Inspection on 25/08/05 for Meadowcroft

This inspection was carried out on 25th August 2005.

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 13/10/06

Meadowcroft 24/02/06

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 Delia Styles Announced 25 August 2005 th 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 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 H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Meadowcroft Address Towersey Road Thame Oxfordshire OX9 3NN 01844 212934 01844 215630 manager.meadowcroft@osjctoxon.co.uk The Orders of St. John Care Trust Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Helen Plant Care Home (CH) 45 Category(ies) of Care Home Only (PC) registration, with number of places Dementia - over 65 years of age (DE(E)) 20 Physical disability over 65 years of age (PD(E)) 7 Old age, not falling within any other category (OP) 45 Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1: The total number of persons that may be accommodated at any one time must not exceed 45. 2: As vacencies arise the numbers of persons in the PD/E category will be reduced to 4. 3: The continued registration of this service past April 2007 is dependent upon the physical environment meeting standards. Date of last inspection 15th March 2005 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. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection lasting from 09.35 to 17.10. The trainee home manager and acting care services manager for the registered provider, The Orders of St John Care Trust (OSJCT), were available throughout the day and the inspector fed back to them at the end of the inspection. The registered manager was on sick leave on the day of inspection. The managers had completed a pre-inspection questionnaire, and there was a total of 21 comment cards from relatives and visitors, nine from residents, two from visiting health & social care professionals, and three from GPs. Opinions from the completed comment cards are included in the report. The inspector toured the building, spoke to residents, staff and two visitors, inspected a sample of residents’ care records and maintenance records, and joined residents for lunch. Meadowcroft is one of a group of Oxfordshire care homes that were formerly owned by Oxfordshire Social Services until transfer of ownership to OSJCT in 2003. OSJCT is replacing many of the old homes with purpose built new premises, so that the accommodation and facilities will meet the National Minimum Standards for Care Homes for Older People. Meadowcroft residents are looking forward to the new premises that are to be built in Thame that will replace the present building. What the service does well: The residents are well cared for and spoke highly of the staff who they said are hard-working and kind. The home is clean and odour-free, and there is regular attention to maintenance and redecoration. Staff and residents have a good relationship. The home has an active residents’ committee and ‘Friends of Meadowcroft’, so that residents feel that their views are taken into account and the home has established links with, and support from, the local community. The gardens and grounds are well cared for and planting, both outside and houseplants, add to an attractive and homely environment. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: The home was aware of, and already taking action on, the recommendations made by the inspector. The written information about the home – the Statement of Purpose and Service Users’ Guide – need updating to include all the information that should be available to residents and prospective residents. The quality of meals and variety of menu choices should be improved – several residents commented on this. The home should assess each resident’s nutritional status when they are admitted, and reassess regularly, depending on their risk of being malnourished. Though improvements have been made to the system of written records of residents’ care, further work is needed to make sure that there is enough detail in the information about what actions staff need to take to help each resident, and whether the care has been effective in meeting the person’s care needs. The staffing levels should be increased because the care needs of many of the residents have increased. Though staff were praised for their kindness and hard work, several of the relatives’/visitors’ comment cards showed that they felt that staff were ‘stretched’ and more staff were needed; this was also said by several residents who felt that staff no longer had enough time to spend ‘having a chat’ or getting involved in the social activities in the home. The activities programme should continue to be developed and extended, to increase the range and variety of opportunities for residents to be involved in social and recreational activities. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 7 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. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 & 3 The Statement of Purpose and Service Users’ Guide need amending to provide all the information that should be available to help people make a choice about the suitability of the home to meet their needs. EVIDENCE: The Orders of St John Care Trust (OSJCT) provides an informative and well designed colour brochure with information about the Trust’s philosophy of care, a copy of their quarterly magazine ‘Trust in Care’ and details of the Trust’s head office contact numbers and other care homes managed by OSJCT. The Trust has produced a template Statement of Purpose that needs to be adapted for each individual care home. The current document did not contain all the information required and work was underway to rewrite it. The manager and/or a senior member of staff assess all prospective residents and this process involves gathering information from the individual and their relatives or representative and any other professional carers. The home uses a detailed assessment form. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 10 The system for regularly reviewing residents’ care needs approximately six monthly had lapsed, perhaps because of the registered manager’s absence from the home on sick leave. The home was in the process of a review and reassessment of all residents’ needs, including an assessment by NHS nurses from the RNCC (Registered Nurse Care Contribution) team. Several residents’ care needs have become more complex and they now need 24 hour nursing care, which the home cannot provide. Care managers were involved in the process of helping relatives and residents to choose new care homes with nursing that would meet residents’ increased care needs. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 & 8 Progress has been made in the way in which care plans are written but should be further improved to make sure they are detailed enough to guide care staff in the actions they need to take to assist residents, and to show whether the planned care has met the residents’ needs. The systems for residents to have access to medical, nursing and social care are good. EVIDENCE: A sample of three care plans examined showed that the residents’ care assessments had been reviewed and were more detailed but the care plans should be improved by setting out more guidance for staff about how the individual’s care needs should be met. The daily statement entries did not refer to the care plans specifically, so the comments were general and repetitive, without showing evidence of whether the resident and/or relatives felt their care was being carried out in a way that suited them and met their needs. Residents and/or their representatives had signed their care plans showing that they had been involved in the process. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 12 Four residents spoken to were satisfied that they could see a doctor promptly, and had regular eye tests, chiropody and access to other health and social care specialists, if necessary. Comment cards from three GPs and two health & social care professionals indicated that they were satisfied with the communication with the home’s staff and the way in which residents’ health needs were dealt with by the home. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 & 15 Social activities and meals are generally well managed. There was some evidence that residents were not wholly satisfied with the suitability of the current activities organised in the home. Links with the community are good and residents’ family, friends and representatives are welcomed. Residents’ views about life in the home, and their individual choices about their care, are sought and acted upon. The quality of cooking and variety of food does not consistently meet residents’ tastes and choices effectively. EVIDENCE: The home has recently employed a new activities organiser and now has two part-time workers in this role. A small group of residents were engaged in art and crafts work, and had completed a range of painted pots, papier mache models, tissue paper flowers and other artwork to display at an Activities Open Day, organised by OSJCT to demonstrate the scope of activities and social events that residents from all the Oxfordshire OSJCT homes had been involved in during the year. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 14 Another group of residents were knitting and crocheting, and there was a display cabinet of finished articles for sale in the reception foyer. There was evidence that residents had some criticisms about the quality of food, presentation and meal choices. Residents’ views are taken into account and the menu choices and mealtimes are being reviewed through the home’s own quality audit. On the day of inspection,= the lunchtime choices were vegetable pie, or pork & apple hotpot, served with cabbage, cauliflower and mashed potatoes, followed by rice pudding and jam. There was also jelly or a choice of yoghurts as dessert alternatives. Some residents commented that the vegetable pie was ‘bland’ and that the presentation of the food – pale green and white vegetables – did not look appealing. The rice pudding was undercooked. The manager said that a review of menus was already in place and that residents had requested fewer sandwiches and this had been implemented. Lunch was from 12.30 to 13.30, a cup of tea was served at 14.30 and supper at 17.30. The supper meal now includes a light hot dish. A later snack is available at around 7.00pm. Fresh fruit is available. Menus are displayed on the board and residents are reminded of the choices each morning. There was some evidence of assessment of residents’ nutritional condition on admission to the home, but not of a regular review of how well nourished individuals were (other than a record of their weight). The recommended nutritional assessment process, and accompanying ‘risk’ assessment and care plan, is the one recommended by the community dieticians in Oxfordshire – the Malnutrition Universal Screening Tool (MUST). The OSJCT has not introduced this yet in its care homes, but is recommended to do so, so that it uses a consistent way of assessing someone’s risk of malnutrition that is also being used in NHS hospitals and in the community. Also, so that the homes can show in detail, if necessary, what actions have been taken to improve the resident’s nutritional status. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 The home has a satisfactory complaints system with evidence that residents feel that their views are listened to and acted upon. EVIDENCE: The OSJCT complaints procedure information leaflet is displayed on the noticeboards. Comment cards received from residents, relatives and visitors showed that they knew who to go to with any concerns or complaints. An Age Concern advocate is readily available to residents regarding how to contact them and discuss any complaints in confidence. The home maintains a complaint log and said that one complaint had been received and been resolved. Another family had raised concerns about their relative’s care, both with the home and the CSCI, though those concerned did not wish to make a formal complaint. The managers and care manager were planning further meetings with the family to try to address the issues. A visitor told the inspector that a complaint s/he had made had been satisfactorily resolved. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20, 23, 24, 25 & 26 The home has an ongoing programme of redecoration and routine maintenance and creates a comfortable and safe environment for the residents and visitors. EVIDENCE: The OSJCT acknowledges that many of the room sizes in Meadowcroft do not meet the National Minimum Standards for Care Homes for Older People and provisional plans are being considered for the construction of a new, purpose built care home. There is a shortfall in many room sizes and door widths to bathrooms and toilets. However, the home was commendably clean and individual resident’s rooms and communal areas were attractively decorated and furnished. Residents were pleased with their rooms though all felt that there were several things that they hoped would be improved in the proposed new building, such as individual en-suite toilet facilities, and improved storage and wardrobe space. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 17 Two residents spoken to said that a separate desk or writing area would be useful in their rooms, because they liked to write letters and reports, etc. The manager said she would look into the possibility of providing fold-down shelves for this purpose. Residents were keen to know about how soon the new building work would start. A comment card from a representative of the Friends of Meadowcroft felt that the committee was not kept in touch with managers responsible for the home and that this led to anxiety about the future of the home. On the day of the inspection managers said that they were aware of these anxieties and were committed to sharing any news with residents and their representatives as soon as they had it. The passenger lift had recently broken down for 48 hours but repairs had been undertaken as soon as possible and with minimal disruption to residents. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 29 Staffing levels need to be improved to meet the increasing needs of the current resident group. Managers are aware of this and have agreed an increase in the number of staff in view of the current assessed dependency of residents. The systems in place for recruitment of new staff are satisfactory, demonstrating a systematic and thorough screening and interview process. EVIDENCE: Relatives’ and residents’ comments showed that there were still some concerns about whether there were enough staff on duty, as there had been at the last inspection. The managers said that the recent review of residents’ care needs had shown that many residents were now more dependent on carers’ assistance and that OSJCT had responded by agreeing an increase in staffing levels. One additional carer had been added to the day shifts to increase the staffing numbers. The home uses agency staff to cover vacancies in carers’ and cooks’ shifts and, where possible, the same agency and staff are used, so that the agency staff and residents are known to each other, and residents’ care routines are not disrupted. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 19 As at the last inspection, residents and their relatives and visitors were again complimentary about the caring, friendly and welcoming attitude of staff, despite their ‘busyness’. Residents were also very positive about the organisational abilities of the trainee manager and said that they felt confident that she listened to any concerns and acted promptly to resolve them. Inspection of a selection of 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. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 & 38 The systems for resident consultation are good with some evidence that indicates that residents’ views are both sought and acted upon. The manager is supported well by senior staff in providing clear leadership in the home. Staff show an awareness of their roles and responsibilities. EVIDENCE: The involvement of the ‘Friends of Meadowcroft’, the Age Concern advocate and residents themselves, through a residents’ led meeting, are evidence that the managers and staff are open to the opinions and suggestions made by residents, relatives and visitors. The OSJCT has its own systems for checking the quality of care in the homes, involving residents through use of quality questionnaires, for example, about the catering service. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 21 Maintenance records and routine safety checks on equipment and gas and electrical installations were up to date. Staff training in health and safety, fire safety, moving and handling, care of substances hazardous to health (COSHH) and first aid awareness had taken place in the past 12 months. Future training is planned and includes infection control, food handling and hygiene, and updates in moving and handling and infection control. Senior care staff – care leaders – have responsibility for specific health and safety aspects within the home, such as mobility equipment, risk assessments (fire safety), and ordering and storage of medications. Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 2 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION 3 3 x x x 3 3 3 STAFFING Standard No Score 27 2 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x x x x 3 Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 23 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 1 Good Practice Recommendations Amend to the Statement of Purpose and Service Users Guide to include all the information required under Schedule 1, and details of the complaints prodedure, including the right to access the CSCI at any stage of a complaint investigation Continue the planned training and development for staff in activities and consider ways in which the range and variety of activities could be improved Continue to implement the planned menu changes and catering quality audit. Access training for staff in the use of the MUST nutritional assessment tool for residents Continue to improve the standard of care plans and records by adding evaluation and making the daily statement entries more specific to the care plans. Ensure that staffing numbers and skill mix are consistently meeting the needs of residents 2. 3. 4. 5. 12 15 7 27 Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 24 Commission for Social Care Inspection Burgner House 4630 Kingsgate Oxford Business Park (South) Cowley, Oxford, OX4 2SU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Meadowcroft H57_H08_S36097_Meadowcroft_V234295_250805_Stage 4.doc Version 1.40 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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