Inspection on 19/06/06 for Chestnuts

This inspection was carried out on 19th June 2006.

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

Other inspections for this house

Chestnuts 30/04/08

Chestnuts 27/09/05

Chestnuts 27/04/05

Chestnuts 07/09/04

Chestnuts 26/07/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Chestnuts Yapton Road Barnham Bognor Regis West Sussex PO20 0AZ Lead Inspector Mrs H Church Unannounced Inspection 19th June 2006 04:00 Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chestnuts Address Yapton Road Barnham Bognor Regis West Sussex PO20 0AZ 01243 554678 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) jotargett1@ntlworld.com www.care-ltd.co.uk CARE (Cottage and Rural Enterprises Ltd) Miss Joanne Targett Care Home 6 Category(ies) of Learning disability (6), Learning disability over registration, with number 65 years of age (3) of places Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 6 persons in the registration category LD (persons with learning disabilities) of whom up to three (3) may be in the category LD(E) over the age of sixty five years. 27th September 2005 Date of last inspection Brief Description of the Service: Chestnuts is registered to accommodate up to six service users in the category LD (Learning Disability) aged 18 to 65 years. The establishment is situated in the village of Barnham, close to train and bus services and local shops. All rooms are for single occupancy. The service is a voluntary charity. The registered providers are ‘CARE’. The responsible individual on behalf of the charity is Mr Michael Keighley and the registered manager is Ms Joanne Targett. Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors planned for this site visit, revisiting previous reports, letters, Regulation 26 reports and any accident or incident forms received since the previous inspection. The home’s documents had been reviewed to inform residents about the service and how to be involved in making changes. The manager joined the inspectors and was present for the majority of the Site Visit. The residents were in the main workshop block initially but returned to Chestnuts at the end of their working day to meet with the inspectors, have their evening meal and follow their personal programme of activities. It was clear from resident’s comments, manner and demeanour that they felt part of a large family; coming together at the end of the day and sharing their experiences. All of the residents were happy and relaxed in their chosen activities. During the inspection, four records and the six residents were seen during the inspectors’ site visit. One member of staff was on duty with the manager and gave her views on the support mechanisms to provide the care required. Speaking with residents and observing their interactions with each other and the staff as they prepared their evening meal followed a tour of the building. All of the residents were able to give a clear account of their lives at Chestnuts and all were enthusiastic. It was clear that residents are encouraged to say what they like or don’t like about the home. There was one requirement made at this inspection regarding the care plans for updated information not amalgamated into individuals care plans but subsequent to this site visit, this was actioned prior to the report being published. Outcomes for residents were good but poor record keeping could result in residents being unprotected from staff not being fully conversant with their care needs. What the service does well: Chestnuts continue to value resident’s individual and collective needs in a warm, homely and friendly environment. Residents are encouraged to own it as their own home and live their lives in it to the fullest extent. A high standard of staff recruitment and training ensures residents are supported to seek out new opportunities and develop their independence. Outcomes for residents are good with staff committed to individuality and treating residents with respect and dignity. Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 Trial visits are provided according to the individual and collective needs of the residents. Care plans are well documented and residents are provided with full information of care and services. Contracts are provided. Quality in this outcome area is good. This judgment has been made from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. EVIDENCE: No new residents had been admitted since the previous inspection but trial visits are still provided and form the basis of care provided. Visits of varying lengths are agreed with CARE, the prospective resident, any professionals involved and representatives of the prospective resident and during the trial visit, their interaction with current residents is assessed before a commitment is made. The manager is involved in all initial assessments. The home’s documents were seen in a pictorial format and every resident is provided with this and an updated copy when reviewed. These include the Statement of Purpose, Service Users Guide and the Contract agreed with individual residents. Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9,10 Residents are consulted and involved in decisions involving their individual and collective care and supported to take reasonable risks in both the care home and work placement. Independent living is available and residents have full choice about their work, home and social activities. Quality in this outcome area is adequate. This judgment has been made from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. EVIDENCE: Four records were examined by two inspectors and all contained records of treatment and rehabilitation covering aspects of personal, social support and health care needs (See Standard 19) but the records did not contain updated care plans formulated from reviews held over the past year. For some residents, it is accepted that their overall care had not changed but for most residents, the risk levels may need to be adjusted as new aspirations and activities are agreed. Future aspirations form the basis of care and three of these had not been updated although it was clear from the draft reviews seen, that these had changed. Risk assessments were seen in all the care plans viewed but all of these were out-of-date. It was clear from discussions with Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 10 staff that staff are fully aware of the holistic care needs of all the residents but the inspectors were concerned that new staff would not be aware of current information without intervention from long term staff. This would inevitably undermine their role within the home, causing residents to lose confidence in their ability to fully understand and provide their care. A requirement was made on this aspect. Enthusiastic comments from residents on all aspects of their lives showed that the home is being run according to the residents needs and wishes. Residents make decisions about their lives, participate in the day-to-day running of the home and contribute to the development and review of policies and procedures. One resident had been involved in the interview process being held that day for bank staff. This demonstrates how residents are being involved. One resident was reassessed under the Home Alone policy for supervised activities whilst another reassessed for additional supervision due to poor hearing. Information on these aspects of care was well documented. Resident’s rights to privacy and dignity are being maintained and written information in used in accordance with the Data Protection Act. Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17. All residents have opportunities for personal development and to take part in activities in the community. Personal activities and relationships are respected and forming new relationships encouraged accordingly. The meals provided are nutritious and meet the needs and wishes of the residents. Quality in this outcome area is excellent. This judgment has been made from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. EVIDENCE: Residents can take part in group and individual activities, inside, outside and within the local community and with their peer group and families. The formal reviews seen contained all the information available from resident’s abilities to develop independence within Main Site’s workshops to personal interactions with staff, other residents, family members and contacts in the community. It was clear that resident’s leisure activities and personal family contacts were being maintained and had goals set to develop these. Residents can attend educational courses, training events with CARE or take outside employment. Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 12 One elderly resident plans the garden and produce, selling this to purchase plants and garden equipment. Residents can choose holidays either with group or individually. Social activities include barbeques and events where families, friends and neighbours in the community could be included. One resident has planned a “Healthy Eating” talk for the Main Site’s Family Open Day in June. Many residents were looking forward to the fun competitions arranged. Activities are provided within Chestnuts and residents encouraged to pursue their own hobbies and interests. One resident has taken up horse riding and won four rosettes. Another resident is involved in local groups providing a secretary’s role to one and treasurer to another. Daily routines and house rules promote independence and staff support family links and friendships. Residents are consulted at all times to make informed choices and decisions. The choice, shopping, preparing and cooking of food is very much led by residents with staff supervision. Emphasis is placed on healthy eating with residents taking turns to choose the menus, shop and assist with cooking the meals. It was clear that residents health and well being are promoted with a varied, balanced diet provided at times to suit the needs and wishes of the residents. The nutritional assessments recorded in the records are accommodated in the catering. Four separate meals were being prepared as per resident’s requests. One resident told the inspectors they could choose what they wanted. Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20. Residents receive personal care and or supervision and are supported to manage their own medication. The system for recording, storing, handling and disposal of drugs met the Medicines Act 1968, guidelines from the Royal Pharmaceutical Society and the requirements of the Misuse of Drugs 1971. Quality in this outcome area is good. This judgment has been made from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. EVIDENCE: Four records were seen to include the health, care needs of the resident. A thorough health care assessment had been carried with the resident who was frequently having falls. This assessment identified all aspects of the person’s health and an appointment has been brought forward with the consultant and to have a scan. The inspectors observed a new Health Care document in pictorial format being used to assess resident’s full health care needs. This document will assist other healthcare professionals understand the resident’s particular needs and help the person understand and protect their own health. Nutritional assessments formed part of the care plans where this had been assessed as a need. Evidence of the involvement of the professional was seen Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 14 and the resident or their relative had signed the reviewed care needs assessment. However, a number of reviews were still in draft form and not typed up for relatives or their representatives to sign. health care needs. The home’s medication procedures demonstrated safe practice with the handling, administration, storage and disposal of medicines. Each resident’s record included information on the purpose, side effects and overdose of each medication and the prescribed medication recorded in the case notes, compared accurately to the MAR sheets. All staff have been trained and assessed as competent to undertake the procedure. A pharmacy inspection is planned. MAR charts were accurate with no gaps noted in recording of administration of medicines. Self-administration is monitored and the risk assessment included in the records but not updated although staff said this had not changed. There are policies and procedures informing residents about medication to protect the health and welfare of the residents but these were not examined . Two Accident Records were examined and the inspector spoke to the manager and deputy manager about the health care provided. Both were well informed about individual health care needs. Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23. Residents are protected from abuse; self harm or neglect and involved in all discussions on all aspects of their daily lives. A complaints procedure is displayed and available in the Statement of Purpose and Service Users Guide. Quality in this outcome area is good. This judgment has been made from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. EVIDENCE: The complaints procedure is included in the Statement of Purpose and Service Users Guide and in a format suitable for this client group. No complaints had been recorded recently but previous records showed a full investigation was made within the time limits, action taken and the complainant informed of the results. Financial procedures were sampled and these records were well managed with residents having good access to their personal records. The inspector observed there was safe storage of money and valuables and consultations on resident’s finances remained confidential with the persons concerned. Residents meet regularly to discuss their views about the way the home is run and issues of concern in a group. Their views are recorded. Any areas of dissatisfaction are noted and action taken. No relative was visiting at the time of the inspection but four residents told the inspector if there was anything they were unhappy with anything, they would tell the staff or manager. The manager confirmed that residents had been Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 16 given a copy of the complaints policy and that it has been explained to them. A pictorial comment card was discussed with the residents and it was clear that there were no concerns at present. The member of staff on duty confirmed that in-house training for Adult Protection Training had been given recently. The West Sussex Multi Agency Guideline was present in the office. Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,29,30. The communal areas and resident’s bedrooms generally met these standards with specialist equipment present in areas where staff are required to assist with resident’s physical needs. Quality in this outcome area is good. This judgment has been made from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. EVIDENCE: The lounge/dining room was of a suitable size and arranged to allow residents to participate in activities. It included a television, music equipment, puzzles, games and a computer situated outside the room for residents to enjoy without impinging on the television. It was clean and bright with suitable furniture and furnishings. The kitchen and laundry facilities are suitable for the number of people who live there. There are handrails on the stairs but the manager said that none of the service users currently have any difficulty using the stairs. If this changes, a ground floor room may be needed if available. . Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 18 All accommodation is in single rooms with one room having an en-suite shower. Resident’s rooms were of a good size and decorated in individual styles with personal items arranged according to their wishes. Residents were able to display items and all rooms were lockable. Four residents said they were very happy with their rooms and have the support of staff if needed to keep their space clean and tidy. Window restrictors are not required for this client group but there are radiator covers to protect residents from scalds and burns. Toilets and bathroom facilities are arranged to meet individual needs with specialist equipment to assist residents with mobility needs if required. All areas are well maintained, with a programme of redecoration and refurbishment in place. Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,35,36. Staff are recruited according to robust recruitment procedures and receive training and supervision. Quality in this outcome area is good. This judgment has been made from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. EVIDENCE: There is a small but dedicated staff team employed at Chestnuts with bank staff covering absences. All staff have received Criminal Records Bureau clearance and Protection of Vulnerable Adults checks prior to their employment and this was confirmed with the deputy manager on duty. Staff are provided with job descriptions to ensure they understand their individual and team role. Two staff records showed the recruitment process is thorough. Three references are standard; an Application Form, Interview Format and staff contract were seen in place even where staff had applied for senior posts. A thorough induction programme includes the mandatory health and safety training. The staff spoken with said that the training opportunities are very Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 20 good and that staff are encouraged and supported to apply for training. A training manager has been employed since the last inspection to identify specialist courses and coordinate the training needs of all staff. A specialist course dovetails with the Induction and foundation courses and all staff are expected to undertake National Vocational Qualifications. Although staffing levels seemed sufficient to meet residents “hands on” needs, the major delay in finalising reviews (some dated 2005), agreeing these and formulating care plans from this information, did present a risk to residents. An additional member of staff would provide management time for this vital work to be done. This would also ensure residents could be diverse at weekends in their activities as staff numbers were limited at this time. Supervision is being provided as required and the deputy manager confirmed this. Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37,38,39,40,41,42,43. The management style benefits and protects residents whose views are respected whilst acknowledging their rights as citizens. A new business plan has been made available. Quality in this outcome area is good. This judgment has been made from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. EVIDENCE: The care records did include some information on the health, safety and welfare needs to be met but as the review information had not been included, outcomes for residents were based solely on staff knowledge, leaving residents at risk from poor information. However, staff were provided with basic knowledge and supported the main aims and values of the home. The records show that staff are appropriately trained to identify and meet residents needs. The registered manager is well qualified and experienced but is focussing on being “hands on” , dealing with the immediate needs of Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 22 residents. Clerical support or more staffing hours would ensure staff are deployed to meet immediate needs but also ensure records reflect the up-todate care needs of residents. Policies and procedures were not examined on this occasion as they are regularly updated by the organisation. A Quality Monitoring Assurance System is in place for residents but not examined and the Family Forum is discussing implementing a questionnaire for representatives and visitors to the home. Financial procedures for residents are robust with accurate records kept of all transactions. Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 3 30 3 STAFFING Standard No Score 31 3 32 3 33 2 34 4 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 4 2 3 LIFESTYLES Standard No Score 11 4 12 3 13 3 14 4 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 X X 2 3 3 Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 24 NO 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Worthing LO 2nd Floor, Ridgeworth House Liverpool Gardens Worthing West Sussex BN11 1RY 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 Chestnuts DS0000014446.V299127.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!