Inspection on 17/07/07 for Holgate House

This inspection was carried out on 17th July 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.

Other inspections for this house

Holgate House 02/08/06

Holgate House 01/03/06

Holgate House 14/09/05

Holgate House 01/02/05

Holgate House 20/07/04

Holgate House 25/02/04

Similar services:

Littledale Hall Therapeutic Community

Bennett House

Padgate House

Mary & Joseph

Westcliffe House

Richards House

Hamer Cottage

Turning Point (Hoole Road)

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

CARE HOME ADULTS 18-65 Holgate House Mill Bridge Mill Lane Gisburn Lancashire BB7 4LP Lead Inspector Jane Craig Unannounced Inspection 17th July 2007 10:00 Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 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 Holgate House DS0000009645.V338447.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 Adults 18-65. 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. Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Holgate House Address Mill Bridge Mill Lane Gisburn Lancashire BB7 4LP 01200 445200 01200 415974 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) Holgate House Limited Miss Zoe Louise Ingham Care Home 7 Category(ies) of Past or present alcohol dependence (7), Past or registration, with number present drug dependence (7) of places Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 2nd August 2006 Brief Description of the Service: Holgate House is a small unit offering rehabilitation for adults with a history of drug and/or alcohol dependency. The service can offer 24-hour personal care and accommodation to seven people. The treatment approach at Holgate House is person centred and cognitive therapy, based on the 12-step philosophy. The home is situated on the edge of the forest of Bowland, within walking distance of the small village of Gisburn. There are a few shops and a local bus service in the village. The house has a mix of single and shared bedrooms. Communal rooms include a large lounge, a dining room, a group room and kitchen. Counselling rooms are available in an adjacent building. Holgate House stands in large grounds with patio areas and a covered area housing a table tennis table. A large garden across the lane provides space for badminton and football. There are ample car parking spaces. Information about the home is given to prospective service users on referral. Copies of the latest inspection report are available from the manager on request. The registered manager confirmed that the fees at 17th July 2007 ranged between £393.00 and £463.00 per week. The fee did not cover the following items: hairdressing, toiletries, activities, magazines and papers. Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A key unannounced inspection, which included a visit to the home, was conducted at Holgate House on the 17th July 2007. At the time of the visit there were six people accommodated at the home. The inspector met with them all in a group situation. This was in keeping with the ethos of the home, where group work is an essential part of the programme. People were asked about their views and experiences of living in the home and some of their comments are quoted in this report. Discussions were held with the registered manager, another member of the management team and two members of staff. The inspector made a tour of the premises and viewed a number of records and documents. This report also includes information submitted by the registered manager prior to the inspection. Two people who use the service and three health professionals returned surveys before the inspection visit. Their views about various aspects of the home were positive. What the service does well: People thinking of using the service were encouraged to visit Holgate House and meet with the staff and other residents before they made a decision whether to stay. People said they received a lot of information during the visit, which was very useful. One person said they had been made to feel very welcome. People were assessed before they were offered a place. This helped to make sure that the manager and staff understood their needs and did not admit anyone whose needs could not be met by the service. People using the service were involved in all aspects of planning their care. Staff encouraged them to set their own goals and review their progress towards meeting them. Staff helped people using the service to identify and manage risks of relapse that they faced during their daily lives. People said that staff always gave them reasons why their activities were restricted. One person said that staff were good at explaining this in ways they could understand. People were happy with the way the menus were chosen and how the cooking was organised. One person said, “It’s an excellent way of doing it.” Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 Page 6 People using the service said the strength of the home lay with the staff, who, one person described as, “excellent.” Another person said, “They are the best counsellors I have ever come across.” The whole group agreed that the staff were very good at what they do and very caring. When they were asked what they thought the service did well, the group’s comments included: “stability,” “offer a safe environment,” and “help us to build up safe networks.” What has improved since the last inspection? 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. Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The admission process was thorough and ensured that the service user’s needs were understood. EVIDENCE: People using the service said they were sent information about the home to help them decide whether the service was right for them. They were given an information pack when they visited and they said there was always a copy around the home if they needed to refer to anything. The manager had access to people’s health and social care histories before deciding whether to accept a referral. In most cases the person thinking of using the service was invited for an introductory visit and assessment to ensure the programme was suited to their needs. In exceptional circumstances the manager would go out to see the person or conduct a telephone assessment. The manager talked about the importance of ensuring that the person was able to fit in with the existing group. People using the service said the assessment visit was useful and one said, “I was made to feel very welcome as soon as I arrived.” Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People were involved in setting their own goals and staff had sufficient information to help people to meet their needs. The lack of freedom to make decisions and take risks was understood and agreed by people using the service. EVIDENCE: As part of the assessment and care planning process people were asked to give their own perceptions of their strengths and needs and to identify treatment goals. Care plans followed the 12 step programme and advised treatment approaches to be used. People said they were responsible for writing their own diaries and notes and progress towards meeting goals was discussed during a weekly group meeting. People were happy with this format. One person said that talking with the others helped them to focus. Other needs, such as ongoing healthcare needs, were addressed on separate plans, some with input from health professionals. Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 Page 10 People said their ability to make decisions was limited but they had expected that. The admission pack and house rules stated clearly what issues were decided for people whilst they were resident at Holgate House. One person wrote, “we can only make decisions to a certain extent but I realise that we need to follow rules and regulations.” The manager stated that there was more flexibility and decision making towards the end of people’s stay to prepare them for more independent living during the next stage of the programme. There was a detailed policy with regard to risk taking. The registered manager discussed how people were encouraged to identify the potential risks involved in any activity they did. One person using the service said, “Everything we do that is not laid down in the programme is subject to a risk assessment.” The group discussed the risks and made suggestions as to how they could be minimised. The group made the decision whether the activity should go ahead or whether the risks were too great. One person said, “sometimes it hard to take but that’s what we agreed to.” Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service agreed with the restricted lifestyle they had whilst taking part in the rehabilitation programme. They were satisfied with the meals served to them. EVIDENCE: The house rules were very clear about how people’s lifestyles would be restricted whilst they were taking part in the programme. The weekly programme of educational and therapeutic sessions was very full. One person said, “Most of us have led very chaotic lives and need some stability and discipline.” Another said that they had spent so long doing exactly what they wanted they found it a bit hard at first. As people were moving on to the next stage staff assisted them to look at new areas of activity and occupation to fit in with their new lifestyle. Staff also helped with housing, budgeting and other areas of daily living. Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 Page 12 People using the service expressed some concerns that their weekly leisure outings did not have as much status as the rest of the programme. The manager had already acknowledged in her self assessment that there was room for improvement in this area and was looking at ways to do this. There was restricted visiting which was made clear in the house rules. There were restrictions on who people were allowed to see or contact by telephone. The manager said that there was some flexibility for people who had children. People using the service had limited access to community facilities. They generally only went out in groups to AA or NA meetings. They were not able to go out alone or without a completed risk assessment. People said that staff were good at explaining the reasons for the restrictions in ways that they could understand. People said that their privacy was respected by staff and each other. Those people who shared rooms said they were happy to do so. The manager said she tried to accommodate people who requested single rooms. This was confirmed during the group discussion. People using the service were responsible for planning meals, shopping and cooking on a rota basis. One person said, “it’s an excellent way of doing it, it means everyone gets to have their favourites at least once a week.” The group said that people who were less proficient at cooking were teamed up with someone more experienced. One person said, “It’s all about working together.” Staff checked the weekly menus to ensure variety and a degree of healthy eating. The manager stated that alternatives were available if someone did not like what was on the menu and the group said that sometimes they may have to cook two meals, for example if someone was a vegetarian. Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The healthcare needs of people using the service were clearly identified and met by staff, with support from the multi-disciplinary team. The management of medicines provided safeguards for people using the service. EVIDENCE: There were strict times for personal care routines within the treatment programme. The house rules stated an expectation that people would be appropriately dressed and groomed at all times. Staff support was available if necessary. People’s physical and mental health needs were identified during the assessment process and documented on a separate care plan. Staff said they received verbal information about any ongoing health needs and also had written guidance in the care plan for any special needs. A member of staff described the care and potential emergency procedures for one person with ongoing physical health needs. This was accurately reflected in the care plan. Records showed that referrals were made to outside agencies and staff ensured that people kept appointments. Health professionals who completed Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 Page 14 surveys indicated that people’s healthcare needs were met at the home. One person wrote, “from a general practice perspective their administration seems first class,” and another commented, “strong impression of a good service.” There were improvements in the way medicines were managed. Everyone using the service had an up to date list of medication. There were complete records of medication received and disposed of. Medication Administration Record (MAR) charts showed that medicines were given as prescribed. Stock balance was recorded daily and stocks were checked every month. The MAR charts were handwritten but had not been countersigned. Some people using the service administered some of their own medicines. They signed a declaration that they were able to self medicate but there were no assessments to show that they were able to do so safely. All medicines were stored safely. There was no excess stock and unused medicines had been returned to pharmacy. Staff with responsibility for handling medication had received training. Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service knew how to make a complaint and were confident that their concerns would be dealt with appropriately. Staff understood safeguarding issues ensuring that any allegations would be investigated. EVIDENCE: Everyone received a clear complaints procedure in their information pack. People who completed surveys indicated that they knew who to speak to if they were not happy. During the group discussion people said that they could approach any of the staff at anytime if they were unhappy about something. They were confident that it would be dealt with fairly. One person mentioned that they were able to ring the advocate, a member of the local clergy, if they needed to. Everyone said they knew how to make a formal complaint, there had been none to the service or to CSCI. Staff received training in safeguarding adults during their induction training and were encouraged to refresh their knowledge by re-reading the policy and other written guidance. Staff spoken with were aware of how to report any allegations outside the home. There were other policies and procedures in place, such as dealing with bullying, violence and aggression, to help staff protect people using the service. One person said, “It’s the safest place I have ever lived.” Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service were satisfied with the environment, which suited their needs. The standard of cleanliness and hygiene was satisfactory. EVIDENCE: Work was in progress to extend the home and increase the number of bedrooms. Although the building work impacted slightly on the existing environment none of the people using the service were bothered by it. Some communal rooms had been swapped around and completely renovated which improved the living space. There was a three monthly audit of the environment and an action plan drawn up to improve any areas identified as needing attention. However, during a tour of the premises two bedrooms were identified as needing repainting and two carpets needed to be repaired or replaced. Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 Page 17 People using the service said they were happy with the environment, which one person described as, “sound.” They said they were able to point out any problems or could make suggestions for changes during house meetings. On the day of the visit the home was clean and tidy. People using the service were responsible for domestic tasks and their own laundry. All said they were happy with this arrangement. People said that staff were very keen about kitchen hygiene and they were pulled up if they weren’t wearing an apron or using the right coloured chopping board. The manager’s self assessment indicated that food hygiene training for people using the service was being planned. The manager stated that all staff were due to have infection control training next month. Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment practices safeguarded people using the service. People were supported by a competent and qualified staff team in sufficient numbers to meet their needs. EVIDENCE: There were sufficient staff on duty to meet the needs of people using the service. Staff were available to facilitate groups and provide individual counselling as indicated on people’s programmes. There was flexibility to increase staffing levels at any time. One new member of staff had been recruited since the last inspection. Records showed that they had been recruited in accordance with policy. Their file contained evidence of pre-employment checks and the required documents and information had been obtained. The manager had purchased a new induction training package since the last inspection. The pack met the common induction standards and included Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 Page 19 assessment of competencies. All recently employed staff were doing the training, which one person said was very useful. In addition to health and safety training, staff had access to other courses relevant to the specific needs of people using the service. For example one person said they had recently been on a counselling course and were waiting for a date for drug awareness training. The manager’s self assessment indicated that over 50 of staff held an NVQ in health and social care although she was still not able to access training to meet the Drug and Alcohol National Occupational Standards (DANOS). A number of people said that the best thing about the service was the staff. One described the staff team as, “the best counsellors I’ve ever come across.” Others said the staff were, “really good at what they do,” and “they know what they are doing.” The whole group agreed that the staff were very caring. Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using the service and staff benefitted from a safe and well managed home. There was some consultation with people using the service and staff but there was a lack of structure for the development of the service. EVIDENCE: The registered manager had many years experience of working with the service user group. She held a management diploma and a diploma in person centred counselling, which was applicable to her work. Staff and people using the service said the registered manager was approachable, supportive and competent. Other members of the management team, including the responsible individual, supported the manager. Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 Page 21 People using the service were asked to complete satisfaction surveys during their admission and on discharge. All those seen were very positive. The manager said that any comments or suggestions would be followed up but there was no development plan in place to show the future plans for the service. People using the service said they could make suggestions during house meetings and as far as they were aware they were acted upon or they were given reasons why not. Staff meetings were held each week and focussed on care issues rather than service development, although a member of staff said she felt quite comfortable in making suggestions for change. There were no internal audits of systems or procedures such as care plans or medication. Staff had received update training in health and safety topics, including fire safety. Fire drills, involving staff and people using the service, were held every two months and whenever anyone new was admitted. Records of outcomes were kept. The fire risk assessment was reviewed every month. Fire safety equipment was serviced regularly. Information submitted by the manager showed that electrical equipment and installations were tested and serviced. Risk assessments were in place where service users had access to potentially hazardous items. All staff were qualified in first aid. Holgate House DS0000009645.V338447.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 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 2 X X 3 X Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 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. Standard Regulation Requirement Timescale for action 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 YA20 YA20 Good Practice Recommendations In order to reduce the risk of errors, handwritten entries on MAR charts should be checked and witnessed. Risk assessments should be carried out with people who wish to administer their own medication to identify whether they need help to do so safely. The registered person should make sure that bedrooms with dirty and scuffed paintwork are repainted and carpets with worn patches are repaired or replaced. A plan should be drawn up to show how the service is to be developed. Views of people using the service should underpin the planned improvements. 3. YA24 4. YA39 Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Holgate House DS0000009645.V338447.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!