Inspection on 01/08/05 for Hollygrove

This inspection was carried out on 1st August 2005.

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

Hollygrove 16/02/09

Hollygrove 04/02/08

Hollygrove 12/10/06

Hollygrove 20/12/05

Hollygrove 29/03/05

Hollygrove 15/07/04

Hollygrove 08/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Hollygrove 49 Roman Road Salisbury Wiltshire SP2 9BJ Lead Inspector Roy Gregory Unannounced 1 August 2005 st 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. Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hollygrove Address 49 Roman Road Salisbury Wiltshire SP2 9BJ 01722 415578 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) Turning Point Limited Ms Deborah Stone Care Home 9 Category(ies) of LD Learning Disability (7) registration, with number LD (E) Learning Disability - over 65 (2) of places Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 No more than 7 service users with a Learning Disability at any one time 2. No more than 2 service users with a Learning Disability, over 65 years of age at any one time. Date of last inspection 29th March 2005 Brief Description of the Service: Hollygrove is a purpose-built service, initially opened in 1996, providing care and accommodation for nine people with a learning disability, the majority of whom have a range of personal and communication needs.The home is operated by the voluntary organisation, Turning Point, who also have a number of other services within Salisbury.The property is situated in a residential area of the city, a short drive or bus ride drive from the centre. Hollygrove is a two-storey building, with residents’ bedrooms on both floors. All bedrooms are single, have wash hand basins fitted and are close to toilets and bathrooms. Various aids and adaptations are provided for less mobile residents, and a stair lift has been installed. Communal space includes a large kitchen and dining area, a sitting room, and seating areas in the hallway and on the landing. There is also an attractive garden. Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 10:00 a.m. and 3:50 p.m. on Monday 1st August 2005. The inspector met with four residents, including as a guest at the midday meal. The registered manager, Debbie Stone, was available during most of the inspection and made documentation available. Additionally there were conversations with care staff. The inspector looked at a number of care plans; other records consulted included those relevant to staff supervision and training, and health and safety. All communal areas of the building were visited and many individual rooms were seen. What the service does well: What has improved since the last inspection? What they could do better: A feature of the home is that for a number of residents, needs related to ageing are becoming more apparent, with consequences for staff resources in particular. It is therefore a requirement that staffing needs should be formally reviewed, and it is recommended that staff receive training specific to issues associated with the ageing process. The home should produce a policy on how far related needs are to be met in the future. Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 6 There are requirements in respect of hygiene shortfalls, namely to provide staff with better hand-washing facilities, and to obtain certification that the home is free of legionella, together with a system for routine minimisation of risk of conditions conducive to legionella. 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. Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.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 Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.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) 5. (The key standard no. 2 was not considered relevant at this inspection, as there have been no new admissions since 2003, and none were in prospect at this time). The home provides good documentation, to service users and their representatives, in respect of contract and terms and conditions of residence. EVIDENCE: Individual plans contained contracts of residence that had been signed by residents’ representatives, who in turn retained copies for their own reference. Also in each record was a licence agreement, and a Housing Corporation leaflet “Charter for Licence Holders” for reference. Previous inspections have identified that the home has an assessment procedure that would be followed in the event of a vacancy arising to be filled. Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.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 Individual plans direct care and show needs and responses are kept under review. Residents and their supporters contribute to this process. There is appropriate support to risk-taking and to making decisions. EVIDENCE: Care planning for each individual was presented in terms of “what you must know to care for me…to keep me safe”, with guidance on established likes and dislikes. This resulted in effective and understandable plans, some very specific, for example about mealtime support. There was evidence of additions and regular reviews. Individual plans incorporated a range of risk assessments, which again presented as working documents that were competently produced. In one example, an assessment had identified a need to improve safety of an individual’s wheelchair transfers, leading to referral to the occupational therapist, and thus to an appointment on the day of inspection at a wheelchair supplier’s. Review documentation included pictorial content, adding to residents’ direct involvement in the process, and showed evidence of family and external professionals’ involvement. Plans also included evidence-based guidance on how to offer support and encouragement to decision-making. There was recorded evidence in a plan, as to the reasons why the individual did not have use of a bedroom key. Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 10 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 & 17 The nature of care planning, and quality of working relationships between service users and staff, mean that residents have access to planned and spontaneous activities that fit their individual wishes and needs. These provide for access to the wider community, maintenance of significant relationships and homely routines within the home. Good quality meals are served, taking account of individual needs. EVIDENCE: All care plans included an element for leisure and activities. Each resident had a weekly schedule, showing their commitment to attendance at day resources, with which the home maintained evidence of close liaison; and key worker time provided by the home. For one resident for example, use of key worker days was planned for shopping trips, both locally and further afield, support to visiting a friend, hair appointments, meals out, and reflexology sessions. The manager said that, when the key worker is not available, it remains a priority that planned key work activities go ahead with an alternative member of staff. Residents spend considerable time out of the home, and plans showed attention to support to maintenance of significant relationships. Arrangements were in hand to secure community-based support to a resident’s wish to attend Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 11 church regularly. Within the home, there were facilities for audio-visual entertainment in the sitting room, complementing provision residents had made for themselves in individual rooms. Care planning has been augmented by the commencement of Person Centred Planning (PCP), which has assisted identification of individual interests and personal historical factors that can be built upon. For example, one person had been enabled to express and develop an interest in railways and in flying. Minutes of residents’ meetings showed they helped identify wishes about holidays, and a variety of individually planned holidays had been supported in preceding months. Besides daily records diaries for each service user, there was a separate folder for recording key work, leisure and one-to-one activities. Whilst two had most recent entries in June and July 2005 respectively, the others had fallen into disuse since March 2005. Meals are taken at a table large enough for all residents and staff on duty, in the kitchen/diner. Staff showed they had a good knowledge of residents’ likes and dislikes, and there was a picture book to assist indication of preferences. There was plenty of fresh fruit available and offered; one staff member spoke of this as an element in the home’s preference to minimise use of medications. There was attention to individual practical needs in eating, for example by use of special cutlery or cup. The inspector saw the menus in current use, which took account of seasonal factors. Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 12 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 - 21 Staff offer personal support that matches service users’ recorded needs and preferences. Healthcare needs are clearly recorded and managed, with full use of external consultation and guidance. Medication practice is competent and shows a pro-active approach that protects service users’ interests. These indicators in turn mean that age-related factors for individual residents receive appropriate consideration, but there is scope for the home to determine how such factors will be further addressed in the future. EVIDENCE: The question of ageing is becoming significant for a number of residents, the home already being registered for two service users aged over 65 years. The manager said there had been some emphasis over the previous twelve months on reviewing age-related health issues with GPs. For one person for example, there had been a major medication review and referrals to audiologist, eye clinic and occupational therapist. A stair lift has been installed in the past year. The manager said she has been increasingly questioning the staffing needed to support residents who are becoming slower and who have an increasing amount of medical need. She had made a link with Age Concern locally, and recognised the desirability of ensuring staff are trained in aspects of working with the ageing process, and of considering a home statement or policy on what “a home for life” will mean in practice. Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 13 For all residents, there was good documentation of all health appointments and outcomes. Again, the manager said there were an increasing number of external health appointments requiring staff support. A very full health check on a resident in June 2005 had resulted in an action plan involving attention to four main areas of physical health, plus a medication review. Where applicable, there was liaison with mental health services, for example a support plan included recent “guidelines for anxiety” drawn up by a consultant psychiatrist, that stressed non-medical approaches in tandem with reduction of medication use. In some instances, all staff had been required to sign that they had read care plans related to specific health guidance. Medication storage, administration and documentation were seen to be sound, but written additions to the MAR sheets were not signed. Staff have to demonstrate competency in administration of medication, initially as part of induction and then at intervals. At this time, one member of staff was excluded from medication administration as a result of this process. Service users’ plans clearly set out guidelines for how personal care is to be provided to each individual. These provide a useful guide for staff, and are regularly reviewed and updated. Each plan sets out what staff need to do as well as what service users are able to do for themselves. The Manager tries to ensure that there is usually a mix of male and female staff on duty to enable care to be provided by someone of the same gender, and personal care is provided in private. Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 14 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 and their families can feel confident in the home’s provisions for their security, and in the procedures for staff and management to follow in responding to any concerns raised. EVIDENCE: The home has a clear concerns and complaints policy. This highlights how to contact the CSCI and outlines the timescales within which a complaint will be dealt. The complaints procedure has been circulated to and acknowledged by the next of kin of all residents. No complaints have been received either by the home or by the Commission. A number of compliments expressed by relatives through the review process were noted. Turning Point has written procedures regarding abuse and protection, and a whistle blowing policy is in place. The registered manager is familiar with the local multi-agency adult protection procedures, and information is available in the home about this. Protection of vulnerable adults is also part of the staff team mandatory training. Handling of service users’ money was closely recorded, and there was a written format for key workers to request prior manager approval of the use of residents’ monies for significant purchases. The home itself provides a secure environment. A local advocacy service had been engaged to support a resident in respect of housing option needs identified through the person centred planning process. Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 15 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 Hollygrove provides a homely environment where residents enjoy private and communal facilities in comfort and in line with their respective needs. The premises are kept clean and hygienic, but staff hand-washing facilities require improvement and the home has no certification in respect of freedom from legionella. EVIDENCE: All areas of the home were clean and attractively decorated. A maintenance folder showed prompt recognition of and attention to defects. Residents’ bedrooms were of good size and reflected their occupants’ differing interests and personalities. Features such as labelling of drawers aided independence, and it could be seen that residents chose to use their rooms, for example, for rest or listening to music. Bathrooms and toilets were very clean and homely. In one there was a written reminder of the support needs of one service user, as assessed by an occupational therapist. One bathroom contained a Parker bath and quotes were being obtained for the installation of another specialist bath with hoist. The main sitting room was furnished with a mix of provided and individually owned chairs and recliners. There was an audio-visual system that included loudspeakers placed around the room, allowing the television to be heard Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 16 without having to be too loud, and also providing for loud music when wanted. There were further sitting areas upstairs and down, plus an attractive enclosed rear garden, with shade, accessed by patio doors. It was said that residents’ visitors made use of this variety of available meeting space. The kitchen area was a supervised-only room for residents, for safety reasons, whilst the laundry room was restricted to staff use only, otherwise residents enjoyed full access to the home. A stair lift was fitted within the preceding year. There was widespread provision of grab rails to suit individual needs. There was a clear cleaning schedule in place for staff; high risk areas, such as the laundry room, demonstrated the effectiveness of its implementation. It was necessary to point out, however, that hand-washing facilities in the staff toilet risked a compromise of otherwise good practice with regard to hygiene; and there was no current certification in respect of the water system being free from legionella, the last recorded attention being a full water system risk assessment in 2003. Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 17 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, 35 & 36 Staffing has been sufficient in numbers and quality to ensure service users are safely and consistently supported, but changing levels of need suggest a review would be timely. Staff are supported in their roles by regular supervision and by employer support to NVQ and other training. EVIDENCE: Residents have the benefit of a stable staff team that includes many who have worked with them for several years. The manager is supported by two project workers, effectively deputies, which ensures availability of a senior staff member on at least one shift every day. The rest of the staff team comprises support staff, whose duties include domestic and cooking tasks. Rotas showed there were three staff on duty at key times, falling to two or one at times of low occupancy in the house. Debbie Stone said she has found it increasingly necessary to make herself a “fourth person” on shift, as residents’ needs for support have become greater; for example, with two people working upstairs during morning routines, it could be difficult for the member of staff downstairs to monitor all that needed to be done. Added to this was the desire to uphold support to community access to individuals, alongside increasing attendance at service users’ medical appointments. Ms Stone said she had raised concerns about staffing levels with Turning Point’s regional office, hoping they can be considered before becoming too acute by virtue of escalating levels of need. Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 18 There was an information point for staff, and minutes showed staff meetings included updating information about each service user. Records showed staff received regular supervision, which also incorporated reference to needs of residents in general, and an individual’s “key” resident in particular. Training records were very good, showing what individual members of staff had achieved and what was further planned for them, including renewal of mandatory courses, based on personal development plans. In addition there was an overview for the whole team. Ten of the staff have attained NVQ to level 2 or 3 (mainly 3) and one to level 4. There had been no new staff recruitment since previous inspection. Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 19 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 There is clear leadership and direction from the provider company and the registered manager. There are systems in place to identify and promote the health and safety needs of residents and staff. EVIDENCE: Office systems and documentation were orderly and up to date, such that issues requiring attention could be seen to be in hand. Debbie Stone has achieved the Registered Managers Award. There was efficient delegation of some responsibilities, such as infection control, ensuring such matters did not get “lost.” There was a current business plan for the home. With regard to health and safety, accident records were good and there were up to date records of servicing and checking of gas and electrical wiring and appliances. All fire precautions records were complete and there was evidence that environmental risk assessments were working documents, subject to review. Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 20 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 x x x 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 x 3 3 3 3 x 3 Standard No 31 32 33 34 35 36 Score x 3 2 x 3 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Hollygrove Score 3 3 3 3 Standard No 37 38 39 40 41 42 43 Score 3 x x x x 3 x D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 21 Are there any outstanding requirements from the last inspection? No, none were set at previous 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 30 Regulation 13 (3),(4)(c) Requirement The registered person must ensure the home is certified as free from legionella bacteria, and that a procedure is in place for routine testing and risk minimalisation in relation to legionella. Hand-washing facilities in the staff toilet must accord with recognised infection control guidance. There must be a review of staffing needs in the home. Timescale for action 30th November 2005 2. 30 13 (3) 30th September 2005 30th November 2005 3. 33 18 (1)(a) 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 11 20 21 Good Practice Recommendations Greater use should be made of the key worker diaries already in place, to record and monitor residents participation in activities. Any handwritten additions to the MAR sheets should be signed and dated. There should be a policy on how the home will meet care needs related to the ageing of residents. D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 22 Hollygrove 4. 21, 35 All members of staff should receive training concerning ageing processes and associated care needs. Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 Page 23 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire SN15 2BB 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 Hollygrove D51_D01_S28451_HOLLYGROVE_v183728_010805_Stage4.doc Version 1.40 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. 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!