Inspection on 21/07/05 for Fairfields House

This inspection was carried out on 21st July 2005.

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 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

Fairfields House 14/07/09

Fairfields House 24/07/07

Fairfields House 15/05/06

Fairfields House 01/12/05

Fairfields House 11/11/04

Fairfields House 03/06/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Fairfields House 21 Tuddenham Road Ipswich Suffolk IP4 2SN Lead Inspector Claire Hutton Announced 21st July 2005 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 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. Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Fairfields House Address 21 Tuddenham Road, Ipswich, Suffolk, IP4 2SN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01473 213988 01473 785062 None provided Fairfields House LTD Post Vacant Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23) of places Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11/11/04 Brief Description of the Service: Fairfield House is a care home providing personal care and accommodation to up to 23 older people. It is a privately run home and is situated in a quiet area of Ipswich, not far from the town centre. The home is a two-storey building with bedrooms on the ground and first floor. The home has a shaft lift and stair lift. Twenty-one bedrooms are single and twelve provide en-suite toilet and wash hand basin. There is also one double en-suite bedroom. There are car-parking facilities at the front of the building and the rear provides an enclosed garden, which is well maintained and sheltered. Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection lasted seven hours on a weekday in July 2005. Fourteen people at the home were spoken with. Four residents four visitors and three staff. In addition the two owners and the new manager were also fully involved with the inspection. A tour of the accommodation was completed with the guidance of the manager. Records inspected included: assessments, contracts and all care records for four residents, recruitment records for three staff, roters, menus, complaint and accident records and various records of staff training. A date was set with the new manager for her fit person interview with the commission and they await her completed application form. What the service does well: What has improved since the last inspection? The main improvement at the home has been to recruit a permanent and appropriately qualified manager. Both staff and residents were pleased with this. Another good achievement has been to address the previous requirements bar one. These improvements include ensuring staff are trained to administer medication (this is going to be further developed) Staff had also received training in first aid, fire and manual handling. Staff receive regular formal supervision. The environment is being upgraded and the patio has been relaid and was level. The roof was being replaced. The lounge, entrance, landing and back entrance had all been redecorated. The Statement of Purpose had been revised and was available in size 14 print for people of poor sight and a recent survey of residents, relatives and professionals had been conducted. Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 6 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. Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3 and 6 does not apply People who use this service can expect to have up to date information about the home, an assessment of their needs and be provided with a contract and terms and conditions. Therefore, the choice of home is more likely to meet their needs. EVIDENCE: A copy of the newly revised Statement of Purposed was available for inspection. The same document was available in size 14 font for those of poor sight. The document contains information on what the service has to offer. The contract and terms and conditions for four residents was requested and this was available for inspection. All were signed appropriately. The assessments for four residents were requested and all four were available for inspection. Assessments had been provided by social services and were appropriate, but there was also an assessment completed by the home to show they were aware of needs before a person moved into the home. Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8 and 9 People who use this service can usually expect to have their care needs documented and met, but more consistent recording and further development of instruction of how to care will ensure quality of care for every resident. EVIDENCE: Four different care plans and associated records were examined. The plan of care developed from the assessment set out individuals care needs under different sections such as personal care, communication, diet and nutrition, daily routine and had risk assessments for manual handling. The new manager had gone on to develop a different format that included a brief history of the resident, each element of care had the need identified, and then what support was required by care staff. This instruction was precise and based on individual’s requirement. One of the care plans had a manual handling assessment that had been amended in several places and needed to be rewritten. Another plan had so much information it was confusing to know what was the up to date care needs and would benefit from the new style of instruction to care staff. This one plan did not have an up to date record of review where the three other plans did. Residents spoken with felt their care needs were attended to and that staff knew them well. Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 10 All residents at the home were registered at a GP surgery. The exact detail of individual GP was not specific on one care plan and should be added. A GP had visited that morning to see one resident and staff recorded the outcome in the daily notes. The district nurse visits individuals for treatment and there was a section in care plans to record each visit. This was not completed on each occasion for one individual. There was not a plan of care relating to the care support required when an individual had treatment from the district nurse. An example of the care and treatment dovetailing together may be, care staff raising a persons legs, ensuring pressure relieving devices are used or prevention of infection strategies. Care plans showed visits and appointments to hospital, opticians, hearing clinics and chiropody. A photograph of the resident was not available in each case. The daily statement of care given to residents was overall ok but not all staff were consistent in recording the care given. Individuals weight was recorded. One resident said there healthcare needs were attended to promptly by the home. Medication was not fully audited at this inspection, but had been assessed at previous inspections; therefore, the previous requirements were followed up. The seven staff designated to administer medication had all undergone training as had two additional people. Further in-depth medication training is planned through Otley College. A previous requirement was made for all drugs returned to the pharmacist to be individually recorded and signed for. This was now the case. One requirement last time was to have medication with a limited shelf life dated upon opening. In the fridge there were opened eye drops that were not dated. The home has a small amount of medication that requires refrigeration and was stored in the domestic fridge in the door. It was recommended that this be stored in a lockable tin to offer better security and keep it free from contamination. Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13 and 15 People who use this service will find that visitors are warmly welcomed and that individual lifestyle and choices are respected. EVIDENCE: Eleven visitors to the home were noted in the visitors book. Four of these were spoken with. When asked there view of the home all stated that the individual they visited were happy therefore they were happy with the home. Staff attended to the door bell promptly and were polite and helpful to each visitor. Some residents had several visitors a day. The Statement of Purpose sets out details of visiting. In the afternoon a game of bingo was organised in which several residents joined in. A small number of residents stayed in their room through choice and liked their own company or their private entertainment of television, radio or books. A new activity had been introduced and been enjoyed the day before. This was a small group of residents making cakes in the morning, these were then taken to the kitchen to be baked and then eaten in the afternoon. Social activities will be explored further at the nest inspection. The dining room was very pleasant and one resident set the tables as was their usual routine. A lunch of home baked ham, jacket potato, carrots and Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 12 cauliflower cheese was eaten by the inspector. The ham was particularly tasty. Dessert was cherry pie and custard. Menus are set out over a four week period and show what is on offer for lunch and tea. If what is on the menu does not appeal then the cook will provide a different choice. Examples of this were given and one resident confirmed they were offered different if they wanted it. Three residents spoken with all praised the cook and said they enjoyed the good home cooking that she provided. One resident said ‘you can’t find fault with the food’. Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 People who use this service can expect that their complaints and prevention of abuse are taken seriously, therefore residents are protected as far as possible. EVIDENCE: The complaints procedure for the home is provided in the Statement of Purpose and was displayed at the entrance to the home for all to see. The log of complaints was examined and the two complaints received since the previous inspection had been investigated and a written outcome given to the complainant. The new manager appointed was well aware of the protection of vulnerable adults and had training in this area from Suffolk social services. This was a skill she intended to pass on to care staff at the home. Information about the scheme operated in Suffolk was displayed in the office and was available to staff to read. Staff had access to the video produced by Suffolk. Evidence of training in abuse for care staff was seen. One member of care staff spoken with was very aware of her duty of care in reporting any incident of concern. Evidence of CRB (criminal records bureau) checks were in place along with checks on the national POVA (protection of vulnerable adults) list. Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25 and 26 Fairfield’s provides a small, comfortable family type home that generally meets the needs of older people. The plan of developments will ensure these needs continue to be met. EVIDENCE: A stated in the summary developments such as a new roof, re-laid patio and decoration on communal parts of the home have taken place and this has made a difference that residents and visitors have noticed and appreciated. Further painting such as the laundry room and the linen cupboard upstairs must take place soon. In addition, the replacement of floor coverings in the downstairs bathroom and the back corridor and back entrance must take place soon. A plan of developments and maintenance on a time line with budget planned should be available for inspection. This needs to include such developments as the upgrading of the kitchen and the extension of a conservatory. The kitchen had a door hanging off and a worn worktop. The ceiling had a crack and was very yellow from cooking. The conservatory would be a solution to the lack of communal space. Currently not all residents could Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 15 sit in the lounge as it did not have sufficient space. The lounge and dining room were comfortable, clean and well used by residents and visitors. External facilities were not inspected. In addition to the thirteen en-suites, toilets there were two bathrooms with toilet and bath with aids for older people near the lounge. On the first floor there was a bathroom with bath aids and a toilet. In addition, there was a separate staff toilet. Fairfield’s has a modern shaft lift that provided a smooth ride and a stair lift. There were various pieces of equipment to enable personal care such as hoists available. Two resident were particularly pleased with their earphones that allowed them to watch the television as loud as they individually wished without disturbing other people. ‘It’s as clear as a bell and spoils you when you have to listen to normal levels of conversation’ said one resident. Four occupied bedrooms and two empty bedrooms were visited. The occupied bedrooms were very individual and full of resident’s possessions and furniture. Three residents said they were very happy with their room and that they had it just the way they wanted and needed it. One of the empty bedrooms had new bedroom furniture on order. On the first floor all windows had restrictors to prevent falling and all radiators had nice coverings to prevent scalding. The cleaner was making his way through the home cleaning all communal areas, bedrooms and bathrooms. The home was managing odour well and no strong odour was found anywhere in the home. The laundry room and linen cupboard on the first floor needed a good clean and a fresh coat of paint. Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29 and 30 People who use this service will find that majority of the time there is enough staff available who are suitably trained and generally well recruited. EVIDENCE: The home have a weekly rota available for inspection that shows everyone employed at the home and in what role. The home employ a total of 22 people. The manager, a cook, a handyman and a cleaner, the rest are care staff. Generally, there are three carers on in a morning and three carers on in an afternoon and two carer awake at night. When the residents were asked if their care needs were met by this amount of staff the answer from everyone was yes and they did not have to wait long for care, but there were times when they felt the care staff were overworked. One care staff said she thought the staffing levels were about right, but there was the odd day when it was busy and not a spare minute was had. The home only employs one cook currently; therefore, at a weekend the rota shows that a carer (especially on Sundays) has to be cook. This leaves care staff short. This was noticed by residents and commented upon to the inspector. Staff training at the home was well recorded with each individual having evidence available, but also a spreadsheet was available to show who had what training overall and when it needed a refresher. This record was not quite up to date and was due to be amended. Staff are trained to administer Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 17 medication (this is going to be further developed) Staff had also received training in first aid, abuse, fire and manual handling. Senior staff had the fire marshal training. Three care staff have NVQ 2 in care and another three were about to start this training. The new manager had plans for staff to access various training at Otley College such as nutrition and health and health and safety. Staff recruitment records for three staff were examined. A CRB (criminal records bureau) check was available for inspection. As was 2 references, contracts and job description. A health declaration was said to be completed, but no available for inspection. Information about the change in regulation that occurred last July was discussed with the owners and new manager. It is important that these changes are understood and form part of the recruitment of staff. Specifically, looking for gaps in employment with reasons identified for these and reasons for leaving employment when working with vulnerable adults or children. Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35, 36, and 37 The newly recruited manager shows potential, but in the absence of a manager this home has been run in the interests of the residents and further tasks such as procedures for staff were agreed to be developed. EVIDENCE: The home has been without a permanent manager for almost a year. In that time the owners have tried to recruit suitable people, but for reasons explained they did not stay. The new manager recruited is Ms Laura Sherridan. She had been at the home about 3 weeks. She is suitably qualified and experienced. Staff and residents spoken with at the home were all happy with her performance so far and felt she had potential. One person felt ‘she’ll be good if she stays’. The CSCI await her completed application for them to process her as a ‘fit’ person to be registered. A date for interview was set. Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 19 A satisfaction questionnaire had been sent to residents, relatives and professionals as part of the homes quality assurance. The responses had been collated and action formulated. Residents have regular meetings and minutes were kept. The owners confirmed that they do not involve themselves with individual’s finances apart from holding a small amount of petty cash. This was kept secure in the safe and records and receipts were kept for anyone relevant to see. A record of staff supervision was kept and a note of the matters supervised. One staff member confirmed that they had supervision. Staff meetings generally followed residents meetings in their patterns to follow up any issues. There was a fixed agenda and staff could raise any matters under the generic headings. It was not possible to ascertain the exact practice of cleansing commodes during the inspection and the home did not have a specific policy and procedure for staff to follow. Therefore, it was agreed that new guidance would be produced from department of health information specific to Fairfield’s and then given to an appropriate professional to ensure the best possible protection from infection is afforded to staff and residents. The pre inspection questionnaire stated that all other policies and procedures were available for inspection. The new manager was able to locate these for the inspector. Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 3 3 3 3 3 3 2 STAFFING Standard No Score 27 2 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x 3 3 2 x Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 21 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 7 Regulation 13,(5) 14,15 Requirement Timescale for action immediate 2. 8 13 (3) (4) 17 (1) 3. 9 13 (2) 4. 19 23 (2)(b) All residents health and care needs must be set out in a plan therefore, plans must be reviewed and updated, specifically for manual handling and the plan identified with confusing information. The plans must have clear instructions to care staff on individual requirements. In order to demonstrate that immediate residents health needs are fully met all medical intervention requested and provided must be recorded. Care plans must include a plan of support for medical treatment. e.g District Nurse treatment. Medication with a limited shelf immediate life must have the date of opening written on the package. Staff must then ensure medication is within date before administering. (this is a repeat requirement from 11/11/04) A programme of maintenance 01/10/05 and renewal must be developed. It must include: - Painting of the laundry room nd linnen cupboard. - Replacement of floor coverings Version 1.40 Page 22 Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc as identified in this report. - Repair and decoration in the kitchen of items identified in this report. 5. 26 23 (2)(d) All areas of the premises must be kept clean, therofre the laundry room and linnen cupboard should have a deep clean (including the floor). The home must ensure it has sufficent staff on duty at all times. e.g Sunday when a carer becomes cook. The recruitement process must include the revised regulation details as set out in this report. A policy and procedure for stff on cleansing commodes must be developed. immediate 6. 27 18 (1)(a) 01/10/05 7. 8. 29 37 7, 9, 19 sched 2 13 (2) 16 (2)(j) immediate 1/10/05 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. Refer to Standard 7 9 20 Good Practice Recommendations Daily care records completed by care staff should state the care given. The small amount of medication in the fridge should be more secure in a lockable tin to prevent contamination. The home is unable to accommodate all residents in the lounge, therefore a plan of how communal space will be increased should be provided to the CSCI with timescales, planning consent and budget identified. Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection St Vincent House Cutler Street Suffolk, Ipswich IP1 1UQ 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 Fairfields House I54-I04 S58630 Fairfields V226788 050721 Stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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