Inspection on 13/10/06 for Meadowcroft

This inspection was carried out on 13th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Meadowcroft 30/09/08

Meadowcroft 24/02/06

Meadowcroft 25/08/05

Meadowcroft 15/03/05

Meadowcroft 19/08/04

Meadowcroft 12/02/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Meadowcroft Towersey Road Thame Oxfordshire OX9 3NN Lead Inspector Annette Miller Unannounced Inspection 13th October 2006 09.30 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 Meadowcroft DS0000036097.V317740.R02.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. Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Meadowcroft Address Towersey Road Thame Oxfordshire OX9 3NN 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) 01844 212934 01844 215630 manager.meadowcroft@osjctoxon.co.uk The Orders Of St John Care Trust Zalina Grazette Care Home 45 Category(ies) of Dementia - over 65 years of age (20), Old age, registration, with number not falling within any other category (45), of places Physical disability over 65 years of age (7) Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. The total number of persons that may be accommodated at any one time must not exceed 45 As vacancies arise the number of persons in the PD/E category will be reduced to 4. The continued registration of this service past April 2007 is dependent upon the physical environment meeting standards. 24th February 2006 Date of last inspection Brief Description of the Service: Meadowcroft is situated in a quiet residential area near to the centre of the market town of Thame. It is close to local services - a health centre, community hospital, shops, library, pubs, clubs and churches. The home is registered to accommodate 45 older people, some of whom may have physical disabilities or are mentally frail. The accommodation is provided in 27 single rooms and 9 double rooms, on two floors that are served by a passenger lift. Three of the double rooms are used as single rooms for residents whose care needs are such that they need space for additional disability equipment. The home also provides day care for up to five elderly people a day. There is a large ground floor lounge and dining room, a second smaller ground floor dining room and two further sitting rooms and a dining room on the first floor. There are three assisted baths with over-bath showers and 14 toilets. None of the rooms have en-suite facilities but all have a washbasin. The home is set in its own grounds, with surrounding lawns, gardens and mature trees and shrubs, and is next to a secondary school, overlooking the school playing fields at the rear. There is an attractive central courtyard garden, accessible from the ground floor lounge and dining areas. The fees range from £525.00 to £625.00 per week. Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Since the 1st April 2006 the Commission for Social Care Inspection has developed the way it undertakes its inspection of care services. This inspection of Meadowcroft was an unannounced ‘key inspection’. The inspector arrived at the home at 9.30 am and was in the service for eight hours. The inspection was a thorough look at how well the service is doing. It took into account detailed information provided by the home’s manager, and any information that the commission has received about the home since the last inspection. The inspector asked the views of the people who use the service and other people seen during the inspection or who responded to questionnaires that the commission had sent out. Eleven residents, thirteen relatives and four GPs returned comment cards to the commission giving their views on the home, which are referred to within the report. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. The inspector discussed her findings with the home’s manager at the end of the inspection. What the service does well: What has improved since the last inspection? The good practice recommendations regarding care plan records and the management of medication have been implemented. Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 6 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. Meadowcroft DS0000036097.V317740.R02.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 Meadowcroft DS0000036097.V317740.R02.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 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment procedure for prospective residents assures residents that their needs can be met by the home. The company provides a good range of training, which ensures all staff have the skills and experience to deliver the services and care the home offers to provide. Intermediate care is not provided. EVIDENCE: The manager visits all prospective residents to carry out a needs assessment to determine whether or not the home can provide the care that is required. The assessments of two recently admitted residents were examined and the inspector saw that all aspects of assessment had been covered. Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 9 The manager has a good understanding of staff training needs and recent training in specific areas of care has included, for example, dementia care, infection control and diabetes. Members of staff spoke enthusiastically about the training opportunities that were provided. During 2006 staff have also attended equality and diversity training, giving assurance to prospective residents that staff are well informed on these matters. From the evidence seen by the inspector and comments received, the inspector considers the home would be able to provide a service to meet the needs of individuals of various religious, racial or cultural needs. Meadowcroft DS0000036097.V317740.R02.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health needs of residents are well met and personal support is offered in such a way that promotes and protects residents’ privacy, dignity and independence. EVIDENCE: The inspector looked at three residents’ care plans and found they contained comprehensive information about each person’s care needs. The action that staff need to take to assist residents is listed so that carers are clear about what they have to do. The inspector spoke individually to a resident in her bedroom and also to a number of other residents sitting in the main lounge. They all expressed complete satisfaction with their care. There was evidence that the home had sought the advice of specialist nurses when expert knowledge was needed, for example a falls clinic nurse and a community psychiatric nurse had each visited the home recently to see residents. GPs and district nurses visit the home regularly to provide residents with their health care. Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 11 Residents are weighed monthly so that staff can monitor any weight loss or gain and there was evidence in care plans that appropriate action to deal with problems is taken. For example, the inspector saw that a resident who had particular nutritional problems had been referred to a dietician. The manager said the home had not yet started to use a nationally validated nutritional screening tool, but that this was planned. The home’s systems and procedure for the ordering, safe storage, administration and recording of residents’ medicines are good. One resident was ‘self-administering’ her own medication and the home has good procedures in place to ensure residents are able to do this safely. Five carers attended medication training in 2006 ensuring their knowledge and skills are up-to-date. Staff were observed to be polite and respectful towards residents, and to knock on bedroom doors before entering. 10 out of 13 relatives who returned comment cards to CSCI said they were satisfied with the overall care provided. Three relatives said they were not satisfied – one respondent did not give a reason and two said it was because there was not enough staff. (See the inspector’s finding on staffing under Standard 27). The inspector spoke individually to a relative during the inspection and he said he was entirely satisfied with the care that was provided and always found staff to be helpful and polite. Meadowcroft DS0000036097.V317740.R02.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. The home continues to make progress in developing stimulating and motivating activities for residents. Dietary needs of service users are well catered for with a balanced and varied selection of food available. Most residents are satisfied with the standard of food. EVIDENCE: The home employs two part-time activity organisers. One person works 9 am to 12 midday Monday to Thursday and a second person has recently been appointed to work 8 hours a week. The manager said that the activities leader had attended a training course organised by the company and had worked with another home’s activities leader to help develop ideas for residents’ activities and social events in the home. During the inspection a group of residents were involved in artwork, whilst enjoying general conversation with each other and the activity organiser. A popular social activity is the home’s regular Friday evening ‘bar’ opening hours between 6 and 8 pm when alcoholic drinks are served. The cost of Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 13 drinks is subsidised by the Friends of Meadowcroft, a group of people involved in fundraising for the home. The manager said that the money made from the bar is put towards events/activities, such as the fish and chip supper that was arranged and was being delivered by a local ‘fish and chip’ shop. The supper was planned to coincide with the bar opening hours so that residents could have a drink with their meal. On the day of inspection a light lunch was served to take account of the fish and chip supper being provided later. Choice is provided at every meal to take account of individual likes and dislikes. The home has open visiting and a visitor confirmed he was able to visit whenever he wished. In response to the question in the residents’ ‘Have Your Say’ questionnaire – ‘Are there activities arranged by the home that you can take part in?” - one said ‘always’, five said ‘usually’, three said ‘sometimes’. Two said they were not well enough to take part. One resident added an additional comment that said: “To begin with I was a bit bored, but more activities have been added recently”. In response to the question in the residents’ ‘Have your Say’ questionnaire – “Do you like the meals at the home?” - 5 said ‘always’, 5 ‘usually’. One made no comment. Two residents made additional comments about the food saying: “Not bad but could do with something different for a change.” “Some of the meals are rather unimaginative and not very appetising.” Meadowcroft DS0000036097.V317740.R02.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. The home has a satisfactory complaints system with evidence that residents feel their views are listened to and acted upon. The home has training and procedures in place so that staff have a good understanding of adult protection issues to protect residents from abuse. EVIDENCE: Comments made by residents and relatives in questionnaires returned to the commission showed that people know whom to go to with any concerns or complaints. An Age Concern advocate is readily available to any resident who wishes to discuss any complaint in confidence. The home’s complaints procedure leaflet is displayed on notice boards within the home. The manager has not received a complaint since the last inspection, nor has the commission received any information about a complaint. New staff receive training during their induction period about reporting suspected abuse and have mandatory training regularly thereafter. The manager said that all grades of staff had attended training during the past year on the protection of vulnerable adults. Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. 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. The home has an ongoing programme of redecoration and routine maintenance and this creates a comfortable and safe environment for residents and visitors. However, some of the environment standards fall below the standards set by the government and although the company has stated it plans to rebuild the home, the lack of information given to residents and staff about this is causing anxiety and concern, which needs to be resolved. EVIDENCE: The furniture and fittings are domestic in style providing a home-like environment, although some items of furniture were showing signs of ‘wear and tear’. The main lounge is a large room separated into three distinct areas. Two areas are furnished with comfortable armchairs and lounge furniture. The third area is the main dining room, which is spacious and overlooks a very Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 16 pleasant courtyard garden. There are also small lounges situated around the home, which provide quiet and less busy areas. The company acknowledges that many of the room sizes in Meadowcroft do not meet the National Minimum Standards for Care Homes for Older People and the company plans to construct a new, purpose built care home to the rear of the present home. During the inspection a significant number of residents and staff commented on the lack of information received about this project, and relatives also commented on this on comment cards returned to the commission. A member of staff said that a meeting arranged by the company to take place in August 2006 to discuss the project had been cancelled at short notice and was not rescheduled. Lack of communication about the proposed building work was also referred to in the commission’s inspection report of 25th August 2005. Cleanliness was found to be good throughout the home, although there was a slight smell of stale urine in the home’s reception and a stronger smell of stale urine in a resident’s bedroom. The manager said that carpets were cleaned regularly and every attempt was made to keep the home smelling fresh. This needs to be monitored carefully and if the elimination of odour cannot be achieved by routine cleaning, the company must consider what action is necessary to resolve the problem. In response to the question in the residents’ ‘Have Your Say’ questionnaire – ‘Is the home fresh and clean’ – 8 said ‘always’, 2 ‘usually’, 1 ‘sometimes’. One resident made an additional comment saying the home was “old and dated”. Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. 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. At the time of inspection staffing levels appeared to be appropriate for the needs of the current resident group to be met. The systems in place for recruitment of new staff demonstrate a systematic and thorough screening and interview process. EVIDENCE: On the day of inspection there were 38 residents living in the home. Five carers were on duty from 7 pm – 2 pm, four from 2 – 5 pm, five from 5 – 6 pm and 6 from 6 – 10 pm. Overnight there were 2 carers and an on-call carer. The inspector considers, from her observations and comments from residents and staff, that this number of staff was adequate to meet the needs of residents at the time of inspection. The manager, an activity organiser, administrator, 2 catering staff, 3 domestic staff and 2 laundry assistants were also on duty. The staff spoken to during the inspection said they were happy working in the home and thought staff morale was good. Two carers have left since the last inspection and as a result of a recent recruitment drive five carers have been appointed. Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 18 In response to the question in the residents’ ‘Have Your Say’ questionnaire – ‘Are the staff available when you need them?’ - 5 said ‘always’, 3 ‘usually’ and 3 ‘sometimes’. Inspection of three staff files showed a systematic and well-organised approach to recruitment and screening of prospective new staff. There was evidence that appropriate police checks and references had been received before staff were employed. The only shortfall was that a full employment history had not been obtained for any of the three staff whose files were looked at. This is needed to enable any gaps in employment to be checked. The home is working towards achieving 50 trained members of care staff with NVQ level 2 in care (or equivalent). Six carers currently have this qualification (33 ) and another 6 carers have recently started. The home has access to one external NVQ assessor and is looking to obtain further external assessors to assist the home in meeting the 50 target. The home’s induction programme is based on the Skills for Care Council standards and new staff have a booklet to complete to record what they have learnt and for the manager to be assured that all areas of training have been covered. The inspector spoke to a new carer who considered she was receiving the level of support she needed. Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. 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 manager has a good understanding of the aims and philosophy of the home and communicates effectively with the residents, staff and relatives. Staff have a good level of awareness of their roles and responsibilities. EVIDENCE: The manager is well qualified and has considerable management experience. She has obtained the registered manager’s award (NVQ level 4 management) and is a registered nurse. As a registered nurse the manager has had extensive experience in teaching student nurses and in working in a wide range of health care settings and this benefits the home, but as Meadowcroft is not registered as a nursing home the manager cannot provide nursing care herself. Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 20 Evidence was seen of the manager’s attendance on relevant training courses ensuring she has up-to-date knowledge and skills to assist her in her present role. Staff spoken to during the inspection said they felt able to approach the manager with any queries or concerns and thought they had good support from senior staff enabling them to carry out their duties satisfactorily. The inspector saw several residents approach the manager with queries and it was clear residents felt at ease with her. Residents’ meetings are held approximately four times a year, last held on 2nd July 2006. Staff meetings are also held quarterly, more often if needed. This means that residents and staff have an opportunity to raise matters for discussion ensuring people who live and work in the home feel involved. The company has its own systems for checking the quality of care in the home through use of quality questionnaires sent to residents. A recent theme from a set of questionnaires was the lack of information provided by the company to people living in the home about the planned building work (see also comments under Standard 19). The manager arranges to look after small amounts of residents’ money if this is their wish. Any money received is paid into a bank account that is separate to the company’s assets. The home pays for incidental expenses, such as chiropody treatment and hairdressing, as needed, and then sends out monthly invoices showing what has been paid for, which is reimbursed from the resident’s money in the account. The manager and the administrator are signatories. The manager said a firm of external accountants had audited the accounts in the past year and found them to be in good order. Health and safety training is provided and training records showed that attendance by staff was good. Maintenance records were in good order and provided evidence of routine maintenance tests, such as weekly fire alarm tests and monthly emergency light tests. Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 22 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 OP29 Regulation 19 and Schedule 2 (as amended) Requirement ●The manager must ensure that a full employment history is obtained from new workers and that gaps in employment are checked. ●The manager must confirm in writing to the inspector that this has been implemented. Timescale for action 07/12/06 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 OP19 Good Practice Recommendations The company’s ‘responsible person’ should ensure that residents, relatives and staff are kept informed of the company’s plan to construct a new care home to the rear of the present home. The manager should ensure that the smell of stale urine is eliminated from all areas in the home. If this cannot be achieved by routine cleaning, the company will need to consider what action is necessary to resolve the problem. 2 OP26 Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU 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 Meadowcroft DS0000036097.V317740.R02.S.doc Version 5.2 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!