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Inspection on 17/02/06 for Cloudesley Road (92)

Also see our care home review for Cloudesley Road (92) for more information

This inspection was carried out on 17th February 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

As part of their care and support service users are encouraged by staff to lead an independent lifestyle inside and outside the home. One individual spoke passionately about his forthcoming holiday to the USA and a potential move to alternative accommodation in the short term. Individual activities charts had been drawn up to facilitate the process and those who are capable of moving on to more independent living are supported to be responsible for their medication and to self medicate. Generally, a good relationship between staff and service users was observed and a service user notable provided staff with an appraisal of how their day was spent at the day centre, including the food that they ate. This would equip staff with the knowledge and guidance as to what to prepare for the individual`s evening meal, thereby ensuring that the same type of food is not served twice on the same day.

What has improved since the last inspection?

The last inspection report stated that assessments carried out were not available. These outstanding assessments are now in place and are comprehensively written, the only exception being that they have no date for future review. Care plans have also been updated and these too have been holistically drawn up. Essentially, the care plans must include a review date for each activity so that any staff member would learn of the progress being made, if any. Improvements to provide more security to service users` finances have been made and the procedural practice has tightened. A copy of the actual policy and procedure was however, not evidenced at this inspection. The introduction of individualized activities programme for the service users is an improvement also.

What the care home could do better:

The files of service users must be reviewed, removing old information and archive them. Staff must also distinguish between a complaint and an incident. The longterm concerns relative to the emotional health of an individual because of constant noise disturbances at night is a serious matter and guidance could have been sought from Environment Health, Noise Abatement Team. Also, some of the service users have no social worker allocation and input is required for one particular service user who portrays anti-social behaviour. Such a resource would provide a reassessment of service user`s needs and provide a gauge as to whether the placement is satisfactory for the individual. As mentioned above, further review of the care plans are required so that each activity is evaluated at a set timescale and recorded and dated by a named staff. The manager is asked to attend to the list of requirements outlined in the report and to produce an action plan for redress.

CARE HOME ADULTS 18-65 Cloudesley Road (92) 92 Cloudesley Road Islington London N1 0EB Lead Inspector Pearlet Storrod Unannounced Inspection 10:00 17 February 2006 th Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 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 Cloudesley Road (92) DS0000020971.V249318.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Cloudesley Road (92) Address 92 Cloudesley Road Islington London N1 0EB 020 7833 2326 020 7833 2326 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) Psychiatric Rehabilitation Association Mr Joseph Kissoon Care Home 7 Category(ies) of Learning disability (1), Mental disorder, registration, with number excluding learning disability or dementia (0), of places Mental Disorder, excluding learning disability or dementia - over 65 years of age (0) Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Home for adults (male and female) with needs relating to mental disorder including old age, and including one adult with learning disabilities. 5th July 2005 Date of last inspection Brief Description of the Service: Cloudesley Road is a registered residential care home for 7 people requiring support to deal with their mental health problems. The home is located in Islington in a residential area and within close proximity to local shops, transport and other amenities. Service users living at the home all have single rooms decorated to their desires. Psychiatric Rehabilitation Association is responsible for management of the care and support provision and their philosophy is to encourage and support service users individually with their development in social and life skills activities. The building consists of 4 floors and New Islington and Hackney Housing Association who owns the property provide maintenance. Each service user has a licence to occupy the home. Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report is of an unannounced inspection carried out at Cloudesley Road. It is the second statutory inspection for the year April 2005 – March 2006. The inspection focussed on reassessment of the requirements and recommendations made in the previous inspection report together with discussion with individual service users and staff, scrutiny of two service users’ files and some other documents, continuous observation and a tour of the home. Staff files were not checked as part of the process of inspection as these are situated elsewhere. What the service does well: What has improved since the last inspection? The last inspection report stated that assessments carried out were not available. These outstanding assessments are now in place and are comprehensively written, the only exception being that they have no date for future review. Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 6 Care plans have also been updated and these too have been holistically drawn up. Essentially, the care plans must include a review date for each activity so that any staff member would learn of the progress being made, if any. Improvements to provide more security to service users’ finances have been made and the procedural practice has tightened. A copy of the actual policy and procedure was however, not evidenced at this inspection. The introduction of individualized activities programme for the service users is an improvement also. 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. Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 5 The previous inspection report highlighted a lack of documentation relative to the assessment of service users’ needs and systems for review. Each service user has a licence agreement, which includes the terms and conditions. EVIDENCE: Each service user has had an assessment carried out in relation to their continual accommodation placement. The assessments are comprehensively written and showed that three out of the seven service users are capable of moving into more independent living accommodation. The assessments were conducted in April 2005 by the PCT, each of which took over 3 months to be issued to the home. From scrutiny of the assessments, they are comprehensively written but they include no dates for review. A date for future review must be recorded on each report. Information available shows that some service users have lived at the home long term. As outlined in the previous report two people have statutory reviews. Not everyone has the benefit of a social worker allocated to them; those who do not are reliant upon the duty social work system which poses implications for the service users who need an assessment of their needs and reviews from a social work perspective, so that appropriate support are ensured for the service users. Each service user has been provided with a licence agreement. The licenses indicate that service users are responsible for insuring their personal Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 9 belongings. The manager must ensure that insurance for the service includes cover for service users personal belongings that are looked after by the home. Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8,9 Service users assessed and changing needs and personal goals are reflected in their individual care plans. Identified goals though recorded are not properly addressed in regard to reviews. Consultation occurs with service users about aspects of life in the home and where necessary, they are risks encouraged to take in preparation for independent living. EVIDENCE: From the examination of two service users files there is evidence to indicate that the care plans have been updated with identified personal goals. Further review is needed so that the progress for each activity is monitored, evaluated and recorded at set dates. An example of this is in regard to a service user who is required to have his weight increase. Support staff are monitoring this activity but the care plan includes no set date when staff intend to review the individual’s progress and achievement if any. This would inform staff whether to explore and engage other methods that are appropriate to assist service users to reach fulfilment. Two service users are expected to move into more independent living accommodation in the short term. Of the two service users, one spoke emphatically about his forthcoming holiday to the USA in September and his potential move into more independent accommodation. The other service Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 11 user had returned from viewing a flat that offers a more independence lifestyle arrangements and whilst the staff member that accompanied the service user, believed the accommodation to be suitable, the service user’s view contrasted with this. The staff member reported that staffing levels were under review with the likelihood that no staff would be on duty at night. The service user’s dissatisfaction was that “the accommodation is only temporary for two years, he would have to move on again.” It was obvious from the information to hand that an imminent move to this proposed service offered no stability for the service users and the security and safety raised a moot point for all concerned. The Manager asserted that they would “respect service users choice and decisions on where to live but that this service user wants to move to accommodation with the same level of staff support.” He commented, “no one would be asked to leave if a potential placement was unsuitable and a trial period would be given.” Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12 and 17 There are opportunities for service users independent personal development and service users are supported individually to participate in age appropriate and cultural activities. Service users dietary needs are monitored. EVIDENCE: The previous inspection report highlighted that the weekly activities report needs a review. There is evidence to demonstrate that staff have reviewed the activities with the involvement of each service user, two of whom confirmed that they had input in drawing up their activities programme. The individualized programmes include social and leisure activities and tasks associated with development in daily life skills. One service user attends a day centre provided by Jewish Care and others attend day services locally. A service user who declined to speak with the inspector and who reported that she was “feeling unwell” (at this inspection and the previous one), appeared to have a heavy cold and chest infection, which was being addressed medically. The service user entertained herself watching classic films on video in the smoking lounge and did not want to be disturbed. Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 13 Service users have responsibility for preparation of their breakfasts and lunch and staff prepares the evening meals with encouragement from individual service users to participate. A notice board consisting of the weekly menu for the evening meals is situated in the kitchen. From observation of the meals on offer these appeared nutritious and balanced. Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Personal support is provided in a way that promotes privacy, dignity and independence and staff try to ensure that service user’ physical and emotional health needs are met. Service users are supported to self medicate where appropriate and are protected by the home’s policies and procedures. EVIDENCE: A main concern reported to the inspector by two service users and staff is that the eccentric behaviour and lifestyle of one individual is causing annoyance for others. The issues relate to the toilet door being left unlocked whilst the service user is sitting on the toilet. This practice occurred during the inspection process and it was stated by a staff member that this behaviour is communally portrayed whether the service user is having a bath or using the toilet. It was asserted also that the same individual has a tendency to enter other service users’ rooms without knocking and waiting to be invited in. Playing the radio loudly was another matter associated with the behaviour of this service user and another individual, to an extent where another service user is kept awake at night, which is impacting on this service user’s emotional health. (See concerns, complaints and protection at standards 22 and 23) Strong efforts must be made by the manager to secure social worker allocation for the service user for reassessment of the service user’s needs and review. Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 15 Evidence exists to show that service users are supported well by staff to control their medication and to self medicate. Staff liaise with the pharmacist for guidance and a programme of support carried out on a gradual process in 3 stages is in place. One service user is presently going through the selfmedication process. Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Service users’ views are listened to but not always heard, as long-standing issues are not appropriately addressed. The home’s operational practice with regard to the protection of adults from incidents needs review. EVIDENCE: The manager reported that a service user is kept awake at the night by two service users’ playing their radios loudly. The loudness of the radios is at times compounded with other noises deriving from the service users themselves. The manager believed that the complainant should wear a set of earplugs. This was not to the complainant’s liking and it was evidently clear that this problem has been going on for a long time without redress. In discussion with the service user who made the complaints he emphasised, “why should I have to wear ear-plugs to get some sleep.” The manager was advised to consider investing in two sets of headphones or personal stereo with earphones for the two service users to use with their radios. Alternatively, Environmental Health, Noise Abatement Team could be approached for guidance. Before leaving, the manager consulted with one of the service users who agreed to use a personal stereo with earphones or headphones with their radios to reduce the noise. Notably, the noise disturbance is a breach of the licence agreement and grounds for eviction. Interestingly, this matter was recorded in the incident book when, because of the frequency and length of time that the service user has been reporting the issues, it should have been taken more seriously and dealt with as a complaint, with resolution and outcome and whether the complainant was satisfied with the outcome decision. Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 17 The Manager must ensure that the on-going complaint relating to noise disturbances at night are appropriately addressed. It was reported by the manager that they have some difficulties in supporting a service user to manage their finances, simply because of the service user indulgence in their personal interests and pursuits that are addictive and expensive to maintain. The manager said that rent arrears have build up because the service user draws the money from her account prior to the payment of the rent. The inspector suggested that the service user is consulted and supported about setting up a direct debit system on their account so that the rent is paid on the day that the money is received in the account. This would prevent the accrual of rent arrears. It is once again reiterated that strong effort is made by staff to secure social worker input for the service users where advice, guidance and support would be given to the staff relative to the needs of the service users. The manager has obtained a copy of Islington’s Adult Protection Policy as required in the previous inspection report. Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 and 30 The home is clean and comfortable with sufficient bath and toilets to meet service users needs. EVIDENCE: There is sufficiency of toilets and baths to meet service users’ needs. One shower/wc is installed on basement level opposite the kitchen and a number of service users use these facilities because of location and ease of accessability for everyone. The installation of the shower was make assistance with personal care easier for a service user who suffered a stroke but since that time, other service users enjoy the shower and make more use of the shower/wc room. An additional shower over one of the baths would maximise individual service users independence and choice with regard to personal care. The manager agreed to given some consideration to this recommendation. Three service users gave the inspector permission to look into their individual rooms. The rooms viewed were clean and in an orderly state; each decorated with colour schemes chosen by the individuals themselves. The home is clean throughout. Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34 and 35 Staff files were not examined at this inspection as these are held elsewhere. The home’s recruitment policy showed that further developments are required. Staff are appropriately trained to meet service user’s needs. EVIDENCE: The inspector had a brief look at the recruitment policy that was available at the home and observed that the document needs to be reviewed to include induction and appraisal following the first 13 weeks of employment. The induction policy scrutinised must make mention the appraisal as outlined in the recruitment policy. The policy for recruitment and selection of volunteers is outdated and is restated. It must be reviewed to include the POVA checks. All personal files are held elsewhere and were not inspected. Staff files will be inspected at an announced inspection as mentioned in the previous inspection report. 3 staff members have successfully completed their NVQ 2 qualifications and are to be congratulated on their achievements. Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 20 The manager is schedule to do a conversion course in psychology Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 42 The health and safety and welfare of two service users are generally promoted and protected EVIDENCE: From examination of the record and discussion with the manager the inspector noted that following a recent fire test and drill that two service users did not respond. The service users reluctance to acknowledge and to participate would potentially put them at risk. Staff must make strong effort to ensure that service users understand the importance of their participation in fire drills in the home and the support provided must continue regularly and with a consistent approach to the support. Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x 2 Standard No 22 23 Score 2 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 3 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score x x x 3 x x 3 LIFESTYLES Standard No Score 11 3 12 3 13 x 14 x 15 x 16 x 17 Standard No 31 32 33 34 35 36 Score x x x x 2 x CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Cloudesley Road (92) Score 3 2 4 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x DS0000020971.V249318.R01.S.doc Version 5.0 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA2 Regulation 14(1)(b) Requirement The registered manager must ensure that social worker assessments are carried out for those services users with antisocial behaviour and must also ensure that a date for future review is recorded on each assessment The registered manager must ensure that a set timescale for review of the care plans are recorded for each activity and name of staff accountable The manager must ensure that concerns made repeated by the same person is treated as a complaint and resolved to the service users satisfaction. The manager must approach Environmental Health for guidance regarding noise disturbance if other methods prove unsatisfactory The registered manager must submit to the Commission a copy of the home’s policy and procedure for the safe handling of service users monies and valuables. The manager must ensure that a DS0000020971.V249318.R01.S.doc Timescale for action 05/08/06 2 YA6 15(2)(b) 05/06/06 3 YA22 22(2) (23(5) 05/06/06 4 YA23 16(2)(L) 05/08/06 5 YA42 23(4)(iii) 05/06/06 Page 24 Cloudesley Road (92) Version 5.0 consistent approach to the safe evacuation of two service users is regularly applied by staff during fire drills RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 7 Refer to Standard YA34 Good Practice Recommendations The recruitment policy needs to be reviewed to include induction and appraisal. Additionally, the induction policy needs to include timescale for appraisal Updating of the policy on the recruitment of volunteers is restated from the previous recommendation 8 YA40 Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Camden Local Office Centro 4 20-23 Mandela Street London NW1 0DU 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 Cloudesley Road (92) DS0000020971.V249318.R01.S.doc Version 5.0 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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