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Inspection on 05/05/05 for Fort Horsted Nursing Home

Also see our care home review for Fort Horsted Nursing Home for more information

This inspection was carried out on 5th May 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff have a good understanding of the support needs of the residents. This is evident from the positive relationships, which have been formed between staff and residents. One resident was quoted as saying "Wonderful staff team". It was evident from discussion with the residents at the home that the primary focus was on developing a tailor made service to enable the residents to maintain independence and enable choices. Evidence was seen that the daily routines of the home were entirely focussed on the choice and freedom of the individual service users. The meals in this home are good offering both choice and variety and cater for special dietary needs.

What the care home could do better:

It was noted that the homes service users guide and statement of purpose are contained as one document this needs to be separated and used for their required purposes. The staff are not recording enough detail in the daily report, it was also noted that when events and care delivery occurs during the day that the record does not indicate the time these happened. There also needs to be kept on file an agreement about sharing a room and evidence that consent has been sought. The home needs to review and rewrite the homes Adult protection and complaints policies. The home needs to ensure that staff supervision is taking place, new staff are supervised till their CRBs are cleared and that staff files are kept up to date and contain all the necessary information.

CARE HOMES FOR OLDER PEOPLE Fort Horsted Primrose Close Chatham Kent ME4 6HZ Lead Inspector Lucy Ansell Unannounced 5 May 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. Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Fort Horsted Nursing Home Address Primrose Close Chatham kent ME4 6HZ 01634 406119 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) Mrs. Ann Taplin Care home with Nursing 26 Category(ies) of Older People 26 registration, with number of places Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 27 January 2005 Brief Description of the Service: Fort Horsted is a privately owned, purpose built, 26 bedded home, providing 24 hour nursing care to older people. The property is a single storey detached bungalow. There are a variety of aids and adaptations around the home, which enable more independence for the residents. The home is in the process of building an extension to provide 4 further bedrooms with ensuite facilities, a bathroom, staff room and office for matron. The home is situated in a residential cul-de-sac close to Gillingham and Chatham town centres. The home is located on a main bus route and within walking distance of shops and a Post Office. The home has an attractive garden to the rear of the property and also some limited parking facilities. Parking on the road is time restricted. Dr and Mrs Jana own the home, one of three in the area. A registered nurse manages the home and there is an additional qualified staff on duty at all times, as well as care staff. The home also employs domestic and catering staff. At the time of this inspection 23 service users were living in the home and there were two vacancies. Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection under the terms of the Care Standards Act 2000 carried out by two inspectors who were in the home from 10.00 to 14.30 on the 5th May 2005. During the inspection the owner and Manager were both in attendance. Documentation and records were read, including care plans. A tour of the premises was undertaken. The inspectors spent time talking with 10 service users. What the service does well: What has improved since the last inspection? There has been an improvement in the care plans however it was noted that reviews are not happening monthly, and Care plans are more up to date than the assessments. A representative or the resident has now signed the contracts for all residents but these must have a room number on them. There is a significant improvement in the handling of medications since the last report, but the home needs to carry out a PRN review for all residents and the MAR sheets need to be printed not hand written. The home is looking to employ a new activities co-ordinator with increased hours and this will help to fulfil residents with more meaningful activities during the day. Evidence was seen that the homes owner and senior staff implements improvements and changes needed Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 Page 6 from any requirements quickly. On entering the home it was apparent that staff maintain a high level of cleanliness, and no odours were detected. 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. Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 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 Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 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 4 The home’s statement of purpose and Service User guide contains the required information for residents and families to make an informed decision about moving into the home. Service users benefit from a comprehensive assessment of their needs prior to moving into the home. EVIDENCE: The home has its statement of purpose and service users guide together in one format. It is clear and concise with all relevant information included, however these are two separate documents and they need to be used for their correct purpose of informing residents prior to choosing a home and as a source of reference after moving into the home. Residents are provided with a statement of terms and conditions when moving into the home. Evidence was seen of the homes contracts, which were very detailed and signed by the resident or their representative, this needs to have the room numbers on them. The homes manager or the deputy manager admits residents following a full assessment both are registered nurses. The information gathered forms part of the overall care plan. The home uses a mini mental test within the preassessment paperwork and the “waterlow” test to determine levels of risk. The home does not offer intermediate care. Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 Page 9 Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 to 11 Residents benefit from a good standard of care planning. Residents are treated with respect and dignity and their independence is promoted. Resident’s wishes in the event of death and dying are respected and are protected by the homes policies and procedures for dealing with medication. EVIDENCE: The plans of care seen on the files sampled covered a wide range of needs individual to the said resident. The plans detailed the care required to preserve the residents dignity while promoting independence, choice and social interaction. In the files sampled it was evident that not all the plans of care are reflected in the daily events. Examples of this were discussed with the manager. It was also evident from observation that staff do more than they detail in the daily record. The documentation seen confirmed that all Service users have a GP and visits from other health professionals are arranged and enabled. The chiropodist visited on the day of the inspection, the appropriateness of attending to resident’s feet in the lounge was discussed with the matron. The matron confirmed that the families are asked to accompany there relative to hospital appointments, the home will always try to arrange this for residents who do not have any family. Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 Page 11 The medication storage at the home was inspected and seen to be stored correctly, the treatment room was clean and tidy but there were boxes on the top of one unit that need to be moved. Records were kept of medicines received into the home and sent back to the pharmacy. There were no gaps seen on the administration records however it was noted that the sheets should be printed not hand written. The PRN recording of medication indicates that the medicine is not given as required but when the drug trolley comes round regardless of needed or not, this practice needs to be reviewed and a new policy set out. The staff on duty were observed indirectly throughout the inspection. They were seen to interact in a positive and respectful manner with residents. Residents gave positive feedback during the inspection about the approach of the staff team, comments included “nothing is too much trouble for the girls” and “they are lovely”. In the residents shared rooms it was noted that privacy curtains were in place that ensured privacy and dignity for the occupier. Residents are consulted regarding their wishes concerning terminal care and arrangements after death. These wishes are seen recorded on the care plans. During the inspection the family of a recently departed resident came to collect the personal items from the home, the staff were seen to deal with this very well with sensitivity and warmth. Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 14 and 15 The residents do not benefit from having access to a good range of social activities and, for some, this could affect their quality of life. Residents are encouraged to maintain their independence and exercise their right to choice and control. Dietary needs of residents are well catered for with a balanced and varied selection of food. EVIDENCE: The home is looking to employ an activity co-ordinator to work at the home full time; they have an activity lady twice a week who comes in the afternoons for games. The residents also enjoy the music man who comes once a week and sings and plays an organ. A local vicar visits once a month and one service user who is a Catholic has the priest come in to see her once a week. The home also once a month has access to a minibus for trips out and also a monthly shopping trip takes place. The home also has entertainers coming in monthly. The residents spoken to did not complain about the lack of activities but it was noted that some residents could benefit from more stimulation. All of the residents spoken to in the home commented on the food, and said how good it was and that they welcomed the daily choices offered. Evidence was seen of the four-week menu and of a daily menu being displayed. Residents were observed during meal- time and choice and variety were seen to be offered. One resident stated, “ the food was smashing and they always have something which I like”. A suggestion was made to the matron to consult with residents on the day what they would like to eat rather than the day Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 Page 13 before as most residents had forgotten what they had ordered. One resident spoken to explained the flexibility of the meal times and type. She explained that she prefers to have her main meal in the evening and this has been accommodated. The home does not record what each resident has eat each day, some residents do have food charts, this is so that residents with a poor appetite can be monitored. The home is able to offer special diets the matron confirmed. Visitors are made welcome at any time and a private visitors room can be made available with refreshments as required. This was evidenced during the inspection and on speaking to a relative. They stated, “They were free to visit when ever they wished and were very happy with the home”. The home can provide meals for a small charge to relatives who wish to stay for this. Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 Whilst residents have access to a clear complaints procedure which is known to them and their relatives little use was being made of it. Residents are potentially put at risk because the adult protection polices and procedures in the home are not clear and are in need of revision. EVIDENCE: The home has a procedure that nearly meets the requirement of the regulations. A review and update of the policy would be appropriate to include time scales, evidence of the outcome and whether the complainant was satisfied, also the addresses and persons to complain to need to be changed. The complaints procedure was displayed within the home and evidence was seen of it included in the statement of purpose and service user guide. The home has received no complaints since the last inspection; evidence was seen of a copy of the complaints form. Matron was asked if she could include all complaints made to the home not just the most serious, so we could evidence that residents are encouraged to have their views listened to and acted upon. The home has several different adult protection guidelines from various professional bodies involved with the home. The matron has been asked to look at these and that of the local authority to ensure that the procedure they adopt meets the requirements and is easy for staff to follow. Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 and 26 Residents live in a safe, well-maintained, clean and homely environment in which there are high standards of décor, furnishings and fittings. EVIDENCE: The home is a single storey building; the accommodation consists of single and shared rooms, 3 bathrooms and sufficient toilets. The communal lounge and dinning room is L-shaped with a conservatory added to one end. The building work has been delayed for several months due to circumstances outside of their control but hopefully is starting again this month. The owner stated that a plan of full refurbishment would commence when the building work has been completed. This will include bedrooms as well as lounge and dinning room furniture. Bedrooms seen had all been personalised by the service users. The rooms were all clean and well decorated. Bedrooms have sufficient space to accommodate the required furniture. The home had high standards of cleanliness and no odours were detected anywhere in the house. The home has a separate laundry room, which met infection control requirements. The kitchen was viewed and the remaining areas were clean and tidy. Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 Page 16 The home has a sluice room, however storage space seems to be an issue in the home and equipment was seen stored in the conservatory. When the extension is finished this will hopefully address this problem and a staff room for the staff to go to when on a break. Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 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 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 - 30 Residents benefit from living in a home that is adequately staffed to meet their needs. Residents are potentially put at risk owing to staff receiving insufficient training. The home’s recruitment procedures do not fully protect residents from abuse because of the home’s inadequate practice in this area. EVIDENCE: The home ensures that there is always at least one trained nurse on duty at all times. At the busiest time of the day this goes up to two. The matron confirmed that care staff numbers reflect the current care needs of the residents. The home also employs sufficient staff to ensure the home is kept clean, a laundry person and cooking staff. The staff training matrix seen did show that some required training has not been done by all staff or refreshers were needed for some staff. The home has put a copy of the training certificates on the individual staff files. The matron was asked in future to ensure that the certificates indicate competency rather than just attendance as some do now. The matron and owner confirmed that two members of staff do interview staff, there was no record seen of the interviews on the staff files. Most of the required information was seen on the individual staff files sampled. In discussions with the owner the reference request form is to ask for past employers to confirm the dates that the staff member was employed by them in future. A photo of the staff member is required on file and staff contracts Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 Page 18 need to include the contracted hours as well as their rate of pay. CRB checks were seen on the staff files, one very new member of staff is still waiting for the disclosure to be returned, the Matron was reminded that until that disclosure is returned the staff member must be chaperoned at all times. Only one carer out of 16 has an NVQ in care, Matron explained that five other staff are doing the award at this time. This was confirmed by two of the care staff spoken to during the inspection. The owner explained that they have been encouraging staff to do the award and some that have completed have since moved away. The owner and manager were aware of the need to ensure that 50 of the care staff are trained to NVQ level 2 in care. Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 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 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) 31, 32, 33 and 36,37, and 38 The residents benefit from living in a home that is largely well managed though shortfalls in staff supervision, misunderstanding of CRB procedures and limited quality assurance could compromise the quality of care offered to residents. EVIDENCE: The managers past experience as a registered nurse enables her to meet the needs of the residents and also with her formal management training that is being undertaken during her R.M.A. During a tour of the home records were found to be kept in a secure and safe place. There was no evidence that formal staff supervision took place this was confirmed in discussion with staff and also by the manager who intends to start supervision as soon as possible. The manager also confirmed that the induction process for new staff uses the Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 Page 20 TOPPS paperwork, but she was unaware that new staff needs to be shadowed until the CRB comes through. Quality assurance needs to be more robust as the home not aware of the resident’s comments and complaints. Resident and relative meetings are taking place and minutes were seen. Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 2 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 4 15 2 COMPLAINTS AND PROTECTION 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 3 3 3 x x 2 3 2 Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 Page 22 yes 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 OP7 Regulation 13 (4) Requirement The registered person shall ensure that— (b) any activities in which service users participate are so far as reasonably practicable free from avoidable risks; and (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, physical activity;… Subject to regulation 4(3), the registered person shall provide facilities and services to service users in accordance with the statement required by regulation 4(1)(b) in respect of the care home while maintaining the privacy and dignity.. To ensure medication practices follow desidnated policies That the meal choices and amounts taken by individual service users are recorded on a daily basis To ensure robust complaint procedures Robust procedures for Timescale for action 30 june 2005 2. 3. OP9 OP15 13(2) 12 30 june 2005 30 june 2005 30 june 2005 30 june Page 23 4. 5. OP16 OP18 22 (1) 12 Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 responding to suspicion or evidence of abuse or neglect (including whistle blowing) ensure the safety and protection of service users, including passing on concerns to the NCSC in accordance with the Public Interest Disclosure Act 1998 and Department of Health (DH) guidance No Secrets. 6. OP28 18 Shall ensure that 50 of the care staff have gain an NVQ level 2 in care or above by April 2005 The registered person shall, having regard to the size of the care home, the statement of purpose and the number and needs of service users— (a) ensure that at all times suitably qualified, competent and experienced persons are working at the care home in such numbers as are appropriate for the health and welfare of service users; (b) ensure that the employment of any persons on a temporary basis at the care home will not prevent service users from receiving such continuity of care as is reasonable to meet their needs; (c) ensure that the persons employed by the registered person to work at the care home receive— (i) training appropriate to the work they are to perform; The registered person ensures that there is a staff training and development H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc 2005 30 june 2005 7. OP30 12 30 june 2005 Page 24 Fort Horsted Version 1.30 programme which meets National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. 8. 9. OP36 OP38 18 12(1) staff receive formal supervision at least 6 times a year. The manager ensures the health and welfare of the residents 30 june 2005 30 june 2005 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 OP1 OP12 OP29 Good Practice Recommendations The Statement of Purpose and Service User Guide need to be available as two separte documents and used appropriately. The home to ensure a designated activities worker is employed. The home includes the dates that an employee says they work for an organisation on the reference reqest, asking for confirmation of there accuracy. Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 Page 25 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent, ME16 9NT 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 Fort Horsted H56-H06 S26168 Fort Horsted V225877 050505 Stage 4.doc Version 1.30 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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