Inspection on 03/10/05 for Oakmeadow Community Support Centre

This inspection was carried out on 3rd October 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 but made no statutory requirements on the home.

Other inspections for this house

Oakmeadow Community Support... 30/06/06

Oakmeadow Community Support... 20/06/05

Oakmeadow Community Support... 19/01/05

Oakmeadow Community Support... 01/10/04

Oakmeadow Community Support... 04/03/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Oakmeadow Community Support Centre Peelhouse Lane Widnes Cheshire WA8 6TJ Lead Inspector David Jones Announced Inspection 3rd October 2005 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Oakmeadow Community Support Centre Address Peelhouse Lane Widnes Cheshire WA8 6TJ 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) 0151 424 9185 0151 420 1993 dorothy.white@halbon.gov.uk Halton Borough Council Francine Coy Care Home 32 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (3), Old age, not falling within any other of places category (32), Physical disability (2) Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 32 service users to include: * Up to 22 service users in the category of OP (old age not falling within any other category). (Hawthorns 7, Ashleigh 8 and Elms 7 = 22) * Up to 10 service users in the category DE(E) (dementia over the age of 65) may be accommodated. (Chestnut and Beeches). * Up to 3 service users in the category DE (dementia 55 years and over) may be accommodated. (Hawthorns1, Chestnuts and Beeches 2) * Up to 2 service users in the category PD (physical disability 55 years and over may be accommodated. (Hawthorns 2) * Up to 2 service users in the category OP (old age not falling within any other category) who are 60 years of age and over may be accommodated on Hawthorns and Elms areas of the home from time to time. The registered manager must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of service users at all times and shall comply with any guidelines that may be issued through the Commission for Social Care Inspection. The registered provider must ensure that Ms Francine Coy achieves a qualification at NVQ level 4 in care by 31st December 2005 20th June 2005 2. 3. 4. Date of last inspection Brief Description of the Service: Oak Meadow is a Local Authority Community Support Centre that incorporates a day centre and a personal care home. The day centre is not subject to inspection. The care home offers personal care on a permanent or short term/respite basis for up to 32 older people. It includes an intermediate care unit The Hawthorns for up to 7 residents and dementia care unit The Beeches and Chestnuts for ten residents. It is owned and managed by Halton Borough Council. The premises are purpose built and designed to meet the needs of older people. They are set out on three floors with first, second and mezzanine floors. Access to the second floor is provided by stairways and a Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 5 passenger lift. Accommodation is set out in a number of group living areas each equipped with lounge/dining room with kitchenette, and bathroom and toilet facilities. Twenty single bedrooms each have a washbasin, hot and cold running water and privacy screening, where required. A further 12 single bedrooms are provided with en-suite facilities. Kitchen and laundry facilities are located on the mezzanine floor, which are only accessible from the lift in the interior of the building. The home is located in a residential area of Widnes with access to public transport and local amenities Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place on one day the 3rd October 2005, over a 7 and a half hour period. Fourteen residents, four members of staff and one visitor were spoken with during the inspection. Comment cards were received from seventeen residents, seven relatives, three health and social care professionals and one GP. We looked at some parts of the building, looked at some records and read the case notes of three residents. What the service does well: Oakmeadow is run in the best interests of residents. The location and layout of the home is suitable for its stated purpose. It is accessible, safe, comfortable and well maintained. The standard of cleanliness is good. Residents benefit from the ethos, leadership and management of the home. The atmosphere in the home is relaxed and sociable. The vast majority of residents and visiting relatives speak highly of the home indicating satisfaction with facilities and services and the standard of care provided. Rehabilitation facilities are sited in a dedicated part of the home known as the Hawthorns and include equipment for therapies and treatment, as well as equipment to promote activities of daily living. A multidisciplinary team of staff including social care staff and health care professionals provide care and rehabilitation. Residents are helped to maintain and develop independent living skills so they can live in their own homes’ with assistance where required. There is a dedicated team of staff who present in good humour and carry out their duties in an efficient and effective manner. There is a sense of teamwork amongst the staff and management teams. Staff and resident meetings are held on a regular basis and staff benefit from regular supervision. The manager maintains detailed records of the home’s various health and safety systems including routine maintenance records, fire precautions, risk assessments, control of substances hazardous to health and precautions against Legion-Ella including disinfection of shower heads. Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 7 What has improved since the last inspection? What they could do better: The home’s admissions procedures must be fully employed to make sure that new residents are clear as to how the home will meet their needs and to make sure they are adequately prepared before moving in. Each new resident must receive written confirmation as to how the home will meet their identified needs before they move in. Without this information residents are disadvantaged when making decisions about the home. Communication amongst staff and health and social care professionals must improve to ensure the wellbeing of residents. Quality assurance arrangements require further development to make sure that residents and their representatives are consulted about the quality of care and services provided. Care plans for residents with dementia should be developed to make sure that all residents’ identified needs including mental health needs are catered for. The home’s quality assurance systems must be further developed to make sure that residents, their representatives and other interested parties are asked about the quality of care provided and their views acted upon. Please contact the provider for advice of actions taken in response to this Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 8 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 4 and 6. No resident moves into the home without having his or her needs assessed by a competent person. Consultation, and care planning arrangements must improve to make sure that new residents know how the home will meet their needs and communication must improve to ensure their well being. EVIDENCE: Information provided by the manger indicated that the home’s new admissions procedures make provision for discussion with residents as to the home’s suitability to meet their needs before they move in. However two people who had moved in together said they had not visited the home before they moved in and no one from the home had discussed how their needs would be met. They had not received written confirmation that the home is suitable to meet their needs. They said there had been confusion over what they needed to do with medication, which they brought in without the original container. See requirement 1. Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 11 Rehabilitation facilities are sited in a dedicated part of the home known as the Hawthorns and include equipment for therapies and treatment, as well as equipment to promote activities of daily living. A multidisciplinary team of staff including social care staff and health care professionals provide care and rehabilitation. Discussion with residents and staff and reading of the home’s records systems confirmed that residents are helped to maintain and develop independent living skills so they can live in their own homes’ with assistance where required. A resident on the Hawthorns was unable to say why he had moved into the home and care staff were unable to clarify the matter. This resident had moved into the home a few days before the inspection. An outline care plan had been drafted that confirmed primary care needs but did not confirm how short term memory problems would be addressed or the aims and objectives of the resident’s stay. According to an entry in the person’s case records a nurse had visited him the day before but there was no further information as to the outcome or reason for this visit and staff were unable to clarify the matter. Staff said there had been no verbal communication between the staff involved in the admission of the resident and the staff on the Hawthorns. See requirement 2 and recommendation 1. Information provided by a visiting GP and a number of relatives and discussion with the manager and staff confirmed that there are communication difficulties between care staff and the various health and social care professionals involved. Visiting relatives stated in inspection comment cards that they are not informed of important matters and information provided by a GP practice indicated that there has been an occasion when a GP has been called in the morning but staff on duty in the afternoon have not been able to say why. See requirement 3 Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8 and 10. The home’s care planning systems are based on good practice. Residents identified needs are planned for. Some of the care plans require further development to ensure that the personal care needs of residents are consistently met. Communication in the home must improve to ensure the wellbeing of residents. EVIDENCE: The home’s care planning arrangements are under review and development. The same care plan format will be used in all parts of the home. The manager stated that the new care plans would be “holistic” in design. This means that they will identify the residents’ strengths and needs and confirm precisely how needs will be met and how independence and rights will be promoted and preserved. Some staff had received training on care planning and progress was being made converting care plans to the new format. Care plans for people with dementia need further development to confirm how mental health needs are being met. See requirement 2. Care plans for people with dementia should confirm how the person’s needs for stimulation and orientation are to be met. See recommendation 2. Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 13 Various health and social care professionals visit the home for the benefit of respective residents including Social Workers, District and Community Psychiatric Nurses, GPs, Occupational therapists, Physiotherapists and representatives of the continence advisory service. Some visiting professionals praised the staff group for communicating clearly and working in partnership. One said that the care and accommodation provided is excellent. However discussion with the manager, staff and information provided by a GP and some visiting relatives indicated that communication between staff must improve to ensure the health and well-being of residents. See requirement 3. Residents said they were treated with respect at all times and staff are caring and courteous. Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. The lifestyle in the home reflects the expectations and personal preferences of residents and choice is promoted. Visitors are made welcome, the standard of catering is good and residents have access to a range of appropriate activities. EVIDENCE: The atmosphere is relaxed, pleasant and sociable. Seventeen comment cards were received from residents prior to the inspection the vast majority confirmed satisfaction with all aspects of the home. Three residents indicated that there had been occasion when they were not entirely satisfied with the standard of care. These people had not raised their concerns with the manager or senior staff. The manager confirmed that quality assurance procedures must be improved to make sure that residents have opportunity to comment on the quality of care provided. See requirement 4. Fourteen residents were spoken with during the inspection, all indicated satisfaction with the home, the standard of care, food and facilities and services provided. Visiting relatives confirmed that they are made welcome and could see their relative in private if they wished. The home employed an activities co-ordinator and there is evidence of on-going activities including arts and crafts around the premises. Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18. Complaints were acted upon and appropriately investigated and appropriate procedures were in place for the protection of vulnerable adults. EVIDENCE: The home’s complaints procedure provides appropriate guidance and information on how to make a complaint. Five complaints have been received since the last inspection. A record is kept in the home of all complaints made, including details of the investigations and any action taken as a result. Robust procedures for responding to suspicion or evidence of abuse or neglect are in place including whistle blowing as in accordance with the Public Interest Disclosure Act 1998. Information provided by the manager indicated that all staff have received guidance and or training on the implementation of adult protection procedures Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26. The location and layout of the home is suitable for its stated purpose, it is accessible, safe, comfortable and well maintained. The standard of cleanliness is good and carpets on corridors have been cleaned to remove in-ground stains. EVIDENCE: The home is located in a residential area of Widnes with access to public transport and local amenities. Accommodation is set out in a number of group living areas each equipped with lounge/dining room with kitchenette, and discrete bathroom and toilet facilities. The gardens have been sub-divided to provide two discrete gardens. Both were in need of maintenance, however it is understood that they are to be landscaped in the near future. The corridors have been cleaned and the handyman maintains a programme of deep cleaning as required. Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. Staff are employed in appropriate numbers and skill mix sufficient for the well being of residents. Residents are protected by the homes thorough recruitment procedures. EVIDENCE: Twenty-four out of a possible 32 older people are living at Oakmeadow. Observation and staff rosters indicated that staff are employed in appropriate numbers. There is a minimum of two senior care and six care assistants on duty throughout the day time period. The home aims to employ a minimum of one senior care assistant on duty at night-time supported by 3 night care assistants. However with reduced numbers of people accommodated the home is currently operating with one senior night care assistant and two night care assistants. This did not affect the home’s capacity to meet residents’ needs. The manager advised that numbers of night staff will increase when numbers of residents increase. Information provided by the manager indicated that 18 members of the 43 strong care staff team had achieved an NVQ in care to level two or above and a further three are working towards the qualification. When 22 staff have gained this qualification the standard of at least 50 of the home’s care staff team achieving an NVQ level 2 in care will be met. See recommendation 3. Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 18 Discussion with the manager indicated that Halton Borough Council continue to operate a comprehensive staff-training programme that incorporate “Skills For Care” staff training standards. All staff had recently received training in the care of residents with dementia and there is a rolling programme of training that covers: Safer Handling, Risk Assessment, Medication, Fire Awareness, and training in conjunction withy identified training needs. Staff records and recruitment information provided confirmed that Halton Borough Council operates thorough recruitment procedures based on equal opportunities and ensuring the protection of residents. Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 36 and 38. Residents benefit from the ethos, leadership and management of the home. Communication must improve to ensure the wellbeing of residents. Quality assurance arrangements require further development to make sure that residents and their representatives are consulted about the quality of care. The health and safety of residents and staff are promoted and protected. EVIDENCE: The new manager has completed an induction programme and application has been made for registration with the CSCI. The atmosphere in the home is relaxed and sociable. Staff present in good humour and carry out their duties in an efficient and effective manner. Some communication problems are identified as discussed in other section of this report. See requirement 3. Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 20 The vast majority of residents and visiting relatives speak highly of the home indicating satisfaction with facilities and services and the standard of care provided. Three residents expressed some concern about the quality of care but these issues had not been raised with senior staff. The manager routinely consulted residents about the quality of care but there is no structured quality assurance system in place and resident surveys have not been carried out. See requirement 4. There is a sense of teamwork amongst the staff and management teams. Staff and resident meetings are held on a regular basis and staff benefit from regular supervision. The manager maintains detailed records of the home’s various health and safety systems including routine maintenance records, fire precautions, assessments, control of substances hazardous to health and precautions against Legion-Ella including disinfection of shower heads. Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 2 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X X 3 X 3 Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? yes 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 OP3 Regulation 14 Requirement The registered persons must not provide accommodation to a resident unless the full requirements of regulation 14 are met including: · there has been appropriate consultation with the resident regarding the assessment · the registered person has confirmed in writing to the resident that having regard to the assessment the care home is suitable for the purposes of meeting his/her needs in respect of his/her health and welfare. (Previous timescale 31/08/05 not met). The registered persons must ensure that care plans confirm how service users’ needs are to be met. (Previous timescales of 01/10/04 and 31.01.05, 15/07/05 not met). The registered persons must ensure that communication systems in the home are effective to ensure the wellbeing of residents. Timescale for action 30/11/05 2 OP7 15 30/11/05 3 OP4OP8 12 30/11/05 Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 23 4 OP33 24 The registered persons must establish and maintain a system for reviewing at appropriate intervals and improving the quality of care in the home including consultation with service users and their representatives. (Previous timescale of 31/12/04 and 31.03.05, 31.08.05 not met.) 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP3 OP7 OP28 Good Practice Recommendations The registered persons should ensure that admissions procedures are effective and all relevant information is passed on to senior care staff via the handover system. The registered persons should develop care plans for residents with dementia that confirm how their needs for orientation and stimulation are to be met. The registered persons should ensure that a minimum of 50 of staff achieve an NVQ level 2 in care. Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Oakmeadow Community Support Centre DS0000037125.V253176.R01.S.doc Version 5.0 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!