Inspection on 11/09/06 for Limegrove

This inspection was carried out on 11th 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Limegrove 01/06/06

Limegrove 07/11/05

Limegrove 19/04/05

Limegrove 12/10/04

Limegrove 18/05/04

Similar services:

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

Old Hastings House

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

CARE HOMES FOR OLDER PEOPLE Limegrove Limegrove St Martin`s Close East Horsley Surrey KT24 6SU Lead Inspector Sandra Holland Unannounced Inspection 11th September 2006 10:30 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 Limegrove DS0000033691.V312806.R02.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. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Limegrove Address Limegrove St Martin`s Close East Horsley Surrey KT24 6SU 01483 280690 01483 280834 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) Sharon.blackwell@anchor.org Anchor Trust Mrs Dawn Morewood Care Home 54 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (27), of places Physical disability over 65 years of age (13) Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st June 2006 Brief Description of the Service: Limegrove is a large purpose built home for older people located in the village of East Horsley. The home is registered to provide personal care and support for up to 54 service users. The home is divided into five self contained units each with their own lounge, dining room, kitchenette, toilets and assisted bathrooms. All residents bedrooms are for single occupancy with an en-suite facility. A meeting room is available and is used for some resident activities. Other activities are carried out on the individual units. The home has spacious, well-maintained gardens and is located close to the local village, with its shops and church. There is parking to the front and rear of the property. The fees at this service range from £………... to £……………. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was the second to be carried out in the Commission for Social Care Inspection (CSCI) year April 2006 to June 2007 and was carried out under the “Inspecting for Better Lives” programme. Mrs Sandra Holland, Lead Inspector for the service carried out the inspection over eight hours. Mrs Dawn Morewood, Registered Manager was present representing the service. Areas of the home were seen and a selection of records and documents were sampled, including staff files, care plans and medication administration record (MAR) charts. A number of records (but not all), relating to health and safety were seen, including fire records and food records. The people living at the home prefer to be known as residents and that is the term that will be used throughout this report. The inspector would like to thank the residents and staff for their assistance with the inspection process. What the service does well: What has improved since the last inspection? Residents have been supplied with contracts containing the terms and conditions for living at the home. The quality of the information contained in residents’ care plans has improved. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 6 Assessments have been carried out of any known risks to residents. Photographs of residents have been attached to medication divider cards, to ensure that residents are correctly identified and to reduce the risk of medication errors. The standard of recruitment practices has improved. The activities co-ordinator and housekeeping staff have received training to enable them to carry out their role. Further staff have been enrolled to undertake National Vocational Qualification (NVQ) training. The manager has now been registered by CSCI. The summary of the recent report into the quality of the service provided by the home has been supplied to CSCI. Hazards to the health or safety of residents have been removed. 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. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3 and 6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Contracts have been supplied to most but not all residents. The needs of recently admitted residents were fully assessed before the resident was admitted on a permanent basis. EVIDENCE: A requirement was made at the inspection carried out on 1st June 2006, that each resident must be provided with a contract or statement of the terms and conditions of their residence, and that these must contain the information specified by the Care Homes Regulations 2001 (As Amended). A timescale of 4th August 2006 was given and this has been partially met. The files of a number of recently admitted residents were seen. Contracts between the home and the resident detailing the terms and conditions for living at the home were included for most but not all residents. Of those supplied, all had been signed by the resident, but it was noted that only one of these included the amount that was payable. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 9 A number of residents are supported financially by local authorities, but only one contract stated which local authority was involved. Copies of the agreement held between the home and the local authority regarding the care and support of the resident, were not held in the resident’s file as required. From the files seen, it was clear that the needs of residents had been fully assessed before their permanent admission to the home. For two of these residents who had decided that they would like to live at the home whilst staying for short respite breaks, the assessment of their needs was carried out during the respite stay. Assessments of residents needs had been appropriately carried out by experienced senior staff at the home and all the assessments seen had been signed and dated by the person carrying out the assessment. The manager advised that intermediate care is not provided at the home. A requirement has been made regarding Standard 2. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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. The standard of the information in residents’ care plans has been improved and residents healthcare needs are well met. Medication appears to be effectively managed and staff treat residents with respect and dignity. EVIDENCE: Staff advised that an individual plan of the care and support needs required by each resident has been drawn up and it was clear that the information in these had been taken from pre-admission assessments. A number of the individual plans were seen and contained detailed information which would effectively guide staff to meet the needs of residents. It was pleasing that overall, the standard of the care plans was much improved and more detailed than previously seen. Although photographs of residents are held on their medication records, it is recommended that these are also attached to resident’s individual plans of care. This enables ease of identification for staff using the plans and in the event that a resident should be missing from the home. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 11 From the records sampled and from speaking to residents, it was apparent that a number of healthcare professionals are involved in the support of residents. These include general practitioners (GP’s), community psychiatric nurses (CPN’s), continence advisors, community nurses, chiropodist and optician. Staff advised that if a change is noted in the health or well-being of a resident, healthcare professionals are accessed, usually after referral to the resident’s GP. Medication in the home appears to be effectively managed and recorded. The deputy manager stated that two members of the senior staff take the lead in the management of medication, including the ordering of supplies, monitoring of these and checking new stock on receipt. Medication administration record (MAR) charts were seen for a number of residents and it was pleasing to note that all medications had been recorded appropriately and there were no gaps in the recording. If medication was not administered at any time, this was recorded on the rear of the MAR chart, stating the reason for omission. Senior staff were observed to administer medication on those units of the home where staff have not been trained in this. It is recommended that if it is necessary to crush a medication before it can be administered to a resident, the written agreement of the doctor prescribing the medication is obtained, as the effectiveness of some medications may be changed by crushing and other medications may not be suitable for crushing. Residents spoke appreciatively of the help and support provided by staff and advised that their privacy is respected. Staff were observed to knock before entering residents’ rooms or bathrooms and to interact with residents in a friendly manner, whilst showing respect to residents as individuals. Recommendations have been made regarding Standards 7 and 9. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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. A range of activities and a well-balanced diet are made available to residents. Residents are supported to maintain contact with their friends and families and to maintain their independence. EVIDENCE: Staff advised that they were organising social activities for residents as the activities co-ordinator was on holiday. Staff were seen preparing to make a mural with one group of residents whilst another member of staff was organising board games. An activities programme is displayed on the notice board in each unit to guide residents and staff as to the activities available. An activities room is allocated in the home and this is equipped with large tables and a number of chairs and armchairs. Storage cupboards for activity equipment are also provided and residents artworks were displayed on the walls. Residents advised that they enjoy the activities that are organised and spoke of quizzes and of playing a form of bingo which uses letters instead of numbers. A small group of residents advised that they preferred not to join in with activities and this choice was respected. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 13 Visitors were observed at the home and were welcomed by staff, whilst residents spoke of keeping in contact with their families and friends. Many residents spoke of their visitors and a number advised that they have telephones in their rooms which enable them to have direct contact with others outside the home. One resident was pleased to speak of being supported to maintain her involvement with her local church and other social activities. Residents were also willing to show their bedrooms, most of which contained belongings they had brought from their previous home. These included small items of furniture, televisions, ornaments, pictures and photographs and residents advised that these made them feel more “at home”. Staff advised that meals are served in the dining rooms of individual units and these were attractively decorated and furnished. Small tables, seating up to four residents had been set with colourful tablecloths, tablemats and napkins. Fruit drinks and fresh fruit were available and residents were encouraged to serve themselves independently. The meals offered were seen to match those stated on the menu which was displayed and this appeared to be well-balanced and nutritious. A choice of hot main courses were available and it was pleasing to hear residents state that they enjoy their meals, that the food is good and is hot when served. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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. The complaints procedure has been made more accessible, but still requires review. Staff are aware of their responsibilities in the protection of residents. EVIDENCE: A requirement was made at the last inspection that the home’s complaints procedure must be reviewed because it is not suited to the needs of the residents. A timescale of 1st September 2006 was given and this has been partially met. The Anchor Homes corporate policy has been redesigned to incorporate the Anchor branding, but the content of the policy has not been changed. The main part of the complaints procedure highlights that complainants should write to Anchor at the address displayed. As most of the residents at the home are elderly and frail or have dementia or physical disabilities, this requirement of the complaints procedure does not meet these needs. The complaints procedure is displayed in the main entrance hall and from speaking to residents it was clear that they knew who to speak to if they had any concerns or wished to make a verbal complaint. The complaints record was seen and only one complaint had been recorded since the last inspection and the actions taken to address this were also recorded. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 15 From speaking to staff it was clear that they would report any concerns that they had to the manager or the person in charge. A number of staff have received training in the safeguarding of vulnerable adults, but from speaking to ancilliary staff it was apparent that they had not had this training. As these staff freely interact with residents and have access to residents’ rooms, it is required that they receive this training to ensure they know how to respond to any incident of abuse, or suspicion of abuse that may occur. The manager stated that in the event of any incident or suspicion of abuse, the home would follow the Surrey Multi-Agency procedure for safeguarding adults. A copy of this procedure is held in the home and the procedure has been implemented in the past. A requirement has been made regarding Standard 16. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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 is attractively decorated and furnished and presents as a comfortable place to live. EVIDENCE: The deputy manager advised that the home was purpose built and is divided into five units, two of which accommodate twelve residents and three of which accommodate ten residents. Each unit has its own lounge, dining room and kitchen area, with spacious and light corridors. Individual bedrooms with toilet and basin facilities are provided and bathrooms with specialist, easy access baths are available. The home has been furnished throughout in a comfortable, homely style, with co-ordinated soft furnishings and decorations. Residents stated that they were happy with their bedrooms and with the comfort and facilities of the home. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 17 All areas of the home were seen to be clean, freshly aired and appeared hygienic. Hand washing facilities were appropriately placed with paper towels and liquid soap made available. Staff were observed to maintain good standards of hygiene, washing their hands before serving meals and after assisting residents. Staff were also seen to use the personal protective equipment which was supplied, such as gloves and aprons, when appropriate. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission 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. A team of staff are employed to meet the needs of residents and staff receive training appropriate to their role. Recruitment of staff appears to be effectively managed. EVIDENCE: A team of staff are employed to meet the needs of residents and these include care staff, kitchen staff, laundry staff, housekeeping staff, receptionists and administrators, activities co-ordinators and a maintenance worker. The manager stated that a further twelve staff have been registered to undertake training to achieve a National Vocational Qualification (NVQ) to Level 2 in care. This was recommended at the last inspection and is in addition to six staff who have already achieved this qualification. This number of staff in total will ensure that the home achieves a ratio of fifty percent of trained care staff, as recommended by the National Minimum Standards for Older People. Four staff are NVQ assessors and a further four are working towards this, the manager advised. The recruitment of staff appears to be effectively managed. The files of a number of recently recruited staff were sampled and it was pleasing to see these contained all the required information and records. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 19 From the records seen and speaking to staff, it was clear that they receive training which is appropriate to the role they are to carry out. This included fire safety, food hygiene, health and safety, manual handling and back-care Housekeeping staff have also received training in the Control Of Substances Hazardous to Health (COSHH) to ensure they are aware of the precautions to be taken when using cleaning products, to safeguard themselves and residents. As noted at Standard 18, ancilliary staff require training in the safeguarding of vulnerable adults. It was observed that the staff group was culturally and racially diverse whilst the resident group is predominantly British. The manager stated that the home is supportive to staff or applicants to work at the home, who may have disabilities. The ability to carry out the role required, being the criteria for selection. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 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 home has been effectively managed and a quality assurance survey has been carried out. The health and safety of service users is protected and promoted. EVIDENCE: It was disappointing to hear that the newly registered manager will be moving from the home next month, as the standards in many areas of the home have improved since the last inspection. The manager stated that an experienced manager who has worked with the Anchor organisation for many years is to be appointed. It was advised that the new manager should be arriving in the home before the registered manager leaves, to ensure that a smooth handover of responsibilities takes place and to ensure continuity for residents and staff. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 21 A quality assurance survey was carried out at the home by an independent company earlier this year and a summary of the results has been supplied to CSCI. The home was measured against thirty-six attributes, such as cleanliness, bedrooms, laundry, food, personal need, staff attention and complaints. It was pleasing to see that many positive comments had been received and staff were praised for the level of care and kindness they displayed. The administrator advised that records of residents’ monies held for safekeeping are held on a computer and in a paper format, and these were seen. The majority of residents’ monies are held in a communal, personal allowance account, with the amount for each resident listed individually. Cash is withdrawn from this account and held, to enable residents to draw on this as required, and a record of all transactions is maintained. To safeguard residents and staff, all transactions had been signed by two people. It was noted that although all residents’ monies could be accounted for, the two recording systems did not accurately match for all residents. For one resident, a withdrawal had been recorded on the computer system, was not entered on the paper record but had been recorded in the residents’ monies cash book. For this same resident, another entry was incorrectly dated. A number of records regarding health and safety matters were seen but not all. Those seen related to food storage and serving, fire safety and accidents. All had been carried out to the required frequencies and were within appropriate ranges. No hazards to the health or safety of residents were noted in the areas of the home that were seen. A recommendation has been made regarding Standard 35. Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 22 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 2 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 2 X X 3 Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 23 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 5 (1) (b & c) Requirement Each resident must be provided with a contract or statement of terms and conditions of their residence, containing the information specified in Regulation 5. Timescales of 05/12/05 and 04/08/06 not met. The Anchor complaints procedure must be appropriate to the needs of the residents. Timescale of 6/02/06 and 01/09/06 not met. The registered person must ensure that persons employed to work at the care home receive training appropriate to the work they are to perform. Specifically, ancilliary staff must be trained in the safeguarding of vulnerable adults. Timescale for action 15/12/06 2. OP16 22 15/12/06 3. OP30 18 (1) (c) (i) 15/12/06 Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations It is recommended that photographs are attached to resident’s individual plans of care, for ease of identification in use and in the event that a resident is missing from the home. It is good practice to obtain the prescriber’s written agreement if medication is to be crushed before administration. All records relating to residents’ monies held for safekeeping should be accurately maintained. 2. 3. OP9 OP35 Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Surrey Area Office The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Limegrove DS0000033691.V312806.R02.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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