Inspection on 14/05/07 for Little Meadows

This inspection was carried out on 14th May 2007.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Little Meadows 30/03/10

Little Meadows 08/05/09

Little Meadows 21/08/06

Little Meadows 03/02/06

Little Meadows 13/07/05

Little Meadows 25/01/05

Little Meadows 30/06/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Westmead

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

CARE HOMES FOR OLDER PEOPLE Little Meadows 1 Poplar Avenue Cross Heath Newcastle Staffordshire ST5 9HR Lead Inspector Mr Berwyn Babb Draft Unannounced Inspection 14th May 2007 02:00 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 Little Meadows DS0000004974.V338567.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Little Meadows DS0000004974.V338567.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Little Meadows Address 1 Poplar Avenue Cross Heath Newcastle Staffordshire ST5 9HR 01782 711669 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Rashid Baserat-Ahari Mrs Jennifer Diane Baserat-Ahari Mrs Jennifer Diane Baserat-Ahari Care Home 19 Category(ies) of Dementia - over 65 years of age (4), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (4), Old age, not falling within any other category (19), Physical disability over 65 years of age (8) Little Meadows DS0000004974.V338567.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection Brief Description of the Service: Little Meadows is a large detached house which has been extended over the years to provide high standard accommodation. It is conveniently situated on the outskirts of Newcastle served by public transport. The resident proprietors have operated the home since original registration in 1987. Accommodation is on 2 floors with shaft lift access to the first floor. There are 3 lounges and separate dining area. There are 17 single and 1 shared bedroom, all have en-suite facility, the shared room also has walk-in shower. Furnishings and equipment are to an exceptionally high standard. The home is registered for up to 19 residents, 4 of whom may require dementia care and 8 may have a physical disability. The exterior of the building provides a very pleasant safe garden area with patio and sitting areas attractively laid out, there are ramps/handrails for safety. There is CCTV to protect the home. Both the internal and external areas of the building are maintained to a high standard. The proprietors have constantly sought to further extend the already high standards of the total environment. Little Meadows DS0000004974.V338567.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection was carried out during the afternoon of Monday the 14th of May 2007 by one inspector. He toured the premises, spoke to management, staff, and most of the residents, and reviewed a sample of care plans and other documents held in the home. One member of staff was engaged in a formal interview, and further information was taken from records already held by CSCI, including that provided through formal notification by the home itself. Unfortunately there were no visitors in the home, and due to administrative difficulties, the documents to be filled in by the providers had not been dispatched by CSCI, in time for them to complete and return these before the inspection. All requirements of the previous report had been robustly responded to in a positive fashion, and all those people using the service who spoke to the inspector said what a good service it was, and how comfortable they were with their lives at Little Meadows. The Registered Care Manager, her deputy, and two carers were on duty in the home, together with the managers co-proprietor and husband, Mr Rashid Baserat-Ahari. Current fees for the home were given as £357 to £366 with a £20 top up. What the service does well: What has improved since the last inspection? Little Meadows DS0000004974.V338567.R01.S.doc Version 5.2 Page 6 Since the last inspection steps have been taken to; strengthen the pre-admission assessments, ensure that residents their spiritual needs met, records the details of complaints investigations, report all accidents to the Commission for Social Care Inspection, and ensure that documents to find in Scheduled to hold provided to all new staff will top Additionally, new carpets have been provided in bedrooms, and ensuite toilets have been fitted with individual tiled floors as and when rooms became vacant. 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. The summary of this inspection report can be made available in other formats on request. Little Meadows DS0000004974.V338567.R01.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 Little Meadows DS0000004974.V338567.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4, and 6. The quality outcome for this group of people who use the service in this area was good. This judgment was arrived at using all the available evidence including that gathered during a visit to the service. It is based upon people who use the service having sufficient information about the service for them or their supporters to make an informed decision as to whether their needs and choices could be met there, and on the home being in possession of an adequate pre-admission assessment for them to determine their ability to respond appropriately to the choices and needs of that individual. Intermediate Care as defined in N. M. S. 6, is not provided in this home. EVIDENCE: The concerns raised in the last report in this area had all been addressed. The variation in the registration categories had been approved to reflect the needs of those people using the service, and the statement of purpose had been suitably amended to show what care was available. Little Meadows DS0000004974.V338567.R01.S.doc Version 5.2 Page 9 Care plans of those residents admitted since the last inspection were reviewed, and these contained both the written assessment undertaken by the care manager or deputy prior to the admission of the person using the service, and the care manager assured the Inspector that written confirmation of the ability of the home to meet their needs had been sent to all these people, and would continue to be sent to any new prospective residents. The information volunteered by the deputy care manager that the most recent admission of a person who used the service had been preceded by a free trial stay in the home, was verified by reference to that persons care plan. This plan also demonstrated that very thorough social histories, medical histories, risk assessments, assessments of the daily living skills, and mapping of significant friendships and relationships had taken place, and were available to assist those people employed as carers in the home to meet the needs and personal choices of people who use the service in the most effective and acceptable way. While the shared room in the home has historically been used to accommodate one person on a respite basis, the home does not provide intermediate care as defined in national minimum standards number six. Little Meadows DS0000004974.V338567.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, and 10. The quality outcome for this group of people who use the service in this area was good. This judgment was made using all the available evidence, including a visit to the service. It was founded upon residents having a comprehensive Service Users Plan, which demonstrated how both their social and health needs were being met, how their medication was administered and reviewed, and them being treated at all times with dignity and sensitivity. EVIDENCE: In response to a requirement made in the last report a file has been set up for recording the half hourly night-time checks that are carried out on people who use the service, and this was reviewed in conjunction with both people’s care plans, and with their comments during conversation with the Inspector. In a sample of care plans reviewed, there was evidence of positive planning for the person with dementia. Little Meadows DS0000004974.V338567.R01.S.doc Version 5.2 Page 11 Additionally, the plans had been reviewed at regular intervals as required, and in response to any arising new situation. There was clear evidence of the assessing of social need and any risks that are associated with the choices and personal likes of the person who used the service, and of the involvement of the persons family. The plans were written in professional and non-judgemental language, and were informative, thus ensuring that the needs and choices of the person who uses the service could be met appropriately by anybody employed to care for them. Little Meadows DS0000004974.V338567.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): All. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People who use the service stated the life within the home met their expectations. Regard for the choice of a resident was observed, and everybody spoken to said that the food was extremely satisfactory. The programme of activities was confirmed as being appropriately robust and appreciated. EVIDENCE: The activities book was reviewed and this showed that a wide range of activities were undertaken by people who used the service. Several people who live in the home tells the inspector that they enjoyed different aspects of these endeavours, some favouring the past time aspects such as the reminiscence sessions, during which the home use a sound machine to replicate the experience of hearing such things as a stream trickling over its country bed; a railway train passing by; the distinctive cries of market stall holders; city traffic; children at play; or a brass band in the park. Other people preferred the more tactile sensations of a session of nail care, or engaging in planned beauty care, and several of the ladies were very enthusiastic about the weekly visits of the hairdresser. Little Meadows DS0000004974.V338567.R01.S.doc Version 5.2 Page 13 This lady was in the home at the time of the inspection and impressed the inspector with how modest her charges are, and the skilful way that she bolstered the self-esteem of her clients not only by her service but also by her positive and encouraging repartee. People who used the service spoke about the enjoyment they took from such things as outings and the Christmas party, and the benefits they felt they were receiving from the gentle exercise sessions set to music. To help ensure that the people who use the service find that their lifestyle experiences match their expectation and preferences, the home has started a process of reviewing each session with those who have taken part in it, to ensure both that they had enjoyed it, and also that it was an appropriate activity. The record of these reviews was made available to the inspector who noted where feedback had been used to guide planning for future sessions. People who use the service also told the inspector how they value the various meals they took in the home, and the flexibility they enjoyed in being able to choose alternatives to the planned menus, or to have refreshments at any time of their choosing throughout the 24 hours of the day. The menus themselves were reviewed in the kitchen, and seen to cater for a range of tastes, and to include both seasonal and local delicacies. Fridge and freezer temperatures were also checked at this time, and seen to be kept within the recommended ranges, and the kitchen storage areas were seen to be clean and tidy, with sufficient reserve stocks to meet any likely emergency. A discussion took place with the care manager over the staffing arrangements for the kitchen, and she assured the inspector that whilst there were no dedicated catering staff, all employees on kitchen duty had their rota’s arranged so that they started in that area and would only proceed to undertaking personal care after finishing their duties in the kitchen. In addition, she added that both herself and the deputy care manager were always available on standby Little Meadows DS0000004974.V338567.R01.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. 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. Residents were seen to have access to an appropriate complaints procedure, and be in the care of staff dedicated to their protection. EVIDENCE: Following the requirement made at the last inspection, the complaints book kept by the home was reviewed, and it is confirmed that this now records all the details of investigation made following complaints, and the outcome for the people who use the service, of steps taken to address any concerns that they may have. A formal interview was undertaken with a member of staff, during which, time was spent discussing the protection of those vulnerable adults who use this service. The responses given demonstrated not only a proficient knowledge of the abuse policy of the home, and that agreed by all agencies locally, but also a deep empathy with protecting the rights of those people who use the service, and ensuring that their voice is heard when they are concerned about anything. This included an appreciation of the need to determine what if anything might be distressing somebody who through their condition (such as say, Dementia) was not able to communicate effectively or easily. Little Meadows DS0000004974.V338567.R01.S.doc Version 5.2 Page 15 The member of staff being interviewed referred to being familiar with the normal pattern of someones expressions or behaviour, and been aware of any changes in their body language that might indicate that they were in distress. People who use the service were asked if they knew how to make a complaint, and one gentleman assured the inspector Wed never have too, but if we did we could talk to any of the staff or to the manager . Another said You never have to worry about anything like that (being afraid of anything), the staff here make sure that you are always well looked after. Little Meadows DS0000004974.V338567.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 24, and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The general state of décor, furnishing, and maintenance, was very high. Bedrooms were spacious, well furnished, and extremely well personalised. Toilet and bathing facilities were sufficient, supportive, and homely. Equipment was available to assist mobility. Cleanliness, infection control, and odour control were excellent. EVIDENCE: The previous report had assessed the environmental standards of this home as being excellent and nothing was found during this inspection to challenge that judgment. Little Meadows DS0000004974.V338567.R01.S.doc Version 5.2 Page 17 Following up on a comment in that report, about two Windows having been broken by stones that have been hurled, the inspector was informed about a Neighbourhood Watch response to problems generated from the service road adjacent to the property. This will take the form of lockable gates being provided at both the King Street and Popular Avenue ends of the road, allowing unlimited access by day, and access restricted to those with legitimate claims after dusk. A cursory visual examination of the exterior of the building did not identify anything outside the normal scope of the planned annual painting program, and internally, whilst not every private bedroom was inspected, all areas that were visited were decorated, furnished, and maintain, to the very highest standard. The individual rooms of people who use the service were all equipped with ensuite toilet facilities, and these are being fitted with individual ceramic tiled floors at the same time as the carpets are being renewed, whenever a room becomes vacant. The impression of each room reflected the choice of the person resident in it, and several people recounted the association of different items that they had chosen to bring with them to make their rooms more homely . All radiators seen during this inspection were of the low temperature surface type which protects people who use the service from the danger of accidental burns. There were absolutely no unpleasant odours in any part of the premises, and appropriate procedures were noted in both documentation, and through observation in the home, for the containment of any possibility of cross infection, and for the safe handling and disposal of clinical waste, including the use of colour coded personal protective equipment for different tasks undertaken by the carers. They were observed to change out of their blue protective pinafores after finishing in the kitchen, and put on fresh white ones before undertaking care tasks. It was noticed that some of the privacy locks on bedroom doors were incomplete. People who use the service who were in those rooms said that they did not want a lock on the door, but this issue was taken up with the care manager and a recommendation will be made that she seeks the advice of the fire officer regarding the most appropriate way of ensuring their privacy, without endangering their safety should have fire occur. Little Meadows DS0000004974.V338567.R01.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. JUDGEMENT – we looked at outcomes for the following standard(s): All. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The needs of people who use the service was being met by an adequate number of staff with appropriate experience and skill, who had been recruited using practices that were safe both for the residents and all the prospective employees. Staff had received training to enable them to perform their duties. EVIDENCE: Staffing records showed that the requirement to have over 50 of staff trained to NVQ standard to or above in order to ensure that people who use the service are in safe hands at all times, had been exceeded in all of the previous three years. In a formal interview with a member of staff, positive responses to questions about the process of her recruitment, interaction, initial and ongoing training, and verification of her good character, all confirmed that the people who use the service are being protected by the homes recruitment policies and practices. Necessary evidence of a completed application form, receipt of written references, and confirmation of a clear record with the Criminal Records Bureau was retained in her personal file. Little Meadows DS0000004974.V338567.R01.S.doc Version 5.2 Page 19 The employee, affirmed that she had received regular training to make her competent to do her job, and volunteered that: She (the proprietor/care manager) this has set me up for life with the training and support she has given me. The current arrangements for staffing the home are that there will be one person watchful waking throughout the night, with access by mobile telephone [which they carry at all times], to either the care manager or her deputy, both of which lives on the premises. During the day two carers have the physical support of either or both the care manager or her deputy, and the co-proprietor, Mr Rashid Baserat-Ahari. Little Meadows DS0000004974.V338567.R01.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. 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 health, safety, and welfare of people who use the service was seen to be promoted, by appropriately qualified and experienced care manager and staff, with systems to obtain their views about the service, and to incorporate these into future provision. EVIDENCE: In the wake of the requirement in the last inspection report relating to ensuring that all significant accidents to people who use the service were reported to the Commission for Social Care Inspection, close attention was paid during this visit to the accident book. Little Meadows DS0000004974.V338567.R01.S.doc Version 5.2 Page 21 All events that had been entered into this book had also been notified to the CSCI, and furthermore, followed the accepted procedure of auditing through from the antecedents, to the behaviour that led to the accident, to the consequences for the person who uses the service. Not only does the Registered Care Manager have the necessary experience, qualifications, and (through being the proprietor) authority to run the home, but she is ably supported by a deputy who has now completed her NVQ level 4, and is undertaking the managers award to enable her one-day to be approved as a Fit Person herself. The home undertakes periodic canvassing of the people who use the service and their supporters, to ensure that it is run in their best interests, and the results of a recent survey were being worked on as the inspector entered the home. People using the service told inspector that having the proprietors living on-site and being available daily in the home made it easy for them to pass on any comments that they had about any aspect of the service. One lady said: We can always talk to Jenny (proprietor/care manager) if there is anything we feel strongly about, but we dont, because there isnt. another said: What would we want to tell her about? It all first class here. The home does not manage financial matters on behalf of residents. They are all encouraged to manage their own affairs, usually with the assistance of relatives if this is necessary. As stated earlier, accident records were examined and found to have been strengthened in line with suggestions made in the last report, and during the tour of the premises, appropriate safeguards were seen for the Containment of Substances Hazardous to Health, storage and medication, and the storage of chilled and frozen foods. Additionally, the health, safety, and welfare of people who use the service, were seen to be promoted and protected by the provision of well serviced equipment, robust risk assessment, and sturdy training for members of staff engaged in caring for the residents of the home. Little Meadows DS0000004974.V338567.R01.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 X 4 4 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X 4 4 X 4 X 4 STAFFING Standard No Score 27 4 28 4 29 4 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 Little Meadows DS0000004974.V338567.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 OP24 Refer to Standard Good Practice Recommendations The home should seek the advice of the fire officer regarding the most appropriate way of ensuring the privacy of people who use the service, without endangering their safety should a fire occur. Little Meadows DS0000004974.V338567.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Little Meadows DS0000004974.V338567.R01.S.doc Version 5.2 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. 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