Inspection on 03/05/06 for Mid Meadows Care Home

This inspection was carried out on 3rd May 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 no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Mid Meadows Care Home 11/05/09

Mid Meadows Care Home 23/04/08

Mid Meadows Care Home 01/05/07

Mid Meadows Care Home 10/10/05

Mid Meadows Care Home 21/05/05

Mid Meadows Care Home 03/02/05

Mid Meadows Care Home 27/05/04

Similar services:

Coopers Mill Ltd

Bramley Avenue (73)

Paradise Lodge

Grangewood

Upaya Ananda

Newton Court (1-2)

Kings Lane (32)

Pemdale

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

CARE HOME ADULTS 18-65 Mid Meadows 72/74 Elm Tree Avenue Frinton On Sea Essex CO13 0AS Lead Inspector Jane Greaves Key Unannounced Inspection 3rd May 2006 09:30 Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 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 Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 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. Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Mid Meadows Address 72/74 Elm Tree Avenue Frinton On Sea Essex CO13 0AS 01255 675085 01255 675085 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) Black Swan International Limited Care Home 17 Category(ies) of Physical disability (17), Physical disability over registration, with number 65 years of age (17) of places Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, under the age of 65 years, who require care by reason of a physical disability (not to exceed 17 persons) Persons of either sex, aged 65 years and over, who require care by reason of a physical disability (not to exceed 17 persons) The total number of service users accommodated must not exceed 17 persons The 3 bedrooms on the first floor of Mid Meadows may only be offered to service users who are able to access them independently via the stairs 10th October 2005 Date of last inspection Brief Description of the Service: Mid Meadows is a detached two-storey property on the outskirts of Frinton -onSea. The home provides a service for 17 physically disabled people aged 1865. There are 14 bedrooms on the ground floor, 3 of which are used for respite care, and 3 bedrooms on the first floor that are used by service users who can access stairs independently. These rooms are to enable individuals to test skills of independence prior to moving into the community. The ground floor communal rooms comprise a dining room, a computer room, a quiet lounge and a lounge where smoking is permitted. At the rear of the house there is a fully enclosed garden and to the front of the property there is ample off road parking. A copy of the most recent report by Commission for Social Care Inspection was displayed in the notice board and a copy of the home’s service user guide was present in service users’ rooms. Information from the registered provider received by the commission in January 2006 showed that the fees payable were £730 per week and that additional charges are made for services as Chiropodist, Hairdresser and daily papers. Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This routine unannounced inspection took place over 6 hours one day in May 2006. 22 of the 43 National Minimum Standards were assessed at this visit and 17 were met. On the day of this inspection visit some residents were holidaying in Portugal accompanied by staff members. During the course of this inspection visit records were sampled, discussions were held individually and collectively with residents and staff, a physical tour of the premises was undertaken and the views of visiting healthcare professionals were gathered. The inspector appreciated the assistance received with the inspection process by the home’s manager, the staff team and the residents. What the service does well: What has improved since the last inspection? The previous inspection identified that the cook at that time did not have any knowledge around the provision of a nutritionally balanced menu for the residents. The new cook doesn’t have qualifications in this area however was able to demonstrate some knowledge. The residents were generally pleased with the improvement of the food provision and reported that the fish and chips on a Friday were ‘second to none’ Training in the Protection of Vulnerable Adults from abuse had been delivered to all established staff members since the previous inspection visit. New members of staff were scheduled to attend this training at the earliest opportunity. Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 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. Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 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 Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 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. Residents could be confident that their personal, spiritual and healthcare needs were assessed as part of the pre-admission procedures. EVIDENCE: The manager reported that a full assessment of prospective resident’s needs was made before being admitted into the home. The assessment was made with the involvement of the resident and family or representative. The home’s assessment together with the Social Services assessment of the resident’s needs and aspirations formed the basis of the care plan. Files sampled included that of a resident admitted into the home since the previous inspection. Scrutiny of the file and discussion with the resident demonstrated that the information gathered through the pre admission process was accurate and a true reflection of the resident’s needs Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 9 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 adequate. This judgement has been made using available evidence including a visit to this service. The home provided a service that treated the residents with respect, staff engaged positively with residents and demonstrated a good understanding of their needs, however residents were not supported to take risks as part of an independent lifestyle. EVIDENCE: The residents’ care plans were clear and easy to navigate however would benefit from more detailed information regarding the actions to be taken to assess and manage risk. Any restrictions on choice or freedom were detailed in the care plans with the residents’ signatures present to confirm their involvement with the process. There was very little family/representative involvement evident in the care plans however the residents at Mid Meadows had the capacity to be fully involved with their care planning and were supported by the home to be independent and take control of their lives and decision making. Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 10 The staff team did not demonstrate an understanding of the risk assessment process or their responsibility to support residents to take risks. One staff member reported that if a resident wished to participate in an activity or pursuit that carried a high degree of risk the home “would not be able to encourage” them because of the level of risk involved. Discussions took place with the registered manager surrounding the provision of training for all staff members about the risk management framework and their role and responsibility in supporting residents to enjoy a fulfilling lifestyle. Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 11 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. Overall the residents were supported to maintain an independent lifestyle and their rights were respected in their daily lives. They were offered a healthy and appetising diet. Residents would benefit from more support to engage in activities in the community. EVIDENCE: The registered manager reported that if extra staff members were required on duty to facilitate residents accessing the community that would be arranged. Residents’ response was mixed; some reported they were amply supported by staff to access the local community whilst others’ expectations were not being met. No documentary evidence was available to confirm the additional staffing provision. One resident wanted to recommence evening classes that they had once attended. The resident had not approached the staff team regarding this. Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 12 Discussion was held with the registered manager around ways of exploring residents’ aspirations and ambitions. At the last inspection some residents reported the home’s minibus was extremely uncomfortable for long trips and consequently they were wary of suggesting potential venues for days away from the home. The situation had not changed and staff confirmed the minibus was uncomfortable and that they understood the residents’ reluctance to undertake long trips away from the home. Residents spoken with confirmed that they enjoyed pursuing their own hobbies and interests such as computing and watching television and were happy to be able to spend time on their own in their private rooms when they wished. One resident reported that the registered provider was intending to install wireless Internet connection at the home; this was a popular idea with the residents. Mid Meadows welcomed visitors and maintained good relationships with residents’ families and representatives. The daily routines at Mid Meadows were flexible around individuals’ needs on the day. Staff were observed to knock before entering residents’ rooms however it was reported that an agency care worker had ‘burst in’ whilst one resident was using the bathroom facilities. Staff members were observed to interact with residents in a wholly appropriate manner showing respect and warmth. Mealtimes were found to be much happier events in the residents’ day than at previous inspection visits. The registered manager reported the new cook mentioned in the previous inspection report had not stayed at the home long and further recruitment had taken place. The present cook had been in post for 3 weeks at the time of this visit and the response from residents was positive however a little guarded as they did not feel confident that the cook would settle and stay at the service. The inspector joined residents for lunch at this visit, the food was very pleasant and the conversation around the table with staff and residents was lively and had a ‘family’ feel. The kitchen facilities appeared cleaner and fresher than previously observed and it was reported that fresh produce was provided for residents daily. The cook reported no formal training around formulating nutritionally balanced menus however reported the intention and demonstrated enthusiasm towards attending training in this area. Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 13 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. Residents’ physical and emotional needs were met and they received personal support in the way they preferred. Residents’ health and welfare were protected by the home’s medication policies and procedures. EVIDENCE: Residents were supported to take control of their own healthcare requirements and manage their own medical conditions where appropriate. Care plans sampled contained details of routine and specialist healthcare appointments made on behalf of residents. Residents were encouraged to access NHS healthcare facilities in the community. The registered manager reported on the support offered to one resident to obtain specialist healthcare support, the care plan for this resident confirmed the support offered and recorded the resident’s refusal to accept specialist healthcare support. Risk assessments were contained within the care plan surrounding the potential impact of this decision. Care plans contained evidence of how personal and emotional issues of individuals were managed and discussion with residents confirmed the accuracy of the recording. Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 14 Medication was administered under a monitored dosage system and all staff involved in the administration, handling and storage of medicines had received external competency assessed training. There were no controlled drugs maintained at Mid Meadows, there was a metal cupboard secured to a wall for the storage of controlled medication however this only had one lock. Residents who wished to self medicate had appropriate lockable storage facilities in their private rooms. Residents reported feeling confident of the staff team’s competence in medication administration. Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 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 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents could be confident their views were listened to and acted upon however the home’s recruitment practices did not adequately protect the residents from abuse. EVIDENCE: There had been no complaints received by the home or the Commission for Social Care Inspection since the last inspection. The home had robust complaints policy and procedures; it was reported that these were subject to annual reviews. The staff team had received externally provided training in the Protection of Vulnerable Adults from abuse. Information provided by the organisation prior to this inspection identified that two staff members had commenced working at Mid Meadows prior to the registered manager receiving a completed enhanced Criminal Records Bureau Disclosure. There was no evidence to show that the new staff members had been checked against the Protection of Vulnerable Adults from abuse list before they started to work at the home. The registered manager confirmed she did not have a good understanding of the recruitment procedures required with regards to Criminal Record Bureau checks. Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents lived in a homely and safe environment that appeared clean and hygienic. EVIDENCE: Since the previous inspection a constant programme of repair and renewal had continued. The home employed a dedicated ‘handyman’ who was present at the home at this inspection. The residents’ lounge had been repainted and was fresh and bright. The manager reported that this room was subject to frequent repainting as the residents were able to smoke in this room. Some lighting had been replaced providing a more domestic and homely feel. Residents spoken with confirmed they were happy and comfortable with the environment they lived in. The premises were accessible to all residents and the doorways were wide enough to allow wheelchair users adequate access. The home appeared clean with no offensive odours present. Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 17 Mid Meadows did not employ dedicated domestic staff, these duties were undertaken by support staff. Infection control training had been provided. Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 18 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. Appropriately trained, competent and qualified staff met residents’ individual and joint needs, however residents’ safety and well being were not adequately protected by the home’s recruitment procedures. EVIDENCE: The registered manager reported that she now had autonomy in her management duties and responsibilities enabling her to amend the duty rota according to the number and needs of residents living at Mid Meadows. There was a more appropriate mix of age and experience within the staff team than at previous inspection visits. This had a positive impact on the residents who reported feeling confident with the support they received. Records showed that 7 care staff (50 ) were working towards NVQ level 3 qualifications. Evidence of statutory training refresher courses was available on the office notice board, records identified that some members of the staff team were overdue for Moving and Handling refresher courses. This home provided Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 19 accommodation and care for people with physical disabilities therefore it is judged that regular refresher training in moving and handling is a basic need. Training records sampled subsequent to the inspection site visit identified that training in ‘equality and diversity’ had started in 2003, there was no completion date for this training and there had been a number of changes in the staff team in the interim. The registered manager was advised to study the records to identify areas of training relevant to the residents’ individual and joint needs that may need to be ‘refreshed’ for the benefit of the residents. As mentioned previously in this report the home’s recruitment procedures had not been followed in the case of two recent additions to the staff team. This did not serve to protect the safety and welfare of the vulnerable adults living at the home. Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 20 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 adequate. This judgement has been made using available evidence including a visit to this service. Residents benefited from a well run home and could be confident their views underpinned all self-monitoring, review and development of their home. The health, safety and welfare of the residents would be better protected if the home’s established recruitment procedures were followed and staff achieved a better understanding of risk management. EVIDENCE: The registered manager reported she as due to start to work towards NVQ level 4 within two weeks of this inspection visit and to attend a PoVA for Managers course, date not yet confirmed. The manager was able to demonstrate the home’s quality assurance system. Residents were surveyed annually about the service and facilities available to them at Mid Meadows. Families of residents only received surveys if they Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 21 requested them. This was discussed with the families and representatives at admission and subsequent reviews. A summary was made of the survey forms and any areas of concern were identified and used to drive forward changes within the home. Residents spoken with as part of this inspection process all confirmed they felt comfortable speaking their mind and bringing any perceived shortfalls in the service provision to the attention of the registered manager or staff. All spoken with were confident that their views and opinions did affect changes within the home and it was apparent to the inspector that the residents viewed Mid Meadows as their home. A physical tour of the home was undertaken and no health and safety issues were raised. Certificates were available to evidence that mandatory health and safety checks had been made. Risk assessments were undertaken however these took the form of a hazard identification exercise with little apparent understanding as to why the assessment was done and what the desired outcome should be. As mentioned earlier in this report the health, safety and welfare of residents would be better protected if the staff team had a better understanding of the risk assessment process. Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 22 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 3 23 2 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 2 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 2 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 23 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 YA9 Regulation 13(4)(c) Requirement Timescale for action 01/08/06 2. YA12 16(2)(m) 3. YA23 13(6) 4. 19 Schedule 2.7 The registered person shall ensure that unnecessary risks to clients are identified and so far as reasonably practicable free from avoidable risks. This is a repeat requirement with an original agreed timescale for action of 31/12/05 The registered person shall 31/05/06 having regard to the size of the care home and the number and needs of the service users consult service users about their social interests and make arrangements to enable them to engage in local. Social and community activities. The registered person shall make 03/05/06 arrangements by training staff or other measures to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. This specifically refers to recruitment procedures. The registered person shall 03/05/06 ensure enhanced criminal record Bureau checks are applied for and a minimum of a PoVA 1st DS0000017885.V291268.R01.S.doc Version 5.1 Mid Meadows Page 24 5. 19 Schedule 2.7 check has been received before new staff members start to work at the home. The registered person shall ensure enhanced criminal record Bureau checks are applied for and a minimum of a PoVA 1st check has been received before new staff members start to work at the home. 03/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Mid Meadows DS0000017885.V291268.R01.S.doc Version 5.1 Page 26 - 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!