Inspection on 06/09/05 for Millstream

This inspection was carried out on 6th September 2005.

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

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

Other inspections for this house

Millstream 31/07/09

Millstream 31/07/08

Millstream 31/07/07

Millstream 09/01/07

Millstream 05/07/06

Millstream 12/01/06

Millstream 23/11/04

Millstream 28/04/04

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

CARE HOME ADULTS 18-65 Millstream Mill Road Frinsbury Kent ME2 3BT Lead Inspector Anne Butts Unannounced 6 September 2005 08.30 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. Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Millstream Address Mill Road Frinsbury Kent ME2 3BT 01634 299970 01634 299971 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) Opus Living Mrs Susan Trevett Care Home 20 Category(ies) of Physical disability (20) registration, with number of places Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1) Persons accommodated will have a diagnosis of Huntingdons Disease. 2) To accommodate one person whose date of birth is 14 November 1937. Date of last inspection 23 November 2004 Brief Description of the Service: Millstream is a large care home situated on the outskirts of Strood. Local services are approximately 1½ miles away downhill. It is in keeping with the local area. The home caters specifically for adults with a diagnosis of Huntingdons Disease, and has been designed with their needs in mind. The home is set over three floors. All bedrooms are en-suite and there is a range of shared spaces. There is a large rear garden which has terraced, paved and lawned areas and has good access for service users. There is some parking space to the front of the building. The home also has three vehicles which are used for the service users benefit. Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on 6th September 2005. Anne Butts and Lucy Ansell carried out the main part of the inspection with the full co-operation of the manager. The commission was also represented in part by the pharmacy inspector, who concentrated on medication needs only. A number of requirements and recommendations had been made on the last inspection and a full action plan on how these were to be addressed had been presented to the commission within the requested timescales. Although this report also contains some requirements and recommendations the inspectors are very aware that the manager is newly in post and is in the process of addressing many of the issues – alongside those that have already been attended to. Overall it was felt that this was a positive inspection with the manager clearly committed to moving the home forward in terms of meeting service users needs and supporting staff in their role. What the service does well: What has improved since the last inspection? This was the first visit to the home by these inspectors, and the home is currently undergoing a period of change specifically with regards to the homes management structure. The management structure is aimed at ensuring that service users needs are met and staff are trained and competent in meeting these needs. Training needs are currently in the process of being addressed. Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 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. Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 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 standard(s) 1 and 5 Service users benefit from having enough information to make an informed decision about moving into the home so that residents are confident the home can meet their needs. Service users’ contracts, whilst containing all the necessary detail, are invalidated because they are not being signed off by the service users and/or their representatives. EVIDENCE: The home’s Statement of Purpose contains the required information. It is clear and concise with all relevant information now included. The service user’s guide is still lacking information and would benefit from being produced in a format that is suitable for the residents with pictorial prompts and simpler language. Both of these documents need to be kept updated with information and reviewed as required. New residents will now be provided with a statement of terms and conditions when moving into the home. The manager must ensure all existing residents also have the terms and conditions. Evidence was seen of the home’s contract, which appeared detailed. However none were seen signed by the resident/representative. All contracts between the home and the Local Authority are kept at the home. Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 Page 9 Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7 and 9 The home’s care planning procedures do not evidence that service users’ care needs are being properly addressed since there is little correlation between care plans and service delivery and they contain too much irrelevant information which is not regularly reviewed. EVIDENCE: The manager is aware of outstanding requirements concerning the care plans. This includes inconsistency in the standard of information supplied according to the key worker, whether reviews were carried out and how accurate and up to date the recordings were. The manager is tackling this by revamping all the paperwork so it is more streamlined and efficient. She is sending all staff on training to cover care planning, risk assessments and all forms of communication. The staff are also reviewing all paperwork as PCT and Social Services reviews come round. The deputy manager when in post will hold responsibility for ensuring that resident’s files are reviewed monthly and then six monthly as required. Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 Page 11 The daily recordings are containing good detail however activities, tracking and evidence of monitoring need to be clearer. Gaps were seen on sheets and times and dates and signatures all need to be recorded. The staff are now starting to evidence when rights and choices are being made by the resident or when made by the staff. The new manager will be using person centred planning to ensure the care plans are formatted to suit the individual’s personal wishes and capabilities. The organisation no longer holds financial responsibility for any of the residents and this has gone to the local authorities if there is no representative/family. Risk assessments were seen in the care plans these were detailed and on the whole well written. These included risks in the home, to the person or when out and about. Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11, 14 and 17. Service users’ opportunities for development of skills are not a primary need, but every chance is provided to develop independent living. The home does not facilitate sufficient leisure activities to enable residents to maintain appropriate and fulfilling lifestyles. The resident’s benefit from nutritious varied and balanced meals. EVIDENCE: Many of the residents at the home are severely disabled due to the degenerative nature of the disease, however they are all supported to remain as independent as they would wish. They all can access speech and language therapists who enable communication through pictorial aids, equipment and staff support. Residents are also provided with specialist interventions like hydrotherapy and aromatherapy as requested. The home does not have any activity co-ordinators, and it was noted that service users did not appear to be partaking in any structured activities in the Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 Page 13 home except music day on a Friday and aromatherapy. The manager stated she now wants to restructure the activities to make them more person centred and individual to that resident. She is trying to get staff motivated to take responsibility for providing activities in the home. All the service users have been on holiday this year, some several times with trips to a farm in North Wales and Centre Parcs in Suffolk. The home takes the residents out on trips to concerts, theatres, pubs and shopping trips. Several residents are keen fishermen and go out for and one resident a keen football fan and attends as many matches as he is able. The home has two minibuses and a people carrier but does need to recruit another driver to ensure every one is able to go out. The home has a catering firm provided the meals for staff and residents. The overall quality of food seen on the day was very good with fresh ingredients used and good presentation provided with the pureed food. The month’s menus were seen; these contained a varied and balanced variety of meals in association with the dietician. Staff were observed to be seated whilst assisting service users to eat and seemed aware of individual needs. Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 and 21 Whilst the new manager was striving to attain good standards in medication handling further training for staff was required to ensure that service users were not put at any risk with regard to the administration and handling of their medication. Service users benefit from having full access to all professional health care services as required and they can be confident that their health needs will be met. Service users and families are supported with regards to their wishes in respect of later stages of life and death. EVIDENCE: The policies and procedures dated October 2004 with regards to medication did not reflect best practice and lacked the detail required for staff to follow procedures. There were fairly comprehensive records of receipt, administration and disposal. However in many instances, two staff were signing for administration in one small box so it was unclear who had carried out the administration. Records indicated that the direction for medicine to be given one hour before food was ignored. Although the home has a large airconditioned clinical room, it has no medicine cupboards apart from a Controlled Drug (CD) cupboard. The drug trolley is very full. There is a formal means of identifying service users and for prompting doctors to review medication. Staff Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 Page 15 training is being addressed with some bookings on courses but training needs to encompass all staff handling medicine. The manager has developed close links with the local hospice and they provide support and guidance with regards to the palliative needs of service users. This is aimed at ensuring the needs of service users are met and is proactive in supporting service users needs. Huntingdon’s is a degenerative disease and service users and their families are consulted with regards to their wishes about end of life issues and the manager is committed to supporting service users, their families and staff. Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 Page 16 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 and 23 Service users and their relatives / representatives can be confident that their complaints are taken seriously and acted upon. Adult protection policies and procedures are in place but service users would be better protected by all staff completing Adult Protection training. EVIDENCE: There is a full complaints procedure in place and the manager confirmed that the home has a copy of the Kent and Medway Joint Adult Protection Protocols that their own adult protection policy and procedure supports. The complaints procedure is on display, in the statement of purpose and the service users guide and gives contact details for the Commission. The inspectors viewed the complaints record and it evidenced that all complaints are taken seriously, acted upon and responded to within the required timescales. The new manager is committed to ensuring that service users and relatives can be confident that they are able voice any concerns. Physical and verbal aggression is understood with some staff having training in this area, training is required however for all members of staff and also it should be a priority for all staff to attend Adult Protection training. The manager is aware of the need for training and is currently addressing this. When the care plans are developed into a more suitable format the manager must ensure that they routinely record individual procedures for dealing with signs of aggression. Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 Page 17 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 and 30 Service users benefit from living in a safe, clean and comfortable environment that suits their needs. EVIDENCE: The home was designed with the needs of a more dependent service user group in mind. The large majority of rooms have a good outlook with good natural light. There is level access across the lower floors, an upper floor has ramped access to the sunroom. All bedrooms are large with en suite facilities, which include toilet, shower and washbasin. Furniture is domestic in style and suits the needs of the service users. Bedrooms were seen to be well personalised with own possessions and pictures. All rooms have plenty of drawer and hanging space, plug sockets and television points. There are a range of shared spaces, which includes lounges, dining rooms, an activities room, a sunroom and there is a separate smoking lounge on the lower level and good outdoor space. Service users were seen generally to use Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 Page 18 either the main lounge or the smoking lounge. The gardens have wide level paths, grass and raised beds. In addition to the en-suite facilities there are bathrooms with Parker baths. Additional toilets are provided on each floor and close to day spaces. Some toilets are Closomat toilets allowing for ease of personal hygiene management. Hygiene products are stored discreetly in the bathrooms. Toilets and bathrooms are lockable. A range for aids and adaptations are provided to suite the needs of the service users and include: • An overhead tracked hoist in each communal bathroom • Electrically operated bedroom windows • A number of Closomat toilets • A touch pad call alarm system • Two 8 person passenger lifts • Wide access doors • A wheelchair charging room • A number of wide access en-suite facilities. A number of service users also benefit from specialist reclining armchairs. Bed rails are fitted within a risk assessment process. There are sluice rooms on each floor with hand washing facilities and appropriate protective personal equipment, although it was noted that one of rooms was not locked. There are designated laundry and cleaning staff. The laundry is located on the lower level. There is an industrial washing machine, which was in need of repair on the day of inspection and a domestic washing machine that was in use. There is also an industrial tumble dryer. Sheets and bedding are currently contracted out, while laundry staff deal with towels and personal washing. It was noted that the actual room where the washing machine and tumble dryer were located was extremely warm, and staff stated that this was usually the case. It was recommended that it should be ensured that the room is of a comfortable working temperature. Laundry staff spoken to felt supported and stated that they had received training, and they felt confident in approaching the manager if they had any concerns. The Environmental Health Officer had visited in April and the kitchen had benefited from a deep clean. It was noted, though, that storage space was limited and the kitchen was cluttered. At the time of inspection, the home was clean, bright and airy and generally free from offensive odours, although a slight odour could be detected in the main lounge at some points during the inspection. Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 Page 19 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) 34 Whilst the homes recruitment processes largely protect service users there is a need for the home to improve some aspects of its practice in this area. EVIDENCE: The home operates a thorough recruitment procedure and staff files viewed showed evidence of application forms, two references, interview and feedback forms and a letter of offer. Files also contained terms and conditions, job descriptions and equal opportunities. Files were of a structured format. Health declarations and CRB cheques were recorded in a different file for confidentiality purposes. It was noted, though, that on one of the application forms viewed the application form had not been fully completed and did not contain a full work history for example and, therefore, could not evidence that there were no undue gaps in employment. It was recommended that as part of the recruitment process, either at application or interview stage, all gaps in employment be thoroughly explored. Training was not inspected on this occasion but the manager stated that training is a priority and she is exploring a full training package which can be accessed by all members of staff and which is aimed at meeting the needs of this service user group. It was agreed with the manager, that as she is newly in post, that this would be inspected at the next visit in order to give her time to implement. Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 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 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 and 38 Service users best interests are safeguarded by the manager’s leadership style and clear sense of direction. EVIDENCE: The manager has only recently taken on the role of manager for the home. During the previous three months she has been in post as acting manager. She has previously worked in the care sector for a number of years, and a significant amount of this time in a management role. She is about to start her Registered Managers Award (NVQ level 4). During her time as acting manager she has addressed some of the concerns that had been highlighted in the previous report including some staffing issues. She has made links with local organisations in order to ensure that the various and complex needs of this service user group can be supported including end of life issues and is looking at a pro-active approach and person centred planning. Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 Page 21 She demonstrated an awareness of areas of the service that need to be addressed including the care plans and activities and is working towards ensuring that these are improved. She also aims to improve the training with a specific training programme aimed at meeting service user needs. A deputy manager, who will also be newly in post, will support her in this role. Records evidenced that she has supported service users with any concerns and / or complaints and fully monitors accidents and incidents with regards to looking for outcomes and reducing risks. Overall the inspectors felt that she showed a thorough awareness of the needs of service users and staff and had a clear sense of direction and leadership. Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 2 x x x 3 Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 2 Standard No 11 12 13 14 15 16 17 3 x x 2 x x 3 Standard No 31 32 33 34 35 36 Score x x x 3 x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Millstream Score x 3 1 3 Standard No 37 38 39 40 41 42 43 Score x 3 3 x x x x H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 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 Y.A. 1 Regulation 5 Requirement The service users guide must include all information as required in the Care Home Regulations 2001, and be reproduced in a format which is suitable for service user needs. The care plan must contain current information in sufficient detail to ensure that all persons involved in the care of the individual has the information necessary to do so effectively and in an agreed manner. The home has detailed procedures for all medicine handling taking place in the home . Medicine storage is reviewed and improved There are clear records of who is responsible for administering medicine to service users and a clear audit trail Medicine is administered at appropriate times as detailed on the label There are clear details for keeping medicine for 7 days following a death All staff handling and managing Timescale for action Action plan to be received by 30 November 05 Action plan to be received by 30 November 05 31 December 05 31 December 05 30 September 2005 30 September 2005 31 October 2005 15 Page 24 2. Y.A. 6 15 (1) 3. Y.A. 20 13 (2) 4. 5. Y.A. 20 Y.A. 20 13 (2) 13 (2) 6. 7. 8. Y.A. 20 Y.A. 20 Y.A. 20 13 (2) 13 (2) 18 (1)(a) Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 medicine are trained and competent 9. November 2005 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. 4. 5. 6. 7. Refer to Standard Y.A. 14 Y.A. 20.6 Y.A. 20.9 Y.A. 20.10 Y.A. 23 Y.A. 24 Y.A. 34 Good Practice Recommendations It is recommended that activities are promoted within the home. The home reviews the need for carrying so much in the drug trolley at every round. The home has a current BNF as a source of reference The home has a Controlled Drugs Register It is strongly recommended that all staff are trained and competent in Adult protections issues. It is recommended that the laundry area has adequate ventilation. It is strongly recommended that the home ensures that application forms are fully completed and any ommissions are explored at the interview stage. Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 Page 25 Commission for Social Care Inspection The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Millstream H56-H06 S57566 Millstream V241549 060905 Stage 4 .doc Version 1.40 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. 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