Inspection on 29/01/08 for Milliner House

This inspection was carried out on 29th January 2008.

CSCI found this care home to be providing an Adequate service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Milliner House 13/10/09

Milliner House 20/11/08

Milliner House 29/05/07

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

CARE HOMES FOR OLDER PEOPLE Milliner House 23 - 29 Marsh Road Luton Beds LU3 2QS Lead Inspector Katrina Derbyshire Unannounced Inspection 29th January 2008 10:30 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 Milliner House DS0000066373.V355972.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. Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Milliner House Address 23 - 29 Marsh Road Luton Beds LU3 2QS 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) 01582 490080 01582 491080 millinerhouse@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Healthcare Services Ltd Manager post vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (10) Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd December 2007 Brief Description of the Service: Milliner House is situated on the Marsh Road in Luton within easy reach of the town centre amenities by car or public transport. The home is within walking distance of community resources, which include churches, shops, pubs and restaurants. An enclosed garden area is at the rear of the building alongside parking. The home provides personal care for up to 30 people over the age of 65 years who have dementia and 10 people over the age of 65 who have mental health needs. Accommodation is provided across two floors, there are 40 single rooms providing en suite facilities. The home consists of 4 unit areas, each area consisting of bedrooms, and lounge/dining facilities. The home has a rear garden which is accessible to people living in the home and car parking is also available. Access to the first floor is via a shaft lift or stairs. Various communal areas are located throughout the home. The manager at the home provided the following information on charges. The fees for this home vary from £459.00 per week, to £809.00 plus per week, depending on the funding source and assessed need of the person. Additional charges are made for hairdressing and chiropody services. Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Two Regulation Inspectors carried out this unannounced visit on 29th January 2008. The manager was present throughout the inspection and was joined later by the area manager. During the visit the communal areas of the home were seen alongside some of the individual accommodation. The inspectors spent time with many of the people who live at the home in the sitting areas and dining areas at the home. The care of four people was examined in detail. We had also carried out a random inspection after the last key inspection to follow up on the requirements we had made, this visit showed that most of these had been met. Information from the home had been provided and included documents relating to meals, staff training and activities to assist in assessing the outcomes within each standard. Evidence used and judgements made within the main body of the report include information from this visit, feedback from people who live at the home and the management’s submission of documentation. Feedback from people who use the service and staff was also received through returned comment cards. Observations of care practice and communication between the people living at the home and staff was also made at the inspection. The focus of this inspection was to look at the key standards and to follow up on previous requirements. What the service does well: Staff have continued to be good at making referrals under a scheme known as the Protection of vulnerable Adults policy. There is a certain way that Luton Borough Council, Police and Commission for Social Care Inspection should be told if something has happened to any person living in the home. This might be for example if someone has fallen, but no one had witnessed this happening so it may not have been an accident. Staff had reported incidents so that a decision could be taken by the lead agency to ensure people at the home were being protected. Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 6 Staff organise access to healthcare for people very well. When a person needs to see their General Practitioner or require help from another medical specialist for example they are very quick to arrange this, so people receive prompt healthcare. People also regularly see chiropodists, speech therapists and physiotherapists when they need to, and most visit the person at the home itself. People living at the home feel that the staff are friendly and they find many of them are supportive. One person said, “ Nothing seems to be to much trouble, they are so nice to me”. What has improved since the last inspection? What they could do better: Most of the medication records and stocks that we checked were correct, however one persons stock of medication was wrong. The amount that was in stock did not match the records being kept. There was no way of knowing if the person had received their medication when they should have. This means that this person’s health was at risk in them not receiving the medication that they need. Menus on display in the home show that several options are available at the evening meal. However these options are actually not offered to the people living at the home. Soup and sandwiches are offered everyday; none of the evening menu is available. This misleads people and the provision of soup and sandwiches each day would not provide the individual needs of the people living at the home. Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 7 Fourteen staff at the home had either not yet received or their training in moving and handling was out of date. It is very important that staff have up to date training in this area, to reduce both the risk of injury to themselves and the people living at the home. 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. The summary of this inspection report can be made available in other formats on request. Milliner House DS0000066373.V355972.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 Milliner House DS0000066373.V355972.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 6 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Pre admission assessments and information on the home is sufficient to ensure people can make an informed choice as to whether to move into the home or not. EVIDENCE: The statement of purpose was seen to be displayed in the home. The document provided information on the staffing, accommodation and services available at the home. All comment cards returned to the Commission for Social Care Inspection from people using the service indicated that they felt they had been given enough information, before they decided to move into the home. Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 10 Assessment documentation as previously assessed was also noted to be in place within the care records of people whose care was tracked at this visit. The standard of information was good and gave information on the physical, social, emotional and psychological needs of the individual. Staff through interviewing demonstrated a good level of knowledge of the people living at the home, the information that they gave matching the entries within the care records seen. Intermediate care is not offered at this home. Milliner House DS0000066373.V355972.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Good access to medical support by staff ensures peoples healthcare needs are met. However inconsistencies in the management of medication place people at risk of not receiving the care that they need. EVIDENCE: The Commission for Social Care inspection were notified of errors in recording of a person’s medication on their return from hospital. This resulted in the person receiving the wrong medication. An investigation into the incident had been carried out and a safeguarding adults meeting arranged to review the incident and actions taken. The Acting Manager advised that as a result she was arranging some additional training for staff in medication management. Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 12 Medication stocks were examined alongside the records relating to this area. The medication administration records showed current balances and contained initials of staff when medication had been given. The stock maintained in the home was sufficient to provide for the current 28-day administering period for most of the people living at the home. However one person’s stock within the current 28-day cycle was 19 tablets out, from the entries on their medication administration record. It was not possible to determine if the person had received their medication as the records had been signed, with the stock counted this intimated that although staff had signed to say it had been given, it had in fact not been administered. Information submitted by the home stated that everyone was registered with a General Practitioner and received medical support through referrals from them. Records seen at this visit and people spoken to confirmed that this was correct. Staff if needed would escort people to appointments at the local hospital for example. A District Nurse was seen to be visiting at this inspection; this was following a request from staff at the home. In addition documents were seen from varying healthcare professionals within the records to show that they had received varying treatment, including support from dieticians and physiotherapy Departments. During this visit many staff were observed by both inspectors to communicate with the people living at the home in a courteous manner. Examples included providing an explanation to the person when staff were advising people that lunch was ready, the staff member explained throughout what they were doing and why. Of the four people asked at this visit if they found their needs to be met, three felt that they were and one did not. All four people stated that at times they would have to wait sometime before staff would respond to them, but when they did they would be supportive. One person spoken to felt that they would like to have a member of staff with them at all times, they had been advised that this was not possible and knew this when they moved into the home. They explained that they understood the reasons why and that this was their preference rather than their need, but that they would still like a member of staff to be with them at all times. Care plans were seen to be of a good standard. The plans contained sufficient information to guide staff in how they should support the person. Staff when questioned were able to describe the needs of the people living at the home, although some had a greater understanding than others. Milliner House DS0000066373.V355972.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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. People living at this home feel that arrangements in place for activities are good and meet their social needs. EVIDENCE: As previously described staff again through discussion confirmed that a choice of activities is available in the home and records of these are in place. Within the areas of the home, where people with dementia are accommodated, signposting and sensory boards are in place. Boards were up to date and showed the date and weather for example. In addition bedroom doors are designed to look like ‘front doors’ with letterboxes and door knockers, this is an approach used by the home in which, corridors become known as streets. Cleaning items and a cot are some examples of what is available to aid in the socialisation of people, these were seen to be used and engaged the people living at the home and staff in conversation. Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 14 A choice of meals is available at lunchtime and menus are displayed in the home, a brief observation of the lunchtime meal, showed it to be unrushed and enjoyed by the people living at the home. Meals were seen to be taken in small dining areas within each unit of the home. However the menus also described several choices being available for the evening meal, these in fact were not offered. Staff, people living at the home and kitchen records showed that soup and sandwiches were offered everyday and a requirement has been made. Relatives were seen to visit at this inspection. Staff were seen to greet them in a courteous manner and information was shared with them on the well being of the person that they were visiting The manager confirmed that people living at the home are able to have visitors at any reasonable time. People continue to be able to bring personal possessions into the home and evidence of this was seen in the individual rooms and included photographs, pictures and ornaments. People said they are consulted and are given choices as to how they conduct their lives within the home; choices offered included meals, activities and relationships. Milliner House DS0000066373.V355972.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Systems in place at this home for receiving and investigating complaints is good so people are assured that their concerns will be acted upon. EVIDENCE: A requirement was made at the last key inspection that “Complaints must be managed and responded to so people feel that their concerns will be listened to and acted upon appropriately. Information on how to complain must be updated so that people know to whom they can complain. Complaints and safeguarding issues were reviewed at a random inspection undertaken in September 2007 and the requirement relating to complaints had been met. The Commission for Social Care Inspection have received no complaints since the random inspection. Review of the homes records identified that one complaint had been received since the random inspection from a relative about the care of a resident. This complaint had been investigated and responded to appropriately. The Commission for Social Care Inspection had been made aware of concerns about the care of a person that had been investigated by social services Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 16 through their safeguarding procedures. Social services had been satisfied with the actions that were being taken to meet the person’s needs. The actions have been discussed with the Acting Manager and advice has been given to include in the homes complaint records details of all complaints and the findings and actions taken regardless of who is investigating them. This will help to ensure that any required actions can be reviewed and that any trends/patterns can be identified helping to protect residents. The Acting Manager has been asked to confirm the outcome of an investigation into allegations made in October 2007 against a former member of staff to CSCI to ensure that appropriate action has been taken to protect vulnerable people. Milliner House DS0000066373.V355972.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use this service experience good quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. The general maintenance of the environment and furnishings are good and create a pleasing and pleasant environment for people to live in. EVIDENCE: Discussions with the maintenance man confirmed that systems were in place to ensure that equipment is serviced regularly. Records for the servicing of movement and handling equipment such as hoists were seen by the inspector and had been serviced within the last 6 months. The home is divided into four separate areas, these are known as houses. Each house has a dining and sitting room alongside bedrooms, bathrooms and Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 18 toilets. An activity room, sensory room and consulting room are also available for people to use. There is an enclosed rear garden for use by the people living at the home. The furnishings, fittings and décor are of a good standard. All people seen spoke highly of their environment, and felt that the home catered very well for their needs. The staining on several ceiling areas throughout the home were seen to have been removed, this had been caused by a problem with the heating system earlier in the previous year. All areas visited were noted to clean, tidy and free of odours. Staff were observed to wear suitable protective clothing when carrying out certain activities. Cleaning schedules were in place and clinical waste was disposed of in an appropriate manner. Milliner House DS0000066373.V355972.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Inconsistencies in the training of staff mean that people do not always have their needs met by staff who have a full understanding of their needs. Although the recruitment of staff in following national guidance makes it safer for the people living at the home, as the risk of someone being employed who is unsuitable to work in the home is reduced. EVIDENCE: A requirement made about the adequacy of the recruitment process in protecting people at the inspection carried out in May 2007 had been met at the time of the inspection in September 2007. Review of the files for three recently recruited staff confirmed that good recruitment practices being maintained with criminal record bureau checks and references obtained prior to staff working in the home. This is important in helping to ensure that the recruitment process protects people. Review of the staff training records, which are held on the computer, indicated that fourteen staff have not received training in movement and handling. Discussion with the Acting Manager confirmed that further training had been Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 20 booked as although she believed that some of the staff had received the training there was no evidence in the form of records or training certificates to evidence this. A sample check of the staff rota confirmed that there were some staff on duty who were listed as having received the appropriate training. Staff training in movement and handling is particularly important in reducing the risk of injury to people living at the home and staff. It was noted that some staff had received dementia awareness training, however records indicated that only one staff member had done more in depth dementia care training. There was evidence that the Acting Manager has now booked various training courses including dementia care training, however it is of concern that staff caring for people with dementia appear to have no or minimal training in this area. Milliner House is also currently registered to provide care for some people with a mental disorder and the Acting Manager confirmed that there are people with a mental disorder living in the home. There is however no record of staff receiving any training in the types of mental disorder to help them in understanding and meeting these specific needs. Milliner House DS0000066373.V355972.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. JUDGEMENT – we looked at outcomes for the following standard(s): 33, 35 & 38 People who use this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence including a visit to this service. Health and safety systems are sufficient to protect the people living at the home. People have an opportunity to influence the running of the home through the quality assurance programme. EVIDENCE: At the time of this inspection there was no registered manager in post. As Standard 31 relates specifically to a registered manager it has not been assessed. However as the management of any service is key to residents well Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 22 being, the arrangements have been taken into account as part of this inspection. Concerns had been expressed at the time of the inspection carried out in May 2007 about the adequacy of the management arrangements. This related to the fact that the manager at that time was spending only one or two days in the home. At the time of this inspection there was a full time Acting Manager in post, who advised that she was in the process of completing an application for registration. The Acting Manager demonstrated through discussion an understanding of her responsibilities and the needs of people living at the home. Small amounts of money are held on behalf of people living at the home to help assist them in paying for additional services such as chiropody treatment and hairdressing. A sample check of the records confirmed that receipts are kept which confirm the transactions made on behalf of people helping to protect them. It was however noted that some money had been withdrawn from people’s accounts for raffle tickets. Given that the majority of people have dementia advice was given to ensure that there was a system in place to ensure an informed choice has been made. There are quality assurance systems in place, which include sending questionnaires to relatives to ascertain their views on the quality of care provided. A requirement was made following the inspection in May 2007 about the need to collate people’s views on the service provided. These comments were collated in November 2007 and were displayed on a notice board in the foyer together with details of the action being taken to address issues raised. Review of the responses received in recent questionnaires indicated that improvements in standards have been made. Comments included “overall I am very happy with the care given.” And I would like to take this opportunity to praise the new management and the new activity person for all the changes taking place”. Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 1 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 2 X X 3 Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? NO 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 OP9 Regulation 13(2) & 18(1) (a) Requirement People must receive their medication when prescribed and accurate records of this must be kept to ensure their level of health is maintained. The choices detailed in the homes menu must be offered to provide a varied balanced diet to the people living at the home. All staff must receive training in the specific needs of the people living at the home including moving and handling, so that they have a full understanding of their needs. Timescale for action 31/03/08 2. OP15 16(i) 31/03/08 3. OP30 18(1)(c) (i) 30/04/08 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 Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 25 1. OP35 Safe systems should be in place to protect with dementia to determine the suitability of them purchasing raffle tickets. Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Inspection Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Milliner House DS0000066373.V355972.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!