Inspection on 30/08/07 for Nicholas House

This inspection was carried out on 30th August 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 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

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

CARE HOME ADULTS 18-65 Nicholas House The Broadway London Road West Amersham Buckinghamshire HP7 0EZ Lead Inspector Chris Schwarz Unannounced Inspection 30 August 2007 08:45 th Nicholas House DS0000069886.V349465.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 Nicholas House DS0000069886.V349465.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. Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Nicholas House Address The Broadway London Road West Amersham Buckinghamshire HP7 0EZ 01494 433788 01494 433788 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) Hightown Praetorian & Churches Housing Association Mr Andrew Curl Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home only (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following category: 2. Mental Health, not falling within any other category (MD) The maximum number of service users to be accommodated is 12. Date of last inspection New service. Brief Description of the Service: Nicholas House provides care for up to twelve adults who have experienced or are experiencing mental health problems. The service aims to be a short term rehabilitation service and works towards providing service users with a safe environment in which people can develop the emotional and practical resources needed for independent living in the wider community. The service is located within Old Amersham and is close to shops, pubs and transport links. Fees for the service were £547.19 per week at the time of this visit. Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was conducted over the course of a day and covered all of the key National Minimum Standards for younger adults. A further meeting was arranged at the service with the manager to provide feedback on the findings and to cover any remaining areas of inspection. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion and comment cards were distributed to service users, relatives and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with service users, examination of some of the service’s required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. The manager, staff and service users are thanked for their co-operation and hospitality during this unannounced visit. What the service does well: Prospective service users are thoroughly assessed prior to admission and are given opportunity to visit the home beforehand to ensure it meets their needs. Effective and detailed care plans are in place which adequately document service users’ needs and how these are to be met, within a risk assessment framework. Service users have a varied and active lifestyle which reflects their interests and provides opportunities for learning new skills and accessing the community, to promote independent living. The health and personal care needs of people living at the home are well met, promoting health and well-being and ensuring that they receive medication in a safe and consistent manner. Complaints and adult protection are effectively managed to listen to views of people who live at the home and reducing the risk of harm to them. The premises are clean, well decorated and adequately maintained, promoting a positive environment for the people who live there. Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 6 The service provides staff cover to meet needs and undertakes thorough recruitment procedures, coupled with effective training to ensure staff have the right skills and competencies to support the people who live there. The management and administration of the home promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. 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. Nicholas House DS0000069886.V349465.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 Nicholas House DS0000069886.V349465.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): 1,2,4 Quality in this outcome area is good. Prospective service users are thoroughly assessed prior to admission and are given opportunity to visit the home beforehand to ensure it meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service had a statement of purpose and service users guide in place, outlining the scope of the service and how it aims to meet the needs of people with mental health problems. Useful local contacts of outside agencies were included in the service users guide. The service had an admissions policy to guide staff on the process to be adopted when considering new referrals. Using the most recent admission as an example of how the service operates in this area of practice, it was clear that a wide range of background information had been obtained, including known risks and history. There was a record showing that the service user had been involved in pre-admission contacts with the service, visiting to meet other service users and share an evening meal. Once the admission had been arranged, a month’s assessment period was undertaken with a review at the end of this time. A comprehensive report of the assessment period had then been completed by the person’s keyworker. Overall this admission looked well managed and had progressed at the service user’s pace. Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 9 Most of the service users completing comment cards said that they had been given sufficient information before moving to Nicholas House. A care manager commented “I have always felt confident about Nicholas House’s assessments.” Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is good. Effective and detailed care plans are in place which adequately document service users’ needs and how these are to be met, within a risk assessment framework. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A sample of care plans and accompanying risk assessments were looked at as part of the inspection. Detailed care plans were in place with a photograph to identify the person. Signed agreements were in place regarding use of drugs and alcohol and management of medication; risk assessments had been drawn up covering various scenarios including risks associated with mental health problems. Missing person procedures were in place in the event of a service user being absent. Copies of relevant documentation from outside agencies were contained on files, such as Care Programme Approach care plans. There was evidence of reviews taking place this year for each person. In most cases, care plans and supporting documents were dated and signed. Staff said that training on person centred planning would be taking place shortly after the inspection, which may change the format and content of care plans at the Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 11 service. Current care plans promote service users being as independent as possible. The service holds regular house meetings which are minuted and provide evidence of service user consultation and involvement. Management of service users’ money is well handled, with accurate records kept of expenditure and safe storage facilities. A regular check is made of balances by staff; those balances checked as part of the inspection tallied with records. A care manager commented “Excellent service, both my clients have made great progress there. They and their families are delighted with care Nicholas House offers. I think they offer a wonderful service.” Another care manager said “It is always difficult in residential care to get the balance right (supporting people to live the life they choose) but Nicholas House does a good job with this.” A community psychiatric nurse described Nicholas House as a “very good service.” A relative said that the service “always seems non-judgemental” and added that their son was supported to make decisions. The relative went on to say that one of the things the service does well is “help with the rehab of our son, without institutionalising too much although this balance is difficult due to the nature of his illness.” Another relative commented “In our opinion Nicholas House meets our son’s needs very well…we consider that the care and support given to our son is excellent…and he is treated in a respectful and sensitive manner.” Another relative commented “I feel the care home has always been a great support to my son and taught him the skills to look after himself in the future.” Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good. Service users have a varied and active lifestyle which reflects their interests and provides opportunities for learning new skills and accessing the community, to promote independent living. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People responding via comment cards said that the service manages this aspect of care practice well. A health care professional said it “fully engages with the broader community”. A relative said that “Weekly activities are available e.g. football, badminton and trips out for the day. Encourages cooking and all domestic duties.” Another relative said “There are plenty of well organised activities, good food and the residents are encouraged to learn new skills which will help them in later life.” Service users also confirmed that they are involved in a wide range of activities, sports and in some instances work opportunities and college courses. Service users are expected to attend morning meetings during the week and to participate in keeping the premises clean as well as their own rooms. Service users prepare their own breakfasts Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 13 and lunches; cooking the evening meal for everyone is undertaken on a rotational basis with staff support. A cookery group is run once a week and there is a health eating group also weekly. The service is located opposite a large supermarket and ingredients for the main meal are purchased by service users each day. Contact with family and friends is maintained and visitors are asked to leave the premises by 9.00 pm. There is a payphone for service users to use. Nicholas House DS0000069886.V349465.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): 18,19,20 Quality in this outcome area is good. The health and personal care needs of people living at the home are well met, promoting health and well-being and ensuring that they receive medication in a safe and consistent manner. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service user plans provide good information about care needs and how these are to be met. No one required physical staff support to attend to personal hygiene or grooming although occasional prompts may be needed to remind people to carry out these tasks. A community psychiatric nurse (CPN) said that one of things the service does well is by providing “individualised care packages, focusing on the recovery model, aiding independence, insight and stability.” The CPN considered that the service liaises well with the community mental health team and raises any concerns as appropriate. It was also mentioned that staff attend Care Programme Approach reviews. A doctor said he was satisfied with overall care provided at the service and considered that staff communicate well with the surgery, demonstrate Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 15 understanding of care needs, manage medication appropriately and incorporate specialist advice into care plans. He also commented “excellent care provided, often in difficult circumstances.” These comments were echoed by two other doctors. A relative said “The care home has always helped and encouraged my son, especially if he is feeling stressed or anxious”. A care manager said she had not had any concerns at how health care needs are monitored by staff at the service. Medication practice supports service users taking responsibility for their medicines, subject to risk assessment and signed agreements. Where service users are managing their own medication, they have safe facilities in which to keep their medicines and agree to staff making spot checks to ensure that they are taking them. These spot checks are recorded and any problems identified and acted upon. The service’s medication cabinet is securely located in the office and was seen to be kept locked when not in use. Service users who do not manage their medicines themselves come to the office for medication to be administered. Records of drug administration were looked at and found to be in good order with no gaps evident alongside prescribed dose times. The service had a medication policy to refer to and individual “as required” medication protocols had been written with involvement of doctors. A record was being kept of the amounts of clozapine and “as required” medicines at the service. Specimen staff signatures had been collated to identify entries on medication administration records. It was noted that the service did not have any controlled drugs at the time of this visit. Staff had undertaken good quality training on the care and administration of medicines. The appropriateness of staff carrying out random testing for illicit drugs was discussed with the manager. The need for such testing to take place using urine dipping sticks was not an issue, the concern was the relevance of care staff doing this rather then external health care professionals. It is recommended that the manager reviews this practice with senior management within his organisation and seeks to transfer responsibility to community health resources. Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome area is good. Complaints and adult protection are effectively managed to listen to views of people who live at the home and reducing the risk of harm to them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Most people who completed comment cards were aware of how to make a complaint. One person said “This information was given to us in a very helpful booklet when our son first became a resident…the staff have responded appropriately and in a very caring and efficient manner when we have raised concerns.” Another relative said “If my son or myself have any issues they are dealt with promptly.” There had not been any complaints about the service and the Commission has not been contacted directly by service users or their representatives. It was noted that the complaints and compliments log book contained several compliments about the service. Adult protection procedures were in place as well as the local authority interagency guidance. There had not been any Protection of Vulnerable Adults/safeguarding issues or referrals. Staff had undertaken safeguarding training recently. Useful local contacts to support service users are contained within the service users guide. Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24,30 Quality in this outcome area is good. The premises are clean, well decorated and adequately maintained, promoting a positive environment for the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Nicholas House is a two storey building located in Old Amersham. It is close to transport links and shops, pubs and a large supermarket are nearby. There is ample parking at the side of the building. The service provides accommodation for up to twelve people in single room accommodation. Bedrooms are close to toilets, showers and bathrooms and service users have keys to their doors. There are two lounges, one nonsmoking, a main kitchen and a second, smaller self-catering kitchen. A range of leisure equipment is available to service users and there is internet access. Service users have access to a laundry and there is a well maintained garden with seating and a barbeque. Lighting and ventilation were sufficient in the building although attention is needed to one shower room where there is no Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 18 natural ventilation and grouting had become brown around some of the tiles. A recommendation is made to address this. All toilets had the necessary items for hand washing and it was noted that paper towels had been provided as a way of improving hygiene standards in the service. There were no issues with odour control at the service. The building was generally clean, well maintained and communal areas had been arranged to look homely. Advice was given to replace non-slip shower mats where they have become grubby and to ensure that spills on carpets are cleaned promptly. Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 Quality in this outcome area is good. The service provides staff cover to meet needs and undertakes thorough recruitment procedures, coupled with effective training to ensure staff have the right skills and competencies to support the people who live there. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Positive feedback was received from those who completed comment cards about staffing. One person said “We are deeply indebted to Andy Curl and our son’s keyworker and to all the other members of staff for the wonderful care given to our son and for giving him and ourselves hope for the future.” Another comment was “The skills and experience of the care staff appear to be excellent.” A service user said “The staff are fantastic.” Rotas were arranged with sufficient staff to meet care needs and to support activities and groups. No agency staff were being used to cover the rota. Records showed that regular staff meetings were being held to discuss practice and current issues. Staff described a good sense of team work and were seen to communicate information between each other and different shifts. Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 20 The full range of required recruitment checks were being carried out before staff commenced work at the service, with copies of documents available for inspection. Records of training showed that staff have undertaken and kept up-to-date with mandatory courses and specialist training has also been attended. There was good uptake of National Vocational Qualifications. Induction of a new member of staff was following a structured and detailed format over the course of six months, with mandatory training arranged to take place during this time. Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 21 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): 37,39,40,42 Quality in this outcome area is good. The management and administration of the home promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The service has an experienced and competent manager who is registered with the Commission and is qualified in excess of the minimum standards. He is able to demonstrate compliance with The Care Standards Act 2000 and accompanying regulations and other practice requirements and legislation. The detailed self-assessment audit submitted before the inspection had been completed to a good standard and bore close resemblance to the findings of this inspection. Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 22 There have been numerous visits to the service from senior managers and line management since change of provider earlier in the year and the manager felt well supported by the new organisation. There were policies and procedures to refer to at the service for guidance. The corporate policies file was poorly laid out making it difficult and time consuming to find key documents, which could be a deterrent for staff. The provider should look at ways of making the information more readily accessible to staff and a recommendation is made to address this. There was good regard for health and safety with routine fire safety checks regularly recorded and a fire risk assessment in place. Contraventions to fire safety identified by the fire officer in 2006 had been rectified. Fridge and freezer temperatures were being monitored and fridges were kept clean with dates of opening written on labels and cling film used to cover opened foods. The last environmental health inspection resulted in the service being given the prestigious Gold Award for food hygiene standards. Portable electrical appliances had been tested in October 2006 and there was a current gas safety certificate and electrical hard wiring certificate. The boiler had been serviced in April this year and generic risk assessments were in place. Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 2 3 3 x 4 3 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 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 x 3 x LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 3 3 x 3 x Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action 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 Refer to Standard YA20 Good Practice Recommendations It is recommended that the manager reviews the practice of carrying out random drug testing with senior management within his organisation and seeks to transfer responsibility to community health resources. It is recommended that ways of improving ventilation in the shower room be explored and that stained grouting around wall tiles is replaced. It is recommended that the policies and procedures file be better organised and indexed in order that important information is readily accessible to staff. 2 3 YA24 YA40 Nicholas House DS0000069886.V349465.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection 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 Nicholas House DS0000069886.V349465.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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