Inspection on 06/06/07 for Havengore House

This inspection was carried out on 6th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Havengore House 19/05/06

Havengore House 08/11/05

Havengore House 07/06/05

Havengore House 07/02/05

Havengore House 26/05/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Havengore House 27 Fairfield Road Eastwood Leigh On Sea Essex SS9 5RZ Lead Inspector Helen Laker Unannounced Inspection 6th June 2007 10:00 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 Havengore House DS0000051663.V341971.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. Havengore House DS0000051663.V341971.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Havengore House Address 27 Fairfield Road Eastwood Leigh On Sea Essex SS9 5RZ 01702 529243 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) Mrs Anne Sik Yee Shum Mr Cheuk Wah Shum Hayley Amanda Atkins Care Home 20 Category(ies) of Dementia - over 65 years of age (4), Old age, registration, with number not falling within any other category (20) of places Havengore House DS0000051663.V341971.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Number of service users to whom personal care is to be provided shall not exceed 20 (twenty). Accommodation and personal care may be provided to no more than 20 older people over the age of 65 years (OP). Accommodation and personal care may be provided to no more than 4 service users over 65 years with Dementia (DE(E)). Total number of persons over 65 years to be accommodated must not exceed 20. Date of last inspection 19th May 2006 Brief Description of the Service: Havengore House is registered to provide personal care and accommodation for twenty older people over 65 years of age including four places for residents who have been diagnosed with dementia. The home is located at the end of a short private road of a quiet residential street in Eastwood. The premises are situated within a short walking distance of numerous bus routes, which have direct links to Rayleigh and Southend. The building is a converted and extended farmhouse in its own gardens and as such, provides spacious rooms many of which have ensuite facilities. A shaft lift has been provided. Residents in the home are encouraged to be involved in social activities both within the home and in the local community. The Service User Guide and Statement of Purpose can be made available and the inspector was in formed that residents and their representatives are provided with this information. The latest Commission for Social Care Inspection report was available in the office. At the time of this report the manager confirmed that the fees ranged from £360.00 to £485.00 per week. Havengore House DS0000051663.V341971.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine, unannounced inspection which took place over one day with one inspector in the home. There was a tour of the premises and grounds and an inspection of records and documentation. Time was spent discussing the care of the service users. The manager in charge of the day to day running of the home was spoken with. Further feedback was also received from service users and care staff through survey and discussion. A pre-inspection questionnaire and other reports and correspondence provided by the manager and staff on duty were also used as evidence to inform this report. Twenty one National Minimum Standards were inspected on this occasion, eighteen overall outcomes were met and there are two requirements and two recommendations detailed in this inspection report. Discussion of the inspection findings took place with the manager in charge of the day to day management of the home, at the end and throughout the inspection and guidance was given. The homes proprietor was not present on the day of inspection. Key standards as identified in the intended outcomes sections of this report are inspected at least once every twelve months during a key inspection. What the service does well: What has improved since the last inspection? All bedrooms have been redecorated. New double glazing has been fitted in 3 bedrooms and a toilet. The exterior side gate has been made secure to ensure the safety of residents (particularly those with dementia), who may wander into the road area without the knowledge of staff and advice from the fire officer sought. A security key punch pad to the indoor lounge area door has also been fitted. New armchairs and a new washing machine have been purchased. It was noted at the homes last inspection that the door leading to the utility room/laundry was not lockable which could be a danger to residents if they accessed this area and into the garden. This has now been actioned. Some of the paving stones were previously noted in the garden area to be hazardous and need levelling off as residents could be at risk of falling. This Havengore House DS0000051663.V341971.R01.S.doc Version 5.2 Page 6 has now been done and a fence erected to prevent accidents. Risk assessments are being updated to ensure a safe home environment and to take account of the security of residents who may be at risk. 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. Havengore House DS0000051663.V341971.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Havengore House DS0000051663.V341971.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users and their supporters have adequate information about the home so that they can make informed choices. The admission procedure generally does include an adequate assessment, which ensures that service users needs can be met. The home provides a caring environment where visitors are made welcome. EVIDENCE: Care records generally evidenced a full assessment had been undertaken by the manager. Full social worker assessments were available for those residents sponsored by local authorities. Pre admission assessments were reviewed for the homes most recent admissions. Attention should be paid to dating and signing documentation and any assessments at the time of completion to ensure accurate information is maintained. Wherever possible it is advised that residents or their relatives are Havengore House DS0000051663.V341971.R01.S.doc Version 5.2 Page 9 involved in the assessment process and the home was reminded that following the assessment they must confirm in writing whether they are able to meet the prospective residents’ health and welfare needs. All prospective residents and their families are invited to visit the home before making a decision. Havengore House does not provide intermediate care. Havengore House DS0000051663.V341971.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. Each service user has an individual plan and service users are generally supported to take risks as part of an independent lifestyle via a process of assessment. The health needs of service users are met, and documentation does ensure clarity of needs. Medication procedures are followed appropriately overall. Personal support is overall provided in a way that promotes dignity. EVIDENCE: Case tracking took place in respect of three residents and other personal care records were also looked at. As previously noted basic instructions were available for key workers and daily log sheets completed by staff were up-todate. Various areas are identified for care input together with support such as communication, breathing, pressure area and skin care. Care plans need not be formulated where service users are not presenting with needs to be met. This was discussed with the manager on the day of inspection. The manager stated that she is due to attend a course on care planning the next day. Medical care provided by healthcare professionals had been regularly recorded Havengore House DS0000051663.V341971.R01.S.doc Version 5.2 Page 11 and updated as and when district nurses and doctors had visited. In-house reviews still take place on a monthly basis and these dates are recorded on a summary sheet but cross-referencing of these dates had not always been shown or updated on the individual elements of care plans. Risk assessments were available for service users but were also noted to require more detail in some areas and include potential complications of the risk. This was noted at the previous inspection also. Residents were complimentary with regards to the way their personal and health care needs were being met and felt that staff treated them in an appropriate way, respecting their privacy and dignity. They stated that the quality of care was good and that relatives were kept informed of any changes. Staff were approachable and there is always opportunity for any issues of concern to be discussed. This standard remains unchanged overall, a nomad medication system is in place for each resident. Medication is stored in a lockable cabinet and the administration records were being maintained in accordance with agreed procedures. Record sheets on the whole had been correctly recorded and signed for. Transcribed medication should evidence two signatures and the use of tippex should be avoided. Reviews of prolonged refusals of drugs should take place. Training records indicated that all staff have regular medication training. This should take place annually. The outcomes of the inspection showed that the health and personal care provided to residents in the home is appropriate and in accordance with their identified needs and delivered in a way which respects their privacy and dignity. Havengore House DS0000051663.V341971.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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides an activities programme to meet individual’s needs. Links with families are good and contacts are maintained. Choice in the routine of the day can be adapted to ensure residents rights are maintained. The home provided good food in ample quantities and is served in a congenial setting. EVIDENCE: Staff regularly ask residents what they want to do and these requests are put into place. Within the home is an activities book and plan in the lounge that evidences this and showed the various arrangements for each day of the week. During the inspection the residents were positive as to how well they are looked after in the home. The manager stated that they had recently been taken out to Hadleigh tea rooms, Rossi’s ice cream, the arches restaurants , Priory and Belfores Park. Social activities within the home include musical exercises, singing and dancing as well as cheese and sherry evenings. Church services still take place on a four weekly basis. All residents have visitors to the home who are able to come whenever they choose. Staff are approachable and there are regular meetings for residents. Havengore House DS0000051663.V341971.R01.S.doc Version 5.2 Page 13 Individual bedrooms evidence that residents are encouraged to bring in belongings and to personalise their rooms. Some residents have lockable cash boxes in which to keep cash and valuables if required. Residents spoke positively of the good standard of food, and drinks which are provided. Drinks and snacks are available at any time of the day or night. Choice is taken into account and the need for individuals to enjoy the food provided. The outcomes of the inspection showed that the residents find the daily life and social activities of the home match their expectations and preferences as well as satisfying their social, and holistic needs in accordance with personal choice. Havengore House DS0000051663.V341971.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. The home has an appropriate complaints policy which informs complainants of their rights. In the event of any informal or formal complaints, documentation must be maintained appropriately and fully. The complaints procedure within Havengore House is followed adequately. Staff receive relevant training relating to the protection of vulnerable adults. EVIDENCE: The home has a complaints policy and procedure and people may raise concerns formally or discuss any issues in a more informal way with the homes manager and proprietor. It was reported by manager that there have been no complaints made since the last inspection in May 2006. The home would benefit from having a formal recording system in place to avoid recurrence of issues and highlight areas where services could be improved. The home has an Adult Abuse Policy and Whistle Blowing procedure. Most staff have attended “Protection of Vulnerable Adults” training and other sessions are planned. The home must continue to ensure that all staff receive training and updates in the protection of vulnerable adults and ensure through the home’s supervision procedures that all staff are fully aware of what is expected of them. Staff members within the home were observed working in a supportive and enabling manner with residents Havengore House DS0000051663.V341971.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, 21 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Havengore House is clean and generally well maintained and provides the service users with safe, homely and comfortable surroundings. Some attention is required with regard to current refurbishment/conversion plans and the CSCI must be informed. EVIDENCE: All bedrooms have been redecorated. New double glazing has been fitted in 3 bedrooms and a toilet. The exterior side gate has been made secure to ensure the safety of residents (particularly those with dementia), who may wander into the road area without the knowledge of staff and advice from the fire officer sought. A security key punch pad to the indoor lounge area door has also been fitted. New armchairs and a new washing machine have been purchased. It was noted that an uneven floor area on the first floor would benefit from demarcation to ensure people were aware of it preventing any trip Havengore House DS0000051663.V341971.R01.S.doc Version 5.2 Page 16 hazards. There were no unpleasant odours in the home and bedrooms were found to be clean and personalised to reflect individual residents’ choice. It was noted at the homes last two previous inspections that although the bathing and washing facilities are generally appropriate for existing residents, serious consideration must be given to the first-floor bathroom area which requires remodelling in order to provide a facility which is suitable for frail and/or wheelchair dependent people. This facility must also be able to accommodate a hoist and/or mechanical bath lift. The manager informed the inspector that it is planned that works commence to convert the adjoining bathroom to room 6 to accommodate these requirements. The proprietor must submit plans in writing for this to the CSCI outlining a schedule of works, how this will impact on existing residents and specifically those two residents whose right of way to their bedroom it affects directly. Copies of any building plans must also be submitted. Plans for the use of the upstairs bathroom are still to be decided as the boiler is housed there also. It was noted at the homes last inspection that the door leading to the utility room/laundry was not lockable which could be a danger to residents if they accessed this area and into the garden. This has now been actioned. Some of the paving stones were previously noted in the garden area to be hazardous and need levelling off as residents could be at risk of falling. This has now been done and a fence erected to prevent accidents. Risk assessments are being updated to ensure a safe home environment and to take account of the security of residents who may be at risk. Havengore House DS0000051663.V341971.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, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate staffing levels are currently maintained to meet the needs of service users. Recruitment practices currently have some shortfalls which need addressing. Staff training although requiring updates is appropriately developed and undertaken to provide a competent work force. EVIDENCE: At the time of inspection, the home was adequately staffed and the skill mix is still being used positively in meeting the various needs of residents. There are two awake staff on duty at night and there are two cooks and two domestics which cover the week during the day as well as care staff. The home does not use agency workers and regular staff still cover any sickness or annual leave voids. Staff rotas evidenced that there is adequate cover throughout the day and night. Two staff files were sampled during this key inspection, one had no evidence of permissions to work and highlighted that the homes internal procedural handling of a supervision issue had shortfalls. Another did not show clear evidence that the home had addressed work permit issues, and working time regulations as they were rostered on duty for 15 hours on one occasion. Attention should be paid when recruiting, to addresses for references, incomplete application forms, comprehensive work history and proof of identity. The manager was advised that staff members should not start work at Havengore House DS0000051663.V341971.R01.S.doc Version 5.2 Page 18 the home until all relevant recruitment checks have been completed. The manager was also advised of current immigration requirements and regulations and where clarification of the same could be obtained. She was advised to inspect other staff personnel records to ensure that the home was compliant with all legal requirements. The present induction programme used in the home needs to comply with, ‘Skills for Care‘ standard. Staff need to complete an adequate induction within the first six weeks of employment. All staff should be involved in the induction so that senior staff can support new and inexperienced staff. New members of staff are encouraged to read policies and procedures. Individual staff files evidenced certificates in place of training courses that had been undertaken. The manager concurred that this was not all up to date but planned. Alongside mandatory and specific training 8 out of 11 staff members are N.V.Q. trained and staff meetings take place regularly. Havengore House DS0000051663.V341971.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. Management systems are good and the home is run in the best interests of residents. The management respond robustly & rectify matters of health & safety when identified. EVIDENCE: The registered manager has 9 to 10 years experience as a carer and approx 2 to 3 years experience in a senior managerial position. As reported previously she has further developed her experience by attending relevant courses. She is hoping to start her N.V.Q.4 Registered Managers Award shortly. The homes registered provider was not present at this inspection. Good liaison and communication takes place with relatives and other healthcare professionals. The manager works at the home most days in a supernumerary capacity and Havengore House DS0000051663.V341971.R01.S.doc Version 5.2 Page 20 oversees the day-to-day running and provision of care and treatment. Residents and their relatives can discuss care and any issues with the manager informally or formally when they visit. Records in respect of the service were noted to be stored appropriately. Certificates in respect of service and maintenance of gas, electric (including portable appliance testing), lifting and fire safety equipment at the home were noted to be satisfactory. Fire drills are being regularly documented and undertaken and attendees’ names documented. The manager is aware of her duties under health and safety. A sample check was made of residents personal allowances which were being safeguarded by the home and financial transactions had been properly documented, signed for and with the appropriate receipts on file. Risk assessments for a safe environment have been completed by the home to ensure potential risks are minimised. Havengore House DS0000051663.V341971.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 2 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 2 X X X X 3 STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Havengore House DS0000051663.V341971.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? Yes 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 OP21 Regulation 23 Requirement The Registered Person must ensure that the premises are suitable for the purpose of achieving the aims and objectives set out in the Statement of Purpose. This includes providing suitable space to allow highly dependent residents to be bathed, with the assistance of staff and any appropriate equipment, which may be required. This also with regard to the consultation with the CSCI regarding any internal structural changes which directly affect current residents and the submission of plans, a schedule of works and a statement of how residents needs will be met and relevant party consultations whilst works are being undertaken. (This is a repeat requirement from the last two inspections, previous timescales of 01/04/06 and 31/12/06 not met). DS0000051663.V341971.R01.S.doc Timescale for action 31/08/07 Havengore House Version 5.2 Page 23 2. OP29 7, 9, 19 (1) to (7) Schedule 2 The registered person must operate a robust and thorough recruitment procedure based on equal opportunities and ensuring the protection of service users. (This is a repeat requirement from the last inspection previous timescale of 30/06/06 not met) 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP3 OP9 Good Practice Recommendations The home must confirm in writing that they are able to meet the resident’s needs in respect of their health and welfare. Where medication is transcribed for any reason two signatures should be evidenced as checking the transcription. Havengore House DS0000051663.V341971.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG 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 Havengore House DS0000051663.V341971.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. 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