Inspection on 12/04/05 for Millcroft

This inspection was carried out on 12th April 2005.

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

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

Other inspections for this house

Millcroft 08/08/06

Millcroft 08/02/06

Millcroft 21/09/04

Millcroft 20/04/04

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 Millcroft Royston Road Barkway Royston SG8 8BU Lead Inspector Louise Bushell Unannounced 12 April 2005 10:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Millcroft Version 1.10 Page 3 SERVICE INFORMATION Name of service Millcroft Address Royston Road Barkway Royston Herts SG8 8BU 01763 88848306 01763 849440 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Conquest Care Home (Peterborough) Limited Mrs Katharine Tones Care Home 8 Category(ies) of LD Learning Disability 8 registration, with number LD (E) Learning Disability 1 of places PH Physical Disiability 1 Millcroft Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: The home may accommodate one young adult (under 65 years of age) with learning disability together with associated physical disability and who will be accommodated in a ground floor bedroom. The home may accommodate one elderly person (of 65 years of age and above) with learning disability and who will be accommodated in a ground floor bedroom. Date of last inspection 21 September 2004 Brief Description of the Service: Millcroft is a care home providing personal care and accommodation for 8 adults with a learning disability, one who may have associated physical disabilities and one who may be over the age of 65. The Home is owned by Conquest Care Homes (Peterborough) Limited, which is a subsidiary of Craegmoor Healthcare Limited. The home is located in the village of Barkway, which is situated in a rural area of Hertfordshire and it has its own means of transportation. The home was opened in 1998. Accommodation is offered on 2 floors. The ground floor comprises of a lounge, a quiet room, a dining room, a kitchen and 2 bedrooms (which are used to accommodate service users with mobility impairment as the home does not have a passenger lift) and one assisted bathroom with toilet. The first floor consists one lounge, 6 further bedrooms and 2 bathrooms with toilet. The entrance to the grounds is gated. There is ample parking facility to the front of the home and an extensive and well-maintained fenced garden at the rear with patio and lawn areas. Millcroft Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first unannounced of this year. It took place in morning to mid afternoon. The inspectors spent time talking to all staff on duty, and the service users who were at home during the inspection. Time was also spent with the manager and the area manager of the home, discussing progress and plans for the future, looking through records and care plans. The building and the grounds were inspected. This was a positive inspection in terms of the needs of the service user being met, with many improvements being made to the environment. What the service does well: The home has clear policies and procedures that are well organised, maintained and accessible to all. The atmosphere throughout the inspection was calm and friendly, promoting a good relationship between staff and service users. Staff spoken with during the inspection were complimentary of the management style within the home. The ethos of working openly, honestly and with a transparent approach appears to be effective. The home has a high ratio of staff to service users (2:1) ensuring that individual and complex needs can be met. The home has a stable staff team to promote continuity for the service users. All service user bedrooms are individually decorated reflecting their individual personalities and preferences. Staff should be commended for their efforts. The staff approach within the home ensures that service users are empowered to make choices and encourages service user self-determination. Service users assessments have recently been recompiled ensuring that all changing needs are recognised and assessed. The home is currently adapting and implementing a new care planning system. Although areas of this still require completing, the style and the details within each persons care plan is immense. The care plan is clearly a working document, which is being regularly reviewed. The care plans in place are excellent examples of meeting individual and changing needs. The home has a sound system for the provision of training and many training courses are currently available and are being attended by the staff team. All staff members have clear defined roles and responsibilities ensuring that the home functions smoothly. Millcroft Version 1.10 Page 6 What has improved since the last inspection? What they could do better: The home is currently working to develop the provision of activities offered within the home. Development ensuring that individual specialist needs are met will ensure a individual tailored service us offered, this should include the recording systems used and a display system used to ensure and empower service users to be consulted with and involved as much as possible. Medication administration practices require attention within the home to ensure that all staff are following policy and procedural guidelines. Continued works are required within the home to ensure timescales are met with regards to fire safety requirements. All environmental works must continue to ensure that the home is safe and functioning in all aspects as required by a care home. Millcroft Version 1.10 Page 7 Where a need has been identified through the completion of a service users assessment that specialist equipment is required this must be provided by the home. All accidents and incidences must be recorded in an accident book that is compliant with the Data Protection Act 1998. Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Millcroft Version 1.10 Page 8 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 Standards Statutory Requirements Identified During the Inspection Millcroft Version 1.10 Page 9 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 standard(s) 1, 2, 3, 4, 5 Prospective service users individual aspirations and needs are assessed and reviewed, enabling the service user and the home to continuously review the individuals care package provided. EVIDENCE: A comprehensive Statement of Purpose is held within the home and all current and prospective service users are provided with a copy. The Statement of Purpose requires details of the floor plan and room sizes to be added to it, and information about the costs incurred by service users for planned holidays, enabling service user to make an informed choice about where to live. Full assessments of each service users needs and aspiration are made before the service user moves into the home. Detailed and full assessments had previously been completed by the home; however, the home is currently completing all service users new assessments to ensure that they are meeting all changing needs. The new assessment format is comprehensive in details and once fully operating in line with care plans, will become an active working document ensuring changing needs can be addressed and met. Where a specialist need has been identified in an assessment, for example the need for manual handling equipment, the home must ensure that they are able to provide and demonstrate that they can meet the needs of the identified individual through the provision of such equipment. Advice and contacts were discussed with the manager of the home during the visit Millcroft Version 1.10 Page 10 The admissions procedure to the home includes trial visits for the service users to make an informed choice about where to live. The home holds a detailed policy on new referrals and admissions to the home. A contract is then drawn between the home and the service user. The contract includes the terms and conditions within the home and the rights of the service user. Millcroft Version 1.10 Page 11 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 standard(s) 6, 7, 8, 10 Individual needs and choices within the home are being promoted to encourage and empower service user self-determination. EVIDENCE: All service users have an individual care plan and an allocated key worker and to support them in the home. Individual daily notes and guidelines for the service users where observed within the home. All service users are supported within the care management process and the care programme approach (CPA) framework and frequent reviews occur to ensure changing needs are continuously assessed and reviewed. The ethos within the home promotes that the care plans of each individual are owned by the individual. The home is currently adapting and implementing a new care planning system. Although areas of this still require completing, the style and the details within each persons care plan is vast. The care plan is clearly a working document, which is being regularly reviewed. The care plans in place are excellent examples of meeting individual and changing needs. Millcroft Version 1.10 Page 12 All information within the home is handled with care and respect. All personal notes and files detailing information on the service user are locked away. The main care plan and files are held in a locked office. An external advocacy agency works with a number of the service users to support them in making decisions in their lives. Risk assessments are completed within the home for necessary actions. Activities and outings enjoyed by the service users determined that service users are supported to take risks as part of an independent life style. Millcroft Version 1.10 Page 13 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 standard(s) 11, 12, 13, 14, 15 Personal development opportunities are encouraged for all service users ensuring interactions within the local community and that individual rights and responsibilities are recognised and supported. Service users have opportunities to join in activities in the home. EVIDENCE: Service users attend a variety of different day centres and colleges accessing courses suitable to their individual needs and aspirations. Discussions with the service users with support from staff determined that they have a variety of day activities to be involved within. Access to transport occurs with the use of local transport where appropriate support is provided to individuals. The home also has access to a mini bus and an allocated driver. Staff support and encourage all service users to maintain and develop social, emotional, communication and independent living skills. The involvement and encouragement of the service users in a variety of tasks was observed throughout the inspection. Millcroft Version 1.10 Page 14 The home is rurally located, but is within a short distance from shops and the local community amenities. The home values and seeks to reflect racial and cultural diversity of service users through celebration of, and awareness of different cultures, religions and festivities. During the inspection staff and service users were observed to interact equally with one another. Service users are supported appropriately to take part in activities within the home. Individual needs, choices and preferences are always considered. A record of activities is maintained within the daily recording system. Service users access the local community services frequently and visit the local area, enjoying going out for lunch and shopping. The home is currently reviewing the provision of different activities within the home and the current recording and displaying systems. Once implemented this will further develop and support all service users to participate in leisure activities. Millcroft Version 1.10 Page 15 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 standard(s) 18, 19, 20 All personal and health care support is well maintained within the home ensuring individual needs, choices and preferences are met at all times. Specific areas within the homes medication procedures require improving to ensure safe practices are maintained and managed for the safety and well being of the service users. EVIDENCE: All care provided is individual and tailored to each person, with service users needs, choices and preferences being promoted. Assessments and reviews are continuously completed ensuring that the approach adopted by the home is person centred and holistic to each service users needs. The home is currently implementing new detailed assessments and care plans, which once fully completed will demonstrate an excellent example of a service tailored to individual changing needs. Service users needs and are supported with all aspects of their physical and emotional health and receive adequate and appropriate input from specialists such as community nurses, consultants, GP, dentists, opticians and dieticians. Information and advice is provided to all services users regarding general health issues. The home has a robust policy and procedure in place to support the safe administration, storage and receipt of medicines. All staff receive training prior to being deemed competent to administer medication. Training opportunities within the home surrounding medication administration are sound and are now Millcroft Version 1.10 Page 16 being offered through a local hospital. The home uses a local pharmacy and has a good working relationship with them. Contracts are present between the pharmacy and the home and pharmacy inspections are carried out frequently. The home uses a Nomad Dosette box system for safe administration. Records showed that gaps were present in some of the Medication Administration Records (MAR). The home must also ensure that individual medications are administered independently and mass dispensing of medication must cease to continue. All bottled medication must detail a date when opened to ensure shelve life and expires are not extended. Medication held within the home must be prescribed to individuals specifically; all unlabelled medications must be returned through the appropriate source. Millcroft Version 1.10 Page 17 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 standard(s) 22, 23 The complaints procedure within the home is sufficient and adequate in order for the service users to feel that their individual views are listened too. Robust policies, procedures and training are in place to ensure service users are protected and safe. EVIDENCE: The home has a comprehensive complaints procedure in place, which details that all complaints are responded to within 28 days. A record is maintained within the home of complaints made detailing actions and outcomes as necessary. All service users have been informed about the complaints procedure. This is also on display within the home. Robust procedures are in place to ensure that service users are protected from abuse and harm. Staff receive suitable and adequate Protection of Vulnerable Adults (POVA) training, which is currently occurring within the home. Staff employed within the home are all subject to enhanced Criminal Records Bureau (CRB). Staff personnel files were unable to be inspected due to not being held on site. Millcroft Version 1.10 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24, 25, 26, 27, 28, 29, 30. The home is in need of some continued maintenance, redecoration and works throughout, to ensure it functions as a homely, comfortable, safe environment for the service users showing compliance with relevant legislation. Each service users individual space within the home is extremely well decorated and maintained, reflecting individual choices and preferences. EVIDENCE: Major works are continuing to occur within the home regarding compliance with fire safety requirements. The home has made tremendous developments to date, however minor areas still require completing. Many areas within the home have been redecorated and a plan of works is in place to ensure this is completed. Areas that are complete within the home are airy, bright, clean and hygienic promoting a homely functioning environment for the service users. The home offers suitable light, heat and ventilation. The premises, although specific to service users needs, present in style and ambience that is reflective of the local community. Some of the current and future works being completed within the home include, upgrading of the outside lights and pathway, door locks to enable Millcroft Version 1.10 Page 19 access by service users, repairs to dining room flooring, complete refurbishment of the upstairs bathroom and redecoration, new window restrictors, the creation of a new boiler room and storage facilities, redecoration of service users rooms, including hall ways and shared communal spaces and new domestic style lighting in the main lounge area. Individual rooms are extremely personalised reflecting the individual characters of the service users. Shared space is appropriate to the needs of the service users. The grounds outside are well maintained and include appropriate seating and a large wooden walkway containing sensory plants and further seating adds to the relaxed atmosphere of the garden. The home offers bathing adaptations to meet the needs of individual service users. It was identified that one service user requires the provision of some specialist manual handling equipment following an assessment completed by the home. The laundry facilities within the home are separate from the main building promoting good infection control procedures. The home has recently purchased two new industrial washing machines and has introduced a system to ensure that each service users laundry is washed separately. This appears to be working effectively. Millcroft Version 1.10 Page 20 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 34, 35. The home is suitably staffed with well-trained individuals ensuring that at all times service users complex and changing needs can be met. Recruitment policies and all personnel records must be held on site and be available at all times. EVIDENCE: Staff spoken with during the inspection appeared very clear of their individual roles and responsibilities. Staff were observed offering a consistent approach for all service users. There are four staff on shift at any one time, providing a ration of 2:1, this ensures that specialist and complex needs can be met. Staff were seen to support the main aims and values of the home. All staff have received a copy of the General Social Care Council Code of Conduct. The home has clearly defined job descriptions and person specifications in place. All staff have received a series of mandatory training course in order for them to meet the complex needs of the service users. Training includes Protection of Vulnerable Adults, food hygiene, risk assessment, challenging behaviour and first aid. Training records are maintained within the home. The home provides two staff that are trainers in manual handling. Dates for fire training and fire marshal training are to be set. Due to the complex needs of the service users, specialist challenging behaviour training has also been arranged. A number of staff are completing their NVQ’s in care. One of the management team is also Millcroft Version 1.10 Page 21 an assessor. The manager is near completion of the Registered Managers Award NVQ level 4. Recruitment practices within the home appear well structured. With relevant checks occurring prior to employment. All policies and procedures relevant to the home were appropriately held on site. Millcroft Version 1.10 Page 22 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38, 40, 41, 42. The management within the home is secure and effective ensuring that changing needs of service users are met and that the home is running meeting its aims and objectives. Systems for effective health and safety management are in place, works are still required within the home to ensure the safety is maintained. EVIDENCE: The relationship between the service users and the staff is well balanced with interactions observed being appropriate and supportive. The ethos and management approach of the home creates an open, positive and inclusive atmosphere, staff and service users spoken to commented that they feel extremely supported and they feel the home is well managed. A clear commitment is made to equal opportunities within the home, with staff and service users expressing positive views with regards to this. The service users appeared to benefit from this well structured and well run home. Service users spoken to during the inspection appeared to be extremely happy with the home and appeared to be relaxed in their environment. Millcroft Version 1.10 Page 23 All staff and managers within the home are adequately and suitably trained in order to meet the complex changing needs of the service users. The staff team and the manager of the home are adequately trained and experienced to ensure that service users needs are being met. Periodic training occurs within the home to ensure staff development is maintained. The home has a vast range of policies and procedural guidelines in place. Staff are requested to read and sign risk assessments and polices. The home has a multitude of risk assessments in place. All records required by regulation were available and maintained. All accident and incidences within the home were recorded however not in the required format under the Data Protection Act 1998. All records are secure within the home and were up to date and held in accordance with the Data Protection act 1998 ensuring that service users rights and best interests are safe guarded by the homes polices and procedures. Works relating to fire safety within the home are currently still ongoing. Millcroft Version 1.10 Page 24 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. Where there is no score against a standard it has not been looked at during this inspection. 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 2 3 2 3 3 Standard No 22 23 ENVIRONMENT Score x x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 2 3 2 3 2 3 Standard No 11 12 13 14 15 16 17 3 2 3 2 3 x x Standard No 31 32 33 34 35 36 Score 3 3 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 2 2 x Millcroft Version 1.10 Page 25 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. 2. Standard 1 3, 29 Regulation 41 (c), Schedule 1 23 (2) (n) Requirement The Statement of Purpose must include a floor plan with individual room sizes specified. The home must provide disabibility and environmental equipment necessary to meet assessed needs of a service user. Activities provided within the home must be developed having regard to the needs of the service users in relation to recreation, social and community activities. All medication must be signed for once administered. medication must not be multi dispensed. Date opening must be added to all liquid bottles and packets. All unlabelled medications must be returned to source. (Previous time scale of 21/09/04 not met). Works required to be completed by the Fire Authority must continue. Continued maintenance and redecoration plans must occur within the home. All accidents and incidents within the home must be recorded in accordance with the Data Version 1.10 Timescale for action 15th June 2005 30th June 2005 30th June 2005 3. 12, 14 16 (2) (m) & (n) 4. 20 13 (2) 15th June 2005 5. 24, 42 12 (1) (a), 13 (4) (a), 23 (4) 17 (2) Schedule 4 30th June 2005 6. 41 15th June 2005 Millcroft Page 26 Potection Act 1998. 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. 2. 3. Refer to Standard 14, 1 20 24 Good Practice Recommendations That the cost of service users’ holidays is included in the contracted cost of care. That the balance of medication is carried forward onto the active MAR sheet to provide an audit trail for the reconciliation of medication. That the fluorescent lights in the lounge should be replaced with lighting of a domestic type. Millcroft Version 1.10 Page 27 Commission for Social Care Inspection Mercury House 1 Broadwater Road Welwyn Garden City Herts AL7 3BQ 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 Millcroft Version 1.10 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. 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