Inspection on 12/03/07 for Dom Polski

This inspection was carried out on 12th March 2007.

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

Dom Polski 07/03/06

Dom Polski 19/07/05

Dom Polski 09/11/04

Dom Polski 29/06/04

Dom Polski 17/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Dom Polski 18 Carlton Road Whalley Range Manchester M16 8BB Lead Inspector Michelle Moss Key Unannounced Inspection 10:00 12th March 2007 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 Dom Polski DS0000021545.V301351.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. Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dom Polski Address 18 Carlton Road Whalley Range Manchester M16 8BB 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) 0161 226 1836 Society of Christ (Gt.Britain) Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th March 2006 Brief Description of the Service: Dom Polski is a large detached property that provides accommodation for 14 elderly residents requiring personal care only. The home provides a specialist service for elderly Polish people. The home is owned and operated by the Fathers Of The Society of Christ (Great Britain) a Polish religious organisation and a registered charity. The home is situated in a residential area in the south of the City of Manchester. Local facilities and bus routes are within easy walking distance. The garden area is accessible to residents and was well maintained and presented. Parking facilities are available to the rear of the property. The Polish language, culture and traditions were upheld within the home. The home provides a comfortable environment and familiy atmosphere for the residents. The fees for the home between 2006/07 were £373.54 per week. A statement of Purpose and Service User Guide was available for prospective residents, their families and professionals enquires. Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector went to the home on the morning of Monday 12th March 2007. The total time spent at the home was 5 hours. This included meeting staff, residents and a relative. The inspector also: • Spoke with the senior executive administrator and registered provider. • Looked at some files. • Completed a tour of the premises • Watched how the residents were cared for by the staff. To help the inspector to write the report the home was asked to provide a selfassessment report /questionnaire which was completed by the home’s previous manager and received by the Commission on 21 July 2006. Also eight questionnaires completed by residents were sent into the inspector that confirmed their experiences of living at the home. The inspector also took into account other information, which the commission knew about the home. There were some important things the inspector wanted to find out about the care given by the home. These were: • How the health needs of residents were met. • How the residents’ personal care needs were met. • How the staff helped to kept residents safe. • How the home respected residents’ rights, diversity and identity. If you want to get a full picture of what it is like to stay at Dom Polski you might like to read the last report as well. You can find the address or website details on page 2 where you can obtain the report. The term of address preferred by the users of the service was confirmed as “residents”. It was felt that this best reflected the function and purpose of the home. What the service does well: From information received through questionnaires completed by residents all showed that the staff in their care of residents’ were ensuring care was done respectfully and that a positive atmosphere was achieved. The staffing was set at a level that met the needs of the residents. This showed that there were enough staff to make sure residents were kept safe and adequately supported. Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 6 The home made sure the health of residents was monitored. This was done through various health monitoring records and reviews of care plans. Familys’ experience of the home was found to be positive. They felt well informed, found the care staff to be very caring and knew the meals served at the home reflected the residents’ culture and religious identity. The home had a Chapel that enabled the residents to practice their faith. The staff who cared for the residents also practiced the same religion. This meant they valued the residents faith and ensured practices of care reflected beliefs and religious customs. What has improved since the last inspection? What they could do better: Overall, the home was meeting nearly all the National Minimum Standards that were looked at during the visit. However, there were some things that could be better. Although the care planning system was informative and provided a lot of important information, it was written in English rather than Polish, which was the preferred language used by residents and understood by the care staff. This may compromise the care staff’s ability to be fully informed about meeting the care, health and individual needs of residents. It is reccommended that the home considers keeping records in Polish. The recording out of administered medication was not always adequately detailed to show that the care staff administering medication to residents were following the prescribers instructions. This included counter-indication advisory instructions provided by the pharmacist. This weakness in recording/ following instructions had the potential to compromise the health of residents. The recruitment of staff was not always adequately carried out to ensure all required checks were completed before staff staerted working at the home. This included CRB checks/ POVA first Checks. By not having this information available before a staff member started, it meant residents were not supported by staff that had been rigorously vetted. Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 7 The care staff were not routinely supervised to ensure their practices of care and personal development were both evaluated and reviewed. This weakness in staff receiving supervision had the potential to impact on the quality of care provided. The home was not formally seeking the views of residents and other stakeholders through a quality assurance survey. This included publishing findings and sharing them with residents and their families. This weakness in internal monitoring the quality of care meant the residents views could not be taken into account in the management and development of the service. 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. Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 8 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 Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 9 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): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home undertakes an assessment of prospective residents’ care needs prior to their admission and they and their relatives/friends are able to visit the home before making the decision to stay. EVIDENCE: A pre-admission assessment document was used. The assessment included the involvement of the prospective resident, his/her representatives and any relevant professionals. This was usually undertaken by the registered manager and carried out before admission. However, at the time of the visit to the home the registered manager had left, therefore the senior executive administrator and senior carers were undertaking the assessments of any referral until a new manager was appointed. Following the pre-admission assessment, the home would confirm in writing to the perspective resident that the home was able/ not able to meet their needs Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 10 in respect to their health and welfare. A copy of this letter was held on the resident’s files. Where possible, prospective residents and their family/representatives were encouraged to view the home prior to making a decision about admission. The home did not provide intermediate care. Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 11 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 adequate. This judgement has been made using available evidence including a visit to this service. Health needs were generally assessed and met and rights and privacy respected. However, the care and management of medication was not effective to ensure the health of residents was adequately safeguarded. EVIDENCE: Each resident had an individual care plan that had been developed using information from the Care Management Assessment and the pre-admission assessment carried out by the home. The care plans included a pressure area risk assessment and a nutritional assessment and various health surveillance monitoring records. It covered areas of diverse and religious needs as well. There was documentary evidence to show that care plans were reviewed on a monthly basis to ensure the changing needs of residents were identified and met. Although the collated information made the care plan informative it was noted that care staff and residents’ preferred language was not English. The Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 12 care plan did not reflect this fact. It is reccommended that the home consider also keeping the records in Polish. Each resident was registered with a local General Practitioner (GP). Where possible residents had retained their own GP. Residents could see their GP in the privacy of their own room. There was evidence to show that residents had been referred to other specialised services according to residents’ assessed needs. This included District Nurses, Dentist, Dietician and Chiropodists. A visiting relative confirmed that they were kept well informed about the health needs of their mother. The monitoring of residents health was regarded by the relative as a quality of the care provided by the home. Medication records for February / March 2007 were examined. It was noted that various instructions were made about the way medication should be administered. For example some instructions stated the medication should be given 30 minutes before food and not with other medication. From looking at the records it was not possible to identify this was carried out. As the time of administrating the medication was the same. When various dosages were prescribed staff were not clear about the GP’s instructions on when lower / higher dosages should be administered. The signatures of staff were not up to date. Single initials were used. This sometimes made cross-referencing with the medication charts coding confusing. The staff did not have access to additional patients leaflets on medication. On one medication chart it had two hand written medications that had been added. Lactlose and Movical. No additional details had been record. E.g.:The dosage. The time to be administered. The prescribing doctor. The start date. The length of the course. The amount received. No cross-reference to the daily care plan log was made about why the medication had been prescribed. Because it was not on a repeat prescription at the end of the month the staff returned the medication without knowing if the medication was to be continued or not. This and other weaknesses in the recording out of medication were discussed with senior care staff and management. During the inspection the Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 13 senior executive administrator spoke with one of the GP’s about undertaking a medication review for residents he was responsible for. A full review of practices on administering medication to residents was required to ensure the health of residents was not compromised. Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 14 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 good. This judgement has been made using available evidence including a visit to this service. A range of activities were offered, family contact actively sought and wholesome and appealing meals were offered to residents. EVIDENCE: The home served traditional Polish meals, which were nutritious, well balanced and offered a healthy and varied diet for residents. Menus were available both in English and Polish. The menus had been developed in accordance with residents’ likes and dislikes. Every resident who had returned a questionnaire to the commission told the inspector that they always liked the meals provided by the home. A relative spoken with during the visit further commented on the high standard of meals provided. During the visit residents were seen to be engaging in various activities with staff and visiting professionals. This included recreational games and low impact exercise. The returned questionnaires overall indicated that activities Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 15 were usually arranged by the home. For some residents they felt there could be more activities offered. One particular strength of the home seen by both residents and their families was having on the premises a Chapel and having access to a calendar of religious events that reflected the religious believes and cultures identity. Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 16 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 had a complaints procedure, which gave residents and/or their representatives an opportunity to raise their views and concerns and the home has the policies, procedures and systems in place to protect people from harm. EVIDENCE: Each resident had been given a copy of the complaint procedure. A written record was kept of all complaints made and included details of the investigation and any action taken. The home’s complaint procedure included the address and telephone number of the Commission for Social Care Inspection and the complainant’s right to refer their concerns to the Commission for Social Care Inspection at any stage. There was evidence to show that staff had received training relating to the action to be taken in the event of an allegation of abuse, thus ensuring the safety and well being of the residents. Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 17 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents lived in a safe and well-maintained environment including good standards of hygiene. EVIDENCE: The home had a warm and welcoming atmosphere and felt comfortable and homely. All areas of the home were clean and tidy, tastefully decorated and the furniture was of a domestic nature and of a good standard. There was evidence to show that the home had a programme of routine maintenance and renewal of the fabric and decoration. In Summer 2006 the home had been fitted with new windows. Also areas of the home had been redecorated and new curtains fitted. Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 18 Residents’ bedrooms had been fitted with a privacy lock suited to their capabilities and accessible to staff in emergencies. Residents were provided with a key on request unless a risk assessment suggested otherwise. All rooms had a lockable storage space for medication, money or valuables. Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 19 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, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number, training and deployment of staff available appeared sufficient to meet the residents’ assessed needs. However, some areas of recruitment and staff supervision had the potential to compromise the residents welfare, health and safety. EVIDENCE: On the day of the visit the home appeared to have an appropriate number of suitable staff on duty to meet the needs of the residents at the home. Beside the care staff the home had other staff employed that supported the running of the service. The support of the other personnel meant the hours allocated for care were designated care hours and not for undertaking duties such as catering, cleaning, administration and laundry service. Two staff files were examined. It was noted that where two new staff had been appointed not all required checks had been completed prior to commencing working at the home and caring for the residents. This included carried out Criminal Record Bureau checks (CRB) / POVA first checks. Police checks were taken from the country of which the prospective staff was previously resident, although no checks were completed in respect of English regulatory checks. Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 20 It was noted from examining staff records and speaking with staff that regular supervision was not taking place. This was an area that the home needed to improve on. Good practice indicates the home should offer supervision to care staff at least 6 times a year. On going training was offered to staff. This included in the last 12 months induction training for new starters, Protection of Vulnerable adult training (POVA), Infection Control, End of Life Care, No Secrets, Recording with Care, Emergency First Aid. It was noted that the number of staff holding an NVQ in care was below the National minimum standard at 33 . It was recognised that translation of the assessments criteria was proving to be a difficult for the home in securing the NVQ award for staff who’s first language was not English. It was noted that the organisation had identified that additional training for care staff in English language had become essential. This was important for staff taking charge of a shift, especially when it came necessary to speak to health professionals when residents were poorly. Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 21 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, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Overall there were systems and procedures in place that safeguarded and protected residents’ financial interests and promoted the health, safety and welfare of the residents and staff. However, the views of all stakeholders were not sought or included in the development and improvement of the service. EVIDENCE: The financial records of residents were examined. These were found to have an audit trail, which included a running balance of all transactions made on behalf of residents and receipts. However, from examining the care plan it was not always clear about the capacity of residents in regards to their financial arrangements. Sometimes records indicated amounts of monies being given to families, of which some of these could be sums of over £200. It was unclear Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 22 from the entries the purpose of the handover of funds and the consent of the residents in this transaction. It was noted that families and residents were consulted about events within the home through meetings. However, this did not extend to a formal quality assurance systems that sought the views of all stakeholders. In previous years such views had been obtained, but this had not been maintained to ensure residents’ views were sought and incorporated into the development of the service. The home had a good auditing system in place for health and safety checks. On examining records relating to fire safety, water safety, food safety and premises safety every area had an up to date record that demonstrated checks were carried out and action taken were any concerns arose. The home’s previous registered manager had left just prior to the inspection. The organisation had started the process of recruiting a suitably qualified manager who would oversee the service. During the interim period the senior executive administrator was overseeing the management of the home. Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 23 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 X X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X 3 3 Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? no 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 OP9 Regulation 13 (2) Requirement Timescale for action 30/04/07 2 OP29 18 3 OP33 24 To ensure the health of residents in sustained all recording out of administered medication must be adequately detailed to show that the care staff administering medication are following the prescriber’s instructions. This includes noting and acting counter-indication advisory instructions provided by the pharmacist. The recruitment of staff must be 30/05/07 rigorous to ensure residents are adequately safeguarded from any possible abuse. This includes completing checks of prospective staff suitability before they commence working at the home. This included CRB checks/ POVA First Checks. 30/05/07 To make sure the views of residents are actively sought and acted upon, the home must carry out a satisfaction survey. This must include formally seeking the views of residents and other stakeholders. This will also involve publishing the finding and sharing them with residents and their families. DS0000021545.V301351.R01.S.doc Version 5.2 Dom Polski Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP7 Good Practice Recommendations The Care plan should also be written in the preferred language used by residents and understood sufficiently by the care staff so that they care meet all the needs of the resident. The care staff should be routinely supervised to ensure their practices of care and personal development are both evaluated and reviewed to make sure their practices meet the needs of residents. Information about prescribed medication needs to be made available to staff carrying out the administration of medication. This should be in the preffered language of staff to ensure they will be adequately informed about instructions / advice on administering medication to residents to ensure their health is positively promoted and safeguarded. The home should have within the care plan a section on health care. This should cover medication, including detailing adverse effects and important details about how and when a medication should be administered and any links to illness / medical conditions. The care plan needed to be clear about the capacity of residents in regards to their financial arrangements. This included recording the purpose of the handover of funds to families and the consent of the resident in these transactions. It is recommended that the home seek the views of residents regarding activities. 2 OP36 3 OP9 4 OP7 5 OP35 6 OP12 Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection CSCI, Local office 9th Floor Oakland House Talbot Road Manchester M16 0PQ 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 Dom Polski DS0000021545.V301351.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!