Inspection on 14/09/05 for Hylands House

This inspection was carried out on 14th September 2005.

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

Hylands House 24/05/06

Hylands House 14/06/05

Hylands House 07/12/04

Hylands House 13/07/04

Hylands House 24/01/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Hylands House Warwick Road Stratford-upon-Avon Warwickshire CV37 6YW Lead Inspector Deirdre Nash Unannounced 14 September 2005 10:00 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 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. Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Hylands House Address Warwick Road Stratford-upon-Avon Warwickshire CV37 6YW 01789 414184 01789 414383 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) Mrs A Barton, Mrs F Roebuck, Mrs S Sandle CRH Care Home 19 Category(ies) of OP Old Age - Number 19 registration, with number of places Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: NONE Date of last inspection 14 June 2005 Brief Description of the Service: Hylands House is registered for 19 older people requiring personal care. The home does not provide nursing care other than that available from the local community nursing teams. The home is set close to the town centre of Stratford Upon Avon with all the town’s facilities close at hand. The home is located close to a busy main road out of the town. Local and national buses provide good transport links. The railway station is about 15 minutes walk away. Hylands House is an adapted former hotel with service users’ accommodation on the ground and first floor. A shaft lift is provided which enables access to all but one bedroom in the main building without having to negotiate any stairs. The home also has an annexe consisting of four bedrooms, all of which can be reached via the stairs or a stair lift. There is a choice of two linked sitting areas on the ground floor and an integral dining area. A conservatory has also been added to provide an additional sitting area. The conservatory leads off from the large lounge. In addition seating is provided in the reception area. Hylands House has a no smoking policy with the exception of some outside areas. Car parking is available to the rear of the property. Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspector called unannounced, talked to residents, staff and the acting manager and toured some of the building. She also looked at records and the care files of three residents and at other documents. What the service does well: What has improved since the last inspection? What they could do better: Assessment of peoples need should be done more systematically and lead on to a clear ‘plan’ for their everyday/night care in the home that tells staff how to look after them. These plans should be re written when people are going Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 6 through major changes. More detail is needed in these plans for people who are developing dementia and for people with sensory loss so that the home can provide them with the extra help that they need and make sure that staff are kept up to date with new approaches to looking after them. Staffing levels need to increase to make sure that residents who need it can be safely watched over wherever they are in the home or the garden. Residents that need to keep on the move would be able to use the garden by themselves if it was made safer and secure. A written complaints procedure needs to be made available to residents and relatives and a number of other important procedures need updating and staff need to be trained in them. There is no sign that residents are being treated in any way other than kindly by staff but the procedure for hiring staff has not been tight enough to make sure that people unsuitable to do care work are not taken on. This is very serious and the manager is putting this right immediately. A second communal toilet is needed on the ground floor near the public rooms to avoid queues and therefore ‘accidents’ at certain times in the day. 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. Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 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 standard(s) 2 3 4 Information gathered by the home about what people need is not kept up to date or organised in resident files in away that is helpful to the staff that look after them. Residents may not be receiving a consistent approach to their care. EVIDENCE: The Inspector asked to see the care files of three residents, two who have recently moved into the home and one who is considered to be ‘challenging’ to look after. Each file was differently organised with slightly different forms for assessments and care plans. The home does gather a lot of information about residents. In two of the files assessment of needs and ‘care plans’ for daily living were mixed up. That means that there is not a clear difference between information gathered to show what a persons needs are and then the plan to direct staff how to meet those needs on a daily basis. There was no evidence that some of the more specific needs of two of these residents were being met. For example one resident was noted as being registered as blind but there was no evidence in the care plan of specific measures to help her. Asked about another resident staff reluctantly described some one probably with dementia including some periods of aggression Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 9 towards others. There was no direction in up to date good practice in dementia care in the care plan. Staff are ‘muddling along’ with good intentions and kindness. The third care file belonging to one of the recently admitted residents was much clearer with a plan that better directs staff and a new approach to making these records was evident. The file for the longer established resident was full of records and information but little of it showed how or why this resident has more challenging needs than others and did not detail the changes in her condition over two years that staff described when the Inspector asked them about her. This matter was raised at the last inspection over a different resident. Staff know residents well and look after them but a new care plan is not written as their condition changes. It must be. Staff continue to use ‘common sense’ in their approach. Existing paper work is amended without date and no clear picture of the resident emerges. There was evidence also that staff do not read the care plans. This is not surprising as they are of little practical use as they are. The new manager is making changes to the layout and review method of care plans in the home. This is positive. The assessment of need and care plan for the resident who may be experiencing dementia must be brought up to date as a matter of priority. The manager must go through all the care files and prioritise other residents who have complex needs or needs and conditions that have changed and request that social services carry out Community Care reviews of their need. The home is not registered to care for people with dementia but inevitably residents needs change the longer that they live there. If the home is to continue to care for residents as they develop dementia it must professionalise its approach to looking after people with complicated conditions to make sure that it gives them the service that they need including meeting their psychological needs. See also comments under standard 19 about the building and standard 27 about staffing levels later in the report. Written contracts for care and accommodation in the home were seen kept in a file elsewhere for each of the three residents. They also varied in their content and form depending on whether the resident was privately funded or local authority funded and also varied between different local authorities. The new manager showed the Inspector a draft contract that she has recently put together and that meets the guidance in the National Minimum Standards. This is progress. Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 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 standard(s) 7 9 Care plans for residents do not show when their needs and conditions have changed, are not useful to staff and are not read by staff. Residents are not benefiting from an agreed and professional approach to meeting their needs as they change. The administration of residents medication is properly monitored and controlled. Residents are safeguarded by good systems and procedures. EVIDENCE: Three care plans were looked at. Each was different in its format and quality of information to direct staff how to care for individuals. Signed ‘review’ sheets of these plans were not meaningful as plans had not been changed to reflect a residents change in condition. Staff comments show that they do not read care plans. The new manager is working on improving plans and plans for residents with complex and changing needs must be prioritised and turned into useful working documents. Storage of medication has been improved. The new manager has set up an system for auditing medication regularly. This is positive. Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 0 EVIDENCE: Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 12 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 standard(s) 16, 18 Written procedures for dealing with any complaints and for taking action on abuse have not been produced. Residents could be put at risk from a muddled or inappropriate response to a serious complaint or suspicion or allegation of abuse. EVIDENCE: The Commission for Social Care Inspection has received no complaints about the home since the last inspection and there is no record in the home of any complaints. The home has no written complaint procedure or complaint recording log book. The Inspector saw a complaint monitoring system that has been put together by the new manager. A proper written procedure must be put in place that includes the name and address of the Commission for Social Care Inspection and this must be made easily available to residents and to relatives. The new manager is making progress on bringing up to date policies, procedures and staff training on protection from abuse. This must include the Warwickshire wide multi agency agreement and protocol on how to properly respond to allegations or suspicions of the abuse of a vulnerable adult. This is outstanding from the last inspection. Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 13 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 standard(s) 19, 21, 20,22 23 The home is kept clean and well maintained. Residents enjoy a pleasant environment. The layout of the house is complex and confusing and not best suited to people with physical, sensory or mental impairment. The garden is not secure. Some residents cannot safely enjoy the freedom of the house and garden. EVIDENCE: This was an unannounced visit and the inspector found the home clean, tidy and smelling pleasantly. The building and the interior are well maintained. The home has a tidy garden but although it was a very warm late summer day no resident went into it at any time during this day. There is no safe access to the garden for residents to use it unaccompanied. Staff said that they have to distract one resident from trying to walk into the garden by the back door during periods of agitation. The steps present a danger to her, the garden is open to the street and the busy town and she suffers some confusion at these times. Staff said that they could not leave the house to take anyone into the garden unless everyone wanted to go as only Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 14 two care staff are on each shift. Residents should not be restricted in their movement unless it is absolutely necessary and it has been agreed with them if possible or at least relatives and/or social workers, put in their care plan and kept under regular review. There was no record of this ‘restraint’. This situation must be dealt with properly. There is no wheelchair access to the garden without using the drive to the car park. The house itself has been built and extended over time on different ground levels. The rooms are all above minimum standard size but the house has full and half flights of stairs, landings and half landings, corridors that lead on somewhere and to dead ends. The layout of the house is confusing and people with mental impairment may find it distressing. There are grab rails and handles around the house but the shaft lift cannot comfortably accommodate a wheel chair. The manager must get an assessment of the premises and facilities made by an occupational therapist so that any further equipment or adaptations needed for existing residents can be identified. The registered person must clearly establish the needs that can and cannot be safely and comfortably met in this building. This must be put in the statement of purpose. There is a call system in bedrooms and bathrooms and the Inspector tested it on the first floor. A care assistant answered it within two minutes. There are no alarms in the public rooms however and staff say that they depend on a more able resident to ring a hand bell if any one is in difficulty when staff cannot be in the room. Staff say that they cannot always hear the bell if they are upstairs with another resident. There are residents in the home who are prone to falls. This practice must be risk assessed and proper decisions made about its reliability. The home has more than sufficient numbers of toilets in total but there is only one communal toilet on the ground floor near the public rooms. Residents told the Inspector that there are queues for this toilet at some times of the day. This does not help individuals to continue to manage their own continence. One resident said that he uses the toilet en suite to another resident’s bedroom when there is a queue for the communal one. This is not fair on the resident that occupies the room. There appear to be a couple of potential sites. The registered person must provide one more communal toilet near the public rooms. Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 15 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 29 30 Current staffing levels are not sufficient to supervise residents given the layout of the building and the garden. Some residents cannot safely enjoy the freedom of the house and outdoors. There are gaps in recruitment practice. Residents may be exposed to people who are not suitable to work with vulnerable people. EVIDENCE: The home keeps a written staffing roster that the Inspector saw. Two care staff are on duty each shift with extra support from the manager and deputy and an hours overlap between some night and day staff early mornings. There is a cleaner and a cook. The home currently has thirteen residents. Reference has already been made in this report to the difficult shape of the building. Staff cannot easily see and hear what is happening downstairs if they are both needed upstairs to assist a resident. Some residents need a lot of help from staff and one has episodes of agitation that can create conflict with other residents if not managed. Staffing levels have been reduced as the home is carrying vacancies. However the layout of the building, the needs of some residents and the lack of safe independent access to the garden mean that two operational care staff per shift is not sufficient for safety. This staffing level must be put under review on the basis of a written risk assessment and adjustments then made as found appropriate. Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 16 The Inspector asked to see personnel files and the new manager reported that her own audit of these files has shown many gaps in required proofs and documents. For example references had not always been obtained for workers and Criminal Record Bureau Disclosure certificates for longer serving care staff have been obtained at only ‘standard’ and not ‘enhanced’ level. There was no evidence that volunteers who work in the home have had any criminal records checks. These are serious omissions. Work to obtain the full information required by law to protect residents had already been started by the manager before this inspection but this must be completed quickly now and a proper procedure followed rigorously in the future. Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 36, 37 The home is going through a period of change in management structures and ethos. Residents are likely to benefit from a fresh approach to the running of the home. EVIDENCE: The home does not have a manager who is registered with the Commission for Social Care Inspection. A new manager started at the home in August 2005 and she must make an application to become registered. There was evidence that the new manager has done a considerable amount of work in a few weeks to develop or review and revise necessary procedures and policies. Staff job descriptions are also being updated. Regular one to one staff supervision and appraisal is being set up. A quality assurance survey is being planned. Residents told the Inspector that they had attended a residents meeting last month where they were able to air the issue of the toilet Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 18 queues. There is no annual development plan for the home. It is important that this is done as current social policy makes it likely that the home will be getting referrals to look after increasingly frail people including people with considerable mental impairment. The Inspector saw a current certificate of insurance for the home including employer’s liability. The registration certificate was on display in the entrance hall. Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 x COMPLAINTS AND PROTECTION 2 x 2 2 3 x x x STAFFING Standard No Score 27 2 28 x 29 1 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 2 3 2 x x 2 3 x Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 20 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 14 Requirement The registered person must ensure that the needs of all residents are comprehensively reviewed, prioritising those with changing and/or complex needs. Social Services must be approached where appropriate to undertake community care assessments or reviews. The registered person must ensure that service user plans are revised/re written to direct staff when an individuals condition changes (compliance date from last inspection 1st September 2005. Part met). The registered person must ensure that the adult protection policy is reviewed and updated to contain information about the process followed by Warwickshire Social Services in investigations.(compliance date from two inspections back 1st November 2005 not met) The registered person must ensure that where access to a communal area is being resticted for safety of an individual, this is clearly written in his/her plan of care and kept under review. E53 S4247 Hylands House V248657 140905 Stage 4.doc Timescale for action 1st December 2005 2. OP7 15 1st December 2005 3. OP18 12 1st January 2006 4. OP20 12 1st November 2005 Hylands House Version 1.40 Page 21 5. OP22 23, 12 6. OP22 23, 12 7. OP22 13 8. OP21 23 9. OP27 13 10. OP29 19 The registered person must approach a suitably qualified person to make an assessmnet of the premises, including the garden and call system with a view to recommend how the home can best safely meet the environmental needs and requirements of residents. The registered person must ensure that a plan for implementing any recommendations made from the assessment of the premises by a suitably qualified person is produced. Any shortfall in the ability of the premesis to meet particular needs common to older adults must be subsequently put in the statement of purpose. The registered person must ensure that the practice of alerting staff who are upstairs in the house to an incident taking place in the communal rooms by means of a resident sounding a handbell is risk assessed in writing. The registered person must ensure that a second toilet for communal use is made available on the ground floor near the lounges and dining room without infringing on the privacy of any resident. The registered person must ensure that current staffing levels are put under review on the basis of a comprehensive risk assessment a copy of which must be submited to the Commission. The registered person must ensure that all proofs and documentation required by law are obtained on all staff that work in the home. 1st December 2005 1st March 2006 1st November 2005 1st December 2005 1st November 2005 immediate Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 22 11. OP18 13 12. OP18 18 13. OP33 24 14. OP33 24 15. OP31 8 16. OP33 24 The registered person must ensure that all volunteers that work in the home have CRB Disclosure certificates at the appropriate level. The registered person must ensure that staff receive up to date training on vulnerable adult protection(compliance date from two inspections back 28th February 2005 unmet) The registered person must ensure that an effective quality assurance and monitoring system is put in place, seeking the views of service users (compliance date from two inspections back 30th June 2005 part met) The registered person must ensure that the results of service user surveys are published and made available to all stakeholders in the service and to the Commission (compliance date from 2 inspections back not met) The registered person must ensure that a suitable person makes application to the Commission to register as manager of the home. The registered person must ensure that an annual development plan for the home is made and a copy sent to the Commission. 1st November 2005 1st December 2005 1st December 2005 1st January 2005 1ST November 2005 COMPLIED 31st December 2005 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. Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 23 Refer to Standard Good Practice Recommendations 2. 3. 4. 5. OP21 OP26 Any further development of the home includes the installation of a sluice room. Consideration should be given to moving the laundry so it is more appropriate to demand and more easily accessible to staff undertaking their duties. Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Hylands House E53 S4247 Hylands House V248657 140905 Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!