Inspection on 31/07/06 for Cullum Welch Court

This inspection was carried out on 31st July 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Cullum Welch Court 23/01/06

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Cullum Welch Court Morden College 19 St Germans Place Blackheath London SE3 0PW Lead Inspector Ms Pauline Lambe Unannounced Inspection 31st July 2006 09:30 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 Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 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. Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Cullum Welch Court Address Morden College 19 St Germans Place Blackheath London SE3 0PW 020 8858 3365 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) Callum Welch Court ** Post Vacant *** Care Home 60 Category(ies) of Old age, not falling within any other category registration, with number (60) of places Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the 60 places, 28 places on the ground floor of the home are for personal care only and the 32 places on the first floor can provide nursing care. 23rd January 2006 Date of last inspection Brief Description of the Service: Cullum Welch Court Care Home is a purpose built care home built by the Trustees of Morden College. The home was registered to provide nursing care for 32 older people and personal care to 28 older people. The home forms part of the overall services provided by Morden College for its residents both on and off site. The home was built to a high standard and to comply with the requirements of the National Minimum Standards. Accommodation is provided on two floors with staff facilities on the third floor. All bedrooms are for single occupancy and have en-suite shower, hand basin and toilet facilities. Adequate communal, bathing and toilet facilities are provided and the home was decorated, fitted and furnished to a high standard. A pleasant and wellfitted hairdressing room was provided. The home is situated in the College grounds and is close to Blackheath Village with its shops and transport facilities. Residents have access to the College social club and other areas including the well-maintained and pleasant gardens. The current weekly fees range from £354 - £612. Residents pay privately for personal items such as hairdressing and toiletries Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two inspectors from the Commission completed the site visit for this unannounced inspection on 31st July 2006 over 7.75 hours. The manager and staff assisted with the inspection. The service was last inspected on the 23rd January 2006. At the time of this inspection forty-six residents were in the home and one resident was in hospital. This inspection included a review of information held on the service file, a tour of the premises, time spent talking to residents, staff and the manager, inspection of records and reviewing compliance with previous requirements. Feedback from residents was positive about the service, the staff and the quality of care provided. What the service does well: What has improved since the last inspection? What they could do better: Risk assessments must be completed prior to providing fitting bedrails and bedrails provided must be of a suitable height to ensure resident safety. Care must be taken to ensure medicine records are kept so as to enable an audit trail to be completed. Administration records must show the dose given when a variable dose has been prescribed. When entering medicines on the administration charts care must be taken to transcribe the information correctly and the entry signed by two members of staff. Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 Page 6 Social care plans should be improved and reflect the interests of the resident also records should be kept to show the activities provided for the less able residents and those requiring one to one activity time. The information included in staff files must evidence staff were employed as required by regulation and schedule 2. The registered person must be satisfied that references received for employees are authentic. 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. Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 Page 7 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 Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 Page 8 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 and 3. Standard 6 did not apply to the service. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to the service. Adequate information was provided about the service provision however not all residents were aware of the home’s statement of purpose and service user guide. Residents were admitted to the home based on assessment however not all files seen contained evidence that residents received written confirmation that the home could meet their needs. EVIDENCE: A statement of purpose and service user guide was provided. The statement of purpose had been updated to reflect the change of manager and a copy was sent to the Commission. Some residents on the ground floor seemed unaware that the home had a statement of purpose and service user guide. Residents were admitted to the home based on a pre-admission assessment of need. Pre- admission assessments were seen on resident files. A letter was prepared to send to residents confirming the home could meet assessed needs. Copies of this letter were seen in resident files on the ground floor but not the first floor. Recommendation 1. Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 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 – 10. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. Care plans were prepared to show how residents’ needs would be met. Staff supported and assisted residents to access health care services. Medicines were satisfactorily managed with some minor improvements needed. Residents said staff treated them with respect and they were satisfied with how their needs were met. EVIDENCE: Seven care plans were viewed. These were generally well prepared and reflected how assessed needs were to be met. On both floors risk assessments and care plans were reviewed monthly or when needed. On the first floor a resident had been admitted with a pressure sore. Staff had obtained advice from the tissue viability nurse on management of the wound. The wound assessment record did not show the grade of the wound but photographs had been taken to show how the wound was improving. The sister in charge of the first floor said that plans were in place for the tissue viability nurse to provide staff training in relation to wound grading. Concerns were also noted on this floor in relation to the use of bedrails. No risk assessments were in place for the use of this equipment and bedrails fitted to beds with an additional pressure relief mattress were not of sufficient height to ensure the safety of Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 Page 10 the resident. Daily care records reflected how care was delivered. Residents spoken with confirmed they were satisfied with how their care needs were being met. All residents were registered with a GP and staff arranged for residents to see a dentist, optician and chiropodist when needed. The College employed physiotherapists who assessed residents, provided physiotherapy as needed, assisted with moving and handling assessments and monitored accidents within the home. Residents spoken with confirmed they could see a GP or other professionals when needed. Verbal and written feedback from the GP was positive and complimentary about the quality of care provided to residents. Policies and procedures were provided in relation to medicine management. Medicines were safely stored and records kept for receipt, administration and disposal. All entries on administration charts were hand written but the information was not always copied exactly as on the pharmacy label. Staff had access to up to date information on medicines. On the first floor medicines records were checked for three residents and some inaccuracies were noted. For example there were too many of one medicine and too few of another when checked against records. Also when a variable dose was prescribed the amount given was not recorded. Records for controlled drugs were well kept and accurate records were seen. A homely remedy policy had been agreed with the GP. On the first floor homely remedy medicine records were well kept and found to be accurate. No issues were identified with medicine management on the ground floor. All bedrooms were for single occupancy and bathroom and toilet doors had locks fitted. A number of residents on both floors said staff were very kind, caring and respectful and said they were satisfied with how their care was provided. From observation staff were courteous and polite when addressing and interacting with residents and relatives. Staff knocked on doors before entering bedrooms, locked doors when giving care and spent time explaining procedures and reassuring residents. Residents spoken with said staff treated them with respect. One resident said ‘I like the sense of freedom here’. Requirements 1, 2 and 3 and recommendation 2. Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 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 – 15. Quality in this outcome area was excellent. This judgement has been made using available evidence including a visit to the service. Social care plans were generally good but could be improved for less active residents. In general residents were satisfied with activities provided, visiting times, their ability to make choices and the quality of meals provided. EVIDENCE: Two part time activity organisers were employed. On the first floor the monthly programme of activities was displayed. The programme included flower arranging, ceramic classes, quizzes, shopping trips, exercises and watching T.V. Residents had access to the College clubhouse with its range of social events and to the College mini bus. A number of residents said they were satisfied with the activities provided. On the first floor social care plans were not specific. Staff must ensure that activity records, particularly for residents requiring one to one activities or who are too frail to take part in group activities or outings, are kept up to date. A weekly church service was held in the home and some residents chose to attend the service held in the chapel located in the college grounds. On the ground floor activities were well organised with residents enjoying fortnightly outings. A visiting librarian ensured residents had access to ample reading material. Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 Page 12 The home had an open visiting policy and a number of residents said they enjoyed and benefited from regular contact with family and friends. Visitor rooms were provided where residents could greet family and others in private. Arrangements could be made for visitors to stay overnight or to have a meal in the home. Feedback from residents was good with comments made such as ‘staff are great’ and ‘I can spend the day how I like’. From observation residents were encouraged to make choices about how and where they spent their time and staff were seen promoting choice at mealtimes and throughout the day. Meals were prepared in the College kitchens and brought to the home in heated food trolleys. The menus seen showed that residents had access to a varied and nutritious diet. Each floor had a kitchen where meals were served, dishes washed and snack food and tea making facilities provided. Residents were supported to choose their meal from the varied menu on a daily basis. A cleaning schedule for the kitchen was up to date and fridge temperatures were recorded daily. A number of residents commented on the high quality of meals provided. Lunch was observed and staff served this efficiently and provided residents assistance and time to enjoy the meal. Recommendation 3. Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 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 and 18. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. Satisfactory procedures were in place to manage complaints and adult protection. Staff displayed an awareness of adult protection and had received training on this topic. EVIDENCE: The complaints procedure was displayed in the reception area and on each floor. The procedure included a timescale for responding to complaints and contact details for the Commission. Records showed that since the last inspection three complaints were recorded on the first floor and these had been appropriately managed. No complaints had been made about the service on the ground floor or to the Commission. Residents spoken with were aware of the complaints procedure and knew who to talk to if they had a concern Staff had received training on adult protection and staff spoken with indicated they were aware of the home’s policies and procedures. Staff spoken with displayed a good understanding of adult protection and how to handle an allegation of abuse. The adult protection procedure was printed in 2003 and must be reviewed to reflect that all allegations or suspicions of abuse are referred to social services for investigation and reported to the Commission under regulation 37. Since the last inspection no allegations of abuse were reported to the home or the Commission. Requirement 4. Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 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, 21, 24 and 26. Quality in this outcome area was excellent. This judgement has been made using available evidence including a visit to the service. The environment was clean, tidy and well maintained. Residents were satisfied with the personal and the communal space provided. EVIDENCE: The standard of decoration and quality furniture and fittings provided was of a high standard. No maintenance issues were identified on either floor. Grab rails were provided in corridors and by toilets. Ceiling and portable hoists were provided to ensure safe moving and handling of residents. The home had adequate assisted baths and toilets to meet the needs of the residents. All bedrooms had en-suites with showers, toilets and washbasins. All of these areas seen were clean, tidy and well maintained. Bedrooms seen were clean and tidy and residents said they were always like that. Residents could bring personal items to the home and those spoken with were satisfied with their personal and the communal space provided. Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 Page 15 The home was clean, tidy and odour free. Clinical waste was stored appropriately. Staff had access to infection control training, policies and procedures and antiseptic hand gel was provided in key areas. Staff were provided with adequate supplies of protective clothing. Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 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 – 30. Quality in this outcome area was adequate. This judgement has been made using available evidence including a visit to the service. Staffing levels were very good and the staff team had the skills to meet the needs of the residents. Staff were provided with training relevant to their work but improvements were needed to staff recruitment procedures. EVIDENCE: Staff rotas seen showed that the number and mix of staff on each shift was good and maintained above minimum levels. Staff communicated appropriately with residents and presented as approachable and helpful. The home had a stable staff team, which provided continuity of care for residents. The home had a bank of casual staff, which meant agency staff were only used in an emergency. Since the last inspection the issue regarding the provision of nursing care on the ground floor had been resolved and clarified with the registered person. Residents on the this floor received personal care only with nursing care provided by the district nursing team in the PCT. Residents were complimentary about the staff and comments made included ‘staff are great’, ‘staff are lovely’, ‘staff are very pleasant’ and ‘the care is very good’. From the information provided twenty-one registered nurses and forty-two care assistants were employed. A system was in place to check that nurses employed were registered with the Nursing & Midwifery Council and over 50 of care staff had achieved NVQ 2 qualification. The staff team included domestic and ancillary staff. Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 Page 17 Four employee files were inspected and a number of concerns were identified in relation to CRB checks, POVA first checks and reference authenticity. None of the files had a POVA first check, one had no CRB and two had CRB checks completed by previous employers. Some hand written references seen had not been checked to ensure they were authentic. The registered person must be satisfied that the references received without a company stamp, compliment slip or on headed paper were authentic. Staff spoken with said they felt supported by management and were satisfied with the training provided. The home employed a training coordinator who arranged vocational and mandatory training for staff and maintained staff training records. Two staff records were inspected and showed that both members of staff had attended a variety of relevant training sessions during the past year. Since the last inspection staff had access to training such as emergency first aid, fire safety, food hygiene, stoma care and principles of care. Requirements 5 and 6. Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 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, 33, 35 and 38. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to the service. The new manager had applied to register with the Commission. A quality assurance system was not yet in place. Residents’ personal finances were safely managed and attention was given to providing a safe environment for residents and others. EVIDENCE: Since the last inspection a new manager was in post. From the information provided she had the skills, qualifications and experience needed to manage the service. The new manager had submitted an application to register with the Commission. Regulation 26 reports were sent to the Commission regularly. The new manager was looking into the introduction of a quality assurance system. She hoped to implement this in the near future. Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 Page 19 A number of residents managed their own finances or a family member did this on their behalf. A safe system was in place to assist residents to manage their personal allowances where needed. Individual computer records were kept and made available to residents. Financial records checked for two residents were correct. Accounts were subject to an annual audit. Maintenance records were well kept. Safety records checked were up to date and showed attention was given to providing a safe environment for residents and others. The registered person must ensure fire drills are held for staff in line with advice from the fire safety department. Accident records were well kept and the home manager and a physiotherapist monitored accidents to residents and put strategies in place to reduce the incidence where appropriate. Requirement 7 and recommendation 3. Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 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 X 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 4 X 4 X X 4 X 4 STAFFING Standard No Score 27 4 28 4 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP7 Regulation 13 Requirement The registered person must ensure risk assessments are completed prior to providing residents with bedrails and must ensure that bedrails provided are the correct height to ensure the safety of the resident. The registered person must ensure receipt and recording of medicines enables an audit trail to be completed. When staff write the medicine on to the medication administration chart they must transcribe the details as they are on the pharmacist label. (Timescale of 20/03/06 was not met). The registered person must ensure medicine administration records show the dose given when a variable dose is prescribed. The registered person must ensure the procedures in relation to adult protection make it clear that all allegations of abuse are referred to the adult protection team at social services for investigation. DS0000058195.V290653.R01.S.doc Timescale for action 18/09/06 2. OP9 13 11/09/06 3. OP9 13 18/09/06 4. OP18 13 18/09/06 Cullum Welch Court Version 5.1 Page 22 5. OP29 19 6. 7. OP29 OP33 19 24 Also these incidents must be reported to the Commission under regulation 37. The registered person must ensure the information required by regulation and schedule 2 is obtained for all employees and available for inspection. (Timescale of 27/03/06 was not met). The registered person must be satisfied that references received for employees are authentic. The Registered Person must ensure the quality assurance system is implemented and a report on any review of the service sent to the Commission. (Timescale of 27/03/06 was not met). 18/09/06 18/09/06 18/09/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations The registered person should ensure all residents have access to a copy of the home’s statement of purpose and service user guide and also have evidence to show residents receive written confirmation that the home can meet their needs based on assessment. The registered person should ensure wound assessment records are kept up to date and show the condition of the wound. The registered person should ensure social care plans reflect the interests of the residents and show how this need will be met. The registered person should ensure the number of fire drills held in a year for night and day staff complies with the advice of the fire safety unit. 2. 3. 4. OP7 OP12 OP38 Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Cullum Welch Court DS0000058195.V290653.R01.S.doc Version 5.1 Page 24 - 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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