Inspection on 31/01/06 for Cliff Court

This inspection was carried out on 31st January 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

Cliff Court 08/11/06

Similar services:

Deepdene Care Centre

Ferndale Residential Care Home

David Gresham House

Elizabeth House

Elvy Court Nursing Home

Fontenay Nursing Home

Clairmont Residential Home

Cornford House

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

CARE HOMES FOR OLDER PEOPLE Cliff Court 70 The Promenade Peacehaven East Sussex BN10 8ND Lead Inspector Jennie Williams Unannounced Inspection 31st January 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 Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. 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. Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cliff Court Address 70 The Promenade Peacehaven East Sussex BN10 8ND 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) 01273 583764 01273 585562 Mrs S Awotar Mr R Awotar Miss Sue Burke Care Home 18 Category(ies) of Dementia - over 65 years of age (18) registration, with number of places Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The maximum number of service users to be accommodated is eighteen(18). Service users must be older people aged sixty-five (65) years or over on admission. Service users with a dementia type illness only to be accommodated. Date of last inspection 12 May 2005 Brief Description of the Service: Cliff Court is a care home registered for 18 places and is for people over 65 years of age with a dementia type illness. No nursing care is provided at this home. Cliff Court is located on the cliffs at Peacehaven, offering sea views from many of the rooms. Residents bedrooms are located over two floors. There is a stair lift available for residents requiring assistance to access the first floor. Once on this floor, there are three to four steps in either direction that residents must independently mobilise to access individual rooms. The location of the room and an individuals mobility is taken into account when assessing prospective residents. The home is located within an easy walking distance to local amenities. Bus services are available at the end of the road. There is a dining room and lounge room on the ground floor. There are suitable toilet and bathing facilities at the home to meet the needs of the residents. There is a small car park available at the home and free parking in the adjacent streets. Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The reader should be aware that the Care Standards Act 2000 and Care Homes Regulation Act 2001, uses the term ‘service user’ to describe those living in care home settings. For the purpose of this report, those living at Cliff Court will be referred to as ‘residents’. The reader should be aware that new providers took over the ownership of the home on 21 November 2005. The registered manager and most staff remained the same. It was confirmed that the change in ownership did not have an impact on the running of the home or the residents. This unannounced inspection took place over seven and quarter hours on the 31 January 2006. Individual rooms and the environment were spot-checked. Records, some policies and procedures, care plans and individuals’ personal allowances were inspected. Staff files were unable to be accessed on this occasion. Residents and staff were spoken with throughout the inspection. The Inspector ate lunch with the residents and observed activity participation. There were 17 residents residing at the home on the day of the inspection. The Inspector would like to thank the staff and residents for their assistance throughout the day. What the service does well: What has improved since the last inspection? The care plan format is currently being changed. There has been some work done to comply with previous requirements, although further work is required. There is a menu board in the dining room to demonstrate what the meal is for the day and a new staff and resident board has been implemented. This contains photos and names of all staff and residents working and residing in the home. Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 Page 6 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. Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 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 Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 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): 1, 3 & 5 Prospective residents/relatives are provided with information about the care and services provided at the home. This information must be amended to reflect the change in ownership. Some needs of newly admitted residents are at risk of not being met due to the lack of information obtained at the pre assessment. EVIDENCE: The Statement of Purpose and Service User Guide must be amended to reflect the new changes in management. The copy shown to the Inspector still contained information regarding the previous owners. A new Statement of Purpose and Service User Guide was provided to CSCI during the registration process for the new owners. These documents must be implemented. There had been three new admissions in the two weeks prior to the inspection. The pre assessments inspected did not provide sufficient information about the needs of the individual. They only demonstrated the dependency levels. Basic information is obtained and during the first month of admission, additional information is written and then a care plan is developed. The shortfalls were discussed in detail with the registered manager on the day of the inspection. Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 Page 9 This remains an outstanding requirement. Risk assessments must be put in place for all residents, with particular attention to falls. The registered manager undertakes the pre assessment of all prospective residents. Additional information is obtained from other health professionals wherever applicable. The deputy manager is currently attending pre assessments with the registered manager to learn the procedures. Residents/relatives are provided with an opportunity to visit the home prior to admission. It was confirmed that the first month of admission is a trial period. The home does not have dedicated accommodation to provide intermediate care. Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Care plans provide staff with suitable information on the needs of the residents. Residents’ privacy and dignity are respected. Medication is being signed for at the time of administration. Including an individuals mental health status in care notes will demonstrate that care or treatment provided is effective and monitored. EVIDENCE: The care plan format is currently being amended. It was confirmed that the new format will be more person centred. Care plans were only spot-checked on this occasion. The care plans provide staff with suitable guidelines regarding the needs of the residents. It was discussed with the registered manager that there must be evidence that care plans are reviewed on a monthly basis or earlier if the needs of an individual changes. Care notes are improving but there remain some shortfalls in the care notes written by staff. As the home is registered for people with dementia, it is important that staff document in the care notes the mental health status of an individual. This will ensure that treatment/medication in use is effective and will assist staff to note any changes in an individuals’ behaviour. The registered manager is addressing this shortfall with staff during supervision Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 Page 11 sessions. This requirement has been made a recommendation and will be reassessed at the next inspection. There were no risk assessments implemented for some residents. It was made an immediate requirement that all residents have suitable risk assessments in place, with particular attention to falls. Residents’ health needs are being met at the home. Specialist advice is sought whenever needed. A district nurse visits the home if an individual requires nursing input. Residents spoken with felt that their privacy and dignity are respected. Staff were observed to have a good professional rapport with residents. Residents were seen to be neatly dressed. It was confirmed that there are policies and procedures in place for all aspects of dealing with medication. There is no one capable of self-administering their own medication. MAR charts demonstrated that a medication had been prescribed to an individual. ‘PRN’ (as needed) was handwritten on the MAR chart. There was no evidence to show when this was changed to PRN or signed to show who changed the original prescription. It was discussed with the registered manager that hand written amendments are signed and to evidence that changes are agreed with the GP. The home needs to ensure that MAR charts are updated to accurately reflect the current administration dosage/frequency of a medication. The home is obtaining two signatures from staff when handwritten MAR charts are in use, as recommended at the last inspection. There was evidence that medication was being signed for at the time of administration. There was cream being used in a double room which was not labelled with the residents name. It was discussed with the registered manager to reiterate to staff the importance of labelling creams for an individual. This has been reflected as a recommendation. When implementing the new care plan format, the home needs to obtain information on the wishes of individuals’ following death. Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 15 Residents’ lifestyles are as flexible as possible in a care home that caters for people with a dementia type illness. Residents have opportunities to participate in activities that are within their capabilities. Visitors are welcomed at the home. EVIDENCE: There is a new activities person employed at the home since the last inspection. She works three hours every afternoon, Monday to Friday. The Inspector observed residents enjoying a game that was made at the home. The activities person showed the Inspector other work and games that she is currently devising. Staff were observed to interact well with residents. When obtaining a life story from residents it has been identified that some residents enjoyed swimming. The registered manager is arranging swimming costumes for those interested and is looking into arranging this activity. Visitors are welcomed at the home. There are time restrictions for visitors, but these are imposed in the best interest of the residents. Arrangements can be made with the home to visit outside these times if it is more suitable. There is no one capable of managing his or her own finances. Residents are encouraged to bring in personal possessions with them. Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 Page 13 The Inspector enjoyed a tasty meal with the residents. Staff were observed to be nearby to offer discreet assistance to those needing help. A list of residents’ likes/dislikes/allergies has been provided to the cook as required at the last inspection. Residents spoken with confirmed that they enjoyed the food and most were observed to be enjoying their lunch. The Inspector was pleased to note that the ingredients of a meal were vitamised separately for those residents requiring a softer diet. Residents were provided with a choice of drinks. The cook confirmed that daily temperatures of the fridge/freezers are taken and that there are no restrictions imposed when purchasing/providing food for the residents. Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Staff are provided with information on procedures to follow in the event of an allegation of abuse being made. EVIDENCE: There have been no complaints made to the home or directly to CSCI since the last inspection. The complaints procedure must be amended to reflect the new ownership and their procedures of dealing with complaints. The manager has attended a two-day course in Protection of Vulnerable Adults (POVA). This was a train the trainer course that will enable her to provide refresher training to all staff working at the home. There have been no POVA investigations undertaken since the last inspection. There is suitable information available to staff on procedures to take in the event of an allegation of abuse arising. Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 Page 15 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, 21, 25 & 26 The location of the home provides opportunities for residents and visitors to access local amenities and transport. Residents live in a clean environment. EVIDENCE: The home is located on the cliff tops in Peacehaven and sea views are accessible from communal areas and some individual bedrooms. It is a short walk to local amenities and there is a bus stop near the end of the road. There is a no smoking policy at the home. There is a chair lift available to assist residents accessing the first floor. There are still three or fours steps in either direction for service users to negotiate to all first floor bedrooms. Residents being admitted to these rooms must be able to mobilise independently. Rooms spot-checked demonstrated that some rooms have been personalised to reflect the individual’s choice and personality. The Inspector was pleased to note that individual rooms were no longer being used for storage purposes, as required from the last inspection. Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 Page 16 The newly appointed maintenance man is gradually working his way through the home and redecorating and repairing rooms/furnishings as needed. One room was being painted on the day of the inspection. Rusty commodes have been removed and replaced as required from the last inspection. Some rooms had energy efficient bulbs in place and no coverings. These did not look domestic in character or homely. The Inspector has advised the registered manager to ask the residents/relatives if they are satisfied with the current lighting arrangements, if not, then further action must be taken. The home is still having problems with the delivering of hot water in some parts of the home. Some taps were delivering water at 30 - 35°C. It was confirmed that the hot water problems were being addressed. This is now outstanding for the last three inspections. This is mainly for water being delivered in an individual’s room. It is required that hot and cold taps are clearly labelled for the residents. One room was noted to have two free standing heaters. One of these had not been PAT tested. One also had tape on the electrical cord. The maintenance man immediately removed this. The radiator felt cold and did not appear to be working. This has not been reflected as a requirement as the maintenance man assured the Inspector that he will address this problem. The home was warm and comfortable in all other parts of the home. There was a towel observed to be in a communal bathroom. It was confirmed that a towel had been provided due to residents often blocking the toilet with hand drying paper. It was discussed with the registered manager that alternative measures are explored to promote infection control. It is not suitable to have a towel for communal use in communal areas. Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 Page 17 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 The skill mix and number of staff on duty are meeting residents’ needs. Staff are provided with opportunities to attend training sessions. EVIDENCE: Staff spoken with confirmed that there are suitable numbers of staff on duty at all times to meet the needs of the residents. The rota also demonstrated that there is sufficient staff on duty at all times. Staff work a waking night. Staff spoken with confirmed that they are provided with opportunities for training. The cleaning person will be undertaken infection control training in April 2006 as recommended from the last inspection. Four new staff members have commenced employment at the home since the last inspection; two care staff, an activities person and a new maintenance person. Staff files were unable to be inspected on this occasion, as there was no key available for the filing cabinets. It was discussed with the registered manager that staff files should be available at all times for inspection. Efforts were made to have the key returned whilst the Inspector was at the establishment. Due to this standard not able to be assessed, it remains an outstanding requirement that staff files comply with Schedule 2. The home is working towards achieving the 50 ratio of NVQ level 2 qualified staff. The home has four staff with NVQ level 2 qualifications, another nearly completed NVQ 2 and another carer is finishing their NVQ level 3 training. There are a further three staff commencing their NVQ level two training in April 2006. Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 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, 35, 36, 37 & 38 Residents’ benefit from a well managed home. Residents’ personal allowance are safeguarded by the procedures in place. EVIDENCE: The registered manager is registered with CSCI and has the relevant skills and experience to manage the home. She is a registered nurse with current registration with the Nursing and Midwifery Council (NMC). The Registered Manager Award is nearly complete. The registered manager has been restricted in completing this award due to the budget unit. The registered manager does not currently have control of any budgets. Financial viability was not assessed on this occasion. Financial references are obtained during the registration process. The home holds personal allowance for residents. Records spot-checked demonstrated that there are suitable procedures in place for the safe handling of residents monies. Receipts are kept and clear records maintained. There Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 Page 19 are procedures in place to ensure residents have access to their money at all times. The registered manager has made a clear fire drill checklist that has clear actions and prompts for staff to follow. The registered manager has implemented a plan for evacuation, which includes a floor plan. The registered manager confirmed that this has been agreed with the homes’ fire inspector. The home had a fire inspection about six weeks prior to the CSCI inspection. The report was not available at the home yet, but it was confirmed that any shortfalls have/are being addressed. The registered manager is currently providing fire training for staff at the home. The registered manager confirmed that staff are receiving supervision every three to four months. She is aware that staff should be receiving supervision six times a year. This has not been reflected as a recommendation as the registered manager is aware of this shortfall and will be taking action to address this. This will be reassessed at the next inspection. It was confirmed that there is always a first aider on every shift. The home has purchased a standing hoist since the last inspection to assist staff with any manual handling duties. COSHH information is stored with the hazardous substances being used within the home as required from the last inspection. Staff know where to easily access this information. The cleaner has been provided with her own folder of COSHH information. Radiator guards have been secured as required from the last inspection. A window was found to be unrestricted. This was pointed out to the maintenance man who is addressing the issue. This has not been reflected as a requirement. Regular health and safety checks are undertaken at the home. Any other shortfalls in health and safety have been addressed in the relevant sections of the report. Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 1 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 3 X 3 X X X 2 2 STAFFING Standard No Score 27 3 28 2 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X X 3 2 2 2 Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 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 OP1 Regulation 4&5 Requirement That the Statement of Purpose and Service User Guide that reflects the new owners be implemented. That the pre assessment form is fully completed to clearly demonstrate that the home can meet the needs of an individual. (Timescale 30.06.05 not met) That all service users have suitable risk assessments in place, with particular attention to falls. (Immediate requirement) That MAR charts are updated to accurately reflect the current administration dosage/frequency of a medication. That the home obtains the wishes of an individual following death. That the complaints policy reflects the new owners procedures. That hot water is delivered around the recommended 43°C. (Outstanding from last two inspections) That hot and cold taps are DS0000064914.V269828.R01.S.doc Timescale for action 28/02/06 2. OP3 14(1) 28/02/06 3. OP7 13(4) 01/02/06 4. OP9 13(2) 15/03/06 5. 6. 7. OP11 OP16 OP25 12(2 & 3) 22 13(4) 30/06/06 31/01/06 31/03/06 8. Cliff Court OP25 13(4) 31/03/06 Page 22 Version 5.0 9. OP29 Schedule 2 17 10. OP29 clearly labelled. That all staff files comply with Schedule 2. (Outstanding from last two inspections, see content of report) That staff files are available for inspection at all times. 31/03/06 28/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard OP7 OP7 OP9 OP9 OP25 OP26 Good Practice Recommendations That care plans are reviewed on a monthly basis or earlier if the needs of an individual changes. That care notes provide information on the mental health status of each individual. (Requirement now made recommendation, see content of report) That handwritten amendments to MAR charts are signed. That all creams are labelled and dated when opened. That the views regarding the provision of lighting be obtained from individuals/representative and action taken if required. (See content of report) That hand towels are not used in communal areas. Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Cliff Court DS0000064914.V269828.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!