Inspection on 12/07/05 for Kingsfield Care Centre

This inspection was carried out on 12th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Kingsfield Care Centre 26/10/07

Kingsfield Care Centre 14/09/06

Kingsfield Care Centre 24/02/06

Kingsfield Care Centre 13/03/05

Kingsfield Care Centre 19/07/04

Kingsfield Care Centre 10/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Kingsfield Union Road Ashton-under-Lyne Tameside OL6 9JF Lead Inspector Steve Chick Announced 12 July 2005 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. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Kingsfield Address Union Road, Ashton-under-Lyne, OL6 9JF 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) 0161 330 1853 Tameside Care Limited Ms R Shockledge CRH - Care Home 52 Category(ies) of DE(E) DE(E) Dementia over 65 (48) registration, with number MD(E) Mental Disorder over 65 (48) of places OP Old Age (52) PD(E) Physical Disability over 65 (18) SI(E) Sensory Impairment over 65 (2) Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Service users to include up to 52 OP; up to 48 DE (E); up to 48 MD (E); up to 18 PD (E); and up to 2 SI (E). Date of last inspection 13 March 2005 Brief Description of the Service: Kingsfield is a single storey, purpose built, detached property set in its own grounds. It offers accommodation for up to 52 older people, in single rooms. Kingsfield is near the town centre of Ashton under Lyne and, consequently, has good access to public transport facilities. There are also parking facilities in the vicinity. Kingsfield has two lounge/dining rooms and one small lounge, which is a dedicated smoking area, and a quiet room. The building also has a conservatory area off the main lounge and a patio area in the inner garden. Kingsfield is run by Tameside Care Limited, which also runs several other care homes in the area. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During the inspection six service users were interviewed, as were seven relatives/friends of service users and two staff members. Discussions also took place with the manager, other staff in the home and two visiting professionals. ‘Comment cards’ were received from seven service users; three relatives/ visitors and seven General Practitioners. Additionally, one telephone call and one written note were received in response to this inspection. The inspector also undertook a tour of the building and scrutinised a selection of records relating to service users and staff. Other records examined included staff rosters, accident records and maintenance records. What the service does well: What has improved since the last inspection? The process for vetting staff to ensure all reasonable steps are taken to protect the interests of service users was much improved. Staff rotas had been adjusted to provide better cover in the evening. Work to the roof is also addressing the unsightly appearance of the facia boards. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 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. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 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 Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 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) 1, 2, 3, 4, 5 & 6 Kingsfield makes appropriate information available to prospective service users. Service users are admitted on the basis of an assessment, are able to visit the home before any decision is made and are given written confirmation of the suitability of the home. The home provides written terms and conditions relating to the service user’s residency. Kingsfield does not offer intermediate care. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 9 EVIDENCE: The home has produced a service user guide and statement of purpose. These documents were not scrutinised at this inspection, but have been found to contain appropriate information at previous inspections. The manager reported that they had not been amended since the previous inspection. It was reported that a copy of the service user guide was made available to each service user, and copies were seen in service users’ bedrooms. A random selection of service users’ files was examined. All had a copy of the home’s terms and conditions which had been signed by the service user. All the files seen had a copy of an assessment of service users’ needs, either completed by an appropriate professional in the community or by the home. Examples were also seen where community based assessments were complemented by assessments undertaken by the home. These assessments were seen to have been undertaken before a decision to offer a place at Kingsfield. In addition to the assessment, each file had a copy of a letter confirming that, based on the assessment, Kingsfield believed it was able to meet the needs of the service user. There was documentary evidence that Kingsfield offered the opportunity to visit the home before a decision to move in. This was confirmed as being the practice, whenever possible, by the manager. Whilst not all service users spoken to could recall if they had visited, several relatives were able to confirm that Kingsfield had been positively chosen as an appropriate care home following contact with the home. Kingsfield does not offer intermediate care. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 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, 8, 9 & 10 Service users have a written plan of care. More rigour is needed regarding the involvement of service users in the care planning. Service users’ health needs are appropriately met and appropriate procedures and practice are in place in connection with medication administration. Service users are treated with respect and their privacy is maintained. EVIDENCE: In the random selection of service users’ files, each had a copy of a care plan which had been appropriately reviewed. There was evidence that the care plans were updated or amended when necessary as a consequence of the reviews. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 11 Evidence of service user involvement in the formulation and agreement with the care plan was less consistent. There was good evidence of involvement in some examples and none in others. Discussion with some visitors confirmed their involvement, whilst others were not aware of any structured involvement. All but one service user ‘comment card’ which was returned reported that they felt well cared for. The service user who only felt well cared for “sometimes” was reported by her family as being used to one to one care when at home and was thought to be having some difficulty adjusting to the residential care environment. Other comments regarding the care offered at Kingsfield included “Dad is being looked after very well” – “… I am writing principally to say how well she [my mother] is being cared for” – “They [staff] have been attentive towards my mother’s needs throughout her respite stay …“. There was written evidence of the appropriate involvement of medical and para medical support from the community. Service users, visitors and staff spoken to during the inspection expressed confidence that residents’ health needs were met at Kingsfield. Visitors also expressed confidence that they were kept appropriately informed about their friend’s or relative’s changing health needs. Of the seven comment cards received from GPs, all reported that staff understood the care needs of the service users, that the home took appropriate decisions in respect of health and that they were satisfied with the overall care offered at Kingsfield. Two were less positive about communication with the home and one commented on “confusion over repeat prescriptions …” Medication was seen to be appropriately stored. Medication administration records also presented as appropriately maintained. It was reported by the manager that one service user was administering their own medication. A written risk assessment (a ‘flow chart’) was seen which appropriately addressed potential risks. A limited number of staff are authorised by the home to administer medication. It was reported by the manager that they had all received relevant training before they can undertake those duties. All service users have single rooms, most of which have en-suite facilities. Service users spoken to expressed the view that their privacy was respected and that staff were appropriately respectful. All service user comment cards received reported that they were treated well in the home and that their privacy was respected. All GP comment cards confirmed that they could see their patients in private. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 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 standard(s) 12, 13, 14 & 15 A range of social activities are made available by the home. Kingsfield welcomes visitors to the home. Service users are able to exercise choice and autonomy over their lives, within the confines of communal living. Meals are provided to a good standard. EVIDENCE: Social activities were publicised on the home’s notice board. This indicated a wide range of activities within the home and occasional outings. A separate record is also maintained of activities undertaken. Two service user comment cards reported that the home provided suitable activities “sometimes”, the others expressed satisfaction with the nature of activities provided in the home. Service user files seen included a basic ‘social history’. More detail in the ‘social history’ could be used to help inform the home if there were specific activities which any service user may wish to participate in. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 13 All visitors spoken to confirmed that they were free to visit the home at any reasonable time. Several commented on how they were made to feel welcome by the staff when they visited. Observation and discussion with staff and service users confirmed that, within the confines of communal living, service users were able to exercise choice over their daily routines. One service user confirmed that “you can do what you want to”. Two meals were sampled during the inspection. They were both pleasantly presented and tasty. Appropriate supplies of food were seen on the premises. One service user comment card reported that they did not like the food, but a significant majority of service users spoken to reported favourably on the food. A report from a dietician, in respect of a specific service user, was seen. This commented positively on the provision of food by the home. Ample supplies of fresh fruit were also available between meals. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 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 standard(s) 16, 17 & 18 The home operates an appropriate complaints procedure. Service users’ legal rights are protected. Systems are in place in the home to maximise service users’ protection from abuse or exploitation. EVIDENCE: The home has an appropriate written complaints procedure which is available for all service users. All service users and visitors expressed confidence that any complaint would be listened to and appropriate action taken. The complaints log presented as being appropriately maintained. The manager reported that service users are entered on the electoral roll and are facilitated to participate in local and national elections if they wish to. Access to advocates is also facilitated if necessary. Nothing was identified during the inspection to indicate that service users’ legal rights were not appropriately protected. The home has an appropriate ‘Adult Protection’ policy including information to staff on ‘whistle blowing’. Staff who were interviewed during the inspection demonstrated a good understanding of the need to be vigilant against potentially abusive situations and of what action to take in such an eventuality. Training on protection of vulnerable adults was also available for staff. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 15 All service users and visitors spoken to, together with all comment cards, indicated that service users felt ‘safe’ in the home. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 16 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, 20, 21, 22, 23, 24, 25 & 26 The home presented as being clean, tidy, hygienic and appropriately maintained throughout. Suitable toilet and bathing facilities were available. Service users were able to personalise their rooms, which presented as being pleasant and comfortable. EVIDENCE: At the time of this inspection major work was being undertaken to replace the roof tiles. The nature of this work was such that there was some inevitable disruption to the home. However, this appeared to be being managed in such a way as to minimise the impact of the work on the service users. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 17 Communal areas presented as being appropriately decorated and maintained. One small lounge was a dedicated smoking area. The pleasant garden/patio area was temporarily not in use at the time of this inspection due to potential risks associated with the building work. During a tour of the building a sample of service users’ bedrooms was inspected. These presented as appropriately personalised, clean, tidy and maintained. Service users who were asked, said they liked their rooms. An appropriate range of toilet and bathing facilities were available, including mechanical hoists and specialist baths to assist service users with restricted mobility. The building presented as being clean, tidy and hygienic. Service users and visitors confirmed that this was the usual state of the home. At the time of this inspection the home was visited by a fire officer (at the request of the home) to assess the safety of fire exit routes. He reported satisfaction with the fire exits and the management structures, insofar as they related to fire safety. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 18 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, 28, 29 & 30 Staffing levels are provided in line with the assessed dependency of service users. Staff have access to appropriate training, including NVQ II. The home’s recruitment practices include appropriate vetting to maximise the safety of service users. EVIDENCE: The staff rota for the week ending 10th July 2005 was examined. This demonstrated that usually seven carers were on duty in the morning, six in the afternoon and early evening, four in the later evening and three from 22:00 until 08:00. There were occasional times during that week when there were slight variations to these figures. Senior carers, who have a support role to the care assistants, are included in these figures. Since the previous inspection the manager had produced a report identifying her rationale for the staffing levels and noting that levels are monitored on a daily basis and adjusted accordingly. It was also reported by the manager that night staff have been issued with two way radios to improve communication, given the layout of the building. Ancillary workers such as domestics and cooks were also on duty during the week. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 19 It was reported that all care staff are given a period of induction. confirmed in discussion with staff. This was It was reported that the home employs 26 care assistants. Sixteen of these hold a NVQ II (62 ). In addition to these sixteen, seven staff were reported as undertaking NVQ II. A random sample of certificates confirming these figures was seen. A selection of files relating to recently recruited staff was inspected. These demonstrated that appropriate vetting procedures had been followed prior to the staff commencing work at the home. There was documentary evidence of a range of training opportunities being available for staff. The company’s continuing commitment to training was confirmed in discussion with the manager and staff who were interviewed. Visitors described staff as “very friendly and helpful”, “[you] can’t fault them”, “very supportive and approachable”. Service users also commented favourably about the staff, these observations included – “staff are good and kind”; “staff are 99.9 perfect”, and, “staff are very kind”. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 20 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, 35, 36, 37 & 38 The home is run by a competent manager who strives to create an open and inclusive atmosphere, and where staff are appropriately supervised. The home has appropriate procedures to safeguard the financial interests of service users. Recording would be improved by more rigorous dating to ensure maximum accountability. The health and safety procedures in the home offer appropriate protection for service users and staff. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 21 EVIDENCE: The manager has considerable experience of managing care homes, and appropriate qualifications. Tameside Care Limited management structures provide clear and structured lines of accountability. Staff, service users and visitors described an open, approachable and responsive management team. An example was seen where staff had instigated a meeting to explore an idea of altering shift patterns to the benefit of service users. Staff who were interviewed reported that they felt comfortable in seeking advice and support from senior colleagues, and that support was forthcoming when requested. One visiting professional reported that, in their view, the staff team was supportive, approachable and knew the service user she was involved with well. Regular structured meetings are held with service users. The minutes of these meetings indicated that this forum did enable some service users to make suggestions about the running of the home. The manger reported that appropriate action was taken as a consequence of these suggestions, although an absence of “matters arising” being recorded at the subsequent meeting made it more difficult to verify this. A selection of records relating to money held by the home on behalf of service users was inspected. These records presented as being appropriately maintained, with receipts available for purchases Staff confirmed that they had regular supervision with a senior member of staff. This was confirmed by examination of a supervision ‘diary’ demonstrating actual supervision sessions for each staff member. The Commission for Social Care Inspection receives regular reports on the conduct of the home undertaken by a representative of the registered individual. Other records seen presented as being appropriately maintained, although they would be easier to ‘audit’ if dating of amendments to documentation was more rigorous. Service users receive written confirmation that they can access any records held about them by the home. The manager reported that appropriate health and safety checks and equipment maintenance contracts were maintained. A sample of documentation relating to health and safety issues was scrutinised and presented as being in order. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 22 The home had received a visit from a health and safety officer in June 2005, when two issues had been identified as requiring action. Neither of these had direct implications for service users. The manager reported that action to address the issues was in hand. The home’s “handyman” undertook the annual electrical tests on portable equipment. Information regarding what relevant qualifications he had was not available at the time of this inspection. Staff who were interviewed confirmed the availability and mandatory use of disposable gloves and aprons to minimise the risk of cross infection. Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 3 x x 3 3 3 3 Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 24 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 OP7 Regulation 15 (1) & (2) Requirement The Registered Person must ensure that service users and/or their representatives are involved in the formulation of their care plan and of any reviews which result in amendments to the plan. Timescale for action immediate 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. Refer to Standard OP7 Good Practice Recommendations The registered person should ensure that service users or their representatives sign to confirm their agreement with the plan. If the service user is unable to sign, the care plan should contain an explanation of their inability. The registered person should ensure that all records and amendment to records are effectively dated to maximise transparency and accountability. The registered person should ensure that they have evidence that personnel undertaking specific health and safety checks are trained and competent to do so. The registered person should ensure that as full a social history as reasonable is obtained recorded and used to identify appropriate social activities for each service user. F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 25 2. 3. 4. OP37 OP38 OP12 Kingsfield Commission for Social Care Inspection 2nd Floor, Heritage Wharf Portland Place Ashton under Lyne OL7 0QD 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 Kingsfield F54 F04 Kingsfield A s5573 v230861 120705 Stage 4.doc Version 1.40 Page 26 - 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!