Inspection on 06/03/07 for Klair House

This inspection was carried out on 6th March 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Klair House 02/02/09

Klair House 31/01/06

Klair House 27/06/05

Klair House 15/02/05

Klair House 15/09/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Klair House 236 Wroxham Road Sprowston Norwich Norfolk NR7 8BE Lead Inspector David Welch Unannounced Inspection 6th March 2007 16:10 Klair House DS0000055729.V331140.R01.S.doc Version 5.2 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 Klair House DS0000055729.V331140.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 Adults 18-65. 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. Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Klair House Address 236 Wroxham Road Sprowston Norwich Norfolk NR7 8BE 01603 417617 01603 423566 klairhouse@lineone.net 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) Klair House Ltd Mr Robert Ian Arneil Care Home 12 Category(ies) of Learning disability (2), Mental disorder, registration, with number excluding learning disability or dementia (12) of places Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Up to twelve (12) services users who have a mental disorder may be accommodated in the category MD. Up to two (2) service users who have a learning disability may be accommodated in the category LD. Maximum number accommodated must not exceed twelve (12). Date of last inspection 31st January 2006 Brief Description of the Service: Klair House offers care for up to twelve adults with mental heath needs. It is a domestic style detached house situated in a residential area on the outskirts of Norwich and the home blends extremely well into its surroundings. The bedroom accommodation is situated on both ground and first floors. There is good car parking space at the front of the house and a well-maintained garden area at the rear. Within the last year a great deal of building work has taken place to extend the facilities. There is now self-contained accommodation in an annex where people can live and maintain a semi-independent lifestyle. The garden area has been quite markedly reduced by the new building, but still has a summerhouse. The owners have plans for a Function Room in the grounds where ‘workshops’ and games can take place. When complete, within the next 3 months or so, each resident will have a larger bedroom with an en-suite bathroom. Already they have a new kitchen attached to their Dining Room and a much larger lounge/sitting area. Staffing levels do not allow for a great deal of assistance with intimate personal care. Following receipt of the draft report Mr Arneil said that any resident requiring personal or intimate care has been, and always will be, assisted. There is advice and guidance on offer. Residents come and go as they wish. Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection began during late afternoon just as residents were returning from any day care services or activities in the community. It lasted until mid evening. In that time more than half of the 9 people living here were spoken with at length. One person, with her agreement, was interviewed in private in one of the semi-independent units. The Commission had the benefit of a Pre-Inspection Questionnaire (PIQ) completed and returned by Mr Arneil, the manager, before the visit took place. The home’s latest quality assurance document was included, together with the results of a resident survey carried out by the providers. We also had Comment Cards from all the residents and from 4 relatives. Overwhelmingly, the feedback given to us was of a very positive nature. It was also possible during the visit to spend some time with Mr Arneil. A member of staff also provided some useful information. One good practice recommendation has been made. What the service does well: Residents said appreciative things like: “We are encouraged to make our own decisions”. I liked this home from the first time I visited it”. “…a good written information booklets provided by the manager early on and invited to drop in for a coffee any time passing”. “Am aware of complaints procedure. Even if I didn’t know it, there is a copy on the notice board”. Speaking about carers – “They are pretty good, some exceptional and take a genuine interest” and, “Excellent staff are employed here. This is one of the main reasons I’ve been contented and happy”. Also, “The staff always listen to what you have to say. They are very friendly and very understanding”. “Very healthy diet”. One relative mentioned ‘the very good home-cooked food’. Talking about the home’s freshness and cleanliness – “This is the exceptional quality of the home. I’ve never lived anywhere with such a good standard in this area”. And, “The house is spotless”. Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 6 When asked if they know who to speak to if they are not happy, one resident said, “Robert or Hugh, the management”. One person said, “I am treated very well and the staff and management and the manager Robert I get on with very well and love being in Klair House and I get on fairly well with the residents there”. A relative said, “I feel the residents are physically very well cared for with the staff being polite and caring”. Another relative said, “…always invited to discuss any concerns, family occasions etc. Always receive support and help for my …(relative)”. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4 and 5 Quality in this outcome area is good. The people living here have a contracted service that meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mr Arneil said that there have been no new residents since the last inspection of the home. He said that there are few specialist health services available to the people living at Klair House, although he mentioned a couple of services that residents tap into on a regular basis, one of which is operated by MIND. Mr Arneil has not made any attempt to fill the vacant beds (3) at the home because the building work is not yet complete and could take up to another three months. Accordingly, nobody new has made a preliminary visit prior to coming to live here. Mr Arneil said that when the building work is finished he will begin the process of assessing people for admission, if they are suitable, and the home can meet their needs. He has clear ideas of who would benefit from the service offered at Klair House. There is a great deal of emphasis on self-caring, supported living even. Mr Arneil described the procedure for ensuring that prospective residents are compatible with the group and will be Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 9 happy living here. One resident described the process of moving in here, which took almost a year because s/he wanted to wait for a vacancy rather than go elsewhere. The impression is that Klair House is very concerned about providing a good service and not about maximising profits. Everybody living here has a contract with the home as well as their social services contract, which is financially based. Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10. Quality in this outcome area is good. The residents can make most decisions for themselves, which promotes independence and improves self-esteem. They can be sure their personal details are only shared on a need-to-know basis, which safeguards their privacy and dignity. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All of the residents have bank accounts into which their benefits are paid. Mr Arneil acts as what he described as ‘a 3rd party signatory’ for 8 of the people currently living at Klair House. He occasionally draws sums of money for the residents to cover their weekly personal allowance, which is paid to them and which they hold. The financial records relating to these transactions were seen. One person manages their own finances. Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 11 The Commission was interested in the results of the quality assurance survey provided by Mr Arneil as part of the Pre-inspection Questionnaire (PIQ). The results of a resident survey component revealed a very high level of satisfaction with many aspects of care provided at the home. In one or two cases the satisfaction level was down to 70 , for instance in the matter of bathrooms and toilets. Mr Arneil said that no changes had been made as a result of the survey. This was discussed during the inspection. He explained that the lower levels of satisfaction had to do very much with the current building work, the length of time it was taking and the anticipation of residents who will have access to bigger rooms all with en-suite facilities. Mr Arneil was asked if the home had any statement of its approach to confidentiality when dealing with partner agencies. He said that this does not really apply, as contact with other agencies is almost non-existent. For instance, residents access facilities in the local community in the way that other citizens do and no concessions are sought beyond those available to everybody in the community. One person carries contact information in a handbag and this has on at least one occasion allowed concerned members of the public to assist in an appropriate way. Information that is kept at the home is under lock and key in the staff office. Everybody goes out independently. Evidence of this was seen on the evening of the inspection when a number of people were coming and going – one or two from day care services. Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. The residents lead busy lives and to a large extent enjoy activities and leisure time pursuits of their own choosing at times convenient to them. The food is nutritious and balanced which they appreciate. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Some quite limited ‘outside’, counselling services are available to the people living at Klair House, but currently, Mr Arneil said, nobody takes advantage of them. Mr Arneil said that several people are interested in church activities and religious observance. Three people attend church regularly and one reads the Bible. Two residents confirmed to the inspector that they go to church and another discussed aspects of his bible reading in the home. Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 13 Mr Arneil agreed to provide some information about residents’ leisure activities on a pro-forma that he said he would deliver to the Area Office before the end of the week and later did so. One person smokes at the home. He mentioned this in the comment card returned prior to the inspection and he confirmed it when spoken with during the visit. He said that a small summerhouse is available in the garden for this, but he did not use it. There is no smoking in the house. The menu was seen. It is designed to be a 4-week rolling menu with, each day, a basic choice and a ‘healthy eating option’. Residents confirmed that the food provided is ‘very good’. Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21 Quality in this outcome area is good. The help residents need, including medical services, is delivered in a sensitive way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mr Arneil said that two people do have some help with bathing and in one case this involves using a hoist. Assistance can also include a member of staff standing outside the bathroom in case of seizure. Residents do receive a lot of advice, guidance and supervision. Although residents do not have annual health checks built in to their care programme, they all see the doctor regularly in the course of the year. Mr Arneil said that support from the local doctor is ‘very good’ and the home has a very good relationship with the GP’. Some people have regular checks for asthma; they have flu ‘jabs’ and blood pressure checks. Each resident has an annual medication review. Several residents have access to a mental health consultant and where necessary other physical health checks have been made. One relative mentioned in a comment card returned to the Commission that Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 15 her relative had received exemplary care by all concerned during a recent health scare. One person self-medicates in a limited way. In this case, the pharmacist makes up daily dosette boxes every week. Staff assist by handing one of these to the resident each day and the resident then takes responsibility. The matter of ageing and death has been dealt with in respect to some residents. The home had a very sad death of a member of staff in tragic and sudden circumstances quite recently and the manager had to inform everybody living and working in the home. This brought the matter into sharp focus and made everybody think about their own position. One person has discussed with Mr Arneil financial arrangements relating to funeral expenses. Mr Arneil’s view is that the people living here are quite ‘tuned in’ to the issue of ageing and dying. Staff on shift confirmed that those responsible for administering medication had been given Boots training in monitored dosage systems (MDS). Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. Consideration was taken of past history and performance in this area. EVIDENCE: Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29 and 30. Quality in this outcome area is good. While building work continues there is some inevitable disruption. Everybody will be relieved when things return to normal. The work that has been finished has provided very good facilities that residents are enjoying. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The lounge and dining areas have been enlarged. The site shows obvious evidence of on-going building work. Mr Arneil was able to bring the inspector up to date with progress. He expects work to continue for another 3 months or so, by which time it will be complete. He intends to have a ‘Function Room’ in the garden where residents can play table tennis and darts and where a computer will be available. Apparatus can be folded away and the space used for ‘workshops’ on whatever residents wish to discuss or be involved in. Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 18 Gradually, residents are moving back into their old rooms that have been enlarged and provided with en-suite bathrooms. A resident has moved in to one of the semi-independent units built in the garden. These have a small kitchenette and a bathroom. There is a foldaway bed and a sitting area. The person was pleased with the provision and described the home as the best s/he could imagine. Mr Arneil said that the various permissions needed to complete the project had taken much longer, and the processes are far more protracted, than he envisaged, but finally things look like coming together. Clearly, the residents will be very pleased when work is finished and they can return to normality. Their comment cards supported this. As part of the new accommodation, residents have a small kitchenette in the Dining Room. This was seen to be used during the inspection. The residents help with clearing and tidying away. Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is good. Staffing levels are ‘thin’ in some respects, but probably sufficient to meet the needs of the people living here. New supervision schedules will go a long way to ensuring that carers are providing a consistently good service, which will be of benefit to residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Mr Arneil was asked about his ‘baseline’ staffing levels. He explained that one person sleeps in at night, this shift running from 9.00pm to 9.00am the next morning. On the duty roster Mr Arneil is shown on duty in the home from 9.00am to 5.00pm every day. When the inspector arrived for the visit at about 4.00pm he was away from the home, but staff called him on his mobile phone and he soon arrived. The duty roster shows Mr Arneil on call every night. He said that a carer is on shift from around 11.30am to 5.00pm every day and would, during this time, have some ‘cooking duties’. Another Cook/carer is on shift from about 4.00pm to 9.00pm, when the night carer takes over. Staffing is undeniably quite ‘thin’. One relative mentioned that she would like staff to have more time to simply chat with residents, but Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 20 understood that they have a lot to do. Fees can be kept at this comparatively low level only as a result of the few staff on duty. Mr Arneil said that frequency of individual supervision of his staff was a problem, but one which he was getting to grips with. On the staff notice board was a message reminding staff to speak to the manager about supervision dates, so it is something that is taken seriously. At the next visit an inspector might wish to see an at-a-glance Supervision Log showing proposed dates for supervision (at least 6 a year) and the actual dates the session took place. A recommendation has been made about this. Mr Arneil said that once the supervision sessions are underway, responsibilities for supervising will be shared out among senior personnel. Mr Arneil said that he intends to included the following topics in supervision sessions:- staff member’s well-being, notes of last meeting, coping strategies, difficulties with the work, activities, new work coming on stream, policies and procedures, issues with residents, health and safety and agreeing the date for the next meeting. There are 6 staff meetings a year. There is a handover meeting every morning. There is also a Message Book and a diary. The PIQ showed, and Mr Arneil confirmed, that 2 staff have come to work here since the last inspection. Their training record showed that they had received induction. Recruitment checks had been made and the inspector noted the dates and numbers on their CRB disclosure certificates. One person had come into post before Mr Arneil had obtained the full CRB disclosure, but there was a PoVAFirst that showed that the person concerned was not on the POVA list. Mr Arneil confirmed that five staff have been assessed at NVQ level 2. Two others would rather not do NVQ. Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42 and 43. Quality in this outcome area is good. The home is managed in an ‘open’ way. This judgement has been made using available evidence including a visit to this service. EVIDENCE: During previous inspections the matter of Mr Arneil taking NVQ level 4 in Care has been discussed. In other respects he is well qualified. He has had some conflicting information about what he should do. Not surprisingly, he said he had ‘held off’ making any plans to enrol on NVQ. He emphasised that he is not a ‘front line carer’. Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 22 The Fire Log and Accident Book were looked at. There are 2 break glass points in the house and both are tested weekly in rotation. The accident records are not in a bound book, but are ‘loose leaf’. The details are being recorded in a satisfactory way. Klair House DS0000055729.V331140.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 Adults 18-65 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 X 2 3 3 3 4 3 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 3 34 X 35 X 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 3 X 3 LIFESTYLES Standard No Score 11 3 12 X 13 X 14 3 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 X X X X X 3 Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 24 No 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. Standard Regulation Requirement Timescale for action 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 YA36 Good Practice Recommendations The Registered Providers should consider having an at-aglance Supervision Log that shows proposed dates for individual supervision throughout the following period and the dates the sessions actually took place. Klair House DS0000055729.V331140.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispin’s Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Klair House DS0000055729.V331140.R01.S.doc Version 5.2 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. 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