Inspection on 24/05/07 for Field View

This inspection was carried out on 24th May 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

Field View 18/05/09

Field View 10/02/06

Field View 01/09/05

Field View 17/01/05

Field View 26/07/04

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

CARE HOMES FOR OLDER PEOPLE Field View Hayes Lane Fakenham Norfolk NR21 9EP Lead Inspector Jenny Rose Unannounced Inspection 24th May 2007 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Field View DS0000027478.V341464.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. Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Field View Address Hayes Lane Fakenham Norfolk NR21 9EP 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) 01328 856037 01263 713222 fieldview66@fsmail.net Imperial Care Homes Limited Mrs Helen Forsyth Care Home 17 Category(ies) of Old age, not falling within any other category registration, with number (17) of places Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th February 2006 Brief Description of the Service: Fieldview is a care home providing personal care and accommodation for 17 older people. On the day of inspection there were 15 service users accommodated. The home had one vacancy and one resident in hospital. Imperial Care Home Limited owns the home and the Registered Manager is Helen Forsyth and the Proprietors are Mr Steve Smith and Mrs Laura Smith. The home is located on the western outskirts of the market town of Fakenham, pleasantly situated, and is close to all local amenities. The home provides accommodation on the ground and first floor with flats for staff being situated on the second floor. There are two shared bedrooms and thirteen single bedrooms with all bedrooms having en suite facilities. There is a five person lift to the first floor. There is adequate communal space and a patio area and large garden, mainly laid to lawn, to enjoy in the summer months. Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care Services are judged against outcome groups, which assess how well a provider delivers outcomes for people using the service. The key inspection of this service has been carried out by using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgements for each outcome group. This was a key, unannounced inspection taking place on 24 May 2007 and a second visit on 31 May 2007 as, due to exceptional circumstances on the first day, the keys to some confidential records were not available and neither was the Manager, due to illness. In all, the inspection took place over 8 hours over 2 days. On the first day, a tour of the building was undertaken, some care plans, files and records were seen. On the second day, staff files and other information were examined. There had been a pre-inspection questionnaire and comment cards returned, two from Healthcare Professionals, three from relatives and seven from residents, which all contained positive comments. One visitor was spoken to, a group of five staff, as well as three staff members in private. All the residents were seen and five residents spoken to in private; all comments are reflected in this report. What the service does well: • • • The home is pleasantly situated on the outskirts of a market town. Overall, the people living in the Home are very satisfied with the quality of care they receive. All rooms are personalised, have ensuite facilities and there is pleasant, comfortable, communal space with easy access to a large patio, with garden beyond, containing visiting wildlife, especially birds, which many residents enjoy. Care plans, as well as other records, are well kept, with useful and detailed information for staff to follow. Comments from Healthcare Professionals gave a positive picture of the healthcare available to residents. • • Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 6 • • • There is an enthusiastic, well trained, staff team; a large majority of which have achieved NVQ qualifications. People living in the home are encouraged to continue activities in the community and visitors are welcomed to the home. A newsletter has been produced on a monthly basis since the last inspection, featuring members of staff and residents, if they wish, and other items of interest, which aids communications within the Home. What has improved since the last inspection? • • • Staff recruitment documents are all in place, thus ensuring the people living in the Home are protected from abuse. People living in the Home are offered lockable facilities in rooms for privacy and valuables. A new Quality Assurance System has been introduced, which together with other monitoring systems will further ensure the quality of care delivered to people living in the Home, when the information is collated and published. The lounge, dining and kitchen areas have been redecorated, new boiler and new cooker fitted in kitchen and new front door bell fitted. A louder, front door bell has been fitted, but there is still a security issue surrounding this. • • What they could do better: • • • • A keyworking system would further ensure that individual preferences regarding meals, activities, choices and rights would be promoted. It is recommended that the front door security is reviewed to further ensure the safety of the people living in the Home. Lighting in the upstairs corridor could be improved for the benefit of residents, especially for those with visual impairment. Improvement plans based on the published results of the new Quality Assurance system would further ensure that the service is resident focussed. Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 7 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. Field View DS0000027478.V341464.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 Field View DS0000027478.V341464.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 (N/A) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Assessments are made prior to admission and all the people living in the Home are having their assessed needs met. The Home does not offer intermediate care. EVIDENCE: Prior to admission the manager completes an assessment and care plans showed that additional information is also obtained from health and social services. Prospective residents are encouraged to visit the Home, if possible, and to have a meal. One newly admitted resident said that his relatives visited several homes and he was able to make a choice, as to which would suit his needs. One resident had been to the Home before as her sister had lived there and another resident had visited the Home for respite care. However, one resident felt that the information given had been rather rushed, despite the fact that the Manager said that all residents and relatives are given the same information details prior to admission. Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the Home are happy with the way that staff deliver their care and respect their dignity. EVIDENCE: All comment cards, including those received from healthcare professionals, three relatives and those received from residents and those residents spoken to were positive overall about the healthcare delivered in the Home. ”Staff are vigilant with any medical condition”, was one comment. Another resident spoken to was very complimentary about the personal care she received and that her health had improved since living at the Home. Four care plans were examined. These all included a photograph of the resident and comprehensive details necessary to enable staff to deliver the care needed. There were risk assessments, particularly for falls, weight charts and particular likes and dislikes which were noted at Reviews, together with any changes. There were informative details regarding residents’ personal wishes for their daily routines. Care plans were reviewed regularly and signed by the resident/and or a relative, if appropriate. Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 11 All care plans contained details of the residents’ medical needs, GP and other healthcare professionals visits were recorded separately. There were weight charts as well as monitoring for those residents with Diabetes. The Manager said there is a good relationship with the District Nurse team and an efficient equipment supply. The Manager also said there is good liaison with hospitals and there is always an assessment of residents’ changed needs by the Home before discharge. Medication practice was observed at lunchtime with the help of the member of staff responsible for the medication on the day of the inspection. Practice observed was good and records seen were correct. All staff who administer medication have had the appropriate training. The Deputy Manager is responsible for the auditing of medication. A risk assessment for self medication was seen in one care plan, which stated that the resident chose not to administer his own medication. One resident spoken to administers her own medication with support from staff members and a risk assessment was seen for this. All residents spoken to and evidence from observation, confirmed that residents were treated with respect and that their privacy was protected. Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the Home have choice and are given the opportunity to take part in some activities within the Home and in the community, but these and the content of meals would benefit from being more varied. EVIDENCE: Over the two periods of inspection, most of the people living in the Home were spoken to, together with one visitor. Comments from these people and the comment cards confirmed they were satisfied with the lifestyle in the Home and had choices in their day-to-day lives. Some residents choose to stay in their rooms, having some, or all, of their meals there. Others preferred to spend their time in the communal areas. Opportunities were available for residents to watch television, read, knit or play board games, all of which activities were seen taking place on the two days of the inspection. Residents said they could go to bed and get up, when they chose, and were also encouraged to be as independent as possible. Three residents enjoyed playing cards regularly together. There is a programme of activities, including trips out in the mini bus, reflexology and manicures, which are enjoyed by many of the residents. One resident has the local paper delivered. Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 13 One resident spoken to said “I am happy here”, she goes out regularly to a social club in the town and another resident enjoys being able to come and go as she pleased to walk on the patio. The Home tries to be flexible to accommodate residents’ individual needs. One resident was observed returning to the Home later than the usual meal time and her meal had been kept for her. A visitor spoken to said that she visited regularly and at different times of the day and a comment card confirmed that one relative was involved with her mother’s care plan. In the staffing area, it was observed there were instructions to staff regarding those residents who needed support with walking at different times of the day, in order to encourage their mobility and independence. However, there is a recommendation that all residents living in the Home have access to a keyworker to ensure that all people using the service can be sure that their needs, choices and rights are known, protected and promoted, especially for those with multiple impairments. The Home has minimal involvement with residents’ finances and residents and/or their families or representatives are encouraged to take responsibility in this area. Some money is kept in the office for small items, hairdressing or chiropody; all transactions are receipted and recorded and signed. These were randomly checked and found to be accurate. Residents confirmed that they are able to bring in personal items from home, as well as items of furniture. Menus seen demonstrated that there is some variety of meals and residents confirmed that there was some choice and alternatives offered. One resident said that in particular, the evening meal seemed limited and this was confirmed by sight of the menu. However, the Manager said that if residents request alternatives, these can be obtained fairly immediately. For example, requests such as pate on toast, teacakes or crumpets or baked potatoes could easily be met. Residents’ meetings are held regularly and this is often a time for asking about changes in menus. On the day, it was observed that staff were asking residents for choices and meals were served individually, taking into account likes and dislikes. One resident liked to have a glass of wine with her lunch. One resident said that she needed a special diet and she found the food particularly good. There were no residents with particular nutritional needs at present, but the Manager confirmed that arrangements can be made for these and residents’ weight is monitored in the care plans. Several residents take their meals in the dining area off the sitting area, with pleasantly laid tables, but others took their meals in their rooms, or their easy chairs with an individual table. However, one resident did comment that a 12.00 o’clock lunch was rather early, especially if she wished to go out in the morning. Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the Home feel that complaints and concerns would be listened to and acted upon, and the Home’s policies and procedures ensure that residents are protected from abuse. EVIDENCE: There is a complaints procedure and details of this are made available to everyone coming to live in the Home and their relatives. Comment cards and residents spoken to said that they would know how to make a complaint if necessary. Policies and procedures for the protection of vulnerable adults are in place. Staff training in this area takes place at the time of induction and then in more detail as part of the mandatory training or within the NVQ. The Manager was aware of local procedures and had taken an advanced course in the Protection of Vulnerable Adults recently. All members of staff spoken to gave a good account of their knowledge of the issues surrounding the protection of vulnerable adults. Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the Home enjoy a good standard of homely accommodation, which is clean, safe and well maintained, with access to appropriate facilities and equipment. EVIDENCE: The Home is located in a residential area near the market town. It has an attractive, accessible, well-maintained garden. The communal space is varied with a conservatory area overlooking the garden, which contains wildlife which the residents enjoy watching. Some of the bedrooms overlook the garden. All the bedrooms seen were personalised with residents’ possessions, if they wish. There have been some improvements since the last inspection in terms of a new water boiler and cooker in the kitchen, which has also been decorated. The Lounge/Dining Rooms have been redecorated and a louder door bell fitted, since the last inspection. However, on the day, it was observed that a visitor, although expected, was able to walk in the Home without ringing the bell and Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 16 the recommendation from the previous inspection is therefore repeated, as this open door could compromise the safety of the residents. It was observed on the day that the lighting in the first floor corridor was rather dim and there is therefore a requirement that this should be reviewed, particularly for those residents who are visually impaired to ensure their safety and independence. All residents are provided with a lockable facility within their room and are asked whether they wish to have this when they first come to the Home. Some residents choose to lock their rooms, but others do not wish for a key. The Comment cards and people spoken to, as well as from a tour of the building, gave evidence that the Home was fresh, clean and tidy. There is a maintenance person, shared with the two other Homes in the Organisation. The Manager makes a recorded tour of the building once a month to note maintenance items and a daily inspection to check that it is clean and tidy. The member of staff responsible for cleaning is given the opportunity of attending the same training as the care staff in such areas as Moving and Handling, Protection of Vulnerable Adults, First Aid and Continence, which is good practice. Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the Home are satisfied with the care they receive and that it meets their needs and is delivered by a well-trained staff team. EVIDENCE: “Medals all round”; “Staff are excellent”, are two comments from comment cards and there were generally positive comments regarding the staff team from those people spoken to. Those members of staff spoken to said they enjoyed working in the Home and felt they all worked well together and looked forward to coming to work. They also felt they were well supported by the management and with training opportunities. The Manager said that she had flexibility in obtaining extra staffing hours when necessary to meet residents’ particular needs, or in times of illness. A requirement had been made at the previous inspection concerning the recruitment and selection process, which has now been rectified and all staff files seen contained all the relevant information, including CRBs and references, thus ensuring protection of residents from abuse. All but two members of staff have an NVQ2 qualification or above and the company has appointed a dedicated NVQ assessor to work with staff in this area. The file of the most recent member of staff showed evidence of the Skills for Care Programme. As mentioned elsewhere in this Report, the Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 18 member of staff responsible for cleaning (Environment) was also supported to attend several courses in common with the care staff. Staff are supported by regular supervision and appraisals and also regular staff meetings, which are recorded for members of staff unable to attend. Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the Home feel their interests are safeguarded by the management approach of the Home. The new Quality Assurance system will hopefully further ensure that the service continuously improves in the best interests of the people living there. EVIDENCE: The Manager has completed her Registered Managers Award and has several years experience in the care of older people. She has the backing of the larger Organisation and the quality of management is reflected in the good quality care provided in the Home. She is supported to refresh her skills and has recently attended an advanced course in the Protection of Vulnerable Adults. All records, care plans and staff files are well kept and up to date. Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 20 The Home has recently introduced a new Quality Assurance system, which together with the Regulation 26 visits, staff meetings, residents’ meetings, staff supervision and appraisals, as well as a monthly newsletter contributes towards the auditing of the care and quality of the service delivered. Some questionnaires are used to gain information and the Home has done some good work in this area, but the recommendation from the previous inspection has been repeated, in that the information from the newly instituted quality assurance system should be annually collated and published. The people living in the Home are protected by the financial procedures, see previously in this Report (Daily Living) All accidents and incidents are recorded and the manager is aware of her responsibilities in this area. As noted earlier in this Report (Environment) the front door to the Home is unlocked during the day and it is recommended that a review of the risk assessment be completed in this area. Certificates of the servicing and testing of equipment were seen to have been carried out, thus ensuring that as far as possible the health and safety of residents and staff is protected. Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 22 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 OP22 Regulation 23.2(p) Requirement A review of the quality of the lighting on the first floor corridor must be undertaken. This could further protect the safety and independence of the people living in the Home. Timescale for action 01/09/07 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. Refer to Standard OP13 Good Practice Recommendations A keyworking system would ensure that all people living in the Home can be sure that their needs, choices and rights are known, protected and promoted. In this case, particularly for those with multiple impairments. in the area of meal choices and activities. Improvement plans based on the relevant information collated and published from the new quality assurance system would further ensure that the service is run in the best interests of the people living in the Home. 2. OP33 Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 23 3. OP38 A review of the risk assessment concerning the fact that the front door is open during the day would help to ensure that the safety of the people living in the home is not put at risk. Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Field View DS0000027478.V341464.R01.S.doc Version 5.2 Page 25 - 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!