Inspection on 05/12/05 for Liam House

This inspection was carried out on 5th December 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Liam House 23/05/07

Liam House 26/02/07

Liam House 23/05/06

Liam House 10/05/05

Liam House 22/11/04

Liam House 02/06/04

Liam House 01/03/04

Liam House 03/11/03

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

CARE HOME ADULTS 18-65 Liam House 13 Spencer Road Bournemouth Dorset BH1 3TE Lead Inspector Stephanie Omosevwerha Unannounced Inspection 5th December 2005 10:00 Liam House DS0000003956.V271363.R01.S.doc Version 5.1 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 Liam House DS0000003956.V271363.R01.S.doc Version 5.1 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. Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Liam House Address 13 Spencer Road Bournemouth Dorset BH1 3TE 01202 294148 01202 789983 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) Mr Marvin Charles Stephens Care Home 11 Category(ies) of Learning disability (11), Learning disability over registration, with number 65 years of age (11) of places Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th May 2005 Brief Description of the Service: Liam House is a home for adults of both sexes who have a learning disability. It is a large, semi-detached house situated in a central area of Bournemouth close to Boscombe and Bournemouth town centres. The home is conveniently located near shops and facilities and is not far from the sea. It has good access to public transport. Residents accommodation is provided in 7 single and 2 double bedrooms. Seven bedrooms are located on the first floor and two on the ground. The first floor also has 2 bathrooms with WCs and a separate WC. The ground floor has one bathroom with a WC. The communal space is located on the ground floor and consists of a lounge, separate dining room and kitchen. There is a small locked office where all the records are kept. Outside there is a small garden at the rear of the property that has a large storage shed, which contains the laundry facilities and 2 large freezers. The front of the property provides offroad parking. The home is staffed 24 hours a day, with 2 sleeping in staff at nights. Most residents attend day activities organised by different agencies outside the home although this is flexible and residents are also supported to spend time at the home. Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced inspection of the home and took place over 5 hours. It was carried out as part of the planned inspection programme for care homes undertaken by CSCI and to address the requirements and recommendations made at the previous inspection. During the inspection various records and documentation were sampled including service users’ care plans, health and safety records and staffing records. A tour of the premises was undertaken including all of the communal rooms and all except one service user’s bedroom. The inspector was able to talk to 4 members of care staff who were on duty throughout the day. The registered proprietor was also interviewed. The inspector met with all the residents on their return from their daytime activities and was able to speak to 4 residents on an individual basis in the privacy of their rooms. What the service does well: What has improved since the last inspection? There has been some investment in the environment and six service users have had their rooms re-painted in their colour choice personalising their accommodation to their individual tastes. A new system of administering medication has been introduced and staff report that this has made this task easier to manage. A new shed has been purchased outside to create more storage space. Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Liam House DS0000003956.V271363.R01.S.doc Version 5.1 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 Liam House DS0000003956.V271363.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 The home has no vacancies at present but previous evidence indicates professionals assessments of service users needs were carried out prior to admission to ensure the home could provide appropriate care. EVIDENCE: A sample of 3 service users’ files was examined as part of the inspection. There was evidence that care management assessment and plans had been completed prior to admission. Some residents had lived in the home for a number of years and there had not been a new admission to the home since 2003. There were currently no vacancies in the home so no prospective admissions were planned. There was evidence that service users plans were being reviewed and written notes were available in service users files. A service user also confirmed they had recently met with their care manager to review their care needs. Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Detailed care plans are in place reflecting individual support needs. These have been regularly reviewed and any changes have been recorded and implemented. The home currently needs to re-organise the way service users finances are managed to ensure it meets regulatory requirements. Assessments were in place to minimise risks to service users, which were carried out individually taking into account each service users abilities to manage tasks independently. EVIDENCE: All 3 service users whose files were sampled had detailed care plans. These contained information regarding health needs, communication, personal care, community access, mobility, money management, domestic tasks, social, leisure and recreational activities and relationships and sexuality. Plans also contained clear guidance to staff about the support required e.g. how to deal with ‘challenging behaviour’. There was evidence that reviews had been carried out and any changes to care plans had been recorded. Staff spoken with said they were able to access the care plans and despite not having a Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 10 manager they were working as a team to ensure service users needs were met. There is an outstanding requirement regarding the management of service users finances. This was discussed with the proprietor who reported some progress had been made on this. He said he had contacted the bank and arranged for money relating to the business to be moved to a different account so that all service users monies would be managed in a separate account naming all the residents in the home. An extension to the original timescale was given and the proprietor agreed that this would be in place by the next inspection. A sample of individual risk assessments were seen on service users files including finances, community access, slips/trips/falls, and medication. These were based on promoting service user choice rather than imposing unnecessary limitations e.g. one service user said he could go out into the community independently whilst others needed to be supported by staff. Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 15 & 16 Satisfactory daytime activities were organised outside the home although day care provided by the home appeared to be unstructured and failing to meet the best interests of the service user. Visits with relatives was promoted and the home had actively been involved in trying to re-establish family contacts. Service users were able to exercise individual choice and had freedom of movement although increasing service users participation in household routines would provide further opportunities for developing independent living skills. EVIDENCE: Suitable daytime activities were recorded on service users files and these included day centres, college courses and work placements. Discussion with service users on their return from their daily activities confirmed they were happy with their individual arrangements. The home currently provides day time care for one service user, although on the day of the inspection the service user stayed in bed all morning. The staff said that this was through Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 12 choice and it was very difficult to persuade the service user to do things he didn’t want to do. However, this would not appear to be in the service users best interests and it is recommended that professional advice is sought about ways of motivating service users and promoting mental health. Another service user is supported to spend a day at home mid week. There was evidence that personal relationships were supported and details of relatives were recorded on service users files. Service users were able to visit and spend time with their families, although not all service users had relatives living locally. It was noted on one service user’s file that the care manager had been involved in trying to trace the relative of one service user with whom they had lost contact. Observation during the inspection evidenced that service users had unrestricted access to all communal areas of the home. On their return from day centre activities service users choose whether to spend time in the kitchen, dining room, and lounge or in the privacy of their bedrooms. Staff were seen to interact with the service users and they were all looking forward to a night out at an event organised by a local service user advocacy group. Individual choice was respected e.g. one member of staff was staying home with 2 of the residents who didn’t want to go out that evening. Service users responsibilities for housekeeping tasks were identified on their care plans e.g. “X is a capable assistant in the kitchen, can dry up and tidy bedroom”. There was some evidence that service user could get involved in daily routines such as making up lunch boxes and helping with the shopping. The main responsibilities for cooking and cleaning are undertaken by staff employed specifically to do these activities, which means there are less opportunities for service user participation. It is recommended that ways of further involving service users in household chores be explored to promote independent living skills. Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 & 19 Care needs and preferences were clearly documented on service users plans and service users felt appropriately supported by most members of staff although they had less confidence in less experienced staff members. Clear guidance is available for staff on service users’ physical and mental health although the lack of a manager has allowed certain conditions to drift rather than proactively seeking professional advice and support. EVIDENCE: Personal care needs were well documented on service users’ care plans. These included information on washing, oral hygiene, hair care, shaving, continence and dressing giving staff clear guidance about individual support needs. Discussion with service users confirmed they were generally happy with the support they were given, although some reservations were reported to the inspector about a newer member of staff. Staff said there is not currently a key worker system in place as there have been recent changes in the staff team with only 3 existing members of staff remaining. These members of staff are currently overseeing things and ensuring that service users needs continue to be met. Service users plans contained detailed information about their health needs including their physical and mental health. G.P. details were clearly recorded Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 14 and all visits to healthcare professionals were noted. Clear written instructions were available to staff on how to care for particularly conditions e.g. monitoring mental health and a protocol from managing diabetes. Advice was also included about when to seek professional advice e.g. referral to psychiatrist and contact details for the district nurse. Staff told the inspector they were continuing to ensure residents kept medical appointments and were supported to attend these in the absence of the manager. The inspector did feel that professional advice should be sought concerning the mental health needs of one service user who was spending a considerable amount of time during the daytime in bed. Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 A satisfactory complaints procedure is in place and service users can access advocacy/professional support to ensure their views are listened to. EVIDENCE: The home has a satisfactory complaints procedure that is available in a format accessible to residents. This is displayed prominently on the notice board in the dining room. Residents were able to articulate their views to the inspector and were aware they could speak to other professionals e.g. care managers about any concerns that they had. Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Recent investment has improved the living environment providing service users with more choice about personalising their accommodation. A good standard of cleanliness is kept in the home. EVIDENCE: A tour of the premises was carried out as part of the inspection. All communal areas were viewed including the lounge, dining room, kitchen, laundry room and garden. The inspector observed the premises had suitable lighting and heating. Furnishings and fittings were well maintained and domestic in appearance. All but one service users’ bedrooms were seen. Recent redecoration of bedrooms had taken place and 6 had been re-painted personalising them more to the individual occupants taste. On the day of the inspection the home was seen to be clean and tidy with no offensive odours. The home employs a domestic assistant who works Mondays to Fridays who is responsible for keeping the home clean. There are separate laundry facilities in an outside storage shed. It was recommended that all perishable food was stored in airtight boxes or moved into the kitchen away from laundry facilities. Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34, 35 and 36. Since the last inspection the standard of vetting and recruitment practices has declined with appropriate checks not being carried out potentially leaving service users at risk. The home’s training and development programme does not currently meet the standards for induction and qualifications meaning there is a reliance on staff experience rather than trained skills and competencies. There is no formal system of staff supervision in the home to give them opportunities to express their views and gain feedback on their performance. EVIDENCE: There had been a number of changes within the staff team since the last inspection with 3 members of staff leaving the home in October 2005. 4 new members of staff had been recruited and records for these staff were checked. Appropriate records were in place for 2 of these staff who had been recruited prior to the registered manager leaving the home. However, records for the 2 newest members of staff did not meet with regulatory requirements and an immediate requirement was made to ensure satisfactory POVA checks were in place prior to members of staff working in the home. In addition it is necessary to obtain CRB checks, 2 written references and work permits (if required). The proprietor also needs to ensure photographic proof of identity Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 18 is established. Discussion with residents also indicated a lack of confidence in one of the newer staff’s abilities. There was no written evidence to indicate that any formal induction had taken place with the 2 newest members of staff. The previous manager had designed an induction programme format, but these had not been completed. Members of staff said new staff were supported by more experienced members of staff and initially shadowed them until they were competent to work on their own. Staff said that the registered proprietor was currently overseeing training and they had undertaken some courses recently e.g. Infection Control, First Aid, Administrating medication and Makaton. There are no staff currently that hold an NVQ qualification, which means the home does not meet the required target of having 50 of staff with a NVQ qualification. Two members of staff are currently undertaking NVQ Level 2. A third member of staff told the inspector she also works at another residential care home where she is currently undertaking her NVQ Level 2. Discussion with the registered provider showed he was unaware of the need for training to follow the Learning Disability Award Framework and it was recommended he find out information about the availability of courses to ensure the home’s training programme follows current regulatory requirements. During the course of the inspection the inspector spoke to 4 members of staff. Morale within the staff team appeared variable with some staff feeling positive saying in spite the lack of the manager there was a good atmosphere with staff working as a team. Other staff seemed more unsettled by the changes in the home. There is still an outstanding requirement to implement a formal system of supervision for staff. This has not been addressed due to the lack of a registered manager. The registered proprietor is currently overseeing the home and holding regular staff meetings. Staff said there had been at least four meeting since the registered manager had left in October. Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 and 42. A lack of qualified and experienced leadership has impacted on the running of the home. This situation is having a detrimental impact on the standard and consistency of care offered within this home. Some slippage in health and safety records meant service users welfare was not been promoted as effectively as it was at the previous inspection. EVIDENCE: The registered manager resigned from his post in October 2005. The registered proprietor is currently overseeing the home and told the inspector he was currently exploring various options to recruit a new manager. The inspector reinforced the importance of having a registered manager in post to ensure the home meets its regulatory requirements. Although most health and safety records were checked at the previous inspection, a brief look at fire records showed that weekly fire alarm tests were not up-to-date and staff fire training had also become out of date, i.e. 3 monthly for night staff and 6 monthly for day staff. Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 20 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 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 x ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 2 STAFFING Standard No Score 31 x 32 x 33 x 34 1 35 1 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 1 x 3 x LIFESTYLES Standard No Score 11 x 12 2 13 x 14 x 15 3 16 2 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 2 x x 1 x x x x 1 x Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 21 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA7 Regulation 20 Requirement The registered person should not pay money belonging to any service user into a bank account unless the account is in the name of the service user(s) and is not used in connection with the carrying on or management of the care home. (Previous timescale of 31 January 2005 not met.) The registered person must help service users to find and keep appropriate jobs, continue their education or training, and / or take part in valued and fulfilling activities. The registered person must obtain a POVA first check prior to care workers commencing employment in the home. The registered person must obtain all the information in respect of care workers in the home identified in Schedule 2 of the Care Homes Regulations 2001. The registered person must ensure that there is a staff training and development programme which meets the DS0000003956.V271363.R01.S.doc Timescale for action 01/02/06 2. YA12 12 01/03/06 3. YA34 19 05/12/06 4. YA34 19 31/01/06 5. YA35 18 31/03/06 Liam House Version 5.1 Page 22 6. YA36 18 7. YA37 8 8. YA42 23 Sector Skills Council workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users’. The registered person should 01/06/06 ensure that persons working in the home are appropriately supervised. (Previous timescale of 01/09/05 not met.) The registered person must 01/03/06 appoint a person to manage the care home and provide the Commission with the relevant details. The registered provider must 01/02/06 ensure that all records concerning fire training are upto-date, i.e. 6 monthly for day staff and 3 monthly for night staff. Records for testing the fire alarm should also be kept up-todate. 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 YA1 Good Practice Recommendations It is recommended that the service user guide would benefit from being available in a format accessible to service users with learning disabilities. (This was repeated from the previous inspection but not assessed on this occasion.) It is recommended that the service users contract specifies the room that is to be occupied. (This was repeated from the previous inspection but not assessed on this occasion.) It is recommended that ways of further involving service users in household chores be explored to promote independent living skills. DS0000003956.V271363.R01.S.doc Version 5.1 Page 23 2. YA5 3. YA6 Liam House 4. YA19 5. 6. YA30 YA35 7. YA42 8. YA42 It is recommended that professional advice should be sought concerning the mental health needs of one service user who was spending a considerable amount of time during the daytime in bed. It was recommended that all perishable food was stored in airtight boxes or moved into the kitchen away from laundry facilities. It was recommended that the registered person find out information about the availability of courses to ensure the home’s training programme follows current regulatory requirements e.g. LDAF. It is recommended that a member of staff is nominated as being responsible for Health and Safety checks in the home as well as the manager to ensure that these are carried out in his absence. (This was repeated from the previous inspection.) It is recommended that the names of service users taking part in fire drills are recorded to facilitate monitoring. (This was repeated from the previous inspection.) Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF 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 Liam House DS0000003956.V271363.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!