Inspection on 16/01/06 for Linden Cottage

This inspection was carried out on 16th January 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Linden Cottage 10/10/08

Linden Cottage 13/10/06

Linden Cottage 24/05/05

Linden Cottage 11/01/05

Linden Cottage 01/09/04

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Linden Cottage Linden Chase Uckfield East Sussex TN22 1EE Lead Inspector Jenny Blackwell Unannounced Inspection 11:00 16 January 2006 th Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 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 Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 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. Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Linden Cottage Address Linden Chase Uckfield East Sussex TN22 1EE 01825 763872 01825 763787 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) Elizabeth Fitzroy Support Graham John Jerrom Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The maximum service users to be accommodated is 6 Up to 4 residents may also have a physical disability Date of last inspection 24th May 2005 Brief Description of the Service: Linden Cottage provides care and accommodation for six people with a learning disability; up to four of them may also have a physical disability. The house is a detached property set in a quiet residential area of Uckfield. The High Street, with its shops and access to bus and rail routes, are a short level walk away. The building is a converted bungalow; ground floor accommodation is adapted to accommodate people who have a physical disability and require the use of a wheelchair. First floor accommodation is allocated to those service users who can manage stairs. There is a large rear garden with a patio and lawn area, most of which can be accessed by wheelchair users. Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During this summary and report the people who live at the home will be referred to as people/person, and the people who work at the home as staff or by their job title. This was an unannounced inspection of the home under the Care Standards Act. The people who live at the home, some of the staff team and manager were present during the inspection. Time was spent with all of the three people who live at the home and a brief time was spent with the other two people. The manager was spoken to individually and four staff were spoken to throughout the day. The requirements made from the inspection in May 2005 were checked to see if they had been met. The manager produced evidence to show that one of the requirements had been met and one requirement will be carried forward. The people who live at the home and the staff were helpful throughout the inspection and contributed to the report where possible. What the service does well: Daily activities were planned and arranged around each person’s likes and dislikes. During the day all the people either went out or had an activity at home. Staff organised their shifts around the people’s wishes. It was observed that the staff consult the people regularly throughout the day about their preferences. During the inspection a workman was using dangerous equipment, the staff were seen to handle this sensitively as they had to restrict the movement of the people around the home. The staff had made particular effort with the service user guide to make it accessible for the people. They had taken photos of the home outside and inside, pictures of the bedroom and the bathroom facilities had been made up to show any new person to the home what the home looked like. The staff spoken to were aware of their roles in the home. They were experienced staff and knew the people well. The home had clear lines of accountability in the staff team, with a manager and two assistant managers. Each shift has an identified shift leader who oversees the activities for that shift. The manager stated that the current staff team is competent in their work and believes the team to be a “great team, the best we have had.” Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 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 Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 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): 1-4 Prospective people had the information they needed about the home to make informed choices. Not all of the people had their placements and aspirations assessed. New people referred to the service had the opportunity to visit and try out the home. EVIDENCE: The Statement of Purpose and Service User Guide were looked at. The information in the documents describe the facilities at the home, the staff numbers and the type of support that would be available to people wishing to move to the home. The staff had made particular effort with the service user guide to make it accessible for the people. They had taken photos of the home outside and inside, pictures of the bedroom and the bathroom facilities had been made up, to show any new person to the home what the home looked like. It was noted that the current service user group had not had their placements reviewed by their placing authorities (social services). The manager and staff ensured that each person had a review of their care twice a year, however the manager will need to ensure that each person’s placing authority review the placement every year. The staff team receive training about the aspects of supporting people with learning disabilities and other associated disabilities. The staff were seen to Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 9 approach each person as an individual and used different methods of communication with each person. Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,8 and 10 Each person had a care plan in place that reflected their changing needs, and wishes. The people were consulted on daily aspects of the home’s function. Information was stored correctly in the home. EVIDENCE: Time was spent with one person going through her care plan. The care plan contained pictures of her and information about her daily routines. There were sections about how to support her with her interest. Detailed information about the exercises she did when she went swimming was clearly logged. The plan had checklists that the staff used to ensure that her health care was monitored. The staff were seen to involve the people in the daily tasks and activities of the home. The people who live at the home have a variety of abilities and some limitations in the methods of communication they use. Therefore the staff gain an understanding of people’s choices by working with them closely and observing reactions, signs and gestures. A formal process of consultation, such as service users meetings was not used. During the visit staff were seen to offer people choices about their meals and drinks. They allowed themselves to be led by the people when the people wanted to go to different parts of the home and have some support from the staff. Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 11 The majority of the records were held in the office in filing cabinets. This included personal details about the people’s financial and medication records. The assistant manager was asked to provide access to some records and she demonstrated knowledge about their whereabouts and why some records were stored securely. Other records were kept downstairs for easy access for the staff. These included the daily recording files and routine checklist referred to as “daily summaries”. Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,14 and 17. All the people who use the service were encouraged to participate in activities and choose from a variety of leisure activities at the service and based in the community. The people were offered meals based on their choices and appeared to enjoy their meals. EVIDENCE: Each person is encouraged to maximise their potential and staff were seen to encourage the people to do things for themselves. For example helping themselves at mealtimes and participating at certain levels to clear up after the meals. On the day of the inspection each person had a planned activity arranged. One person was out for the day at a local day service. Another person had chosen to go out on a bus to Tunbridge Wells. The staff said that he enjoyed transport and had a Transport Session at Ringmer College. Two people attend sessions twice a week at Plumpton Agricultural College where they mixed with a variety of people, not only people with disabilities. Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 13 Later that day one person was going swimming at the local leisure centre. The staff encourage people to spend time in their local community with their support. They go to pubs, restaurants and cinemas locally. A staff member talked about a new home that had opened nearby that was also part of the Elizabeth Fitzroy Support organisation. The people who lived at the home had started to meet up with them for social gatherings. She felt that this was a nice opportunity for some of the people who lived at the home to build relationships with other people. The staffing levels reduce in the evening and the manager was asked how they offer evening activities to the people. He said that generally most activities happen during the day, however that on occasions people indicate an interest to go out in the evenings and extra staff are brought in for the evening. An example was seen of an outing to an evening club where an extra member of staff had come in to take people out. The support staff prepare and cook the meals at the home. The food choices were based on the known preferences of the people who live at the home. The menus were also written to reflect the dietary needs of the individuals. Some of the people needed their meals prepared and presented in a particular way. The staff preparing these meals were able to explain the reasons behind these methods and demonstrated knowledge of the peoples support needs. The meal times were unhurried and each person was given time to eat at their own pace. Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 20 The people were supported with personal care in the methods indicated in their support plans. The people who use the service are protected within reason by the service medication system, policies and procedures. EVIDENCE: Information about the well being of the people was recorded in their daily summaries. The daily summaries contain the health checklist previously mentioned. These lists were a quick reference tool for the staff to ensure the health care issues were monitored. The daily summaries did not contain information about how they preferred to receive personal care support. More information was held in each person care plan, although further work could be done about ascertaining the preferences of the people. The staff spoken to demonstrated a good knowledge of the people’s health care needs and were able to discuss the support they provided for one person’s epilepsy. One of the assistant managers facilitated the medication check. The assistant manager had the delegated responsibility for the medication system. She was involved in checking all the incoming medication that was made up by the community pharmacist. The system was properly administered according to the home’s policy. When errors occur such as spoilt medication, the staff recorded on the medication sheets when and why the error happened. During Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 15 tracking of an error it was noted that an archived medication sheet containing the information could not be found. It was required that all medication documents are held securely. Some changes to the medication sheet had been written in by the staff under instructions from the G.P’s. It was recommended these notes be signed by the staff member to enable the managers to identify who had written the new instructions. The medication system was found to, on the whole, be appropriately administered. Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 The complaints system allowed the peoples representatives to have their concerns acted on. The arrangements to protect people from abuse were appropriate in general although further training was required. EVIDENCE: The manager went through the complaints procedure and was able to describe the homes and organisations complaints procedure. The complaints records file was viewed and the home had received six complaints in the last year. All of the complaints related to noise levels from the home. The manager stated that these complaints related mainly to a person who used to live at the home and has now moved on. The complaints were dealt with in accordance with the organisation’s procedures and the manager had kept all the correspondence to the complaints. The home had not received any complaints from the representatives of the people who live at the home the home. The home has a policy on protecting vulnerable adults and whistle blowing. The organisation ensured that staff receive adult protection training as part of the mandatory training programme. It was noted that the manager was not wholly clear about the investigation protocols under Adult Protection guidelines. It was required that training was provided for staff and the manager, about working within multi agency guidelines. Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 25,27,28,29 and 30 The home was well maintained, clean and homely. Specialist equipment ensured the people living at the home were able to be supported according to their needs. EVIDENCE: People had their own rooms. The bedrooms contained personal items that reflected the person’s interests. The rooms were well kept and nicely decorated. A brief time was spent with one person in her room. She had a variety of items that she had personal interest in. The staff member said that the person liked to use her room to have some quiet time and occupy herself with her belongings. The people who live at the home have additional disabilities to their learning disability. Some people who use wheelchairs had lifting equipment and handrails were around the home for people with visual impairments. The home had adapted bathroom facilities that enabled the people to access the bathrooms easily. The bathrooms provide sufficient privacy for the people and meet their current needs. The lounge was of a reasonable size although a little small. The staff were making more use of the attached conservatory to increase the communal Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 18 space available. On the day of the inspection radiators were being installed to the room so that it can be used during the winter. The kitchen was large enough to have a dining table in. The laundry facilities were appropriate for the needs of the people. At the previous inspection the home was not able to produce an infection control policy. The manager stated that he was waiting for the organisation to forward one to the home. He had purchased an infection control manual produced by a specialist company and was introducing some of the procedures to the home. The home was well kept and staff had good knowledge on how to handle soiled laundry and keep the bathrooms and kitchen clean. Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34 and 35 The staff understood their role and the home had clear lines of accountability. The staff team were knowledgeable about the people’s needs and were effective in their work and well trained in most areas. EVIDENCE: The staff spoken to were aware of their roles in the home. They were experienced staff and knew the people well. The home had clear lines of accountability in the staff team with a manager and two assistant managers. Each shift has an identified shift leader who oversees the activities for that shift. The manager stated that the current staff team is competent in their work and believes the team to be a “great team the best we have had.” The rota was written around the needs of the people who live at the home and additional staff are rota’d on for particular outings or appointments. As previously stated the staffing levels reduce in the evening however this did not appear to interfere with arranging evening activities. One staff member said that the people mainly prefer to be active during the day and to relax at home during the evening. At the previous inspection it was noted during an examination of the recruitment records that gaps in employment on staff application forms were not always followed up. Since that inspection no new members of staff have been employed. The manager said he had made arrangements for the next Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 20 recruitment round to follow up on any gaps that are left on application forms. He had also discussed this with his line managers. The manager said that Elizabeth Fitzroy Homes run their own N.V.Q training centre. One person had completed an N.V.Q level 2 and another person was completing her level 2, one person was completing the level 3 and another person was completing her level 4 N.V.Q. In addition the staff receive mandatory training such as fire safety, food hygiene and first aid. The staff spoken to said they had access to training and would arrange this with their managers through supervisions. The manager was asked to evidence the supervision support he was receiving from his line manager. He said that a new line manager had been recently in post and as yet had not had many supervisions sessions. It is important that the manager receives appropriate levels of support and management from the organisation to ensure the home does not become isolated from the organisation. Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38,39,41,42, and 43 The ethos of the home ensured that people were supported well as individuals. The self-monitoring of the service was generally good although improvements were needed and the organisation needs to adhere to the regulations. Record keeping protocols protected the people’s interest. The home had suitable policies and procedures to protect the health and welfare of the people living at the home. EVIDENCE: The staff were spoken to about the ethos of the home. They reflected the views of the manager that the home focuses on the support for the individuals and not as a group. Each person’s support plan is based on the staff knowledge of the individuals preferences including how they received personal care, their likes and dislikes and their preferred activities. During the inspection the atmosphere in the home was relaxed and calm. The staff maintained this approach when the fire alarm was set off. The home had undergone major adaptations to meet the needs of the individuals but remained homely. Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 22 The home produced a questionnaire for the relatives of the people who live at the home and other professionals. The information that is received from them is looked at by the home and organisation to review the quality of the home. Further work is needed to produce a comprehensive quality assurance tool that would produce a report that would be made available to the people and the Commission. The manager and inspector discussed the type of information needed to be collated in the quality review. The home is supposed to receive unannounced visits to it by a representative of the provider. This is required as part of the function of the provider to check on the quality the service provides. The last visit was in October and the visit was not unannounced. It was required in the previous inspection that these visits must be unannounced, this will be continued in this report. The home’s record keeping was secure and the staff dealt with information about the people sensitively. The staff were seen to use records and return them to the secure storage. The manager ensures that weekly health and safety checks are carried out in the home. The home has a designated health and safety person who was one of the deputies. All staff conduct checks on food temperatures, the fire alarm call points and water temperatures. Risk assessments were in place for areas of the home and risk assessments were in place for hazardous substances. Elizabeth Fitzroy Homes are responsible for the financial management of the home. The manager controls the homes budget and reported that the home is financially sound. Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 2 3 3 x Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 X 3 X 3 Standard No 24 25 26 27 28 29 30 STAFFING Score X 3 X 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 X 13 X 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 X 3 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Linden Cottage Score 3 X 2 3 Standard No 37 38 39 40 41 42 43 Score X 3 2 X 3 3 3 DS0000021403.V259912.R01.S.doc Version 5.0 Page 24 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 YA2 Regulation Requirement Timescale for action 01/07/06 2. 3. 3. YA20 YA23 YA39 14(1)(a-c) It is required that the manager ensures the needs of the service users have been assessed by a suitably qualified person. 13(2) The medication records are stored appropriately. 13(6) That all staff receive training in adult protection and reporting procedures. 26(2&3) The monthly visits made on behalf of the registered provider must be unannounced. 16/01/05 01/07/06 16/01/06 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. Refer to Standard YA20 YA39 Good Practice Recommendations That handwritten information is signed on the medication sheets. Results of quality assurance surveys should be published. Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection East Sussex Area Office Ivy House 3 Ivy Terrace Eastbourne East Sussex BN21 4QT 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 Linden Cottage DS0000021403.V259912.R01.S.doc Version 5.0 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. 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!