Inspection on 18/05/05 for Occombe House

This inspection was carried out on 18th May 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Occombe House 23/10/07

Occombe House 23/10/06

Occombe House 20/10/05

Occombe House 19/11/04

Occombe House 26/05/04

Occombe House 30/12/03

Occombe House 06/08/03

Occombe House 09/12/02

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

CARE HOME ADULTS 18-65 Occombe House Preston Down Road Marldon Paignton TQ3 1RN Lead Inspector Judy Cooper Announced 18/05/2005 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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. Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Occombe House Address Preston Down Road, Marldon, Paignton, Devon,TQ3 1RN Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01803 556605 01803 556605 Torbay Council Emelyn Jeffries Care Home 12 Category(ies) of Learning Disability (12) registration, with number of places Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Service Users with Learning Disability who may have additional Physical Disability or Sensory Impairment. Date of last inspection 19/11/04 Brief Description of the Service: Occombe House is a large detached listed building situated in Preston, Paignton and registered to care for up to twelve adult residents with profound learning disabilities, and who may have additional physical or sensory disabilities. There are separate long term (for up to 8 service users) and short-term care facilities (for up to 4 service users). Residents accessing the short stay unit are more often than not well known to the home, having used the service reguarly for a number of years. The home is also attached to a day service for service users with profound learning disabilities. There are easily accessible level gardens for all residents use. To the front of the home is car parking. The first floor of the home is currently being used for staff purposes only, although the rooms, on this floor, do remain registered. On the ground floor there is a large lobby/hall, which residents sometimes like to sit in. This floor is used by the permanebt residents. There is also an office, a large dining room, a lounge, a quiet area, a catering kitchen, a double bedroom, six single bedrooms, two bathrooms (one with a walk-in shower, toilet and assisted bath), and a separate toilet for staff use, sited on this floor. The laundry facilities are situated outside of the building. The short-term care facilities consist of four single bedrooms, an assisted bathroom, a walk in shower and toilet, and a separate toilet and a kitchen/dining area and lounge, all sited on the lower garden level. Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over one full day and into the early evening. Unfortunately, as the manager had not distributed any feedback forms to residents’ relatives, written feedback was not received prior to the inspection. However, opportunity, was taken to tour the premises, examine appropriate records and policies, talk with the manager, staff on duty and those residents able to verbalise, and time was also spent with those that did not have any communication skills. One short stay resident’s next of kin was spoken with and their views of the service taken into account. What the service does well: Families and friends of the residents are welcomed and encouraged to the home and there are excellent relationships between the residents’ families and the home’s manager and staff. The manager and staff provide a continuity of care, which allows the residents to feel secure. Any changes, either small or large, in respect of resident’s care, are well planned and undertaken. This ensures that any resident with severe learning disabilities, and in many cases limited communication skills, are enabled to understand and accept the change. This means that staff have to be, and are, sensitive to all the residents’ personal likes, dislikes and individual choices. The home’s environment is such that residents are safe to wander freely and so, where ever possible, enjoy a personal freedom due to the environment being maintained in such a way as ensure that the residents, who do have limited awareness, are safe at all times safe. Occombe House ensures that residents benefit from as many experiences and challenges as they wish and use both local community facilities as well as specialised facilities. Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Quality monitoring information, requested and received from interested parties, regarding the way the home runs and whether it meets the needs/expectations of the residents, has not yet been made public. This means that residents and/or their relatives are not aware if any views or suggestions they may have expressed are to be addressed or not. Residents’ contracts have not been sufficiently expanded to ensure that residents and/or their families are fully aware of the terms of the residents’ stay, so that the resident has a degree of protection. The review of the home’s policies and procedures has not yet been completed, which needs to be undertaken to ensue that staff are aware of what expectations/guidelines they must work within. The registered provider should ensure the manager is allocated sufficient time to carry out necessary management tasks, within reasonable timescales, therefore ensuring that residents’ care is not compromised. Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 7 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. Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 8 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 Standards Statutory Requirements Identified During the Inspection Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 9 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 standard(s) 2,5 Prospective residents and /or their families are provided with adequate information to make an informed choice regarding an admission to the home, however a resident’s residency is not fully protected as the residents’ contracts do not contain all necessary details. EVIDENCE: Occombe House historically has had a very stable permanent resident group for several years. Consequently, admissions are for the short stay unit only. Contact is initially made via the Social Services and then the resident and/or their family/carer are contacted by the home and invited to look around. Due to the dependency and limited communication skills of the residents admitted to Occombe House it is very important that sufficient details are obtained from all sources to ensure residents needs and aspirations are assessed and known. To this end there was very detailed information regarding each prospective resident, most of which was obtained from the resident’s family during these visits, which would ensure that all involved in the care of the resident was aware of all care needs. However, the initial contact details, in respect of Social Services and the home, were not held for each resident. Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 10 Each prospective resident had been offered an introductory “tea visit” before a nights stay, building up to longer times as the resident was considered able to cope with. During the inspection, a relative of resident who uses the short stay unit, was able to confirm that the resident’s needs had been well known, prior to admission, and that she had been enabled and encouraged to let staff know of the “small things” that her son needed to ensure his happiness and security whilst a resident at Occombe House. Resident’s individual contracts have not yet been fully updated to contain all necessary information to ensure that residents are aware of their rights Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 11 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 standard(s) 6,7,9 Staff are skilled at identifying residents’ individual needs and preferences about every aspect of their life. This fully enhances the residents’ quality of life. EVIDENCE: Residents and/or their families are involved in planning for all aspects of their care needs and personal goals. Each resident has an in-depth personal file which includes daily diaries, care plans, risk assessments, as well as any specific information such as if a resident suffers from epilepsy. There is also a “working file” for each resident. This is information that is easily available to all staff on duty, which allows them to have the required immediate information to provide the individually tailored care set for each resident. Each resident has an appointed key worker who takes overall responsibility for the resident’s day to day needs. Residents were noted as being able to live their lives as they choose. After the residents returned from their various day activities, all were noted as being able to go to their own room, watch T.V, sit quietly, draw etc. It was also Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 12 noted that, residents were facilitated by the staff to fully participate in the necessary tasks associated with daily living. Some have recently been away on holiday, and others are about to do so. During the inspection a staff handover was held. During the handover, various daily living tasks were discussed and each resident was appointed a member of the evening staff to support and encourage them with this. Each task was different dependent on the resident’s needs. For example some residents were going to have bubble baths and help with personal hygiene, others were going out and others were going to have hand massages. Risk taking is encouraged within safe limitations to ensure residents well being. Recently a resident enjoyed a trip out to the theatre escorted and supported by two carers. This was a major achievement as the resident had not been able to cope with such an experience before. One short stay resident was able to convey her pleasure at having been to a circus the night before the inspection and had clearly enjoyed it immensely. Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 13 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 standard(s) 12,13,15,16,17 The staff are skilled at involving the residents in every-day living activities and therefore they lead fulfilling lives. EVIDENCE: Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 14 One resident who is now retired, remains at home during the day and enjoys the facilities of the house, and is supported to undertake a wide range of activities, with a member of staff on a one-to-one basis. He appeared to be happy at the home and enjoyed listening to his music, in the louge, during some of the inspection. When asked if he was enjoying doing this he smiled and looked very content. On the evening of the inspection all other residents returned to the home from their various day activities. They were escorted back into the home with a member of staff from the day service, who then fed back to the homes’ staff how the resident’s day had gone. Residents also have an individual communications book, which is used between the various day centres that the residents attend and the home. Due to residents lack of communication skills this ensures that all involved in the resident’s care are aware of the residents needs or of any changes/concerns. Occombe House is considered to be part of the local community and residents use local facilities such as the shops, hairdressers and pubs. Visitors are welcomed to the home and a visitors record kept, evidenced that residents were able to have visitors at times to suit them. Personal, special, friendships that residents might have outside the home are supported and residents are able to invite their friends back to the home. The assistant service manager, who consulted with a dietician, plans meals and ensured meals provided are nutritionally balanced. There are details on each resident’s file as to individual likes and dislikes. Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 15 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 standard(s) 18,19,20 Occombe House provides sensitive support and care to maximise a residents’ privacy, dignity, independence and control over their own lives. Residents’ health and welfare needs are well managed by the staff of the home so that residents’ overall well-being is maintained as far as possible. EVIDENCE: Care provided is tailored to each individual resident’s needs. All residents require a high degree of support and this was noted as being provided sensitively and efficiently by the staff who were clearly aware of the residents’ needs. Staff were seen helping residents with activities and with some personal care. Residents’ written records contained fuller details of all care provided. Medication records demonstrated that residents’ medication is administered and the same recorded correctly. No resident holds their own medication and all medications are securely stored. Senior staff only, administer medication and appropriate training has been provided. No controlled medicines are currently being administered. Residents’ emotional needs are well known and changes are recognised. A resident’s father has recently died and the staff are aware of this and understand how this may have affected her. Also another resident has recently changed their eating habits, staff are monitoring this to see if any reason can Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 16 be identified and to ensure that it does not become detrimental to the resident’s health. Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 17 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22,23 Arrangements for protecting residents and responding to their concerns are satisfactory therefore ensuring that residents and their families know how to complain. EVIDENCE: The complaints procedure is written in a pictorial format, so that residents can better understand it. It is displayed within the home’s dining room. The Local Authority (Torbay Council), who is the registered provider for Occombe House, has amended its complaint policy. This has been forwarded to all residents’ families/careers along with contact details of the CSCI. The home maintains a complaint log with all details of any complaint made recorded. There have been no complaints reported either to Occombe House or to the CSCI since the last inspection undertaken in November 2004. Adult training has been made available with all staff being required to undertake this. It was noted by talking to staff that they had an awareness of the literature available, within the home on such issues. Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,30 Occombe House is comfortable, clean, well maintained and provides a safe environment apart from two issues regarding the use of stair gates which could hinder residents’ safe evacuation in the event of a fire and the use of nonsafety glass within a downstairs corridor. EVIDENCE: The tour of the building showed that the accommodation is comfortable, clean and welcoming and is being well used by the residents. Some of the communal furniture and fittings, as well as some in the bedrooms, have been recently upgraded. New carpet has been provided within the home’s dining room. A new, very popular massage chair has been purchased and it was noted that residents enjoyed using this. There are good assisted bathing facilities. The home’s laundry room is well appointed and has adequate laundry equipment to meet residents’ laundry needs. The manager and staff maintain the homes’ fire precautions in line with the requirements of the local fire department. A new improved emergency lighting Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 19 system has recently been installed within the home, which would help ensure resident safety in the event of a fire however the positioning of two stair gates and the use of non-safety glass, within a downstairs corridor glass door, does pose a degree of risk to residents’ safety. Residents’ bedrooms are very individually furnished according to individual residents’ wishes. The manager and staff maintain the required health and safety procedures and policies, within the home appropriately. . Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 35 Residents’ needs are met and supported by an experienced, well trained staff team but there are not yet sufficient numbers employed to fully meet the residents’ needs at the weekends. EVIDENCE: Staffing levels are in the process of being increased so that residents’ needs could be met at all times. Since the last inspection the home has had a recruitment drive and has appointed some experienced trained staff, which has reduced the need for agency staff. A domestic member of staff still needs to be appointed for weekends to support the care staff and allow them to concentrate on providing for care rather than having to undertake domestic duties as well. Staff were noted as interacting in a friendly, respectful manner with the residents and were supportive of each other. Training is well planned and supports the staff in providing for the varied needs of the residents. Several care staff hold NVQ 3 and 4 and other role related training is provided regularly to ensure staff are competent within their role and able to provide the necessary support to the residents. Staff stated that they felt supported in their job and it was evident, from watching the verbal communications and other interactions that took place Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 21 between the residents and staff, that the staff and residents have good, meaningful relationships. Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38,39,42 The overall management of the home is good but some management tasks are not being finalised within previously agreed timescales. The home’s quality monitoring conclusions have not been made available to residents and /or their families, who therefore remain unaware how their views will be acted upon. EVIDENCE: The two assistant service managers, who were present throughout the inspection, were very professional and helpful and clearly had an understanding of the management role within Occombe House. (Discussion again took place at this inspection, with the manager, regarding the allocation of management hours that she continues to have allocated for Occombe House. Currently these are approximately 18.50 per week, with the other part of her role seen as providing management cover for the adjacent day care unit). Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 23 It was concluded that, only having this number of hours to work within Occombe House, does not allow her the time to fully implement some of the necessary administration tasks, within the required timescales. Suitable quality monitoring has taken place, including residents and/or their families questionnaires, monthly management meetings, three-monthly house meetings, parent meetings and staff meetings. However the collated findings obtained from these measures has not yet been fed back to residents or their families. The manager and staff continue to maintain a mostly safe environment with appropriate and required checks in place to ensure that residents’ health and safety is maintained. However, fire evacuation is being compromised by the use of two stair gates to the home’ stairs and the use of non-safety glass within aground floor glass door. Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 2 x x 2 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 x 4 3 3 Standard No 31 32 33 34 35 36 Score x x x x 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Occombe House Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score x 2 2 x x 2 x D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 25 NO Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA24 Regulation 23 Requirement The registered provider must ensure that safety glass is provided within the glass door on the ground floor. Timescale for action 18/06/05 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. Refer to Standard YA2 Good Practice Recommendations The registered manager should formalise a document that can be used, in the pre assessment process, to record details of the initial contact made to the home by professionals, or others, on behalf of a resident. The registered provider should give consideration to providing a lower window to a bedroom room on ground floor and so enable the service user to have a view when seated. Previous recommendation. Existing staff supervision records should contain fuller details regarding the content of the supervision session. The registered provider should consider ways of ensuring that the management role within the home, is allocated sufficient time to allow the manager to undertake necessary management tasks as identified by this Commission. Previous recommendation. The registered manager should ensure that all the home’s policies and procedures continue to be reviewed regularly D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 26 2. YA26 3. 4. YA36 YA38 5. YA40 Occombe House 6. YA24 and updated by the registered manager. (Previous recommendation). The registered provider should ensure that, if the office door, which is a fire door is to be held open, a suitable hold open devise is provided. Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 27 Commission for Social Care Inspection Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Occombe House D54-D07 S36987 Occombe House V215964 180505 Stage 4.doc Version 1.30 Page 28 - 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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