Inspection on 04/10/05 for Cherry Trees Care Home

This inspection was carried out on 4th October 2005.

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

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

Other inspections for this house

Cherry Trees Care Home 03/12/09

Cherry Trees Care Home 08/05/09

Cherry Trees Care Home 30/01/08

Cherry Trees Care Home 10/01/07

Cherry Trees Care Home 19/04/05

Cherry Trees Care Home 06/12/04

Cherry Trees Care Home 21/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

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

CARE HOME MIXED CATEGORY MAJORITY OLDER PEOPLE Cherry Trees Care Home Cherry Trees Care Home Stratford Road Oversley Green Alcester Stratford Upon Avon B49 6LN Lead Inspector Jo Johnson Unannounced Inspection 4th October 2005 09:30 X10029.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People and 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. Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cherry Trees Care Home Address 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) Cherry Trees Care Home Stratford Road Oversley Green Alcester Stratford Upon Avon B49 6LN 01789 764022 01789 764024 Barchester Healthcare Homes Limited Care Home 81 Category(ies) of Dementia - over 65 years of age (67), Old age, registration, with number not falling within any other category (67), of places Physical disability (14) Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Provider must ensure that all nursing and care staff receive accredited/certificated training in care for people with dementia. 19th April 2005 Date of last inspection Brief Description of the Service: Cherry Trees Care Home is situated approximately half a mile from Alcester town centre along the main road through Oversley Green. The area is very rural with infrequent public transport and the nearest shops are half a mile away. The care home can accommodate up to 81 people. The registration of the care home includes older people, older people with dementia and younger people with physical disabilities. The home is divided into dedicated living units for each client group. Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over 2 days. The first day was unannounced and the second day was announced in order to spend time with the new manager of the home. This was the second visit of the inspection year. The inspection was spent talking with and observing the people who live and work at the home. Care, staff and maintenance records were inspected. Relatives were spoken with. What the service does well: What has improved since the last inspection? The home is starting to feel more homely and lived in. The staff’s understanding of dementia care and an improved standard of dementia care is being provided to residents. Staff are being trained in dementia care. There is better management and deployment of staff throughout the home. There are more staff working at the home and the number of staff working long hours and subsequent days has reduced. Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 6 Staff now respect residents’ dignity whilst eating and drinking and whilst being assisted to move. 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. Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home Health and Personal Care Daily Life and Social Activities Complaints and Protection Environment Staffing Management and Administration Scoring of Outcomes Statutory Requirements Identified During the Inspection Older People (Standards 1–6) (Standards 7-11) (Standards 12-15) (Standards 16-18) (Standards 19-26) (Standards 27-30) (Standards 31-38) Adults 18 – 65 (Standards 1–5) (Standards 6, 9, 16 and 18–21) (Standards 7, 15 and 17) (Standards 22–23) (Standards 24–30) (Standards 31–35) (Standards 8, 10 and 37–43) Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 (Older People) and Standards 1 – 5 (Adults 18 – 65) are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. (YA NMS 1) Each service user has a written contract/ statement of terms and conditions with the home. Each Service User has an individual contract or statement of terms and conditions with the home. (YA NMS 5) No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Prospective Service Users’ individual aspirations and needs are assessed. (YA NMS 2) Service users and their representatives know that the home they enter will meet their needs. Prospective Service Users know that the home they choose will meet their needs and aspirations. (YA NMS 3) Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Prospective service users have an opportunity to “test drive” the home. (YA NMS 4) Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. 6. The Commission considers Standards 3 and 6 (Older People) and Standard 2 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 The assessments completed by staff at the home, prior to residents moving in, ensures that residents’ personal and health care needs can be met by the staff working at the home. However, some ongoing assessments do not always have sufficient information to ensure that resident’s needs can be met. EVIDENCE: Standard 3 was fully assessed at previous inspection. Progress on meeting the requirement was assessed at this inspection. Six residents assessments and care plans were seen, this included 3 recently admitted residents. The assessments completed for new admissions were more comprehensive than at the last inspection. Pre admission assessments were completed appropriately for new residents. However, one resident who was Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 9 identified as nutritionally at risk was not weighed on admission. Ongoing pressure area assessments had not been reviewed for one resident even when a pressure area was recorded in the care notes. The residents’ assessments, care plans and care records have been reorganised since the last inspection. Staff commented that they were much easier to follow and to find relevant information. There has been progress made on meeting the requirement from the previous inspection. The requirement will be carried forward and a new timescale for completion given. Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 (Older People) and Standards 6, 9, 16, 18 –21 (Adults 18-65) are: 7. The service user’s health, personal and social care needs are set out in an individual plan of care. Service Users know their assessed and changing needs and personal goals are reflected in their individual plan. (YA NMS 6) Also Service Users are supported to take risks as part of an independent lifestyle. (YA NMS 9) Service users’ health care needs are fully met. Service Users physical and emotional health needs are met. (YA NMS 19) 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, retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicine. (YA NMS 20) Service users feel they are treated with respect and their right to privacy is upheld. Service Users rights are respected and responsibilities recognised in their daily lives. (YA NMS 16) Also Service Users receive personal support in the way they prefer and require. (YA NMS 18) Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The ageing, illness and death of a Service User are handled with respect and as the individual would wish. (YA NMS 21) 8. 9. 10. 11. The Commission considers standards 7, 8, 9 and 10 (Older People) and Standards 6, 9, 16, 18, 19 and 20 (Adults 18-65) are the key standards to be inspected at least once during a 12 month period JUDGEMENT – we looked at outcomes for the following standard(s): 7 Care plans have improved since the last inspection. However, some important elements of care plans or risk assessments have not reviewed or updated to safely ensure that staff have the current information to meet the resident’s needs. EVIDENCE: There was evidence of improved care planning at the home. The residents’ relatives or representatives had signed some care plans seen. The care plans seen on the dementia care unit now focus on aspects of daily living and this is Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 11 positive progress. The change in focus was evident in the way staff are starting to work and interact with the residents. Risk assessments and care plans had not been routinely reviewed on a monthly or when a resident’s needs change. Not all care plans included recent photograph of the resident. Moving and handling risk assessments and plans are now in place. The residents’ personal profiles or life histories are now stored with care plans. They did not all include sufficient information for staff to be able to have a good understanding of the individuals that they were working with. There has been progress made on meeting the requirements from the previous inspection. The requirements will be carried forward and a new timescale for completion given. Previous poor practices relating to how staff assisted residents to eat have now stopped. There was a relaxed atmosphere during lunchtime and residents’ needs were managed sensitively. Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 (Older People) and Standards 7, 11– 15 and 17 (Adults 18-65) are: 12. 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 have opportunities for personal development. (YA NMS 11) Also Service Users are able to take part in age, peer and culturally appropriate activities. (YA NMS 12). Also Service users engage in appropriate leisure activities. (YA NMS 14) Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service Users are part of the local community. (YA NMS 13) Also Service Users have appropriate personal, family and sexual relationships. (YA NMS 15) Service users are helped to exercise choice and control over their lives. Service Users make decisions about their lives with assistance as needed. (YA NMS 7) Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. Service Users are offered a healthy diet and enjoy their meals and mealtimes. (YA NMS 17) 13. 14. 15. The Commission considers standards 12, 13, 14 and 15 (Older People) and Standards 12, 13, 15 and 17 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,15 Residents are able to have visitors when they choose and are supported to maintain community contacts. Some residents are able to exercise choice and control over their lives. Staff need to provide additional support to residents with dementia and complex ways of communicating to enable them to exercise choices. EVIDENCE: Residents said that they could see their relatives in private. Relatives were seen in residents’ bedrooms and those spoken with said that they were made welcome. Some residents were going into the local town to visit a traditional ‘Mop’ fair. Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 13 Residents said that it was good that they are able to visit the local town as the home is in a rural location. Residents manage their own financial affairs whilst they are able to. One resident has an independent financial advocate. Residents are able to bring in their own personal possessions and this is evident in their bedrooms. Residents with dementia were not offered any visual or verbal choices of food. Some people who live at the home who have differing ways of communicating are not able to understand the written information or complaints procedures. Using other formats including pictures and photographs should be developed. These recommendations are carried forward. Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 – 18 (Older People) and Standards 22 – 23 (Adults 18-65) 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 feel their views are listened to and acted on. (YA NMS 22) Service users’ legal rights are protected. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Service users are protected from abuse. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) The Commission considers standards 16 and 18 (Older People) and Standards 22 and 23 (Adults 18-65) 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 The policies and procedures and staff’s improved understanding of recognising and reporting abuse provides protection to residents. EVIDENCE: Recognising and reporting types of abuse is covered in the staff induction training. The recognising and reporting of abuse has been raised and discussed in recent team meetings. Staff spoken to had an understanding of recognising and reporting abuse. Any allegations and incidents of alleged abuse have been managed and referred to other agencies appropriately by the manager. Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 (Older People) and Standards 24 – 30 (Adults 18-65) are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) Service users have access to safe and comfortable indoor and outdoor communal facilities. Shared spaces complement and supplement service users’ individual rooms. (YA NMS 28) Service users have sufficient and suitable lavatories and washing facilities. Service Users toilets and bathrooms provide sufficient privacy and meet their individual needs. (YA NMS 27) Service users have the specialist equipment they require to maximise their independence. (YA NMS 29) Service users’ own rooms suit their needs. Service Users’ own rooms suit their needs and lifestyles. (YA NMS 25) Service users live in safe, comfortable bedrooms with their own possessions around them. Service users’ bedrooms promote their independence. (YA NMS 26) Service users live in safe, comfortable surroundings. Service Users live in a homely, comfortable and safe environment. (YA NMS 24) The home is clean, pleasant and hygienic. The home is clean and hygienic. (YA NMS 30) The Commission considers standards 19 and 26 (Older People) and Standards 24 and 30 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The key standards were assessed at the previous inspection and were met. EVIDENCE: Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 16 Staffing The intended outcomes for Standards 27 – 30 (Older People) and Standards 31 – 35 (Adults 18-65) are: 27. 28. 29. Service users needs are met by the numbers and skill mix of staff. Service users are supported by an effective staff team. (YA NMS 33) Service users are in safe hands at all times. Service Users are supported by an effective staff team. (YA NMS 32) Service users are supported and protected by the home’s recruitment policy and practices. Service Users benefit from clarity of staff roles and responsibilities. (YA NMS 31) Also Service Users are supported and protected by the home’s recruitment policy and practices. (YA NMS 34) Staff are trained and competent to do their jobs. Service Users individual and joint needs are met by appropriately trained staff. (YA NMS 35) 30. The Commission considers standards 27, 28, 29 and 30 (Older People) and Standards 32, 34 and 35 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 There are now more staff employed at the home to safely support the needs of the residents. Some staff working long hours and subsequent days without sufficient rest periods puts the safety and well being of residents at risk. Staffing levels need to be maintained to ensure that there continues to be enough staff to meet the needs of the residents. The procedures for the recruitment of staff through the international recruitment agency are not robust. Appropriate pre employment checks are not being carried out or evidenced in the home thus potentially leaving residents at risk. EVIDENCE: There were enough staff on duty throughout the home during the inspection to meet the needs of the residents. Rotas showed that there were times when there were less staff on duty, specifically on the dementia care unit. Staff commented that it was difficult to care for residents in the same way when staffing levels were reduced. Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 17 From discussion with the manager the agreed staffing levels for the dementia care unit were: 2 RGNs plus 6 carers in the mornings, 1 RGN plus 5 carers in the afternoon and 1 RGN plus 1.5 carers at night. The staffing levels must be maintained at this level to ensure that the residents’ needs are met. Staff rotas show that some staff are continuing to work long hours and for up to 10 subsequent days without a day off. There has been a general reduction in the number of hours that staff are working and this is positive progress. However, the requirement to reduce staff to a working week of 70 hours remains and must be met. The manager said that there are now only four carers vacancies at the home and there enough staff employed to cover for sickness, staff training and holidays. Three staff files were seen. They were all recent recruits including two who had been recruited by the organisation’s international recruitment agency. The member of staff who was recruited locally had been through all of the required recruitment checks and the correct evidence of her identification was in her file. Two of the staff who had been recruited by the international agency, had arrived to live in the staff accommodation without sufficient evidence of their fitness or suitability to work at the home. The manager also said that the staff had arrived at the staff accommodation before she had received their staff files. These practices place the residents at risk and must cease. Progress is being made on meeting the conditions of registration relating to all staff having dementia care training. This was evident in the improved staff interactions and understanding of the residents living on the dementia care unit. Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 (Older People) and Standards 8, 10, 23, 37 – 43 (Adults 18-65) are: 31. 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 a well run home. (YA NMS 37) Service users benefit from the ethos, leadership and management approach of the home. (YA NMS 38) The home is run in the best interests of service users. Service Users are consulted on and participate in, all aspects of life in the home. (YA NMS 8) Also Service Users are confident their views underpin all selfmonitoring, review and development by the home. (YA NMS 39) Service users are safeguarded by the accounting and financial procedures of the home. Service Users benefit from competent and accountable management of the service. (YA NMS 43) Service users’ financial interests are safeguarded. Service Users are protected from abuse, neglect and self-harm. (YA NMS 23) Staff are appropriately supervised. Service Users benefit from well supported and supervised staff. (YA NMS 36) Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. Service Users know that information about them is handled appropriately, and that their confidences are kept. (YA NMS 10) Also Service Users rights and best interests are safeguarded by the home’s policies and procedures. (YA NMS 40) and (YA NMS 41) The health, safety and welfare of service users and staff are promoted and protected. The health, safety and welfare of service users and staff are promoted and protected. (YA NMS 42) 32. 33. 34. 35. 36. 37. 38. The Commission considers standards 31, 33, 35 and 38 (Older People) and Standards 37, 39 and 42 (Adults 18-65) the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 The home is being managed effectively through a period of change. Systems are being established to ensure that the home is run and managed in the best interests of the residents. The finances, health, safety and welfare of the residents and staff are promoted and protected. Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 19 EVIDENCE: The organisation has a quality assurance system that the manager is now implementing. Monthly audits will be completed in order to monitor standards. The manager is developing ways of consulting directly with residents and relatives at the home. The organisation also sends out questionnaires to residents, relatives and staff and the manager then develops an action plan based on the results. Policies, procedures and the safe keeping of residents’ monies are safe. The administrator audits the records and accounts on a monthly basis and the records are audited annually by the organisation. The manager now informs the Commission of events under Regulation 37 and the Regional Director is visiting the home on a monthly basis to talk to residents, staff and look at records. All electrical, water and heating systems have been serviced. Specialist bathing and hoisting equipment has also been serviced. There are good systems in place for the regular maintenance and testing of equipment etc in the home. Fire records and test were up to date. Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 2 4 X 5 X 6 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 3 ENVIRONMENT Standard No Score 19 x 20 x 21 x 22 x 23 x 24 x 25 x 26 x STAFFING Standard No Score 27 2 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No Score 31 3 32 X 33 3 34 X 35 3 36 X 37 X 38 3 Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 21 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 OP3 Regulation 14 Requirement Assessment of needs must be completed in sufficient detail to ensure that staff can meet the needs of residents. (Part met, Previous timescale 01/07/05) Care plans must be person centred, based on residents strengths and abilities. They must include attention to communication, psychological, personal care and social care needs. Care plans from other professionals must be evident in care records. Care plans must include a recent photograph of the resident. Document the involvment of residents and/or relatives in the development and review of care plans. (Part met, previous timescale 01/07/05) Life histories must be completed for people with dementia and people who do not communicate verbally. ( part met, previous timescale 01/07/05) DS0000032656.V260045.R01.S.doc Timescale for action 01/01/06 2 OP7 15 01/01/06 2 OP7 14,15 01/01/06 Cherry Trees Care Home Version 5.0 Page 22 3 OP27 13,18 4 OP27 18 5 OP29 19 6 OP29 19 The Registered Manager must ensure that staff do not work excessive hours and days without sufficent rest. Staff must work less than 70 hours a week. (part met, previous timescale 16/05/05) The Registered Manager must maintain the staffing levels on the dementia care unit (as agreed at this inspection and recorded in this report). The Registered Manager must ensure that the international recruitment agency completes all pre-employment checks prior to staff starting work. (previous timescale 16/05/05) The registered manager must receive potential staff files prior to the staff arriving to live in the staff accomodation at the home. 01/11/05 01/11/05 01/11/05 01/11/05 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 OP10 OP10 OP12 OP16 Good Practice Recommendations Consider how the payphone can be used in a private area and any possibilities should be implemented. Residents with dementia and or complex ways of communicating should be offered visual choices of food. A dementia care mapping exercise should be undertaken to establish whether residents are in well being. A complaints procedure supported by pictures and photographs be developed. Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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. Cherry Trees Care Home DS0000032656.V260045.R01.S.doc Version 5.0 Page 24 - 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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