Inspection on 03/04/07 for Omnia

This inspection was carried out on 3rd April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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

Omnia 28/11/05

Omnia 06/07/05

Omnia 13/01/05

Omnia 19/04/04

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

CARE HOME ADULTS 18-65 Omnia 50 Sale Road Norwich Norfolk NR7 9TP Lead Inspector Hilary Shephard Unannounced Inspection 3rd April 2007 10:20 Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Omnia Address 50 Sale Road Norwich Norfolk NR7 9TP 01603 435621 01603 435621 headoffice@norwichmind.org.uk 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) Norwich MIND Sandra Flanagan Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (12) of places Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Twelve (12) people with a mental disorder, excluding learning disability or dementia, may be accommodated. 28th November 2005 Date of last inspection Brief Description of the Service: Omnia has been developed to provide a service assisting and enabling people with mental health problems to lead a more independent and fulfilling lifestyle. Omnia is split into two houses (wings) each accommodating six clients. There is a range of facilities ensuring the planned skills and personal development programmes can be undertaken in pleasant and well-maintained surroundings. The third wing of the building accommodates the main offices and outreach team for Norwich MIND. Omnia charges £535 per week for clients accommodation and personal care. Clients are expected to pay for their own toiletries and reading material. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Care services are judged against outcome groups, which assess how well a provider delivers care outcomes for people using the service. The key inspection of this service has been carried out using information from previous inspections, information from the providers, the residents and their relatives, as well as others who work in or visit the home. This has included a recent unannounced visit to the home. This report gives a brief overview of the service and the current judgments for each outcome group. What the service does well: Omnia makes sure that people who use their service are involved in their admission and have plenty of information about the home beforehand to enable them to make a decision about moving in. People who use the service are involved in planning with staff how their individual care needs are to be addressed. People who use their service are encouraged to lead their care, make decisions about their lifestyle and take responsibility for their care needs in conjunction with the support staff at the home. People who use the service are expected to take part in specially designed activities and programmes to enable them to develop skills to manage their health care problems and their daily lives. People who use the service say they have benefited greatly from attending these programmes and many exclients return to attend the programmes. Omnia offers people who use their service a comfortable and homely place to live where they can relax, meet their friends and family or have private space as they wish. The layout and design of the home has been adapted to allow clients as much independence as possible within the terms and conditions of their residency. Omnia employs competent and skilled staff who work with clients to help them develop ways of managing their individual health care needs. Training opportunities are excellent and staff are provided with specific training linked to the health care needs of the clients thus enabling them to manage a variety of problems. Clients benefit from living in a home that is well managed by a competent, skilled and well-qualified manager who involves clients and staff in the running of the home. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2 People who use the service experience excellent outcomes in this area. Clients are involved in their admission, they benefit from a full assessment completed by the home and social services before they are admitted and are made well aware of the services terms and conditions of their residency. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections found care plans contained good and comprehensive assessments completed before the clients were admitted. These included a section about what clients hoped to achieve by being in the home. The home uses the care programme approach and uses all information gathered before and after admission in conjunction with the clients to formulate a plan of care. The inspection carried out April 2007 found that no changes had been made to the pre-admission process and staff continue to use the same format. The care programme approach is used well by the staff and information from social workers and other professionals is always used by the home to form the clients care plan. Care records showed clients and their families were involved in their admission process and the records contained full assessments of the clients care needs. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 9 Information taken from CSCI’s recent survey indicates clients feel they have benefited from being able to stay overnight and experience “taster” days giving them the opportunity to see what they will get out of being in the home. This survey also indicates that 85 of clients were asked if they wanted to move there and 100 received enough information to help them decide to move in. Comments made by clients were: “I looked at many places and as soon as I saw Omnia that was it, that was where I wanted to be:” “I was offered day care and taster days as was allowed overnight stays:” “I chose to come here because it seemed to offer everything I needed to get better:” “I spent a few days here before I moved in which was very helpful”. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 People who use the service experience good outcomes in this area. Clients are fully involved in the care planning, their care records are generally comprehensive, but some lack detail and are a little disorganised. Staff manage risks well and formulate clear strategies in conjunction with the client and other professionals as required. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections found that clients planned and agreed their care needs with their key workers, and risks to their health were clearly identified with good guidelines in place enabling staff to work with the clients to overcome or manage them. The April 07 inspection found that care records contained explicit and comprehensive risk management strategies written in conjunction with clients, care staff and community mental health nurses. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 11 Information from the initial care programme assessment continues to be used in planning for how the clients care needs are to be addressed but some detail in the care planning guidelines was not detailed enough to ensure staff were clear about the care they should be giving. Information in one persons care file indicated coping strategies were in place for specific care needs but there was no detail recorded about these strategies, however, the manager advised this persons care needs were currently being reviewed as they had very recently changed. One other care file contained good, comprehensive and up to date information about the clients care needs. The plan was clearly written in conjunction with the client and showed the client taking the lead in their care. Clients spoken with confirmed they are involved with their care planning and are encouraged and expected to make decisions about their lifestyles and that staff would help them with this if they needed them to. One client said how much living in the home had improved his health. Layout of care records was a little muddled and disorganised which could make it difficult for the clients to easily identify their care needs and care management strategy. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17 People who use the service experience excellent outcomes in this area. Clients benefit greatly from the specially designed activity programmes and opportunities for self-development the home provides. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections have shown that Omnia encourages input and support from clients’ families and friends and offers comprehensive and structured training programmes instructing clients in the development of the skills they require for managing their lives. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 13 The April 07 inspection found that Omnia continues to offer excellent activity programmes that have been designed to enable clients to develop the skills they need to cope with daily life and their mental health problems. Clients state they are expected to attend the programmes and these have helped them develop the skills they need to enable them to move into their own accommodation. One client spoken with says he is now feeling well enough to be able to plan his move into the community and is currently looking for a flat. Food is not provided at the home, but clients are given a weekly food budget and part of the activity programmes are designed to give clients guidance about how to shop, plan and prepare meals. Clients are provided with fully functioning kitchens and are expected to prepare their own meals. Clients state they are made aware of this before they are admitted and said they were clear about the expectation on them to attend the activity programmes. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20 People who use the service experience good outcomes in this area. Clients benefit from good support from staff regarding their healthcare needs but some improvement is needed regarding monitoring and recording medication issues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections found that care records indicated clients health needs were identified and staff advised they provided input and support as required but this was very much led by the clients themselves. Clients work with staff putting guidelines together to enable their emotional and physical needs to be identified then strategies are put in place enabling these to be addressed. Clients generally administer their own medication unless their risk strategy has identified a problem. Staff work with clients as part of their care programme to guide and support them in the administration of their medication. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 15 The April 07 inspection found this continued. Clients said they feel their mental health has improved significantly since being in the home and that the staff are always there to help with anxiety and are very understanding and kind. One client stated in CSCI’s recent survey of the home “Omnia is a good place to come to, it offers a lot of support and helps you to learn about your illness and how to manage it.” They have also said “this place has been a godsend to me” and “I chose to come here because it seemed to offer everything I needed to get better” “Omnia is an amazing place.” Staff spoken with showed a good understanding of the clients’ individual health care needs and spoke about how they address individual clients particular needs. Staff spoke of how well they know the clients and said they complete daily risk assessments for each person and change their care planning as required. Medication was looked at and the manager advised that all clients are expected to be able to administer their own medication as part of their care programme. If clients are unwell, or struggle with this, then staff re-assess their ability to self-administer and address any issues that arise. The medication administration records (MAR) indicated that two clients have been refusing their medication, one for a considerable length of time. Care records showed that this issue had not been recorded in a plan of action to address the problem, however the manager advised that the psychiatrist was involved and they were currently reviewing the clients care needs. Records of receipt of medication were checked which showed that medication is being booked in correctly but medication being carried over from previous months is not recorded as such on the MAR, thus making it difficult to complete an audit trail. The manager advised they do not regularly audit the medication. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People who use the service experience good outcomes in this area. Clients are protected by the homes robust procedures regarding safeguarding adults and complaints and staff deal with concerns quickly and appropriately. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections have found that clients knew who they would report concerns to and were confident they would always be listened to, and that any issues they raised would be acted upon. Staff receive training in adult protection, and demonstrate a good understating of the reporting procedure. Pre-inspection information received in February 07 indicates that clients are totally funded by social services and manage their own finances. Staff do not manage money for any client, but provide a weekly food allowance that clients are given and shown how to budget with. The April 07 inspection showed this continues. Clients stated in CSCI’s recent survey that they were given a complaints procedure and 71 said they knew how to make a complaint. Staff spoke of how they would immediately report serious concerns to the manager and that any immediate issues regarding clients would be dealt with straight away, either by them or the manager. The manager takes a lead role in safeguarding adults and regularly provides training to her staff and those in other care settings. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 People who use the service experience good outcomes in this area. Clients benefit from living in a home that is homely, comfortable, well maintained and adapted to meet their specialist needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections have found the home to be well maintained but the clients’ kitchens have not always been very clean. As part of the independent living skills development programmes, clients are expected to take part in the homes cleaning roster. The April 07 inspection found many areas within the home had been refurbished and decorated offering clients pleasant and comfortable bedrooms and communal areas. Clients spoke of the cleaning rosters and said they knew it was their responsibility to keep the home clean but that some people were better at doing this than others. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 18 A tour of the premises found all areas to be reasonably clean. A specific room has been made available for therapeutic activities such as counselling, massage and relaxation. This room has been decorated and designed in a way that aims to provide a relaxing environment for the clients who use it. Clients have also been working on developing an organic vegetable plot. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35 People who use the service experience good outcomes in this area. Clients’ healthcare needs are well supported by competent and well-qualified care staff who are provided in sufficient numbers to meet clients individual care needs. Improvements need to be made to the staff personnel files to ensure they provide information regarding the safe recruitment of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections have found the home provides staff who are well trained and experienced in mental health care. Clients have always given positive feedback about how the experience of living in the home has enabled them to move on to either independent community living or a supported care environment. There have always been sufficient staff on duty and more are available to be deployed as clients needs dictate. The April 07 inspection found this continues to be the case. 7 out of the 8 permanent care staff are NVQ 3 qualified and 1 member of bank staff is currently working towards NVQ 3. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 20 Staff spoke of their training and said it was entirely geared around the care needs of the clients and as many clients were being admitted with a variety of mental health needs their training was arranged to cover the entire range of their needs. This clearly has a beneficial effect on the clients who continue to give very positive feedback about the care they receive. One said: “staff are very supportive and understanding and good at what they do” another stated “being here has benefited me, I get lots of support to help me cope with life and moving onto community living.” Rosters showed there continues to be staff available to meet clients individual needs and the day of the April visit found an extra staff member had come in to work with a client who needed extra support with the development of social skills. An inspection carried out in January 05 found one staff file did not contain any references. The personnel department keeps all staff files and manages Omnia’s recruitment process and at that time, the manager did not have free access to staff files, and was not allowed to have sight of new staffs references. Criminal Records Bureau (CRB) disclosures for new staff were seen, but the Provider was keen to follow guidance from the CRB by destroying the staffs disclosures after 6 months. The previous 2 inspections have shown that the manager was checking staff files to ensure they contained references and CRB checks. The Commission has not viewed staff files since January 2005 because of the homes low staff turnover. The April 07 inspection found the home has not needed to employ any new permanent staff for many years, but continues to recruit and employ bank staff and volunteers. Clients are involved in interviewing care staff and the manager advised she follows safe recruitment practices by always checking staffs references and CRBs before they commence. Recruitment continues to be managed by the providers personnel department. Two staff files seen at this visit and one failed to contain the references the manager confirmed were there before the staff was employed. This staff currently works as a student nurse and had completed a mental health placement in the home before commencing on the bank. One persons personnel file contained documents relating to other staff therefore it is likely that these references have been misfiled as this visit identified staff files to be very disorganised. The personnel department is still following guidance from the CRB and destroys CRBs after 6 months. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 People who use the service experience excellent outcomes in this area. Clients benefit from living in a home that is well managed by a very competent manager, clients are encouraged to be involved in how the home is run and benefit from staff having a very good understanding of how to meet their individual care needs. The home is safe and well maintained and the manager puts a high emphasis on risk management in a way that does not restrict clients’ rights. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Previous inspections have found the home being managed by a competent and well-qualified manager who has been in post since September 2001. The April 07 inspection found this continues to be the case and staff and clients spoke of how the manager motivates and supports them. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 22 The manager continues to involve clients in the running of the home and regularly holds client meetings. Reviews with staff and clients are held regularly to monitor and update their progress. The home continues to be managed in conjunction with the clients and staff input and it is clear from discussion with clients and observations of the staff and client interaction they all feel it is very much their home. The manager carries out regular formal quality audits, which she discusses with the clients at their weekly meetings. One member of senior staff is responsible for managing health and safety within the home and ensures all relevant training and checks are carried out. Safety records were not checked at this visit but observations of the premises showed it to be maintained safely. One serious incident has occurred with a client and although the staff managed this well, they have failed to notify the Commission. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 4 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 4 33 X 34 3 35 4 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 4 X 4 X LIFESTYLES Standard No Score 11 X 12 4 13 4 14 X 15 3 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 X 4 X 4 X X 3 X Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? None 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 YA41 Regulation 37 Requirement In order for serious incidents to be monitored, incidents reports should be sent to the Commission. Timescale for action 01/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA6 YA20 YA34 Good Practice Recommendations It is recommended that guidelines in care plans are fully developed to ensure clients’ needs are fully understood by care staff. In order to form a complete audit trail, medication records should show full details of all medicines and records should include reference to clients’ refusal of medication. It is recommended that staff files are kept in good order and are held and maintained by the registered manager. Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Norfolk Area Office 3rd Floor Cavell House St. Crispins Road Norwich NR3 1YF National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Omnia DS0000027301.V335310.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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