Inspection on 27/01/06 for Hawthorn Green Nursing Home

This inspection was carried out on 27th January 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 but made no statutory requirements on the home.

Other inspections for this house

Hawthorn Green Nursing Home 18/05/09

Hawthorn Green Nursing Home 01/07/08

Hawthorn Green Nursing Home 04/09/07

Hawthorn Green Nursing Home 19/06/06

Hawthorn Green Nursing Home 11/08/05

Hawthorn Green Nursing Home 17/03/05

Hawthorn Green Nursing Home 25/10/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Hawthorn Green Care Home 82 Redmans Road Stepney Green London E1 3XX Lead Inspector Sarah Greaves Unannounced Inspection 17:00p 27 January and 2 February 2006 th nd 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 Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 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. Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Hawthorn Green Care Home Address 82 Redmans Road Stepney Green London E1 3XX 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 7702 7788 020 7702 8045 Sanctuary Care Limited Care Home 90 Category(ies) of Dementia - over 65 years of age (45), Old age, registration, with number not falling within any other category (45) of places Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. MINIMUM STAFFING NOTICE The home can accommodate two (2) named service users under the age of 65 years. 11th August 2005 Date of last inspection Brief Description of the Service: Hawthorn Green Care Home is a ninety bedded nursing home situated in Stepney Green, close to Stepney Green and Whitechapel underground stations and accessible by local bus routes. This purpose built care home has a ground and first floor, with lifts. The home is divided into six separate units, each with up to fifteen service users. Three of the units provide nursing care for people with dementia and the other three units provide general nursing care. Six of the beds have been purchased by the Tower Hamlets Primary Care Trust for the provision of Continuing Care. A limited day care service is offered. Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector visited the premises on 27th January 2006 to undertake an unannounced inspection primarily concentrating on the dementia care units. This unannounced inspection was followed by an announced inspection on 2nd February 2006 in order to speak to the manager and access information that was not accessible in the absence of the manager and deputy manager at the unannounced inspection (staff recruitment files and supervision records, and financial records). The inspector read a randomly chosen sample of care plans and checked the home’s compliance with the ten requirements and four recommendations issued at the previous inspection on 11th August 2005. What the service does well: What has improved since the last inspection? There had been a number of improvements since the last inspection: The dignity of service users at mealtimes is further promoted; the annual maintenance of bathing equipment is undertaken. A recommendation that signs should be applied to toilet facilities to promote easier recognition was met and part of a recommendation (for registered nurses to receive resuscitation training) had been met. Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 Page 6 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. Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 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 Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 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 the following standard(s): 2,3 and 4. The home needs to improve upon the level of specialist care provided to service users on the three dementia care units, in order to be able to competently meet the assessed holistic needs of people living with dementia. EVIDENCE: The inspector looked at a sample of contracts for service users who had been placed by their local social services department and for service users who were self-funding. It was noted that the contract for a self-funding service user did not clearly identify whether the service user or their representative had signed the contract. The inspector was informed that the vast majority of service users were admitted to the home via arrangements by their local social services. The preadmission assessments co-ordinated by social services were stored with the care plans developed by the home. Hawthorn Green provides forty-five places for older people with general care needs and forty-five places for people with dementia care needs. Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 Page 9 A requirement was issued in the previous inspection report for the home to address the training needs of the registered nurses working in the three dementia care units. No evidence was found to demonstrate that this requirement had been met, which may impact adversely on whether both nursing and social care needs are being appropriately assessed and met. It is the view of the inspector that the home is vulnerable to complaints if specialist care on the nursing/dementia units is not informed and underpinned by appropriate training. Standards 1 and 5 were assessed at the previous inspection and Standard 6 was not applicable for assessment, as the home does not provide intermediate care. Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 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 the following standard(s): 7,8,9,10 and 11 The care plans failed to demonstrate that the care needs of service users were being monitored and addressed. A more robust and rigorous approach must be taken to ensure the safe management of service users’ medication. EVIDENCE: The inspector read three care plans at this inspection visit. The standard of care planning and documented monitoring of individual’s healthcare needs was noted to have deteriorated from the standard found at previous inspection visits. The deputy manager was present with the inspector to observe these findings, which included no recorded monthly monitoring for one service user for four months. Another service user was identified to have needs relating to their dietary intake; however, a regular monitoring of weight had not been documented. A complaint from the family of a service user had been investigated at the time of this inspection the findings of which were being challenged by the complainant. It is the view of the inspector that the home is vulnerable to such complaints and criticism if the care plans do not adequately signpost and document the care needs of an individual and, thereby, enable staff to Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 Page 11 discharge their duties appropriately. In relation to the complaint, a staff member acknowledged that she had spoken to a service user inappropriately. The inspector looked at the storage of medication and recording within medication administration records at the unannounced inspection on 27th January 2006 and the follow-up announced inspection on 2nd February 2006. A requirement was issued in the previous inspection report for medication records to be correctly completed in order to accurately document whether medication had been given or not. The inspector found that there were still gaps on medication charts. Additionally, a jar of aqueous cream was not stored securely in a service user’s bedroom, to which other possibly confused service users may have had access. These shortfalls compromise the efforts to improve, which are acknowledged. The manager was not able to confirm the proposed agreements for a pharmacist to regularly audit the home’s medication practices as a change of pharmacy supplier was being arranged at the time of this inspection. A recommendation was issued in the previous inspection report for the home to ensure that the resuscitation status of service users is recorded in their care plans and for registered nursing staff to have up-to-date resuscitation training. The recommendation for the recording of resuscitation training had not been actioned at the time of this inspection and has been re-issued in this report as a requirement. Via subsequent discussion with the home, the CSCI has been informed that registered nurses undertook some resuscitation training in November 2005 but due to the absence of a training matrix and individual training profiles, the home was not able to adequately evidence staff training related to terminal care. Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 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 the following standard(s): 12,14 and 15 The home satisfactorily provided services to meet the social needs of service users; however, interactions observed on one of the dementia care units indicated that staff needed to understand the importance of on-going communication and interaction with service users. The wishes of people who are unable to verbally express themselves must be explored with their representatives, wherever possible. The manager needs to evaluate the current catering arrangements to ensure that a balanced and adequate diet is provided. EVIDENCE: The home employed activities staff and provided a wide range of entertainments and recreational pursuits. The inspector did not have an opportunity to meet with the activities organiser at this inspection; however, previous inspection visits have identified this aspect of the service to be well managed and of a positive benefit to service users. Flexible visiting hours were permitted; this was confirmed via discussion with service users. The two visits for this inspection were primarily focused upon the dementia care units. The inspector found via reading care plans and through speaking to relatives of a service user, that the home did not utilise the knowledge of relatives, friends and former carers of people with dementia Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 Page 13 to find out the preferences and routines of service users (for example, whether an individual wished to be changed into their nightwear directly after supper or later). It is acknowledged that the service users on the general nursing units would be able to convey their choices to staff. The inspector observed service users receiving their evening meal; there appeared to be a satisfactory amount of food and choices of food but relatives of two service users have stated that there have been incidences of insufficient food and the non-availability of fresh fruit. Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17 Service users and/or their representatives are aware of the home’s complaints procedure; but the home can do more to increase the confidence people feel that complaints will be listened to more sympathetically and acted upon so that services improve as a consequence. EVIDENCE: The Commission for Social Care Inspection had received three complaints about the home since the last inspection; the Commission has not observed this level of complaints activity at Hawthorn Green previously. At the time of this inspection, the home had investigated a complaint from the representative of a service user, which alleged inadequate care practices and staff attitudes. The complainant proposed to challenge the findings of this complaint investigation. The Commission, as part of its own complaints procedure will require further information from the home as to the outcome of this complaint. During the inspection the inspector found evidence to suggest that action in relation to two elements of the complaint could have been more robust and acted upon more proactively i.e. in relation to personal hygiene care and inappropriate language. The legal rights of service users were recognised by the home, for example, service users may vote at election times, and privately meet with professionals or other persons of their choice, such as consultations with a solicitor or local councillor. Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21,22,23,24,25 and 26. Hawthorn Green service users live in a safe and well maintained environment; however, ongoing improvements are needed to the home’s physical environment, including better management of offensive odours and redecoration. Staff need to be trained to use wheelchairs safely. EVIDENCE: A requirement was issued in the previous inspection report for the home to redecorate the communal toilets; this requirement had not been met at the time of this inspection visit. However, the inspector observed that a programme of re-decorating had commenced within the home on the ground floor; the manager stated that this would be extended throughout the premises to include the communal toilets and bathrooms. At the first inspection visit, the inspector noted that a safety strap on a wheelchair was broken; this was pointed out to the staff nurse pushing the occupied wheelchair. On the second inspection visit, the inspector and the Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 Page 16 deputy manager observed a service user being transported in a wheelchair without foot rests. A perceptible odour of urine was noted in some of the communal toilets and in a communal lounge area. A service user commented upon this odour (from the carpet) to the inspector, in the presence of the deputy manager. The inspector had observed that excess supplies of clinical equipment was being stored in the bedroom of a service user on the first inspection visit on 27th January; this had been satisfactorily removed by the second inspection visit on 2nd February. Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,29 and 30 The service provider must urgently address the training needs of staff, taking into account how this directly impacts upon the quality of care received by service users. The home must comply with current legislation to ensure the safe recruitment of staff. EVIDENCE: A requirement was issued in the previous inspection report for the home to ensure that a training plan was developed for all of the qualified nursing staff on the three dementia units, to ensure that these staff were offered dementia care training (or up-dates to any existing dementia care qualifications). The inspector had limited this requirement to the qualified staff at this stage, taking into account their duty to provide leadership to other staff. This requirement had not been met within the given timescale. The inspector was informed that Sanctuary Care were working towards providing dementia training for nursing and care staff. A requirement was issued in the previous inspection report for the home to ensure that references are checked to ascertain their validity. The inspector looked at the file of a member of staff who commenced employment in December 2005 and found that there was a reference which required further clarification to determine its authenticity. One recently appointed member of staff was noted to have commenced shifts in the home prior to the home receiving the results of a Protection Of Vulnerable Adults (POVA) check. Staff attainment of National Vocational Qualification (NVQ) LEVEL2 was satisfactory. Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 Page 18 The inspector issued a recommendation for the home to ensure that all staff had individual training profiles, as stated within the National Minimum Standards. The manager stated that staff maintained evidence of their training at home. A requirement has been issued in this report for the registered person to ensure that all staff possess an individual training record, which must be kept on the premises for the purpose of inspection so that the inspector can determine whether staff are adequately trained and the appropriate skill mix is evident. Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34,35,36,37 and 38 Following the departure of the previous manager Sanctuary Care acted promptly in identifying a person to take over. An application to register must be forthcoming. The manager had been in post for only a few days prior to the inspection. As this report suggests the manager will need to address a number of issues to effect improvement e.g. staff supervision is of variable quality and frequency and identified health and safety practices must be addressed. EVIDENCE: The inspector looked at the home’s management of petty cash and service users personal allowances with the administrator; these records were found to be clearly and accurately recorded. The inspector was concerned to find that one service user was regularly purchasing food items such as basic soups, as well as “build-up” food supplement drinks. The deputy manager was asked to investigate why these items were not being supplied by the home. Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 Page 20 A requirement was issued in the previous inspection report for the home to ensure that staff received a minimum of six supervisions per year. The inspector looked at two staff files and found that staff had not received supervision since July 2005. The quality of supervision (a staff nurse supervising a care worker) was noted to be variable. Issues of concern relating to the home’s record keeping practices have been identified within this report (staff supervision, staff recruitment files, staff induction dates, individual training profiles for staff, service users care plans and service users medication administration records). A comprehensive range of health and safety practices were checked upon at the previous inspection. The inspector found an expired milk drink in a refrigerator within a service users’ kitchen; this item was stated to belong to a member of staff. It was also noted that there were gaps in the recordings of food and refrigerator temperatures. Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 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 2 3 1 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 2 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 3 18 X 2 2 2 2 3 3 2 2 STAFFING Standard No Score 27 X 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 3 3 1 2 2 Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 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 Regulation 18 Requirement The Registered Person must ensure that staff are trained to meet the care needs of people admitted to the dementia care units. The Registered Person must ensure that the care plans are monitored by senior staff and audited by the manager. The Registered Person must ensure that the health care needs of service users are recorded in the care plans (for example, consistent weighing of service users with identified nutritional needs) and appropriate action is taken in response to any findings of concern. • The Registered Person must ensure that medication administration charts are properly recorded to demonstrate whether a medication has been administered or not. • The Registered Person must ensure that topically Version 5.0 Page 23 Timescale for action 30/04/06 2. OP7 15 31/03/06 3. OP8 12 and 15 31/03/06 4. OP9 13 31/03/06 Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc 5. OP10OP14 12 (2 and 3) 6. OP11 12 (2) 7. OP16 22 8. OP21 23 (2)(c) 9. OP22 18 and 23 (2n) 10. 11. OP26 OP29 23 (2d) 19 applied creams and lotions are securely stored. The Registered Person must ensure the dignity and choices of service users with dementia, through improved liaison with their representatives. The Registered Person must ensure that service users (and their representatives) are offered the opportunity to express whether they would wish to be resuscitated within the care home. Guidance from the General Practitioner must be sought as part of this consultation. The Registered Person must ensure that complaints are robustly and effectively investigated. The Registered Person must ensure that the communal toilets are maintained in a good decorative order. The Registered Person must ensure that wheelchairs are safely maintained and that staff are trained in how to safely use the wheelchairs. The Registered Person must ensure that the premises are free from any offensive odours. • The Registered Person must ensure that references are checked to ascertain their validity, as required. The Registered Person must ensure that all staff has received a minimum of a POVA First check prior to employment. The Registered Person must demonstrate that new staff receive a comprehensive programme of induction training DS0000007357.V272540.R01.S.doc 30/04/06 31/05/06 31/03/06 30/04/06 31/03/06 31/03/06 31/03/06 • 12. OP30 18 31/03/06 Hawthorn Green Care Home Version 5.0 Page 24 13. OP30 18 14. OP36 18(2) 15. OP38 13 that is properly documented. The Registered Person must ensure that all staff possess an individual training profile that is maintained within the home. The Registered Person must ensure that all staff receive a minimum of six supervisions per year. a)The Registered Person must ensure that out of date food is not stored in the service users refrigerators. b) The Registered Person must ensure that the food temperatures are recorded daily c) The Registered Person must ensure that refrigerator temperatures are recorded daily 31/05/06 31/03/06 15/03/06 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 OP2 OP15 Good Practice Recommendations Contracts for privately funded service users should clearly indicate whether the service user or their representative has signed the contract. The manager should monitor the quantities and choice offered to service users at mealtimes, and availability of fresh fruit. Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection East London Area Office Gredley House 1-11 Broadway Stratford London E15 4BQ 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 Hawthorn Green Care Home DS0000007357.V272540.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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