Inspection on 09/06/06 for Cricklade House

This inspection was carried out on 9th June 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 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

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

CARE HOMES FOR OLDER PEOPLE Cricklade House Cricklade House 57 Cricklade Avenue Streatham Hill London SW2 3HD Lead Inspector Ms Rehema Russell Unannounced Inspection 9th June 2006 10:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address DS0000066465.V295704.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. DS0000066465.V295704.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cricklade House Address Cricklade House 57 Cricklade Avenue Streatham Hill London SW2 3HD 020 8674 9408 020 8769 2759 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) Mrs Mary Madden Mrs Mary Madden Care Home 4 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (4) of places DS0000066465.V295704.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection N/A Brief Description of the Service: Cricklade House is a semi-detached house on two floors which was formerly a family home and which is indistinguishable from the other residential homes in the street. There is ample on-street parking and a large shopping centre, with full community facilities and transport links, a few minutes walk away. The ground floor has a large entrance hall, toilet with washbasin, large front bedroom, lounge, conservatory, kitchen/diner and back garden. The first floor has an office, three bedrooms and a bathroom. The downstairs bedroom and two of the three upstairs bedrooms have an en-suite toilet with shower. All rooms are decorated, fitted and furnished to a high quality. The home does not have a lift and so is not suitable for persons with mobility problems. Written information about the home would be given to prospective service users and their relative/carers in the form of the Statement of Purpose and Service User Guide. A copy of most recent CSCI inspection report would be available at the home if this was requested. The current fee set by the local authority is £450 per week. DS0000066465.V295704.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 9th June 2006. The home had been registered on 15th March 2006 and the inspector was unaware that the home had only actually admitted its first service users one week prior to the inspection. The home is registered to take four older people with dementia. Two service users had been admitted on different days during the first week and a third service user was admitted on the day of the inspection. The inspector spoke with the manager and both of the care workers on duty, toured the premises, spoke with all three service users and looked at documentation. Subsequent to the inspection feedback was obtained from relatives of the two service users who had been admitted during the first week. The feedback was very positive. What the service does well: 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. DS0000066465.V295704.R01.S.doc Version 5.2 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection DS0000066465.V295704.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, 6 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Prospective service users and their carers have the information they need to make an informed choice about where to live. Each service user has a contract/statement of terms and conditions. No service users move into the home without having their needs assessed and being assured these will be met. Prospective service users and their relatives and carers have an opportunity to visit and assess the suitability of the home. The home does not take service users solely for intermediate care. EVIDENCE: The home has a Statement of Purpose and Service Users’ Guide, which were submitted and vetted by the CSCI Central Registration Team at the time of registration. A relative spoken with confirmed that she had been given these documents and several policies prior to her mother’s admission so that she could make an informed choice about the home. DS0000066465.V295704.R01.S.doc Version 5.2 Page 8 One of the two care plans was seen and showed that a thorough assessment of the service user’s needs had been made prior to admission and that both the Community Care Assessment and discharge report from the hospital had been obtained. There was also an admission taking place on the morning of the inspection, which the inspector observed. The new service user came to the home with her social worker and carer and was introduced to the other service users and to staff and offered refreshments. After a while the whole party went upstairs to the service user’s room and the admission continued in private. The Manager asked the service user how she wished to be addressed, which items of furniture she would like brought from her previous home, recorded the possessions she had brought with her, took all relevant details such as next of kin/current health/interests and activities, sorted out financial responsibilities, and continually reassured the service user on any worries that she had. The process was relaxed and unrushed and the manager showed great patience with all of the questions and concerns of the new service user. When everything was completed the manager made sure that the service user was orientated and familiar with the other rooms on the first floor and which room was hers, and then accompanied her down for lunch. The manager was disappointed that the carer had not brought the service user’s photographs and framed pictures to the home as she likes to put these up as soon as possible (preferably the day before admission) so that the new service user feels an immediate affinity with their new room. As there was no relative accompanying the new service user, nor available in this country, the Manager explained to the social worker that, after the service users had had time to settle down, she would read through and explain the contract with the service user and make sure that she understood it. The manager will not admit anyone to the home unless they have had at least one trial visit and the family/carers have also visited. This had been the situation with both of the already admitted service users. One had visited with her daughter and the other had visited from the hospital after her family had already separately visited the home. The home does not take service users solely for intermediate care. The manager was also clear that the home would not admit service users on an emergency basis. DS0000066465.V295704.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Initial individual care plans have been written and service users’ health care needs are being met. Service users are protected by the home’s policies and procedures for dealing with medicines. Service users are treated with respect and their right to privacy is upheld. EVIDENCE: Initial care plans have been written, generated from the assessment information obtained by the home and from the placing authority, and also from the discharge hospital report where applicable. The service users have only been at the home for one week and so a full care plan will be written during their first 3-4 weeks at the home as staff get to know them and understand their care needs. Full daily notes, written at the end of each shift, were seen on care plans and these gave a comprehensive picture of the activities, health, mood and welfare of each service user over each period of the day and night. DS0000066465.V295704.R01.S.doc Version 5.2 Page 10 Service users were well dressed and groomed. They have been registered with the local General Practitioner surgery and the manager was in the process of registering them with the chiropody services. The GP surgery has a community nurse attached and the manager is aware of continence services, should these be required. None of the service users have a Community Psychiatric Nurse but one of the Community Care Assessments mentioned that the service user had been seen by a doctor from a mental health hospital and the manager intended to follow this up. Whilst admitting the new service user on the day of inspection the manager noticed that she had a cough, enquired for how long, and consulted with the service user about registering with the GP and getting an appointment as soon as possible. The storage, administration and recording of medication was checked and no problems were found. There is a locked medicines cabinet in the dining area. Currently only one service user is taking medication and as this had been supplied directly from the hospital it was in individual packets. The manager said that she intended to consult with the local pharmacist about supplying medication in dossette boxes so that doses are individually pre-packaged. The home’s medication policy had been supplied to the CSCI Pharmacist on registration and the manager had been told that if there were any problems with it the pharmacist would contact her. Observation of the way that the manager and staff approached and treated service users evidenced that service users are treated with respect and their dignity and privacy safeguarded. The manager asked the newly admitted service user how she would prefer to be addressed and throughout the inspection staff were observed to speak with service users respectfully. The other two service users, who had only been at the home for one week, were observed to feel completely at ease, moving from room to room at will and using their bedrooms for private space when they wished to be alone. The inspector was told that one service user does not use the downstairs toilet nor the generally bathroom, but always goes to her own en-suite upstairs. During the day she was observed to go to her room from time to time, sometimes to tidy up her things, and each time closing the door behind her for privacy. Staff were observed to respect this, coming upstairs to call her for lunch but not entering her room. Another indication of the importance given to dignity and respect at the home is that the manager has put a laundry basket in each ensuite shower room so that each service user’s linen and clothes are washed on an individual basis and returned to them, rather than being washed communally. The inspector was told that on the day before the inspection the first service user to be admitted to the home was overheard to tell the second service user “….this is our home”. DS0000066465.V295704.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users’ social, cultural, religious and recreational interests are provided for and they are encouraged and supported to maintain contact with family and the local community. Service users are encouraged and supported to exercise choice and control over their lives. Service users receive a wholesome and balanced diet in pleasant surroundings. EVIDENCE: Although service users had only been at the home for one week, they were already engaging in individual leisure interests and accessing the community. On the day of inspection one service user was knitting and another reading the newspaper. Later on the first service user was observed to be trying to teach the second service user to knit. One service user had been out shopping with the manager and the newly admitted service user was asked about her interests and what she would like to do. The social worker accompanying the newly admitted service user said that once admitted to a residential home, the London Borough of Lambeth considered that the service user’s leisure and social interests were met and so access to day centres was no longer facilitated. The manager tried to explain this sensitively to the newly admitted DS0000066465.V295704.R01.S.doc Version 5.2 Page 12 service user, who had expressed her wish to continue to attend the day centre for two days per week. Two of the three service users are from minority ethnic groups and the manager is obtaining information from them about any specific cultural needs or preference they have. One service user used to attend the temple of a specific religion before entering the home and the manager has arranged for representatives of this religion to visit her and to take her to the temple weekly. The manager is very committed to service users’ contact with family and friends. On the day that the first service was admitted to the home the manager invited all of her five ‘children’ and their spouses to a full roast lunch to welcome them and ‘open’ the home. The second service user has daily visits from her daughter. These two sets of relatives were contacted by the inspector for feedback and said that “staff make you very welcome and encourage you to visit”. Service users are encouraged and supported to exercise choice and autonomy as much as they are able to within the limits of their dementias. Routines are flexible with service users choosing when to rise and when to go to bed. One serviced user gets up at about 6.30 am for a cup of tea then stays in her room or goes downstairs to the lounge in her dressing gown. The other service user gets up early but then goes back to bed and gets up again after 9 am. Both service users choose to go to bed at various times, as it suits them. The manager is supportive of the role of advocacy and said she would contact Age Concern for their advocacy services if the need arises. Service users or their families are encouraged to maintain control of their own finances and on the day of inspection this area was thoroughly explored with the service user being admitted and her social worker, and agreement on how she would continue to control her own finances reached. The finances of the other two service users are controlled by their families. DS0000066465.V295704.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has suitable policies and practices to ensure that complaints will be listened to and acted upon and that service users are protected from abuse. EVIDENCE: The complaints and abuse policies were submitted and accepted during the home’s registration in March of this year. There have been no complaints to date. The manager values the complaints process and ensures that service users and their relatives understand the policy and how to complain. Relatives spoken with confirmed that they had been given a copy of the policy by the manager. Staff spoken with were aware of the abuse policy and the manager said that she would obtain a copy of the adult protection policy of the local borough to ensure that her own policy conformed with it. DS0000066465.V295704.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service users live if a safe, well-maintained environment, with access to safe and comfortable indoor and outdoor communal facilities. There are sufficient and suitable lavatories, washing facilities and aids to facilitate independence. Service users’ bedrooms suit their needs and are safe and comfortable. The home is clean, pleasant and hygienic. EVIDENCE: The location and layout of the home is suitable for its stated purpose, and it is accessible, safe and well maintained. It is a few minutes walk from a large shopping centre with full community and transport facilities but as it is located in a wide residential street it is also safe and accessible. Conversion works to build a conservatory, widen the kitchen/diner area and add en-suite bathrooms to three of the bedrooms have been completed to a very high standard and the whole home has been newly redecorated and fitted. DS0000066465.V295704.R01.S.doc Version 5.2 Page 15 There are four communal areas, the lounge, the conservatory, the kitchen/diner and the garden, and each area is spacious and well laid out. The indoor areas have good quality decorations, fittings and furnishings and are homely and comfortable. There is a large table in the conservatory that can be used for leisure facilities or for eating at as an alternative choice to the dining area. All four single bedrooms meet minimum space requirements, with three of the bedrooms being much larger than minimum size and also having an ensuite shower, washbasin and toilet. Bedroom fittings, furniture and furnishings are attractive, comfortable and of good quality and service users are encourage to bring their own possessions, including items of furniture if they wish. In addition to the en-suites, there is a toilet with washbasin downstairs and easily accessible from the lounge, and a bathroom with toilet upstairs. There are grab rails besides all of the toilets in the home and the manager is in the process of obtaining a raised toilet seat for the service user who would benefit from it. Laundry facilities are located in the conservatory, completely away from the kitchen, and are housed in a low wooden cupboard structure which makes them non-visible. The home is well lit and ventilated throughout and there is a window in the conservatory roof that was opened on the day of the inspection to give greater airflow and coolness in the conservatory. On the day of inspection the home was found to be meticulously clean and hygienic throughout. DS0000066465.V295704.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users’ needs are met by the numbers and skills of staff and service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. EVIDENCE: There have only been two service users at the home for the first week of its operation. The rota showed that there are two care workers on duty each morning till 2 pm (one of whom may be the manager), one care worker on duty during the afternoon and evening and one waking staff on duty at night. The inspector was told that additional staff are available if required and on the day of the inspection there were two care workers on duty during the morning as well as the manager, because there was a new admission that day. Staff recruited so far to the home are the manager, three experienced staff (one of whom will deputise for the manager as necessary) and two less experienced staff. The manager and experienced staff members all have a minimum of 4 years experience with the client group, with the manager and one member of staff having many years more experience than 4. At the current time the staff group does not meet the 2005 NVQ Level 2 training target but the manager said that staff will be encouraged and supported to start the NVQ training in September. DS0000066465.V295704.R01.S.doc Version 5.2 Page 17 Two staff files were seen and showed that the home had obtained the necessary information to safeguard and protect service users, including Criminal Records Bureau clearances and two written references. Because the home had just opened and was still in the process of establishing records and documentation systems some information, such as photographs, identification evidence and declarations of health, had not yet been compiled but the manager said that this would be done imminently (see Recommendation 1). Staff training was not assessed as the home has only been opened for one week but the manager intends to induct new staff using the Malvern Partnership induction system, which is a very comprehensive induction tool. DS0000066465.V295704.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge her responsibilities fully. Service user benefit from the ethos, leadership and management approach of the home. Service users financial interests are safeguarded and their health, safety and welfare is promoted and protected. EVIDENCE: The Registered Manager, who is also the Registered Provider, is a very experienced practitioner who is a registered nurse and who ran her residential care home for older people for 15 years. The previous care home was registered for elderly people and up to five people with dementia and so she is amply experienced and competent to run a four bedded home for older people DS0000066465.V295704.R01.S.doc Version 5.2 Page 19 with dementia. Throughout the inspection she demonstrated a thorough knowledge and understanding of the conditions associated with old age and dementia, a loving and caring attitude towards service users and a commitment to providing a high quality service tailored to their individual needs. She does not have NVQ Level 4 in management and care but has undertaken to begin the course in September. There was an open, friendly and joyous atmosphere at the home on the day of inspection and staff spoken with said that they found the manager’s style to be open, approachable, encouraging and supportive. Staff said that they could speak to the manager about anything and that they appreciated that she would always tell them if they did anything wrong or could do something in a better way. The manager is very “hands on” and so staff are able to benefit and learn from her attitude and experience. Quality assurance at the home could not be fully assessed as the home has only been opened for one week, but the manager has already devised a form for obtaining feedback on the service from service users, relatives and other visitors. As previously mentioned, the manager ensures that service users, their relatives and visitors are aware of and able to access the complaints policy. The manager ensures that either the service user or their family/relatives control their monies and does not wish to undertake power of attorney or similar personal financial responsibilities. The service user admitted on the day of the inspection was still in control of her own finances and the manager said that should there be a time when the service user could no longer do this then the home would hold a review with the social worker and family members to decide who would take control from then on. The report written at the time of registration of the home, March 2006, found no problems with health and safety at the home but noted that the step between the kitchen and conservatory might present a possible hazard to service users. The Manager has provided a wooden slope on both sides of the step which was found to be suitable and safe at the time of this inspection. DS0000066465.V295704.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 4 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 4 3 4 4 3 3 STAFFING Standard No Score 27 3 28 2 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 3 X 3 X X 3 DS0000066465.V295704.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? N/A 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 Refer to Standard OP29 Good Practice Recommendations The Registered Manager should ensure that staff recruitment records are fully compiled as soon as possible. DS0000066465.V295704.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection SE London Area Office Ground Floor 46 Loman Street Southwark SE1 0EH 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 DS0000066465.V295704.R01.S.doc Version 5.2 Page 23 - 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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