Inspection on 02/08/05 for Highland Mist

This inspection was carried out on 2nd August 2005.

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 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

Highland Mist 06/06/08

Highland Mist 03/12/07

Highland Mist 15/05/07

Highland Mist 11/01/07

Highland Mist 19/06/06

Highland Mist 21/02/06

Highland Mist 09/03/05

Highland Mist 16/06/04

Highland Mist 26/03/04

Highland Mist 09/03/04

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

CARE HOME ADULTS 18-65 Highland Mist Bronshill Road Torquay Devon TQ1 3HA Lead Inspector Sam Sly Announced 2 August 2005 nd 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Highland Mist Address Bronshill Road, Torquay, Devon, TQ1 3HA 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) 01803 328156 01803 312697 Mrs Susan Irene Ann Hill Mrs Susan Irene Ann Hill Care Home 8 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (8) of places Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 15/06/05 Brief Description of the Service: Highland Mist provides care for up to 8 adults with mental health needs. The premises are in a residential area of Torquay within walking distance of shops, and the town centre. There is parking to the front of the home, and a grassed and patioed front garden. There is also a shed at the bottom of the garden for smokers. Entrance to the house is up several steps into the conservatory, which is also used for meals. The ground floor also has a shower room with toilet, three bedrooms, the office/staff sleep-in room, kitchen and laundry facilities which are outside in the yard. Stairs lead to the first floor which has a bathroom with toilet, and five bedrooms one of which is en-suite. An additional shower room with toilet is being built. Residents should be aware that a staff member sleeps in the lounge at night. Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection was announced and took place on a weekday in August between 9.45am and 1.30pm. The Owner Mrs Hill was present throughout the Inspection, except when the Inspector was talking privately with residents and a visitor. . Evidence was collected through a tour of the premises, excluding some bedrooms that residents had not consented to being entered, and examination of care records, staff files and health and safety records. Four of the residents were spoken to in depth, as were the deputy manager, Owner, and two staff on duty. Due to concern about the number of outstanding requirements at the last unannounced Inspection in February 2005 an additional visit was made in June 2005 where it was found that requirements were still not fully complied with, although progress had been made. A report about this visit can be obtained from the Commission’s Ashburton office (01364 651800) What the service does well: What has improved since the last inspection? There had been sustained improvements since the last Inspection. One improvement was that the Owner was delegating more responsibility to the deputy manager, which was contributing to some of the outstanding requirements being met. Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 6 Staff recruitment procedures had improved with Criminal Record Bureau checks now made on all staff, and the appropriate fitness processes being done. Also rotas and comprehensive staff records are now kept. Generally better records throughout the home were being kept. The Owner had started to ‘get to grips’ with staff training needs with the help of an external training advisor; some training had been provided and individual training records are being started. 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. Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 Prospective residents cannot be confident that their needs and aspirations with be fully understood and acted on by staff. EVIDENCE: Three resident’s assessments, including the most the two most recently admitted, were examined and although there was information within Care Programme Approach paperwork, consultant’s letters and a pre-admission assessment carried out by the Owner there was no clear, comprehensive, holistic assessment. The Commission will be meeting the Owner in October 2005 to ensure compliance. Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 & 9 Residents can make decisions about their lives, but can’t be confident that all their needs, goals and aspirations will be fully understood and met by all staff. EVIDENCE: Three resident’s files were examined including those most recently admitted. Assessments and care plans were not comprehensive and did not set out clearly how resident’s needs and goals would be met and by whom. The risk assessments did cover identified risks, but did not inform the resident’s care plan. Non-compliance with these requirements is of concern to the Commission, and a meeting has been arranged in October 2005 to ensure compliance. Restrictions imposed on residents were agreed and signed by residents and recorded in contracts or on Care Programme Approach care plans. It was recommended that any restrictions were regularly reviewed. Residents gave examples of how they made decisions daily about their lives, with support from staff where appropriate. The Owner was a financial agent for two residents who were unable to do this themselves. Other residents either looked after their own money or had help from the Court of Protection. Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 10 All residents had their own bank accounts, and money was handled safely and records kept appropriately by the Owner. The Local Authority had recently reviewed the financial status of all residents and found procedures in the home to be appropriate. Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 &16 Residents keep active at Highland Mist and in the local community, but would benefit from information on educational, employment, and leisure opportunities so as to develop skills and independence. EVIDENCE: None of the residents at Highland Mist currently attended educational courses. Three residents did voluntary work; one of these residents said they really enjoyed it; the other two were not spoken to. One resident liked painting, and said he had recently sold a painting. Some residents attend a local drop-in centre, which they enjoyed as it gave them a ‘change of scenery’ and they met up with friends. Most residents were able to go into Torquay unsupported to go to the shops, for appointments and to café’s and pubs. Each resident had a written activities programme. One resident’s programme included going regularly to their hometown, cooking and pottery however their attendance had ‘tailed off’ and the programme had not been revised. The Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 12 resident had also showed a desire to maintain their cooking skills, and records showed that they had helped in the kitchen several times over the past month. Although staff had found residents some activities to do there was little information available in the home about educational or occupational, leisure and community activities so that residents could make informed choices about what to do, so it was recommended that the Owner obtain comprehensive information, that is kept up to date, to encourage residents to take part and gain skills. The Owner had plans to set up a day activity centre for residents, and was also going to hire a music teacher, as she felt it was very difficult to find things for them to do in the community. These plans were at an early stage. The Owner also talked about getting a mini-bus to take residents out. All the residents were looking forward to going to Butlins on holiday in September, and some had been on an enjoyable boat trip recently. Residents were encouraged and supported to keep in touch with family and friends. Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Resident’s personal and health care support and medication was provided safely and as they required and preferred. EVIDENCE: Residents mainly required prompting and encouragement to carry out their own personal care. Residents said staff supported them well and were respectful. Two residents said they liked being looked after and preferred it that daily chores were done for them. Times for getting up and going to bed were flexible, and meals were kept for residents if they were out at mealtimes. Residents either managed their own health appointments or if required were supported by staff. Residents said this was what they wanted. Most residents had support from a Consultant, Psychiatric nurse or social worker. A visiting Psychiatric nurse was very complimentary about the service Highland Mist, and especially the Owner, provided saying that they were able to manage very challenging people and often ‘turn their lives around’ in a positive way. The Owner is knowledgeable and enthusiastic about working with people with mental health needs, and staff said this was passed onto them. She was in daily contact with Highland Mist and saw it as her role to monitor the resident’s welfare; she is on-call and involves herself fully if a resident’s mental health Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 14 deteriorates. In this way deteriorating health is picked up, and professional help sought at an early stage. It was very clear that the Owner works closely and has a good working relationship with the local mental health team. None of the residents administered their own medication, and residents spoken to said this was their choice. The Owner has demonstrated in the past that self-administration of medication by residents is a valued goal and promoted. Staff procedures for the receipt, recording, storage, handling and administration of medication were being adhered to. Staff had received medication administration training, and were about to do a more in-depth distance learning medication course. Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Residents can be confident that their views will be listened to and acted on, but not that all staff fully understand and would be able to protect them from abusive situations. EVIDENCE: Residents did not have any concerns on the day of Inspection, and the commission had not received any complaints since the last Inspection. The Owner demonstrated that she had dealt with a complaint from a resident appropriately. There was a clear complaints procedure available and residents said they felt able to approach the Owner or staff with any concerns. All new and existing staff had now had, or were awaiting the results of Protection of Vulnerable Adult list (POVA) and Criminal Record Bureau (CRB) checks and the Owner understood her responsibilities with regard to the guidance. Staff had not yet undertaken any formal adult protection training although the Owner said she had applied for all staff to attend the Local Authority training, but did not yet have a date. The home had appropriate policies and procedures, but it was unclear whether staff had all read, understood and were implementing them. It is of concerns to the Commission that there has been an outstanding requirement with regard to this issue from the previous 3 Inspections. Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 & 30 For the premises to remain clean, comfortable and safe, maintenance and renewal must be regularly reviewed, planned and carried out, and staff must have adequate health and safety training. EVIDENCE: A continuous cycle of maintenance and renewal is required at Highland Mist, and on the day of Inspection the premises were clean, and adequately furnished to provide a comfortable homely environment for residents. The maintenance person had very recently left, and the Owner said she had secured the services of two other maintenance contractors. The shower room on the first floor was not completed or useable, the plugs were missing from the first floor bathroom sink and bath, the wall paper in a downstairs bedroom was coming away from the wall, a divan was broken, bathroom tiles required re-painting and some paintwork needed freshening-up. The Owner said the bath and showers were now fitted with thermostatic valves and she was about to carry out procedures to control Legionella. The maintenance and renewal plan was in need of updating with timescales. There was an environmental risk assessment, which was reviewed monthly and it was recommended that this check included highlighting any redecoration or refurbishment Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 17 requirements. The Environmental Health Department had visited in May 2005 and left no requirements. All fire checks were taking place, and the Fire Service had not visited since the last Inspection. It is of concern to the Commission that there were two outstanding requirements regarding these standards outstanding from the previous 3 Inspections, and still not fully complied with. Although some staff had done some health and safety training in previous jobs, the Owner said not all staff had done all the required health and safety training. Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 34, 35 & 36 Staff are well supported and supervised and levels of staff competency and skills, and recruitment practices are improving, but do not yet fully meet the needs of residents. EVIDENCE: The Owner had engaged the services of an external training co-ordinator who she is working with to meet some of the staff training needs. The Owner was keen for staff to train, and staff said they enjoyed the courses offered and felt it helped their work. Most care staff had recently finished a City & Guilds ‘Contributing to the Care Setting’ qualification. Staff were also all starting a distance learning medication course, although they had already completed a medication course run by Boots. The Owner said that a number of staff were going to do NVQ courses in September 2005. The Owner did not have an overall staff training plan, but individual training and development profiles were being developed for staff. Some staff had relevant training that they had completed in previous care jobs. None of the staff had done any specific training in working with people with mental health needs, and the Owner said she would look into this. Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 19 Several staff files were examined and found to have most of the required information. Criminal Record Bureau checks had been done for all staff, however there was no written evidence about the Owner’s decision-making when employing staff with issues about their fitness. The rota was available, as were past rota’s, and it appeared that sufficient staff were employed for the needs of residents: two staff throughout the day and 2 staff sleeping-in at night. The staff on duty on the day of Inspection were interacting at all times with residents, were responsive to their requests and showed genuine warmth and respect for them. One resident said they liked the fact that staff supported their ‘funny ways’, and listened. Residents were positive about all the staff. There were records of regular resident and staff meetings, and the Owner and Deputy manager were available on a daily basis for support and advise. All staff were receiving supervision and recently had an appraisal, which highlighted strengths and training needs. Staff said the Owner was a ‘great boss’ who was ‘always there to ask’ if they had problems. Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 & 42 The health, safety and welfare of residents would be better promoted through appropriately trained staff. EVIDENCE: The Owner is also the registered manager at Highland Mist. She is undertaking NVQ 4 and the Registered Manager Award, but has not yet completed it. Although the Owner’s quality assurance system was not examined in depth at this Inspection, it was found that questionnaires had been sent out to residents and professionals that use Highland Mist. Staff had not all received the required health & safety training. The Fire records showed the appropriate checks were regularly carried out. Accidents were also being recorded appropriately, and gas and wiring checks had been done. The Owner said the bath and showers were now thermostatically regulated and she was aware of, and about to put into place a system to Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 21 control the risk of Legionella. Also an environmental risk assessment was regularly carried out and acted on. Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 x 3 2 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 2 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x x Standard No 31 32 33 34 35 36 Score x 2 3 2 2 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Highland Mist Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x x x x x 2 x D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 23 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 2 Regulation 14 Requirement A detailed assessment of a potential residents needs must be carried out before admission (Previous timescale 02/08/05 not met) Each resident must have a care plan that covers all the identified needs in assessments. Residents, their representatives and any other relevant professional must be involved in making their plan (Previous timescale 02/08/05 - not met) The action required to minimise risks identified in a residents assessment must be recorded in their care plan (Previous timescale 02/08/05 - not met). All staff must undertake formal adult protection training, and there must be records to confirm they have read, understood and are implementing Highland Mists adult protection policies and procedures. (Previous timescale 02/08/05 - not met) All care staff must have training in First Aid, food hygiene and infection control At interview the Owner must question, and record her Timescale for action 31st October 2005 31st October 2005 2. 6 15 3. 9 13 (4) (b) (c) 31st October 2005 6th October 2005 4. 23 13 (6) 5. 6. 30 & 42 34 18 (c) 19 31st October 2005 6th September Page 24 Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 7. 35 18 (c) decision-making with regard to gaps in employment, CRB convictions, and poor references (Previous timescale 02/08/05 not met) New staff must have appropriate Induction and foundation training. A staff training assessment and plan must be carried out for the whole staff team. In this instance a copy must be sent to CSCI (Previous timescale 02/08/05 - not met) There must be a comprehensive quality assurance system in place which captures the views of the residents and stakeholders. An annual report must be produced, with a copy available for CSCI and other interested parties. (Previous timescale 02/08/05 - not met) The maintenance and renewal programme must be up to date and include issues identifeid in the Homes risk assessment, CSCI, fire and environmental health reports. In this instance a copy must be sent to CSCI. 2005 6th September 2005 8. 39 24 31st October 2005 9. 24 23 31st October 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. Refer to Standard 6, 12, 13 & 14 12, 13 & 14 32 Good Practice Recommendations Staff records of residents activity programmes, medical meetings and general daily recording should be reviewed regularly and changes should inform their care plans. Up to date information on educational and employment opportunities, local activities and facilities and leisure activities should be provided for residents. At least 50 of care staff should have NVQ 2 by 31st D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 25 Highland Mist 4. 5. 32 37 December 2005. Staff should have specific training in working with people with mental health needs. The Owner should have gained NVQ 4 and the Registered Manager Award by 31st December 2005. Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Highland Mist D54-D07 S18370 Highland Mist V231811 020805 Stage 4.doc Version 1.40 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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