Inspection on 20/06/07 for Lynwood

This inspection was carried out on 20th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Lynwood 30/04/09

Lynwood 18/06/08

Lynwood 19/10/06

Lynwood 26/05/06

Lynwood 28/02/06

Lynwood 09/05/05

Lynwood 14/10/04

Lynwood 19/04/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Lynwood Lynwood 57 Mersey Road Heaton Mersey Stockport Cheshire SK4 3DJ Lead Inspector Michelle Haller Unannounced Inspection 20th June 2007 08:15 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 Lynwood DS0000008603.V343414.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. Lynwood DS0000008603.V343414.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lynwood Address Lynwood 57 Mersey Road Heaton Mersey Stockport Cheshire SK4 3DJ 0161 432 7590 0161 613 0633 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. Mohsin Munif Mrs. Anne Munif Mrs. Anne Munif Care Home 23 Category(ies) of Dementia - over 65 years of age (10), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (3), Old age, not falling within any other category (20) Lynwood DS0000008603.V343414.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users to include up to 20 OP, up to 10 DE(E) and up to 3 MD (E). 19th October 2006 Date of last inspection Brief Description of the Service: Lynwood is a large Victorian detached house that has been converted into a care home and is set in its own extensive grounds. The accommodation consists of 21 single rooms and one shared room, which are spread over three floors. Three of the single rooms and the one shared room have en-suite facilities. There is one large dining room, which has a small seating area overlooking the garden, two further lounges and a conservatory. The home is owned by Mr and Mrs Munif and is managed on a day-to-day basis by one of the registered providers, Mrs Munif. Lynwood is registered to care for 23 older people. The registration also allows for up to ten service users who are suffering from a dementia type illness and three service users who may have a mental health problem. The home is located in the Heaton Mersey area of Stockport and is close to local shops and other amenities. Stockport town centre, motorway network and public transport are easily accessible. The fee structure at the home ranges from £392-£400. There is an additional charge of £10 for rooms with en-suite facilities. The previous CSCI inspection report was available on request. Lynwood DS0000008603.V343414.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was completed over a period of 9 hours on 20th June 2007 and 21st June 2007. The manager of the home was not informed beforehand of the inspection. This is called an unannounced inspection. The inspection process included examining records, reports and correspondence concerned with providing care and support and all other aspects of running the home. A tour of the building was completed and observations of the interaction between those in the home were made. A number of people were interviewed including service users, their relatives and members of staff. Lunch was sampled and time was spent sitting in the dining room and lounge area. Four people returned Commission for Social Care Inspection (CSCI) service user surveys, and the information provided in these was used as part of the evidence in compiling this report. The outcome of Lynwood’s’ previous CSCI inspection and improvement plan were also taken into consideration when completing this inspection What the service does well: People at Lynwood benefit from having a registered a manager and owner who are very involved with the home, and who take a personal interest in making sure that people feel satisfied with the services. The manager respects the rights of people living at Lynwood and treats everyone as individuals. People benefit because the manager promotes the right to independence for service users. People also benefit from an ethos in the home that encourages openness and honesty and this, in itself, helps to safeguard against abuse. The manager recognises the home’s shortfall and has purchased support from a care consultant agency. This will help the manager to make the necessary improvements. People benefit from well-trained staff and the manager appreciates the importance of providing good opportunities for learning and improving skills. Staff recruitment and selection practises at Lynwood are more thorough and now reduces the chance of employing unsuitable people. Lynwood DS0000008603.V343414.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Lynwood DS0000008603.V343414.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 Lynwood DS0000008603.V343414.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 (standard 6 is not applicable.) Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People have their needs assessed before moving into Lynwood ensuring they can be confident the staff have the ability to meet their needs. EVIDENCE: Five care files and records were inspected. Each contained assessments of needs. Evaluation of these identified that the pre-assessment visits took place and included information about physical and mental health, strengths and needs about personal care, daily living and other independence skills, communication, hearing, eyesight, sleep pattern, risk assessments and other information to assist in planning care. Lynwood DS0000008603.V343414.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Most people living at Lynwood have their health needs met in accordance with their assessed needs. In general people are treated with dignity and respect. EVIDENCE: Care plans and risk assessments concerning health, psychological, personal and social care were in place. The risk assessments were detailed and informed staff of the actions they were to take to meet people’s needs. These plans had been reviewed approximately once a month. It was clear that the system was relatively new and not yet routine. The manager is in the process of changing from recording everything collectively to individually. The change over is causing some problem because the new system involves dealing with individual files, this may be contributing to communication problems for example, when cross referencing letters and correspondence there was indication that at times instructions and suggestions made by professionals were not followed up. Lynwood DS0000008603.V343414.R01.S.doc Version 5.2 Page 10 Routine health checks such as dental care, optician and podiatrist occurred in the home, and it was clear that an acute physical illness was dealt with swiftly a doctor, other medical professional or emergency services quickly summoned. The records for health care intervention are also under review and omissions and inaccuracies were identified. When the manager and senior staff become used to the system a more accurate record of medical and health intervention and check ups will be kept. Tissue viability and nutritional screening in the home could be improved and the home must ensure that they can accurately assess the nutritional status or weight of all the people in the home. The medication record sheets were examined and no omissions were noted and, in the main, medication was stored safely. The manager has had self-closing hinges installed to a number of toilet and bathroom doors, this is to preserve the dignity of people who forget to close doors. This process should continue so that privacy is assured whichever toilet people use. Staff interviewed were knowledgeable about the needs of service users and were observed supporting them as they required. Staff were pleasant to people and related to them in a gentle and caring manner. Daily records were written respectfully and some demonstrated that staff observed for mood and general contentment. It was also noted that these could be improved if they related to the care plans that had been written. It was observed throughout the inspection day that the manager and staff had good relationships with doctors, nurses and other health professionals attending to people. Conversations and interactions that were observed between the manager, senior staff and health professionals, demonstrated that they were knowledgeable, and able to provide accurate information about the symptoms and general condition of people in need of health and nursing care. During the inspection it was noted that relatives were listened to and their emotional and an attempt was made to meet their emotional needs and offer reassurance and comfort. The manager is trying to put new management systems in place and keep direct control of all the other process in the home. The inspection process highlighted that tasks are not delegated to senior staff who have received training. Because there are so many tasks to be done there are times when the manager is unable to fulfil all responsibilities efficiently, and this may have a Lynwood DS0000008603.V343414.R01.S.doc Version 5.2 Page 11 negative impact on the care provided to people living in Lynwood. More effective use of experienced and qualified carers and, re arrangement of the key-worker system may assist in improving the organisation of health care provision in the home. People living at Lynwood and their families were satisfied with the health care in the home and comments included: ‘I am very very happy with care at Lynwood, once she settled she looked better, they’ve never left her with a cold or sore eye, the doctor is always called. Staff have got to know her and say that she is more alert in the morning. She always looks clean and tidy, the hair care is very good.’; ‘ The care is very good, I feel well looked after and staff are very well mannered and easy tempered.’; ‘Medical service, excellent.’ And from a returned CSCI service users survey: ‘……says that she gets what she needs here at Lynwood.’ Lynwood DS0000008603.V343414.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): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A feeling of wellbeing is promoted at Lynwood as people are able to make choices about their lifestyle and social events such as meals and activities are enjoyable. EVIDENCE: Records were made of people’s preferences and observations made throughout the day demonstrated that staff were familiar with and respected these choices. People were served breakfast in bed, in the dining area or in a quieter area according to their wishes. Relatives commented that they could visit the home freely. People in the home are supported in maintaining their independence including going out unescorted if that is their wish. The manager must provide additional support through the development of appropriate risk assessments and care plans, for people who chose to continue with community based activities independently. This will enable staff to respond appropriately and consistently Lynwood DS0000008603.V343414.R01.S.doc Version 5.2 Page 13 to the choice being made and also provide guidance to problem solving should they arise. The activities calendar indicated that activities though repetitive included games such as, soft ball, bingo and video games ‘Deal or no deal’; the home organised poetry readings, music for sing-a-longs and dancing, pub outings and celebrations for birthdays. A group of four also attended a weekly club held in a local Church. One person comment summed up the general feeling about activities in the home- ‘There’s not much going on but we’re comfortable.’ However there were also comments from individuals that confirmed that when a preference was expressed steps were taken to provide what was wanted ‘ ….enjoys going out to the pub or a walk to the post if anyone is going out. She appreciates this as she likes walking and being outside. Meals and meal times at Lynwood are good and people said that they were satisfied with the meals served. The lunchtime meal was mince beef and onion pie, mashed potatoes, peas and cauliflower. This was sampled and the meal was tasty and nicely presented. Over lunch discussion with service users confirmed that food in the home was good and a variety of traditional meals were offered. On that day there was a choice of desert that included, rhubarb fool, trifle or rice pudding all of which were homemade. The cook on duty was from an agency, he was keen to confirm that the food larder and fridge were well stocked with ingredients so that nutritious and enjoyable meals could be prepared. The menu offered a variety of meat and poultry stews and casseroles, fish meals, pies, tarts and soups. Mealtime was unhurried, and staff were courteous and patient. People said that the food was ‘very good, very nice and I get enough to eat.’ And ‘Food is a very high standard and variety.’ . Lynwood DS0000008603.V343414.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 adequate. This judgement has been made using available evidence including a visit to this service. People know how to complain however the manager needs to be more rigorous in dealing with concerns that are brought to her attention, so that everyone is clear that complaints and concerns are taken seriously. EVIDENCE: The complaints procedure was read through and this provided information about how to complain and the timescales in which issues would be dealt with. People stated that they felt the manager would listen to them if they had any concerns. Comments included: ‘I have never had to make a complaint but I would tell Anna.’; ‘….…says she would speak to a member of staff, she would also tell…..(family).’ And ‘ Because Lynwood is run by the owners someone is always available with very competent and friendly staff.’ Staff who were interviewed were clear about the actions and omissions that could be considered to be abuse, and stated that if they had any concerns they would speak to the manager or senior staff. Staff understood that there was a ‘protected disclosure’ policy operating in the home and thought that anything they said to protect service users would be treated confidentially. However the home had received a detailed letter of concern from an outside organisation about the conduct of a member of staff concerning equality and Lynwood DS0000008603.V343414.R01.S.doc Version 5.2 Page 15 diversity and adult protection issues. No action had been taken because the manager wasn’t confident about what to do. The need to investigate the complaint as a matter of urgency was highlighted to the manager, and action was taken on the day of the inspection. Lynwood DS0000008603.V343414.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 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. In the main the Lynwood provides a comfortable and safe environment. EVIDENCE: A tour of the building was completed. The majority of the home was clean and free from unpleasant odours. Furniture, fixtures and fittings were clean although some furniture looked well worn. The assisted bathroom has been redecorated and was clean and warm. During the inspection the manager pointed out improvements that had been completed since the previous inspection, this included installation of a ramp to make access around the home easier and self-closing hinges on some toilet doors. Pictures and photographs had been placed on doors to assist people in recognising their bedrooms and the toilet. Lynwood DS0000008603.V343414.R01.S.doc Version 5.2 Page 17 The majority of bedrooms had been personalised and some could be described as ‘homely’. People were observed mobilising around the home independently and with aids such as frames, walking sticks and wheelchairs. The home does not have a good system for storing bulky items and this increases the risk of falls and the fire escape becoming blocked- dealing with this problem should be given some priority. Comments about the environment included: ‘The home is usually fresh smelling’. And ‘whenever we visit everything seems fresh and clean.-……also thinks it’s all ‘very nice’.’ Lynwood DS0000008603.V343414.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): 27,28,29 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People at Lynwood House benefit from a well trained and skilled staff team. EVIDENCE: On the day of inspection there were 23 people living at Lynwood and a service was been provided by a team of seven including both owners, one of who is the registered manager and a consultant in care services. The cook was from an agency and the domestic was off sick. In spite of this people were well groomed, medication was administered and doctors, district nurses and health care was provided. Staff were overheard speaking to people in a patient and enabling manner. Supervision is in place and a member of staff came in for supervision on the day of inspection. These records were inspected and it was noted that they covered the strengths, areas that would like to improve and the aspiration of the staff short, medium and long term. It was also clear from these records that staff were able to voice concerns about any issues in the home. Staff are offered opportunities to attend training courses and at least six members of staff have the award National Vocational Qualification (NVQ) 3 in care. Funding is in place for new staff to commence the NVQ level 2 in care. Lynwood DS0000008603.V343414.R01.S.doc Version 5.2 Page 19 Training records and certificates also confirmed that staff had received training in food hygiene; protection of vulnerable adults, fire awareness, health and safety, medication awareness, dementia awareness, TB care, life story work, bereavement, care planning, communication, nutrition, infection control moving and handling and equality and diversity. The future training calendar will include a more in-depth medication course and a course geared towards learning about providing activities in residential care. Staff who were interviewed appeared knowledgably about care for older people and were willing to take on responsibilities. Comment from staff included: ‘I find that if I am lacking in a certain area we are able to attend courses.’; ‘They are good employers.’ Induction records confirmed that this was provided in line with the Skills for Care Common Induction Course’. The files of the most recent recruits were examined and these contained documents including CRB checks, two references and a completed application form, demonstrating that the recruitment and selection process was now more robust. The main issue concerning staff on this occasion was the management’s failure to invoke the home’s disciplinary procedure following at least three adverse occurrences in the home. This issue was dealt with during the inspection period. Lynwood DS0000008603.V343414.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 adequate. This judgement has been made using available evidence including a visit to this service. The leadership in the Lynwood is open, however management processes are inconsistent and staff skills are not fully utilised. EVIDENCE: The registered manager was on duty during the inspection; in the main a consultant from a care consultancy agency supported the inspection process. This person is supporting the manager in developing management systems including, care plans and other care related records, staff supervision and appraisals, review and update policies and procedures in the home, and introduce quality monitoring. Lynwood DS0000008603.V343414.R01.S.doc Version 5.2 Page 21 There continues to be management issues that need to be ironed out, for example staff conduct and discipline needs to be treated less casually. The quality assurance process has commenced and the questions are based on the care standards national minimum standards for older people. Personal money is not managed at Lynwood House. People or their relatives are billed each month for all expenditures undertaken on their behalf. Health and safety records were looked at and were found to be correct. The home’s fire safety records were completed at the required frequency. Accident records need to be dealt with in a more consistent manner, and a system for analysing accidents should be introduced. Servicing records for lifts and hoisting equipment were up to date. Lynwood DS0000008603.V343414.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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 x 3 x 3 x x 3 Lynwood DS0000008603.V343414.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. 1 Standard OP18 Regulation 22 Requirement The registered person must demonstrate that all complaints and concerns received by the home are investigated and treated seriously- this will help to educate staff and illustrate to people that they have been taken seriously. Timescale for action 01/09/07 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 OP32 OP29 Good Practice Recommendations The registered person should review the tasks carried out by senior care workers and key-worker. The registered person should make sure that staff who break the GSCC code of conduct or their condition for employment, are investigated and dealt with in accordance with the home’s disciplinary procedure so that, steps can be taken to make sure that staff are able to safeguard service users. Lynwood DS0000008603.V343414.R01.S.doc Version 5.2 Page 24 3 OP8 The registered person should make sure that a system is in place to monitor the nutritional intake and weight of people so that they always receive the most appropriate assessment and support. Lynwood DS0000008603.V343414.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Text phone: 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 Lynwood DS0000008603.V343414.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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