Inspection on 07/02/06 for Ocknell Park

This inspection was carried out on 7th February 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 15 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Ocknell Park 17/07/07

Ocknell Park 10/05/06

Ocknell Park 24/05/05

Ocknell Park 21/02/05

Ocknell Park 18/10/04

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Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Ocknell Park Stoney Cross Lyndhurst Hampshire SO43 7GN Lead Inspector Mr Ian Craig Unannounced Inspection 7th February 2006 09:45 Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 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 Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 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. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Ocknell Park Address Stoney Cross Lyndhurst Hampshire SO43 7GN 023 8081 1287 023 8081 4083 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) Truecare Group Limited Mr D Bennett Care Home 11 Category(ies) of Learning disability (11), Mental disorder, registration, with number excluding learning disability or dementia (11) of places Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th May 2005 Brief Description of the Service: Ocknell Park is a large detached house set in its own grounds in the heart of the New Forest. The home has one lounge and one lounge/dining area and a large conservatory that leads to a patio area with fishpond. The eleven residents each have their own bedrooms and these are located on both floors of the home. The home has large well-maintained gardens. Within the grounds there is also a day service that the residents can attend. The aim of the home is to provide accommodation and support for people with complex and challenging behaviour who have either a learning disability or a learning disability with associated mental health problems. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over approximately 6 hours and involved discussions with the registered manager and the assistant manager. Two residents were interviewed and the inspector joined the residents for the lunchtime meal. Documents were examined including assessments and care plans for residents as well as policies, procedures and supporting documentation such as service certificates. Two social workers and a consultant psychiatrist were also spoken to during the visit What the service does well: What has improved since the last inspection? Improvements have been made to the home’s physical environment as required by the last inspection report, with the exception that furniture in the conservatory has not been replaced. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 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. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 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 Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 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, 3 and 4 Clearer information needs to be given to residents and potential residents regarding the home’s policies and procedures where independence is curtailed. Whilst assessments of need are completed before the home decides to admit someone, there are instances where the home accommodates those whose needs it cannot meet. EVIDENCE: The home’s Statement of Purpose and Service Users’ Guide are freely available in the home and one resident referred to the documents when being interviewed y the inspector. The two documents give information about the service provided by the home as well as the complaints procedure and information about the staff group. Emphasis is made in the documents about the independence of the residents is promoted, without reference to the fact that the needs of some mean that there will be continual one to one, or two to one, supervision from an allocated staff member or members, except when in bedrooms. The home’s process for admission of residents involves the completion of its own assessment using specific pro formas, as well as representatives of the home attending multi agency Care Programme Approach (CPA) planning meetings led by social services and health trusts. Residents’ files contained copies of completed pre admission assessment pro formas, which were found to be comprehensive plus notes and minutes from attendance at CPA meetings. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 Page 9 There is a question as to whether or not residents are accommodated with needs beyond that which can be met by the home. The inspector formed the view that this is undoubtedly the case in several instances. This is based on the relatively high number of incidents of aggression and violence from residents necessitating physical restraint, the home not being secure, and residents leaving the building after being assessed as a risk of ‘self harm’ or risk to the public if outside the premises unescorted. This then results in restraint or physical intervention, which borders on detention. Records are not maintained to show what has happened when violent incidents occur, the liaison with other agencies, decisions made by other professionals and the actions of staff. Following incidents of violence, the liaison by the home with the placing health and social services departments needs to be improved as this often only involves the sending of a copy of a notification to the Commission for Social Care Inspection when a full and immediate discussion and possible request for a mental health assessment may be needed. Residents are free to visit the home before deciding to move in, but this is not always possible due to the needs of the residents. On these occasions the social worker and consultant psychiatrist have visited the home to check on the suitability of the home. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 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 and 9 Whilst each resident has various documentation regarding their needs, improvements are needed to reflect the level of staff supervision being undertaken and how this judgement has been arrived at. Opportunities for residents to go out are planned within a framework that assesses risk. This is good practice. EVIDENCE: Several of the residents are subject to constant one to one supervision by a member of staff. In some cases this may be increased to two staff for each person. This involves the resident being accompanied at all times except whilst in the toilet, bathroom or their bedroom when the staff member waits outside. The inspector observed this practice in operation for the two residents interviewed. The need for this supervision was inconsistently recorded and whilst the inspector acknowledged that this level of supervision may be necessary there was no assessment indicating how a decision had been made to determine this. Also, for one resident it was recorded that he needed one to one supervision whilst outside the home but there were no details of the level of supervision required in the home where the one to one was also in place. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 Page 11 Care plan documents were subdivided into different needs, such as physical health, managing aggression etc. Sections of these were recorded to a good standard with clear details of how staff should deal with specific activities where risk had been identified. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 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): 16 There are opportunities for residents to exercise independence and control over their lives within limits set by assessed needs. Residents’ rights are recognised but these can also be limited. Changes are needed to ensure the rights of individuals are upheld in specific areas, such as the complaints procedure and when residents’ are arrested. EVIDENCE: When continually monitored by staff, residents have the privacy of their own bedroom. There is a policy on residents’ privacy in their bedrooms. The inspector interviewed one resident in his bedroom whilst a staff member waited outside. The specific restrictions placed on residents’ freedom of movement need to be included in the Statement of Purpose and Service Users’ Guide. Each resident has a key to his bedroom. The inspector was informed that all mail is handed to residents unopened and this was confirmed by one of the residents. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 Page 13 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): 19 and 20 Whilst physical health needs are being met the home is not liaising effectively with psychiatric professionals regarding resident’s mental health. Procedures for the administration of medication are satisfactory with the exception that records fail to give staff guidance as to when medication ‘as required’ is needed. EVIDENCE: Records clearly detail the physical health needs of individuals and the checks and treatment required for dentistry and other health needs. Liaison with community psychiatric professionals is in need of improvement. The lack of a contemporaneous recording system made it difficult for the inspector to tell whether or not the home had contacted psychiatric professionals when symptoms arose, especially those of aggressive behaviour and intention to ‘self harm.’ When the inspector asked the home’s management if they liaised with mental health practitioners when a resident became aggressive the reply was that they are sent a copy of the notification made to the Commission for Social Care Inspection. This is inadequate and highlights the need for a more pro-active and assertive system of liaison and request for assessments if necessary, alongside maintaining records of these contacts. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 Page 14 Procedures for the administration of medication were examined. The home uses a monitored dosage system to administer and hold medication. Records of medication dispensed were satisfactory and the cassettes of medication showed the system to be working. Residents may have ‘medication as required.’ This is only dispensed after care staff have confirmed that it should be administered by consultation with the home’s manager or clinical supervisor. Care plans do not detail the symptoms that indicate when this medication needs to be dispensed. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 Page 15 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 and 23 Whilst residents have a copy of the complaints procedure, and the home has acted upon complaints made by residents, there was neither a record of how the home had investigated the complaint nor communication with the resident about the outcome. Restraint is used when assessed as necessary, but its frequent use indicates that the home accommodates residents with needs that it cannot always meet, as well as a need to improve health and safety procedures. The home’s staff undertake roles normally arranged by social services, which may compromise the residents’ rights and affect whether or not suitable care is provided. EVIDENCE: The home’s complaints procedure is contained in the Statement of Purpose and the Service Users’ Guide, which residents were seen to have copies of. A resident raised a number of concerns and allegations, which were discussed with the home’s management. The home has involved the police and an advocate when looking into these matters. There was, however, an absence of any recording of the complaint, how the complaint was dealt with, as well as the outcome of the investigation. The resident was unaware of any outcome of his concerns. The home has a copy of the local authority adult protection procedure. Each resident’s case records contain a section detailing needs and the risk of abuse. There is a policy on the use of physical restraint and the manager is accredited with the British Institute of Learning Disability to train staff working in the home in the correct use of physical intervention. Where appropriate, the home carries out an assessment of the resident’s needs regarding aggression and Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 Page 16 how this should be dealt with. Restraint is used as a last resort with procedures clearly setting out methods to deescalate and defuse situations where there is a risk of aggression. Physical intervention may also be used to escort a resident back to the home when there is a risk of that person harming himself. The frequency of the use of physical intervention reflects the high level of needs of the residents and that the home is at times accommodating residents whose needs it cannot meet. A resident described his general satisfaction with the service provided by the home, but did not like the level of aggression exhibited by one resident in particular. From discussion with the home’s management it was evident that staff act in the role of appropriate adult under the Police and Criminal Evidence Act 1984 when a resident is arrested. Whilst the inspector acknowledged that the motivation for this may be for reasons of assisting the resident because of delays in social services providing an appropriate adult, this is outside the remit of the home’s operation and impinges on the role of social services. This may have the effect of comprising the residents’ rights and arrangements for suitable care. The home does not have a copy of the local agreement for the provision of appropriate adults. It was of concern that a resident had been arrested because of an incident at the home, that a staff member from the home acted as an appropriate adult at the police station, and that social service were not involved in any of this, as well as the decision of where to place the person. There is a need for the home to have clearer roles and responsibilities in this area, as well as the development of policies and procedures in line with those of social services. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 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 Improvements have been made to the environment, although specific areas need attention including possible structural damage. EVIDENCE: The previous report required that the conservatory floor must be replaced and new furniture purchased. At this inspection it was confirmed that the floor has been replaced but that the furniture has been ordered but has not yet arrived. Also, as required by the last report measures have been taken to prevent possible burns to residents by the installation of covers on radiators. A significant portion of the home’s cellar has collapsed including a concrete supporting lintel. The area has been cordoned to prevent any staff from entering. It was unclear whether any structural damage has been caused and whilst the section of the organisation dealing with the home’s premises has been notified of the damage it was unclear when a qualified person would be assessing the situation. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 Page 18 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): 32 and 34 In order to ensure that the complex needs of the residents are met the home needs to improve the situation regarding the numbers of staff trained in dealing with mental disorder and learning disability. EVIDENCE: The previous inspection report required that the home review the levels of qualified staff and preferably for additional staff who have registered nurse qualifications in learning disability and mental health. This has not been achieved although he manager stated that it is the intention of the home to employ two registered nurses, possibly one qualified in mental health and the other in learning disabilities. General training records were monitored for each individual staff member. The inspector discussed the maintenance of staff records in the home and the recent guidance from the Commission that for organisations these can be centrally held. Arrangements for staff records will be re-examined at the next inspection. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 Page 19 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): 37, 39 and 42 In view of the number of requirements, the quantity of violent incidents and need to improve many of the liaisons with other agencies, the home could not be said to run in the best interests of the residents. The home does not have a quality assurance system incorporating the views of the residents although this is being developed. Health and safety is satisfactory regarding routine testing and maintenance of equipment, but the incidence of aggression and restraint is of concern. EVIDENCE: At the time of the inspection the registered manager was also holding an additional management post. A new manager has been recruited and is due to start work in the home in March 2006. Due to the number of requirements made in this report, the incidence of violence and restraint and the lack of effective liaison with community mental health professionals, the management of the home is in need of improvement. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 Page 20 Residents’ meetings are held. Apart from a survey of the food, there is no system of surveying the residents’ views about the home. The inspector was informed that residents are informally asked about their views but this is not recorded. A quality assurance system has not yet been developed although the management stated that this will be introduced in the near future. Health and safety in the home was assessed. All equipment is checked as recommended by the health and safety executive. The fire logbook showed that the fire safety equipment is tested and that staff and residents have regular instruction in fire safety as well as weekly fire drills. Staff receive training in first aid, food hygiene and infection control. Staff are in the process of receiving manual handling and lifting training. Whilst the safety of the building and equipment is maintained the significant number of occasions where staff have to deal with violent incidents, and the frequent use of restraint, indicates that the associated health and safety risks to both staff and residents needs closer attention. For instance, the inspector was informed that one violent incident was partly due to a lapse by staff in the policy for the safety of cutlery. It was also apparent from examination of resident’s records that several incidents had occurred that had not been notified to the Commission as required by Regulation 37. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 Page 21 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 2 2 2 3 1 4 3 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 2 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 2 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 1 2 X 2 X 3 X 2 2 X Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 Page 22 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 YA1 Regulation 4 and 5 Requirement The Statement of Purpose and Service Users’ Guide must detail the supervision of residents, which has a direct effect on the independence and privacy of the residents. Care plans must accurately reflect the level of staff supervision both outside and inside the home. Assessments must clearly show how a decision has been arrived at regarding this supervision. Individual care plans must detail the symptoms and signs indicating that a resident may need medication ‘as required.’ The home must ensure that referrals and contacts are made with relevant health and social services’ personnel regarding changes in mental health and the involvement of the police. Contemporaneous records must be maintained to show that this liaison has taken place. Where a resident makes a complaint about the service a record of this must be maintained as well as details of DS0000055846.V272072.R01.S.doc Timescale for action 30/04/06 2 YA2YA6 14 and 15 30/04/06 3 YA20 13 (2) 30/03/06 4 YA41YA19 13(1) 30/03/06 5 YA22 22 30/03/06 Ocknell Park Version 5.1 Page 23 6 YA40YA23 12 7 YA24 23(2)(d) 8 YA24 23(2)(b) 9 YA32 18 (1) (a) 10 YA39 24 11 YA41 12 12 YA42 13 the investigation of the complaint and its outcome. All complaints must be responded to. The home must obtain a copy of the local agreement regarding appropriate adults under the Police and Criminal Evidence Act 1984. The role of the home must be in accordance with that policy. Following this the home must devise its own policy and procedure regarding residents who are arrested and held in custody. New furniture must be purchased for the conservatory. This is outstanding from the previous report. Arrangements must be made regarding the collapsed lintels in the cellar to establish the structural safety of the building and any building works required. The home must review the levels of qualified staff within the staff team to ensure that they can meet the needs of the residents. This is outstanding from the previous inspection report. The home must implement a quality assurance system, which must incorporate a method whereby the views of residents are sought. Notification must be made to the Commission of any incident falling within the definition of Regulation 37, such as significant aggression. The home must ensure that the correct safety policies and procedures in the home are followed. 30/04/06 30/04/06 07/03/06 30/04/06 30/04/06 07/03/06 07/03/06 Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 Page 24 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 Good Practice Recommendations Standard YA42YA39YA37 The home’s management should review its operational basis in view of the significant numbers of violent incidents and restraint, combined with accommodating residents who have a high level of need. Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Ocknell Park DS0000055846.V272072.R01.S.doc Version 5.1 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. 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!