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Inspection on 08/06/05 for Charterhouse Residential Care Home

Also see our care home review for Charterhouse Residential Care Home for more information

This inspection was carried out on 8th 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The residents are encouraged to maintain their optimum independence; the care staff are skilled at recognising when the residents require help. The residents asked were positive about the manager and the staff at the home. The home is bright and pleasantly presented, residents rooms are personalised with items of the resident`s choice. The home benefits from extensive coastal views from the garden and some residents rooms. The grounds and gardens are immaculately maintained. All the residents said they really enjoyed the garden. The inspector was told that a pheasant and a squirrel that live in the grounds of the home regularly provided amusement for the residents.

What has improved since the last inspection?

Internal quality audits have been completed using the Commissions inspection template, which covers all the care standards. The residents survey questionnaires are ready to be completed. Staff have received or are in the process of completing the training required at the last inspection. The programme of repairs, decoration and renewals has continued since the last inspection.

What the care home could do better:

The manager has yet to complete the resident`s quality assurance survey. The residents do not have access to the views of others regarding the home they live in. However all the residents spoken to advised the inspector that Charterhouse was a nice place to live.

CARE HOMES FOR OLDER PEOPLE Charterhouse Residential Care Home Second Drive Dawlish Road Teignmouth TQ14 8TL Lead Inspector Rachel Proctor Announced 8 June 2005 th 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. Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Charterhouse Residential Care Home Address Second Drive, Dawlish Road, Teignmouth, Devon, TQ14 8TL 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) 01626 774481 Margaret Louise Brett, Stephen Barry William Brett Margaret Louise Brett Care Home 20 Category(ies) of Dementia - over 65 years of age (20), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (20), Old age, not falling within any other category (20), Physical disability over 65 years of age (20) Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 03.02.05 Brief Description of the Service: Charterhouse Residential Home is a registered as a Care Home that provides personal care for up to 20 people over the age of 60. It is able to accommodate elderly people and those with a physical disability such as mobility problems perhaps through arthritis or as a result of a fall. The home also has the category of DE (Dementia) so as to meet the needs of those with minor memory problems. The home is not registered provide nursing care. The home is a large detached property situated on a quiet road about half a mile from the centre of the Devon seaside town of Teignmouth. It has been adapted to cater for some disabilities having a shaft and stair lift to aid residents to move freely between each floor. There are also assisted bathing and toilet arrangements using mobile hoists. The home has mainly single room accommodation with ensuites although there are two double rooms, both with en-suites, available for those who prefer to share. There is a lounge, a conservatory (sun room) and a separate dining room that are used daily by the residents. The Home has well kept grounds and being in an elevated position enjoys good views of the town, sea and surrounding countryside. There is a resident pheasant and squirrel in the grounds that provide visual entertainment and relaxation when they feed on the patio. Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The commission for social care inspection has introduced key standards to be inspected over each inspection year. Therefore, unless it is felt necessary by the inspector, some standards will not be inspected. To obtain a full picture of the home it is recommended that previous reports also be taken into consideration. This was an announced inspection, which took place on 8th June 2005 between 9.30am – 4pm. Several residents and staff were spoken to during the inspection. The lunchtime meal and the activities provided for residents were observed. A tour of the internal environment of the home was completed. Some records were inspected. What the service does well: What has improved since the last inspection? What they could do better: The manager has yet to complete the resident’s quality assurance survey. The residents do not have access to the views of others regarding the home they live in. However all the residents spoken to advised the inspector that Charterhouse was a nice place to live. Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 6 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. Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 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 standard(s) 3, The residents at Charterhouse have their care needs assessed by staff who are competent and capable. This ensures the residence personal preferences and choices are taken into account throughout the assessment process. EVIDENCE: Four residents care plans were review during the inspection. These had full assessments of each resident care needs. Three of the residents asked said they had been asked about their personal choices and preferences. These were seen to be recorded as part of the assessment. Copies of the additional social services assessments were provided and the resident’s plan of care had been developed from these. The manager uses the computer to prepare the written assessment and care plans for the residents in her care. This she advised had enabled the care plans to be updated easily. The statement of purpose the Charterhouse was displayed in the reception area of the home and was easily available to the residents and their visitors. Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 9 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, 10, The residents can have confidence that their care needs will be provided in a way that enables them to maintain their self respect and dignity. EVIDENCE: The selection of the residents care plans view during the inspection gave clear information for staff regarding the actions they should take to address the individual residents care needs. One resident advised that the staff who cared for her had enabled her to maintain as much independence she was able and only assisted with the thing she couldnt do herself. How independence is promoted was recorded in the residents plan. None of the residents were able to confirm that they had participated in the development of their plans of care. However the information contained in the plans of care evidence that the residents had been asked about the way they wanted their care delivered, personal choices and preferences the residents have expressed had been recorded. The residents like and dislikes and the way they like to be addressed had been recorded. Staff were seen to use the residents preferred form of address when Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 10 they were speaking to them. The residents advised that the staff are always friendly and supportive and speak to them in a respectful way. Two of the residents were receiving care of the district nursing service. The records of the district nurses intervention were held in the individual residents rooms. One resident advised that the manager had asked the district nurse to visit her. One resident advised that they were due to go to a hospital appointment and that staff were going to accompany them. Each of the residence plans of care viewed had been reviewed monthly; changes to the residents care had been recorded and dated. Each resident’s plan of care had a photograph of the resident attached. A risk assessment process is in place for manual handling, risk of falls, the use of this sinks in the residents rooms and the activities the residents have chosen to undertake. The home has recently started to take residents with mental disorder over the age of 65. These residents appear to have integrated well with existing residents at Charterhouse. The home has a locked medicine trolley with the resident’s medication. An assessment system is in place for the residents who are able to self medicate. An example of this was seen. A copy of the pharmacist report from March 2005 was provided for inspection. Not all aspects of the homes medication practices were assessed on this occasion. Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 11 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, 15, The current activities provided do not always meet the resident’s needs for social interaction and stimulation. EVIDENCE: The minutes of the staff and residents meetings were provided. These identified some of the request the residents had made. The suggestion that the home has a budgie and some fish had been carried out. One resident said she was hoping the budgie would start to talk and enjoyed having him in the lounge. The manager explained the activity she was trying to arrange for the residents. This included a visit from the donkey Sanctuary and a local pianist who played for the residents to sing along. She also said that the activities to music that had started recently had been accepted well by the residents. Some of the residents commented on the pheasant that lived in the grounds and how tame it was. All the residents spoken to said how much they liked the grounds and the gardens at Charterhouse. One resident said she preferred to sit in her room and look at the views across the sea. The manager advised that the residents are able to freely choose whether they spend time in one of the two lounge areas or in their own rooms. Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 12 Three comment cards received and two residents spoken to identify that they would like a greater variety of activities to take place. The manager advised that she was trying to balance the needs of all the residents when planning activities. She confirmed that she would continue to talk to individual residents to ensure that their ideas for activities were taken into account. During the afternoon of the inspection to members of the care staff team were providing one-to-one activities for the residents. One resident was playing cards with the carer and the other was having their nails manicured. Some of the residents had chosen to eat their lunchtime meal in their own rooms. The staff were seen to take trays into the individual residents rooms. One residents relative advised that because her relative had difficult eating she felt more comfortable eating in her own room, the residents confirmed this. The inspector joined the residents in the dining room for the lunchtime meal. Each of the residents were eating their meal at their own pace and the lunchtime was unhurried. Some of the residents said they enjoyed the meals others said they would like more variety. All the residents said the meals are always well prepared and attractively presented and there is choice if they dont like whats on offer. Very little wastage was seen at the lunchtime meal. The three-week rotational menu was provided which had a variety of meals for the residents. The manager confirmed that she had recently reviewed the choice provided at suppertime meal. Visitors were scene coming and going throughout the time of the inspection. The manager advised that she had asked visitors not to visit during lunchtimes to allow the residents to enjoy their meals. Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 13 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) 18, The residents can have confidence that any concerns or wishes they raise with the staff will be dealt with in a sensitive supportive way. EVIDENCE: The manager has provided clear policies for the staff for the protection of residents from abuse. The training staff had received for adult protection had been recorded. The manager advised that she had used an external trainer to provide the training for her staff. The manager confirmed that Staff have an up-to-date CRB and reference checks before they start work at the home. Copies were available for inspection. The complaints procedure was easily available for the residents and staff. The residents asked said they knew who to complain to if they had any concerns and had confidence that they would be treated respectfully Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 14 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, 22, 24, 25, 26 Although suitably qualified occupational therapist has not assessed the home this has not prevented the residents from having access to equipment that helps them maintain their optimum independence. The laundry floor needs to be sealed to allow it to be easily cleaned; this will reduce the risk of cross infection. EVIDENCE: Charterhouse has been adapted from a large private detached house set within its own grounds. The home is attractively presented clean and fresh free from odour. The refurbishment programme started by the current owners has continued with more of the residence rooms being redecorated. The manager confirmed that each of the residence rooms would be redecorated. The home has a spacious lounge, sun lounge and dining room. The sun lounge provides access to a patio terrace overlooking the front garden of the home. The gardens of the home are attractive and Stocked with a variety of colourful shrubs and flowers for the residents to enjoy. Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 15 The home is registered for 20 residents. However the manager has chosen to use the existing shared rooms are as single occupancy rooms this has reduced the available rooms to 17. The home has been adapted over several years to provide accommodation for older people who require care. A shaft lift and stair rider is provided for the residents who are unable to use the stairs. An assessment of the home by a suitably qualified occupational therapist had not been undertaken. However the adaptations provided for the residents were meeting their needs. The views from the home include a panoramic view across Teignmouth towards the sea and Torquay. The residents have access to individual assessments for the equipment they require, which enabled them to maintain their independence. Each of the residence rooms entered had been personalised with items of the residence choice. The manager confirmed that risk assessments had been carried out for the use of lockable doors to the residence rooms. These are not provided at present. The owner confirmed that it was planned to provide locks for all the residence rooms, a suitable lock had been identified and these would be fitted as soon as is practicable. Each resident’s room is naturally ventilated with opening windows and has a good degree of natural light. All but one of the resident’s rooms have windows they can see out of when seated. The residence occupying this room said she was happy with the room and enjoyed watching a television. Emergency lighting is provided throughout the home although this was not tested during the inspection. The home is kept clean by the staff and a domestic is employed for five hours each day. During the tour of the home it was found to be clean and tidy and free from odour in all areas. The small laundry area is set away from the residence rooms. The laundry flooring is made of concrete that has been painted. The paint on the floor had started to peel which could make the floor difficult to clean. The manager advised that the laundry area would be extended to give more room for the staff to work. The washing machine currently in use at the home does not have a disinfecting sluice cycle. The manager confirmed of the new washing machine had been purchased that had a disinfecting sluice cycle. Risk assessment had been completed with a radiator is the use in the home. The owner advised that radiators would continue to be covered or replaced with Cool wall radiators on a risk assessment basis. Furniture in some individual residents rooms had been positioned in front of radiators others had been guarded. Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 16 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) 29, 30, The residents at Charterhouse can have confidence that they are cared for by a well-trained motivated friendly team of staff. EVIDENCE: The duty rota covering two weeks is displayed in the home. This showed the number of staff on duty during the day, evening and night time shifts. Six of the seven comments card received before the inspection identified that the residents or their representatives felt there were enough staff on duty in the home. The residents asked during the inspection didnt comment on the numbers of staff available in the home. The manager has provided a recruitment policy for staff. Two staff files contain the information required which included photographs of the staff member and proof of identity. The recruitment policy adopted by the manager protects the residents from unsuitable staff. The manager provided a list of the training that the staff had undertaken since the last inspection. This included food hygiene and adult protection. The training staff had received is recorded in their personnel files. Copies of certificates staff had received after completing courses were displayed. 50 of the staff employed are trained to NVQ level 2 in care. The home also employs three senior carers with qualifications equivalent to NVQ level 3 from overseas. The residents asked advice that all the carers are friendly and caring towards them. The staff observed interacting with the residents for doing so in a friendly supportive way. Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 17 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) 33, 35, 37, 38 The way the Charterhouse is managed by the current manager ensures that the resident’s best interests are safeguarded. The provision of the results of the quality audit will enable the residents to have access to the views of other about the home they live in. EVIDENCE: The manager has not yet provided a formal quality assurance system that includes the views of the residents. The residents themselves gave the inspector very positive feedback about what its like to live at Charterhouse. The manager confirmed that she was in the process of designing a questionnaire with the residents to complete. The minutes of staff and residents meetings were available these identified how the residents and staff were involved in the day-to-day decision-making within the home. The manager advised that she had used the Commission for Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 18 Social Care Inspection quality assurance audit tool to assess how far she met the standards. This was available for inspection although not reviewed. The manager has a system for handling individual residents money. The records of money held were provided for inspection. The manager confirmed that some of the residents continue to manage their own finances with the support of relatives. The records required for managing a care home were available for inspection. Information was also provided by the manager on the pre-inspection questionnaire regarding the dates when maintenance or health and safety checks were carried out. The residence care plans had been reviewed monthly and had been changed when the residence care needs required this. A copy of the legionella risk assessment was provided. This showed how the manager reduces the risk of legionella infection with the residents. The latest environmental health report was provided; the cook confirmed that the recommendations made in this report had been action. The hazards analysis of the kitchen areas and practices was provided. The meat thermometer is available to check the temperature of the cooked meat. The owner confirmed that they had recently had a new boiler fitted for the central heating and hot water supplied in the home. Risk assessment is an integral part of managing health and safety at Charterhouse. The risk assessments were provided for inspection they showed how the identified risks were minimised to protect residents. Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 19 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 x x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x 2 x 2 3 2 STAFFING Standard No Score 27 x 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 3 x x 2 x 3 x 3 3 Charterhouse Residential Care Home D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 20 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 OP33 Regulation 24(1)(3) Timescale for action The register person shall 31/04/05 establish effective quality extended assurance and quality monitoring 31/12/05 systems, based on seeking the views of service users, and are in place to measure success in meeting the aims and objectives and statement of purpose Requirement RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. Refer to Standard OP12 OP 22 OP 24 OP 26 Good Practice Recommendations How service users are involved in planning the activities provided and making choices should be clear. Information about activities provided should be easily available. The home should ensure the premises and facilities are assessed by an occupational therapist with specialist knowledge of the service uses needs. The home should provide locks for service uses bedrooms that are accessible to staff in the emergency, and within a risk management framework On replacement of the washing machine this should have the specific programming ability to meet disinfection standards. The laundry floor should be easily cleanable D54-D07 S53232 Charterhouse V222773 080605 Stage 4.doc Version 1.30 Page 21 Charterhouse Residential Care Home Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. 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