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Inspection on 21/02/07 for Hillcrest Residential Home

Also see our care home review for Hillcrest Residential Home for more information

This inspection was carried out on 21st February 2007.

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

The inspector 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

Information provided by the home is informative and up to date. Assessments are routinely carried out before a prospective resident moves into the home. The manager is very dedicated and caring. Both she and care staff are all approachable and friendly. The recording in the care plans and daily statements about residents in the home is good and shows what care had been provided and by whom. When a resident moves into this home all aspects of their care are reviewed and solutions found. Examples of this included new glasses with a changed prescription and consultation with a dietician that had led to weight gain in three cases looked at. The home is comfortable and on a smaller scale than some care homes and therefore has more of a domestic feel. This home tends to suit and attracts people who may not be mainstream and may have led an alternative lifestyle. Care staff were seen to be respectful of these choices.

What has improved since the last inspection?

The last key inspection was in July 2006 when six requirements were made. At the random inspection in September 2006 five of these requirements were actioned. At this inspection those five requirements were seen to have been maintained and the sixth requirement was actioned. Hot water is supplied to both baths and is within an acceptable temperature range. The recruitment and supervision of staff is appropriate and evidence of this was seen on the day. The manager is progressing with her qualification NVQ 4 and the registered managers award.

What the care home could do better:

There are three areas that the manager agreed to concentrate on over the coming months. These included further developing regular activities presented to residents based upon their interests. Ensuring that reviews of care plans are consistently done and recorded. And finally the environment; There must be repairs carried out to shower tiles, the upstairs bath and the boarding in the downstairs toilet. The environment in the home is clean, warm and has a lived in feeling, a lot of the fabric of the home is well worn, therefore a plan to include what refurbishment is planned along with a timescale and a planned cost should be developed.

CARE HOMES FOR OLDER PEOPLE Hillcrest Residential Home 14 Northgate Avenue Bury St Edmunds Suffolk IP32 6BB Lead Inspector Claire Hutton Unannounced Inspection 21st February 2007 10:45 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 Hillcrest Residential Home DS0000024417.V330135.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. Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hillcrest Residential Home Address 14 Northgate Avenue Bury St Edmunds Suffolk IP32 6BB 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) 01284 760774 Mr Christopher J and Mrs Magda Hope Mrs Magda Hope Care Home 13 Category(ies) of Old age, not falling within any other category registration, with number (13), Physical disability (1) of places Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named individual as notified to the Commission on 23/11/06 in the category of Physical Disability. Condition to expire on 07/01/09. 7th July 2006 Date of last inspection Brief Description of the Service: Hillcrest Residential Home is a privately run care home based in a Victorian property that has been extended and adapted to provide residential care since 1997. The home is located in a quiet residential area of Bury St. Edmunds. It is close to a small shop that is accessible to some residents. Hillcrest provides two single bedrooms and one double bedroom on the ground floor along with nine single bedrooms on the first floor. Access to the first floor is by stair lift. There is a step between the lift and the bedrooms, which may prove difficult for service users with mobility difficulties. One of the bedrooms benefits from the provision of en-suite facilities. There are two communal assisted bathrooms and five assisted toilets within the home. Residents have access to a lounge that overlooks the pleasant garden with seating provided. There is also a separate dining room on the ground floor. Smoking is not permitted at the home. Fees at this home range from £331 to £415 per week. Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over four hours on a weekday. This was a key inspection, which focused on the core standards relating to older people. The report has been written using accumulated evidence gathered prior to and during the inspection. The progress made at the random inspection carried out on 14th September 2006 was reviewed to ensure maintenance of quality of care. Time was spent talking with three residents, three staff and the manager. Additionally a number of records were inspected including those relating to residents care plans, staff personnel and training, medication, quality assurance and polices and procedures. What the service does well: What has improved since the last inspection? The last key inspection was in July 2006 when six requirements were made. At the random inspection in September 2006 five of these requirements were actioned. At this inspection those five requirements were seen to have been maintained and the sixth requirement was actioned. Hot water is supplied to both baths and is within an acceptable temperature range. The recruitment and supervision of staff is appropriate and evidence of this was seen on the day. The manager is progressing with her qualification NVQ 4 and the registered managers award. Hillcrest Residential Home DS0000024417.V330135.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. Hillcrest Residential Home DS0000024417.V330135.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 Hillcrest Residential Home DS0000024417.V330135.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, 2 and 3. Standard 6 does not apply. Quality in this outcome area is good. Residents can expect all their needs to be properly assessed before they move into the home, and up to date information about the home is available. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The owners of this home recently sent the Commission a revised Statement of Purpose and service Users Guide. This was part of the information they submitted for a variation to their registration to care and support one individual under the age of 65 who required care with their physical needs. Information is available from the home that clearly states what Hillcrest can offer any prospective resident and their representatives. Assessments and contract relating to three residents were examined. Either the manager or one of the two senior staff carries out assessments. This tended to be done by visiting the individual and their representatives at their current address. Other information such as a community care assessment was seen as well as discharge information from hospital. Contracts and agreements were seen to be in place for those records examined. Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. Quality in this outcome area is good. Residents can expect that care plans are developed to ensure that needs are met. Timely referrals to health care professionals are made. Residents are protected by the home’s medication procedures. Residents are treated with dignity and respect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care plans, with daily records and ongoing assessments were examined. The quality of care plans is much improved. From reading care plans, chatting to residents and discussing care needs and responses from staff this all demonstrates that the plan of care and the care and support given does meet the needs of the residents. Each plan was individual with specific areas concentrated upon. One resident had been admitted with concerns over selfneglect and therefore the home had consulted a dietician. In the three months that the resident had been at the home they had gained 7lbs. Similar concerns about weight were noted for another resident and they too had gained 5lbs in the two months they had been resident. A third resident who had been at the home some time told me very proudly that they had put on half a stone since being here and that was because the food was lovely. Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 10 Care plans not only set out clearly the care needs, but also had risk assessments such as falls prevention information, safety in bathing and use of the chair lift. One area that needs to improve is the evidence that care plans are consistently reviewed on a monthly basis. Access to medical services was clearly documented. Two new residents had seen an optician and a new prescription and glasses had been prescribed. Access to the GP, continence advisor and District Nurse were all documented appropriately. One resident had a long standing condition with their legs that required regular visits from the District Nurse. However since being at the home this condition had improved and the nurse no longer needed to visit. However the care plans clearly stated in what circumstances a District Nurse should be contacted if the need arose. Medication at the home was inspected and all was found to be satisfactory and as it should be. All three people (manager and two seniors) have the appropriate training. Medication was stored and adequately secured. Stocks of medication matched that prescribed. Records were well kept and able to be audited and showed that all residents received medication as prescribed. Staff were observed knocking on residents’ doors before entering, and discreetly checking other episodes of personal needs. One resident was very keen on their privacy and staff had reassured them and given them a key to their own room which was able to be locked when ever the resident chose. Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area is good. Residents independent enough to develop their own pastimes can expect to be satisfied. Contact with family and friends can be maintained, as is a degree of control over ones life. Catering at the home is of a good standard. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans examined showed staff had discussed with residents life histories with them and had asked about their interests in life. There are a number of people at Hillcrest who have traditionally been on the fringes of mainstream society. These people appear to be well accommodated at Hillcrest because their choices around their lifestyles are respected. If individuals choose not to socialise or just be observers to happenings at the home then this is OK with the homes community. The signing in book showed that a local artist had visited to work with residents in February. Over Christmas various community groups such as Brownies and Guides visited and performed carols at the home. Residents were seen to be in control of the TV, requesting it to be turned off and have radio Suffolk on instead. A couple of residents were doing a jigsaw puzzle together and two others were seen to have a daily paper. One resident spoken with was celebrating his Birthday and was getting ready to go to relatives for the day. Information about the home states that visitors are welcome to visit at any reasonable time. The visitor book showed there were several visitors Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 12 for residents. The manager spoke of relatives support being welcomed at the home and on occasion she has helped residents speak up for themselves when the best interests of the resident may have been sidelined. All but one resident came to the dining room for lunch, preferring instead to eat in their room. Two residents spoken to say the food is very good. Lunch on the day was Chicken casserole with mash potatoes, cauliflower and sprouts. Two residents had chosen to have something different and had jacket potatoes instead. All residents had the fruit crumble and custard that followed. The day before residents had eaten Sausage, egg and chips with beans and some had chosen pancakes. This was followed by fruit salad and cream. Breakfast is usually cereal and toast, but eggs and porridge can be requested. Teatime usually is lighter and examples include sardines or cheese on toast. All food planned is on a rotation menu system and all food eaten by residents is recorded. There were no excessive food stocks. The Cook confirmed that the home never ran out of anything and that most of the shopping was done at Tesco which is just around the corner. The environmental health Officer had conducted a routine visit in November 2006. Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. Quality in this outcome area is good. Residents and others can expect that complaints will be listened to and taken seriously by the home. The home has in place strategies to protect residents from abuse as far as is possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a complaints procedure in place and this is part of the Statement of Purpose and Service Users Guide. Information on how to make a complaint is displayed at the home. A form outlining the complaints procedure and how to complain has been left in every resident’s room along with an addressed envelope. The home has not received any complaints since the previous key inspection in June 2006. The home has a protection of adults procedure in place. There is a reporting format now in place that is known and available to staff. Staff have under gone training in this area and evidence of certificates was seen. Recruitment files examined for one staff member currently being recruited showed that they had had a CRB (criminal records bureau) before they take up their post at the home. Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 23, 24, and 26. Quality in this outcome area is adequate. The environment at Hillcrest is comfortable and generally meets the needs of the residents. There are some areas of outstanding repair that would benefit the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A tour of the whole home was conducted except for two bedrooms as this would have infringed upon the privacy of the residents concerned. As you enter the home it is clean and fresh and the entrance is well maintained and welcoming. The entire home was clean, pleasant and hygienic. Hillcrest has a lived in feel with most of the home showing signs of being well worn. Future plans of refurbishment and redecoration were discussed with the manager. The home has sufficient toilets conveniently placed around the home. There are two assisted bathrooms and one shower room. There were two matters of minor repair outstanding and these are repeated from the previous visit to the home in September 2006. There were tiles needing to be repaired in the Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 15 shower room and a panel in a toilet that was in need of repair as moisture and paint loss had affected the area. The upstairs bath has a crack in it from the hoist being lowered too far. This has been repaired. But the bath must be replaced. Bedrooms were suitable for residents with personal possessions in them. The laundry room is well equipped for the needs of the residents and is the area where commodes pans are cleansed appropriately. The home has a pleasant garden at the rear and can bee seen from the French doors in the lounge. However only people who can manage four steps would be able to access the garden. The manager is currently looking into how access can be made easier. The stair lift was seen in operation. A notice of how to use the stair lift safely was posted at each end of travel for additional safety. Risk assessments relating to the use of this equipment was seen. Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Quality in this outcome area is good. Residents can expect to be supported by just sufficient ratios of care staff that are set to improve. Staff are generally well recruited and have reasonable access to training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The current weeks roster and the previous three weeks rosters were examined. Staffing levels were just enough the week of the inspection. In the morning on three days there were three staff on duty and the other four mornings there was two staff. The previous three weeks had shown that generally three staff worked in a morning and two in an afternoon. At night there is an awake carer and a person designated on call. The manager had started the recruitment process and was awaiting the necessary checks to come back before employing another carer and a cook. Therefore staff levels are set to improve. The two senior care staff had evidence of NVQ 2 and 3 completed. A third staff member had their NVQ 2. Three other staff were set to commence their NVQ 2 training. Staff had evidence of their formal induction that they had completed through Kerrison training centre. This included manual handling and protection of vulnerable adult training. Staff had recently attended training in Infection Control and Fire training. The recruitment records for the two staff currently being recruited were examined. These records showed a knowledge of the checks that are required before a person starts work at the home. References and CRB’s had been applied for. The prospective carer had also completed the application for their Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 17 formal induction. All other staff recruitment records had been seen at previous inspections and were in order. Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 18 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, 32, 33, 35, 36, and 38. Quality in this outcome area is good. Residents can expect to live in a home, which has a manger that has a genuine wish to care for older people. And is run for the benefit of the residents. Residents can expect their safety to be safeguarded as far as is possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was helpful throughout the inspection process and along with staff comment and residents comment it is concluded that their approach is one of kindness and a genuine wish to care for older people. Staff and residents find the manager approachable and that she listens. The manager has the appropriate experience to work with older people having worked in this area for several years. She trained as a Registered General Nurse, but has not kept up the registration. Since the last key inspection the manager has enrolled on the combined award at west Suffolk College and this was said to be progressing nicely. The manager hopes to be NVQ 4 qualified, with the registered managers award within the coming months. Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 19 The home does not act as agent in financial matters for any resident but does hold a small amount of personal monies for resident and this is kept secure with a system of accounting in place. Only one person has access. Over the last two inspections there has been thought and development in creating a quality assurance system within the home. An envelope is now left in each bedroom for a new resident. The envelope has a letter of explanation with some forms to receive compliments and concerns/complaints about the home. No complaints had been received but one more satisfaction survey had been completed. When asked about other consultation with residents such as residents meetings, there was evidence that a residents meeting was planned for the next week. The manager stated that staff are appropriately supervised and that formal supervision was taking place. Evidence was available to support this. There was also good recording from the recent staff meeting held at the home. Records and policies relating to servicing of equipment – including all hoists, lifts, fire risk assessment, food hygiene inspection, electrical appliances, and landlords gas safety certificate were examined and found to be satisfactory. Hot water temperatures were examined and found to be within safe limits. Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 20 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 3 X 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 3 X 3 Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 21 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 OP19 Regulation 23 (2) (b) Requirement The home must be maintained to meet the needs and comfort of the residents. Therefore the shower tiles must be replaced and the toilet wall be repaired. The home must be maintained to meet the needs and comfort of the residents. Therefore the upstairs bath must be replaced. Timescale for action 16/04/07 2. OP19 23 (2) (c) 16/04/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP20 Good Practice Recommendations A plan to make level access from the lounge to the garden should be considered to enable all residents to use the garden area. The home is showing signs of ware and tear. A plan for refurbishment and redecoration with work timescales and costing should be developed. DS0000024417.V330135.R01.S.doc Version 5.2 Page 22 2. OP19 Hillcrest Residential Home 3. 4. OP7 OP12 Staff should evidence that they review care plans at least once a month. The home should develop more opportunities for social contact and activities. Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Suffolk Area Office St Vincent House Cutler Street Ipswich Suffolk IP1 1UQ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Hillcrest Residential Home DS0000024417.V330135.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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