Inspection on 18/07/07 for Laurel Mount

This inspection was carried out on 18th July 2007.

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

Laurel Mount 02/08/06

Laurel Mount 19/10/05

Laurel Mount 21/04/05

Laurel Mount 21/10/04

Laurel Mount 15/04/04

Similar services:

Snydale Care Home

Abbey The

Larchfield Manor

Hawkhills

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Laurel Mount Woodville Road Keighley West Yorkshire BD20 6HP Lead Inspector Paula McCloy Key Unannounced Inspection 18th July 2007 10:00 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 Laurel Mount DS0000019880.V343795.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. Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Laurel Mount Address Woodville Road Keighley West Yorkshire BD20 6HP 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) 01353 667482 01535 604366 Mr Christopher Bolland Mrs Catherine Bolland Mrs Judith Helen Wardroper Care Home 34 Category(ies) of Dementia (9), Old age, not falling within any registration, with number other category (34), Physical disability (1) of places Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The places for DE are specifically for the service users identified on 2.4.4 The category of PD is specifically for the service user named in the variation application dated 21 May 2004. 2nd August 2006 Date of last inspection Brief Description of the Service: Laurel Mount is a converted property in a residential area in Keighley, close to public transport routes. The home is registered to provide nursing care for up to 34 older people, some of whom may be suffering from dementia. Accommodation is provided in single and double rooms, two of the single rooms have en suite facilities. Residents have a choice of several lounges and a small dining room. The home is situated in extensive and attractive gardens to which there is level access from the home. There is a car park to the front of the building. The current charges at the home range from £505 - £545 per week The fees do not include hairdressing or private chiropody. Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last inspection of the home took place on 2 August 2006. We have not made any visits to the home since then. This inspection was carried out to assess the quality of care provided to people living at the home. I carried out the inspection over one day and spent approximately 8 hours in the home. I spent two hours in the morning in the lounge watching and recording the care being given to a small group of people with dementia. Using this observational tool, as part of the inspection process, helped me to understand the experiences of people living in the home who aren’t able to communicate their views because of their dementia or communication difficulties. During the visit I spoke to 5 people who live in the home, 1 relative, 2 staff and the manager. I observed care staff delivering care, looked at various records and looked around the home. The home completed a self assessment form and the information provided has been used in this report. Comment cards were sent to 4 people living at the home, 10 relatives, 4 GPs and 2 other health care professionals; these cards provide an opportunity for people to share their views of the service with us. Information received in this way is shared with the home without identifying who has provided it. Two people living at the home, three relatives and two GP’s wrote to us with their comments. Their comments received have been used in this report. What the service does well: Laurel Mount is a friendly, well managed home that is run in the best interests of the people living there. Anyone thinking of moving into Laurel Mount can go and look around and get written information about the home, in the service user guide. If they decide to move in staff from the home will carry out an assessment to make sure that they can meet that person’s needs and arrange a day for admission. People get a contract/statement of terms and conditions document, this means that they are given information about their rights and obligations. Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 Page 6 Each person has an individual care plan that sets out what care and support they require from staff. Staff are quick to involve doctors and other specialists for advice. People look well cared for. All the people who live in the home spoke well of staff and they felt that they were kind and caring. One relative said ‘staff are very good and obliging.’ People can follow their own routines and relatives and friends are welcome to visit at any time. People living at the home and relatives all said that the food was good. One person living at the home was able to move in and bring his dog with him. If people living at the home and/or relatives are not happy about the service they are getting there is a complaints procedure. People were aware of the procedure and said that they would be able to raise any concerns and that they felt any problems would be resolved. The home is clean, tidy, comfortable, and well maintained. People living at the home and their relatives all said that the home was kept fresh and clean. The staff are friendly and well trained. Staff enjoy working at the home and feel they work well as a team. There is very little staff turnover which means that people are cared for by staff that know them well. What has improved since the last inspection? What they could do better: Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 Page 7 Staff need to make sure that they update the care plans as people’s needs change. This will make sure that when staff read the care plan they know exactly what to do in order to meet people’s needs. 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. Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 Page 8 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 Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5 (standard 6 does not apply) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People receive information about the home before they move in and can visit to see for themselves if they think the service can meet their needs. Staff make sure that anyone thinking of moving in is fully assessed. This makes sure that staff are confident they can meet people’s needs before they move into the home. People are given a written contract/terms and conditions of residence document which gives them details of their rights and responsibilities. EVIDENCE: The statement of purpose and service user guide is available from the home. These documents give people a lot of information about the home and the service they offer. The two people living at the home that completed a survey Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 Page 10 said that they had received enough information about the home before they moved in. People are issued with a contract/terms and conditions of residence document when they move into the home. The two people living at the home that completed a survey said that they had a contract. Individual records are kept for people living at the home. The records for one of the people who had moved into the home recently showed that staff had completed the necessary assessment before she was admitted. This means that staff are sure they can meet people’s needs before they move into the home. Staff said that they encourage people to come and have a look around the home, although it is more usual for relatives to do this. This gives people the opportunity to see the home for themselves and decide if it is suitable for them. The home does not provide intermediate care. Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Individual care plans are detailed and give staff the information they require to meet people’s needs. The health care needs of people are being met with health care professionals being involved as necessary. People’s medication is well managed which promotes good health. Personal support in this home is given in a way that promotes and protects people’s privacy and dignity. EVIDENCE: Care plans are well organised and it is easy to find relevant information quickly. The care plans set out in detail what action needs to be taken by staff to ensure people’s needs are met. Staff need to make sure that new care plans are formulated as people’s needs change. For example one person had been seen by her GP regarding weight loss. Staff had not put a care plan in Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 Page 12 place regarding this person’s nutritional needs. Another person needed the assistance of two staff to take her to the toilet. According to her care plan she was mobile and took herself to the toilet. Staff need to make sure everyone’s care plan is up to date and that moving and handling assessments are reviewed. This will make sure that the information in the care plans is up to date and accurately reflects the care that is being delivered. Both of the people living in the home, who completed a survey, confirmed that they get the right care and support and the medical help they need. This view was shared by relatives who said ‘my only concern when my mother and father could no longer look after themselves, was that they were looked after properly (hygiene, food, medication). I have no complaints as far as the staff at Laurel Mount are concerned. I am quite satisfied with the care they receive, especially my mother, who has Alzheimers.’ ‘They look after the needs of my mother , she is well fed and cared for. When I visit the senior staff keep me informed of any needs there are e.g. clothing. My mother has a big family and we all visit on a regular basis and are pleased with the care provided.’ Care plans are being reviewed monthly. All three relatives told us in the surveys that they were kept up to date with important issues affecting their relative. People’s health care needs are being identified and met. Staff are vigilant and GPs and other health care professionals are involved as necessary. Details of any visits by health care professionals are clearly documented in the care plan, together with the advice that has been given. On the day of the inspection the community physiotherapist and optician were both visiting the home. The two GPs that completed surveys said that people’s health care needs are being met by staff. One GP said ‘all staff have a friendly, efficient and caring approach to all patients.’ Another GP said ‘a caring team. They treat everyone as individuals. The senior staff are very sensible. My relationship with them is good. They use the NHS services in a very sensible fashion.’ All of the necessary risk assessments had been completed and showed what staff need to do to make sure risks to people using the service are minimised. For example one person was recently noted to be at risk in relation to their diet and food supplements were prescribed by the GP. The recent review of this person’s care plan said that she was enjoying these. The medication system is well managed. People are receiving their medication at the prescribed times and records are well maintained. People looked smart and well cared for. People spoke well of staff and they all felt they were kind and caring. Laurel Mount DS0000019880.V343795.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s preferences in relation to the routines of daily living are respected. Some activities are provided to keep people stimulated. Relatives and friends feel welcome to visit at any time. The meals at the home are good. EVIDENCE: Care plans contain information about people’s past lives, interests and their likes and dislikes. This is important information as some people living in the home cannot tell staff about themselves. From observation it was clear that staff knew a lot about the people they care for. For example staff were talking to one person about their brother and one person was only given cold drinks, as she dislikes hot ones. There was also some good humoured banter between staff and people living in the home, which was enjoyed by both. The home has recruited an activities organiser who works on Thursdays and is developing activities in the home. There is also a weekly exercise class, which people said they enjoy. Entertainers are also arranged on a regular basis. Staff are currently planning a 100th birthday party for August. The registered manager is aware that staff need to start recording that activities that people have Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 Page 14 participated in so that she can make sure everyone is getting some time spent with them either on an individual or group basis. The two people living at the home that completed a survey said that activities are arranged and that they take part in them if they want to. One person said ‘I prefer my own company and to amuse myself.’ There are no residents at the home currently who have any specific religious needs. Staff will arrange for ministers to visit the home if this service is required. There is information in the service users guide about how residents can contact the advocacy service. Staff were seen to take time listening to people and dealing with requests. For example one person asked for more tea and toast and then for marmalade on her toast. Staff were very patient and made sure she got what she wanted. I spent two hours in the lounge observing a small group of people who were unable to tell me about their care and support. During this time care staff were in and out of the lounge on a regular basis, checking that people were alright and giving out breakfast, drinks and biscuits. Staff were very patient and kind with everyone, helping people with their drinks without rushing them and chatting to people. Staff explained to people what they were doing when moving them. I did notice that one person had very little contact with staff. The only time staff spoke to her was on the four occasions they assisted her with her drink. This was discussed with the registered manager who will make sure that staff increase their contact time with her. The relative I spoke to said they can visit at any time, that they are made to feel welcome and can have a meal if they want one. Visits take place in the communal areas, the dining room or in peoples’ bedrooms if they want to be private. There are five lounges in the home. Residents can choose the lounge that suits them the best. All of the people I spoke to said the food at the home was good. There is a choice of meal and two people said if they don’t like what is on the menu the cook makes them something else. People can have their meals in the dining room, lounge or their bedroom. The lunchtime meal was well organised and people who needed assistance were supported by staff in a relaxed and unhurried way. Laurel Mount DS0000019880.V343795.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home’s complaints procedure is well publicised and people are confident that that any concerns will be listened to, taken seriously and acted upon. Staff have a good understanding of adult protection issues which means people are protected from any abuse. EVIDENCE: The complaints procedure is well publicised. It is in the service user guide and on display in the home. There have been two complaints since the last inspection. The registered manager investigated these and details have been recorded. The two people that completed surveys said that they knew about the complaints procedure and who to speak to if they were unhappy about anything. They also said that staff listen to them and act on what they say. One person said ‘staff are always ready to listen and I feel I can talk to them about anything.’ All three relatives that completed a survey said that they knew about the complaints procedure and that if they had raised any concerns these had been dealt with appropriately.’ The local adult protection procedures are available and staff training is ongoing. The next training session has been arranged for September. Staff Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 Page 16 understand what to do if they feel there are any practices that are not in the best interests of the people living in the home. This means that people are being kept safe. Laurel Mount DS0000019880.V343795.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a clean, safe, comfortable, well maintained home. EVIDENCE: Laurel Mount is situated in a residential area of Keighley. It is a large property, which is set in its own extensive, well kept grounds. There is car parking to the front of the building. There is seating available outside which people enjoy using in fine weather. There is also a secure part of the garden that people can use safely, without any fear of them wandering too far from the home. Environmental health have carried out an inspection of the kitchen this year and awarded the home 5 stars. There is a redecoration and refurbishment programme in place. Recently one bedroom has been redecorated and the office and additional ramped access Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 Page 18 has been provided. There are plans to restore the Pavillion in the ground this year so people can use it. The home was clean and tidy on the day of the inspection. The two people living at the home who completed a survey said that the home is always fresh and clean. One person said ‘excellent, remarkable and unusual.’ There are infection control procedures in place and the registered manager has consulted with the infection control nurse regarding the care of one person living in the home and has put measures in place to stop any infection spreading to other people. The laundry is well equipped, clean and tidy. The required ‘non return’ valves are in place on the washing machines Laurel Mount DS0000019880.V343795.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are enough staff on duty to meet people’s needs. Staff are well trained and competent to look after the people living in the home. Any new staff are thoroughly checked to ensure that they are suitable to work with older people. EVIDENCE: The duty rotas are arranged to provide 1 nurse and 4 care staff on duty throughout the day. At night there is one nurse on duty with 2 care staff. There is cook, domestic and kitchen assistant cover during the day. The laundry assistants work seven mornings per week. Staff said that at the current time the numbers of staff on duty were adequate to meet people’s needs. Staff said they were working well as a team and that they enjoyed coming to work. Staff also said that the registered manager is very approachable and that they can talk to her about anything. There have been few changes to the Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 Page 20 staff team since the last inspection. One relative said ‘the care my father receives is excellent. The staff always seem to respect my father and treat him with compassion and understanding due to his condition.’ Staff are well trained and competent to do the job. There are 15 care staff working at the home, 10 are qualified to NVQ (National Vocational Qualification) level 2 or 3 in caring for older people. There is a further member of care staff in the process of doing this training. Recruitment procedures at the home are robust. Staff files confirmed that the necessary checks are completed to ensure that staff are suitable and safe to work with older people. Laurel Mount DS0000019880.V343795.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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is well managed and run in the best interests of the people living there. People are involved in the running of the home and consulted about their care and support. Practices in the home promote the health, safety and welfare of the people living there and staff. EVIDENCE: The manager is a registered nurse who has also completed the registered manager award. She works in a very ‘hands on’ way and is supernumerary to the rota. This means that she has enough time to manage the home properly and knows the people living in the home and relatives very well. Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 Page 22 People are consulted about the running of the home through the quality assurance questionnaires. The results of the most recent quality assurance survey have been published and made available to people. The registered manager only holds money for some people living at the home and a written record of all income and expenditure is kept. The records seen were up to date and accurate. There is a written Health and Safety policy. Staff receive moving and handling, health and safety, food hygiene, fire safety, first aid and infection control training. The fire alarms are tested weekly. The service reports for the passenger lift and hoists were seen and were all up to date. Laurel Mount DS0000019880.V343795.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 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 Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 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 Requirement The care plans must be up dated to accurately reflect the care and support people are receiving. This will make sure that any new staff will be able to find out from the care plan exactly what they need to do in order to meet people’s needs. Timescale for action 31/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Laurel Mount DS0000019880.V343795.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Laurel Mount DS0000019880.V343795.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. 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