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Inspection on 30/04/08 for High Meadow Nursing Home

Also see our care home review for High Meadow Nursing Home for more information

This inspection was carried out on 30th April 2008.

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

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

What the care home does well

The atmosphere in the home is relaxed. Residents and relatives said the staff are pleasant and attentive both as individuals and collectively. Good interactions were observed during the inspection, as was the caring attitude of the staff. Residents confirmed they feel their privacy and dignity is respected. The choice menu provides residents with appetising and nutritious meals in pleasant surroundings. Prospective residents and their families can visit the home and access the necessary information to help them decide whether or not High Meadows will be the right place for them to live. Relatives also said that they feel welcome at the home and they feel involved.

What has improved since the last inspection?

Planning care and identifying risks for people living in the home has improved but there is still some work to ensure that there is a person centred approach to care delivery. There are more activities happening but this also needs further development to include community participation. The homes environment continues to improve and to provide a comfortable, homely place for people to live in. Staff levels have increased and there have been no departures.

CARE HOMES FOR OLDER PEOPLE High Meadow Nursing Home 126 - 128 Old Dover Road Canterbury Kent CT1 3PF Lead Inspector Geoff Senior Unannounced Inspection 30th April 2008 10:30 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 High Meadow Nursing Home DS0000026098.V361147.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. High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service High Meadow Nursing Home Address 126 - 128 Old Dover Road Canterbury Kent CT1 3PF 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) 01227 760213 01227 762412 avidan@highmeadow.co.uk Avidan Ltd vacant post Care Home 34 Category(ies) of Old age, not falling within any other category registration, with number (34) of places High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Of the 34 beds 15 are registered for residential clients. Date of last inspection 13th June 2007 Brief Description of the Service: High Meadow is a pair of large Victorian detached houses situated on a steep bank alongside Old Dover Road. The home comprises three floors, with two ground floor extensions. There are 28 bedrooms, 5 of which are registered as double bedded. All the shared rooms have privacy screening between the beds and around each washbasin. Five single rooms are ensuite. All the bedrooms have TV points and a call bell system in operation, and a number of them also have telephone points. The home has a large lounge/dining room and a smaller lounge area. There is also a conservatory. There is a large and wellmaintained garden at the rear of the property, with shrubs, flowerbeds, lawns, a patio and barbecue area. There is space for 13 vehicles at the front of the building and 3 spaces at the rear of the property. The Home is located in a residential area within a short distance from Canterbury City Centre, the Kent & Canterbury hospital and Kents cricket ground. Situated nearby is a post box and bus stop, the nearest railway station and main bus station are within walking distance. The home provides 24-hour care for people with nursing and residential needs. The current fees for the service range from £396.00 to £600.00. Information on High Meadow and the CSCI reports for prospective service users will be detailed in the homes Statement of Purpose and Service User Guide. High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Key inspection of High Meadow included consideration of information received by us prior to and during a site visit that was undertaken on 30/4/08. We had the opportunity to discuss with the service users and some visiting relatives their experiences and opinions of the service. Management and staff were spoken with individually and collectively. Interactions with service users were observed as were mealtime and leisure activity. A range of records was reviewed and parts of the premises were seen. The acting manager and deputy were present throughout the visit. The area manager also arrived for part of the day. A Quality Assurance Self Assessment was completed by the home and returned to us when requested. What the service does well: What has improved since the last inspection? Planning care and identifying risks for people living in the home has improved but there is still some work to ensure that there is a person centred approach to care delivery. There are more activities happening but this also needs further development to include community participation. The homes environment continues to improve and to provide a comfortable, homely place for people to live in. Staff levels have increased and there have been no departures. High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. High Meadow Nursing Home DS0000026098.V361147.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 High Meadow Nursing Home DS0000026098.V361147.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): 1,3,5. People who use the service experience good quality outcomes in this area. People who use the service receive sufficient information to enable them to make an informed choice about living at the home. They can be sure that a competent member of staff will undertake a full assessment of their needs prior to arriving at the home. This home does not offer the facility of intermediate care This judgement has been made using available evidence including a visit to this service. People who use the service receive sufficient information to enable them to make an informed choice about living at the home. They can be sure that a competent member of staff will undertake a full assessment of their needs prior to arriving at the home. This home does not offer the facility of intermediate care High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 9 EVIDENCE: The statement of purpose and service users guide contains all the necessary information to assist residents and their representatives to make an informed decision as to whether the home is suitable and able to meet their needs. Discussions with residents and relatives during the site visit indicated that they were given the opportunity to visit the home prior to admission. Pre-admission assessments are undertaken and give staff accurate and relevant information about the resident and their support needs. Information is gathered from, care managers and relatives. The assessments explore all the relevant areas of care including communication and behavioural needs. A copy of the joint assessment is obtained for people who are under the local social services care management team. All the information is brought together to decide whether or not the home will be ale to meet the assessed needs. High Meadow Nursing Home DS0000026098.V361147.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. People who use the service experience adequate outcomes in this area. The manager is still reviewing and updating how care plan and daily support information is shared and documented. Staff indicated an awareness and commitment to the dignified care of the service users. The home needs to review how some people can be helped to better communicate their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service user files are currently being reviewed and updated. A sample number of service user files were viewed; they broadly support people in a positive manner but do not clearly show what, if any, input service users have had. The home has started to develop a more person centred approach to care. Key working is being developed and promoted but there is still some way to go High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 11 before it has a positive impact on the residents. The Manager has reportedly increased the level of relative/advocate consultation. This is not yet clearly evidenced in files seen. Daily records detail health and physical care, input and output levels and meals taken. They describe the basic activities but not the demeanour of the person or what they actually got out of the day. The documentation is navigable but bulky to use and, some staff feel, overly time consuming to record and report to. The service told us that there is a good relationship and liaison with community health services. All residents have access to NHS services and, environmental support is provided for those with a physical disability. The residents do have contact with G.Ps, the district nursing services and the and other specialist services who offer advice, input and assistance when necessary. A dentist called during the visit and was seen liaising with the staff and relatives. Staff were observed generally assisting the residents in a caring and supportive manner and were seen treating them with respect and understanding. Members of staff spoken to confirmed an understanding and commitment to this aspect of care. The response to one service user’s unusual method for gaining staff attention however was less than timely and thought should be given to helping her communicate her need for attention in a more dignified manner. Arrangements for storage and administration of medication was satisfactory and records seen were complete and up to date. There was no indication that any of the service users manage their own medication. The AQAA informed us that the home intends to accommodate and support the people who wish to self medicate in the forthcoming year. All staff administering medication have received training and there is reportedly a process in place to check competency. High Meadow Nursing Home DS0000026098.V361147.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): 12,13,14,15. People who use the service experience adequate outcomes in this area. The service needs to evidence its commitment to helping people maintain and develop independent skills and community presence. The activity programme has improved and now needs to show how it determines and supports individuals’ aspirations and wishes. Family links are encouraged and maintained wherever possible. The home provides nutritious and varied meals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There has been improvement in developing activities that are geared towards meeting needs, abilities and interests of the people who live at the home. The Home employs an activities coordinator who works five, six hour days per week. He is new to the post and is still developing the role. He has ideas for High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 13 each day but no set routine has been established. He prefers to respond to demands of the day. Reminiscence, films and books, News topics, Tabletop stuff –writing/art puzzles crosswords etc. For the ornithologists he obtained a bird table and food and binoculars to sit and watch. Music movement and Tai Chi is being considered. There was little information forthcoming either verbally or on care records about involvement in the community or access to the community facilities. It was not clear whether there are sufficient staff available to help with this. Relatives reported they are made to feel welcome at the home at all reasonable times and no restrictions are imposed. Residents are able to receive their visitors in the privacy of their own rooms or in the communal areas. The home has regular meetings with residents and relatives who are invited to express their views. The people at the home felt that they were able to have choice in regards to their day-to-day lives. Examples given were that they could get up and go to bed when they liked. They could choose what to eat and where to eat their meals. Generally they felt happy with the choices they are offered and feel there is a good and positive atmosphere in the home. There is information available for residents and their families on how to contact external agencies and advocates. The home provides a varied menu ensuring the residents receive a nutritious and balanced diet. Soft foods are served in separate portions. The staff now keep accurate records of the amount of food eaten so that any concerns can be identified and acted on quickly. A visitor commented, “we are made welcome and may stay for a meal if we wish.” A lunchtime meal was observed this was relaxed and unhurried with residents able to take their time to enjoy the food. Staff were observed assisting residents to eat in a respectful way. High Meadow Nursing Home DS0000026098.V361147.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): People who use the service experience adequate outcomes in this area. Written information is available service users/relatives/visitors and staff who may wish to express concern or complain. Staff have attended training in safeguarding vulnerable people from the risk of abuse. Records should show that Service users/relatives/visitors concerns are acted upon and responded to in a satisfactory and timely fashion. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager reported that there have been no formal complaints received since he took up post 6 months ago. He understands that some issues received prior to his appointment are still active but are being addressed at Area Manager level. There was no further detail proffered. The complaints procedure is available within the home and residents, relatives and staff are aware of how to make a complaint. The home has policies and procedures in place to protect service users from abuse. The majority of staff have now received training in safe guarding adults. Staff have an awareness of what constitutes abuse and reported that they would have no problem whistle blowing if the need arose. Staff spoken with High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 15 would be happy to, and are more likely to approach the Provider directly rather than raise the issue locally. Comments from a visitor, “If I have a problem I would go and see the manager without hesitation.” The service does not have any involvement with the monies of the service user. High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 16 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): 19,26. People who use the service experience good outcomes in this area. The home provides a varied and comfortable environment in which to live and work. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During an accompanied tour of parts of the premises we noted works on maintenance and decoration of communal and private areas of the home as part of the continuing programme. Individual rooms were seen to contain items of furniture and ornament personal to the occupant. Service users were seen to be using most parts of the premises and some were in the garden. The conservatory was available but was seen to be used only by staff at this time. High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 17 Laundry and catering facilities are reportedly adequate for the needs of the home. Separate staff are employed for cooking, cleaning and laundry. The AQAA told us that maintenance certification was satisfactory and up to date. The premises appeared to be clean, tidy and free from undue odour. High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 18 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): 27,28,29,30. People who use the service experience adequate outcomes in this area. Staff have a good understanding of the service users and positive interactions were observed. Staff training needs to be further developed to ensure staff skills are commensurate with service users needs. This judgement has been made using available evidence including a visit to this service High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 19 EVIDENCE: The home is registered jointly for residential and nursing services. Therefore the home employs care staff and qualified nurses. There is a static group of staff working at the home. The Manager commented that no staff have left in the past six months. The home employs an experienced deputy manager. She is assisting the manager in developing all aspects of care within the home. We were informed that staffing levels are reviewed regularly and reflect the dependency levels of residents. There are usually 6 staff on in the morning and 5 in the afternoon. Comments from service users and staff suggest this is generally sufficient. There are times however where choice and opportunity may be compromised particularly if keyworkers are to expand their person centred approach. Staff files seen indicated safe recruitment practice in that appropriate checks on potential staff were undertaken and references followed up. More than 50 of the care staff have achieved NVQ level 2 or above. 2 senior carers are completeing level 3 and 3 domestic staff are studying for NVQ2 in housekeeping. Staff said that training is available and they were able to expand their knowledge on different aspects of care. This was also reflected on the training matrix. . All training is linked to ‘skills for care’ and the aim is provide all manadatory training within the first 12 weeks of employment. The service told us that staff receive induction training during which they are made aware of the importance of promoting peoples rights to equality and diversity. There are still some gaps in mandatory training.The staff also need to receive more specialist training to ensure that they have the skills knowledge and capabilities to care effectively, positively and safely for the residents at the home.The manager is aware of this shortfall. Additional input on understanding Dementia and Challenging Behaviour is planned for the near future. Some staff reported that they do not always feel valued by the management. They are commited to the service users and will to perform their duties in a professional manner but were concerned about potential divisions and the effect on staff morale. The home does have regular staff meetings where opportunity for the expression of such feeling should be given and discussed. High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 20 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): 31,33,35,38. People who use the service experience adequate outcomes in this area. Service users benefit from a generally well run home. Quality assurance checks are in place. Systems are in place to protect the health and safety of service users and staff. The acting manager should seek relevant management training as an addition to his nursing qualification and experience. This judgement has been made using available evidence including a visit to this service. High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 21 EVIDENCE: There have been significant changes in the management of the home since the last inspection. An acting Manager has been recruited and is assisted by the former registered manager in the day to day functioning of the home. The acting manager is a qualified nurse and presented a positive vision and direction for the development of the service. He should seek relevant management training as an addition to his nursing qualification and experience. As noted earlier, some staff perceive a disproportionate favour to certain groups of staff. The manager needs to take action to mediate circumstances that may become divisive and affect staff morale and perhaps performance. Quality assurance matters were not fully reviewed at this visit. Previous reports noted that ‘The home has developed quality assurance and monitoring systems to assess its performance. Questionnaires have been returned from relatives and results are on display in graph form. Quality assurance needs to be further developed to seek the views of residents and other stakeholders who use the service.’ The AQAA told us that. ‘Residents, family/significant others, and advocates, have access to satisfaction forums and feel able to discuss their views. Service users are surveyed for their opinions and it is standard practice to publish these opinions. Effective quality assurance is pursued based on seeking the views of service users. Regular visits are made to the home by a representative of the provider to ensure the documentation, care of the service users and maintenance of the home is satisfactory and up to date The Health, Safety and welfare of Service users and staff is ensured in so far as is reasonably practicable.’ Policies are in place to strengthen safe practices. The home has informed us that all the relevant checks and inspection of equipment and system have been undertaken. An accident book is maintained. All fire checks are done. Water temperatures are taken and comply with regulations. The Manager is aware of RIDDOR and reporting incidences to the Commission under Regulation 37. COSSH products are locked away safely. Environmental risk assessments are in place. High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 x 3 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 3 3 x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 x x 3 x 3 High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? no 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 YA10 Regulation 12 (4) (a) Requirement The arrangements for personal care ensure the service users dignity at all times. In that: one service user in particular should be given help to communicate her need for attention in a more dignified manner Timescale for action 31/05/08 High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 24 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 OP9 OP14 Good Practice Recommendations The home to support service users to take responsibility for their own medication if they wish, within a risk management framework. The manager needs to demonstrate how the home maximises service users’ capacity to exercise personal autonomy and choice. 3. OP12 To continue to consult with residents about their interests and make arrangements for them to enable them to engage in local, social and community activities. Training needs to be up to date and on going for all staff members. The home needs to provide specialist training for the staff to ensure that staff are suitably, qualified competent and experienced to meet the needs of the residents and undertake their role effectively and safely The Manager should undertake relevant management training. 4. OP30 5 OP31 High Meadow Nursing Home DS0000026098.V361147.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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. 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