Inspection on 03/10/06 for Northwood House

This inspection was carried out on 3rd October 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Northwood House 30/09/09

Northwood House 28/09/07

Northwood House 27/02/06

Northwood House 20/06/05

Northwood House 17/01/05

Northwood House 07/09/04

Northwood House 22/01/04

Similar services:

Insight - Eastchurch

Southfields

Thorndene

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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

CARE HOME ADULTS 18-65 Northwood House 28 London Road Sittingbourne Kent ME10 1NA Lead Inspector Robert Pettiford Unannounced Inspection 3rd October 2006 09:00 Northwood House DS0000023981.V313728.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 Northwood House DS0000023981.V313728.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. Northwood House DS0000023981.V313728.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Northwood House Address 28 London Road Sittingbourne Kent ME10 1NA 01795 472464 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) Kent Assessment & Training Services (Swale) Limited Denise Simpson Care Home 7 Category(ies) of Learning disability (7) registration, with number of places Northwood House DS0000023981.V313728.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27th February 2006 Brief Description of the Service: The Home is a detached property with accommodation for service users on two floors with office accommodation on the third floor. The home is situated on the outskirts of Sittingbourne approximately 1 mile from the town centre providing access to shopping and all public amenities. The Home offers services for people with learning disabilities who may challenge the service. The Home is is registered for seven service users. Excluding the Registered Manager, the Home employs full/part time care staff who work a rota which includes one staff member working at night on waking duty with a further staff member on-call sleeping. A further senior staff member is available on-call in an emergency. In addition to care staff there is a staff member who undertakes cleaning duties. The Registered Manager, Ms Denise Simpson, undertakes management of Westdene in addition to Northwood House. Although both homes have defined staffing groups, staff from each of the homes have worked in the other home when required, and staff emergency oncall at night has been provided through the sleep-in staff member at Westdene. Northwood House DS0000023981.V313728.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 2nd October 2006 at 8:50am. The Inspector agreed and explained the inspection process with the Registered Manager. Documentation and records were read, including care plans. Time was spent reading a sample of written policies and procedures, reviewing care plans and records kept within the home. A tour of premises was also undertaken. The focus of the inspection was to assess Northwood in accordance to the National Minimum Standards for Younger Adults. In some instances the judgement of compliance was based solely on verbal responses given by those spoken with. Time was spent by the inspector observing service users in their daily activities and discussing the standard of care within the home with the Manager, staff and service users. The inspector also had the opportunity to discuss the standards of care with relatives and a service users. Information with regard to fees is available from the home. The range of such fees is £950.00 to £2,300.00 dependent on the assessment of the service users needs. What the service does well: What has improved since the last inspection? Improvements were noted in all areas with the exception of the environment and further progress noted with regard to maintaining the National Minimum Standards and improving the standards of care for all service users. Northwood House DS0000023981.V313728.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Northwood House DS0000023981.V313728.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 Northwood House DS0000023981.V313728.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,4,5 Quality in this outcome group is good Service users have the information they need to ascertain whether the home can meet their needs though some minor amendments were noted as being needed. Service users rights are protected by a written contract. Prospective service users also have the benefit of a trial period at the home. Service users can be confident that their needs will be properly assessed prior to moving to the home. EVIDENCE: The Statement of Purpose and Service Users Guide for Northwood was seen to include most of the information outlined in the Standards. The Manager was requested to ensure that it includes all information outlined in Standard 1.2 and Schedule 1.of the Care Standards Regulations. The Manager reported that a copy of the previous inspection reports are made available to service users and their families on request. A written contract / statement was available outlining service users’ rights, responsibilities, and conditions of placement is in place at Northwood. Each service user has been provided with a copy. Northwood House DS0000023981.V313728.R01.S.doc Version 5.2 Page 9 Records held showed that service users have an assessment which identifies their individual needs prior to or on admission to the home. The information is provided by the service users, their families and health / social care professionals. This is then reflected into the care plans and these are developed in agreement with the individual. The records also reflected that there may be a transitional period for new service users and ongoing assessments to meet the changing needs were evidenced within service user records. Prospective residents have the benefit of a trial period at the home to assess whether the home can or cannot meet their needs. Northwood House DS0000023981.V313728.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome group is good Service users benefit from having clear and in-depth care plans that identify their individual needs, aspirations and goals and give clear guidance to staff. Service users are treated with respect and their dignity and independence is promoted. Service users are enabled to take risk within a risk management framework. EVIDENCE: The inspector viewed and discussed with the Registered Manager the care records relating to several service users who lived at Northwood. In the care plans viewed there were clear guidelines in respect to support needed with regard to strategies to manage and support service users with their challenging behaviour at Westdene. Plans sampled demonstrated that the home used positive planned interventions to manage behaviour. Northwood House DS0000023981.V313728.R01.S.doc Version 5.2 Page 11 The home undertakes regular reviews. Formal reviews involving significant professionals and relatives where possible are also undertaken. The home and its staff are committed to supporting the service users in accordance with their needs at Northwood. This was evidenced through the knowledge and experience of the staff seen by the inspector whilst supporting several service users. Care plans are developed following person centred planning principles. Each resident has a plan that has been agreed with him or her. It is presented in a format that ensures residents can access and understand the information it contains. It is written in plain language, is easy to understand and considers all areas of the individual’s life including health; specialist treatments, personal and social care needs. Staff have skills and ability to support and encourage residents to be involved in the ongoing development of their plan. Staff make the process interesting, using a variety of ways to enable residents to make a worthwhile contribution. A key worker system enables staff to establish special relationships and work on a one to one basis. Key to achieving an individually appropriate lifestyle is the Service User Plans. At Northwood care plans are determined by assessment and drawn up between the home and the service user /relative. They put the individual at the centre of service delivery by the care home. The Plans seen reflect the needs, aspirations and goals of the individual, set out the services to be provided by the care home to meet needs and achieve goals. No recording systems were seen to be in place to identify if the service users hopes and aspirations are being achieved. The manager stated that this would be reviewed and incorporated into the care planning system in future. It is evident through talking to members of staff that the emotional health of the service users is of a high priority to the home and that staff are pro-active in maintaining and supporting Service Users with their emotional needs in order to maintain their quality of life. The inspector spent some time talking to a number of service users who expressed their opinions of the home. All of them felt that Northwood was a nice place to live and spent time chatting with the inspector with regard to the activities they participated in and job and learning opportunities. Risk assessments were discussed with the manager and viewed and detailed documentation recorded how to support Service Users to minimise risks for personal safety. Northwood House DS0000023981.V313728.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,16,17 Quality in this outcome group is excellent Service users can be confident that they are offered opportunities for personal development and to learn new skills and feel part of the wider community. Service users on the whole engage in a higher than average level of activities which are appropriate to their needs. Service users are supported to maintain contact with family and friends, which ensures they continue to receive stimulation and emotional support. The service users benefit from the appetising meals and balanced diet offered at the home. EVIDENCE: Service users are enabled to participate and contribute to meeting their own self care needs and day to day chores around the house. Northwood House DS0000023981.V313728.R01.S.doc Version 5.2 Page 13 Discussion with the Registered Manager and staff confirmed that the level of activities were of a high level and good quality for all of the service users and that they enjoyed a good level of stimulation through leisure and recreational activities both inside and outside the home. Three of the service users spoken with are supported to continue their education and learn new daily living skills. This support is offered by Skillnet. Service users have been enabled to and encouraged to participate in hobbies and activities which they had an interest in, such as maintaining and building on personal collections and specific recreational activities. It was confirmed that service users are enabled to maintain contact with relatives and friends where they wished to do so. Examples of such included provision for relatives and friends to visit the home and support being provided to enable services users to visit relatives or friends outside the home. Service users were consulted with regard to whom they saw and when and were under no compulsion to accept visitors should they not wish to do so. None of the service users who were discussed about with staff had any spiritual needs which they actively addressed, however it was confirmed that where this was the case all appropriate support would be provided. From observation, records viewed it was evident that service users were offered a choice of menus that meet their dietary needs and individual preferences. Meal times are flexible to suit the service users’ activities and schedules. Service users are able to choose where to eat, and also have facility to make drinks, meals and snacks for themselves and others with staff support should they wish. Service users on evidence seen have had been involved in planning and choosing menus. Northwood House DS0000023981.V313728.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19,20 Quality in this outcome group is good Service users feel supported by the level of help given and that their healthcare needs are addressed. Service users can feel on the whole confident that they are supported by the homes policy and procedures for storing and administering medication. EVIDENCE: Times of getting up / going to bed, having baths, eating meals and other activities at Northwood are flexible to allow for different service users daily routines. Service users were able to make their own choice where possible with regards to what they wished to wear and their hairstyles and this was evident by their individual appearance. The inspector observed excellent interaction between staff and Service users. The homes records fully documented all physical and emotional healthcare needs which is monitored on a daily basis. Records of health care provided by G.P, chiropodist, dentist, and opticians were evidenced. This system ensures that all Service Users receive continuity of care and support and that potential complications and problems are recognised and dealt with at an early stage. Northwood House DS0000023981.V313728.R01.S.doc Version 5.2 Page 15 Staff actively promote the service users right of access to the health and remedial services that they need, both within the home and in the community. Regular appointments are seen as important and there are systems in place to make sure residents are reminded and appointments are not missed. The manager reported that at the time of the inspection no residents were undertaking management of their own medication. The room used to store the medication was found to be suitable. The Home uses a Monitored Dosage System. The inspector viewed the storage arrangements and some records including Medication Administration Record (MAR) sheets, and the protocols for the administration of “PRN/As Required” Medication. The manager informed the Inspector that all staff administering medication have completed the necessary training. The inspection of the medication brought to light several areas which were in need of being reviewed. Prn or as required medication protocols were not written up for all Prn medication. No evidence was seen that any guidelines had been drawn up or that they had been agreed by the Doctor or contained a review date. The inspector requested that the need to write up the MAR sheet is reduced to an absolute minimum. If it was necessary in limited circumstances (following a private consultation between the service user and the Doctor) to add items to the sheet, that it is checked and verified by two members of staff. It is also requested that a copy of the prescription be kept to verify correct drug, dosage, and time of administration, to ensure that it had been recorded properly. Any amendment to the dosage should either be countersigned by the GP or other evidence of his/her agreement obtained. The manager agreed to address these issues and include within the home’s action plan. Northwood House DS0000023981.V313728.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Quality in this outcome group is good. Service users know that their concerns and complaints are taken seriously and are protected from the risks of abuse. EVIDENCE: A copy of the Home’s complaints procedures was reviewed along with the manager. The procedure included details of how to complain, timescales for response and information for referring a complaint to the Commission for Social Care Inspection a copy of the complaints procedure has been provided and explained to service users where possible. The home’s Policy for the Protection of Service Users and staff “Whistle blowing” procedure was discussed. These include procedures for the reporting of suspicion or evidence of abuse with a format for the recording of any allegations and action to be taken. Full training is provided in abuse. Criminal Record Bureau Checks (CRB) have been obtained for all staff. The Manager is aware of her obligations with regard to ensuring the safety of Service users and protecting them from abuse. Northwood House DS0000023981.V313728.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,25,26,27,28,30 Quality in this outcome group is poor. Service users do benefit from which is suitable for their needs however it is not well maintained or clean due to poor maintenance and the need for refurbishment. EVIDENCE: The Inspector undertook a tour of the home including viewing some service users rooms, bathroom/toilet facilities and communal areas. Many areas of the home viewed appeared dirty especially the carpets and bathroom facilities. Fixtures and fittings and general decoration were seen to be of a poor standard. Urgent remedial work was seen as being needed due to the demands placed on the building by the service user group and further decoration of rooms to make the home appear more homely. The manager agreed that re-decoration was needed with the service users input and would include it within the home’s action plan. Northwood House DS0000023981.V313728.R01.S.doc Version 5.2 Page 18 The bedrooms are very well planned and all have on-suite facilities and were seen to be personal in nature with each service users expressing their own identity. The number of toilet and bathroom facilities provided by the Home meets current required standards. Northwood House DS0000023981.V313728.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 34,35,36 Quality in this outcome group is good. Service users’ care, social and emotional needs are promoted by the employment of caring and suitably trained staff. Service users are protected from potential abuse by the home’s robust staff recruitment procedures. EVIDENCE: The home has a mix of management personnel, care staff, maintenance specialist, and housekeeping staff. A copy of the staffing roster seen indicates that rotas have been prepared for the following month. The home provides sufficient staff to meet the needs of service users. The manager stated this was always under review to take in to account any extra activities and changing needs. The rota and observations during the inspection reflected sufficient staff to support residents to participate in activities and to meet their personal needs within Northwood. The Registered Manager stated that staffing levels are regularly reviewed taking account of the changing needs of residents. The Manager and the Registered Provider have encouraged a continuing development and training programme within Northwood, which has supported staff to attain a high level of training. Northwood House DS0000023981.V313728.R01.S.doc Version 5.2 Page 20 Training and development are linked to the homes’ service aims and to service users’ need and individual Plans. On-going training is taking place for all staff. The home has a development programmed which the Manager stated meets National Training Organisation (NTO) workforce training targets and ensures staff fulfil the aims of the home and meet the changing needs of service users. From records viewed by the inspector all staff had received training to NTO guidelines. The manager is in the process of updating the training matrix to reflect an overall picture of staff training within Northwood and ensuring that all staff are properly trained. The inspector viewed details of the Home’s recruitment procedure and a number of records relating to staff members recruited. The Home undertakes a recruitment practice including submission of an application form detailing all previous work history, requests proof of I.D and copies of qualification certificates, seeks written references. All staff appointments are subject to a probation period, which is subject to review. The Manager reported all staff had received statements of terms and conditions of employment, evidence of which was seen in the file. Staff receives supervision on a regular basis, as evidence by records seen within the home. Northwood House DS0000023981.V313728.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39,42 Quality in this outcome group is good. The home is run openly and efficiently, which enables the needs of the service users to be met. The home is run and managed to protect the health and safety and welfare of service users. EVIDENCE: The home operates a keyworker system to identify an individual staff member to directly to work with a service user on a one to one basis. The provider undertakes regular regulation 26 visits to monitor the quality of care within the home. Northwood House DS0000023981.V313728.R01.S.doc Version 5.2 Page 22 The inspector viewed records relating to staff training, Health and Safety Procedures, maintenance and servicing, and risk assessments, which were discussed with the manager. Staff training requirements had been identified and arrangements for staff to undertake the required training relating to health and safety. The inspector was able to evidence that the home had a Fire Log book, reflecting that checks and servicing of fire safety equipment had been undertaken at the required frequency. Pat Testing (portable appliance electrical testing) has been carried out within the home, along with the servicing and maintenance of all service and equipment Procedures are available for the reporting of accidents and incidents (Regulation 37) and records maintained of the same. The home was unable to evidence that COSH (Containment of Substances Hazardous to Health) assessments and data sheets were in place and an environmental risk assessment. Northwood House DS0000023981.V313728.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 3 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 1 25 3 26 3 27 3 28 3 29 X 30 2 STAFFING Standard No Score 31 x 32 x 33 x 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 2 x 3 x LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 x 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x x x 3 x x 3 x Northwood House DS0000023981.V313728.R01.S.doc Version 5.2 Page 24 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA24 Regulation 23(2) Requirement 23.—(2) (b) the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally; Timescale for action 02/04/07 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 Northwood House DS0000023981.V313728.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Northwood House DS0000023981.V313728.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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