Inspection on 27/09/06 for Leycester House

This inspection was carried out on 27th September 2006.

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

The inspector 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

Leycester House 26/09/07

Leycester House 01/02/06

Leycester House 28/07/05

Leycester House 03/11/04

Leycester House 10/06/04

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 Leycester House Edensfield Road Mobberley Knutsford Cheshire WA16 7JG Lead Inspector Bronwyn Kelly Unannounced Inspection 27th September 2006 09:30 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 Leycester House DS0000006512.V306613.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. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Leycester House Address Edensfield Road Mobberley Knutsford Cheshire WA16 7JG 01565 872496 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) www.clsgroup.org.uk CLS Care Services Limited Stephen Maddock Care Home 40 Category(ies) of Dementia - over 65 years of age (1), Mental registration, with number disorder, excluding learning disability or of places dementia (1), Old age, not falling within any other category (40) Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 40 service users to include: * Up to 40 service users in the category of OP (old age, not falling within any other category) * 1 named service user in the category of DE(E) (dementia over the age of 65) * 1 named service user in the category of MD (mental disorder, excluding learning disability or dementia, under the age of 65) The service must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 1st February 2006 2. Date of last inspection Brief Description of the Service: Leycester House is a purpose built home providing care and accommodation for 40 older people. The home is part of CLS Care Services Limited, a not for profit organisation that owns a number of care homes in the Northwest area. Leycester House is in the village of Mobberley, close to the local shops, GP, pub, chemist and bus stop. Mobberley is approximately mid-way between the towns of Knutsford and Wilmslow. Leycester House is a two-storey building and there is a passenger lift for access between floors. Residents accommodation consists of 40 single bedrooms all with wash hand basins. There are sufficient communal rooms such as lounges, dining rooms, activities area and a smoking lounge. The home also provides day care for up to 5 people per day and a separate lounge is available for this purpose. A central courtyard includes a pleasant garden area with outdoor seating for residents and visitors to use and a new raised patio area. This is fully accessible to service users. The current weekly fees range from £343.34 to £430.00. Further details regarding fees are available from the manager. Additional charges are made for newspapers (average £18.00 per month), hairdressing (£3.00 for men’s haircut and £6.00 for ladies set), private chiropody (£10), holidays, trips out, transport and toiletries Prospective residents are able to read the latest CSCI inspection report, which Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 5 is available in a copy of the Service User Guide in the entrance hall. A copy of this guide is also available in each resident’s bedroom. Other information about the home and CLS is available in leaflets on display in the hall. These outline the lifestyle that residents can expect when they move into the home. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process of Leycester House included a site visit to the home, which was unannounced and completed in six hours on one day. Time was spent sitting and talking with people who use the service and observing the day-to-day routines of the home and care staff as they provided support. Time was also spent looking around the building to assess its suitability to provide a comfortable, safe and homely environment for the enjoyment of everyone. A number of records held in the home were also looked at. The visit was just one part of the inspection. The manager was asked to complete a questionnaire to provide up to date details about the services provided in the home. A number of CSCI survey questionnaires for residents and visitors were posted to the home prior to the visit. Three relatives and five residents returned completed questionnaires. Comments from these have been included in the report. As well as the views of the residents that live in the home, visitors to the home were spoken with. Their comments have been included in the report. The views of the staff on duty were also listened to and three visiting community nurses shared their views of the home. What the service does well: The residents living in Leycester House gave some good examples of why they enjoy living there: • “Staff treat residents with respect and dignity”. • “I feel well cared for”. • “Staff are very nice – no rules and regulations”. One resident who visits the home for short stays on a regular basis said, “I think it is marvellous here. I have been a visitor for years. The food is excellent and the staff fall over themselves for me”. One relative wrote on a questionnaire “Am totally impressed with the caring and professionalism given to mum at Leycester House. Many thanks to all”. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 7 Another relative wrote, “The staff are most helpful in every way. Nothing is too much trouble”. Residents have a comfortable home in which to live, with a choice of lounges and sitting areas with garden and patio areas for the warmer weather. The atmosphere in the home is warm and welcoming and there is evidence of good relationships between residents, relatives and the staff group. An activities co-ordinator ensures residents have a choice of activities, entertainment and outings. Very good comments were received from the residents about the quality and choice of food available. What has improved since the last inspection? What they could do better: Recent staff changes due to vacancies or sickness have had an unsettling affect on some residents. One resident said, ““Some carers seem overworked. Most staff are helpful – just a few who do not pull their weight”. Another said, “It has gone down a bit lately”. The manager is meeting with the residents to discuss these concerns. Some of the care plans could be improved in terms of ensuring they are signed and dated to ensure that residents are receiving the care they require when care plans are updated. Some care plans do not provide any evidence that residents have been involved or consulted. It is good practice to involve the residents and/or their families in the care planning process. A photograph should be available in the home for each resident for his or her safety. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 8 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. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 9 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 Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 does not apply, as intermediate care is not provided. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ needs are assessed before they move into the home. This ensures that each resident and their family know that these needs can be met when they move into Leycester House. EVIDENCE: The admission procedure ensures that new residents are fully assessed prior to moving into the home. Either the manager or care team leader visits each prospective resident in their own home or hospital before they move into Leycester House to ensure that the home is going to be the right place for them. Assessments from social services or medical professionals are also part of this process, ensuring all needs of the residents can be met at the home. The files of four residents were checked, including one of a resident who had recently moved into the home. Completed assessment forms were available Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 11 on each care plan, showing that staff had assessed the residents prior to them moving into the home. When the resident moves into the home, this information is used to develop a plan of care. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are well looked after, ensuring their health, social and personal care needs are met. EVIDENCE: Five residents’ plans of care were seen and each had details of how the resident’s needs were to be met. They were generally well written and up to date, but some care plans had not been completed as well as others. Some had no evidence that the residents had been involved in writing the plans and others were not signed or dated, making it difficult to know how up to date the information was. All contained risk assessments, moving and handling information, information about contact with medical professionals, nutritional records and a variety of other records to ensure the residents’ wellbeing. There was no photograph available in the home for some residents, including one resident who had been living in the home for ten weeks. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 13 Residents’ interests, hobbies and previous lifestyle are recorded in a ‘life profile’ document, using relatives help to gather the information. This enables staff to have a better understanding of each resident’s lifestyle before they move into Leycester House. The activities co-ordinator records how residents’ social needs are met, giving examples of any activities and outings they have enjoyed. The care plans show that residents have regular visits from a chiropodist, dentist and optician. A separate section of each resident’s care plan is used for recording any medical interventions, which enables effective monitoring. Referrals are made to other health care specialists as and when required. Three visiting community nurses were spoken with during their visit to the home to see some of their patients. Apart from a minor concern that was passed to the manager, they felt the residents received good care and that residents were referred to the medical professionals appropriately. Residents spoken with were pleased with the care that they receive in Leycester House. One resident wrote in the questionnaire “ Nothing is too much trouble when you ask”. Senior staff in the home that give out medication have attended a medication training course. The home has a medication policy and the manager regularly audits that the medication procedures are followed. Improvements to the way medicines are handled in the home since the last inspection were noted. The storage, returns and recording of medication was all in good order, ensuring residents’ safety. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have choice in how they spend their days in the home, showing that they have some control over their lives. EVIDENCE: Two part-time activities co-ordinators arrange a weekly programme of activities that is displayed on posters around the home. They spend some time on a one-to-one basis with residents as well as organising group in-house activities. Recent events have included trips out to Knowsley Safari Park, Tatton Park, Manchester Airport, pub lunches and a forthcoming trip to Blackpool lights is planned. In-house activities have included visiting entertainers, a summer fair, cheese and wine evening and sausage tasting competition. Residents’ meetings are held on a regular basis, and the minutes seen by residents or read to them. Residents are able to have visitors at any time. Residents are encouraged to be as independent as possible and have choice and control in their lives. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 15 All residents spoken with praised the food, and it was evident they were very fond of the cook. He likes to spend time with the residents getting to know their individual likes and dislikes. He gave some good examples of the way in which he is able to meet diverse individual need through food. One resident said, “We have a very, very good cook. He meets my individual needs – very accommodating”. Some other comments included “Food excellent” and “The food is great”. The daily menus each have two or three choices at each meal, plus a light snack supper before bedtime. There is one main dining area in the home and two smaller dining areas where food is served from a hot trolley. Some residents choose to have their meals in their bedroom. The food served for lunch looked appetising and well cooked, with plenty available for second helpings for those who wanted some more. Cooked breakfasts are available and thoroughly enjoyed by some residents. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements for protecting residents from abuse are good so that residents are not at risk from harm or poor practice. EVIDENCE: The complaints procedure is available in the service user’s guide, a copy of which is displayed in the hall along with information regarding how to contact the CSCI. CLS encourages residents and visitors to express any comments they have about the service provided, and comment cards are on display in the entrance hall. CSCI has not received any complaints about the home since the last inspection. The pre inspection questionnaire indicated that the home has only received one complaint in the past year, and this was resolved in a satisfactory way. The manager encourages families to discuss any issues or concerns they have with the staff, so that these can be put right immediately. The correct policies and procedures are in place to ensure residents are protected from abuse, and many of the staff have attended a training session in the past. The manager is planning further training to update their knowledge. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 17 Residents spoken with said they were comfortable in discussing any issues with the manager. Five residents completed a questionnaire before the inspection, and in answer to the questionnaire “Do you know how to make a complaint?” all five replied “yes”. In answer to the questionnaire “Do the staff listen and act on what you say?” all five replied “yes”. One resident wrote on her questionnaire “Never felt the urge to complain”. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a comfortable and safe standard of accommodation for those living there. EVIDENCE: The home is reasonably well maintained and suits the needs of the residents. It is decorated and furnished in such a way as to create a homely environment for the residents. A programme of refurbishment is in place, and bedrooms are refurbished on change of occupier. Since the last inspection, a number of bedrooms have been decorated and new lounge chairs can be seen around the home. New carpets have been laid in the first floor lounge and the dining chairs re-covered, providing better facilities for residents. The home was clean with no noticeable odours. The manager has identified some areas of the home that are now in need of refurbishment, and has plans to action these. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 19 The home provides a number of different sitting areas, including a smoking lounge. Residents spoken with were happy with the facilities provided. One resident said, “It’s very comfortable here. There is plenty of hot water – you can have a bath at any time”. A number of bedrooms were seen and all were in good order. Residents have been able to personalise their rooms making them comfortable and homely. One resident, who likes to live in her bedroom, said, “I can see out of the windows”. She enjoyed the fact that the windows are low down, and she can watch what is happening outside when sat in a chair in her bedroom. There is a courtyard and a raised patio provided for residents outside, furnished with chairs and brollies for the warmer weather. The fire prevention officer made his last visit in December 2005. Some recommendations are still outstanding. The environmental health officer visited on 21/1/2005 and there are no outstanding requirements or recommendations. His written comments after this visit were “good standard”. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are sufficient numbers of staff that have been trained and properly recruited to meet the needs of the residents. EVIDENCE: The home has continued to fill vacant posts over the past few months, so that less agency staff are required to work in the home. This has continued to provide some continuity of care for the residents. However, some vacancies that have arisen recently and some long term staff sickness has had a negative effect on some of the residents. Some residents spoken with felt the home was short staffed, although the staff rotas showed that this was not the case. Others were sad not to see to see their individual carer in the home and commented on the different ‘carers’ that were on duty. The manager is meeting with the residents to discuss some of these issues. The care staff group are continuing with their training and have reached the 50 trained care staff target. To date, 10 of the 20 care staff hold an NVQ qualification (50 ) and 8 are working towards it. Many of the general staff have completed NVQ training in housekeeping. CLS have a good commitment to NVQ training. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 21 The staff files of four members of the care team, including the two latest employers to be employed were checked. All contained two references and evidence of an interview. Records also showed that all staff working in the home have had a Criminal Records Bureau check completed. These procedures and checks help ensure that only the right people are employed in the home to care for vulnerable elderly people. When new members of staff commence work, they have an induction course. Staff spoken with confirmed that further training is available to all staff to enable them to do their jobs. Care staff spoken with demonstrated an understanding of how to meet diverse needs. One care staff explained how she regularly helps one resident use rosary beads although she is not a catholic herself. Residents spoken with said the staff are kind and caring, and some of the comments received are: • • • • “Staff treat residents with respect and dignity”. “I feel well cared for”. “Some carers seem overworked. Most staff are helpful – just a few who do not pull their weight”. “Staff are very nice – no rules and regulations”. One resident wrote on her questionnaire “Nothing is too much trouble when you ask”. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is qualified and experienced, ensuring the residents live in a well run, safe home where their views are listened to. EVIDENCE: The manager holds the Registered Managers Award, and has had a number of years experience as a manager. The staff spoken with said he supports them well. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 23 A quality assurance system is in place, and residents and/or their families completed a satisfaction questionnaire last year. The results of this survey have been collated and a summary is available in the service users’ guide. A new quality survey has recently commenced, and the views of the residents and their families, local GPs and district nurses are being sought. Residents’ meetings are also held on a regular basis, enabling them to voice an opinion about their lives at Leycester House. The home encourages comments or suggestions from visitors to the home, and forms for this are available in the entrance hall. The home works to a good system for safeguarding residents’ money, and clear records with receipts are kept. Policies and procedures for safeguarding residents’ money provide security. The pre inspection questionnaire provided information to confirm that equipment and installations at the home are serviced on a regular basis. The home employs a handyman who attends to maintenance issues such as checking fire equipment, water temperatures and other health and safety matters, providing a safe environment for staff and residents. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 24 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 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 Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 25 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. 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 2 3 Refer to Standard OP7 OP7 OP7 Good Practice Recommendations Care plans should show evidence that residents and/or their families have been involved in the planning and review process. Care plans and any reviews or updates should be signed and dated. A photograph should be available in the home of each resident. Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Leycester House DS0000006512.V306613.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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