Inspection on 13/06/06 for Mere Hall View

This inspection was carried out on 13th June 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 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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mere Hall View 17/01/08

Mere Hall View 03/12/05

Mere Hall View 18/04/05

Mere Hall View 02/09/04

Mere Hall View 20/04/04

Mere Hall View 21/10/03

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SignHealth

Clover House

Parkside

Park Lodge

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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 Mere Hall View 7 Mere Hall Street Bolton BL1 2QT Lead Inspector Rukhsana Yates Key Unannounced Inspection 13th June 2006 09:30 Mere Hall View DS0000030291.V293590.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 Mere Hall View DS0000030291.V293590.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. Mere Hall View DS0000030291.V293590.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Mere Hall View Address 7 Mere Hall Street Bolton BL1 2QT 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) 01204 337098 01204 337099 Bolton Metropolitan Borough Council Mrs Amanda Jane Allwood Care Home 7 Category(ies) of Learning disability (7), Physical disability (7), registration, with number Sensory impairment (7) of places Mere Hall View DS0000030291.V293590.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 7 service users, to include: up to 7 service users in the category of LD (Learning Disabilities under 65 years of age); up to 7 service users in the category of PD (Physical Disabilities under 65 years of age); up to 7 service users in the category of SI (Sensory Impairment under 65 years of age). The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. 3rd December 2005 2. Date of last inspection Brief Description of the Service: Mere Hall View is part of Bolton Social Services provision for people with learning, physical and sensory disabilities. It provides a short term break service for up to seven people. The building is in a residential area, half a mile from Bolton town centre. Bus routes and several amenities are within easy reach. Accommodation is on two floors with a lounge on each. All bedrooms are single and have a washbasin. The ground floor bathrooms have showers. One of the two bathrooms on the first floor has a bath. The range of fees for the service is from £6.92 to £13.22 per night. Mere Hall View DS0000030291.V293590.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over the course of a day, including a period in the early evening when service users had returned from their daytime activities. During the day, discussions took place with the manager and staff, and paperwork was looked at that related to the support provided to service users, and to the health and safety of people using or working at the service. Some time in the later part of the day was spent talking with service users able to make their views known, and the ways in which staff supported service users were observed. 3 service users, 5 relatives and 2 health professionals provided their views by completing survey forms. The inspection covered all of the key standards. These standards cover introductions to the service, the support provided, routines and social activities, complaints and protection, comfort, safety and cleanliness, how staff are employed and trained, and how the service is managed. What the service does well: What has improved since the last inspection? The service is working well to make sure that only people whose needs can be met at Mere Hall View are using it for short stays. There are more staff on duty when needed so that service users have a better choice of indoor and outdoor activities to take part in with staff support. New fencing in the garden has made it more private so that those who want or need privacy outdoors can enjoy using it. Mere Hall View DS0000030291.V293590.R01.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. Mere Hall View DS0000030291.V293590.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 Mere Hall View DS0000030291.V293590.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 at least once during a 12 month period. 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. Each person considering using Mere Hall View has their needs assessed, and is provided with information about what the service can offer. The admission process seeks to establish that the service is suitable before regular short stays are arranged. EVIDENCE: The statement of purpose provides an outline of the admission criteria, and states that referrals are made through care management arrangements. A Short Term Care Forum meeting takes place approximately once a month. The forum is used to consider assessment information relating to prospective service users, and to decide upon the most suitable service for each person referred. The progress of introductions to the service is also discussed and it is evident that the pace of introduction can vary depending on the individual. The manager stated that better assessment information is obtained before introductions begin, as this requirement has been made clear to referring agencies. The service is also better managing to resist pressures to take inappropriate referrals following difficulties highlighted by these pressures at the last inspection. Mere Hall View DS0000030291.V293590.R01.S.doc Version 5.2 Page 9 There was evidence from care records, survey responses and observations that the service is managing complex needs well. In some instances, service users receive direct payments that enable them to continue having staff support additional to that provided at Mere Hall View. Mere Hall View DS0000030291.V293590.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good progress has been made in updating support plans so they ensure that the changing needs, choices and risks for each person are known, and used to provide support based on that knowledge. EVIDENCE: Three service user files and related records were examined. The main files, for those having a short stay, containing care plans, statements of need and reviews are kept in the office on the first floor. The working documents used by staff on duty consist of day and night reports, along with tick lists for personal care tasks carried out and assistance given. There is also a communication book and a file of useful information relating to health and safety checks and contact details for ‘on-call’. Notes in the communication book show that relatives are informed of any changes in health. The contents of the care files examined were complete and up-to-date. They contained key information, agencies, contacts and care manager details, a contract, a care plan covering living arrangements, personal support, income, cultural and religious needs, education, training and occupation, family and Mere Hall View DS0000030291.V293590.R01.S.doc Version 5.2 Page 11 social contact, risk assessments and management, physical and mental health needs, programmes, communication and compatibility. Care plans were informative and included service users’ cultural needs and preferred language. Risk management is addressed through general and specific guidelines, and there were examples of environmental risks being properly addressed, including liaison with health professionals such as the Occupational Therapist to identify solutions. Personal risks and related strategies are clearly documented and agreed with the individual, their family, and with other professionals involved. This guidance gives staff the confidence to support people in their preferred activities and to maximise their independence and right to make decisions while keeping them safe. Mere Hall View DS0000030291.V293590.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service continues to improve the ways in which individual social and recreational needs, and opportunities for community participation, are met. The service maintains good links with families of service users and supports service users’ rights to develop friendships. Service users enjoy their meals. The meals take account of service users’ needs and preferences. Care practices ensure that service users’ rights are upheld. EVIDENCE: Staff members consulted described an increase in the number of activities taking place since the last inspection. Staffing levels are higher and rotas flexible so that support is available when it is most needed. The introduction of themed stays, such as ‘Ladies weekend’ and ‘Young Male Weekend’ show a good consideration of compatibility and interests to enhance service users’ Mere Hall View DS0000030291.V293590.R01.S.doc Version 5.2 Page 13 short break experiences. There was also evidence of recent trips to the cinema, local pubs, shops, and park. At the last inspection the service was advised to consider obtaining equipment that can be used to provide sensory experiences, stimulating and relaxing, for those who would benefit, and some progress has been made with this. The service has paints, arts and crafts materials, videos, games, and has purchased some sensory equipment for service users’ benefit. The service has open visiting arrangements and visitors feel there is a friendly atmosphere. The manager uses her knowledge of current and prospective service users to ensure compatibility and friendships are promoted in the group as far as possible, for example by maintaining familiarity, friendships in peer groups for those in transition. Service users are encouraged to exercise choice in their daily lives, and the active involvement of advocates when needed ensures that individuals’ rights are promoted. With regard to meals, staff carry out the shopping, with service users if possible, and ensure that there is a good variety and healthy options within meal provision. There was clear evidence that specific cultural and other special dietary needs are met. For example, halal meals are provided for muslim service users, and pureed food is presented in an appetising way. Service users also have the option, at times, to have a takeaway or go out for a meal. Some staff and the manager have been on a safe swallowing course. The service will involve the speech therapist in assessing a service user if required. Mere Hall View DS0000030291.V293590.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Readily available information is needed for staff to ensure that service users having a stay at that time receive personal support in the way they prefer and require. Service users feel that staff are good at meeting their physical and emotional needs. Safe arrangements are in place for administering medication. EVIDENCE: The service has a format in place for compiling a profile for each service user. The format is useful in terms of areas such as daily preferences, routines, and ‘a typical day’ for that person. However, they have not been completed and therefore this information was not readily accessible to staff in relation to the service users currently enjoying a stay. As there is a changing service user group, and the service also uses bank staff, it is important that all staff on duty have a readily accessible profile on each person using the service at that time. The profile should include clear and specific information about how the service user communicates and how staff are to support that person with each area of identified need. The profile could also be added to by staff on duty as they get to know more about that person. It was apparent that staff do try to take Mere Hall View DS0000030291.V293590.R01.S.doc Version 5.2 Page 15 account of service user choice and rights to make decisions, and improved profiles will enhance their ability to promote these areas. There were positive comments made by visiting health professionals about the ability of the service to work cooperatively and competently with them in meeting health needs. Staff receive training relating to service users’ needs. For example all staff have had training in managing eplilepsy, both general and individualised. Care files contain useful information about health needs and the home works to maintain consistency with the management of health issues from home through to short term care environment. As well as being happy with healthcare provision, emotional needs are met in that service users benefit from sensitive staff attitudes, and one service user confirmed that staff talk to her and make her feel better when she is down. Medication arrangements appeared to be satisfactory. Families are expected to ensure medication for the stay is in pharmacy labelled containers. Files showed that a medication form is completed for each service user, for each separate stay, as part of the admission documentation. Medicines are stored safely, and administration records are accurately maintained. Mere Hall View DS0000030291.V293590.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The complaints procedure needs to be provided to service users or their representatives in appropriate languages and formats, and records of complaints and outcomes maintained. This will ensure that everyone is enabled to express views or concerns, and that the service can demonstrate how concerns have been resolved. A system for recording complaints and compliments should be in place as part of a quality monitoring process. Protection policies and practices ensure the safety of service users. EVIDENCE: The Mere Hall View welcome pack contains a lot of useful information about the service, including details of how to complain. The service employs support workers who can communicate with families that have Urdu or Gujerati as their first language. This provides one way in which views can be heard, but their right to an accessible complaints procedure needs to be addressed. This would encourage people to make their views known, and help the service to identify unmet needs. At previous inspections the service was advised to make this information available in different languages and the manager was involved in a working group looking at developing an accessible complaints procedure. It is envisaged by the manager that this work will soon be completed. The message book showed concerns, queries and compliments received recently. When relatives of service users telephone about a concern, the issue, response and outcome should be recorded in a separate complaints and Mere Hall View DS0000030291.V293590.R01.S.doc Version 5.2 Page 17 compliments record to demonstrate that a satisfactory response has been provided. Information relating to complaints and compliments can then be used for ongoing quality monitoring purposes. There are written procedures for the protection of adults and for whistleblowing. Staff members understood these, having covered this topic in training courses. Staff always document instances of service users coming in to the service with any injuries and inform the relevant people, e.g, care manager, day care service, and / or family members. . Mere Hall View DS0000030291.V293590.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Mere Hall View provides a clean and comfortable environment for service users. EVIDENCE: Mere Hall View has three bedrooms on the ground floor and four bedrooms on the first floor. There is a lounge on each floor, providing a choice of communal space for service users. Each room has basic furniture and a sink. The lounge areas are comfortable and homely. Since the last inspection, fencing around the garden has greatly improved privacy for service users who wish to sit outdoors in fine weather. The premises are clean and hygienic, with suitable infection control measures and training in place. Carpets are regularly shampooed as needed. Suitable laundry facilities are in place. Some relatives commented that clothes sometimes go missing or get mixed up, but that the situation is improving. The manager was advised to review arrangements to further minimise this problem. Mere Hall View DS0000030291.V293590.R01.S.doc Version 5.2 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff training arrangements support the development of a competent staff group. Safe recruitment procedures help to ensure that only staff who are suitable are employed. EVIDENCE: There was evidence that staff numbers on duty fluctuate depending on the needs of the service user group at any particular time. For example, there can be 4 members of staff on duty at peak activity times of the day if needed. At the time of this inspection two waking staff were on duty at night due to the irregular sleep patterns of a service user leading to a higher level of support required at night. In addition to the current staff complement, the service has a person employed as an apprentice who will be working full time for 2 years whilst undertaking the NVQ in care qualification. Recruitment is managed centrally by the Social Services Department. Staff files examined contained evidence that safe and satisfactory recruitment procedures are followed, and CRB checks carried out prior to appointment. There was some evidence of supervision meetings, the completion of training and development plans, and information relating to training completed, but the Mere Hall View DS0000030291.V293590.R01.S.doc Version 5.2 Page 20 level of information in files varied. The manager was advised to ensure consistency in staff information available, to include a training plan and up to date list of training undertaken. The service has good staff consistency. Bank staff coming in tend to be longstanding and are therefore familiar to some service users. In terms of staff training, four have achieved NVQ level 3, one has NVQ level 1, and five staff members are due to commence. The induction process for all staff includes the Learning Disability Awards Framework workbook. Staff stated that they receive training in mandatory topics including food hygiene, first aid and moving and handling and additional training related to managing challenging behaviour and managing epilepsy. The staff on duty felt that the staff group works well together as a team. Mere Hall View DS0000030291.V293590.R01.S.doc Version 5.2 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users benefit from a well-managed service. A quality monitoring system and development plan is needed that will show service users and others how their views are being used to improve the service. Regular health and safety checks ensure that the environment is safe for service users and staff. EVIDENCE: The manager is competent in fulfilling her role. She has achieved the Registered Manager’s Award and continues to undertake a range of training to update her skills and knowledge. A recommendation was made to review the manager’s job description to ensure it accurately reflects the role. Mere Hall View DS0000030291.V293590.R01.S.doc Version 5.2 Page 22 Staff members feel they have clear direction and management support and that there are good communication systems in place. Service users and relatives expressed great confidence in the manager and the staff in terms of their understanding, enthusiasm, willingness to listen and to act upon guidance and advice to ensure service users enjoy their stay. These comments, and the progress made since the last inspection, show that quality matters in this service. However, at the last inspection, the service was required to produce a development plan to reflect service users’ experiences and their contributions to future plans. The quality development plan was to be in accessible formats and languages so they service users and their representatives, and other professionals, could see how their views underpinned the improvement process. This requirement remains outstanding. All health and safety checks and equipment tests were satisfactory, and the fire precautions log was up to date. Mere Hall View DS0000030291.V293590.R01.S.doc Version 5.2 Page 23 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 2 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 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 2 3 3 X 3 X 2 X X 3 X Mere Hall View DS0000030291.V293590.R01.S.doc Version 5.2 Page 24 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. 2. Standard YA18 Regulation 15, 17 Requirement The service must develop a profile for each service user, accessible to staff during the stay, that reflects service users’ preferences and needs as to how support is to be provided. (Previous timescale of 09/01/06 not met) The complaints procedure needs to be provided to service users or their representatives in appropriate languages and formats, and records of complaints and outcomes maintained.(Previous timescale of 06/02/06 not met) A quality monitoring system and development plan is needed that will show service users and others how their views are being used to improve the service. The registered provider must visit regularly to assess and report on the quality of the service. (Previous timescale of 06/03/06 not met) Timescale for action 25/08/06 6. YA22 22 25/08/06 10. YA39 24, 26 25/08/06 Mere Hall View DS0000030291.V293590.R01.S.doc Version 5.2 Page 25 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 YA37 Good Practice Recommendations The manager’s job description should be reviewed and updated to accurately reflect the role. Mere Hall View DS0000030291.V293590.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Mere Hall View DS0000030291.V293590.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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