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Inspection on 18/12/06 for Grosvenor Terrace, 100

Also see our care home review for Grosvenor Terrace, 100 for more information

This inspection was carried out on 18th December 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 12 statutory requirements (actions the home must comply with) as a result of this inspection.

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

What has improved since the last inspection?

What the care home could do better:

CARE HOME ADULTS 18-65 Grosvenor Terrace, 100 London SE5 ONL Lead Inspector Lisa Wilde Unannounced Inspection 18 & 22 December 2006 02:00 th nd Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Grosvenor Terrace, 100 Address London SE5 ONL 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) 020 7701 5622 0207 703 8395 www.odyssey-csft.org Odyssey Care Solutions for Today Celia Denise Bownass Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th May 2006 Brief Description of the Service: The home provides care for four women who have learning disabilities and additional needs that arise from physical disability and sensory impairment. It is equipped to provide care for one service user who is a wheel-chair user. All four service users have lived together for many years at this home and view this home as their home for life. The home is in a residential street close to Walworth Road where there are a range of facilities including public transport routes, shops, pubs and restaurants nearby. The organisation that runs this home is Odyssey Care Solutions for Today. The home makes the reports of the Commission’s inspections available in the hallway of the home. The service user part of the fees for a place at this home are £62.35. There are contributions towards transport of £4.25 if on the lower rate of Disability Living allowance or £11.06 if on the higher rate of Disability Living Allowance. Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over two days in December 2006. The inspector spent one day at the home talking with service users and staff and looking through documents and then papers were faxed to the inspector later in the week. Service users at this home cannot speak and the inspector spoke to relatives at the last inspection a few months ago. The main problem at this home for past year has been the number of permanent staff vacancies and the lack of a permanent Registered Manager. The home has improved recently with a temporary manager being brought over from another home in the organisation. What the service does well: A lot of things at this home are good. • • • • • • • • • • • • • Staff find out what service users want and write this down for them. Staff write plans so they can help service users do what they want to do. Staff help service users make decisions. Staff listen to families and other people who know what service users want. Service users get to go out and do the things they want to do. Service users choose their own food and join in with cooking as much as they are can. Staff make sure service users go to the doctor when they need to. Staff give medication to service users properly. Staff protect service users from people who might hurt them. Service users have their own bedrooms. Service users can decorate their bedrooms how they want to. The home is clean and comfortable. Staff make sure the building is safe. DS0000060231.V324431.R01.S.doc Version 5.2 Page 6 Grosvenor Terrace, 100 • • The organisation checks out new staff before they start working at the home. Staff find out what service users and their families think and put in place plans to make things better. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2&5 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users do not yet have full terms and conditions that tell them what they can expect from the home. EVIDENCE: No new service users have moved to this home for many years so it is not possible or useful to try and assess what happens when someone wants to move to the home. There was a previous requirement that the Registered Individuals must ensure that there are terms and conditions for all service users which describe all the areas required by the standards and state the rights service users have under an assured tenancy. These terms and conditions must be signed by service users or their representatives. The organisation has written to the local authority but has not yet received individual terms and conditions back from them. While the requirement is not met, the home has done all it can to meet it and there was evidence that they will continue to chase the local authority for the required documents. (See Requirement 1) Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff work with service users to try and find out what they want and write down things that they will do and get better at over the next few months. This means that service users lives do not just stay the same but they are trying new things and improving. Work that is identified in the annual review of the service users lives is not always done quickly enough which means that service users do not always get what they want or need when they need it. Service users are supported to make decisions as far as possible and most of them have family who are involved to help them make those decisions. Staff work with service users to find out what may harm them and what help they may need. EVIDENCE: Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 10 There was a previous requirement that the Registered Manager must ensure that all support guidelines and risk assessments are effectively reviewed at least every six months following the meeting with social services and other interested parties. This now occurs. There was a previous requirement that the Registered Manager must ensure that ongoing monitoring tools are in place to make sure that action identified in the six-monthly reviews is carried out as soon as possible. There is a monthly monitoring form in use now. There was a previous requirement that the Registered Manager must ensure that the service users’ Communication Passports are completed as a priority. These have been done. There was a previous requirement that the Registered manager must ensure that staff research agencies and individuals who can advocate or offer peer support for service users and who share some of the same culture, heritage and disabilities. The home has approached the current advocate that they use who does not know of any additional formal advocacy agencies. Given the lack of a permanent manager and current staffing levels, this is not the time for the home to be focusing on large pieces of work finding other peer support or advocacy across the borough so again this will be written as a recommendation for now until a more appropriate time. (See Recommendation 1) Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 & 17 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users have individual weekly programmes but there are not enough staff to have a very varied, spontaneous lifestyle. Staff support service users to keep in touch with their families. Service users are offered varied and healthy meals. EVIDENCE: Service users attend day centres and sometimes go out in the local area if this can be planned in advance. Service users at this home have very limited verbal communication and their understanding of things is also limited so it is harder for the staff team to find ways to let them make their own decisions. When the home realises that Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 12 something may have to be done that the service user may not like such as having an operation, a Best Interest Meeting is called where all interested parties are invited along to discuss the issue and make the decision. Staff talked about how they try to find out what service users want by understanding their body language and other communication. There was a previous requirement that the Registered Individual must ensure that vehicle in use at the home is operational. This has been done. There was a previous requirement that the Registered Individuals must ensure that the staffing levels at the home are sufficient to fully meet the needs of the service users. The Commission must be informed of the outcome of the current staffing review. A review was done and generally all parties are in agreement that staffing levels are not sufficient to meet the social and recreational needs of service users. The organisation has approached the local authority to increase the funding to allow for a staffing increase. (See Requirement 2) Service users are supported to maintain contact with their family and have made efforts to help service users re-establish contact with family members they have lost touch with. There is a repeating menu for service users, which has been decided from meals that staff have seen service users eat and enjoy. Staff said that they offer alternatives when service users don’t want to eat something. Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users are supported by staff in the way that they choose and their health need are met by going for regular appointment at the GP. When service users needs special help, meetings are held with all people involved in their care to make sure that decisions are made in their best interests. Medication is given to service users safely but stock is not always monitored properly. EVIDENCE: Service users are supported to attend the GP and other clinics regularly and records are kept of these visits. Best interest meetings are held when decisions need to be made about medical treatment to which the service user cannot consent. Service users have written guidelines for staff telling how they like to have things done for them Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 14 There was a previous requirement that the Registered Manager must ensure that the guidelines for the administration of rectal drugs are clear and if staff are to continue to administer it all staff must attend training in how to administer. Staff do not now administer rectal medication, the District Nurse does it. There was a previous requirement that the Registered Manager must ensure that all current medications are recorded on the current medication administration chart. This is now done. There was a previous requirement that the Registered Manager must ensure that all p.r.n. medication is recorded on the same type of medication administration charts as regular medication. This is now done. There was a previous requirement that the Registered Manager must ensure that the medication stock checking systems are effective. There was a medication error that had not been picked up by the stock checking system. (See Requirement 3) Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Complaints and concerns are taken seriously and investigated properly. Service users are protected from abuse by staff being trained in policies and procedures around safeguarding vulnerable adults. EVIDENCE: There was a previous requirement that the Registered Manager must ensure that the correct contact details for CSCI, along with a brief explanation of their purpose, is included in the Complaints Policy and Procedure and Service User Guide. This is now done. There was a previous requirement that the Registered Manager must ensure that all concerns and complaints from service users, their families and other stakeholders are recorded in the complaints book along with action taken, timescales and whether the complainant was satisfied with the outcome. This is now done. There was a previous requirement that the Registered Individuals must ensure that all staff attend training around abuse and protection of vulnerable adults. This happened in the days following the inspection and the evidence was sent through to the Commission. Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 16 Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The home is clean, homely and attractive. Service users have individualised bedrooms that are decorated to meet their own tastes and the numbers of toilets and bathrooms mean that they have sufficient privacy. On the day of the inspection the home was clean and hygienic throughout. EVIDENCE: The tour of the building showed that the home is clean and comfortable throughout. Service users’ rooms have been decorated in the way they like. The home was clean and no health and safety issues were noted on the tour of the building. Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35 & 36 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. Service users are not being offered the best support possible due to the some permanent staff vacancies and the lack of a permanent manager for along time. Service users are protected by the home’s recruitment procedures. Staff are offered training but there may be gaps in this training. Staff are supervised regularly by a manager which means that service users are offered support from staff who are receiving enough support and guidance. EVIDENCE: The home is not quite meeting the target of 50 of care being offered by staff holding the required NVQ in Care. (See Requirement 4) Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 19 There was a previous requirement that the Registered Individuals must ensure that the Commission’s recruitment form is completed for all staff and held on file at the home. This has now been done. There was a previous requirement that the Registered Manager must ensure that records are held for all staff of all training that they have undertaken. This has now been done. There were previous requirements that the Registered Individuals must ensure that at there is an annual training and development plan in place for the home that is based on individual staff’s annual appraisals and assessment of training needs and that the Registered Manager must ensure that all staff have an annual appraisal of their work. There are documents that state what training has been done and what training is needed for all staff but they do not reflect all the training needs that have been identified in the appraisals. In addition, timescales are not put in the training documents to make sure that if planned training is cancelled that it is done at a later stage in the year. Appraisals have been done but the development part of them that assesses and identifies training needs have not all been completed. (See Requirement 5) There was a previous requirement that the Registered Manager must ensure that all staff are supervised regularly by a line manager who has been trained to offer such supervision. This is now done. Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 & 43 Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. There is no Registered Manager in post, which means that the home cannot be managed as well as it should be. Staff gather the views of service users and their families and tries to make sure that the home gets better in the ways service users want. Service users are generally protected from harm by staff operating health and safety procedures effectively. Service users’ money is not fully looked after properly. EVIDENCE: Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 21 There was a previous requirement that the Responsible Individual must ensure that the acting manager puts in an application to be registered with the Commission. The acting manager has lefty the service and a temporary manager is in place. The organisation has recruited recently and is waiting on personnel checks for an identified person. (See Requirement 6) There was a previous requirement that the Registered Manager must ensure that an annual survey (or other form of annual audit) of service users families and other stakeholders takes place that then feeds into the annual review of the service and the local business plan. This is done. There was a previous requirement that the Registered Manager must ensure that the weekly fire system tests are carried out as required. There were some checks that had been missed in the few months following the last inspection but the new manager said that she had picked up on this and highlighted with staff the need for these checks. There were no gaps since the new manager had started at the home. Health and safety risk checks are conducted weekly but the last full annual audit of the entire home was dated January 2003. (See Requirement 7) Service user finances were checked and all systems were effective except that service users or their representatives are not currently given a monthly statement of their account and all transactions must be signed by two staff. (See Requirement 8 & 9) Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 X 3 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X X 3 LIFESTYLES Standard No Score 11 X 12 3 13 2 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 2 X 3 X X 2 2 Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 23 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 YA5 Regulation 5 Requirement The Registered Individuals must ensure that there are terms and conditions for all service users which describe all the areas required by the standards and state the rights service users have under an assured tenancy. These terms and conditions must be signed by service users or their representatives. Previous requirement: Unmet timescale 31/08/06 The Registered Individuals must ensure that the staffing levels at the home are sufficient to fully meet the needs of the service users. The Commission must be kept informed of developments in this area. Previous requirement: Unmet timescales 30/09/05, 31/03/06 & 31/08/06 The Registered Manager must ensure that the medication stock checking systems are effective. Previous requirement: Timescale for action 31/03/07 2. YA14 YA33 YA13 16(2)(m)(n) & 18(1)(a) 31/03/07 3. YA20 13 (2) 22/12/06 Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 24 Unmet timescale 31/05/06 4. YA32 18 (1) (c) (i) The Registered Individuals must ensure that the home meets the target of 50 of care being offered by staff holding the required NVQ in Care. The Registered Individuals must ensure that there is a training and development plan in the home that reflects training needs identified in annual appraisals. Part of previous requirement: Unmet timescale 31/08/06. The Registered Individual must ensure that there is a manager in post who submits and application to be registered to the Commission and who holds or begins the NVQ Level 4 Registered Manager Award (followed by the NVQ Level 4 in Care) Previous requirement: Unmet timescale 31/05/06 The Registered Individuals must ensure that the health and safety risk assessments are reviewed at least annually as per organisational policy. The Registered Individuals must ensure that all transactions involving service users’ money are signed by two staff. The Registered individuals must ensure that all withdrawals from service users accounts are crosschecked against the bank statements. 31/03/07 5. YA35 YA36 18 (1) (c) (i) 31/03/07 6. YA37 S11 Care Standards Act 31/03/07 7. YA42 13 (4) (a) & (c) 31/03/07 8. YA43 13 (6) 31/01/07 9. YA43 13 (6) 31/01/07 Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA7 Good Practice Recommendations The Registered manager must ensure that staff research agencies and individuals who can advocate or offer peer support for service users and who share some of the same culture, heritage and disabilities. Previous requirement made into a recommendation until a more appropriate time to focus on these areas. Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection SE London Area Office River House 1 Maidstone Road Sidcup DA14 5RH 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 Grosvenor Terrace, 100 DS0000060231.V324431.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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