Inspection on 27/07/06 for Cloudesley Road (92)

This inspection was carried out on 27th July 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Cloudesley Road (92) 17/02/06

Cloudesley Road (92) 05/07/05

Cloudesley Road (92) 19/01/05

Cloudesley Road (92) 25/06/04

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Townley Road, 2-3

Chatsworth Care - Tudor Lodge

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

CARE HOME ADULTS 18-65 Cloudesley Road (92) 92 Cloudesley Road Islington London N1 0EB Lead Inspector Ms Jill Marriott Unannounced Inspection 27th July 2006 10:30 Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 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.V287287.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Home for 7 adults (male and female) with needs relating to mental disorder including old age, and including one adult with learning disabilities. 17/02/06 Date of last inspection Brief Description of the Service: Cloudesley Road is a registered residential care home for 7 people with mental health problems. The home is a four storey building located in a quiet residential area of Islington within close proximity to local shops, transport and other amenities. Psychiatric Rehabilitation Association is responsible for management of the care and support provision. The aim of the service is to encourage and support service users individually with their development in social and life skills. The building is owned by Family Mosaic who provide all of the maintenance for the property. Each service user has a licence to occupy the home. The cost of a placement at Cloudsley Road is approximately £550 per week. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first unannounced inspection of Cloudsley Road for the year 2006/7. The Inspection was conducted over 7 hours on the 27/07/06, all of the key standards were assessed at this inspection and requirements from the last inspection were followed up and referred to in the main body of the report. The inspector examined files and records, toured the building and spoke with staff and service users during the inspection. Six service user, two relatives, three care managers and a G.P returned comment cards to the commission The inspector would like to thank all of those who participated in the inspection process. What the service does well: What has improved since the last inspection? What they could do better: The building is generally kept clean at all times. Recently there has been some maintenance problems, which are being dealt with appropriately and are well documented. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 6 Requirements have been made in respect of: Ensuring reviews of care plans take place with relevant professionals at least six monthly. Ensuring the environment is kept clean at all times. Ensuring Criminal records Bureau Disclosures are up to date. Ensuring all staff have an appraisal each year. Ensuring the home has a development plan. Ensuring all policies and procedures are reviewed. 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.V287287.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 was assessed at this inspection. Quality in this outcome area is good. The process for assessing the needs of prospective service users is good. EVIDENCE: Only one service user has been introduce to the home in the past year. Following an initial assessment and a trial period it was decided that the home was not an appropriate placement. The inspector was told that this decision could be reviewed if the behaviours of the person referred changed. The homes, referral policy and procedure was seen by the inspector the process includes prospective service users visiting the home on several occasions including an overnight stay prior to moving in. The referral information collated during this time includes the service users medical condition and issues related to culture, religion and ethnicity as well as practical issues such as finances, food preferences, activities and medication. All placements are offered on a trail basis. There are some service users living at Cloudsley Road whose behaviours affect other residents. This is usually related to noise. A requirement was made at the last inspection in respect of one service user complaining about the noise made by another. Records show that this situation has been discussed with both service users and alternative rooms have been offered. The service user making the complaint has declined the offer to move to another room and prefers to discuss the situation with staff as and when it re-occurs. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 9 Evidence shows the situation is under constant review. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 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): Standards 6, 7 and 9 were assessed at this inspection, Quality in this outcome area is good. Service users are consulted through out their stay about their changing needs. They are well supported to make decisions about their lives. EVIDENCE: Of the files tracked it was clear that each service user has a care plan, which is developed and reviewed with them. Care plans cover the areas of support needed by each individual. Any restrictions on choice are discussed and agreed with the service user at the initial referral and reviewed at the care planning stages of the placement. Files tracked show that in house reviews are held six monthly but these are not up to date in all cases. There is some confusion between in house reviews and placing authority reviews and how these are recorded. The inspector recommends that the reviewing procedure is discussed between all of the relevant professionals and the in house review and those held with the placing authority and relevant professional be joined together to clearly reflect the service users needs and choices with a system in place for recording the minutes, with decisions and outcomes. As described in standard 6.10. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 11 Evidence shows that service users discuss choices and decisions about daily activities regularly with key workers and the homes manager. At present one service user is being supported to work towards living independently in the community. It is clear from the documentation that this person does not want to move on and their views are well documented on the file. The situation is under regular review with the relevant professionals. Risk assessments were seen on individual files, which cover areas of concern both in the home and in the local community. The three files seen show that risks are discussed with service users and are reviewed at care planning meetings or sooner if necessary. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 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): Standards 12, 13, 15, 16 and 17 were assessed at this inspection Quality in this outcome area is good Service users are supported to maintain independence in their lives. EVIDENCE: Evidence recorded on activity programmes shows that each service user has an activity plan, which has been developed with them. Service users who spoke with the inspector confirmed that activities were discussed with them. One service user told the inspector about the risk of loosing money being involved in one preferred activity and that members of staff had discussed the risk with them. One service user said they enjoyed doing their own thing but discussed their preferred activities with the staff. Another service user told the inspector that they preferred listening to music and liked to spend sometime each day in their room. Daily plans include social and leisure activities and tasks associated with development in daily life skills, for example service users go shopping and visit the local parks and cafés they assist with cleaning and tidying in the home and help to preparing food. Service users also attend day centres and one attends a sheltered workshop. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 13 There was evidence recorded to show that key workers ensure that service users are encouraged to explore opportunities that come their way related to new activities. All service users are supported to maintain links with their families and friends. All visitors to the home are welcomed and have the opportunity to meet in private with service users if this is appropriate. All of the daily routines in this home are based on service users care plans. Members of staff treat service users with respect and the inspector observed staff knocking on doors before entering rooms. One service user told the inspector that staff are easy to talk to and are always available if you need them. Service users have responsibility for preparation of their own breakfasts and lunch and assist staff to prepare the evening meals. A notice board consisting of the weekly menu for the evening meals is situated in the kitchen. The menu shows that meals are nutritious and balanced. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 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): Standards 18, 19 and 20 were assessed at this inspection. Quality in this outcome area is good. Personal support is provided in a way that promotes privacy, dignity and independence Where appropriate service users are supported to self medicate. EVIDENCE: The staff group at this home is culturally diverse, although the manager is male all care workers are all female. In most cases service users are self-sufficient and are able to attend to their own personal care. One male service user who has now left the home did need a high level of support. Evidence from discussion with the manager and records seen show that this persons needs were provided in a flexible and sensitive manner, which included regular input from the manager. All of the, service users are known to the Community Psychiatric Nursing Team but not all have an allocated CPN. The home has regular access to the team and can discuss issues with the duty CPN as necessary. All service users have a named GP and attend dental, optical, chiropody and dietary appointments as necessary. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 15 One service user is on a self-medication programme at present. The plan has been agreed with the service user in consultation with the GP and the Community Psychiatric Nurse. The inspector checked medication charts and the medication cabinet, which show that medication, is kept appropriately and is signed for by staff when administered. No errors in administering medication have been recorded since the last inspection. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 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): Standards 22 and 23 were assessed at this inspection. Quality in this outcome area is good Service users’ views are listened to. The home’s practice with regard to the protection of adults has been reviewed. EVIDENCE: The home has a complaints policy and procedure in place and complaints appear to be dealt with appropriately. Records show that there have been some difficulties related to two service users in particular. One service user who walk into other people’s rooms without invitation and left the toilet door open when using the facilities has been moved to more appropriate accommodation. The second is particularly noisy and has kept people awake at night. The manager has discussed the problem of noise with the service user and the complainant. The person who has made the complaints has been offered another room but has declined the offer and instead has opted to talk to staff if and when it becomes noisy in his room. An action plan related to the noise has been agreed. There have been no further complaints since January 2006. The service user who made the complaints was at work at the time of the inspection so it was not possible to speak with him. This issue will be reviewed again at the next inspection. The homes policy and procedure related to service user money has been reviewed within the last year. There are clear guidelines to follow and these were well known to the staff that spoke with the inspector. The home has an adult protection policy and procedure which is in need of review members of staff are able to demonstrate that they are aware of the Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 17 policy and how to deal with an allegation of abuse should one be made at the home. There have been no allegations related to adult protection since the last inspection. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 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): Standards 24 and 30 were assessed at this inspection. Quality in this outcome area is adequate. Service users live in a homely environment with sufficient facilities to meet their needs. EVIDENCE: Two major problems have arisen at this home since the last inspection. The home has a water leak, which is affecting the electrics on the top floor and is severely damaging the wall. In spite of every effort being made to ensure this problem is dealt with as soon as possible the cause of the problem has not yet been found. The electrical wiring has been made safe. The inspector was shown evidence of ongoing work to find the cause of the problem. The second problem is that of bed bugs these have been found in service users rooms and the house has been fumigated however since the fumigation more bugs have been seen. It is possible that this is because a service user refused to let the Pest Control people into her room. The process will now be repeated and will include all affected rooms. The Pest Control firm who are dealing with the problem, are of the opinion that the bugs have been brought into the unit on second hand items bought locally. The manager has been asked to seek an inspection of the home by the environmental health service and to ensure that a copy of the report is sent to the Commission for Social Care Inspection. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 19 Records show that the manager has done everything possible to deal with these problems efficiently and as quickly as possible. The inspector saw two rooms during the tour of the building one occupied and one empty. Both rooms were of a good size and were adequately decorated. The home is in general clean and tidy throughout. There were some areas such as the basement bathroom and the laundry room, which were in need of cleaning. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 20 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): Standards 32, 34, 35 and 36 were assessed at this inspection Quality in this outcome area is adequate. The staff team in this home hold relevant qualifications. The recruitment policy is under review and was not available at this inspection. Members of staff are appropriately trained to meet the needs of service users. All staff appraisals must be reviewed. EVIDENCE: Three of the four care workers in this home are qualified to the level of NVQ 2. The fourth member of staff is waiting for a date to begin the course. Other training undertaken since the last inspection includes food hygiene, health and safety, first aid and medication. No staff have received adult protection training since 2004. All members of staff need to attend appropriate Protection of Vulnerable Adults (POVA) training within the next six months. POVA training was discussed with the manager and the responsible individual who has agreed to set dates for this training in the near future. The homes recruitment policy is under review at present and was not seen at this inspection. The staff team have been in post for over five years only one person has been recruited since the Care Standards Act 2000 and this person has since left. The inspector did go to the human resources department to see the staff files. Files showed that Criminal Records Bureau disclosures are out of date. None of the files seen had two references but all had a contract of employment with terms and conditions included. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 21 The inspector examined staff supervision files at the home. Staff receive regular supervision at least six times each year and this is recorded. All members of staff have had an appraisal but these are out of date and need to be reviewed. Care workers in this home are competent and have sufficient skills and abilities to support the service users resident. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 22 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): Standards 37, 39, 40 and 42 were assessed at this inspection. Quality in this outcome area is good The health and safety and welfare of service users is generally promoted and protected. The policies and procedures for this home and the development plan are out of date and in need of review. EVIDENCE: The manager of this home is registered with the Commission for Social Care Inspection and holds a Registered Managers Award. The manager works to his Job description, which accurately describes his role at the home. Both service users and members of staff told the inspector that the manager has an open door policy and can be approached at any time for support and advice. The home has a number of monitoring systems in place and these include regulation 26 visits by the responsible individual, service users satisfaction surveys, service user reviews and an annual development plan which was seen for 2005/6 but has not yet been updated for 2006/7. The home has a Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 23 statement of purpose and service users guide, which is in the process of being reviewed. A copy will be sent to the commission on completion. The homes general policies and procedures are all under review and these need to be up dated as soon as possible. Documents that need to be reviewed include adult protection and the homes recruitment policy. Health and safety policies and procedures were seen by the inspector. Regular checks are made to ensure fridges, freezers and other appliances are in working order. Control of Substances Hazardous to Health (COSHH) risk assessments are reviewed each year or sooner if necessary. Gas and electrical certificates are up to date. Fire drills are carried out at least four times each year. There is a continuing problem with two residents who refuse to leave the building when the fire alarm goes off. The manager told the inspector that this is of concern and the drill procedure and the reason for it is discussed with the particular residents after each drill. Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 2 2 X 3 X Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 25 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 YA6 Regulation Requirement Timescale for action 30/09/06 2. YA24 14(2)(a)(b) The Registered Person must 15(2)(b) ensure that all service user care plans are reviewed regularly with the relevant professional and appropriate review minutes are taken with actions and outcomes recorded. 23(2)(b)(d) The Registered Person must ensure that the leak and repairs related to the water leak on the top floor of the building are dealt with appropriately. The Registered Person must ensure that the issue regarding pest infection is resolved and all areas of the home are kept clean and tidy throughout including the laundry room and the basement bathroom. Once received a copy of the environmental health report for the home must be sent to the commission. 30/09/06 3. YA34 19(1)(i) schedule 2 The Registered Person must ensure that all members of staff have an up to date CRB disclosure. DS0000020971.V287287.R01.S.doc 30/09/06 Cloudesley Road (92) Version 5.2 Page 26 4. YA36 18(2) The Registered Person must ensure that all members of staff receive an appraisal, which is reviewed each year. 31/10/06 5 YA39 6 YA40 24(1)(2)(3) The Registered Person must ensure that the home has an up to date development plan, which reflects the views of service users at the home. 24 (1) The Registered Person must appendix 2 ensure that the homes policies and procedures are reviewed and kept up to date. 31/10/06 31/10/06 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. Refer to Standard YA22 Good Practice Recommendations The complaint regarding the noise related to one service user must be kept under review. (see standard 22) Cloudesley Road (92) DS0000020971.V287287.R01.S.doc Version 5.2 Page 27 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.V287287.R01.S.doc Version 5.2 Page 28 - 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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