Inspection on 04/05/06 for Link House

This inspection was carried out on 4th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

Link House 10/03/09

Link House 20/05/08

Link House 10/05/07

Link House 30/11/05

Link House 24/05/05

Link House 19/10/04

Link House 25/05/04

Link House 09/01/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Link House Link House 15 Blenheim Road Raynes Park London SW20 9BA Lead Inspector Emma Dove Unannounced Inspection 4th & 11th May 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Link House DS0000019135.V291938.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 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. Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Link House Address Link House 15 Blenheim Road Raynes Park London SW20 9BA 020 8545 4920 020 8332 1044 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) Central & Cecil Housing Trust Mrs Marie Rose Care Home 52 Category(ies) of Dementia (18), Old age, not falling within any registration, with number other category (34) of places Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Nursing Places To include no more than twenty service users requiring nursing care at any one time. Nursing Unit 1st Floor - Qualified Staff A qualified 1st level nurse must be available on the nursing unit at all times. This person must not have any management responsibilities for the home other than within the nursing unit. Nursing Unit 1st Floor - Care Staff 7.30am to 3pm three care staff must be available on the unit. 2.45pm to 9.30pm two care staff must be available on the unit. 9.30pm to 7.30am one care assistant must be available on the unit. Dementia Care Unit 2nd Floor - Care Staff 7.30am to 3pm three care staff must be available. 2.45pm to 9.30pm three care staff must be available. 9.30pm to 7.30am two care staff must be available, one of which will be the designated senior carer in charge of the home, in the absence of the Manager or Deputy Manager and able to offer assistance and guidance for carers throughout the home. Residential Unit Ground Floor - Care Staff 7.30am to 3pm two care staff must be available. 2.45pm to 9.30pm two care staff must be available. 9.30pm to 7.30am one care assistant must be available. Management One full time Manager 40 hours per week. One full time Deputy Manager 40 hours per week. A member of the management team to be available seven days each week. Ancillary Staff Administrative Staff 37.5 hours per week. Domestic Staff 136.5 hours per week. Cook 49 hours per week. Kitchen Assistants 102 hours per week. Laundry Staff 70 hours per week. Reviews The organisation must ensure that the above minimum staffing levels remain under review and that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of service users. Distribution of Staff The number and distribution of nurses, care staff and ancillary staff must be reviewed at regular intervals. If at any time, the evidence indicates that there are insufficient staff of any category available to meet the assessed needs of service users, the CSCI will require DS0000019135.V291938.R01.S.doc Version 5.1 Page 5 3. 4. 5. 6. 7. 8. 9. Link House additional staffing as appropriate. Date of last inspection 30/11/05 Brief Description of the Service: Link House is a purpose built care home which has the capacity to provide nursing care for twenty older people and residential care for thirty two older people, eighteen of whom may have dementia. Fifty residents are currently residing at the home. The home is owned and managed by Central and Cecil (CC) a charitable organisation who own and manage four other similar services in the Merton and Richmond area. Accommodation is provided over three floors with a lounge, dining room, kitchenette, bathrooms and single bedrooms available on all three floors. Residents have access to enclosed gardens to the rear and side of the home. Each floor at the home is serviced by a lift. The home is situated in a residential area of Raynes Park, close to the main A3 road, local bus services, churches of a number of denominations and local shops. The home is staffed twenty-four hours a day by trained nurse staff and care assistants. Three meals are provided each day with drinks and snacks available between meal times. The Statement of Purpose and Service Users Guide to the home include contact details of the CSCI. The current range of fees for this home are £401 to £745 per week. Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out over the course of seven and a half hours on the 4th May 2006 and two and a half hours on the 11th May 2006 by two regulatory inspectors. The inspection consisted of examination of records, inspection of communal areas of the home, talking to residents, visitors, staff and the registered manager. The inspectors had the opportunity to speak with sixteen residents, two visitors and ten members of staff. A Pre-Inspection Questionnaire was left with the manager on the 4th May 2006 which has not been received by the CSCI. Further questionnaires to health and social care professionals and relatives could not be sent at this inspection due to the lack of information received from the home. Questionnaires were given to sixteen residents, one relative and one health care professional who visits the home every six weeks. Questionnaires have been received from six residents, one relative and one health care professional. Comments from the questionnaires are included in each section of the report. What the service does well: What has improved since the last inspection? Documentation of health issues and pressure sores has improved, ensuring residents health needs are fully met. Records indicated residents are weighed regularly with appropriate actions taken by staff if significant weight loss or gain was noted. Consent had been sought when ‘cotsides’ are in use. Staff have completed training in fire safety and nurses have completed some relevant training. Monthly visits have been completed with reports available at the home with a copy sent to CSCI. These issues were raised at the last inspection. Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 7 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. Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1&3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Information is available to residents to assist them in making an informed decision regarding moving into the home. Residents needs are appropriately assessed prior to admission to the home. EVIDENCE: Five residents questionnaires indicated that the individuals had received sufficient information prior to admission to the home. One resident confirmed that they had ‘visited twice and been impressed by the appearance and cleanliness of the home’. Case files identified that residents needs are assessed prior to admission to the home. One assessment included very basic information and noted ‘no abilities’ in each section. This does not reflect the residents needs and the support and assistance they require from staff. Link House DS0000019135.V291938.R01.S.doc Version 5.1 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 & 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Care plans are in place with further work required to detail residents full needs and wishes. Residents health needs are well met with the exception of administration of medication practices and recording. EVIDENCE: Care plans for six residents were looked at during this inspection. All care plans had been reviewed regularly, however some information could be more detailed and ‘person centred’ to give a complete picture of the individual and their specific care needs. Information in one case file was mixed up, with old care plans and new information stored together. One care plan did not include a social history. The social section in one care plan noted that the resident should take part in house activities, but no further information was included and did not detail what these house activities should be. This lack of information and brief information does not enable staff to fully meet residents needs. One page in one care plan did not include the name of the resident, it referred to ‘the Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 11 client’. One care plan noted to ‘soak dentures, if any’. These issues indicate that the care plan was not completed with the resident or their representative. All residents are registered with a GP who visits the home weekly and completes medication reviews as required. The systems currently in place to meet residents health needs are good. The chiropodist visits every six weeks, tissue viability nurses and dieticians are available to provide advice and support to residents and staff when necessary. Recording of pressure sores has improved with clear daily notes that include good descriptions of changes and photographs. A number of issues were identified regarding the storage and administration of medication on all three floors. The record of a weekly medication audit was available on the first floor which identified some gaps in the signing for medication. Issues raised had been addressed by staff. Examination of medication on all floors identified issues regarding inadequate storage facilities on the ground floor, gaps in the signing on all three floors, some medication was in the blister packs but had been signed as administered, one bottle of eye drops with a twenty eight day expiry did not include the date opened. The medication count for one resident did not tally with the amount received and the amount administered since admission to the home. Residents questionnaires identified that one resident sometimes, four residents usually and one resident always receive the medical support they require and that three residents usually and one resident always receives the care that they require. Link House DS0000019135.V291938.R01.S.doc Version 5.1 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 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents social needs are partially met by the activities and equipment available to them. Residents dietary needs are met, although staff were not aware why some residents have special diets. EVIDENCE: Residents were observed to be in the lounges with televisions on during the course of the inspection visits with little planned activities. A game of Bingo was organised on one floor on one afternoon and staff sat talking with residents, playing cards and reading for a short period on another floor. Staff reported that they involve residents in gardening and try to encourage known hobbies and interests. Four residents questionnaires indicated that there are sometimes activities arranged which they can participate in and one questionnaire indicated that there are usually activities provided. Other comments regarding activities included ‘there’s not much to do, but it’s not a problem’, ‘I’m happy doing my own thing, watching and not joining in with activities’ and ‘perhaps more activities would be useful’. Residents confirmed that they can receive visitors and go out. Visitors are welcome with details of visiting times displayed in the entrance hall. One Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 13 visitor confirmed that they are made welcome and offered drinks, that staff are approachable and welcoming, that they are involved and kept up to date with important issues affecting their relative, that they are aware of how to complain although they have nothing to complain about and they raise issues with staff if needed. A varied menu is displayed around the home for residents. Residents questionnaires indicated that one resident always likes the food, four residents usually like the food and one resident sometimes likes the food. Other comments regarding meals included ‘lunch was very good’, the food is good’, ‘staff know what I like’, ‘I dislike some food, but there is an alternative’ and ‘more choice please’. Staff confirmed that alternative meals are provided to cater for residents religious, cultural and medical dietary needs, however staff were unsure of the reasons one resident had a special diet. One mealtime was observed on the first floor which was well managed, residents received appropriate support from staff in a dignified manner, however in another unit staff were observed standing up to assist a resident. This does not meet residents needs and may make eating uncomfortable for the individual. One resident reported that they eat meals in their room and that this was their choice. Link House DS0000019135.V291938.R01.S.doc Version 5.1 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 & 18 Quality in this area is good. This judgement has been made using available evidence including a visit to the service. Residents are protected by policies, procedures and practices regarding complaints and the protection of vulnerable adults. EVIDENCE: Appropriate complaints policies are in place and accessible to residents and their relatives/representatives. Records are maintained of complaints received. Two complaints were recorded since the last inspection with responses to the complainants available. No complaints have been received by the CSCI since the last inspection. Residents questionnaires indicated that three residents knew how to complain, with three residents aware of who to speak to and two residents sometimes aware of who to speak to. Comments regarding complaints included ‘staff respond to complaints’ and ‘I haven’t complained although staff are approachable and respond to issues raised’. No concerns were raised regarding the protection of vulnerable adults and appropriate policies are in place to protect residents from abuse. Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 15 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, 22 & 26 Quality in this area is adequate. This judgement has been made using available evidence including a visit to the home. Residents live in a safe environment which is maintained to an adequate standard with two exceptions on the first floor. EVIDENCE: The home was purpose built and meets the needs of current residents. Accommodation is provided over three floors with each floor operating as a separate unit with single bedroom accommodation, two bathrooms, a lounge and dining room on each floor. Residents made positive comments about the home and their bedrooms. One resident reported ‘I am very comfortable here’ and another resident said ‘my room is fine and I have a lovely view of the garden’. The home is maintained to a satisfactory standard with the exception of two issues identified on the first floor. The first issue related to a water leak on the second floor, causing flooding on the first floor, with water gathered in an Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 16 electrical light which was still turned on. The manager reported later in the day that electricians had isolated the light rendering it safe. The second issue was a damaged fire door and doorway in which the carpet had come away from the edge, causing a trip hazard, tape was put over the carpet during the course of the first inspection visit. Residents have access to a well maintained garden which has seating for individuals. The swing seat in the garden is unsafe in its current position. The manager reported that the swing seat would be moved if residents wanted to use it. Six residents questionnaires and two visitors questionnaires indicated that the home is always clean and fresh. The inspectors noted a cleaning trolley on the second floor which was left unattended outside residents bedrooms with the lids of cleaning materials open or off. This could be dangerous for residents and puts their health and welfare at risk. Staff reported that the grab rails in toilets on the second floor were difficult for residents to reach. This issue must be addressed by an occupational therapist to ensure residents needs are fully met. Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 17 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 & 30 Quality in this area is good. This judgement has been made using available evidence including a visit to the home. Staffing levels remain adequate to meet residents needs and staff have access to appropriate training. EVIDENCE: The published staffing rota identified two members of staff on duty on the ground floor, two members of staff and a nurse on the first floor and three members of staff on duty on the second floor during the course of the inspection. The manager, deputy manager, domestic and catering staff were also at the home during the course of the inspection. These staffing levels are in line with those set at the time of registration. Three residents questionnaires indicated that staff are always available with three residents identifying staff as usually available to meet their needs. Comments regarding staff included ‘staff are friendly to residents and visitors’, ‘staff are patient’, ‘staff are helpful’ and ‘staff are lovely’. Recruitment records for three members of staff were satisfactory although two files did not contain a photograph and two files did not include proof of the individuals identity. Staff have access to mandatory training through the organisation with records maintained of sessions individual staff were due to attend. The record of Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 18 training needs to include clear details of sessions staff have attended, not just details of the training dates for staff. Thirteen members of staff have completed NVQ to Level 2 with four members of staff working towards this award. All new members of staff complete the TOPPS training within six months of commencing employment at the home, this training must be updated to the new ‘Skills for Care’ common induction standards. These standards will be mandatory by September 2006. Three members of staff have completed training in infection control, working with people with visual impairment, dementia care and stroke care this year. The manager reported that senior staff at the home are currently completing an in house management course which outlines their responsibilities. Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 19 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 & 38 Quality in this area is adequate. This judgement has been made using available evidence including a visit to the home. The manager is registered with the CSCI. Quality and monitoring systems are in place at the home. EVIDENCE: The manager has completed NVQ to Level 4 and demonstrated an understanding of the National Minimum Standards for Older people and conditions relating to old age. The manager is supported by a deputy with senior staff in charge of each unit. The manager reported that a new senior position is currently being advertised which will be based on the first floor with responsibility for activities, auditing care plans and the supervision of casual staff. This position should improve the quality of care residents receive. A representative from the organisation visits the home every month and completes a themed audit, recent visits have covered infection control and Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 20 medication. The manager reported that residents and relatives meetings continue to take place and that a relatives survey was carried out in December 2005 with a further survey due in June 2006. Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 2 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 2 X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 22 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 OP7 Regulation 15 (1 & 2) Requirement The registered person must ensure that care plans are more person centred and include individuals social, emotional and cultural needs, so staff can meet these needs. (previous timescales of 16/12/04 & 19/07/05 not met) The registered person must ensure that medication is appropriately stored. That medication is signed for at the time of administration. That medication is only signed for when it is removed from the blister pack. 3. OP12 12(1)&16 (2)n 07/07/06 The registered person must ensure that staff are employed to provide a variety of appropriate activities and outings for residents. Appropriate equipment and resources must be provided at the home for residents, particularly on the second floor. Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 23 Timescale for action 07/07/06 2. OP9 13 (2) 23/06/06 (previous timescale of 19/07/05 & 30/01/06 not met) 4. OP19 23 (2) & 12 (1) The registered person must ensure that the ceiling and electrical light on the first floor are repaired or replaced. The damaged fire door and frayed carpet on the first floor must be replaced and repaired. The swing seat in the garden must be moved to more stable ground in the garden. 5. OP19 12 (1) The registered person must 23/06/06 ensure that the storage of the cleaning trolley when unattended is reviewed. The registered person must 07/07/06 ensure that an assessment is carried out on the grab rails in the bathrooms on second floor to ensure that they meet residents needs. 23/06/06 6. OP22 23 (2) n 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 OP30 Good Practice Recommendations Staff training records should be easily accessible and indicate training individuals have completed. Link House DS0000019135.V291938.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG 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 Link House DS0000019135.V291938.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!