Inspection on 09/10/07 for Homemead

This inspection was carried out on 9th October 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Homemead 17/07/08

Homemead 12/09/06

Homemead 24/01/06

Homemead 17/06/05

Homemead 28/09/04

Homemead 14/05/04

Homemead 26/02/04

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

CARE HOMES FOR OLDER PEOPLE Homemead 28 Park Road Teddington Middlesex TW11 0AQ Lead Inspector Sharon Newman Unannounced Inspection 07:30 9 October 2007 th 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 Homemead DS0000017373.V350539.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. Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Homemead Address 28 Park Road Teddington Middlesex TW11 0AQ 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) 020 8977 5002 0208 977 8888 carmel.regan@ccht.org.uk Central & Cecil Housing Trust Ms Carmel Regan Care Home 30 Category(ies) of Dementia - over 65 years of age (30) registration, with number of places Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th January 2007 Brief Description of the Service: The service is operated by the Central and Cecil Housing Trust, a not-for-profit provider. The home provides accommodation for a maximum of twenty-nine older people who may have dementia. Staff support is available to residents twenty-four hours a day. The home is situated in a residential area of Teddington. The nearby high street provides a range of community facilities, such as shops, banks, pubs and restaurants. Bushy Park is a short walk away and the River Thames is close by. The Central and Cecil Housing Trusts mission statement reads as follows: We aim to maintain and improve the quality of life, independence and dignity of all within our care by providing comfortable, secure homes in an environment of support. Fees are £600 per week for those residents who are self funding and £561 to £580 for residents placed here by the local authority. Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of this service included an unannounced visit to the home on 9th October 2007 by one regulation inspector. The manager was not on duty however the deputy manager of the home was present throughout this visit and was available for discussions about the service. Two relatives and a number of residents were also spoken to. The deputy manager and staff were welcoming and helpful throughout the inspection. Documentation looked at included medication records, staff recruitment information, residents care plans and health and safety documentation. A tour was also taken of the premises. The manager has also completed and returned an Annual Quality Assurance Assessment (AQAA) which is a self assessment survey of the home. Surveys were left at the home for residents, staff, relatives health professionals and social care professionals to complete. Only two were returned from relatives before this report was completed. These were largely positive about the home. What the service does well: What has improved since the last inspection? Care plans are now reviewed regularly to help to make sure that any change in residents needs is documented. New double glazed windows and doors have been put in place in the lounge area. This greatly improves the look of this area and ensures that it is warmer and more comfortable for residents. Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 6 The fire escape has been cleaned to help ensure the safety of people using it. Staff are receiving training in dementia care to help them have more of an understanding about this conditions and meet the needs of the residents. 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. Homemead DS0000017373.V350539.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 Homemead DS0000017373.V350539.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): 3 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Residents are assessed prior to coming to live at the home. This helps to make sure that the home can meet their needs. EVIDENCE: Senior staff assess residents before they move to the home to help ensure that the home will meet their needs. In the residents files that were looked at all residents had pre-admission assessments in place. Those residents referred to the home by social services have full Local Authority assessments completed before they are referred to the home. There was also evidence of reviews of the residents’ care involving them and their families. This helps to ensure that residents needs continue to be met at the home and that any change in need is discussed and documented. Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 9 A relatives who were visiting the home reported that they were due to attend a review of the care of their family member that week. They said that they were ‘very happy’ with the care provided at the home and that the service provided was excellent.’ Another relative commented that this is ‘a brilliant home.’ Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents have access to a range of health and social care services. Residents were seen to be treated with respect by staff. Staff have a good rapport with residents. No issues were seen regarding the storage, or administration of medication. EVIDENCE: The home is continuing to move towards a computerised system of care planning and records management. The deputy manager reported that most of the residents care planning information was now available on this system. Care plan information about the residents is also available in individual ring binders. As found at the previous inspection visit care plans were seen to be detailed and thorough, they covered areas including continence, nutrition, dressing, personal hygiene, interests and hobbies, mobility, relationships, Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 11 sexuality, religion and culture. Those care plans seen were observed to have been reviewed monthly to ensure that any changes in the residents needs are noted. They are well organised and contain a clear index indicating where to find relevant information. We discussed with the deputy manager that some of the daily entries in the care plans were quite brief and included statements such as ‘she is fine’. These notes would benefit from being expanded upon to demonstrate in more detail how residents needs are being met. Also there were two entries in one care plan recording that a resident was ‘not too well’ but it was not indicated what action had been taken. Action taken must be recorded to ensure that residents’ needs are met. There were many risk assessments in place in the residents care plans covering areas such as continence, nutrition, pressure areas, moving and handling and falls. However one resident did not have a pressure area or nutritional risk assessment in place. The deputy manager reported this would be addressed. There was evidence of input from local GP’s and district nurses. The deputy manager reported that the home has a very good relationship with it’s local GP practice and the district nurses. She reported that the home can call upon these health professionals for advice and that they visit regularly. Regular visits are also made to the home by chiropodists, opticians and dentists. The local Macmillan Nurse service also provide help and support to the home. The deputy manager reported that this service was extremely supportive. Medication was seen to be stored securely within a locked trolley. The medication administration records (MAR) were in good order and no omissions in recording were seen. Most of the allergy section had been completed, however four had not been. All residents with allergies must have these recorded clearly to help ensure the safety of the residents. Where residents no allergies are known then this must also be recorded on the MAR sheets. One MAR sheet did not have a photograph of the resident attached and this should be attached to help to ensure the correct identification of residents. Staff were observed to interact warmly with residents and to show them respect. Residents were seen to be appropriately dressed. Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Activity provision remains good and residents are encouraged to participate in activities. Residents are encouraged to maintain contact with family and friends. Relatives are made to feel welcome. Residents are offered a choice of nutritious food in pleasant surroundings. EVIDENCE: A variety of activities are on offer for residents. Bingo and sing-along-bingo sessions take place. Outings are arranged to nearby Richmond and Bushy Parks and other local attractions. One resident reported that they had been out to Richmond Park recently and another said that they ‘really enjoyed going out on trips in the minibus.’ Other activities on offer include baking, reminiscence sessions and church visits. Two staff members are responsible for activities at the home. The deputy manager reported that they regularly attend meetings with other home staff in Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 13 the local area to discuss activities and share ideas. She said that staff are aware that activity provision is not just about providing formal activities but about everyday actions such as washing and dressing and maintaining independence. A relative commented that ‘there is room for improvement in planning and organising activities.’ Regular residents and relatives meetings are held quarterly to enable residents to voice their opinions and have a say in the running of their home. Breakfast was observed to be taken in a pleasant atmosphere, residents were offered choices and looked relaxed in each others company. Staff were helpful and discreet and helped to preserve individuals dignity when they required assistance. Residents were seen to have breakfast when they wished and at times that suited them. Lunch looked appetising and well-presented and residents were given a choice of main meals. Cold refreshments were offered. Tea, coffee and biscuits were offered to residents throughout the day. Comments about the food at the home from residents were all positive. One said ‘the food is lovely’ another commented ‘it is really good’ and another reported ‘I can’t wait for mealtimes – it’s really nice.’ Refreshments were offered to relatives and visitors who confirmed that they are always welcomed and offered drinks and biscuits. Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. There are appropriate procedures for complaints and protection of vulnerable adults. Complaints are taken seriously by the home EVIDENCE: A log of complaints is kept at the home and the deputy manager reported that no formal complaints have been made this year. No complaints have been received by the Commission for Social Care Inspection about this service. A resident reported that the manager was approachable and if they had any issues they would feel confident that if they approached the manager they would be addressed. An organisational abuse policy is in place and the home follows the London Borough of Richmond Protection of Vulnerable Adults Policy and Procedure. The London Borough of Richmond has investigated an issue which was referred to them this year. A whistle blowing policy was seen to be available in the home. This is for staff to follow if they wish to report any issues or poor practice. Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The environment in some areas of the home is bright, attractive and homely. However, there are some areas within the home, which require redecoration. The home is clean and hygienic. EVIDENCE: There is a very large, spacious lounge which is clean and well decorated. All the windows and doors in this area have now been replaced by new double glazed ones. This looks more homely and the area feels warmer and more comfortable than it previously did. Residents commented positively about this change during this inspection visit. One area of the lounge can be sectioned off by sliding doors and this area allows residents or their visitors to have more privacy. There are two large televisions for residents use one of which is in the main lounge and one in the adjoining quieter lounge. Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 16 The dining room remains brightly decorated and contains sturdy attractive tables and chairs. A homely atmosphere had been created by the use of bright paint colours, photographs and pictures. As found at the previous inspection visit the hallways on the first and second floors would benefit from redecoration, as the décor presented as tired. Scuffmarks were seen on many of the walls and skirting boards and some of the wallpaper has come away from the wall in areas. Some of the wooden skirting boards and door frames are chipped and the area above one radiator is blackened. The bathrooms would also benefit from redecoration to help them appear mere homely. Residents spoken to reported that they liked their bedrooms. Those seen were personalised to individual taste. They were homely and contained many of the resident’s own possessions and furniture. There is a small enclosed garden area to the rear of the home and the deputy manager reported that work was due to be carried out to improve this area. As stated in the previous inspection report a range of adaptations and equipment such as specialist baths and hoists are available in the home to help meet the needs of the residents. There is also wheelchair access to the building. The deputy manager reported that the lighting to the remaining half of the lounge ceiling was to be renewed as was the bedside lights in all the bedrooms. The maintenance contractors were heard to discuss this work with the deputy manager. The home was clean and hygienic on the day of inspection. Relatives and residents commented on the cleanliness at the home. One resident commented ‘this home is spotless.’ Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Staff have a good rapport with residents and are caring and considerate. There is not enough evidence at the home to show that the appropriate safety checks are carried out on staff before they start to work at the home. Although there is a training programme in place this needs to improve in the areas of food hygiene and abuse awareness to help ensure residents are not placed at risk. EVIDENCE: Residents spoke highly of the staff and one reported that ‘they couldn’t do enough for you.’ Staff were seen to talk to residents in a respectful manner and demonstrated a caring attitude towards them. The deputy manager reported that the home is in the process of recruiting three staff members and that two new staff members have started at the home since the previous inspection. They reported that where agency staff are used, the home always tries to ensure that the same staff are used to help to provide continuity of care for the residents. Sufficient numbers of staff were on duty on the day of inspection. Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 18 At the last inspection we discussed with the manager that all those involved in the handling and preparation of food, including the voluntary workers must have attended up-to-date training in food hygiene. This will help to ensure the safety of the residents. this issues was discussed with the deputy manager who reported that the home still needs to address this issue. Food should not be handled by those who do not hold an up-to-date food hygiene training certificate. Evidence was seen to show that there is a rolling programme of training in mandatory areas such as first aid and moving and handling. However there was not enough evidence of training in the area of abuse awareness and all staff need to attend this training to ensure that residents are not placed at risk. The deputy manager also reported that she has attended a four day training programme in dementia care and that other staff are due to attend this training. She said that a further two-day training course in this area has also been arranged. This training helps staff to understand the complex needs of the residents. As stated in the previous inspection report staff recruitment files are not kept at the home but at the organisations’ head office. Therefore these could not be examined. A checklist which contains all the information about the preemployment checks is being compiled. However these were seen to be incomplete. Staff from the home have been going to the head office to complete these forms in addition to their work at the home. However, it would be more beneficial if staff from the human resources department could complete these forms and sign them. This would help to ensure that care and management staff remain at the home. Full checklists containing evidence of all pre-employment information including criminal record bureau (CRB) checks needs to be kept at the home. A staff member reported that they enjoyed working at the home and had been given a ‘very good induction.’ Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. This home is well run and the manager and deputy manager are highly regarded by residents. The manager continues to provide clear direction and leadership within the home. Appropriate systems are in place to manage residents’ finances. Appropriate health and safety checks take place to help ensure that residents and staff are not placed at risk. EVIDENCE: Although the manager was not on duty on the day of inspection she has been spoken to on previous inspection visits and completed the Annual Quality Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 20 Assessment (AQAA) of this home. This is a self-assessment of the home. The manager is experienced and has completed the NVQ level 4 qualification. The deputy manager was present during the inspection visit and is also experienced and has worked at the home for many years. As part of it’s quality assurance process the home organises quarterly residents and relatives meetings to gain their views about the running of the home. It was discussed with the deputy manager that a more formal system of seeking their views could be considered. This could include giving out surveys to residents, relatives and other interested parties such as health and social care professionals. The results of this could then be compiled into a report and fed back to residents and relatives. The organisation also conducts monthly quality inspections of the home and reports of these are sent to the Commission for Social Care Inspection (CSCI). A medication audit was carried out as part of this process to look at areas for improvement. The home has recently also sought advice from an external agency regarding fire safety and are currently responding to the recommendations made. As reported in the previous inspection report appropriate systems are in place regarding residents’ finances. All transactions are recorded on log sheets which are kept in each individuals’ name. Receipts are kept and numbered for crossreferencing purposes. Two people sign the log sheets, one of whom must be senior member of staff. Up-to-date certificates were in place for portable appliance testing, the five yearly electrical wiring check, and gas safety. This helps to ensure the safety of staff and residents. Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 21 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 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 4 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 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? yes 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 OP7 Regulation 15 Requirement The care plan daily notes must contain sufficient information to demonstrate that residents needs and goals are being met. Risk assessments for areas including skin integrity and continence should be in place for all residents. The allergy section of the medication administration records must be fully completed. Where there are no allergies known then this must be documented. The registered person must ensure that the maintenance issues outlined in Standard 19 of this report are addressed. Previous timescales of 01/03/07 and 01/06/07 not met. 5 OP29 19 (4) Schedule 2 The registered person must ensure that there is evidence that the staff files contain all the information required in Schedule 4 of the Care Homes Regulations 2001. 01/11/07 Timescale for action 01/12/07 2 OP7 12 (1) (a) 01/11/07 3 OP9 13 (2) 01/11/07 4 OP19 23 (2) (b) 01/02/08 Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 23 6 OP30 13 (4) Previous timescales of 01/10/06 and 01/03/07 not met. The registered person must ensure that all those involved in the handling or preparation of food completes food hygiene training. Previous timescales of 01/10/06 and 01/03/07 not met The registered person must ensure that all care staff receive training in abuse awareness. Previous timescale of 01/04/07 not met. 01/11/07 7 OP30 18 (1) (a) (c) 13 (6) 01/12/07 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 2 Refer to Standard OP9 OP33 Good Practice Recommendations Ensure that recent photographs are in place for all residents on the appropriate section of the medication administration records. The home should consider giving out surveys to residents, relatives and other interested parties as part of their quality assurance programme. Homemead DS0000017373.V350539.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection West London Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Homemead DS0000017373.V350539.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. 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