Inspection on 15/11/05 for Creswick House

This inspection was carried out on 15th November 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Creswick House 23/03/07

Creswick House 10/05/05

Creswick House 24/11/04

Creswick House 11/05/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Creswick House 77-79 Norwich Road Fakenham Norfolk NR21 8HH Lead Inspector Mrs Lella Andrews Unannounced Inspection 15th November 2005 11.20 Creswick House DS0000027471.V256758.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 Creswick House DS0000027471.V256758.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. Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Creswick House Address 77-79 Norwich Road Fakenham Norfolk NR21 8HH 01328 851537 NO FAX # 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) Jeesal Residential Care Services Limited Mrs Sally Subramaniam Helen Carson Holmes Care Home 13 Category(ies) of Learning disability (13), Learning disability over registration, with number 65 years of age (7) of places Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. Thirteen (13) adults of either sex who have a learning disability may be accommodated. A maximum of seven (7) service users accommodated on the ground floor may be over 65 years of age and have a learning disability, Maximum number not to exceed 13. 10th May 2005 Date of last inspection Brief Description of the Service: Creswick House is a large house situated on the edge of the town of Fakenham. It provides accommodation for up to thirteen adults with a learning disability. Seven of the service users may also be over the age of 65 years. The building is divided so as to provide living accommodation for the group of older, more frail service users on the ground floor and for a group of more physically able service users on the first floor. The service users living on the first floor may have behaviours which staff may find challenging. There are currently separate staff teams working on each floor. There is a large garden to the rear of the Home, which has been divided so that each floor has access to their own part of the garden. The Home is owned and managed by Jeesal Residential Care Services Ltd. Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This Inspection was unannounced and took place between 11.20am and 4.35pm on Tuesday 15th November 2005. The Manager was present throughout the Inspection and provided information verbally and in the form of records. The Inspector spoke to two members of staff on an individual basis. The Inspector spoke to tenants briefly and observed staff and tenants together. Records were inspected and the Inspector was shown the areas of the Home in which improvements have taken place. Completed comment cards were received from tenants, these had been completed with the assistance of staff and not all tenants were able to take part. The comment cards received from tenants were positive, particularly about the meals. Completed comment cards were received from four visiting health professionals and these stated that they are satisfied with the overall care provided to the tenants and that staff are aware of the needs of the tenants. One of the comment cards stated that there were not always enough staff on duty. Completed comment cards were received from six relatives and these also contained mainly positive comments including: “…we are very satisfied with the care….” “…good overall care….” “…staff helpful….” Three of the comment cards stated that there were not enough staff on duty at times. What the service does well: The service provides a good quality of care to tenants with very different needs, including those with complex needs and challenging behaviours. Staff are enthusiastic about supporting the tenants and have a good understanding of the plans in place to support tenants individual needs. The tenants are supported to access community facilities and to take part in a range of activities. The views and wishes of the tenants are sought on a regular basis. Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Creswick House DS0000027471.V256758.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 Creswick House DS0000027471.V256758.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): None of these standards were inspected EVIDENCE: N/A Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 9 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 and 9 The care plans reflect the assessed needs of the tenants and provide clear guidance to staff about how to meet individual needs. The communication needs of the tenants are assessed and plans are in place to enable the tenants to make their own choices wherever possible. The tenants are supported to take risks as part of an independent lifestyle. EVIDENCE: Two of the care plans were seen. These contain detailed information about the tenant’s individual needs with particular reference to how autism impacts on the tenant’s life. The care plans contain information about seemingly small issues but which are actually extremely important to ensure that the tenant has a more enjoyable and rewarding lifestyle. The care plans contain detailed risk assessments and there is evidence that these are reviewed on a regular basis. The staff understand the process and the importance of risk assessment and gave examples of how this is carried out in practice. Risks are considered carefully by the staff team and are Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 10 managed well to enable tenants to take part in activities which interest them. Risk assessments also include information about when a tenant’s choice may be reduced and the reasons for this. Staff were seen and heard to offer choices to the tenants in a variety of ways during the Inspection. Staff are aware of the importance of communication, particularly for those tenants with autism and were seen to be consistent in their approach to the tenants. One of the deputy managers has completed the Communication Co-ordinators training and is in the process of undertaking detailed communication assessments for all of the tenants. The Inspector saw the care plan for one of the tenants whose assessment has been completed. The information is detailed and provides good guidance to staff about how best to communicate with the tenant. All staff attend Signalong training so that they have an understanding of sign language. The deputy manager is planning a training session for the staff team about the work that she has been doing with individual tenants. The care plans contain an individual financial care plan for each of the tenants, which details the arrangements in place for looking after their money. None of the tenants are responsible for their own money. The financial records were checked for two of the tenants against the money held in the Home and these were correct. Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 11 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, 13 and 17 The tenants are supported to take part in activities within their local community. The tenants have opportunities for personal development. The tenants are offered a healthy diet and enjoy their meals. EVIDENCE: A member of staff who is responsible for activities is on duty on each floor for a few hours each day. This member of staff works with the care staff to organised suitable activities for each of the tenants. The hours that the member of staff works can vary depending on the activity. For example, on the day of the Inspection a member of staff was working in the evening to support two of the tenants to see a film and on Sundays the staff work in the morning to support tenants who wish to go to church. Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 12 Each tenant has an activity plan in their care plan. These plans have recently been reviewed on the first floor and the amount of meaningful activities that the tenants are taking part in has increased. Some tenants are supported on a one to one basis whilst others enjoy taking part in a larger group. Staff who spoke to the Inspector were enthusiastic about supporting the tenants to take part in activities away from the Home. On the day of the Inspection a variety of activities were taking place. These included sailing, bowling, tenants forum and the hairdressers. Tenants are also supported to assist with some household tasks such as laundry, cooking and cleaning their own bedroom. The Home has a vehicle but currently there are not many staff who are able to drive. The Home is situated on the edge of the town of Fakenham and so tenants are able to walk to many of the amenities. All of the tenants on the first floor have been away together recently whilst new stairs were being fitted. Staff said that the holiday was a success and that the tenants had enjoyed themselves. The care plans contain information about the dietary needs of the tenants and staff are aware of these. Some of the tenants have particular needs with regard to what they eat or to how the food and drinks are prepared. The dietician and the speech and language therapist are involved with the care plans for particular dietary needs. Particular consideration is also given to the environment in which tenants have their meals and to individual needs at these times. The kitchens on both floors are kept locked when staff are not present following risk assessments but tenants are supported to do some meal and drink preparation. The menus are currently being reviewed and changes made to reflect the move from summer to winter menus. One of the tenants comment cards states that they like the meals. Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 13 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 and 19 The tenants personal care, physical and emotional health needs are met. EVIDENCE: The care plans contain detailed information for the staff about how to meet the personal care needs of the tenants. The staff are aware of the importance of respecting the privacy of the tenants whilst providing support with personal care. Where possible, personal care is provided by staff of the same gender as the tenant. The care plans also contain detailed information about the physical and emotional health needs of the tenants. The staff recognise that there are different issues for the tenants living on the ground floor than those on the first floor. The tenants living on the ground floor are older and have problems associated with failing physical health and ageing. The tenants on the first floor have more complex needs with challenging behaviours. The staff have a good understanding of the tenants needs and of the plans in place to meet these needs. The care plans show that health professionals are involved in the lives of the tenants. These include a range of professionals including, psychiatrist, psychologist, dietician, speech and language therapist. The comment cards completed by health professionals state that the staff have Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 14 a good understanding of the needs of the tenants, that any advice is incorporated into the care plan and that they are satisfied with the overall care provided. A chiropodist visits the Home on a regular basis and the aromatherapist visits on a weekly basis. Tenants use the local optician with a more specialist optician visited by tenants with particular visual difficulties. The Manager said that the Sensory Support team has been contacted for advice about meeting the needs of one of the tenants whose sight has deteriorated. Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 15 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 Tenants are given opportunities to raise any concerns/complaints EVIDENCE: The Home has a complaints procedure which is available in symbol format as well as the more detailed written format. Tenants meet with their key worker on a monthly basis to review any outstanding needs and this is also an opportunity for the tenants to raise any concerns that they have. Tenants meetings take place on a regular basis and two of the tenants are representatives at the Tenants Forum which is facilitated by the organisation. The work that the staff are doing to improve the communication between tenants and staff will enable tenants to make a complaint if they wished to. Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 16 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): 24 and 30 The tenants live in a homely, comfortable and safe environment, which is clean and hygienic. EVIDENCE: The Inspector was shown the areas of the Home in which improvements have been made. Overall, the Home is clean with no offensive odours. Each floor has its own laundry room but improvements are planned for the laundry room on the first floor as there is a need for an industrial washing machine to cope with the amount of laundry there. The ground floor accommodation looks more homely as there are more ornaments/pictures around the Home. New furniture has been ordered for the lounge. The first floor accommodation is more homely now than seen during previous Inspections. A lot of the communal areas have been redecorated and pictures have been safely attached to the walls. The tenants who live on this floor do not always like ornaments or pictures to be around and there are also issues of safety which the staff need to consider. The area on the first floor which had previously had a problem with unpleasant odours has been addressed through the provision of a new carpet and the Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 17 ongoing cleaning routines. The first floor no longer have a dedicated domestic member of staff and so it is now the responsibility of all staff to undertake these tasks. The Manager will need to monitor this to ensure that the Home remains clean and hygienic. The Manager said that the bathroom and dining room will shortly be decorated and that the tenants are in the process of being consulted about colours. The second floor used to provide office accommodation and alterations have recently been made to this space. These rooms have been redecorated and will now provide space for activities to take place for the tenants on the first floor. There will be a sensory room, kitchen, bathroom and craft room. The small staff office which is already in use will remain there but will have a separate access. New stairs have been fitted to the second floor as the previous ones were not safe for tenants to use. The building in the garden which was previously the activity room has been altered into the Managers office. This now provides privacy for supervisions to take place and provides the Manager with a quieter place to carry out necessary management tasks. The Manager said that tenants and staff visit the office on a regular basis and this was seen to be true during the Inspection. The garden is separated into two separate gardens so that the tenants on each floor have their own access to their own garden. For the first time these gardens have been landscaped and designed attractively with appropriate furniture in each. The gardens now look like nice areas in which the tenants might like to spend their time. The Manager said that improved lighting will be provided between the office and the house. It is recommended that the controls for the heating in the office are moved lower down so that it is easier for the Manager to operate them. Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 18 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): 33 and 35 The tenants are supported by an effective staff team who receive appropriate training. EVIDENCE: The rotas show that there are always two members of staff on duty during the day with an additional member of staff for a few hours each day on each floor to enable activities to take place. The Manager will provide support in the Home if needed to enable other staff to go out with tenants. One of the deputy Managers has some hours in which she is supernumerary to the rota and this also enables the care staff to support tenants in activities. The Manager said that the recruitment which was taking place during the last Inspection had not been as positive as had been hoped and that she is recruiting for staff again. She said that she has worked several care shifts recently but that this has now decreased again. The care staff all work 12hour shifts now and the Manager said that during a recent review of this practice staff had all been keen to continue to work these shifts. Staff said that it enables them to support tenants in activities without the constraint of having to be back for staff to finish their shift. They also said that the tenants with autism seem to find it easier when the same staff support them for the whole day rather than have a change of staff halfway through. Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 19 Staff who spoke to the Inspector were enthusiastic about their work with the tenants and really seem to enjoy what they do. They are knowledgeable about the needs of the tenants and provided consistent responses about how support is provided. The Manager is in the process of updating the training and development plan for the team. The majority of staff have attended the necessary mandatory training, for example, first aid, protection of vulnerable adults, health and safety, fire safety. Staff have also attended training with regard to mental health, dementia, autism, challenging behaviour, care planning. The Manager has plans in place to work towards 50 of the care staff having achieved NVQ level 2 or above. The staff said that they receive good training and support to carry out their roles. Some of the recent staffing difficulties have been because the Manager has tried to ensure that staff are still able to attend training days. Two of the comment cards completed by visitors stated that there are not always sufficient staff on duty but no further details were provided. Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 20 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): 37, 38, 39 and 42 The tenants benefit from the ethos, leadership and management approach of the Home. The views of the tenants underpin all developments within the Home. The health, safety and welfare of the tenants and staff are promoted and protected. EVIDENCE: The Manager has been in this post for approximately two years and has made considerable improvements to the service provided to the tenants. The Manager has high standards for herself and others within the team and works hard to support staff to provide a good service to the tenants. The Manager has almost completed NVQ level 4 training and undertakes all appropriate training provided to the staff team. The Manager said that she receives good support from the General Manager and the Proprietors. Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 21 Since the last Inspection the deputy manager who was working at the Home on a temporary basis has returned to another Home within the organisation and two deputy managers have been promoted within the staff team. The Inspector spoke to one of the deputy managers who is enthusiastic and knowledgeable about the needs of the tenants. The Manager and deputy manager work well together and staff said that the management team provide them with good support. Regular staff meetings take place, as does staff supervision. The views of the tenants and the staff are gathered whenever any changes are planned for the service. The Home has an annual development plan, which the Manager is involved in putting together. Quality assurance questionnaires were sent to relatives and health professionals in April. The Inspector did not see the results of these during the Inspection but the Manager said that the responses were positive. As part of their quality assurance process the Home carries out regular reviews of the service, including monthly care plan reviews with the tenants, tenants meetings, Tenants Forum, staff meetings, health and safety monitoring, supervisions. The management team for the Home also hold regular Quality Forum meetings, which look at specific issues each time. The deputy managers and senior care staff have attend training provided by the General Manager about the National Minimum Standards and the role of the Commission. All staff receive Health and Safety training within their induction. One of the deputy managers is responsible for carrying out the monthly health and safety checks of the building. There are systems in place for contacting relevant people to carry out maintenance work. The Inspector was told that the hot water is regulated to a safe temperature. The Inspector saw a sample of the service certificates for safety equipment eg. Gas safety check, record of fire drills and weekly alarm tests. It is recommended that the names of staff are recorded on the record of fire drills so that the Manager can ensure that all staff take part. COSHH assessments are kept and updated. The Manager has completed very detailed fire risk assessments for all areas of the Home and for each individual tenant. Creswick House DS0000027471.V256758.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 X X X X Standard No 22 23 Score 3 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X X X X 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score X X 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Creswick House Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score 3 3 3 X X 3 x DS0000027471.V256758.R01.S.doc Version 5.0 Page 23 no 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. Standard Regulation Requirement Timescale for action 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 24 42 Good Practice Recommendations It is recommended that the controls for the heating in the office are moved lower down It is recommended that the names of staff taking part in fire drills are recorded Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Creswick House DS0000027471.V256758.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!