Inspection on 20/10/06 for Malvern House

This inspection was carried out on 20th October 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Malvern House 07/01/06

Malvern House 20/10/05

Malvern House 04/11/04

Malvern House 24/08/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Malvern House 139 Heysham Road Heysham Lancashire LA3 1DE Lead Inspector Mrs Jennifer Dunkeld Unannounced Inspection 20th October 2006 11:00 Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 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 Malvern House DS0000041790.V299760.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Malvern House Address 139 Heysham Road Heysham Lancashire LA3 1DE 01524 417846 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) emmercare@aol.com Mrs Brenda Christine Emmerson Mr Ronald Emmerson Mrs Keran Farrow Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service can accommodate a maximum of 8 residents in the category LD (Learning Disability) 7th January 2006 Date of last inspection Brief Description of the Service: Malvern House is a small home registered with the Commission for Social Care Inspection to provide care and accommodation for up to 8 young adults who have a learning disability. The home is a situated in Heysham close to a number of facilities and amenities. All accommodation at the home is provided on a single room basis, eight of the bedrooms have en-suite facilities. Care is provided on a 24-hour basis. Some of the carers have National Vocational Qualifications in care at level 2 or above. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection visit to the home, in that the owners were not aware that it was to take place. The length of the visit was for 4 hours. Before the visit took place, surveys were received from residents relatives, and visiting professionals. In the report there are references to the “tracking process”, this is a method whereby the inspector focuses on a small group of residents during the site visit. All records relating to these individuals are examined. Residents are invited to discuss their experiences of the home with the inspector. A tour of the home was made, viewing lounges, dining rooms, bedrooms and bathrooms. Everyone was friendly and cooperative during the visit. What the service does well: Malvern House is a family run business that employs a fairly consistent, competent staff team and as such offers consistency of care and a tailor made service to each individual person. The staff receive appropriate training to ensure they are equipped to offer good support to individuals. The management and staff in addition to offering personal care it enables residents to have age appropriate activities of their choosing and a life style that meets their individual needs. The management team keeps up to date and well informed about current trends in the care of people with a LD (Learning Disability) ensuring people have access to all that is available within the community. The residents are enabled to have a say in the continued employment of support staff, which all staff members are aware of. This ensures that staff understand that the residents views are all important. The residents said that they are encouraged to give their opinions about the services they receive and all aspects of their support. Malvern House DS0000041790.V299760.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. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. Information about the home is good, providing residents and prospective residents and their families with details of the service the home provides, enabling an informed decision about admission to the home EVIDENCE: There is detailed information available about the home for all residents, or possible residents, which has been developed over time into a very clear and easy to read description of the services provided, and who provides them. It is available in written and pictorial format, to help the reader understand the content. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 9 This information, including the latest CSCI report, is placed in the entrance hall of the home for anyone visiting to view. Individual records are kept for each resident, and the staff discussed the way anyone new would be initially invited to visit the home and meet the residents. A social work assessment would be used to help the owner decide whether the home was the right place for the new person, that the staff were able to give the right care, and that the present residents were compatible with them. Assessments were seen for three residents in this home, and were all based on each individuals diverse needs, to make sure the right care and support is given to each person. There was information on the residents strengths, needs, personal goals, and choices on how they wanted their support to be provided. The residents, and families, were included in deciding the best care for them. The home has a robust admission procedure and an emergency admission procedure which ensures that all admissions occur in an appropriate manner. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 & 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a system in place for identifying peoples needs. Generally, residents can make decisions on what they want to do which results in them being content in the care they receive EVIDENCE: The care planning system is currently being re structured to ensure peoples needs are fully identified and goals set to ensure each individual achieves thier goals and aspirations. These are going to be electronically stored with a hard copy given to the individual concerned. The owner and staff constantly talk with the residents, who were seen to feel free to say if they want something. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 11 The residents spoke of their activities including swimming, meals out and visits to the pub. At the time of this visit a goup of residents and 2 staff had gone into Lancaster to have a walk around the castle. The staff said that the residents were encouraged to make their own decisions, and risk assessments are carried out on residents activities. The management of the home endeavours to ensure that the residents rights to equality are met in a way that best meets their individual needs, the production of care plans in audio format would further enhance some residents ability to understand their plan of care. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 &17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can choose from a variety of activities to help develop their skills. Their decisions are respected, and daily routines promote independence. EVIDENCE: The residents had enjoyed a holiday on the North East coast of England earlier in the year. People are enabled to have a variety of activities according to their abilities and preferences. One resident enjoys pl;aying cards and watching TV. She also attends church on a regular basis with support. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 13 Another resident does voluntary work in a charity shop and also works part time in a care home. Her life style appears fulfilling. She was not spoken with during this visit as she was at work. On the day of this visit 4 residents had gone into Lancaster with 2 staff to have a walk around the castle. One man stated that of late his legs have not b een good and as such he is having to change his lifestyle. The management are aware of this and are enabling him to adjust to a different way of life . He stated that the staff are good and help him when he needs help. The service providers are developing a garden at the rear of the home where residents will be encouraged to help grow herbs etc. A large shed/summer house is in this area where residents who smoke will be able to go and sit in comfort to have a cigarrette. The home does not permit smoking in the home and this is clearly stated in the Statement of Purpose. Each resident is offered a key to their own bedroom door ensuring his or her privacy is respected. The comment cards received from the residents reflected that the vast majority are happy with the meals they receive. One resident stated that the meals are good sometimes. The residents stated that together they plan the weeks main meal menu and assist in the shopping for the neceesary items of grocery etc. The breakfast, lunch and supper are by individual choice with people choosing what they individually want to eat. It would be a good practice to record peoples choices to ensure a reasonably balanced diet. People are weighed on a regular basis to monitor weight ensuring people are not losing or gaining weight without choosing to do so. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 & 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service The staff have a good understanding of the resident’s support needs. The medication at this home is well managed, promoting good health. EVIDENCE: Residents come and go to their rooms as they wish, some choosing to stay there for a while to watch television or play music, or just spend time on their own. Two residents when asked stated that staff do knock before they come in our rooms. One resident who was case tracked had increasing physical disabilities which the service providers had ensured could be met in the home by making adaptations to the home as necessary, such as a gradually sloping ramp to the front door and a specific type of en suite bathroom. The staff were well aware of this residents needs and of her plan of care. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 15 Another resident who was case tracked had lived with his parents for a large part of his life before moving to a care home from where he had moved to a nursing home due to physical ill health. Since then he has moved to this home and has settled well. he spoke of his interests and the staff support he receives. He has happy memories of his childhood and early years as a man and enjoys to talk about these. The staff were aware of this and regularly listen to him remanis. This resident said that he is enabled to go to the Doctor when he needs to. When asked he stated that his health care needs are well met and that he is happy in the home. Another man had lived in a large institution for a number of years and then lived semi independantly prior to moving to this home spoke of his changing medical needs and how the staff are supporting to come to terms with the changes and the management have arranged all the necessary medical checks/appintments to identify the possible cause. The Occcupational \therapist and Physiotherapist have also been involved and offered advice and support. His siater staed in a comment card to the Commission for Social Care Inspection that her brother Looks much happier and appears well cared for This mans Plan of Care needs updating to reflect his changing needs. The residents individual plans of care have a detailed record of all professional visits, such as Doctor, Dentist, Chiropodist, Psychiatrist and the District Nurse where appropriate. When assessed as requiring staff support to attend medical appointments this is provided. Staff helping with the administration of medication had attended a medication awareness course. The records were all correct and up to date on records printed by the pharmacist with the medication taken by the residents. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are confident their concerns will be listened to and acted upon.Staff have an understanding of Adult Protection issues, which protect residents from abuse. EVIDENCE: There is a complaints procedure in place, with a complaints book to record any complaints, which may come to the manager’s attention. All the residents and/or their family receive a copy of the home’s complaints procedure, which is contained in the homes Statement of Purpose. The production of the complaints procedure in an audio tape would ensure all residents have equality of access to understanding the complaints procedure. There was evidence of complaints being recorded and acted upon for example one resident had stated during a meeting that Staff sometimes turn the TV over. This was then discussed with all staff and recorded along with the outcome. Staff receive LDAF Learning Disability Award framework training in relation to the protection/safeguarding of vulnerable people. The staff spoken with were aware of what to do should an allegation of abuse be made. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 17 Residents spoken to said they would tell the staff or Keren, homes manager if they did not like something. Staff said that they would note any changes in mood of residents, which would indicate that they were not happy about something, and would try to find out what it was and put it right. All staff had attended a staff conference earlier in the week of this visit to discuss many topics one of which was abuse. The conference had been a success last year and this year. The service provider states this will be an annual feature for this home. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is This judgement has been made using available evidence including a visit to this service. Residents live in a homely, comfortable and safe environment that meets their individual and collective needs. EVIDENCE: A tour of the home revealled that the home is well maintained and the residents individual bedrooms are full of their own possessions which reflect the individuals personality. Bedrooms have en suite facilities. The service user who during the previous inspection was going to have her room adapted to meet her needs spoke of how she is pleased with the outcome. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 19 The new ramp to the front of the home gives equalty of access for people with walking difficulties and wheel chair users. There are two large lounges in the home and people freely choose wher they would like to sit. Some new fire doors have been installed in the home to ensure the safety of the people who live there. In additon to this self closing devices are being installed so that doors can be wedged open when necessary but will automatically close should the fire alarm be sounded. The home has also had new double glazed windows installed which enhances the warmth of the home as well as the appearance. The homes laundry is currently being extended which give greater space for the residents who are able to iron their own belongings and reduce the need for people to iron their clothes in the dining room. \At the time of this visit a pile of ironing wasa on the dining room window sill. It was noted that the carpet in one lounge next to the dining room is rippled in one place and as such presents a hazard to the health safety of the residents. This was discussed with the management team and they agreed to rectify this. The management asre having a darden developed at the rear of the home for the residents to use as they wish. They spoke of how they were looking forward to having a barbeque next year. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34 & 35 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home operates a good recruitment policy, which should ensure that only people who are suitable for this type of work are offered an appointment. EVIDENCE: The management team stated that anyone applying for employment at the home is required to undergo a rigorous and robust recruitment process, which includes filling out application forms, providing a minimum of two referees and undertaking a police check. The checking of 4 staff files revealled that 2 people only had 1 reference each on file as they had been previously known to the provider and manager. Advice was given on the need to always take up two written references. In addition the candidate participate in a formal interview. These processes are carried out under Equal Opportunities and are intended to ensure the applicant is of good character and fit for the job. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 21 Discussed the need to ensure the home askks the applicant for a full employment history and asksfor explanations of any gaps in employment. All appointments are initially on a temporary basis until a successful appraisal has been carried out. The views of the residents are sought during the induction periods of new staff. The residents have a representative take part in the staff interview process, which ensures they feel their views are listened to acted upon. On the day previous to this site visit all staff had attended a Staff conference at a local hotel. The topics for the conference Team building to ensure the staff work together for the benefit of the residents. The staff looked at the Residents Guide and compared it to what actually happened in the home. This had a positive outcome ensuring the quality of care within the home continues to meet the needs of the residents. The residents fill in a Residents assessment of staff form prior the end of the staff probation period. This form uses pictures and signs, which enable the residents to easily follow the questions. Staff attend relevant training for example LDAF Induction and Foundation courses and National Vocational Qualifications in Care. The residents spoke well about all the care staff and the homes manager. The staffing rotas were checked and they showed that an adequate number of staff are on duty during each shift. The staff said there are enough of them to provide a good quality of care to the residents. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service Systems and practices in the home promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: The manager and provider were seen to be working well together and outlined how they have settled their differences and are now making plans for the future. The plans include the manager handing over managing the care home to the provider while the manager aplies to be registered to manage another part of their organisation. The staff on duty stated that the home is well managed and that they all try to wotk together to meet the needs of the residents. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 23 The residents said they were in happy in the home with comments such as I like it here all the staff are lovely Oh its a good home better than some places I have been Its good yes, I can do what I want Brenda (service provider) looks after us, she took a bit of getting used to at first but she is alright. Records of residents meetings were seen. These are held every three months, and cover areas such as: the care given, the environment, menus, and activities. One resident reported the staff turn the TV over, this was recorded and acted upon. The residents spoken with said this was no longer a problem. Surveys are sent to residents in an easy to understand format. Those seen showed that the residents thought the staff were friendly, their room was clean, they were able to make choices and take part in everyday activities, and the staff listened The management stated that the residents’ are encouraged to manage their own finances whenever this is possible. However some people due to their disability are unable to understand their finances. The management keep individual, thorough records of all transactions. The money is securely stored, the Key Holder person in charge, signs all transactions. It is recommended that all transactions are signed by two people to protect all parties and ensure balances are correct. All accidents are recorded on file. Appropriate fire precautions are taken with a fire alarm system, and extinguishers. all which are checked regularly. All staff are instructed on what to do in case of fire, with regular fire drills. Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 2 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 25 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. 3. Standard YA6 Regulation 15(2)(a) Requirement The manager must produce a care plan along with the resident himself or herself and update the plans of care on a regular basis. Timescale for action 12/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA6 Good Practice Recommendations Residents’ care plans should be developed in audio and/or video format. The home’s complaints procedure should be made available in audio and/or video format. 2. YA22 Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 Malvern House DS0000041790.V299760.R01.S.doc Version 5.2 Page 27 - 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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