Inspection on 29/05/07 for Cumberland Care Home

This inspection was carried out on 29th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Cumberland Care Home 01/04/09

Cumberland Care Home 07/05/08

Cumberland Care Home 11/07/06

Cumberland Care Home 29/11/05

Cumberland Care Home 25/03/05

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

CARE HOMES FOR OLDER PEOPLE Cumberland Care Home 67 Whitford Gardens Mitcham Surrey CR4 4AA Lead Inspector Liz O`Reilly Unannounced Inspection 29th May 2007 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 Cumberland Care Home DS0000061986.V344800.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. Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Cumberland Care Home Address 67 Whitford Gardens Mitcham Surrey CR4 4AA 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) 0208 646 1551 0208 646 5283 manager.cumberland@careuk.com manager.burroughs@careuk.com Care UK Community Partnerships Limited Minkailu Sama Care Home 48 Category(ies) of Dementia (2), Dementia - over 65 years of age registration, with number (48), Mental disorder, excluding learning of places disability or dementia (1), Mental Disorder, excluding learning disability or dementia - over 65 years of age (6) Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. As agreed on the 17/10/2006, two Service users under the age of 65 with Dementia can be accommodated within the home. 30th January 2007 Date of last inspection Brief Description of the Service: The Cumberland Care Home is a purpose built facility situated in residential area of Mitcham. The property is detached and single storey with parking available on site. Public transport facilities are close by. The home is owned and managed by Care UK Community Partnerships Ltd, a subsidiary of Care UK plc. Care UK is a private company who own and manage a significant number of homes throughout the country. The home provides long term and respite nursing care and accommodation for up to 48 older people with dementia. Fees for this home range from £651.00 to £800.00. Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by two Regulation Inspectors. The inspection included a visit to the service, discussion with people who use the service, visitors and staff. Questionnaires were provided after the visit to residents and staff. Information received from all of these sources along with observations made at the time of the visit have been used to produce the judgements made in this report. What the service does well: What has improved since the last inspection? What they could do better: Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 6 Feedback from some residents and visitors showed that improvements could be made in helping people to take part in activity outside the home. Including more access to the garden area. One resident told us “I just want to go out, like an ordinary person”. Improvements need to be made in communication between staff and residents. We observed a lack of general communication and one person told us there was “not much friendly chat here”. Although some staff were described in a very positive manner further training and supervision is needed to make sure that all staff respect the privacy and dignity of people who use the service. Staff need to make sure that if someone requests assistance they are prompt and positive in their response. All staff must be provided with training on safeguarding vulnerable adults. Further work needs to be done on organising the way in which food and snacks are provided to make these times more of a social event. The record of food needs to be better maintained. Improvements should be made in supporting new residents and their relatives during the admission to the home. Care plans need to be more person centred with more details of individual needs and wishes and how these are to be met. It is recommended that staff are provided with training on person centred care and care planning. The organisation needs to ensure that staff are supported in their roles with regular supervision and that they are provided with appropriate, on going training, on dementia and mental health care. 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. The summary of this inspection report can be made available in other formats on request. Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 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 Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 5 & 6 People who use this service experience adequate quality outcomes in this area. Before anyone is admitted to the home assessments of their needs are carried out. This information is used by staff to make sure they can meet these needs. The admission process could be more personalised. This home does not provide intermediate care. EVIDENCE: The Statement of Purpose and Service User Guide is available in the entrance hall. A “welcome pack” is available for new residents which provides information on what they can expect from the service. Staff make sure that individual assessments are carried out before anyone moves in. This information is used to assess if the home can meet the needs of the individual and to set up an initial care plan. Feedback from relatives of people who use the service showed that more attention needs to be paid to the admission process. The manager needs to make sure that the admission process is, wherever possible, planned with Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 9 senior staff available to welcome and spend time with any new resident and their family. This will allow time to go through any concerns they may have, check on individual needs and wishes, assist in allaying anxiety, help in making people feel welcome and to explain any documentation such as the service user guide and contract. Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use this service experience adequate quality outcomes in this area. Each person has a care plan but these were not all completed, did not show consultation and some had not been reviewed. Improvements have been made in providing information on the cultural and religious needs and wishes of residents Risk assessments are in place but need to show how staff have consulted with others on restricting people’s freedom. Health care needs are partly met but records and assessments need to be improved. Medication is well managed. Staff are aware of the need to treat individuals with respect and to consider dignity when delivering personal care but this needs to be carried out by all staff in practice. EVIDENCE: We looked at a sample of care plans and found that not all were completed. The activities part of the care planning had not been completed in two instances. There was no evidence that pain assessments were in use. This Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 11 increases the risk that some residents who may have difficulty in expressing themselves may be left in pain. Staff have made efforts to obtain information about the personal history of individuals which may assist in their understanding of the person. Although care plans provided information on individual behaviour there was a lack of information on how staff were to work with people other than for staff to monitor behaviour. Staff need to provide clear instructions on actions or interventions. Some staff had made comments in the daily notes about possible interventions but there was not clear plan. In one instance the care plan stated someone was to have passive exercises but no further information was given. Instructions were in place for staff to make sure that one persons finger nails were kept short to assist in preventing self harm. This had not been carried out in practice. Clear information on what tasks need to be carried out by qualified staff should be included in individual care plans. We noted records which showed weight loss for some individuals but could find no record of actions taken. At the time of this visit the appropriate continence pads were not available for some residents. When talking with staff it was clear they understood the importance of treating people with respect and maintaining dignity. However we observed some members of staff who did not always carry this out in practice. We observed one member of staff standing while assisting a resident to eat and drink, another member of staff attempting to help two people at once to eat also a lack of communication from some staff when supporting individuals. In another instance a resident made a request to another member of staff to assist them in getting on their bed. This member of staff did not communicate well with the resident and having said they would assist left the room for a considerable time without a clear explanation before returning to help the resident. Further work needs to be done on responding to requests from residents and in communication. Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service experience adequate quality outcomes in this area. Residents are offered a good variety of planned activities provided by the activities organiser. Improvements have been made in finding out about the cultural and religious needs and wishes of individuals but not all residents have been provided with an activities care plan. The manner in which meals, drinks and snacks are provided is not well planned or carried out. Improvements have been made in offering choices at meal times. The record of food is inadequate. EVIDENCE: Residents have the opportunity to take part in activities throughout the week including physical exercises, music, arts and crafts and use of the Snoezelen room. The activity session we saw was very well organised with residents joining in and clearly enjoying the event. The activities organiser also takes time to provide one to one activities. “Chat” and “Rummage” boxes are now available in the lounge areas which staff can use to engage with residents. These are a useful tool which residents were seen to be keen to engage in when used by the inspectors. Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 13 Residents did not have easy access to the garden area during our visit. Staff informed the inspectors that residents do not have access to the garden as there was a risk of people falling and that there were not sufficient staff to monitor this. The manager must carry out an assessment of the garden area and staffing to ensure that residents can make full use of the outside space. Visitors to the home told us they felt welcome in the home and could come and go as they pleased as long as staff were aware they were on the premises. We observed drinks being served in the lounge areas from a large trolley in each unit. Residents were given no choice in the drink they were offered or in the biscuit they were given. On one unit the majority of people were given only one biscuit and those with diabetes were offered nothing to eat. On another unit by the time staff reached the second lounge there were no clean cups left and no biscuits. One member of staff was seen to be trying to serve tea to the group and help someone with drinking at the same time. There was little communication between staff and residents. Senior staff need to put more thought into how drinks and snacks are offered and how this is organised. Consideration should be given to providing more snacks in the lounge area throughout the day. As noted previously, at lunch time one member of staff was observed to be trying to assist two residents at once with eating. There was little communication between staff and residents during meal times which did not assist in making this a social event. Staff were heard to talk between themselves about what people had eaten while everyone was in the dining room. Visitors felt that meal times could be noisy and disorganised. Senior staff need to consider how they can improve the experience for residents to make meals times a more enjoyable social event. The record of food kept in the home is inaccurate. The list supplied to the inspectors did not include some of the residents living at the home now and did include some people who are no longer living there. The list included information on only the lunch time food. An up to date record of food must be kept. Staff have clearly made efforts to meet the dietary needs of individuals. In one instance a family member has provided a menu, we were informed they went with catering staff to assist them in shopping for ingredients. The chef has not received any training in providing food for older people living with dementia. Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience adequate quality outcomes in this area. The complaints procedure is available in the home. The staff training records seen do not show that all staff have been provided with training on safeguarding adults. EVIDENCE: Feedback we received showed that people know who to talk to if they have any complaints or concerns. Systems are in place for all complaints to be recorded along with any action taken and outcomes. Access to the complaints procedure could be improved by providing the information in larger print. We were provided with the staff training log. This indicated that not all staff have been provided with protection of vulnerable adults training. Written information provided by the manager following this visit suggested that all staff had received this training. The manager must provide an up to date training log to show that all staff have received training on safeguarding adults. This will ensure that all staff are able to recognise abuse, are aware of their responsibilities should they have any concerns or should anyone inform them of suspected abuse. Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 & 26 People who use this service experience adequate quality outcomes in this area. Improvements have been made to the environment. The home is adequately maintained. As noted previously residents should be provided with access to the garden. The majority of the home is clean and tidy but a number of chairs including those in bedrooms were in need of additional cleaning. EVIDENCE: The environment has been improved by the purchase of new bedroom furniture and new carpeting. Residents can bring their own furniture and belongings to personalise their own bedrooms. The home was found to be well maintained. The majority of areas were clean and tidy. Further care needs to be taken to make sure that chairs are kept clean particularly those in bedrooms and reclining chairs. As noted previously the garden area was not used at all during our visit. Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 16 Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, & 30 People who use this service experience adequate quality outcomes in this area. The staffing levels had been reduced at the time of the visit. This was due to a reduction in the number of people living there at the time. The manager has since reported that the staffing levels have been increased again. Feedback suggests that people are generally satisfied with the care they receive but at times they are required to wait for staff attention. Staff have good opportunities for training however training on dementia care needs to be improved. EVIDENCE: We were unable to examine staff recruitment records as the manager was not on duty. These will be examined at the next inspection. Concerns were raised by visitors and staff about the reduction in staffing levels which had take place at the time of this visit. The manager must make sure that any reduction in staffing does not result in a reduced service for those living in the home. Sufficient staff must be available to meet the needs of people particularly at meal times. Feedback from people who use the service and visitors was mostly positive about the staff group and their approach but this was qualified by some with “it depends who is on duty”. This lack of consistency is something with needs to be addressed by the management. Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 18 As noted previously further work needs to be carried out with staff on effective communication. Recent training has been provided on first aid and managing aggression. The records do not show up to date training on dementia care or mental health issues. The majority of staff spoken to had received some training on dementia care provided through the Alzheimer’s Association. However the records seen suggested this had been carried out some years ago. One qualified member of staff informed us that they had received six hours training on dementia. This level of training, for this level of staff is viewed as basic. Two members of staff told us they had received no training on dementia. In order to keep up to date with care practices staff should be provided with on going training in dementia and mental health issues. Staff should also have access to publications on dementia and mental health issues. Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 People who use this service experience adequate quality outcomes in this area. The manager has the skills and experience to manage the service. Staff, relatives and residents meetings are held on a regular basis. Staff carry out regular checks on the environment to ensure the health and safety of residents, staff and visitors to the home. Further information is required regarding protecting the financial interests of people who use the service. A copy of the annual review of the care provided has not been received from the home. Regular one to one supervision is not being provided to all staff. EVIDENCE: At the time of this inspection the manager was not available. Staff reported that they felt well supported by the senior staff team. However two members of staff told us that they are not receiving regular one to one supervision. In Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 20 order to ensure that staff are provided with support and to make sure that individuals are working within the stated aims and objectives of the organisation all staff providing direct care must be given regular supervision from a more senior member of staff. Relatives reported that they are invited to meetings to discuss general issues about the home. At the time of the last inspection a requirement was made for the home to supply a copy of the guidance on individual finance to the CSCI. This has not been received. Records of health and safety checks were seen to be up to date. Staff were observed to take care not to leave any cleaning materials unattended. Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 21 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 2 X 3 X 2 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 2 X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 3 Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 22 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 15(1)(2) Requirement In order to ensure that each person receives the support and care they need all care plans must be completed, compiled in consultation with the person and or their representative and reviewed on a regular basis. Timescale for action 31/08/07 2. OP7 12(1) 17(1)(a) Schedule 3 (k) 3. OP7 12(2)(3) 14(2) 4. OP8 12(1) To make sure that each person 31/08/07 receives the support they need staff must be provided with clear, detailed instructions on the care to be given and any interventions. Information must be available to staff if any care is to be provided by qualified staff only. In instances where the freedom 31/08/07 of movement of individuals is restricted a risk assessment must be carried out in consultation with other professionals and the residents representative. To make sure that the health 31/08/07 and welfare of residents is protected a review of the manner in which pain is assessed and addressed must be carried DS0000061986.V344800.R01.S.doc Version 5.2 Page 23 Cumberland Care Home 5. OP10 12(4) 6. OP15 17(2) Schedule 4 (13) 12(4) 7. OP15 8. OP18 13(6) 9. 10. OP19 23(1) 18(1)(c) OP30 11. OP33 24 out. To make sure that residents treated with respect and dignity all staff must be provided with training in this area. This training must include communicating with people living with dementia and mental health issues. To make sure that residents are provided with a nutritious, well balanced diet a clear record of food must be maintained for each person. In order to maintain the dignity of residents and to make mealtimes a more social occasion a review of the way food and drink is provided must be carried out. In order to safeguard residents all staff must be provided with training on the protection of vulnerable adults. A record of this training must be available in the home. Residents must be provided with easy access to the garden area of the home. In order to meet the needs of residents all staff must be provided with appropriate, on going training in dementia care and mental health issues. The Registered Persons must carry out an annual review of the care provided taking into account the views of residents, their representatives and other stakeholders. A copy of the report produced following the review must be provided to the CSCI. Timescale of 10/05/07 not met 31/08/07 31/08/07 31/08/07 31/08/07 31/08/07 31/08/07 31/08/07 12. OP35 17 (2) Schedule The Registered Persons must ensure that clear written DS0000061986.V344800.R01.S.doc 31/08/07 Page 24 Cumberland Care Home Version 5.2 4 guidance is available on individual finance. A copy of this document must be supplied to the CSCI. (timescale of 20/11/06 and 10/04/07 not met) 13. OP36 18(2) The Registered Persons must ensure that all staff providing direct care are provided with regular one to one supervision from a more senior member of staff. (timescale of 20/11/06 and 10/04/07 not met) 31/08/07 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 OP5 OP26 Good Practice Recommendations A review of the admission process should be carried out to see how this can be improved for new residents and their families. A review of the cleaning programme should be carried out to make sure that all chairs, including those in bedrooms are cleaned on a regular basis. Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Cumberland Care Home DS0000061986.V344800.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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