Inspection on 30/04/07 for Dorriemay House

This inspection was carried out on 30th April 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 found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Dorriemay House 15/04/08

Dorriemay House 27/04/06

Dorriemay House 07/11/05

Dorriemay House 04/05/05

Dorriemay House 11/01/05

Dorriemay House 20/07/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Dorriemay House Dorriemay House 23/27 Eaton Road Margate Kent CT9 1XB Lead Inspector Sue Gaskell Key Unannounced Inspection 30th April 2007 10:30 Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 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 Dorriemay House DS0000023391.V335562.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dorriemay House Address Dorriemay House 23/27 Eaton Road Margate Kent CT9 1XB 01843 292616 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) Mr David Barrie Mirsky Mrs Jacqueline Ann Mirsky Mr David Barrie Mirsky Care Home 25 Category(ies) of Learning disability (25) registration, with number of places Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th April 2006 Brief Description of the Service: Dorriemay House provides residential care to up to 25 people who require varying degrees of assistance as a result of their learning disabilities. Staffing comprises of the registered provider, a head of care, care staff and ancillary staff. The Home comprises three adjoining terraced properties, with a paved garden area to the rear, the premises are situated close to the sea front in a residential area of Margate. The Home is within a short distance of amenities such as rail and bus services, shops and churches, a library and a concert hall. The premises lack access for people with impaired mobility. The weekly fees charged at the home are £350.00. Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 30th April 2007 between 10.30 and 14.30. The home currently has no registered manager but the acting manager is applying for registration. There were 19 people living at the home and there are 6 vacancies. I spoke with three residents, two resident’s Care Manager, and three members of staff. Some residents have limited communication and therefore I mixed with residents for some time in order to see whether they appeared relaxed and comfortable. I toured the building and looked at all communal areas. Three residents showed me their bedrooms. The inspection process also consisted of information collected before and during the visit to the home, and feedback from a local Care Manager after the site visit finished. Other information seen included general assessments, risk assessments and care plans, medication records, the duty rota and staff recruitment and training records. There were no outstanding requirements from the previous inspection, however some further requirements and recommendations have been made following this inspection. What the service does well: What has improved since the last inspection? Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 6 Pre-admission assessment forms have been reviewed. Care plans contain more detail of residents’ social and emotional needs. The menu records have been extended to cover all meals. Residents’ welfare benefits and their contributions to fees are recorded. The staffing rota has been adjusted. Risk assessments have been produced for residents’ needs and the environment. Infection control procedures have been improved. 2 staff have attended nutrition training. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1&2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The statement of purpose, service user guide and individual statement of terms and conditions, says what service will be offered. The home cannot be confident that prospective resident’s needs can be met as it does not always carry out a full pre-admission assessment. EVIDENCE: Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 9 The statement of purpose and service user guide have been reviewed since the last inspection. The service user guide is now produced in a pictorial format to make it more understandable and accessible to residents. Although there is reference to respecting residents’ religious and cultural beliefs, there is no specific reference to promoting and supporting equality and diversity. There have been no new full time admissions since the last inspection. Although a new respite care assessment form was completed on the day of admission for the recent temporary resident, no pre-admission assessment had been carried out. The acting manager explained that the last admission was for emergency respite care. Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are in place but do not include adequate information on managing risks. Lack of full pre-admission assessments for emergency admissions could affect the home’s ability to meet service users’ needs. EVIDENCE: Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 11 All residents have a care plan. Four of the care plans were examined in detail. The care plans and daily records have generally improved. They now include more detail including the behavioural and emotional aspects of residents’ care and how they are supported to make decisions and choices about their lives. The files also include personal profiles, assessments, likes and dislikes, and some guidelines on how the home will assist residents in achieving their short and longer term goals. Staff said that they always read the care plans. Whilst some care plans have been reviewed recently, some of the assessments lack dates. Residents have key workers who monitor their individual needs and activities and help them understand, and contribute as much as possible to, the contents of their care plans. The residents can also make their views known when they help complete the residents’ review sheets. Some residents have signed their care plans and any necessary consent forms. However there are insufficient written guidelines to support, promote and protect residents who have personal relationships. Although assessments have been prepared for each residents’ needs or activities, they do not include specific guidelines on how to manage particular behaviours or to minimise any risk. The acting manager said that the home generally maintains a level of three staff per shift plus the manager or team leader during the day. A new rota has been introduced to enable staff to be deployed at times when the residents are more likely to be at home. Staff said that extra staffing is provided if there is a necessity. Staff were seen supporting residents’ needs in a respectful manner that protects privacy and dignity. Issues relating to confidentiality are addressed during the induction period. All records are stored in a lockable office and there was no public display of confidential or personal information. Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Daily life meets the residents’ lifestyle preferences and expectations. Residents have regular contact with their families and friends. Residents receive a nourishing and balanced diet. EVIDENCE: Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 13 Over half of the residents are now elderly and therefore it would not be essential for them to attend further education. One resident said that he enjoys going to college where he attends classes in music, movement and drama. Another resident has recently had a holiday accompanied by a member of staff. Many of the residents attend the home’s own daycentre as part of their daily activity. Some activities and opportunities for involvement with the local community are restricted due to staffing numbers. Staff are able to work extra hours in addition to their rota hours, but this does not generally enable them to escort residents on an individual basis. The care plans contain a list of residents’ needs, likes and dislikes and preferences, and some of this is in pictorial form. Residents may come and go as they please. There is a reference is one resident’s file to his lack of awareness of road safety. Whilst the acting manager has risk assessed this issue, a more detailed risk assessment would establish whether it is appropriate for him to go out unaccompanied. There was evidence in the residents’ daily records to show that families, and other visitors are encouraged and welcomed. One resident said that he was going home soon to see his family and another resident had been to see family members. Most of the residents have their finances managed by the home. There is a simple but effective recording system which accounts for money received and spent. Records and receipts and kept for the monies held in personal wallets and individual tins. The acting manager said that records are checked regularly and that two signatures are required for monies taken out when residents spend money on social activities such as going to the pub. Meals are provided mainly based on residents’ choices, but also taking into account the need for a reasonably balanced diet. The records of the food provided showed that an alternative choice of main meal and sweet are available every day. The acting manager and a senior member of staff have attended a nutrition course since the last inspection. One resident has a particular need which requires special consideration and the records showed that he has been referred to a consultant. The store cupboard contained a wide range of food including fresh fruit and vegetables. The menu record form is used for the main meal and all other meals taken. It provides information about the size of the meal provided and an indication as to how much of the meal was eaten. Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ choices over their care are respected. Residents’ care plans are reviewed and their health care needs are met. Residents are protected by the home’s policies and procedures for dealing with their medication. EVIDENCE: Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 15 All of the residents who either spoke with me or were present during the inspection were seen to be relaxed and comfortable whilst interacting with staff. Many residents are in an older age group and they have different needs to the younger ones. Staff referred to the importance of being sensitive to the needs of each individual. Residents’ care plans and daily records referred to clear guidelines on providing support and monitoring health care and social care needs. There was evidence in residents’ files to show that residents’ needs have been closely monitored and that they have been referred for specialist help whenever necessary. One resident’s Care Manager confirmed that staff have been quick to respond to his needs and supportive when he has required treatment. The two members of staff spoken with showed a high level of awareness of residents’ needs and referred to various issues, such as medical, nutritional or communication issues, being included in the care plans. There was evidence of staff involvement in the daily recording, care plans and referrals for specialist help. A senior member of staff said that new members of staff are advised to refer to care plans as a matter of priority. The home has sound medication procedures. There is a purpose built room for the storage of medication, which includes a secure medication cupboard, a refrigerator and a hand basin. There is an appropriate medication trolley for use around the home. Staff confirmed that only trained staff would administer medication and that all staff have to read the procedures stored in the medication file. The administering of medication is recorded appropriately and there are procedures for its receipt and disposal. Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents can be confident their complaints will be listened to and dealt with appropriately. The home’s procedures are designed to protected residents from abuse but staff would benefit from further training. EVIDENCE: Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 17 Although it was difficult to obtain information from the residents due to their communication needs, one resident was clearly comfortable telling staff about anything he was not happy with. Staff said that every effort is made to ensure that residents can let staff know if they are not happy with something. The home uses complaints forms that have been produced in a pictorial format. The home has adult abuse procedures in place and staff confirmed that they have received training on how to intervene in order to safeguard and assist residents. The staff induction process includes information for staff on policies and procedures concerning appropriate behaviour when assisting with personal care, the use of appropriate intervention techniques, and “whistle blowing”. However, the acting manager said that he is aware that there has been a lack of training on adult protection and this is because there is a problem in sourcing affordable training. The registered provider is appointee for a number of residents. Clear records are kept of any involvement by the home in residents’ finances and how their money is spent, e.g. there is clear recording where some of the extra benefits received by residents is taken as part of the residents’ “top up” fees for living at the home. Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a homely,comfortable and safe environment, however the home is not suitable for residents with impaired mobility. The home is hygienic and clean but would benefit from further improvements such as a new stair carpet. EVIDENCE: Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 19 An up to date schedule of accommodation for the home has been attached to the statement of purpose to reflect alterations to bedrooms etc. All bedrooms and living areas are furnished and decorated to a reasonable standard, and contained the type of furniture and equipment necessary to provide a homely environment. Two residents said that they like their bedrooms although they had not helped to choose colours, furniture etc. Some residents have single rooms where they can display their own effects such as posters, models and have their own TV, DVD player etc. Other resident have shared rooms but there is curtain style screening between their beds to give some privacy. The building is on multiple levels and there is only stair access available to upper floors. There is no call bell system at the home. The home is not suitable for people with impaired mobility and there are currently no plans to adapt the building. Although over half of the residents are aged 60 years or older, no preparations have been made to assess their changing needs or to prepare for this. The acting manager acknowledged that there has been a problem with one resident’s room, and that new flooring has been provided, and there are some areas with an odour. However, all areas were seen to be clean and hygienic. There are some areas of the home that would benefit from some refurbishment, including new carpet on the stairs, There is a small but well-maintained garden and patio with garden furniture which is used by the residents. Staff showed a good awareness of health and safety issues. There is separate laundry room with a commercial washer and a drier which at present is still accessed through the staff room. Residents may assist in the laundry with staff support. Disposable hand drying towels and pump soap dispensers reduce the risks of cross infection. Maintenance certificates are current and there are no outstanding health and safety requirements. Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing, in terms of both numbers and competency, is adequate for the current needs of the residents. Residents are protected by the Home’s sound recruitment procedures. Staff would benefit from more training and supervision. EVIDENCE: Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 21 The acting manager said that the current staff rota includes the manager or a shift leader and generally 3 support staff. He acknowledged that there is an issue around staffing and that this is affected by the very low fees paid by the funding authority. The home has introduced a new rota to try to provide more staff when there are more residents present. Night staffing appears adequate for residents’ current numbers and needs and there are emergency on call systems. The staff files included CRB checks on all staff, references and evidence of verbal references. The files also included evidence of induction training. The manager said that over 50 of staff already have NVQ 2 but there is no training planned at present. There is a need for further training and regular recorded supervision. Staff said that there is a high level of morale in the home with good support for any personal issues that affect their work. Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run in a manner that encourages the development of clients. The home is run in the best interests of the clients and their safety and welfare is protected and promoted. EVIDENCE: Although currently there is no registered manager in place, the acting manager is in the process of applying for registration. He has many years experience in Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 23 working with adults with learning disabilities, and appeared knowledgeable and competent. Quality assurance is carried out through regularly reviewing policies and procedures, rather than through a formal system. Staff said that residents’ views and feelings are regularly questioned and monitored, either through talking to them, observing them to see whether or not they appear happy, or through the residents’ review sheets. Staff said that any feedback from residents and/or their families or advocates is acted upon. One Care Manager, who has recently reviewed two clients, confirmed this. The general management of the home and completion of records are of generally of a good standard. One member of staff said that morale in the home is good and that the owner and acting manager are supportive. There were no obvious safety hazards around the home and there was evidence to show that health and safety issues are taken seriously e.g. the home has reviewed infection control procedures, and cleaning chemicals are locked away. Environmental risk assessments have been carried out. The home has access to maintenance staff, who was due to call later on the day of the inspection to check and attend to window restrictors. He has responsibility for routine testing of equipment and ensures that regular weekly tests are carried out and recorded. Staff have had fire safety training and the regular fire drills sometimes include residents. There are current certificates to show that regular checks e.g. gas, electricity, are carried out. Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 25 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA23 Regulation 18 Requirement Ensure staff have all training necessary to meet service users’ needs, including adult protection awareness training. Ensure staff have all training necessary to meet service users’ needs, including training in specific conditions. Timescale for action 30/10/07 2 YA35 18 30/10/07 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 3 4 5 Refer to Standard YA1 YA2 YA9 Good Practice Recommendations Include specific reference in statement of purpose and service user guide to promoting and supporting equality and diversity. Carry out pre-admission assessments for all residents, even those admitted on an emergency basis. Include more detail in risk assessments, including guidelines for managing relationships and certain behaviours. Clean or replace areas of carpet, including stair carpet. Ensure staff receive formal recorded supervision. YA24 YA36 Dorriemay House DS0000023391.V335562.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Dorriemay House DS0000023391.V335562.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!