouraging residents to take part. During the summer months regular outings to coastal resorts and a wine tasting trip were planned and more local trips to the park to feed the ducks, to the Pop in Parlour and the woods took place when the weather was good and residents expressed an interest in going out. Staff accompanied residents to the hairdressers and shops and provided impromptu activities such as singing, puzzles and entertainment in the bar. Nail care and hand massage took place regularly and staff had arranged aromatherapy training. On the day of the inspection gazebos and sun loungers were set up in the garden and residents were offered ice creams, ice-lollies and cold drinks. An annual Fun day for resident’s friends and family was planned. A separate record of the activities that residents had undertaken was maintained. Staff spent time talking and listening to residents. Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 14 Visiting arrangements were satisfactory and relatives said that they felt welcomed in the home. Relatives and residents meetings took place regularly and minutes were maintained about the issues discussed. These sessions were sometimes used to provide information for relatives about dementia or other relevant issues. Staff produced a quarterly newsletter for relatives and residents. Staff were observed offering residents a choice of drinks and food and encouraging residents to make choices for themselves where possible. Staff understood that many of the residents could make decisions for themselves about various issues and did not assume that because resident had dementia they were not able to make any decisions for themselves. Some of the residents choose to have their meals in their rooms. Residents were seen in various parts of the home and garden. The kitchen, laundry, staff room and staircases were the only areas that were restricted. A new menu had been introduced which was said to be popular with residents and result in less waste. The inspector observed lunch being served on the first floor and supper on the ground floor. Some residents had lunch in the garden. Residents were satisfied with the quality and choice of food provided and commented that the “meat was very tender”. Some residents had second helpings. One resident on the first floor did not want any food, staff tried to gently coax the resident to have something to eat. One resident did not like the choice of desserts. Staff discussed possible alternatives with the resident and obtained ice cream with sauce for the resident. This inspection occurred on a very hot day. Staff were seen offering residents cool and hot drinks at regular intervals and snacks. One relative said that they had seen the food and “it looked really good” and another relative said they had to purchase new clothing for their relative as she had gained weight since moving into the home. Meals that were taken to resident’s rooms were covered to keep the food hot. Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 15 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 standard(s) 16 and 18 The home had a comprehensive complaints and adult protection procedure in place for responding to complaints or allegations of abuse. EVIDENCE: The complaints procedure was displayed in the reception area and a supply of concern forms were provided for relatives to use at any time. A complaints file was kept in the office and all complaints were reported and monitored by head office. The home had not received any complaints since the last inspection. The home has an Adult Protection procedure and copy of the local authority guidance. One resident expressed concern about access to personal funds and belongings and said she wanted to make a will. The manager spent time listening to the residents concerns and was able to reassure the resident about the action that she had taken to date. The manager was advised to refer the matter to social services for investigation under their adult protection procedure. Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 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 standard(s) 19, 20, 23 and 26 Work was planned to improve the physical appearance of the home. This should provide a more attractive and homely environment for residents. EVIDENCE: Although the home was clean and comfortable parts of the building require redecoration and some of the furniture was worn. Following the last inspection the registered provider had confirmed that the redecoration and refurbishment programme would take place in 2005/6. The manager said that she had placed an order for new carpet for the lounges and corridors and new bedroom and lounge furniture. New carpets had been fitted in two bedrooms since the last inspection and the redecoration of the hair salon was almost complete. Plans were in place to tile parts of the walls in the kitchen, replace the loose kitchen flooring and repaint the ceiling. The garden was well maintained. The previous requirement to ensure that all of the high surfaces in the kitchen were kept clean and that the freezer was maintained at an appropriate temperature had been addressed. Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 17 Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 This home has a committed and competent team of staff. Staff had a good understanding of resident’s health and welfare needs. The homes recruitment practices were good but some of the older files did not contain adequate documentation. EVIDENCE: There were eight staff on duty, including two senior carers who were responsible for managing residents care on one floor of the home. The home has a stable staff team. Temporary staff were used infrequently as some of the permanent staff like to work additional hours. This provides good continuity of care for residents. Retention of staff was good. The maintenance employee post was vacant but had been advertised. Relatives and residents said that staff were kind and helpful. One relative said, “I am full of admiration for the staff, they keep me informed about any changes and ensure that my family member is kept clean and comfortable”. The visitor also recalled how her relative had told her “We are so lucky to live here”. Staff communicated effectively with residents. Staff were seen kneeling in front of residents to ensure good eye contact and holding or stroking residents hands to reassure resident when they were anxious. Staff used short sentences and kept information simple to make it easier for residents to understand what was being said. Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 19 Two staff recruitment files were examined. Recruitment practices were good overall but older files did not always include two written references. See requirement 2. Staff had attended various relevant training sessions including food hygiene, nail clipping, COSHH, fire safety, challenging behaviour, basic life support, dementia, moving and handling, first aid, abuse, funeral awareness and team leaders training. Eleven members of staff had a vocational qualification in care at level two and eighteen staff were undertaking vocational training at level two or three. Continence and aromatherapy training sessions were planned. A new induction training programme had been introduced for new employees. The programme is completed during the employees first six weeks. The programme includes attendance at various training sessions and discussion of various topics. Staff are expected to answer questions to demonstrate their understanding of the topics covered. The package complies with nationally recognised standards for induction. Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 33, 36 and 37. This home is managed by an experienced manager who works hard to ensure a good quality of life for residents with dementia. EVIDENCE: The management arrangements in the home were stable. The manager’s application for registration was assessed and agreed by the Commission in October 2004. The manager advised the inspector that she had completed a NVQ level four in care and management and some of the units that are required for the Registered Managers Award. The manager should complete this training in 2005 and forward a copy of her certificate to the Commission. Various audits were undertaken each month to assess the quality of the care provided. The inspector examined medication, catering and housekeeping audits. The information collated during audits was thorough and incorporates aspects of the national minimum standards. A score was awarded based on Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 21 the results and a senior manager then checks the score. Where necessary an action plan was devised. The manager was preparing a file of evidence to demonstrate how the home was meeting the National Minimum Standards for Older People. Staff meetings took place regularly. A new format for recording staff supervision was due to be introduced. The inspector was shown a draft copy of the record. The new supervision record provides useful prompts about possible aspects of care to discuss and includes both the supervisor and the supervisee’s signature. Staff supervision took place regularly and additional sessions were provided for staff during periods of personal crisis or stress. The public liability and registration certificate were displayed in the reception area. Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 4 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 3 x x 3 x x 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 Standard No 16 17 18 Score 3 x 3 3 x 3 x x 3 3 x Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 9 Regulation 13(2) Requirement Timescale for action 01 December 2005 2. 29 19 The Registered Person must ensure that systems are in place to ensure the safe administration of medicines. (Previous timescale of 01.04.05 was not met) The Registered Person must 01 ensure that staff files include all Februaury of the documentation listed in 2006 Schedule two of The Care Homes Regulations. 3. 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 Good Practice Recommendations Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 Page 24 Commission for Social Care Inspection River House 1 Maidstone Road Sidcup Kent, DA14 5RH 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 Cedar Court G51 G01 S6786 UI Cedar Court V215660 23.06.05 Stage 4.doc Version 1.30 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. 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