Inspection on 25/07/06 for Keb House

This inspection was carried out on 25th July 2006.

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

Keb House 21/07/08

Keb House 23/07/07

Keb House 18/01/06

Keb House 19/07/05

Keb House 22/11/04

Keb House 15/06/04

Keb House 17/02/04

Keb House 14/11/03

Similar services:

Abbey The

Snydale Care Home

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 Keb House Haytons Lane Appleby Scunthorpe North Lincolnshire DN15 0AP Lead Inspector Malcolm Stannard Unannounced Inspection 25th July 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 Keb House DS0000002886.V306012.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. Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Keb House Address Haytons Lane Appleby Scunthorpe North Lincolnshire DN15 0AP 01724 733956 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) 01724 734800 kebhy@aol.com Mrs Helen Elizabeth Young Mrs Helen Elizabeth Young Care Home 18 Category(ies) of Dementia - over 65 years of age (18), Old age, registration, with number not falling within any other category (18) of places Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 18th January 2006 Brief Description of the Service: Keb House is a care home situated in the village of Appleby near to the town of Scunthorpe. It comprises of an older Victorian style house and an annexe of a single storey purpose built extension. There is a courtyard used for parking and domestic needs and a garden and sitting area to the front of the home. The newer part of the home has its own kitchenette, dining area and lounges. There are no retail providers in the village, but residents can access a nearby church and public transport is available. The home has 14 single bedrooms and 2 shared bedrooms, 7 of which have en suite facilities. Information provided by the homes management in June 2006 identified that the monthly fees charged were £1248, additional charges are made for chiropody, hairdressing and toiletries. Information relating to the home is available from the manager upon request. Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of the home consisted of a range of accumulated evidence, including, views of service users, staff members and relatives of people who contract the services. A site visit was carried out during which records were looked at; premises viewed and service users, staff members and the manager of the home were spoken with. What the service does well: What has improved since the last inspection? Work carried out to the premises, including the kitchen area has enhanced the provision. The manager and her deputy have now both completed the registered managers award. Work continues to be carried out on developing the standard of individual records held. Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 6 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. Keb House DS0000002886.V306012.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 Keb House DS0000002886.V306012.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 & 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Information and pre visits are available to allow an informed choice to made. Assessments of prospective residents needs are undertaken to ensure the home can meet defined needs. EVIDENCE: A statement of purpose is available which meets with the requirements of the standard and the associated schedule. This statement is made available to residents, relatives and social care professionals. Information for prospective residents is made available. All residents are provided with a statement of terms and conditions, which includes details of whom is responsible for the fees, the total cost payable, (including any extras) and the room, which is to be occupied. An assessment is carried out prior to any admission. This is completed by the manager or deputy at the prospective residents home or in hospital. The assessment is used in conjunction with any local authority information to Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 9 ensure that the home can meet the resident’s needs, and contributes to the plan of care. A relative of two residents who had recently come to the home said that the manager had fully explained how the home would care for her relatives and detailed how their needs could be met. Residents are able to have the opportunity to spend some time at the home prior to any formal arrangement being finalised. The home does not offer intermediate care. A book is available to record all visitors to the home. Keb House DS0000002886.V306012.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, 10 & 11. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Plans of care are held and resident’s health needs are met. Residents are treat with respect in a sensitive manner. The right to privacy is upheld. EVIDENCE: An individual plan of care is available for all residents; the home uses the standex system of recording. Each care need identified is recorded on a separate sheet, which allows room for assessment and changes to be recorded. Areas covered include mobility, medication, nutrition, social, environmental and personal care needs of each resident. The manager or her deputy review the plans of care for each resident on a monthly basis and in some of the plans seen it was apparent that changes in residents needs had being identified and recorded. On one of the plans of care seen it would be beneficial for the plan to be reviewed on a more regular basis given that particular residents changing needs. Evidence was available on the plans of care seen that the resident or a relative had signed to say the plan had been explained. Some of the individual records Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 11 seen would benefit from an increase in the quality of recording and some areas being recorded in a more concise manner. The health requirements of residents are recorded on recorded on individual records. Records of visits by GPs, chiropodists and health visitors are all held. One resident’s file seen had very little health related information. The manager explained that this was because the resident had not required a visit from a GP and the family take the lady to a regular 6 monthly hospital appointment. It would be beneficial if details of these visits were recorded on the file. A chiropodist and optician visit the home to cater for the residents. One resident stated that he felt his health needs were being met and that he only had to ask for a doctor to visit if he wished this. A relative of another resident said that the health provision was excellent and that the GP support was much better than at a previous home. Generally the transfer of information in relation to residents from the old system of recording is ongoing and the system itself still continues to develop, care needs to be taken that the information recorded on the plans is of sufficient quality to inform how care is provided. It is recommended that the way and process by which information is recorded continues to be allowed to develop. Many of the records seen were a little disorganised due to a recent office merger, the manager explained that things were gradually becoming more organised. The home uses the “Nomad” system of medication storage and administration. All medications are ordered using a repeat prescription system on a four weekly basis. Actual medication is delivered on a weekly basis by a local pharmacy. The medication is receipted into the home by the member of staff on shift on a Sunday evening. Records and storage were found to be satisfactory. No staff members handle or administer medication until they have completed a relevant college course over three months. The manager stated that they were looking at accessing a medication course, which was now provided by a local pharmacy. There are policies and procedures available for staff guidance in relation to medication including one in regard to self-medication. There are no residents who presently self medicate, however should this be requested, the homes management would carry out a risk assessment and include the residents GP in reaching a decision as to the safety of the request. A lockable provision would be provided for those who then required it. The pharmacy send a representative to visit the home regularly to assess the system and offer advice. Throughout the visit it was observed that staff treat all residents with dignity and called them by their preferred names, (these were nicknames in some cases). Staff were observed to tap on residents bedroom doors prior to Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 12 entering and enquire if they could go in. One resident told the inspector that she is always able to ask for a bit of privacy if she requires it. The home has experienced 5 bereavements in the last twelve months. Comments from relatives contained in cards and letters show that these times were handled in a professional and sensitive way. One lady who resides at the home recently lost her husband who was a resident at the home. The homes manager had supported this lady throughout and had advocated her wishes when it appeared they were not going to be taken into account. Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 13 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 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to exercise choice, maintain contact with family and friends and partake in a range of recreational activities. Food provision is healthy and of a good standard, choice is available in regard to the meal taken and where it is eaten. EVIDENCE: The home employs a part time activities coordinator who arranges stimulating activities on selected afternoons. Today she was engaged giving a resident a manicure. Residents are free to choose whether to join in activities or not. One resident spoken with said that a full range of activities takes place and that there was “plenty to do”, she also said that the residents are often able to go out, but that “staff on today were not able to drive”. One gentleman said that he enjoys sitting in his room listening to music and that he is able to do so whenever he wishes. Any events, which may be of interest to residents, are publicised with a poster on display in the home. A hairdresser was present during the visit, tending to the hair of those residents who choose to attend. She visits the home once per week. Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 14 One resident was being taken out to her daughter’s home for the afternoon, with the home supporting this opportunity by transporting some personal aids for the lady. Residents are encouraged to take part in local community activities should they so wish. One resident attends the local church and a local religious representative visits, however the manager reported that interest was minimal. Residents are able to bring personal possessions with them into the home and most rooms were personalised with items important to them. The food provision remains at a good standard with residents been able to ask for alternatives should they wish. The cook speaks on an individual basis with residents to find out their views and likes and dislikes and dieticians are consulted if felt necessary. Residents commented that the food “is great” and the “food is fantastic”. There are two dining areas available, which allow for meals to be taken in a homely atmosphere. The home also supplies hot meals for two people who live in the village. Relatives and friends are encouraged to visit as often as they wish. Residents are able to see visitors in private should they so desire. Residents are able to exercise choice in their daily lives, including when to get up or retire to bed and how they choose to spend their day. One resident spoken with said he could do as he wished and slept when he “feels like it”. During the visit one lady complained that she was not able to turn over the television channels due to the remote control not working. It appeared that new batteries were needed. This was mentioned to the manager who said she would address this. Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 15 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, 17 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A complaints procedure is available and made known to all. Staff members are trained in the protection of vulnerable adults and the rights of residents as individuals are promoted. EVIDENCE: There have been no complaints made to the home or Commission for Social Care Inspection since the last inspection. It was apparent from observation during the visit that residents are able to voice any concerns or opinions they may have to the manager and staff. A formal complaints procedure is available and a complaints booklet which also includes details of the local authority complaints procedure is available in each of the resident’s rooms. A protection of vulnerable adults policy is available and guidance for staff includes a flow chart, which indicates the actions to be taken in a step-by-step manner. Advice has previously been taken from the adult protection coordinator regarding procedures to be followed. Staff members undergo vulnerable adults training and a whistle blowing policy is available for the protection of all. The proprietor/ manager lives on the site and this enables her to observe all staff whilst working, including those on nights. All staff are checked via the Criminal Records Bureau including a POVA 1st check. Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 16 A diary for the home which details planned visitors or appointments for residents is available. This is kept on a side table near to the entrance to the home. It would be beneficial to ensure resident’s information is held confidentially that the diary was placed out of view of visitors etc. Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 17 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, 22 & 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well maintained and kept safe for residents use. EVIDENCE: The Home despite being split over two buildings continues to provide a homely environment. The original part of the home is on two floors whilst the purpose built annexe is all on the ground floor. The premises are well maintained and decorations are addressed almost permanently. The kitchen has recently being renovated including new units and seamless sheeting affixed to the walls. The cook said that it was a vast improvement and a good environment to work in. The front door to the building has recently being replaced and this adds to the aesthetic nature of the building. In the annexe, work is planned to fit non-slip laminate flooring in the dining room and to carry out some redecoration work in the lounge area. Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 18 A room, which is to be shared by a newly admitted couple, is being decorated prior to their use, the family of the couple have being consulted about the rooms use and the provision required. A new carpet has recently being fitted in another bedroom. Residents are provided with specialist equipment where this is necessary; the homes management ensure that proper assessments are carried out where a need is identified. The home also provides general aids such as grab rails, handrails and ramps etc. A call system is available throughout the home should residents need to summon help. Seven of the available sixteen bedrooms are provided with en suite facilities. Overall the premises are clean and hygienic, with no malodours present. A member of staff is employed to ensure that the home is kept clean. The grounds and garden areas of the home are kept tidy and safe for residents to use by a staff member specifically employed for these areas. Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 19 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 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff undertake mandatory training and are recruited robustly. The competency of staff members cannot be proven due to minimal staff members holding an NVQ qualification. EVIDENCE: The home employs 15 care staff, 1of these holds an NVQ 2 qualification. The manager stated that a further 5 care staff members are enrolled on an NVQ 2 qualification course with a further 3 care staff member enrolled on an NVQ 3 course. The home has 1 NVQ assessor available. There has been minimal increase in the number of staff qualified to NVQ standards since the last inspection, with 7 of the care staff holding the qualification. Many of the care staff work part time hours and the manager explained that it could be difficult to dedicate time to their NVQ work. The requirement is for at least 50 of care staff to hold an NVQ qualification at level 2 or an equivalent. The registered provider must ensure that work continues to ensure staff are enabled to complete these courses. The care staff team are a mixture of experienced and newer to care staff. There are no male care staff employed. All staff members have undertaken accredited dementia and managing behaviour training. All staff undergo an initial training programme, which covers the requirements of induction and foundation training. This programme includes areas such as Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 20 basic care, health and safety, fire prevention, prevention of abuse and moving and handling. All staff spend a day away from the home for an initial days training. Recruitment procedures used by the home remain satisfactory. References are taken, prospective staff are interviewed and checks are carried out with the CRB. Staff members are asked to provide evidence of their identity and qualifications with copies being held on individual files. The staffs individual files would benefit from being organised into sections and been improved in quality. Some information presently held was loose within the individual folder. Whilst the local area is culturally diverse, there are presently no residents who are from an ethnically diverse background. There is one member of care staff whose first language is not English. Residents were complimentary of the care they received from staff, one said, “ the staff are fine, I have no problems with any of them. They come when I need them”, another said, “ I am very happy here”. Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 21 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 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The leadership style of the home is resident focused. Management are appropriately qualified. The home protects resident’s financial interests. Record systems continue to develop. EVIDENCE: The leadership of the home is carried out in an appropriate and open management style by the manger who is also the proprietor. Staff members are able to speak with the manager or her deputy freely in relation to the running of the home. The management ethos of the home is extremely resident focused, with the management team working hard to bring the administration systems into a more concise and workable position. Both the manager and her deputy have now completed the registered managers award. The manager is presently undertaking an NVQ assessors qualification. Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 22 The manager of the home has previously explained that a new staff supervision system was due to be introduced. Previously supervision had not being undertaken in line with the requirements of this visit. During this visit it was not possible to view any records of staff supervision as they had being packed due to the move of records from one office to be merged with those records held in the main office. Supervision of all members of staff must be undertaken as per the requirements of the standard. This will ensure that staff are supported to provide a good quality of care for residents. Health and safety of residents is protected by the management ensuring safety certificates are up to date and appropriate risk assessments are carried out. Contracts are held with local providers to ensure fire detection equipment, electrical and gas equipment is maintained regularly. Accident records were completed and held appropriately. All policies and procedures required for the protection of residents and the smooth running of the home are available. The manager does not act as an appointee for any of the residents. There are nine service users who are subject to power of attorney however their interests are handled by families or in one case a solicitor. Any savings are dealt with in the same manner. Residents personal allowances are held if desired for safekeeping, comprehensive records are kept in relation to these. Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 23 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 3 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 3 18 2 3 X X 3 X X X 3 STAFFING Standard No Score 27 3 28 1 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 24 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 OP28 Regulation 15 Requirement 50 of care staff must be qualified to NVQ level 2 or equivalent. Original timescale not met. Staff must be formally supervised as per the requirements of the standard. Original timescale not met. Timescale for action 31/10/06 2. OP36 17 14/09/06 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 OP18 OP7 Good Practice Recommendations It would be of benefit if the diary recording residents planned appointments were to be held more confidentially. Residents plans of care would benefit from the continuation of development to ensure the organisation of them and quality of information held informs fully how care is to be provided. Staff member’s individual files would benefit from been of a better quality and organised into sections. DS0000002886.V306012.R01.S.doc Version 5.2 Page 25 3. OP29 Keb House Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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 Keb House DS0000002886.V306012.R01.S.doc Version 5.2 Page 27 - 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!