Inspection on 09/05/05 for Courthill House

This inspection was carried out on 9th May 2005.

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 but made no statutory requirements on the home.

Other inspections for this house

Courthill House 27/02/07

Courthill House 03/11/05

Courthill House 17/08/04

Courthill House 05/04/04

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Thorndene

Insight - Eastchurch

Southfields

Magenta

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33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Courthill House Court Hill Coulsdon Surrey CR5 3NQ Lead Inspector Mrs P Long Unannounced Inspection 9th May 2005 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 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 Stationary 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. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Courthill House Address Courthill Coulsdon Surrey CR5 3NQ 01737 557442 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Surrey Oaklands NHS Trust Mr Padmasiri Parakrama Warnakula Care Home 10 Category(ies) of LD - Learning Disability (10) registration, with number of places PD - Physical Disability (2) Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 3. The age/age range of the persons to be accommodated will be : 40-65 years. 4. Out of the 10 beds registered for learning disability (LD) up to 2(two) may have an additional physical disability (PD) 5. Out of the 10 beds registered for learning disability (LD) one may have dementia (DE) Date of last inspection Brief Description of the Service: Courthill House is a pleasant purpose built two storey residential home for up to ten people. It is suitated in a residential area, close to a main road, Chipstead railway station and local shops. Residents bedrooms are single rooms and are provided on both floors. There are a variety of communal spaces, consisting of two sitting rooms, one dining room and an activity room. Access to the first floor is by lift and stairs. The home has a large enclosed garden, suitated to the rear of the property. There is off street parking for several cars at the front of the property. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was the first Inspection of the CSCI year April 2005- March 2006 and was unannounced. The inspection was carried out by one inspector and lasted for three and a half hours. On the day of inspection the Home had a welcoming atmosphere. The Resident’s appearance and wellbeing indicated that their care needs were being met. All of the resident’s and staff on duty were involved in the inspection process and were keen to talk about life in the home. During the inspection process, evidence was gathered in the following ways: • • • • • • • Discussions with the Manager. Discussions with the Residents. Discussions with the staff. Direct observation of interactions between the residents, manager and staff. Examination of Resident’s, staff and service records. Examination of the Last inspection reports. A tour of the Home. What the service does well: The relaxed friendly and supportive atmosphere of the home helps the residents to feel that the home is their own. One resident said, “ I live here, I like it here”. This support has created lifestyles, in which residents can feel safe and have a quality of life which includes opportunities for residents to take part in local clubs, pubs, going to restaurants, the cinema, day centres, visits to the local shops and yearly holidays in England or abroad. The home is active in promoting family involvement and contact with the local church and the wider community. It was observed that there are close bonds between the residents and staff with a lot of laughter and fun in the home. Interaction between staff and resident’s was familiar yet respectful. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: 1. On the day of inspection, the home was observed to be offering a reasonably good standard of care and support to the ten residents. However requirements were made in respect of Privacy and Dignity, Health and Safety and the standard of décor in the communal areas. 2. A resident was observed being treated disrespectfully whilst receiving personal care. 3. The temperature of water in all of the rooms was variable, hot in some of the rooms, cool in others. An immediate requirement has been made in this respect. 4. The laundry room cupboards were unlocked and contained various hazardous substances. An immediate requirement has been made in this respect. 5. There was a tub of liquid paraffin cream sitting on one of the kitchen counters, which was prescribed for a member of staff. 6. One of the sitting rooms was very cluttered and could have caused a hazard to the residents. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 7 7. The communal areas in the home were observed as being poorly maintained, with regard to decoration. 8. The dining room did not promote a homely environment in which to eat. There were no tablecloths, place mats, napkins or condiments on the tables. Requirements and a recommendation have been made in these areas. Please refer to Page 25 of this report. 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. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 9 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 standard(s) These standards were not assessed during this inspection. EVIDENCE: Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 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 standard(s) 7,8,9. The manager and staff had a good understanding of the resident’s health and personal care needs, these were well met. EVIDENCE: All of the residents had individualised Care and risks plans and evidenced a comprehensive needs assessment. On the day of inspection residents were observed being enabled to make choices safely. Some risk assessments were in place and had been reviewed. Care plans included all aspects of personal support and health care needs. Each resident has an individual communication profile, which shows how an individual would communicate with others. These profiles were in pictorial formats and photographs. The close bond between the residents and staff at Courthill House enabled help and support with some tasks the residents found challenging. One member of staff assisted a resident to place the cutlery on the dining tables. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 11 The residents who have the skills and interest support one another in a companionable way. One resident was observed offering another advice on how best to eat her food, by saying, “use a spoon”. Staff were at hand to support and offer supervision to any resident who needed help whilst also being mindful of residents choice. A resident required food to be cut up in order that it could be eaten more easily. On many occasions during the inspection staff were observed offering the residents choices, from, “what would you like to do now”, and do you want to help get the table ready for lunch”, and “would you prefer a spoon or a fork”, and, “are you ready for your desert yet”, and, “would you like to go to the day centre this afternoon”. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 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 standard(s) 11,13,14,17 The Manager and staff enable the residents to maintain fulfilling lifestyles in and outside the home. The meals in the home are good, offering choice and catering for special dietary needs. The home promotes contact with family, friends and the local community. EVIDENCE: The residents at Courthill House are not in paid employment. They do however go to the local Day Centre. Whilst the staff accompany them to the centre, this enables them to have a degree of independence, and the opportunity to meet with other day care users. Whilst the residents were being prepared for the trip to the day centre, their facial expressions and body language indicated that they were looking forward to it. Some were observed as being very keen, moving to the front door whilst putting on their coats. On the day, two of the residents had been out to the local shops to get provisions for the home. They were keen to show what they had bought. The routines in the home are times determined only by the timings of the visits to and from the day centre. One resident had decided to go back to bed. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 13 The residents were observed moving around the home with out restriction. One resident was observed doing a drawing and appeared to be enjoying that and said, “I love doing this,” Other residents were watching the television and were observed laughing at the programme they watched. Staff support residents to continue relationships with their family and friends, which include weekend visits and holidays with relatives. All but two of the residents receive regular visitors. Holidays are taken each year, the most recent one in February 2005 to Toronto in Canada. Last year one of the residents went on a trip to New York. There are many photographs around the home from previous holiday trips, all of the photographs reflected smiling faces which indicated enjoyment. A member of the care staff team was recently married and invited all the residents, two of whom attended and it was reported that they had a “great day”. The residents are offered opportunities for spiritual fulfilment. The trust has a minister who comes to the home on occasions. The manager is keen to involve the local church and is exploring this further. The lunch was prepared by a member of the care staff team, and consisted of scrambled/fried egg, baked beans and bread and butter. The residents were observed to choose their meals from the pictorial menus. The dining room tables were not presented in an attractive manner. However the residents clearly enjoyed their meal as they eat it enthusiastically. Special diets are arranged for residents who have specific dietary needs. A recommendation has been made in this respect. Please refer to page 26 of this report. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 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 standard(s) 18,19,20, The manager and staff have a good understanding of the residents support needs. This was evident from the positive interactions and relationships observed. EVIDENCE: Care plans included clear guidelines on any intervention or support each resident required with personal care. Physical and emotional needs of the residents were also detailed in the care plans and daily records, which included visits to the doctor, dietician, dentist and reviews of care. The homes has a clear medication system. All of the care staff are conversant with the policies and procedures regarding medication. None of the residents in home administers their own medication. All of the resident’s medication record sheets were checked and were found to be properly completed. The controlled drug book was also checked and an error was noted. There were records with regard to the activities and care given being. The manager evidenced a shift communication and daily log book, in which the general activities of daily living in the home were recorded. A resident was observed being treated disrespectfully whilst receiving personal care. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 15 Requirements have been made in these areas. Please refer to Page 25 of this report. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 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 standard(s) 22, 23 The home has satisfactory policies and procedures in place for dealing with concerns, complaints and protection of the residents. EVIDENCE: CSCI have received no complaints about this home since the last inspection. There were no records of complaints being made in the home. All of the residents are allocated key-workers. Staff stated that “if the residents were unhappy with anything this would be communicated by body language, or facial expression if they were not able to verbalise their concerns”. The manager is aware of and has attended the Surrey Multi Agency Abuse training. All of the staff group have attended abuse training. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 17 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 standard(s) 24, 25, 26, The standard of the environment within this home is fairly good, most of the areas in the home, currently meets the collective and individual needs of the residents, providing an attractive and homely place to live. However one of the sitting rooms could present a hazard to some residents. Some of the communal areas need attention. EVIDENCE: All of the resident’s bedrooms were personalised. They were very comfortable, warm, and the quality of the furniture and decoration was very good. There were many soft toys sitting around on the beds. There were photographs of family members and other personal items. All of the bedrooms had a television, music centres, and some had computer games. One of the bedrooms had a mobile foot spa. There were many colourful sensory pieces of equipment for example lava lamps and water based lamps in evidence. The home should be commended in providing this quality of personal space for the residents and should consider providing similar facilities in the sitting rooms. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 18 The main sitting rooms benefited from some new furniture. Although the old furniture was still in place in one of the rooms, leading to a very cluttered space. The standard of decoration in the hallways and the dining room were unsatisfactory. The walls and woodwork were marked, chipped and look dirty. This was discussed with the manager, he explained that the property was leased and maintained by an outside company. He stated that he had made several requests with regard to the environment and decoration, but had no response. The bathrooms and toilet’s were quite clinical in design. It was noted that none of them had toilet tissue. An immediate requirement was made. It was also noted that there were packs of incontinence pads and skin cleaning foam, which indicated communal use. This was viewed as poor practice. Requirements and recommendations have been made in these areas. Please refer to pages 25 and 26 of this report. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,34,35,36 The home employs a stable and efficient staff team who provide a good quality of care to the residents. EVIDENCE: The home has clear policies and procedures for staff recruitment. No new members of staff have been recruited since the last inspection. Staff files seen on the day demonstrated thorough recruitment and selection practice. All staff had satisfactory references and Criminal Records Bureau checks. There were 3 care staff, and the manager on duty on the morning shift. The manager stated that the afternoon shift would consist of 3 care staff and a deputy manager. There are no domestic or kitchen staff employed at the home. The cooking and cleaning is part of every one’s day to day work. The dependency levels of the residents on the day indicated that the present staffing ratio was adequate. Training in the home is given a high priority, in particular non verbal communication skills. Staff talked about their job roles, there was clarity and awareness of the different roles and responsibilities within the home. Staff also Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 20 discussed the training opportunities in the home. Eight members of the staff group are NVQ2 qualified. Some are undertaking NVQ3. Further training included: • • • • • • • • • • • • Dementia. Medication. Infection control. Manual handling. First Aid refresher. Health and Safety. Fire Awareness. Food Hygiene. NVQ 2/3. Vulnerable Adults Makaton Risk assessment. The manager is in the process of drawing up a training programme for 2005-2006. There is a supervision programme in the home. The Manager, Deputy Manager, and two of the Senior Team carry out the staff one to one formal supervisions. To date these have been on a monthly basis. The whole staff team also meet as group on a monthly basis. A recommendation has been made in respect of the domestic arrangements in the home. Please refer to page 26 of this report. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,40,41,42, The home has clear Policies and Procedures and the standard of record keeping in the home is good. The Manager is experienced and qualified to run the home. EVIDENCE: The manager has been in post since October 2004. He is a qualified nurse and at present is undertaking NVQ 4, when this is completed he will embark on The Registered Manager Award. The manager had a very open approach. From observation of his interactions with residents it was clear that there was an atmosphere of openness and respect, in which the residents facial expressions and body language indicated that they enjoyed his company. Since taking up his post the manager has improved the residents access to day care. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 22 Some staff spoken to on the day stated that “ things haven’t quite settled down since the last manager left”, and described various scenarios they were unhappy with. Other staff were happy to discuss these issues, whilst they agreed that there were a few problems, when the new manager started, they were optimistic as to the future of the working relationships in the home. They stated, “ it is always difficult for a new manager” and “ things have improved and we will move on” and “ we are all here to work and the residents care is the priority”. These concerns were discussed with the manager, he was already aware of these issues and had taken steps to ensure that the staff could move on, by holding meetings with all the staff and the area Service Manager to discuss their concerns. The manager holds three monthly resident’s meetings. He is also working with the trust and the day centre to ensure that resident’s views and opinions can be sought. The standard of recordkeeping at the home is very good. Records are stored appropriately and securely. There were some concerns about the health and safety of residents with regard to the temperature of water in all of the rooms which was variable, hot in some of the rooms, cool in others. An immediate requirement was made. The laundry room cupboards were unlocked and contained various hazardous substances. An immediate requirement was made There was a tub of liquid paraffin cream sitting on one of the kitchen counters, prescribed for a member of staff. One of the sitting rooms was very cluttered and could have caused a hazard to the residents. Requirements were made in these areas. Please refer to page 25 of this report. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 23 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 x x x x Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score x 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 x x x x Standard No 11 12 13 14 15 16 17 3 x 3 3 x x 3 Standard No 31 32 33 34 35 36 Score 3 x x 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Courthill House Score 3 2 3 x Standard No 37 38 39 40 41 42 43 Score 3 x 3 3 3 2 x H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 24 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 YA 18 Regulation 12(4) (a) Requirement The Registered Provider must ensure that personal care is provided in a manner which respects the privacy and dignity of the residents. The Registered Provider must ensure that water temperatures in the home are safe. The Registered Provider must ensure that all COSHH substances are stored safely. The registered Provider must ensure that prescription medication for staff is not left where residents can access it. The Registered Provider must ensure that all areas of the home are free from hazards. The Registered Provider must ensure that particular attentation is paid to the in the communal areas of the home and that they are kept clean and reasonably decorated. The Registered Provider must ensure that there is no communal use of incontinence pads and skin cleaning foam. Timescale for action 9/6/2005 2. 3. 4. YA 42 YA 42 YA 42 13(4)(a,c) 13(4)(a,c) 13(2) Immidiate 9/5/2005 Immidiate 9/5/2005 Immidiate 9/5/2005 9/6/2005 9/8/2005 5. 6. YA 42 YA 9 YA 24 13(4)(a) 23 (2)(d) 7. YA 18 12(1)(a)( 4)(a) 13(3) 9/6/2005 Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 25 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. Refer to Standard 17 3,14,30,33 Good Practice Recommendations The Registered Provider should consider reviewing the dining room enviroment, with regard to how the dining tables are presented. The Registered provider should consider employing a cleaner for the home. Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 26 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Courthill House H58_v223615_Courthill House_s13617_090505_stage4.doc Version 1.30 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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