Inspection on 13/06/06 for Munhaven

This inspection was carried out on 13th June 2006.

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

The inspector 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

Munhaven 20/09/05

Munhaven 08/09/04

Munhaven 08/06/04

Munhaven 20/04/04

Munhaven 26/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Munhaven Munhaven Munhaven Close Mundesley Norwich Norfolk NR11 8AR Lead Inspector Ann Catterick Unannounced Inspection 13th June 2006 09:30 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 Munhaven DS0000035176.V300398.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. Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Munhaven Address Munhaven Munhaven Close Mundesley Norwich Norfolk NR11 8AR 01263 720451 01263 722579 munhaven.socs@norfolk.gov.uk www.norfolk.gov.uk Norfolk County Council-Community Care 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) Mrs Patricia Elizabeth Aston Care Home 20 Category(ies) of Old age, not falling within any other category registration, with number (20) of places Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One wheelchair user at point of admission can be accommodated in room number 5. One named person with dementia may be accommodated. Date of last inspection 20th September 2005 Brief Description of the Service: Munhaven is a care home providing personal care and accommodation for 20 older people. It is owned by Norfolk County Council and at the time of asking, on the 25th May 2006, the fee for the home was £368.72. The home is located in the seaside village of Mundesley, and is close to all local amenities including shops, pubs, post office and public transport. The home offers ground floor accommodation for up to 20 older people in 19 single bedrooms and 1 shared bedroom used for single occupancy. The home has ample communal space, including 5 lounges and 1 dining room. There are also assisted bathing, including a spa bath, and toilet facilities within the home. The gardens to the front and rear of the home are easily accessible to service users. There is ample car parking space within the grounds and also on the road. Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was a key inspection and the site visit took place on the 13th June 2006 and was for a period of 8 hours. Seventeen service users were accommodated on the day of the inspection visit. Information was gathered in various ways. Prior to the inspection visit the manager completed a pre-inspection questionnaire that included a copy of the menu and rota. Two comment cards were received from service users and three comment cards from relatives. All comments were positive. At the inspection visit there was opportunity to speak with the manager, service users, staff and a local community health worker. There was also opportunity to look in detail at some care plans, inspect staff files and look at other documentation relating to the home. A tour of the premises also took place. Overall this was a very positive key inspection and the quality of care provided to service users is good. What the service does well: The home is well managed and this is reflected in the care provided. Staff and service users were complementary about the management style of Mrs Aston. All service users spoken to were very positive about the care staff saying that they were very well cared for. These are some of the comments from service users: “Staff are well trained and I am happy with staff”, “Would not change anything it could not be better”. “Absolutely brilliant.” “Staff are so caring they do all they can for you.” Staff were observed to be happy in their role enjoying their work and having a good relationship with service users. At lunch time service users did not have to decide on what they would choose to eat until they were sitting at the lunch table. The food looked wholesome and nutritious and service users said that they enjoyed the food. Positive comments were made by the community health professional who thought the home provided a good service and cared for the service users well. The home was clean, hygienic and tidy throughout. Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? 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. Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 7 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 Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 6 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prior to admission service users and/or their families are given a copy of the Service User Guide and this gives them information about the home. Prior to admission prospective service users needs are assessed to ensure that the home can meet their individual needs and that they are within the home’s registration. Intermediate care is not offered in this home. The home does, however offer respite care. EVIDENCE: The home has a Statement of Purpose and Service User’s Guide that are available at the entrance of the home. Service users are all given a copy of the Service User’s Guide and they and their relatives are encouraged to read Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 9 this. The last inspection report is also available for service users and relatives to read. Care plans were inspected and evidence of assessment by the placing professional and the manager of the home were seen on file. All of those service users spoken to on the day of inspection thought that their assessed needs were being met. Observations made on the day of inspection confirmed this. The home does not offer intermediate care. The home does offer two places for short-term care. Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users have their personal, health and social care needs identified in an individual care plan. The home has a policy and procedure relating to medication with the aim to ensure that all aspects of care of medicine are completed in a safe and competent way. Care plans suggested that the privacy and dignity of service users were encouraged and this was the case when staff were observed interacting with service users. EVIDENCE: Three care plans were inspected in detail and the general quality of these documents was good. The home is in the process of changing the format but this did not deflect from the content. Each care plan had a front page of bullet points which gave the reader a brief but informative description of the basic Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 11 care needs of the service user. Areas of health and personal care were clearly identified including food preferences and weight. There was no nutritional assessment and this would be useful to have for all service users. A recommendation has been made in this area. When inspecting care plans and running records it was noted that 25 of service users had some form of skin irritation and/or rash, and although people had been referred to the GP no clear diagnosis had been given. Some staff members said that rashes and itchy skin had been an issue for some time. The inspector advised the manager to follow this up in more detail. Where skin and pressure areas were at risk appropriate referrals to health professionals were made for special beds and/or mattresses. A district nurse spoken to spoke very positively about the care provided in the home and the friendly atmosphere. The care plans included social history sections and recent history. In some cases these were completed well and in others there were details of recent history, mainly relating to the circumstances prior to admission but nothing very much about the overall life history. A recommendation has been made to gather more information when possible to encourage meaningful and positive interaction between staff and service users. Care plans were being reviewed on a regular basis and service users signatures were on most care plans. Generally practice around medication was observed as being good and most records seen were complete. Medication administration records (MAR) were complete and accurate. The Nomad system is used within the home and the receipt of medication is recorded on the MAR sheet attached to the Nomad. Loose medication is audited each Sunday. The home has a drugs round record that all staff sign to monitor who is giving out the drugs at any time. Controlled drugs were locked in a secure cupboard. All staff who administer medication have received medication training from Boots or the Local Authority training. A service user who was in the home for short- term care had given her medication to the home but the person who received the information had not recorded the amounts of medication received. This meant that there was no way of auditing their medication. A requirement has been made in this area. Staff were seen to work in a way that promoted privacy and protected dignity. They were heard to speak with service users in a respectful way. At lunchtime when some service users needed encouragement to eat their meal support was given in a quiet and non- obtrusive way. Bedroom doors were lockable and all bedrooms have single occupancy. The home has one double room but this is used as a single. Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 12 A service user who was placed in the home for short -term care commented on the difficulties of feeling a lack of control when in a residential setting. The service user felt that when paying for a service this should not be the case. The manager listened to the service user’s comments and said that it was helpful to have differing points of view of the care provided. The service user said that one of the difficulties was, not knowing, the layout of the building and suggested a floor plan would be empowering. The manager said that this was a good idea and that she could follow this up. Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a service that strives to meet the social, cultural and religious preferences of the service users within the home. Contact with family and friends is encouraged and service users are encouraged to take as much control over their lives as possible. Service users receive a wholesome, nutritious and balanced diet in surroundings that are pleasing and suitable. EVIDENCE: The manager encourages staff to become involved in social activities and other social interaction with staff. The home has a healthy amenity fund and this money is spent on services and products that improve the life of service users. The home has a computer with large keys and Internet access. This in one of the lounges and available to all service users and the Internet is a way to keep in contact with family and friends. The home has purchased modern TV’s and DVD’s that offer comfortable viewing and a variety of DVD’s to watch. One Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 14 lounge has a very large fish tank that offers activity and interest for those in that communal area. The home offers art classes, quizzes, reminiscence and Monday club as well as days out in the local community. Local church groups come into the home. No visitors were spoken to on the day of the inspection however three comment cards were received and these all confirmed that visitors were made welcome and could visit at any time. Norfolk County services provide the food in the home and on the day of inspection the food was well presented looking nutritious and appetising. Service users were given the choice and asked what they liked at the dining table. This was seen as good practice as often service users are asked what they would like several hours before the meal. Fresh roses were on the tables and the dining area was bright and airy being small enough to have an intimate ambiance. The carpet had recently been replaced. Where people were assisted with their meal it was done in a sensitive and respectful way. A cooked meal is offered at lunch and teatime every day. Teatime is about 4.45pm and the inspector thought this was rather early leaving many hours between tea time and breakfast. A resident, who had made a comment within one of the homes questionnaires, supported this view. The service users had suggested that a more substantial supper would be nice as it was a long time between tea time and breakfast. A recommendation has been made in this area. Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure and details of this are included in the Service User’s Guide that is issued to all prospective service users and/or their families. It is also displayed in the home. The local authority has clear policies and procedures to protect service users from abuse. EVIDENCE: Speaking with service users all were clear on what to do and who to speak to if they had any concerns or complaints. Details of complaints received were recorded and had been dealt with appropriately. The local authority has clear guidelines with regard adult protection and staff receive training in this area. Those staff spoken to were aware of the whistle blowing policy and were confident on what to do if they witnessed any abuse. Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20,25 and 26 The quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home does not have an annual improvement and development plan on site. The environment was generally well maintained. All areas of the home were clean and well cared for offering a comfortable environment for service users to live. EVIDENCE: There was not a programme of routine maintenance within the home but some of the improvements made were highlighted in the general Annual Development Plan. The dining room carpet has been replaced and three bedrooms have been redecorated and the home now has a new Spa bath that has improved service users bathing experience. Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 17 Munhaven is a single storey purpose built home. The home has five lounges offering ample communal space for service users. The dining area was comfortable and offered a pleasing area for service users to have their meals. The bedrooms, although small were comfortable and service users had made them personable and homely. No bedrooms are en suite and toilets and bathrooms are situated in different areas of the home. Service users particularly enjoy the new spa bath. The heating system within the home is old fashioned and does not enable service users to be able to control the heating in their bedrooms. The manager has provided fans to service users to enable them to cool their bedroom down if they choose to do so. It is recommended that the use of the fans be risk assessed. The windows in the home have old metal frames and would benefit from being replaced. A requirement has been made with regard the heating system and metal window frames. The home was very clean and tidy throughout, free from any offensive odours. Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are generally enough competent and well-trained staff on duty to meet the needs of service users. The home follows safe and thorough recruitment practices. Staff receive induction and foundation training to ensure that the have the skills and knowledge needed to care for service users. EVIDENCE: Since the last inspection the home has appointed an addition 18.5 hours of care coordinator role therefore increasing the number of hours on the rota. One member of staff had been seconded to another post at the time of the inspection visit and this in turn has meant senior care staff filling this role with the possibility of shortages at carer level. The manager has so far covered shifts without too much concern but the ideal will be when the seconded staff member returns. The home is very near the GP practice and it is usual practice for all service users to visit the GP at the practice unless they are too unwell to do so. On average this happens about 4 or 5 times a week and a member of staff always accompanies the service users. This can take up to an hour a time and the Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 19 manager needs to ensure that when a member of staff is out with a service user at the doctor’s surgery that there are enough staff remaining in the building to care for the service users. A recommendation has been made in this area. There is an hour or two on some afternoons that the staffing level goes down to two staff and the manager. The manager addresses this by putting additional staff on the rota to cover but is hoping to address this issue by staff being rostered to cover these hours. Thirty one per cent of staff are trained to NVQ level 2 or above and in the Annual Development Plan for 2006/2007 it states that there is the opportunity for 2 more staff to receive NVQ training in this financial year. The manager supports and promotes staff training. Staff receive induction training and mandatory training including moving and handling, emergency first aid, food hygiene, basic first aid and medication training where appropriate. The local authority has clear policy and procedures regarding recruitment and selection and those files seen on the day of the site visit included all of the information that needed to be collated prior to the offer of appointment. Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 The quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is qualified and competent able to fulfil her role and responsibilities. The home is run in the best interests of the service users. Staff are offered formal supervision and this is recorded. Any money looked after for service users is done in a way that safeguards their financial interests. The health and safety of service users are promoted and protected by policies and procedures and good working practices. Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 21 EVIDENCE: The manager has her Certificate in Social Services (CSS) and has completed the management component of the Registered Manager Award. Prior to the inspection visit she returned all of the appropriate documentation required to the Commission and this was thorough and detailed. Throughout the inspection she proved herself to be competent and knowledgeable and feedback about her from staff and service users was positive. The local authority has completed an Annual Development Plan for Munhaven as part of its quality assurance and within this document they say they are planning to undertake a full quality audit of the home. The manager has systems for completing her own quality assurance and this is continuing to be developed. The way money is looked after was inspected and this is done in a way that protects service users. All transactions are recorded and two signatures, one being the service user, whenever possible, were seen in the documentation. The administrator keeps a reconciliation sheet at the front of the records. Three of the service user’s money was audited and tracked and all were correct. Records of supervision were seen and those staff spoken to all said that they received supervision. Since the last inspection fire alarms are now tested weekly and chemicals are stored in a lockable cupboard. Staff receive training in safe working practices and evidence of this was seen on staff files. Those staff spoken to also confirmed that they had training in areas, such as fire training, moving and handling, first aid and adult protection. Prior to the inspection visit the manager recorded the information with regard the servicing and maintenance of appliances and sent to the Commission. There were no areas of concern. The premises are secure. All staff receive induction and foundation training and evidence of this was seen and staff spoke of their induction when interviewed. The radiator in the hairdressing room has not been covered. A requirement has been made in this area. Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 22 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 3 x 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 3 x x x x 1 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 3 x 2 Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 23 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 OP9 Regulation 13(2) Requirement The registered person must ensure that policy and procedures for the safety of medicines are followed at times. The registered person must ensure that with regard the heating system and metal window frames an improvement plan is drafted to evidence how and when the local authority is to move to a situation of compliance in this area. The registered person must ensure that the radiator in the hairdressing room is covered or changed to a low heat surface radiator. Timescale for action 14/06/06 2. OP25 24.1(B) 01/08/06 3 OP25 13.4 (C) 01/08/06 Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 24 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 Refer to Standard OP7 OP8 OP15 OP27 Good Practice Recommendations It is recommended that care plans include details of a life history. It is recommended that care plans include a nutritional assessment. It is recommended that consideration be given to changing the time for tea, as this seems to be rather early. It is recommended that the manager ensure that when staff are taking service users to the local GP practice that there are sufficient numbers of staff remaining in the building to care for service users. It is recommended that a risk assessment be completed for all service users who have a fan in their room. 5 OP38 Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF 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 Munhaven DS0000035176.V300398.R01.S.doc Version 5.2 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. 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