Inspection on 03/12/05 for Mere Hall View

This inspection was carried out on 3rd December 2005.

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

The inspector 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 11 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 13/06/06

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 Unannounced Inspection 3rd December 2005 10:00 Mere Hall View DS0000030291.V269010.R01.S.doc Version 5.0 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.V269010.R01.S.doc Version 5.0 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.V269010.R01.S.doc Version 5.0 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.V269010.R01.S.doc Version 5.0 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. 18th April 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. Mere Hall View DS0000030291.V269010.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a Saturday over a period of 7 hours. Most of the time was spent with service users in the main lounge, and discussions took place with staff on duty, with service users able to make their views known, and the ways in which staff supported service users were observed. The remainder of the day was spent looking at paperwork relating to the service and to the support needs of the people staying there. A tour of the premises was also undertaken. What the service does well: What has improved since the last inspection? What they could do better: There is a need to make sure that the service is right for the people being introduced, and to make all rooms available for short stays. Written records about service users should be improved, so that any staff member coming on duty can quickly refer to accurate notes that will help them to provide suitable support. There should be more staff on duty when needed to ensure service users have a choice of indoor and outdoor activities. Clear information about Mere Hall View DS0000030291.V269010.R01.S.doc Version 5.0 Page 6 how to complain or compliment the service needs to be provided to service users or their representatives. A quality development plan is needed that takes account of service users’ views and those of other interested parties. The garden needs to be made more private so that those who want or need privacy outdoors can enjoy using it. 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.V269010.R01.S.doc Version 5.0 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.V269010.R01.S.doc Version 5.0 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 and 3 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. Sufficient consideration is not currently given to staffing, the environment and other service users when attempting to meet complex needs. 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 staff group has the experience and ability to meet the support needs of service users who regularly use the service. Staff reported that new referrals being made to the service suggest that they will be expected to support people with increasingly complex needs. Staff training and service development should take account of this to ensure that an appropriate service is provided. The service is currently planning to introduce young adults with autistic spectrum disorders (ASD), and one person has had introductions and a brief Mere Hall View DS0000030291.V269010.R01.S.doc Version 5.0 Page 9 stay. Records show that a prolonged adverse incident occurred during a person’s stay, and that all of the other service users staying at Mere Hall View were affected. Although some staff said they had received training in understanding autism, and in restraint techniques, the service is unable to demonstrate its capacity to meet the specialist needs of people with ASD at this time. Research highlights prerequisites, not met at Mere Hall View, such as “advance planning to ensure that structure, clarity and predictability is inherent within the design of the environment” and “staff training in autism specific skills”. The same writers recognise that “consistency, structure, predictability, calmness…have been demonstrated, time after time, to work best with adults with autistic spectrum disorders” (H Morgan, G Jones and R Jordan 2001). At Mere Hall View, the frequent change in the service user group due to the nature of the service makes consistency and predictability difficult to achieve. The registered person is required to provide clear information about how Mere Hall View will provide a specialist service to people with ASD before short stays are arranged. The information should include staffing considerations in terms of numbers, knowledge and skills, the environment, and service user compatibility issues. An update should also be provided in respect of ensuring that the service is used for short-term breaks and not longterm care. Mere Hall View DS0000030291.V269010.R01.S.doc Version 5.0 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 and 7 Some progress has been made in updating support plans, but further consideration and work is needed to ensure that the changing needs, choices and risks for each person are known, and used to provide support based on that knowledge. EVIDENCE: Four 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 most of the care files examined were complete and reviews were up-todate. For the long term service user, OT activity monitoring had not been completed and the general risk assessment review date showed it was overdue. There were no guidelines for staff on the action to take to prevent pressure sore development, despite the evident risk. Mere Hall View DS0000030291.V269010.R01.S.doc Version 5.0 Page 11 Files showed that staff have started to compile personal profiles for service users, but they reported difficulty in finding time to complete them. The format of the profile is useful in terms of areas such as daily preferences, routines, and ‘a typical day’ for that person. However, those looked at were only partially completed and not meaningful in terms of the detail provided. For example, a current service user’s profile, under the heading for ‘Communication’ stated “uses odd words. A few Makaton signs. Can understand what is said to him”. Another profile, under various headings relating to support required with various tasks, repeatedly stated “assistance”. 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. As one staff member pointed out, they are “learning about service users all the time”. It was apparent that staff do try to take account of service user choice and right to make decisions, and improved profiles will enhance their ability to promote these areas. Daily reports need to be accurate. One service user had refused his cooked breakfast on the day of the inspection, but the written entry stated “enjoyed cooked breakfast”. Staff should sign daily reports rather than only write their first name. Assistance given indicated on the tick charts needs to be initialled and dated at all times. Mere Hall View DS0000030291.V269010.R01.S.doc Version 5.0 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, 17 Efforts are needed 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. Meals take account of service users’ needs and preferences. EVIDENCE: At the last inspection, the service reported the introduction of higher staffing levels at peak times enabling flexible support and an increase in activities. During this inspection staff confirmed that there are occasions on which there are 4 members of staff instead of 3. On the day of the visit, there were 3 staff members on duty supporting 5 service users. One required a staff member to be with them at all times, another needed 2 staff if going out anywhere. Therefore a walk or visit to any community amenity was not possible, as that would leave one support worker with the remaining service users. The longterm service user requires 3 staff to use the hoist, and therefore tasks requiring a hoist could not be considered on the day. The care file of one current service user showed her timetable at the day service she attends. It included music, art and craft, DVDs and videos. Another Mere Hall View DS0000030291.V269010.R01.S.doc Version 5.0 Page 13 service user’s file stated that he likes drawing, music and comedies. These` interests were not reflected in the day’s events or in the daily reports. As highlighted in the previous section, personal profiles should set out the needs and preferences of each person currently using the service. The need to include resources and materials required for use indoors becomes more important when staffing arrangements limit the ability to use community facilities. The service should consider obtaining equipment that can be used to provide sensory experiences, stimulating and relaxing, for those who would benefit. Staff reported that occasional themed weekends continue to take place, with a range of planned activities, and these are enjoyed by service users. However, other weekends, such as this one, highlight the additional pressures on staff when there are 3 staff members on duty, and the resulting lack of flexibility around activities. Mere Hall View DS0000030291.V269010.R01.S.doc Version 5.0 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 and 20 Better and readily available information is needed for staff to ensure that service users receive personal support in the way they prefer and require. Safe arrangements are in place for administering medication. EVIDENCE: Issues relating to standard 18 have been covered under Standard 6. Medication arrangements appeared to be satisfactory. 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.V269010.R01.S.doc Version 5.0 Page 15 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 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. 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 the time of the last inspection, the service 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. An update on this work is now required. 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 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. Mere Hall View DS0000030291.V269010.R01.S.doc Version 5.0 Page 16 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 Mere Hall View provides a clean and comfortable environment for service users, but staff vigilance is required in respect of minimising risks to safety. Improvements to the grounds are required to ensure that service users’ rights to privacy and choice are upheld. 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 sink. The lounge areas are comfortable and homely. The railings securing the grounds do not ensure privacy for service users in the garden. During this inspection, staff recalled recent incidents of young people in the neighbourhood taunting service users and throwing things through the railings. Additionally, as Mere Hall View is introducing young people with autistic spectrum disorders in the near future, some changes to the building will be needed. The need to make the garden less exposed to strangers and to external, unpredictable distractions is an important consideration in creating the right environment. For this reason the recommendation made at three previous inspections is now a requirement to be addressed. Fire doors on corridors were seen to be wedged open. This practice should cease. Mere Hall View DS0000030291.V269010.R01.S.doc Version 5.0 Page 17 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): 33 and 35 Staff training arrangements support the development of a competent staff group. Staff numbers need to be sufficient at all times to ensure that their ability to meet service users’ needs are not compromised. EVIDENCE: There was a mixture of experienced, relatively new, and bank staff on duty on the day of the inspection. There were three workers supporting five service users with a range of needs. This was not sufficient for the purpose of promoting choice and providing a flexible service. (See “Lifestyle” section.) It was stated that staff sickness is covered by the team or bank staff, but the staff rota did not indicate clearly who was covering the sickness, so it frequently appeared that 3 staff members was the usual arrangement although staff did recall occasions when 4 staff members were on duty. Staff stated that they receive training in mandatory topics including food hygiene, first aid and moving and handling. Additional training related to managing challenging behaviour and managing epilepsy. Two members of staff reported that they had not had formal one-to-one supervision meetings, but that the manager made herself available for informal chats if needed. The staff on duty felt that the staff group works well together as a team. The service continues to need to give close consideration to compatibility, occupation, imaginative use of indoor activity materials and staffing arrangements to demonstrate positive outcomes for service users. Mere Hall View DS0000030291.V269010.R01.S.doc Version 5.0 Page 18 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): 39 and 42 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 needs to visit regularly to assess and report on the quality of the service. Significant events are not notified to the CSCI and this must be addressed. For health and safety(standard 42), see ‘Environment’. EVIDENCE: 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. An update on the progress of this must be provided. The registered provider must also ensure that quality assurance visits are carried out at least monthly, and to report on the findings. The visit must cover Mere Hall View DS0000030291.V269010.R01.S.doc Version 5.0 Page 19 consultation with service users and staff, and events, complaints and records (see Regulation 26(4). A copy of the report must be provided to the CSCI. This requirement is outstanding from previous inspections. Support records, together with the message book, highlighted significant incidents that have not been notified to the Commission for Social Care Inspection within 24 hours as required by regulations.(Regulation 37). These include a recent hospital admission, a theft, (December) and the adverse incident (August) referred to previously. This requirement must be addressed, and retrospective reports of the incidents listed here should also be forwarded at the earliest opportunity. Mere Hall View DS0000030291.V269010.R01.S.doc Version 5.0 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 2 X X Standard No 22 23 Score 2 X ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X X X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 X X X X X 3 LIFESTYLES Standard No Score 11 X 12 2 13 2 14 X 15 3 16 X 17 Standard No 31 32 33 34 35 36 Score X X 2 X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Mere Hall View Score 2 X 3 X Standard No 37 38 39 40 41 42 43 Score X X 2 X X 2 X DS0000030291.V269010.R01.S.doc Version 5.0 Page 21 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. 1 Standard YA3 Regulation Requirement Timescale for action 09/01/06 2 YA18YA6 3 YA13YA12 4 YA22 5 YA42YA24 10, 12, 14 The registered person is required to provide clear information about how Mere Hall View will provide a specialist service to people with ASD before short stays are arranged. 15, 17 The service must maintain clear, up to date support plans and risk management guidelines, to include an accessible profile for each service user. Daily reports must be accurately completed and signed. 12, 16 Support must be in place to ensure that individual social and recreational needs are met, and opportunities for community participation provided. 22 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. 23 The lack of privacy in the grounds must be addressed. Wedges must not be used on fire doors in corridors (from immediate effect). DS0000030291.V269010.R01.S.doc 09/01/06 09/01/06 06/02/06 06/02/06 Mere Hall View Version 5.0 Page 22 6 YA33 18 7 YA39 24, 26 Staff numbers need to be sufficient at all times to ensure that their ability to meet service users’ needs are not compromised. 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 06/06/05 not met) Significant events must be notified to the CSCI at the earliest opportunity. 09/01/06 06/03/06 8 YA42 37 09/01/06 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 YA12 Good Practice Recommendations The service should consider obtaining equipment that can be used to provide sensory experiences, stimulating and relaxing, for those who would benefit. The service should give closer consideration to compatibility, occupation, imaginative use of indoor activity materials and staffing arrangements to DS0000030291.V269010.R01.S.doc Version 5.0 Page 23 2 YA33 Mere Hall View demonstrate positive outcomes for service users. Mere Hall View DS0000030291.V269010.R01.S.doc Version 5.0 Page 24 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.V269010.R01.S.doc Version 5.0 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. 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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