Inspection on 05/09/06 for Chilton Court Residential Home

This inspection was carried out on 5th September 2006.

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

Chilton Court Residential Home 07/08/07

Chilton Court Residential Home 09/02/06

Chilton Court Residential Home 16/05/05

Chilton Court Residential Home 25/02/05

Chilton Court Residential Home 17/08/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Chilton Court Residential Home Gainsborough Road Stowmarket Suffolk IP14 1LL Lead Inspector Jane Offord Key Unannounced Inspection 5th September 2006 09:30 X10015.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 DS0000024357.V311288.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 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. DS0000024357.V311288.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Chilton Court Residential Home Address Gainsborough Road Stowmarket Suffolk IP14 1LL 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) 01449 675320 01449 675320 simon@stowcare.co.uk Stowcare Limited Mrs Jean Mary Hayward Care Home 47 Category(ies) of Old age, not falling within any other category registration, with number (47) of places DS0000024357.V311288.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 9th February 2006 Brief Description of the Service: Chilton Court is a private residential home for older people. The home was first registered in 1986 to accommodate 19 residents. In April 1998, the original building was converted to accommodate a further four residents. A further extension was added in 2000 taking the number of residents to 33. The owners of Chilton Court have since extended the service provision by the creation of The Courtyard, a care housing complex on the same site as Chilton Court, which was completed in May 2000 and officially opened in September of the same year. The Courtyard enables people to receive support and assistance with personal care in the comfort of their own homes and can accommodate up to 14 residents. This increased the homes registration to 47 residents. Chilton Court and The Courtyard are situated on the Gainsborough Estate, approximately one mile from Stowmarket town centre. The building is in pleasant surroundings with well-maintained gardens and a pond that is home to a large number of ducks. The fees for the residential home range between £450 and £460 per week. The fees in the Courtyard range between £380 and £655 per week. All fees depend on the accommodation occupied, the source of funding and the dependency of the resident. DS0000024357.V311288.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a key unannounced inspection that looked at the core standards for care of older people. It took place on a weekday between 9.30 and 16.00. The registered manager and general manager were both available throughout the day to assist with the inspection process. During the day a number of residents’ files and care plans were seen as were some new staff files, the policy folder, some maintenance records, the duty rotas, menus and the complaints log. The lunchtime medication administration round was followed and some medication administration records (MAR sheets) were inspected. A tour of the main building and the Courtyard was undertaken. A number of staff, residents and visitors were spoken with and observation of care practice was made. Residents were using all parts of the building, which has a number of small seating areas as well as three lounges. Visitors were welcomed and offered refreshment. The home was clean and tidy and residents looked comfortable and were dressed appropriately for the warm day. Interactions between staff and residents was friendly and respectful. The lunchtime meal looked appetising and was clearly enjoyed by residents and visitors. What the service does well: What has improved since the last inspection? The morning routine has been changed to allow a fifth carer to be rostered who will help with personal care until laundry is sent down. They will then work in the laundry. This means between 7.00 and about 9.30 there is an extra person to help with getting people up and breakfasts. DS0000024357.V311288.R01.S.doc Version 5.2 Page 6 There is a clear recent photograph of each resident attached to the MAR sheets for identification. 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. DS0000024357.V311288.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection DS0000024357.V311288.R01.S.doc Version 5.2 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 the following standard(s): 3, 6. Quality for this outcome area was adequate. People who use this service can expect to have a pre-admission assessment of their needs and be assured they can be met before entering the home but they cannot be certain that the assessment will be signed and dated as evidence of when it was completed. This judgement was made using available information including a visit to the home. The service does not offer intermediate care. EVIDENCE: Four residents’ files were seen and each contained a document headed ‘admission assessment’. The assessment covered some personal details and areas of care such as mobility, continence, allergies, personal care, diet, and medication. There was also space for information on past medical history, social background, memory, interests and next of kin. Two assessment documents were dated with the date the resident was admitted to the home although the manager said they had visited the resident prior to admission. A third assessment was not signed or dated but the general manager said the operational manager had assessed that resident prior to admission. DS0000024357.V311288.R01.S.doc Version 5.2 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 the following standard(s): 7, 8, 9, 10, 11. Quality for this outcome area was good. People who use this service can expect to have a care plan and have their health needs met. They can also expect to be treated with respect, have their final wishes noted and be protected by the home’s medication management. This judgement was made using information available including a visit to the home. EVIDENCE: The four residents’ files seen all contained a care plan that had evidence of monthly reviews. Each care plan had headings of physical health, psychological needs and social needs. There were interventions designed to maintain independence for example, ‘Able to manage meals alone. Will choose their own menu’. There were interventions for mobility, pressure area care, personal hygiene, dressing and undressing, communication, sight, hearing and speech. Personal preferences were noted. One resident expressed the wish to receive personal care from a same gender carer. In discussion with a senior carer they said they always facilitated that for the resident. The psychological needs covered orientation, memory, reassurance, mood and motivation. The social needs looked at family involvement, social interactions and interests and hobbies. DS0000024357.V311288.R01.S.doc Version 5.2 Page 10 There was a front sheet for each resident with a photograph of the resident, the next of kin details, GP, the resident’s preferred name, their religion and details of their final wishes. One resident had not wanted to have a photograph taken and a note was made of their decision. There was evidence in the files of input from health professionals such as physiotherapist, chiropodist and dentist. One resident said the chiropodist had visited them last week. The community nurse was visiting the home during the morning and they said that in their professional opinion the home managed residents’ health needs well. The manager and staff made appropriate referrals for assessment and sought their advice in matters of care. Observation of interactions between staff and residents showed friendly respect. Staff knocked on doors before entering rooms and offered residents choice and support sensitively. Residents spoken with said the staff were, ‘very willing and lovely’. The medication administration round at lunchtime was observed. The home uses a monitored dosage system (MDS) supplied by a local pharmacy. The medication trolley is kept securely in a locked room behind the office and the trolley was secured each time the manager left it during the round. Each MAR sheet had a recent photograph of the resident for identification. No signature gaps were noted on the MAR sheets but the code ‘F- define’ was used without a definition. Some ‘as required’ (PRN) medication that gives a choice of dose i.e. one tablet or two, did not always have the number of tablets administered recorded making an audit impossible. The medication policy and procedures were seen and offered comprehensive guidance. There were guidelines on ‘homely’ remedies and on covert administration of medicines. There was a policy for self-medication and an assessment protocol for any resident who wished to self medicate. The manager said the only resident self-medicating at the present time had been assessed as safe and competent. DS0000024357.V311288.R01.S.doc Version 5.2 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 the following standard(s): 12, 13, 14, 15. Quality for this outcome area was good. People who use this service can expect to be able to follow a lifestyle of their choice, maintain contact with family and friends and be offered a well balanced diet. This judgement was made using available information including a visit to the home. EVIDENCE: The activities diary was seen and showed that twice a week an activities facilitator visited the home. It recorded that a variety of quizzes, some reminiscence, discussions about, places in the U.K., people residents were familiar with like Vera Lynn, some sing-along sessions and nursery rhymes residents had taught their children had all taken place in the last few weeks. Two residents talked about a trip to Needham Market Lake that had happened in the last week. They both said how much they had enjoyed the outing. One resident spoken with said they enjoyed the armchair exercises that the carers did with them in the afternoons. One carer said they tried to spend time in the afternoon with residents and would play bingo or cards or offer to take a resident for a short walk outside. The home has a visiting entertainer once a month. Library volunteers bring in a selection of books to residents every fortnight. They were spoken with and said they had a number of residents who use the service; some make specific requests such as, ‘only large print books about cats’. DS0000024357.V311288.R01.S.doc Version 5.2 Page 12 The Stowmarket Salvation Army band visits the home a number of times each year and play hymns and carols for the residents. A Methodist priest also visits monthly and holds a prayer meeting for people who wish to attend. The manager said that at present no one has requested Holy Communion but they would facilitate that if required. During the day a number of visitors came and went. Staff greeted them and they met with the residents in their own rooms or used one of the lounges or small seating areas around the home. One resident had a visit from a longstanding friend who had come from another part of the country. The friend was welcomed to spend the day with the resident and given refreshments and lunch, which they later said was very tasty. A series of menus were seen and showed that for breakfast there is a choice of juice, cereal or porridge and a cooked breakfast and toast. At lunch time there is a choice of two main dishes such as chicken pie or pigs in blankets with mashed or croquette potatoes and fresh vegetables. If a resident likes neither option there is always a selection of salads or omelette available. Dessert on the day was apple pie and custard or blancmange but in addition there was fresh fruit and cheese and biscuits available. Tea time offered a hot snack such as spaghetti on toast with a selection of sandwiches, cakes, fruit flan and mousse. The kitchen was visited and was clean and tidy. There was a range of fresh and dry goods stored appropriately. The refrigerators and freezers were well stocked and there were records of temperatures done daily. In one refrigerator there was some left over food that was not covered, labelled or dated. There were also a number of plastic storage boxes containing cakes that were not dated or identified. DS0000024357.V311288.R01.S.doc Version 5.2 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 the following standard(s): 16, 18. Quality for this outcome area was good. People who use this service can expect to have any complaint taken seriously and investigated and have policies available to staff to protect them from abuse but they cannot be assured that all staff will undergo Protection of Vulnerable Adults training. This judgement was made using information available including a visit to the home. EVIDENCE: The complaints policy was seen and offers privacy to make a complaint, an investigation into any complaint and a time scale for a response. It does not offer a written response to a complaint. The complaint log was looked at and there have been two complaint recorded since the last inspection. One from a relative concerned about a resident falling during the night. The manager had recorded that extra observation of the resident by the staff would take place throughout the night. The other was from a resident in the Courtyard about shortage of cleaners. The manager had recorded that they had employed a new cleaner and were awaiting the Criminal Record Bureau (CRB) check before they could commence work. The POVA policy was seen and offered clear guidance to staff about referrals including details of where the referral forms were kept. It cross-referenced to the Essex POVA guidance. There was a whistle blowing policy in place too. Care staff spoken with said they had had POVA training and the training records seen confirmed this. Ancillary staff, including the maintenance person, had not had POVA training although they had free access to the home and the residents. DS0000024357.V311288.R01.S.doc Version 5.2 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 the following standard(s): 19, 26. Quality for this outcome area was good. People who use this service can expect to live in an attractive, well maintained environment that is clean and has suitable laundry facilities. This judgement was made using information available including a visit to the home. EVIDENCE: The home offers accommodation of thirty-two single rooms with en suite facilities. There are three lounges and a number of small seating alcoves around the home. The Courtyard development offers ten one and two bed roomed houses and bungalows, each self contained and with their own front door. The Courtyard has a communal lounge and dining area with a conservatory leading to a decking area and the gardens. The décor throughout the home is attractive and co-ordinated with the furnishings. The home has a contract with a self-employed maintenance person who works solely for the service three days a week. On the day of inspection they were varnishing the external window frames before the winter weather arrived. They said there is a rolling programme of redecoration in the home. DS0000024357.V311288.R01.S.doc Version 5.2 Page 15 The laundry was seen and was clean and tidy. There were separate hand washing facilities equipped with liquid soap and paper towels. Staff spoken with were able to explain the infection control policy in relation to managing soiled linen. Alginate bags are used to transport soiled linen, which are then put directly into the washing machines on a sluice wash, avoiding additional handling. Residents seen all looked well dressed with tidy, clean clothing appropriate for the warm weather. Residents and visitors said the laundry service was good and clothing was returned promptly and in good condition. DS0000024357.V311288.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality for this outcome area was good. People who use this service can expect to be supported by correctly recruited, well trained staff. This judgement has been made using information available including a visit to the home. EVIDENCE: Three staff files were seen and each contained evidence of a Criminal Record Bureau (CRB) check having been done before the person started work in the home. There were three references for each staff member and a contract of employment. There was evidence of an induction programme that was to be completed over the first six weeks. The programme covered confidentiality, use of the emergency call system, fire procedures, the home’s policies, kitchen hygiene and cleanliness, infection control and moving and handling. After induction staff are supported to complete Stowcare foundation training in preparation for enrolling for NVQ level 2. The foundation training included promotion of empowerment and antidiscriminatory practice, recognising abuse, communication, understanding the constraints of communal living and identifying individual needs. The home employs twenty-six care staff of whom eight hold an NVQ qualification with a further four completing the course at the present time. Staff spoken with confirmed that they had had induction and then attended other courses such as fire awareness and moving and handling on a regular basis. DS0000024357.V311288.R01.S.doc Version 5.2 Page 17 Senior staff have training with a recognised pharmacy before undertaking medication administration. One carer said the manager had then observed them a number of times for competency prior to being allowed to give medication alone. The duty rotas were seen and showed there were five carers on an early shift, four during the afternoon and evening and two overnight. The manager and deputy manager worked opposite each other usually and were supernumerary. In addition there were domestic and administration support with a cook and kitchen assistant responsible for the meals. Rotas have recently been adjusted to make the morning routine more flexible. There are now five carers rostered and one of them has responsibility for the laundry. As washing does not begin to reach the laundry until about 9.30, as people get up, the carer works on the floor helping with the morning routine and breakfasts until then. This is working well, one of the carers said, and means residents have more choice about the time they get up and have breakfast. DS0000024357.V311288.R01.S.doc Version 5.2 Page 18 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 31, 33, 35 and 38 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, 36, 38. Quality for this outcome area was adequate. People who use this service can expect that a competent person manages the home but they cannot be assured that their opinions will be sought, that all recommendations made for their safety will be complied with or that all staff will receive supervision. The home does not manage any finances for residents. This judgement was made using information available including a visit to the home. EVIDENCE: The manager has an NVQ 4 in care management and has worked caring for older people for many years. They have been at Chilton Court since 1989 and during that time have gained a series of promotions to reach their present position. Staff spoken with said the management team was approachable and had regular meetings with senior staff. Previous inspections have found that no personal monies for residents are handled by the home. The general manager confirmed this. DS0000024357.V311288.R01.S.doc Version 5.2 Page 19 As noted in the last inspection report the latest quality assurance survey was undertaken in February 2005. An external company had done it and the general manager said it had been costly. In discussion it was clarified that it was unnecessary to go to a lot of expense to canvass residents’ opinions of the service they receive, but regular dialogue was part of ensuring people were getting a service that suited them. Some staff spoken with said that they had supervision with the manager but other staff said they did not. The manager said a programme of supervision has been commenced but needs to be extended and the intention is to train senior carers to give supervision to their own teams. The accident/incident records were inspected. There were mainly falls with no injury but there were several records for one resident who had fallen out of bed a number of times. The manager said that the person’s bed had been moved to allow management of a sacral sore. The sore had healed, the bed was in its former position and the resident had had no further falls. A number of certificates for equipment checks were seen. Fire alarms and emergency lighting had been checked in March 2006. Certificates were seen for stair lifts in the Courtyard and the main home’s lift and were dated July 2006. The certificate for employers liability insurance was valid until May 2007. Three hoists had been checked on September 1st 2006 and were deemed safe. A gas inspection on 24/11/05 had left some recommendations but the general manager was not able to confirm that these had been actioned. DS0000024357.V311288.R01.S.doc Version 5.2 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 2 DS0000024357.V311288.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? YES. 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 (1) (a) (b) (c) (d) 13 (2) Requirement Pre- admission assessment documents must clearly indicate when the assessment was undertaken and by whom. Mar sheets must be correctly completed to include a reason why medication has not been given and the amount given if there is a choice of dose. Stored, prepared food must be labelled, dated and covered. All people who work at the home must have POVA training. This is a repeat requirement from the previous inspection. A system for regular consultation with the residents and their representatives about the service they receive must be established. This is a repeat requirement from the previous inspection The system for staff supervision must be extended to all staff. This is a repeat requirement from the previous inspection Evidence must be provided to CSCI that the recommendations made following the gas DS0000024357.V311288.R01.S.doc Timescale for action 05/09/06 2. OP9 05/09/06 3. 4. OP15 OP18 16 (2) (g) 13 (4) (c) 13 (6) 05/09/06 30/11/06 5. OP33 24 (3) 30/11/06 6. OP36 18 (2) 30/11/06 7. OP38 13 (4) (c) 31/10/06 Version 5.2 Page 22 inspection have been actioned. 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 DS0000024357.V311288.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ 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 DS0000024357.V311288.R01.S.doc Version 5.2 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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