Inspection on 19/02/07 for Myrtle Cottage

This inspection was carried out on 19th February 2007.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Myrtle Cottage 25/10/05

Myrtle Cottage 20/04/05

Myrtle Cottage 01/12/04

Myrtle Cottage 24/06/04

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Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Myrtle Cottage 123 New Brighton Road Emsworth Hampshire PO10 7QS Lead Inspector Mr E McLeod Unannounced Inspection 19th February 2007 03:00 Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 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 Myrtle Cottage DS0000058347.V324651.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 Adults 18-65. 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. Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Myrtle Cottage Address 123 New Brighton Road Emsworth Hampshire PO10 7QS 01243 370500 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) Dolphin Homes Limited Miss Stephanie Leigh Turner Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th October 2005 Brief Description of the Service: Myrtle Cottage is a large, detached older style property set within the residential area of Emsworth, Hampshire. The property blends suitably in style with the surrounding properties and has been tastefully converted to provide a suitable home for six younger adults with learning disabilities. There is a large lawn area to the front of the property, surrounded by fencing to ensure privacy and a smaller rear garden. Adequate car parking is provided to the front of the property. Bedrooms have been installed with en-suite facilities and these are tastefully decorated and furnished with service users being encouraged to personalise their room to reflect their interests. There is a spacious, family feeling throughout the home. Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was arranged to update assessments of key standards from the National Minimum Standards made at the previous inspection. The key unannounced inspection visit to the home was undertaken by one inspector on the 19th February 2007 from 3.10 p.m. until 6.30 p.m. The registered manager had completed a pre-inspection questionnaire and information from this plus evidence from previous inspections has been used to inform the planning and inspection process, and this report. Evidence gained during the inspection visit also informs this report. On the day of the inspection visit, the inspector spoke with three residents, two staff, and a line manager for the home. A partial tour of the premises was made. The inspector sampled three sets of admission records for residents, and three sets of care plans. Three sets of staff recruitment and training records were also sampled. The inspector observed an evening meal, and interactions between staff and residents. A number of policies, procedures, and health and safety records were also sampled. What the service does well: There is a good atmosphere in the home, and residents and staff have a positive view of living and working there. Residents enjoy a good lifestyle, and feel they are being encouraged to be as independent as possible. Staff feel supported in trying new things, and have individual areas of the work they take responsibility for. Residents are developing their confidence and life skills in measurable ways, and each resident has a key worker who works closely with them in attaining his or her aims and objectives. The house and grounds are well maintained, decorated and furnished to a good standard, and comfortable and homely. Myrtle Cottage DS0000058347.V324651.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. The summary of this inspection report can be made available in other formats on request. Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. YA2 New service users are admitted only on the basis of a full assessment undertaken by people competent to do so. EVIDENCE: The statement of purpose has been updated to include the service user’s guide. After initial assessment, residents come for visits – tea, afternoon visits and overnight stays over a period of months which helps prospective residents to get to know staff and residents. Three sets of pre-admission records and assessments were sampled, which indicated that residents are being properly assessed before the decision to admit the person is made. Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. YA6, 7, 9 Residents know their assessed and changing needs and personal goals are reflected in their individual plan. Residents make decisions about their lives with assistance as needed. Residents are supported to take risks as part of an independent lifestyle. EVIDENCE: Three sets of care plans were sampled, which indicated that residents’ needs and how they will be met are recorded in a care plan. Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 10 Discussions with staff indicated that residents are very much involved in writing their care plan and in the review of the care plan. One resident interviewed said she added things into her care plan that she wished included. Staff interviewed advised that at a recent care plan review a resident chaired his review meeting, put together the agenda, and asked questions of the people assembled. There was evidence during the inspection visit that residents are supported to manage their own finances, and residents interviewed knew where their money was held and had direct access to it. Staff interviewed said that helping residents with budgeting and using money was part of the independence skills being promoted at the service. Risk assessments were sampled, and there was evidence that action is taken to minimize identified risks and hazards. Residents interviewed said they participated in fire training sessions provided in the home. Staff interviewed provided other examples of how assessed risks are being managed in cooperation with the resident. Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. YA12, 13, 15, 16, 17 Residents are able to take part in age, peer and culturally appropriate activities. Residents are part of the local community. Residents’ rights are respected and responsibilities recognised in their daily lives. Residents have appropriate personal and family relationships. Residents are offered a healthy diet and enjoy their meals and mealtimes. EVIDENCE: Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 12 In the home, residents receive support with doing arts and crafts and developing independent living skills. Relaxation and hand massage are provided, and residents’ meetings take place. Outside of the home, residents are accessing day services, discos, educational courses, cafes, pubs, theatre, cinema, and the library. The service has a mini bus, which had been used for a residents’ outing on the day of the inspection. Residents talked with the inspector about activities planned for later in the week. One resident interviewed said he enjoys running, and on the evening of the inspection he was being taken by the staff to the local sports centre to do some running. Another resident said it was “lovely here”, and that when her key worker takes her to the hairdresser in town they go for a cup of coffee which she enjoys. One member of staff said “the guys tell us what they want and we do what we can to make it happen”. Staff interviewed said that residents all have times or days when they ring mum or other relatives, and go home for weekends and holidays. Staff interviewed felt that there was a good relationship between relatives and friends and staff at the home. Residents interviewed had keys for their bedroom, and residents said staff only came into their rooms when invited to, while also saying that staff had a spare key which could be used to enter their bedroom in an emergency. It was the observation of the inspector that residents were being treated with respect, and no incidents which indicated that residents were being discriminated against on account of their disability, gender or race were noted. Mealtimes are reasonably flexible, and special diets and minority ethnic group diets are catered for. Residents have a choice of menus, and there are facilities for them to make drinks and snacks. Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 13 At a mealtime observed by the inspector, residents were involved in cooking and preparation, and one resident who wished an alternative to the main course had been asked what she wanted to eat and the ingredients were bought that afternoon. Residents interviewed said they enjoyed the food, and residents who needed assistance with their food were receiving this. Residents were eating in a relaxed and sociable atmosphere. Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. YA18, 19, 20 Residents receive personal support in the way they prefer and require. Residents’ physical and emotional health needs are met. Residents retain, administer and control their own medication where appropriate and are protected by the home’s policies and procedures for dealing with medicines. EVIDENCE: Registered manager Ms Turner advised the Commission that residents choose their GP, surgery, dentist and optician, and access services such as audiology, speech therapy, physiotherapy and dietician through their GP. Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 15 One resident was receiving full one to one support on the day of the inspection, and staff advised the inspector that the three staff the resident gets on best with are the ones who are assigned to his care. Privacy and dignity is being promoted, and staff said residents attend to their own cleanliness, with prompts if needed, do their own bathing, and choose their clothes. Residents said that they felt supported by their key worker. At key worker meetings staff said whatever is important to the resident at the time, be it college, friendships, or aims for the future for example is what is discussed. . One resident was doing her laundry, and said she also does her own ironing. She said she feels she is “treated fairly” by staff, and that staff observe residents’ wishes for privacy, and knock on doors before entering. Staff interviewed felt what the home did well was to really allow residents to follow through the choices they make and be independent as possible “even if it takes an hour”. One member of staff said the task with a resident he was key working was “making him more streetwise” and helping him develop independence skills such as using money, budgeting, cooking, walking in crowds, being in pubs, and dealing with confrontation. One member of staff said it was “brilliant” to see residents develop their independence, doing things that used to be done for them. One resident has been assessed as able to administer her own medication, and a risk assessment was carried out as part of this assessment. The resident has a lockable space for storing her medicines, and staff advised that the medication for all residents is reviewed at least once a year by a qualified person. The inspector sampled two sets of medication records, and observed two residents receiving medication and records being completed accordingly. The inspector was advised that there is a plan to include a photograph of each resident for reference as part of the medication record, in order to ensure greater safety. Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 16 Medicines are stored in a lockable cabinet and staff receive training in administering medicines. Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. YA22, 23 Residents feel their views are listened to and acted on. Residents are protected from abuse, neglect and self-harm. EVIDENCE: The provider advises that no complaints have been received, and no adult protection investigations have been undertaken. The director of care is appointee for the finances for one resident. Residents have their own bank accounts, and residents interviewed felt they were in control of their finances with appropriate assistance from staff. There is an adult protection policy and procedure in place, which includes advice to staff on the provider’s responsibility to refer staff “disciplined for misconduct which have harmed or placed at risk a vulnerable adult” to the Protection of Vulnerable Adults register. Staff receive training on adult protection, and senior staff attend training on local adult protection procedures. Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. YA24, 30 Residents generally live in a homely, comfortable and safe environment. The kitchen flooring is however in need of replacement. All areas of the home visited were clean and hygienic. EVIDENCE: A partial tour of the premises was made. Systems are in place to ensure that maintenance or replacement work required is recorded and undertaken. Improvements to the premises since the previous inspection include redecoration of bedrooms and work on the exterior of the building. Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 19 The garden, patio and outbuildings are in good order, and the exterior of the building is being well maintained. The home is furnished and decorated to a good standard, and is comfortable and homely. There are six single rooms provided, all of which have en suite facilities and are over 10 square metres in area. Three bedrooms were visited, all in good decorative order and appropriate to the lifestyles residents are leading. Bedrooms are personalised by residents. Bathrooms and toilets are in good decorative order and meet the needs of residents. The communal areas are well used by residents, and staff advised that residents are planning the redecoration of the sitting room. The kitchen flooring is wearing in places, and an environmental health department visit the previous week had referred to this. The laundry room has suitable facilities, and floors and walls in the laundry room are washable. All areas of the home visited were clean and hygienic. Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. YA32, 33, 34, 35, 36 Residents are supported by competent and qualified staff. Residents are supported by an effective staff team. Residents are supported and protected by the home’s recruitment policy and practices. Not all staff are receiving regular training or supervision which would better ensure that residents’ individual and joint needs are met. EVIDENCE: Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 21 Five of the staff have the National Vocational Qualification (NVQ) in care at level 2 or above. Staff interviewed were competent and clear about how they were expected to undertake their work and observe good practice. Interactions observed between residents and staff indicated that there is a trusting relationship and residents find staff approachable and supportive. Staff rotas seen indicate that there are 3 care staff on during the day from 7 am to 7 pm, one night staff member from 7 pm to 7 am and one sleepover staff member who is on duty until 10 p.m. Staff interviewed said that all staff do day and night shifts, which helps maintain consistency between the shifts. Three sets of recruitment records were sampled, which indicated that a thorough recruitment procedure which protects residents is operated. Staff said that residents were involved in interviewing new staff, and one member of staff said that residents asked him questions at his interview such as “do you cook?” and “do you drive?”. On staff records sampled, the questions and comments of residents at interview were recorded. Staff interviewed said that new staff undertake an induction training which includes working alongside other staff for several shifts, and working on an induction work pack. Staff training in the past year has included the care and administration of medicines, coping with aggression, diet and nutrition, induction training, adult protection, risk assessment, active listening, and NVQ qualification. Mrs Spriggs said the aim of the company was for staff to do refresher training in core topics once per year. Training records seen by the inspector indicated however that there are some gaps in the staff training provided. Staff interviewed said they felt supported in their work, and able to carry through ideas to make residents’ lives better. Staff supervision records seen indicated that some staff are receiving a good level of supervision for which records are made, while the evidence suggested that other staff are not receiving supervision at least six times a year as recommended. Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. YA37. 39, 42 Residents benefit from a well run home. Residents are confident their views underpin all self-monitoring, review and development by the home. The health, safety and welfare of residents must be promoted and protected by ensuring that all staff receive regular training in health and safety topics. EVIDENCE: Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 23 Staff interviewed felt that the home was well managed, and that registered manager Ms Turner was ensuring that the purpose, aims and objectives of the service were being met. The evidence of care records sampled supports this view. The company’s quality assurance review form includes sections on information for residents, staff records, records required to be held in the home, health and welfare of service users, assessment of needs, facilities and services, complaints and fitness of premises. Ms Turner advised the Commission that a questionnaire survey has been sent to relatives, and that the key worker supports the resident is recording his or her views of the service. The inspector sampled resident and staff questionnaires which had been completed, and the provider’s summary of responses received was seen. ThE previous requirement made in respect of this is now assessed as met. Records of provider monitoring visits were sampled, which indicated that visits were unannounced, and staff and residents were interviewed and their views recorded. Action to be taken was recorded. Ms Turner has advised the Commission of the most recent inspection and service visits which have taken place, and also informed us that policies and procedures in the home were last reviewed in August 2006. Health and safety training in the past year has included fire safety and awareness, food and hygiene, infection control, moving and handling, health and safety and emergency first aid. Ms Turner advises that 5 care staff hold a current first aid certificate. As noted in the previous section, however, some gaps in the training of individual staff members were noted. An inspection by the environmental health department of the premises on the 16th February 2007 found standards commendable, but that the flooring in the kitchen needed replacement – Mrs Spriggs advised the inspector that this work will be undertaken to comply accordingly. Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 3 14 3 15 4 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 2 X Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 25 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. 2. Standard YA42 YA36 Regulation 23.2 (b) 18.2 Requirement The premises must be kept in a good state of repair, to include replacement of kitchen flooring The registered shall ensure that persons working at the care home are appropriately supervised Persons employed by the registered person to work at the care home must receive training appropriate to the work they are to perform Timescale for action 25/05/07 30/03/07 3. YA35 18.1 (c) 30/03/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Myrtle Cottage DS0000058347.V324651.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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