Inspection on 12/09/06 for Hook Hall

This inspection was carried out on 12th September 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Hook Hall 24/02/06

Hook Hall 30/11/05

Hook Hall 22/02/05

Hook Hall 09/09/04

Hook Hall 09/03/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Hook Hall High Street Hook Goole East Yorkshire DN14 5PL Lead Inspector Key Unannounced Inspection 12th September 2006 09:00 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 Hook Hall DS0000019683.V309882.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. Hook Hall DS0000019683.V309882.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Hook Hall Address High Street Hook Goole East Yorkshire DN14 5PL 01405 767891 01405 767891 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) Mr James Douglas Ford Mrs Margaret Elizabeth Wrightson Care Home 21 Category(ies) of Dementia - over 65 years of age (21), Old age, registration, with number not falling within any other category (21) of places Hook Hall DS0000019683.V309882.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th February 2006 Brief Description of the Service: Hook Hall is a privately owned care home that lies within its own grounds on the edge of the quiet village of Hook, and is a listed building. The home is registered to provide care and accommodation for 21 older people, including those with dementia. The property is extremely well maintained both inside and out, and shared accommodation is in keeping with the original features of the hall. All bedrooms are single, and sixteen of these have en-suite facilities. Service users are able to access all areas of the home via the use of a passenger lift and ramps. There is a car park to the front of the building. Services in the village are limited to a post office/shop and a village pub, but the registered provider frequently transports service users into the nearby town of Goole for shopping and for visits to health professionals, family/friends and social events. At the time of the site visit on 12th September 2006 the fees for the home ranged between £289.81 and £361 and do not include costs for hairdressing, chiropody and social activities. Hook Hall DS0000019683.V309882.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This report follows an unannounced site visit undertaken on the 12th September 2006. This visit was carried out by David White and Jean Cronin, two Regulation Inspectors and took 6 hours with 5 hours preparation time. The home was able to return the requested information before this site visit, and surveys were sent out to relatives and other professionals who had contact with the home. Surveys were received from three relatives, one GP and three health professionals. Information was also used from the Regulation Inspector’s inspection record, which detailed the history of the home and relevant information about what had been happening in the home since the previous inspection visit. The site visit comprised of a full inspection of the premises. The care records of two residents were looked at which included residents’ assessments, care plans and medication records. Staff rotas and health and safety documentation were inspected. Time was spent talking to four residents, a relative, two members of care staff, the cook, a cleaner, the proprietor of the home and the manager. The activity in the home and the interaction between residents and staff was observed. The focus of the site visit was on a number of key standards and inspecting the case records of a number of residents to establish whether they corresponded with their experiences of life in the home. The manager was available throughout the inspection and the findings were discussed at the end of the inspection. What the service does well: There was a range of information that was explained to the resident and their representative at the time of their admission to the home so that residents were made aware of their rights and entitlements. Residents were encouraged to be independent as much as possible and to make their own choices about how they lived their lives. Care planning information was very detailed so that staff were clear about what actions were needed to meet residents’ needs. Individual risk assessments considered the benefits to residents’ from taking risks, whilst also being specific about how risks were to be managed properly to safeguard residents’ from harm. Hook Hall DS0000019683.V309882.R01.S.doc Version 5.2 Page 6 The home had good relationships with other healthcare specialists and this helped to ensure that the specific healthcare needs of the residents’ were met. Residents were able to enjoy a range of activities and suitable and appropriate activities were provided for those residents with dementia and this helped to meet their social and recreational needs. Staffing levels were good and staff received a wide range of training which equipped them with the knowledge and skills to be able to meet residents’ needs. The home had a good atmosphere and this contributed to the pleasantness of the environment for the residents’. Residents and relatives were encouraged and given the opportunity to voice their views and to contribute towards how the home was run. 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. Hook Hall DS0000019683.V309882.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 Hook Hall DS0000019683.V309882.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Proper pre-admission arrangements were in place to ensure that residents’ could have their needs met by the home. EVIDENCE: A range of information was provided to the resident and their representative at the time of their admission and this included information about the care and services at the home and their rights and entitlements. Two residents’ care records were looked at including those of a recently admitted resident. The records showed that staff at the home had collected information from a number of sources prior to admission so that they were able to make an informed decision as to whether they would be able to meet the needs of the person. Hook Hall DS0000019683.V309882.R01.S.doc Version 5.2 Page 9 Each pre-admission assessment looked at the identified needs of each resident and included a full personal history detailing the person’s likes and interests. From the assessment a care plan was drawn up which described in detail how the assessed needs were to be met. There was evidence within the care records that residents were provided with a contract that either they or their representative had agreed and signed. Residents and their representatives were also made aware of the complaints procedure at the point of admission to the home and a relative said that she had been given the opportunity to visit the home with their relative before any decision was made about moving into the home. Staff had a good understanding of the needs of the residents’ and had undertaken a range of specialist training including dementia training to equip them with the skills to meet the needs of the resident group. The home did not provide intermediate care. Hook Hall DS0000019683.V309882.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area was excellent. This judgement has been made using available evidence including a visit to this service. Clear and effective care planning systems were in place to provide a well-motivated staff team with the information needed to meet residents’ needs. EVIDENCE: Each resident had an individual plan of care which provided very detailed information about each resident and gave clear guidance to care staff as to what actions were needed to meet individual needs. The care planning documentation was descriptive and personalised for each resident and gave consideration to the resident’s preferences about how their physical, social and healthcare needs were met. The care plans contained a range of risk assessments which covered a number of aspects of daily living and focused on promoting the independence and safety of the resident. Risk assessments were in place in relation to reducing the risk from falls, risks from pressure sores and managing challenging behaviour and these were reviewed on a regular basis to reflect any changing needs. Hook Hall DS0000019683.V309882.R01.S.doc Version 5.2 Page 11 The manager also carried out an analysis of all the risk assessments for each resident and the findings from this were recorded in an easy to follow bar chart format and kept within individual care records so that staff could clearly see in which areas people were most at risk and a similar system was used to monitor residents’ weight. Referrals to outside agencies were detailed and their inputs were recorded so that staff knew what care and treatment had been received by the resident and what actions they may need to take. A resident had attended an appointment with a healthcare specialist and the records provided information about the reasons for the appointment and the advice that had been given from it. Labels were used to highlight specific areas of care such as visits from healthcare specialists and this helped to ensure that staff were aware of input provided from other services. Another resident’s care records showed that since moving into the home they had been given a prescription for some glasses to address some visual difficulties. One resident had hearing difficulties and the care plan detailed measures that staff were to take to be able to effectively communicate with the resident and the resident’s hearing difficulties were being monitored by an audiologist. Surveys received from a GP and three healthcare professionals were all complimentary about the care provided by the home and one commented that the care was “outstanding”. A healthcare professional visiting the home at the time of site visit also spoke favourably about the quality of care provided by the home. Surveys received from relatives commented that they were always kept informed about matters relating to their relative’s care. Daily records were informative and up to date and reflected the care that was being provided. Individual records showed how the residents had made choices and assistance had been provided in accordance with their preferences. All the residents spoken to said that the care was good and that the staff were “kind, friendly and efficient” and staff spoken to had a good understanding of the residents’ needs. Staff could be observed to be treating residents with respect and addressed residents by their preferred names. Medication Administration Records were generally accurate although in two cases medications administered had not been signed for and the manager said she would be addressing this matter. The Controlled Drugs records were in good order. Residents did have the opportunity to look after their own medication if following a risk assessment there was agreement that they were able to do so safely. One resident administered her own medication, however there were no locked storage facilities within the resident’s bedroom to keep the medications secure. Hook Hall DS0000019683.V309882.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Residents’ enjoyed a range of activities to meet their social and recreational needs. EVIDENCE: The home had an activities programme that was carried out by the care staff. There were opportunities for residents to enjoy activities both in and outside of the home. Within the home environment there were chances to take part in activities such as quizzes, sing along classes, a reminiscence group and an exercise class. Local entertainers visited the home and residents’ could attend church services within the home. Some residents attended a craft class held at a local council office and recent outings had included boating trips and visits to the theatre. The home also had a dog that was popular with the residents. The home had ample sized gardens that were well used by the residents. Activities were taking place at the time of the site visit and were observed to be appropriate to the needs of the resident group and this included those residents with dementia. One resident particularly enjoyed reading books and it was observed that there were reading materials available some of which were in large print for those with visual impairment. Hook Hall DS0000019683.V309882.R01.S.doc Version 5.2 Page 13 Visiting times were flexible and the manager said that visitors were welcome to the home at any time. Telephone points were available in each bedroom to enable residents to make private telephone calls if they chose to do so. Residents felt that they could plan their daily routines in accordance with their wishes and could get up in a morning and go to bed when they wanted. Although activities were taking place at the time of the site visit it was observed that people were not pressurised into participating in them if they did not want to and residents’ wishes were adhered to by the staff team. Residents said that they enjoyed the meals provided and felt there was enough choice at mealtimes with one resident saying “the food is nice and we get plenty”. Refreshments were provided between mealtimes and alternative meals were on offer if residents did not like what was on the menu that particular day and specialist dietary needs were catered for. Nutritional assessments were carried out on a regular basis and a check was kept on people’s weight. Most residents were able to eat their meal independently however those who needed support with their eating were given assistance by the staff. Most residents ate in the dining lounge although residents could have their meals in their bedroom if they preferred. Hook Hall DS0000019683.V309882.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area was good. This judgement had been made using available evidence including a visit to this service. Complaints and adult protection policies and procedures were in place and understood by staff to ensure that residents’ were safeguarded from harm. EVIDENCE: The home had a complaints procedure that clearly detailed how complaints would be dealt with and this was on display in the home. The home had a system for recording any complaints made, although no complaints had been received by the home since the previous inspection visit. Some residents’ would have difficulty in expressing concerns due to their communication difficulties and level of understanding. Surveys received from relatives confirmed that they were aware of the home’s complaints procedures. The home had a policy and procedure in place for the protection of vulnerable adults and staff had all attended Protection of Vulnerable Adult (POVA) training. Staff spoken to had a good understanding of what would constitute abuse and the actions that would need to be taken if abuse was suspected or had occurred. Recruitment procedures were thorough and safeguarded residents from harm. Risk assessments were in place within individual care records to reduce risks from residents whose behaviour could have caused possible harm to others and staff had attended training in how to manage aggressive behaviour. Hook Hall DS0000019683.V309882.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, and 26 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. The home provided a comfortable and pleasant environment for residents’ to live in although two matters needed to be addressed to safeguard the interests of the residents’. EVIDENCE: The home was warm, clean and bright on the day of the site visit. There was a lot of communal space for residents to move about in safely and a passenger lift and ramps enabled people with disability problems to have access to all parts of the home. The general standard of décor was of a high standard and residents’ bedrooms were personalised with their favourite belongings. It was observed that the bedrooms did not have any lockable facilities and this meant that those residents who looked after their own medications and monies had no place to keep them secure and so the interests of the residents could not be safeguarded. Hook Hall DS0000019683.V309882.R01.S.doc Version 5.2 Page 16 The home was well equipped with assisted baths and toilets to help people with their mobility. Since the previous inspection some new beds had been bought with appropriately fitting bed safety rails to reduce the risk of people falling out of bed and bumpers were being used to protect the bed safety rails. Good laundry systems were in place. Care staff attended to residents’ personal clothing and bed linen in the laundry room where the washing machines had sluicing cycles. Proper arrangements were in place for dealing with soiled linen to reduce risks from cross infection. The manager said that the registered provider carried out regular hot water temperature checks and dealt with any irregularities immediately. However there were no records to show that the necessary checks had been undertaken and what action if any had been taken to address any matters of concern in order to ensure the safety of the residents. Hook Hall DS0000019683.V309882.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. Good staffing levels and staff training programmes meant that resident needs were met by a competent staff team and proper recruitment procedures safeguarded residents from harm. EVIDENCE: The duty rotas showed that the numbers and skill mix of the staff team ensured that resident needs could be met. The home had a good atmosphere and one resident described living at the home as “lovely” whilst a member of staff said that the home was a “wonderful place to work”. Staff recognised the importance of humour in the lives of the residents’ and demonstrated good attitudes towards them. Both residents’ and staff felt that the staffing levels were good and staff could be seen to be carrying out their work unhurriedly. Kitchen, cleaning and maintenance staff were employed in sufficient numbers to be able to meet residents’ needs. All staff had undertaken a range of training and the majority of staff had attained NVQ level 2 or above. Each member of staff had a training and development plan and the training records showed that staff had received training in matters relating to health and safety, abuse awareness, managing difficult behaviours and dementia care. Other specific training was also available such as visual awareness for carers and systems were in place to make sure that staff had fully understood the training they had received. Hook Hall DS0000019683.V309882.R01.S.doc Version 5.2 Page 18 Two staff files of the most recently appointed members of staff were looked at and all the necessary pre-employment checks had been carried out to safeguard residents from harm. The home had an equal opportunities policy and there was evidence within the staff files that this was being followed to promote fairness. Hook Hall DS0000019683.V309882.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38. Quality in this outcome area was good. This judgement has been made using available evidence including a visit to this service. The home was well run in the best interests of the residents’ and overall proper attention was given to health and safety matters although there were two exceptions to this. EVIDENCE: The manager was very experienced in running the home and continued to update her practice and skills through training having previously completed the Registered Manager’s Award to enhance her management skills. She was supported by senior care staff one of whom was doing the NVQ level 4 and it was intended that this member of staff would go on to do the Registered Manager’s Award. Hook Hall DS0000019683.V309882.R01.S.doc Version 5.2 Page 20 Residents and staff were both complimentary about the way the home was managed with one member of staff describing the manager as “brilliant” and other staff particularly liked her “hands on approach” saying that she was always approachable and accessible and a resident said that they felt “safe” at the home. A range of systems were in place to make sure residents, relatives and staff had a say in the running of the home and they had all been sent questionnaires to seek their views about the home. The findings from the questionnaires were summarised and made available to all relevant parties and an action plan was drawn up from the findings stating what was needed to improve the service. The manager had a number of audit systems to monitor aspects of practice in the home and regular resident, relative and staff meetings were held to discuss the services provided and to enable people to contribute to future changes. Supervision systems were in place to support staff in their work and staff confirmed that they were having regular supervision sessions. In general health and safety practices promoted a safe environment although as previously mentioned earlier in this report under the heading of environment, lockable facilities needed to be provided within residents’ bedrooms to keep monies and medicines secure and arrangements needed to be made for the recording of hot water temperatures. The home did not hold monies on behalf of residents’. A number of health and safety certificates were checked and found to be satisfactory. The manager had recently arranged for the electrical systems in the home to be checked but the work had been delayed so an up to date electrical wiring certificate was not available. However written confirmation was received shortly after the site visit to confirm that the electrical systems had been checked and were satisfactory although the home were awaiting the certificate. Hook Hall DS0000019683.V309882.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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 4 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 3 X 3 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Hook Hall DS0000019683.V309882.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP24 Regulation 23 Requirement Timescale for action 12/12/06 2 OP25 13 3 OP38 23 Lockable facility must be provided in each of the residents’ rooms for the storage of medicines, money or valuables. The registered person must 12/10/06 review the arrangements for the monitoring of hot water temperatures from water outlets to which residents have access to prevent risks to residents. An up to date electrical wiring 12/10/06 certificate must be obtained and any necessary risks completed. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Hook Hall DS0000019683.V309882.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ 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 Hook Hall DS0000019683.V309882.R01.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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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