Inspection on 09/10/06 for Merrill House

This inspection was carried out on 9th October 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Merrill House 14/08/07

Merrill House 24/01/06

Merrill House 20/09/05

Merrill House 02/11/04

Merrill House 16/06/04

Merrill House 16/03/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Merrill House Merrill House Queensferry Gardens Shelton Lock Derby Derbyshire DE24 9JR Lead Inspector Angela Kennedy Key Unannounced Inspection 9th October 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Merrill House DS0000035949.V306337.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 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. Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Merrill House Address Merrill House Queensferry Gardens Shelton Lock Derby Derbyshire DE24 9JR 01332 718400 01332 718400 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) Derby City Council Christine Ann Flower Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th January 2006 Brief Description of the Service: Merrill House Care Home is located in the south of Derby. It provides care for up to 40 Residents, who are all aged at least 65 years or older. The Home was purpose built across two floors. Access to the first floor can be gained via a passenger lift, a stair lift or via the stairs. All Residents are provided with their own bedroom, although none of these have ensuite facilities. The Home has three combined lounge/dining rooms, and a central lounge area onto which the three-lounge/dining areas converge. Well-maintained gardens/lawned areas are provided for the Home, and staffing in the Home appeared to be relaxed and friendly. At the time of this inspection the weekly fees at Merrill House were £308. For further information regarding the service please contact the registered manager on 01332 718400. Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was a key inspection, which means the home was assessed against all of the key national minimum standards. The inspection took place over a four-hour period and was unannounced. During the inspection three residents care files were examined to assess the level and quality of care provided to the residents and to determine if the service was meeting the needs of these residents. Other assessments included; looking at the medication administration records, medication storage, the complaints policy and records of complaints, the meals provided to residents and the activities available for residents to participate in. The training available and provided for staff was also assessed to determine if staff had received the training needed to ensure they had the skills and knowledge required to meet the residents’ needs. The records kept for residents’ finance was seen and the records kept regarding the safe working practices of the home. Several resident’s were spoken with to obtain their views of the home and two members of staff were spoken with to obtain their views of the training and support they received and to assess their understanding of the policies and practices in place to ensure resident’s welfare is promoted and protected. A tour of Merrill House was also undertaken to assess the environment regarding safety, hygiene and state of décor. The registered manager was available throughout the inspection to answer any questions and provide the required information. What the service does well: Merrill House provides a homely and comfortable environment for residents, and the décor clearly demonstrated that staff had spent considerable time and Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 6 effort in enhancing the standard of decoration throughout the home for the residents’ benefit. A range of activities and past times are made available to the resident’s at Merrill House which demonstrated that individual resident’s had the opportunity to spend time each day in meaningful past times. Residents spoken with were very positive about the service and stated that Merrill House provided a good quality of care and plenty of things to do. Positive comments were also made regarding the quality and choices of meals provided. The quality assurance systems at the home clearly demonstrated that residents views and opinions were sought and acted upon whenever possible. What has improved since the last inspection? What they could do better: Although the registered manager stated that provider’s monthly visits had been undertaken there was no evidence in place to demonstrate this since July 2006. Management and senior staff undertake training in Safeguarding Adults but this training is not available for other staff employed, which potentially puts resident’s at risk. Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 7 The staffing levels are below the recommended number of the residential forum guidelines; this could potentially mean that residents’ needs cannot be fully met. 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. Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 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 the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using the available evidence including a visit to the service. Staff were able to meet residents’ needs, this had been determined before each resident moved in to Merrill House by means of a needs assessment. EVIDENCE: Three resident’s care files were examined and evidence was in place to demonstrate that a needs assessment had been undertaken for each resident before they moved into Merrill House, this demonstrated that home ensured that each individuals needs could be met by the service. The needs assessment included an assessment in the following areas; personal care and health care needs including diet and weight, sight and hearing, oral health and foot care, mobility, history of falls, continence, prescribed medication including ability to self administer medication, mental health and social interests, cultural and religious needs and hobbies. Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 10 Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Resident’s health, personal and social care needs were set out within their care plans and health care needs were met. In general the homes medication practices are satisfactory, however further development is required to ensure the practices for administering medication are robust to ensure all residents prescribed medication is administered within a risk management framework. Resident’s felt they were treated with respect and their privacy was upheld. EVIDENCE: Of the three residents files seen detailed care plans and risk assessments were in place that provided guidance to the staff on how to support each resident. Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 12 Although care plans had been reviewed the evidence was not always in place within the resident’s care files as some reviews had been recorded within daily log sheets. Log sheets were kept within separate files for the three different units at Merrill House, and within each file separate logs were kept for each resident. Within the log sheets daily records were kept regarding each resident and all Health Care visits were documented for each individual. Risk assessments were in place within the three resident’s files seen; this included a general risk assessment and assessments on nutrition, falls and tissue viability. Not all of the risk assessments seen had a review date, this was discussed with the manager who stated that reviews were undertaken as required but agreed that a set date would ensure that each individual was regularly assessed and guaranteed that any changes in the support they required could be addressed and met. The records and practices for recording, storage, handling and administration of medicines were examined and in general these were satisfactory. However on the day of inspection it was brought to the manager’s attention that one resident, due to their mental health had not taken their medication that had been administered by staff. Discussions took place with the manager as to the need to ensure medication has been taken before the administering staff signed the medication administration record. Continuous refusal of prescribed medicines by residents who lack capacity should be addressed within a multidisciplinary meeting, which includes the resident’s general practioner and other relevant professionals. Several residents were spoken with and all confirmed that the staff treated them respectfully and maintained their privacy whenever possible. All three of the residents care files seen had evidence in place that demonstrated that their wishes after death with regard to funeral arrangements had been addressed. Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Resident’s leisure, social and cultural interests are met by the service and residents’ are helped to exercise choice and control over their lives as much as possible. The meals provided received positive comments from the residents. EVIDENCE: The assistant unit manager co-ordinated the activities at Merrill House and organised a planned rota of activities, however the manager stated that this could be subject to change depending on residents choice. Feedback was sought from the residents for their comments and suggestions on all the activities provided. The activities provided within Merrill House included; a music room equipped with musical instruments such as an organ, tambourines, cymbals and triangles. A gardening and potting room, where residents were able to undertake gardening activities and activity rooms that provided tabletop Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 14 games and other tabletop activities, such as crafts and painting. A quiet room was also available as well as a library area. Outside entertainers also visited Merrill House to provide music and singing. A manicure room was also provided for residents at Merrill House and manicures were undertaken by care staff. Merrill House was also equipped with a hair salon and a hairdresser came to the home once or twice a week dependent on the number of appointments taken. Residents spoken with said that the activities provided were very good and discussed trips out they had undertaken which included trips to reservoirs and local public houses. Resident’s also talked about the Christmas meal that had been organised at a public house for the residents of Merrill House and two other local authority care homes. Religious services were not held at Merrill House however one of the residents attended their local church for services. The manager stated that other residents had not shown an interest in attending church. It was agreed with the manager that this would be discussed at the next residents meeting and residents’ opinions documented. Visiting was open at Merrill House and residents spoken with said they were able to entertain they visitors within communal areas of the home or within their private accommodation as they chose. Residents’ spoken with confirmed they were able to get up and go to bed when they chose, and from observation it was noted that residents were able to move around the home freely as they chose. The menus were seen and demonstrated that a nutrionally balanced and varied diet was available. Residents confirmed that they were consulted about the choices of meals they preferred and were very complimentary regarding the quality of the meals at Merrill House. Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 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 the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Complaints were responded to and acted upon appropriately. Further training is required to ensure residents are protected from abuse. EVIDENCE: The complaints policy was seen and was satisfactory and a record of the complaints made to the service within the last twelve months was looked at. All of the complaints read had been responded to and dealt with appropriately. The management and senior staff employed at Merrill House undertook training in Safeguarding Adults. This training was not made available to other staff employed, which potentially could put residents’ at risk, as if staff do not have the knowledge and skills required to recognise signs of abuse and know how to initially respond to signs or evidence of abuse residents welfare and protection could be compromised. One member of staff was spoken to regarding recognising signs of abuse and how she would respond to any evidence or disclosure of abuse. This member of staff demonstrated that her knowledge in adult protection was limited and said she would pass any concerns she had to senior staff. Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 16 Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 19,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents live in a clean, safe, well-maintained environment. EVIDENCE: A tour of the building was undertaken. Internal decoration had taken place since the previous inspection to cosmetically improve the appearance of Merrill House. At the time of inspection the area next to the entrance of the home was being decorated and discussions took place regarding how this area should be furnished and used, residents were also involved within these discussions, again demonstrating that the views and opinions of the residents were sought and listened to. Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 18 The décor clearly demonstrated that staff had spent considerable time and effort in enhancing the standard of decoration throughout the home for the residents’ benefit, this included tile transfers in bathrooms and accessories to enhance the appearance and provide a relaxing atmosphere, voile panels on windows, attractive seating areas on each corridor and attractively designed name plates with space for a photograph on each residents private accommodation. Merrill House had a clean, airy and bright atmosphere, although one area of the corridor did not access much natural light and required artificial lighting to be kept on to ensure sufficient lighting was maintained to provide visible access. Resident’s private accommodation seen was bright and comfortable in appearance and all rooms had been personalised to demonstrate each resident’s individuality. The laundry area was seen and provided sufficient washers and driers to launder residents’ belongings. Sluicing facilities were provided and built into the washing machines and the temperature of washing machine programmes allowed clothes to be laundered at appropriate temperatures to thoroughly clean linen and control the risk of infection. Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using the available evidence including a visit to the service. Staff have the competencies and skills to meet the residents’ needs but to ensure residents needs can be fully met the staffing levels should be reviewed. EVIDENCE: Staffing rotas from the 2nd to the 16th of October were examined and including the two posts vacant, the staffing levels do not meet the guidelines set by the residential forum. The levels seen indicated that if any holidays or staff sickness were taken staffing levels would have the potential to not adequately meet residents’ needs. Over 70 of the staff team had achieved a National Vocational Qualification (NVQ) in care at level 2 or above, which indicated that staff had the knowledge and skills to ensure residents were in safe hands. The recruitment documentation for staff was kept at the local authorities personnel department and not at Merrill House, however some recruitment checks were available to see as some of the staff had provided copies of their criminal records bureau (CRB) checks, these were seen and found to be Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 20 satisfactory. A list had also been sent to the commission prior to this inspection, which gave details of each member of staffs name, position employment start date and the dates that their CRB checks had been received. Further assessment of this standard could not be assessed and therefore will be thoroughly assessed Merrill House’s next key inspection. The training undertaken in the past twelve months included, basic food hygiene, moving and handling including training on the use of equipment, first aid which had been undertaken by all staff except two who were due to attend this training on the 16th October 06. Dementia care training had been undertaken and fire safety training. Two members of the staff team were spoken with one had worked for the local authority for many years both at Merrill House and other local authority homes and the other had been employed at Merrill House since April 2006. Both staff confirmed that the manager and senior staff were approachable and stated that supervision and support was ongoing in the form of formal supervision, staff meetings and informal chats and discussions as required. Both staff felt the level of training provided was good and relevant to the residents needs. The member of staff who took up post in April confirmed that she had undertaken induction training with the local authority, which included fire training and moving and handling. Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. The registered manager has the qualifications and skills required to manage the home effectively and was able to demonstrate that residents opinions and ideas influence the running of their home. Resident’s financial interests were safeguarded and their welfare was protected by the policies and procedures in place. EVIDENCE: The registered manager has been in post at Merrill House for a considerable number of years and has achieved management qualifications. Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 22 Staff spoken with provided positive comments regarding the manager’s ability to run the home and her approachable open door attitude to staff, residents and visitors. Sufficient quality assurance systems were in place to demonstrate that residents views were actively sought and acted upon whenever possible, this included residents’ meetings which looked at promoting residents’ daily living skills such as making cups of tea and discussed meals, activities including nights out and maintenance of equipment, i.e. the clock in one of the lounges needed to be replaced and this was discussed and a member of staff nominated to deal with this. Amenities meetings were also held that looked at organising activities and events to raise money for the amenities fund. The manager confirmed that providers visits were undertaken each month and records of these visits were seen, however the records seen only went up to July 06, which invalidates any visits undertaken following July 06 as there are no records in place to evidence this. Not all of the residents had the capacity to keep their own money and therefore this was kept for them by the service. The financial transaction sheets were seen and provided sufficient detail regarding all transaction going into and out of each individuals account. It was noted that some transactions had only been signed by one member of staff and as a matter of good practice it is recommended that all transactions are signed by two people, preferably the resident and a staff member or if this isn’t possible due to the resident’s capacity by two staff. Some of the safe working practices of the service were assessed and found to be satisfactory and included; fire safety checks on fire fighting equipment, daily fire alarm panel checks, weekly fire alarm tests, monthly self closing door device tests, records of fire drills and staff training in fire safety. Premises fire risk assessments were also in place as were fire alarm inspections and servicing certificates. First aid training had been undertaken by all staff except two who were due to attend this training on the 16th October 06. Information provided on the pre- inspection questionnaire stated that an electrical wiring certificate had been issued in April 06, emergency call systems had been serviced in March 06 and lifts had been serviced in May 06. Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 23 Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 14 (2) Requirement Residents risk assessments must be kept under review to ensure any changing needs can be addressed and met. Safe administration of medication must be maintained at all times to ensure residents health and well-being is not compromised. All staff must attend training in safeguarding adults to ensure residents’ safety from abuse is enhanced. Timescale for action 31/01/07 2. OP9 13 (2) 01/12/06 3. OP18 13 (6) 01/03/07 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 OP27 Good Practice Recommendations The Registered Providers should provide day care and night care staffing at least in line with that required by the DS0000035949.V306337.R01.S.doc Version 5.2 Page 26 Merrill House Residential Forum. This figure should not include the Managers working time. (This issue should have been addressed from the inspection report dated 16 March 2004 and 24 January 06) 2. OP35 Two signatures should be obtained on residents’ financial records for all transactions undertaken. Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Merrill House DS0000035949.V306337.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!