Inspection on 21/04/05 for Haversham House

This inspection was carried out on 21st April 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Haversham House 25/02/09

Haversham House 11/03/08

Haversham House 24/04/07

Haversham House 20/04/06

Haversham House 09/09/05

Haversham House 01/10/04

Haversham House 05/04/04

Similar services:

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

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

CARE HOMES FOR OLDER PEOPLE Haversham House 327 Bromsgrove Road Redditch Worcestershire B97 4NH Lead Inspector Annie OMara Unannounced 21 April 2005 08:00 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. Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Haversham House Address 327 Bromsgrove Road Redditch Worcestershire B97 4NH 01527 542061 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) Springlea Limited Acting Manager Care Home 16 Category(ies) of DE(E) Dementia (over 65) - 16 registration, with number OP Old Age - 16 of places PD(E) Physical Dis (over 65) 16 Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1 October 2004 Brief Description of the Service: Haversham House is a small home which provides a service for 16 older people who may have a physical disability and/or a dementia type illness. The home is situated close to Redditch town centre. There is a local bus service available. The home is an adapted town house which has accommodaton on two floors, the first floor is accessed by a stair lift. Accomodation is provided in 12 single rooms and 2 double rooms. There are no ensuite facilities. There are a total of three bathrooms, one of which is adapted for use by residents who have mobility needs. A shower facility is available but has a step up to it which can be difficult for residents to use. There are two seperate lounges/dining areas for the residents to choose where to sit. The garden has facilities for residents to sit out in the summer. The home is generally well maintained and comfortable. Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out early on a weekday morning over a period of six hours. Five residents were spoken to as well as one visitor and one relative. All staff on duty were interviewed including three care staff, the housekeeper and the cook. Care plans and other records were looked at and discussed with the acting manager. What the service does well: What has improved since the last inspection? What they could do better: Information about the home should be readily available to show people who might be interested in moving to the home what they offer. Care plans to show what each individual resident needs and how staff are going to help them, and any risks to health do need to be improved. This has been outstanding for nearly a year. There needs to be thought given to residents who have some behaviours which may cause distress to others, and staff need to have more training in order to help these residents in a more informed way. Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 6 There are some outstanding matters to do with the safety of the building which have been ongoing. One of the main concerns has been the management of the home and how the acting manager is organising such things as the care planning and training of staff to bring it up to a standard that provides a safe environment for both residents and staff. Some of these have been outstanding since the last inspection. These concerns are the responsibility of the owners of the home. 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. Haversham House E52 S18486 Haversham House V222635 210405.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 Haversham House E52 S18486 Haversham House V222635 210405.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, 3, 4, Written information about the home was not readily available to help prospective residents make a decision about whether the home would be able to meet their needs. Staff are not supported by training to help them meet the more complicated needs of the residents and to keep them safe. EVIDENCE: Staff who were spoken to during the inspection said that they had not seen the statement of purpose or service users guide. The acting manager could not find a copy of the statement of purpose and said that the newest admission to the home had not been given a copy of document. An assessment for a new resident contained more information than previous assessments carried out showing an improvement in this area. Some information about residents care needs was missing including risk assessments for nutrition and skin care. An abbreviation used in the assessment intended to show that a resident had a short-term memory difficulty. Staff who were asked about it did not know what the abbreviation meant. Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 9 Training received by staff does not support them to meet the specialist needs of the resident group. General care practices observed during the inspection indicated that staff are very experienced and professional in the way they carry out their tasks. This was also apparent in discussions with them and they would welcome specific dementia training and managing challenging behaviours. An Immediate Requirement notice was left in respect of staff training. Haversham House E52 S18486 Haversham House V222635 210405.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, 8, 9, 10, 11 The understanding of the management of care records, reviews and monitoring of residents care personal and health care needs was poor which meant that more complex needs of the residents were not being adequately addressed. EVIDENCE: Four residents care plans were looked at during the inspection, staff were observed in practice and spoken to. Residents and a relative, were spoken to, in relation to the care practices carried out in the home. The care records did not support the work undertaken by staff, nor did it match with the experience of the residents. Although the residents were able to give limited information to the quality of the care they received, relationships between them and staff were warm and respectful. All of the residents said that staff were very kind, “lovely” and “friendly”. Staff stated that they did not use or consult the care plans as part of their work and only made recordings in the daily records of residents. There was no key-worker system in place and care plans were not up-dated or changed following reviews. Regular monthly reviews were not undertaken, one plan having last been reviewed on the 22nd October 2003. The exception to this was an up-dated care plan for a resident who was terminally ill. This record had been kept in good detail although a nutritional and skin care risk Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 11 assessment had not been carried out. The mobility needs of this resident had been detailed in the plan but the risk assessment had not been up-dated. Staff stated that they felt the hoist had not been appropriate to the particular needs of the resident. Fluid charts had not been kept separately although this information had been kept in the daily records. The daily records showed full involvement of the family and that staff were able to spend time with her both day and night. A risk assessment had been written for residents with challenging and aggressive behaviours. The same risk assessment was being used for three residents all of whom had different needs and different reasons for becoming aggressive and upset. There was no up to date list of medication being received by residents recorded in their care plans. Medication was observed being given out by two members of staff safely. The policy for medication was being adhered to and a controlled medication cabinet required from the last inspection had been bought. Medications were still being stored in the kitchen fridge. Two of the three staff on duty had not received external medication training. Residents’ profiles giving details of their social and emotional needs were not filled in. One care plan gave incorrect information about a resident. It stated that she did not need spectacles, but her photograph showed her wearing them and she was wearing them on the day of the inspection. Separate records were kept regarding visits from the primary healthcare team and consultants involved with the residents. Daily records indicated that concerns about residents healthcare needs were recognised and acted upon by care staff promptly. Immediate Requirements notices were left in respect of the following; Care plans to be reviewed and kept up to date. Care plans to accurately reflect the needs of the residents. Moving and handling risk assessments to be put in place. Nutritional and skin care risk assessments to be put in place. Observations made indicated that staff respected the privacy and dignity of the residents. A relative who was spoken to praised the staff and said she was happy with the care received by her relative. She was kept informed of any changes and she said the home was “nothing posh, but wholesome”. Residents who were spoken to also said that staff were respectful. Haversham House E52 S18486 Haversham House V222635 210405.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) 15 The food provided by the home is very good, offers both choice and variety and caters very well for specialist diets. EVIDENCE: All of the residents who were spoken to were complimentary about the meals and enjoyed the choices available. A cooked breakfast was always available which the residents enjoyed. The food served on the day of the inspection was observed to be well cooked and presented. Diabetic food is also home cooked so that all residents are offered the same choices. Tables were laid for breakfast with table clothes and place settings. Tea and cereals were served to the residents by the cook, and they were given choices although some residents would be able to help themselves keeping their independence. Whilst the outcome for residents was satisfactory there were concerns raised about the management of food ordering and shopping which sometimes interfered with the daily menu being followed. This was discussed with the acting manager and registered providers. Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18 Whilst staff were aware of the actions to be taken in the event of an allegation of abuse, the implications and effects of a resident displaying challenging behaviour towards another were not recognised, putting some residents at risk of harm. EVIDENCE: Staff who were spoken to were aware of the “whistle-blowing” policy and were clear about the actions they would take if they suspected a member of staff was abusive. The deputy manager had received training in protection of vulnerable adults. Daily records made a short reference to an incident between two residents. There was no detailed record of the incident between them which resulted in one of them being bruised. There was no evidence of management involvement in this incident to ensure the safety of residents from abusive actions of others. An Immediate Requirement notice was left in respect of this matter. Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, Since the last inspection decorating of some communal areas has taken place improving the surroundings for the residents, although there are some health and safety issues which have not been addressed in the building which may put residents at risk. EVIDENCE: The home was warm and clean on the day of the inspection. The communal areas of the home were well maintained and one of the lounges was being repainted. One of the strip lights in the kitchen did not work and neither of them had covers on. The microwave oven did not have a top plate on it leaving it open to collect food debris. The cooker hood was dirty and in need of replacing or changing. The refrigerator temperatures were not within the recommended limits. An Immediate Requirement notice was left in respect of this matter. The garden area contained a broken wardrobe and discarded garden furniture. Thermostatic controls had not been fitted to the hand washbasins in residents’ bedrooms as required at the last inspection. An Immediate Requirement notice was left in respect of this matter. Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 15 Staff were aware of good practice in relation to infection control and were observed carrying out good hygiene practices during the inspection. The home was clean and odour free. Concerns were raised about the persistent lack of detergent for the carpet cleaner. This matter was discussed with the acting manager and registered providers. Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 28, 29, 30. Staff are committed to supporting and providing care for the residents but are not given guidance by the manager or supported by training which may place residents at risk. EVIDENCE: The levels of staffing have been maintained at three carers on duty throughout the waking day following concerns raised at the last inspection. Core health and safety training has not been kept up to date and staff have not received moving and handling training, basic health and safety training or up dated fire safety training. One member of staff interviewed stated she had not received food hygiene training or infection control training. The cook had not received food hygiene training and has been employed in the home for over six months. Immediate Requirement notices were left in respect of these matters. Staff confirmed that their National Vocational Qualification training had been stopped last year and has not been re-started. The acting manager was undertaking an NVQ assessors award. Five staff are booked to undertake their NVQ training and one member of staff has a qualification. A recruitment file was looked at and lacked information about the identity of the member of staff employed or evidence of qualifications. Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 17 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, 36, 38. There has been very limited progress made in meeting the requirements from the previous inspection, indicating that the management of the home is ineffectual and places residents and staff at risk. EVIDENCE: Eight of the thirty-four requirements from the previous inspection have been addressed in full, the remainder are outstanding or only partially met. The acting manager has been in post since November 2004. He has not yet been registered with the Commission for Social Care Inspection. Regular staff meetings are not held although there had been a meeting with night staff to discuss a particular issue. The acting manager stated that he had delegated the care planning responsibilities to a member of staff. The plans seen and the comments made by staff indicated that very little progress had been made. There was no evidence that the acting manager was overseeing this task. Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 18 The acting manager stated that supervision of staff had begun although staff did not confirm this fact. There were no records of supervision available and there were two supervision dates booked in the diary. A concern raised by a member of staff and reported had not been recorded and there was no evidence that the manager had taken any action. There was no overall record of health and safety training undertaken by staff or plan for future up date training. Risk assessments for the building had been written, but there was no safe working practice assessment for the carrying of the carpet cleaner up-stairs which was a health and safety risk. Staff who were spoken to said they had not received fire evacuation drills and none were recorded. The acting manager stated that the weekly fire test was the drill although no evacuation procedures were practised. There were no drills for night staff recorded although a member of night staff said he had received training as part of his induction. Immediate Requirement notices were left in respect of these matters. The poor response to the previous requirements made from the last inspection were discussed in detail with the acting manager and registered providers. Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 19 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 1 x 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x x STAFFING Standard No Score 27 3 28 2 29 2 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x 2 1 1 1 x x x x 2 Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 20 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. 2. 3. Standard 1 1 3 Regulation 4(1)(2) 5(1)(2) 14 Requirement A statement of purpose must be available in the home for prospective service users. A service users guide must be made available for all service users A full assessment of prospective service users must be undertaken prior to them moving into the home and to include all aspects of their needs. (Previous timescales of October 2004 not met) Specialist training must be provided to staff to ensure that service users needs are understood and fully met. (Previous timescales of October 2004 not met) Each service user must have a comprehensive care plan in place which is regularly reviewed and updated and reflects all aspects of their needs. (Previous timescales of 4th April 2004 not met) Service users plans must be signed, dated and, where possible, the signature of the service user or representative included. (Previous timescales of Timescale for action 31st May 2005 31st May 2005 31st May 2005 4. 4 (1) a,b,c (2) A training plan to be provided by 31st May 2005 31st May 2005 5. 7 15 6. 7 15 31st May 2005 Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 21 31st May 2004 not met) 7. 8 12 Nutritional and skin care risk assessments must be carried out. (Previous timescales of 31st May 2004 not met) Moving and handling risk assssments must be reviewed and kept up to date. (Previous timescales of 31st May 2004 not met) iIndividual risk assessments must be carried out for service users displaying challenging and aggressive behaviours.(Previous timescales of October 2004 not met) An up to date list of medication must be available on the service users care plan. A seperate refrigerator must be provided for medications. (Previous timescales of 31st October 2004 not met) Staff must receive accredited medication training. 31st May 2005 31st May 2005 8. 8 12,13 9. 8 12,13 31st May 2005 10. 11. 9 9 13(2) 13(2) 31st May 2005 31st May 2005 To be included in training plan to be submitted 31st May 2005. To be included in the training plan to be submitted 31st May 2005. 31st May 2005 12. 9 13(2) 13. 18 13(6) 14. 18 13(6) 15. 18 13(6) Arrangements must be made by training or other measures to ensure that all staff are aware of all types of abuse including behaviours displayed by other service service users.(Previous timescales of 30th November 2004 not met) Risk assessments and management procedures must be put in place to ensure that service users are not placed at risk by displayed by other service users. All allegations of abuse must be investigated according to the homes procedures and in Immediatel Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 22 16. 19 13,23 17. 19 13, 23 18. 19. 20. 21. 19 19 19 29 13 13 13 19 accordance with POVA procedure. Thermostatic valves to be fitted to all hand washbasins in service users rooms.(Previous timescales of October 2004 not met) Refrigerator to be repaired or replaced to ensure that food is stored at the required temperatures. The microwave oven to be repaired or replaced The strip lights in the kitchen to be replaced and covered The cooker hood to be cleaned Staff employment files must contain all the required information as specified in Regulation 7, 9 , 19 and Schedule 2. All staff must receive regular supervision from the acting manager The acting manager must evidence that he can manage the home in a competent and skilful manner. The acting manager must ensure that regular staff meetings are held to improve the quality of relationships with staff and to improve the standards of care in the home. A quality assurance system must be put in place in order to audit the service provided by the home.(Previous timescales of 30th June 2004 not met) The registered providers must ensure that they visit and report on the conduct of the home on a monthly basis and provide accurate feedback to the acting manager as to all aspects of the service provided by the home. Immediate Immediate 31st May 2005 31st May 2005 31st May 2005 31st May 2005 22. 23. 29 31 18(2) 9 31st May 2005 30th July 2005 30th July 2005 24. 32 12(5) 25. 33 24 30th July 2005 26. 33 26 31st May 2005 Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 23 27. 38 13 28. 38 13,23(4) 29. 38 13(5) All staff must receive adequate and up dated health and safety training, to include fire safety, moving and handling, first aid, food hygiene, infection control and basic health and safety.(Previous timescales of 31st December 2004 not met) All staff to receive regular fire drills and a record kept. (Previous timescales of 31st October 2004 not met) Risk assessments must be put in place for all working practices including carrying the carpet cleaner upstairs. A training plan to be provided by 31st May 2005 Immediate 31st May 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. 4. 5. Refer to Standard 3 15 15 19 28 Good Practice Recommendations Abbreviations used on care documents should be understood by all staff. Service users should be given the opportunity to help themselves to tea and cereals at breakfast. Food ordering to be reviewed to ensure that there is always staple foods available. Supplies of carpet cleaner should be readily available. Staff should receive NVQ training to ensure that the 50 level of trained staff by 2005 is met. Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 24 Commission for Social Care Inspection The Coach House John Comyn Drive, Perdiswell Park Droitwich Road Worcester WR3 7NW 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 Haversham House E52 S18486 Haversham House V222635 210405.doc Version 1.30 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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