Inspection on 02/08/05 for Murray House

This inspection was carried out on 2nd August 2005.

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

The inspector 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

Murray House 06/12/06

Murray House 12/01/06

Murray House 22/02/05

Murray House 13/07/04

Murray House 30/01/04

Murray House 03/09/03

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Murray House Royal Borough of Kingston Acre Road, Kingston Upon Thames Surrey KT2 6EE Lead Inspector Diane Thackrah Unannounced 2 August 2005 nd 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 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. Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Murray House Address Royal Borough of kingston, Community Care Services, Acre Road, Kingston Upon Thames, Surrey, KT2 6EE 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) 020 8547 6300 Community Care Services Miss Nicola Axon Care Home 38 Category(ies) of Old Age, not falling within any other category registration, with number (38) of places Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection 22 February 2005 Brief Description of the Service: Murray House is a purpose built resource centre, built in 1974 and owned and operated by The Royal Borough of Kingston Upon Thames. The resource incorporates a day centre which provides a range of activities and events for older people from throughout the Borough, and a care home providing 38 resodential places. The home is situated in a residential area of north Kingston, yet is close to the town centre and local transport facilities. Murray House is one of four resouce centres for older people operated by the Community Care Services division of The Royal Borough of Kingston. Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.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 between 11.30 and 15.40. A partial tour of the premises took place and care records were examined. The Registered Manager, care staff, and some service users were spoken with. All comments received about the home were very positive and from observations of service users and their interactions with staff members it is concluded that service users are well cared for. What the service does well: What has improved since the last inspection? This continues to be a well run home, were the health, personal, social and emotional needs of service users are well met. A Requirement made at the last inspection of the service, regarding the need to make improvements to the medication administration process has been met. Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 Page 6 Standard twelve has been assessed as exceeding the National Minimum Standard. This is as a result of the home’s commitment to consultation with service users, and self-assessment regarding the range and quality of activities. It is also as a result of the availability of activities out with the home. 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. Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 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 standard(s) 3 and 5. There are good arrangements for ensuring that service users have their needs fully assessed prior to them moving into the home. This ensures that service user’s needs are met. Service users have good opportunities to visit the home prior to moving in. This allows an opportunity for exercising choice about whether the home will meet their needs. EVIDENCE: All service users are referred to the home through the local Older People and Disability Service. This means that each service user has a social worker who compiles a report about their needs. The management team at the home then make a decision as to whether these assessed needs can be met in the home. Needs assessment documentation was examined for the two most recent admissions. There was information about personal care and well-being, diet, sight and hearing, mobility, continence, medication, social interests, hobbies and religion. Prospective service users and their relatives and friends have an opportunity to visit and assess the home prior to moving in. The Registered Manager said that prospective service users are encouraged to look around the home and Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 Page 9 meet with staff members before moving in. One service user has recently been admitted to the home on an emergency basis. This service user had an opportunity for looking around the home with their social worker before agreeing to move in. Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 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 standard(s) 7, 8, 9 and 11. There are arrangements for ensuring that service user’s needs are identified and met. Service users and relatives have good opportunities to be involved in the drawing up of the care plan, this ensures that service users receive care in accordance with their wishes. Medication is, in general, handled safely, ensuring that service users are protected. EVIDENCE: Each service user has a care plan which is generated from a needs assessment. Care plans examined were found to be comprehensive and to provide detailed information about how staff members should address service users needs. Care plans included information about how service users could be assisted to retain some independence. Moving and handling risk assessments had been carried out, and care plans included information about any risks in this area. There was documentation detailing that care plans are reviewed on a regular basis, and updated to reflect changing needs. Staff members spoken with confirmed that care plans form the basis of the care that they provide to each Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 Page 11 service user. There were comments from service users and their relatives in a recently carried out quality assurance survey detailing satisfaction with the care planning process. Service users said that they were provided with a care plan and attended reviews of their care. Care plans included information about how health needs and there were records detailing that nutrition and weight is monitored. The Registered Manager said that there is currently no service user who has a pressure sore and that a number of service users receive visits from community nurses. Each service user is registered with a local GP. There were records documenting the outcomes of visits to service users by their GP. Additionally, service users see dentists and chiropodists on a regular basis. At the last inspection of the home there were found to be a number of unexplained gaps on service user’s Medication Administration Records. This issue has been addressed and all Medication Administration Records examined were accurate and up to date. There were records detailing that in-house audits of medication handling occur on a regular basis. One staff member confirmed that they had received training in the safe handling of medication. All medication was noted to be stored securely at the time of this inspection. Good practice occurs for the safe handling of controlled medication. There were no service users who were self medicating, however, there is a lockable cabinet in each bedroom should a service user wish to maintain their own medication. One service user had been prescribed eye drops and administration details were available. It is recommended however, that the date of opening is recorded on eye drops as an additional measure for ensuring that they are not used after there ‘use by’ date. The home liaises with community nurses and GP’s regarding pain relief for service users who are dying. Were appropriate, arrangements are made for the service user to be made comfortable in their own bedroom at the time near their death. Some staff members have received training in bereavement and care of the dying. The Registered Manager said that service user’s wishes regarding what happens after death are discussed during the admission process. She also said that the Royal Borough of Kingston Upon Thames contract has recently been amended and now includes a section for recording these wishes. Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 Page 12 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 standard(s) 12, 13, 14 and 15. Varied activities and wholesome and enjoyable meals are provided. Service users are consulted about meals, activities and other aspects of daily living and therefore differing expectations and lifestyles are well catered for. EVIDENCE: The home continues to provide service users with a wide range of activities and to seek their views on these activities. There was an activities programme displayed on each floor of the home. Activities on offer included a news discussion group, gardening, bingo, film club and a Church of England service. A number of service users were taking part in a yoga session during this inspection. Others were spending time in their bedrooms, the communal lounges and the garden. There have been organised trips to the seaside and Kew gardens and a sponsored walk in Richmond Park is planned. Additionally, a group of three service users are being supported by staff members to go on a week’s holiday. Service users spoken with said that they enjoyed the activities on offer in the home. One service user said that it was good to be able to get out on trips. Another said “There’s always something to do” the home has a licensed bar and a pleasant garden with plenty of tables and chairs. Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 Page 13 Visitors are encouraged in the home and the visiting policy is available in the Service User Guide. Visitors can be seen in the any of the four communal lounges, the garden, or in service user’s bedrooms. There have been recent requests from some service users and their visitors for a more private area to meet in. The home is making good efforts to address these wishes and is currently in the process of providing comfortable seating and hot drink making facilities for visitors in an area in the activities room. Service user meetings are held on a monthly basis. Details of when meetings are to occur were displayed on the home’s notice board, as were minutes of a meeting held in June 2005. A service user’s meeting occurred during this inspection which had a good attendance. Service users were observed to be able to exercise choice about issues in the home such as food, maintenance and staff. Service users are invited to attend a review of their placement in the home on an annual basis and are consulted regarding their care plan each month. There was a weekly menu available that detailed that meals provided are varied, and that a choice is always available. Fresh, wholesome and nutritious food was available in the kitchen and a nutritious and well-presented hot meal was served for lunch during this inspection. Tables were set attractively with napkins and flowers, and a choice of condiments was available. Staff members were available throughout the meal and provided appropriate support. Meals can be taken in bedrooms, or in one of three pleasant communal dining areas. One staff member said that hot and cold drinks are provided throughout the day, and on request. All service users spoken with said that meals in the home are enjoyable and of good quality. There are plans to consult with service users about the implementation of a new autumn/winter menu. Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 Page 14 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 standard(s) 16 and 17. There is a system in place for the effective handling of complaints and service users and their relatives are encouraged to raise any concerns they have. Service users therefore know that their concerns will be acted upon. EVIDENCE: There are policies and procedures in place for dealing with complaints. Information is made available in the Service User Guide about how a compliant, concern or suggestion should be made, and how this will be handled. This information also includes details about how a complaint may be made to the Commission for Social Care Inspection. Details about this are also made clearly available in the entrance hall of the home. The Registered Manager is currently in the process of dealing with a complaint made against the home. There was documentation detailing that appropriate procedures for handling complaints have been followed and that the complaint had been responded to in a timely fashion. Service users have their legal rights protected. In general, service users or their family members retain control over any legal issues. There is information available in the home about advocacy services. The Registered Manager said that all service users are given the opportunity to vote in general and local elections if they wish to do so. The activities coordinator is available to assist people to attend polling stations, or to provide support for postal voting. Confidentiality is taken seriously with personal records being stored securely and staff members being required to be familiar with the home’s policy on confidentiality. Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 Page 15 Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 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 standard(s) 19, 20, 21, 22, 23, 25 and 26. The home is, maintained, decorated and furnished to a high standard and in general facilities are clean and safe. This ensures that service users live in a pleasant, homely and comfortable environment. However, some shortfalls in hygiene maintenance have potential for placing service users’ health and well being at risk. Specialist equipment provided throughout the home maximises the independence of service users. A minor improvement in this area could promote further independence. EVIDENCE: The home is laid out over three floors, accessed by lift, stair lift or stairway. The home is decorated and furnished to a good standard and there is a routine programme of maintenance and redecoration. New carpets have been provided in some bedrooms since the last inspection and the hairdressings room was being redecorated during this inspection. The grounds of the home were tidy and there is a very pleasant and accessible garden with tables and Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 Page 17 chairs and a water feature. The home’s kitchen was inspected by an environmental health officer in July 2004 and was found to comply with health and safety Regulations. An inspection by the local fire safety officer in November 2005 found the home to comply with fire Regulations. There are a number of communal areas throughout the home. There are two lounges, a large dining area and a licensed bar/activities room on the ground floor. Smaller lounges/dining areas are available on the first and second floor. Lighting and furniture in these areas are suitable. Toilets and bathing facilities are provided on each floor of the home and are close to communal areas and bedrooms. Sluices are situated separately. The home was assessed in 2000 for its suitability for people who have a physical disability and individual service users are assessed by occupational therapists, depending on their individual needs. A Sensory Impairment Team have recently carried out an assessment of one floor in the home, with a view to improving facilities for service users who have a sensory impairment. The Registered Manager said that any changes would be made once the report from this assessment has been provided. Grab rails, assisted baths and raised toilet seats were noted to be available throughout the home. One raised toilet seat was not securely attached to a toilet during this inspection. A recommendation is made that this seat is adjusted to ensure that it is secure, and therefore safe. Documentation was available detailing that wheel chairs and hoists are serviced on a regular basis. There is a call system, with alarm facility in all areas of the home. All bedrooms are for single occupancy and heating, lighting, water supply and ventilation meet National Minimum Standards. Heating can be controlled individually in bedrooms. Each bedroom has a hand washbasin and water temperatures are tested on a regular basis. Service users spoken with said that they were happy with there bedrooms and feedback from a service user satisfaction survey reflected this view. Emergency lighting is provided throughout the home. The home was in general, clean, hygienic and free from offensive odours. However, one bedroom on the first floor of the home was found to smell unpleasant. The Registered Manager said that measures have been taken to reduce this problem. However, a Requirement is made that immediate measures must be taken to eliminate this odour to ensure that the service user using this bedroom lives in pleasant and comfortable surroundings. Laundry facilities are appropriate and hand-washing facilities are prominently sited. Policies and procedures are in place for dealing with the control of infection. A contract is in place for the disposal of clinical waste. Feedback from service users was that the home is generally kept very clean and tidy. There was documentation detailing that the main kitchen had been deep cleaned in January 2005. The Kitchen was found to be generally clean and well organised Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 Page 18 during this inspection, however, the base and hinges on one fridge were found to be very dirty. A further Requirement has been made regarding the need for this fridge to be cleaned. Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 28. There is a commitment to NVQ training. This provides staff members with the skills necessary for meeting the needs of service users. EVIDENCE: The Registered Manager said that the majority of care staff members have achieved a qualification at NVQ Level 2 in Care. There are currently three staff members undertaking this award and two staff members undertaking NVQ Level 3 training. The majority of senior care staff members are NVQ Assessors. Any new staff member recruited to the home is expected to work towards gaining an NVQ Level 2 in Care qualification. Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 35 and 38. There is leadership and guidance to staff members, ensuring that service users receive consistency in care. A good quality assurance system is in place. Therefore, practice is in the best interests of service users. There are good systems in place for maintaining safety in the home. This ensures that service users are protected and that their well-being is prompted. EVIDENCE: The Registered Manager has been in post for a number of years. She has experience in working with older people and has completed the NVQ Level 4 in Management Award. One staff member spoken with said that they received good support from the Registered Manager and that there were clear lines of accountability in the home. The Registered Manager demonstrated a management approach that was positive and open during this inspection. She was observed to share Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 Page 21 positive relationships with both staff members and service users. The Registered Manager chaired a service user’s meeting were service users were informed about issues of daily living in the home, and were encouraged to contribute their thoughts and wishes. There are good systems in place for monitoring the quality of the service and for ensuring that the home is run in the best interests of service users. A Development Plan was available dealing planned action for improvements in the home over 2005/6. The results of a recent service user and relatives quality assurance survey were available. The home has made good progress in monitoring survey results and taking action to make improvements were requests for improvements have been made. Feedback is also received from service users and their family members in regular meetings, at reviews and on an ongoing, informal basis. Service users are kept informed about inspections undertaken by the Commission for Social Care Inspection and a copy of the summary of each report is made available to service users. Small amounts of money are retained in the office safe for service users who request this service. Written records were available of transactions, including the signatures of staff members who handle the money and receipts. There are good arrangements for ensuring safe working practices in the home. All staff members undergo training in safe working practices and safety procedures are posted throughout the home. Risk assessments of the premises and individuals are in place. All accidents and incidents are recorded. There were records detailing that the gas system had been serviced in July 2005. Portable appliances were testing in 2002. Testing for legionella occurs. All hoists in the home were serviced in December 2004. There are good systems in place for fire safety including regular testing of the fire alarm and emergency lighting and regular fire drills. Two Requirements were made during this inspection in relation to health and safety issues (Refer to Standard 26) Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.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 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 x 3 2 STAFFING Standard No Score 27 x 28 3 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 x 3 3 3 x 3 x x 3 Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 Page 23 No. 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 26 Regulation 23 (1)(a) 16 (2)(k) Requirement Timescale for action 01.09.05 2. 26 23 (1)(a) 16 (2) (j) The Registered Persons must ensure that there is not an unpleasent odour in the bedroom in the first floor identified during this inspection. The Registered Persons must 01.09.05 ensure that the kitchen frigde is kept clean at all times. 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. Refer to Standard 9 22 Good Practice Recommendations The Registered Persons should ensure that the date of opening is recorded on eyedrops which are prescribed to service users. The Registered Persons should ensure tht all raised toilet seats are attached securely to toilets. Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 Page 24 Commission for Social Care Inspection CSCI 8th Floor Grosvenor House 125 High Street, Croydon CR0 9XP 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 Murray House G53-G53 S33769 Murray House V184177 020805 Stage 0.doc Version 1.40 Page 25 - 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!