Inspection on 28/02/07 for Clara Court Care Home

This inspection was carried out on 28th February 2007.

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

Clara Court Care Home 29/07/07

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Clara Court Care Home 21 Courthouse Road Maidenhead Berks SL6 6JE Lead Inspector Julie Willis Unannounced Inspection 28th February 2007 10:00 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 DS0000067946.V328561.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. DS0000067946.V328561.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Clara Court Care Home Address 21 Courthouse Road Maidenhead Berks SL6 6JE 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) 01628 776022 manager.burroughs@careuk.com Care UK Community Partnerships Limited Post Vacant Care Home 76 Category(ies) of Dementia - over 65 years of age (61), Old age, registration, with number not falling within any other category (15) of places DS0000067946.V328561.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A Brief Description of the Service: Care UK Residential Services operate 49 care homes throughout England & Scotland in partnership with the public sector. Clara Court opened for business in 2006. Clara Court has 76 beds and provides care and support for 76 older people. Built over 3 floors, the home provides respite and residential care for frail older people and includes accommodation for those with Alzheimer’s Disease or other forms of dementia. The cost of this service varies between £335 for contract beds to £850 for privately funded individuals. DS0000067946.V328561.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was the first inspection since the home registered with the CSCI and opened for business and was an unannounced ‘Key Inspection’. The inspection took place on Wednesday 28th February 2007 between 10:00 am and 4.30 pm. and covered all the standards for older people. Prior to the visit a questionnaire was sent to the Manager along with survey and comment cards for residents, relatives and visiting professionals such as doctors and nurses. Any replies were used to help form judgements about the service. Consideration has also been given to other information that has been provided to the Commission since the last inspection. The inspector toured the building, examined records and met most of the residents and 5 relatives that were visiting at the time of the inspection. The inspector also spent time talking to staff and observing how care was being delivered to the residents. From the evidence seen by the inspector and comments received, the inspector considers that this service would be able to provide a service to meet the needs of individuals with various religious, racial or cultural needs. The inspector gave feedback about her findings to the homes Acting Manager at the end of inspection. There were 5 legal requirements made as a result of this inspection that should improve the outcome for service users. The Commission has received information about 1 complaint since the last inspection, which is being dealt with by the home. What the service does well: The home is clean, light, airy and attractively decorated and furnished throughout. Users are encouraged to personalise their own spacious rooms and these are decorated and furnished to a comfortable standard. The staff team are kind, caring and are able to effectively meet the needs of the residents. The food is good and users are very complimentary about its taste and presentation. DS0000067946.V328561.R01.S.doc Version 5.2 Page 6 The activity programme is varied and interesting and includes trips out for lunch at local places of interest. 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. The summary of this inspection report can be made available in other formats on request. DS0000067946.V328561.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 DS0000067946.V328561.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 3 Quality in this outcome area is good. Service users are fully assessed prior to admission to ensure their needs can be met effectively by the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Thirty-five of the current residents were transferred from the adjoining home Boyn Grove when it closed in 2006. The needs of these users were fully documented and additional assessment by Clara Court did not take place. All other residents admitted to the home have been fully assessed to ensure the home would be able to effectively meet their needs. The home uses a comprehensive and holistic tool to gain a picture of the needs of the individual. Where the Local Authority has admitted service users a copy of the care management needs assessment has been provided to the home. Information about the needs of the user is gathered from a variety of sources including the user themselves, friends, relatives, advocate and other social and health care DS0000067946.V328561.R01.S.doc Version 5.2 Page 9 professionals. From the information gathered a decision is made as to whether the home can meet the needs of the user or not. The information gathered forms the basis of the care plan. All service users and their relatives are invited to the home to look around and to meet other residents and staff. Following admission all users are offered a trial period of 4 – 6 weeks before the home admits them fully. The inspector had the opportunity to speak with a number of the current residents and relatives. One user said that they had made the decision to live at the home following a hospital admission. They said, “I have not regretted my decision. The home is lovely and the staff are approachable, kind and caring”. Relatives told the inspector “ I’ve never had dealings with a care home before, but seeing how well my mother has been cared for, has made me think that I should like to consider moving to a home like this if and when I can no longer cope alone”. “My mum couldn’t have received better care anywhere”. DS0000067946.V328561.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 Quality in this outcome area is adequate. The information provided to staff in the on-line care plans & risk assessments appears scant and minimal and does not provide sufficient information to staff to provide care safely. Service users are provided with care in the way they wish to be cared for and in a manner, which maintains their right to dignity, privacy, independence and choice. The systems for the administration of medication are good with clear and comprehensive arrangements in place to ensure the safety of users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is currently in the process of transferring all of its paper records onto the ‘Saturn’ computer system. The care plans that were viewed by the Inspector on-line, appeared minimal in content and did not provide sufficient information to enable newly employed or agency staff to meet the needs of users effectively, being composed mainly of tick sheets. DS0000067946.V328561.R01.S.doc Version 5.2 Page 11 Risk assessments were also prescriptive in content and did not provide sufficient guidelines to reduce the hazard identified. This is particularly relevant in relation to the risks associated with bathing for those users with epilepsy. The system, however, does carry out a range of assessments such as nutritional assessments, continence assessments, Barthel Index, mental assessments, personal and night care needs assessments and Braden Score (used for assessing risks associated with tissue breakdown), but it is not clear how useful these assessments would be to new staff. They need to be viewed by computer screen, which requires a certain amount of training. Service users confirmed that they regularly see their GP and are referred to hospital when necessary for further advice, support and treatment. Routine screening and preventative treatments are provided to all residents of the home. Staff were observed to provide personal care in a discreet and sensitive manner. Service users were addressed courteously and staff knocked on service users’ bedroom doors and waited to be invited in before entering. From examination of the medication administration system and discussion with senior staff it is clear that the home follows best practice guidance when administering drugs. Senior staff have been trained in the administration of medication and are regularly in receipt of refresher training. A monitored dosage system is in operation at the home and medication is delivered to the home on a monthly basis. Storage systems are effective and disposal systems are safe. The inspector spoke at length to 9 service users. All confirmed that they were happy with the quality of care provided and felt that the staff were “caring and kind” and “did the best they could”. Users said that they felt involved with the way that their care was being delivered and felt confident that staff would listen to their wishes and concerns. DS0000067946.V328561.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15 Quality in this outcome area is excellent. Service users are provided with the opportunity to participate in a range of leisure activities, trips out and entertainments. Service users are encouraged to maintain contact with the local community, their friends and relatives. The meals in the home are good and offer users both choice and variety. Special dietary needs can be catered for effectively. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home employs 2 activity organisers and it is evident that as a result of their enthusiasm and motivational skills users enjoy a varied, interesting and stimulating lifestyle. Activities are specifically designed with the preferences and capabilities of users in mind. At the time of inspection users were engaged on the ground floor with ‘parachute play’, reminiscence quizzes and craftwork. The inspector was informed by residents that they had particularly enjoyed the recent DS0000067946.V328561.R01.S.doc Version 5.2 Page 13 ‘Valentines Day’ party and the ‘Friday Clubs’ pub lunches. The home has its own shop and there are plans to open it in the near future to enable users to choose their own cosmetics, sweets, cards and other sundries. This will help users to retain their independence and to help orientate users that are mentally frail in time and place. Residents are actively encouraged and they are free to visit anytime. me a cup of tea” and “ I am made alone with the users or are free to communal areas. to keep in contact with friends and relatives One relative said that “they always make most welcome”. Relatives can spend time share meals and other hospitality in the At the time of inspection a ‘wake’ was taking place for one of the residents who had recently died and it was clear that the relatives of the deceased were very grateful for the support, sympathy and condolence shown to them by staff of the home during their recent bereavement. The provision of meals is considered highly important in this home. Meals are an occasion and one resident said “the highlight of the day”. Service users are encouraged to take their meals in the communal dining rooms to aid integration and socialisation. The Chef transferred from Boyn Grove care home when it closed and is highly experienced in cooking for older people. Residents say, “She is a very good cook”. The Chef is well aware of the needs of the users and can cater for special diets and the specific cultural needs of each user. The menu has been developed in consultation with the residents and is varied and nutritious. The lunch consisted of homemade meatballs with creamed potatoes, broccoli and carrots or alternatively there was a choice of vegetable pie and potatoes. The dessert was chocolate custard and pears or ice cream. Service users said, “the food is lovely”, “well cooked” and “like I used to make at home”. DS0000067946.V328561.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 & 18 Quality in this outcome area is good. The home has a satisfactory complaints system. Service users feel their views are listened to and acted upon. Service users are protected from abuse and exploitation by well-trained and competent staff that can demonstrate knowledge of the homes abuse of vulnerable adults and whistle-blowing policies This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has a complaints procedure, which is up-to-date, clear and accessible to users. The complaint policy in the home meets the requirement of Regulation and Standard. Service users are provided with information on how to make a complaint to the home, the time scale for response, and the stages and procedures if they remain dissatisfied. Examination of the complaints records indicated that there have been 9 complaints made to the home since 1st October 2006. The details of the complaints were well documented and evidenced the outcomes provided to complainants. There has been one complaint that has been notified to the CSCI about the home since the last inspection. The Local Authority in conjunction with the home is dealing with this complaint. DS0000067946.V328561.R01.S.doc Version 5.2 Page 15 Service users generally felt confident that if they raised concerns they would be taken seriously by the home and efforts would be made to remedy any problems in a timely fashion. There was evidence in staff files and from discussion with staff, that they receive training in the protection of vulnerable adults as part of their formal induction to the home. This learning is later consolidated when undertaking NVQ training in which it forms a core module. Staff interviewed were aware of the home’s whistle-blowing policy and understood the importance of protecting users from abuse and exploitation at all times. Service users confirmed that they felt safe and well cared for by kind, caring knowledgeable staff. DS0000067946.V328561.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 & 26 Quality in this outcome area is good. Standards of décor and furnishings in this home are good quality and offer residents a comfortable and homely place to live. Service users benefit from living in a clean and hygienic home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the home evidenced that the home was well maintained, clean and odour free. All furnishings are domestic in character and provide a pleasant environment for the users. Communal areas were spacious, bright and airy and well used by the residents. Service users spend much of their time in the lounges, which are the focus of the home’s activity programmes. There are pleasant gardens to the rear of the property with balconies on each floor overlooking them. DS0000067946.V328561.R01.S.doc Version 5.2 Page 17 The laundry is well equipped and staffed by people that show commitment and pride in doing a good job. All staff have received training in infection control and were observed to use personal protective equipment appropriately. From discussion it was clear that all domestic staff understand the need to use appropriate cleaning products and chemicals safely and have had health & safety and COSHH (Control of Substances Hazardous to Health) training. Service users and their relatives made comments such as “it’s a lovely building”, “I’m very impressed with how well it is kept clean”, “the rooms are spacious and Mum can bring her odds and ends with her”. DS0000067946.V328561.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, 30 Quality in this outcome area is adequate. There have been a number of resident accidents during the night that give cause for concern and may indicate that there are insufficient staff employed at the home at night time to meet the needs of users effectively. The skill mix of the staff team was appropriate for the size, layout and purpose of the home. Recruitment policies and procedures at the home are robust and transparent and ensure the safety of users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a need to ensure that there are sufficient staff on duty to keep users free from harm. Examination of the accident records indicate that the numbers of users falling during the night time hours is unacceptably high compared with the records during the day. Examination of the rosters confirms that there are 7 waking night staff on duty but this appears to be insufficient to meet the needs of residents some of whom wander at night. The inspector examined the staff files for 6 employees. The content of the files met the National Minimum Standards and Regulations. From discussion with staff and management it was clear that the policies and procedures relating to DS0000067946.V328561.R01.S.doc Version 5.2 Page 19 selection and recruitment ensure service user safety and are robust, transparent and meet the requirements of current good practice guidance and legislation. All staff have undertaken a full two week Corporate Induction during which they received refresher training in the values & visions of the Organisation, manual handling, fire awareness, food hygiene, safeguarding adults and first aid. All Team Leaders were required to train as Qualified First Aiders and have been certificated following a 4-day course. All new staff undertake induction training to ‘Skills for Care’ specification and are encouraged to gain a professional qualification in care. Examination of the staff files and training records evidenced that many of the current staff have gained NVQ qualifications before they transferred from their previous employment at Boyn Grove. Staff told the inspector that they are keen to acquire more NVQ qualifications at levels 2, 3 or 4 but that access to the relevant training was limited. The Acting Manager is an NVQ assessor/verifier and is keen to provide staff with support and encouragement to gain the necessary skills and qualifications. Staff confirm that they regularly attend team meetings at which they are encouraged to express their views and opinions but have not been provided with any one-to-one supervision sessions. A system of supervision is currently under development, which will cover all aspects of practice, philosophy of care in the home and identifies each staff member’s career development needs. Service users were highly complimentary about the staff team. Comments such as “the staff here are lovely”, “they try so hard”, “they are all lovely girls so caring and kind” were made to the inspector. DS0000067946.V328561.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 31, 33, 35 & 38 Quality in this outcome area is adequate. Service users benefit from living in a well run home, where there is evidence that their health, welfare and safety are of primary importance. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Service Development Manager is currently managing the home – Wendy Dodimead in a temporary capacity, as there is a vacancy for Registered Manager following the resignation of the previous post holder. Wendy Dodimead is highly experienced and has attained the Registered Managers Award to further enhance her knowledge and skills. Wendy is a qualified NVQ Assessor and Verifier and is keen to encourage the staff team’s personal & professional development. Staff confirm that Wendy is a good leader and has DS0000067946.V328561.R01.S.doc Version 5.2 Page 21 put in place policies and procedures, which have improved outcomes for the service users. The Organisation is keen to receive feedback from the residents and visitors to the home and has surveyed users on a quarterly basis since the home opened. There is a comments and suggestions box in the reception area where peoples’ views and opinions are actively encouraged. The inspector spent time with the administrator and examined the procedure for managing service users’ monies. The system appeared to appropriately safeguard users from financial abuse. The users’ cash accounts are held on computer and also in hard copy as a back up. Receipts were on file for monies spent on behalf of the users. Examination of health & safety records indicated that they were up to date and in good order. Routine servicing and maintenance of equipment are undertaken at appropriate intervals in general to maintain the home as a safe and risk free environment for users. DS0000067946.V328561.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 X 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 3 DS0000067946.V328561.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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 OP7 Regulation 15 Requirement The content of care plans should be improved to ensure the staff know how to meet the needs of residents effectively. All hazards to residents should be fully risk assessed and guidelines should be put in place to reduce the risk to users The Proprietor should review night duty staff levels to ensure the safety of residents and reduce the likelihood of accidents. There is a need to recruit to the vacant post of Registered Manager to ensure continuity of care for residents. A plan should be put in place that will ensure all care staff receive formal one to one supervision at least 6 times. This would enable staff to feel more valued and included in the way care is delivered to residents. Timescale for action 28/03/07 2 OP27 18 28/03/07 3 OP31 8 28/08/07 4 OP36 18 (2) 28/03/07 DS0000067946.V328561.R01.S.doc Version 5.2 Page 24 5 OP28 18 (1) c Staff should have access to appropriate professional training which would enhance their practice and help them to develop new skills such as National Vocational Qualifications. 28/08/07 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 DS0000067946.V328561.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000067946.V328561.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. 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