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Inspection on 16/10/07 for Outreach Community & Residential Services

Also see our care home review for Outreach Community & Residential Services for more information

This inspection was carried out on 16th October 2007.

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 3 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Each person`s needs are carefully considered before making a decision to move to this home. The relatives who gave us comments were happy with the standard of care. One comment was "We are happy with the care and the staff". Residents are supported to take part in activities they enjoy, and their cultural and religious needs are respected. Residents` health care needs are well met. The home is clean and tidy, and provides a homely and comfortable environment for residents. Residents can choose how to decorate and personalise their own rooms. Staff receive a good range of training, and this helps to ensure they have the skills they need to support and care for residents.

What has improved since the last inspection?

Since the last inspection, the requirements made by the fire service have been met, making the home safer. Staff members have had training on what to do if they suspect that a person is not being treated properly.

CARE HOME ADULTS 18-65 Outreach Community & Residential Services 86 Meade Hill Road Prestwich Manchester M25 0DJ Lead Inspector Rukhsana Yates Unannounced Inspection 16th October 2007 10:00 Outreach Community & Residential Services DS0000008445.V347444.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 Outreach Community & Residential Services DS0000008445.V347444.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. Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Outreach Community & Residential Services Address 86 Meade Hill Road Prestwich Manchester M25 0DJ 0161 740 3256 0161 740 5678 stuart@outreach.co.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) Outreach Community & Residential Services Lesley Ann Smith Care Home 5 Category(ies) of Learning disability (5) registration, with number of places Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 5 service users, to include: Up to 5 service users in the category of LD (Learning Disabilities under 65 years of age). The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 8th August 2006 Date of last inspection Brief Description of the Service: 86 Meade Hill Road is one of a number of care homes managed by Outreach Care Services. Outreach is a charitable organisation offering 24-hour care, mainly to Jewish people with a learning disability or mental health problems. 86 Meade Hill Road is a six bed roomed detached house owned by Greater Manchester Jewish Housing Association. The home provides care and accommodation for five service users with profound learning disabilities. The remaining bedroom is used as an office. The house is located close to local shops, pubs and Post Office. Buses to and from Prestwich and Manchester pass nearby and a metrolink station is within walking distance. A ramped path is provided to the front door and the house is accessed by one step both at the front and back entrances. A drive provides parking space and on street parking is available outside the house. A safe enclosed lawned and patio area is provided to the rear of the property. The weekly charge for accommodation and services is between £518.00 and £875.00 with an additional charge being made for hairdressing, chiropody, toiletries, some outside activities and holidays. Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. We carried out an unannounced visit to the home, during which we looked at the ways in which staff supported residents, talked to staff and the manager, and looked at paperwork relating to care, health and safety. The visit was carried out over 6 hours. Before the inspection, we also asked the manager of the home to complete a form called an Annual Quality Assurance Assessment (AQAA) to tell us what they felt they did well, and what they needed to do better. This helps us to determine if the management of the home see the service they provide the same way that we see the service. We felt this form was completed in detail, but did not give a clear picture of all the areas that needed to improve. We had written comments about the service from two relatives, and one relative provided comments by telephone. What the service does well: What has improved since the last inspection? Since the last inspection, the requirements made by the fire service have been met, making the home safer. Staff members have had training on what to do if they suspect that a person is not being treated properly. Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Outreach Community & Residential Services DS0000008445.V347444.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 Outreach Community & Residential Services DS0000008445.V347444.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: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective service users would have their needs fully assessed before admission to ensure the suitability of the placement. EVIDENCE: There have been no recent admissions to the home. The records of the people who currently live there contain evidence of care planning information from the time of admission. The procedure followed by the organisation in respect of new referrals includes a full initial assessment and visits to the home by the prospective resident. All new placements are subject to a trial period of three months, with midplacement reviews to assess compatibility with the resident group, and to ensure that the service is able to meet the individual’s needs. The manager is aware of the need for continuing consideration of the compatibility of people living at the home as their needs change. This was demonstrated by recent referrals made to the social services department in order for reviews to be carried out. Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 9 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 & 9: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Plans of care do not fully reflect each person’s needs, choices, goals, support requirements and risk assessments and therefore do not ensure that the full range of residents’ needs are addressed. EVIDENCE: The files of three residents were looked at. They contained a range of information including care plans, behaviour management strategies, risk assessments and daily reports. However, much of the information had not been updated for over a year and some of the health plans had not been completed. The residents have limited ability with regard to verbal communication, and therefore the need to gather and update information about ways of communicating and ascertaining needs and wishes is particularly important. The registered manager of the service has been absent for some months, and the current manager fully recognises the need to ensure that person centred plans of care are in place in order to meet individual needs more effectively. Work has commenced to achieve this, and Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 10 training for staff in person centred care is being arranged. One relative commented that she had not been invited to a review meeting for some years and was keen for this to be addressed, but there were also positive comments about the standards of care from this relative and others. Examples were: “We are happy with the care and the staff”; “They care for my son very well”; “Our son’s needs are catered for very well”. Staff members who have known the residents for a long time showed that they are aware of the residents’ personal preferences regarding their daily lives, and they encourage, assist and support residents in making appropriate choices and decisions. Updated information and strategies are needed to ensure that the staff group share their knowledge of residents’ preferences and needs so that consistent support can be delivered. Risk assessments and strategies, although not updated, were in most instances still applicable and followed by staff. These need to be incorporated into person centred plans, with the involvement of the resident or their representative. Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 11 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, & 17: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users take part in community activities based on their abilities and preferences. They are supported to maintain family contacts, and their health promoted through the provision of varied and healthy meals. EVIDENCE: Residents are supported to take part in age, peer and culturally appropriate activities. These include attendance at day centres, college and shopping trips. A vehicle is available and residents enjoy being taken out for a drive and, on occasion, having a meal out. All of the residents have a weekly planner, currently in the process of being updated. Although the residents are not able to travel independently, they do use local buses, trams, shops, parks, pubs and cafes enabling them to be a part of the local community. Visitors are welcome at the home at any time, with residents’ consent, and residents are supported in maintaining contact with their families. The cultural and religious needs of the residents are respected and the home follows Jewish laws and customs. The home presently accommodates five Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 12 residents, four of whom follow the Jewish religion, and one who follows Christian beliefs. There are three male residents, and the manager is aiming towards increasing the number of male staff in order to better meet the residents’ needs. The residents are not able to manage their own door keys or to open mail without help, but they do have access to all parts of the home and garden. Some residents help with basic household tasks, such as setting the table at mealtimes. A Kosher diet is provided through a varied menu that has been put together from the known likes and dislikes of the residents. Residents’ weight is checked regularly, enabling their wellbeing to be monitored. Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents mostly receive personal care in the way they require, but unclear medication records and information about preferences result in inconsistent practices that compromise the quality of care. EVIDENCE: All of the residents living at the home are fully dependent upon the staff for nearly all personal care tasks. The staff make sure that the residents’ personal hygiene, clothing, hair care and general appearance is appropriate and enhances their dignity. Some residents are able to decide about which clothing to wear whilst others require assistance. Each resident has a designated key worker and written information is being updated in respect of each resident’s likes, dislikes and preferred routines. The routines of the home are flexible this includes mealtimes and the times for getting up and going to bed. Each resident has a health action plan that covers a wide range of topics including eye care, hearing, mobility, nutrition and medical care and hospital visits. These are being updated. All of the residents are registered with Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 14 chiropodists, dentists, opticians, general practitioners, and all relevant social and health care services and are supported by staff to attend appointments. From talking to the manager, the staff and the checking of the above records it is apparent residents’ health care needs are looked after and that prompt action is taken if a resident becomes ill. The home has a satisfactory medicines policy and procedure that includes guidance for the self-administration of medicines and the use of covert medicines. Medication is stored in a locked unit. Medication records contained some gaps, and the manager is in the process of ensuring that all staff understand and follow the correct medication administering and recording procedures. Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for dealing with complaints, and training for staff in safeguarding issues, ensure the promotion of residents’ welfare. EVIDENCE: The home has a satisfactory complaints procedure that states how a complaint can be made and how it will be handled. No complaints have been made to the home or the CSCI in the period since the last inspection. The staff members consulted were aware of the home’s complaints procedure. They showed that they knew what to do if a complaint was made and they said that they would assist residents in making their concerns known. The staff understand that they would need to record any changes which may indicate that someone is unhappy or concerned. The manager is currently arranging for the reassessment of one individual due to incompatibility issues and the need to protect other residents. The home has a full copy of local area inter-agency adult protection policies that give good, clear and sound guidance to the staff should an abuse situation arise. This, and another available document also advises staff about ‘whistleblowing’ if they were to find themselves in such a situation. Discussion with staff showed that they had an understanding of adult protection issues and have received training in this topic since the last inspection. Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 16 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 & 30: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents live in a safe and homely environment, with plans for redecoration and alterations in place to enhance their surroundings. EVIDENCE: Meade Hill Road care home is a large detached house. It is comfortable, bright, cheerful, clean and welcoming, with a reasonable standard of decoration and furnishings. The home is situated on a main road and it is not distinguishable as a care home therefore promoting ordinary life principles. Residents are encouraged to personalise their rooms with their own belongings. The building is adequately maintained. The property is close to shops, a park and pubs and there is easy access to public transport. Ramps are provided to both the front and rear doors and there is a pleasant and well-maintained garden at the back of the building Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 17 The home was clean and tidy on the day of this inspection with a good standard of hygiene and cleanliness achieved. Infection control training is provided to all staff and plastic aprons and gloves are supplied. In respect of laundry facilities, the washing machine is sited in a small room adjacent to the home’s kitchen, and the dryer is in the dining room. The manager recognises that the dryer needs to be moved, and is formulating plans for a separate utility area that will accommodate the dryer, and a new washing machine that will withstand heavy use. The manager is devising a maintenance and renewal programme to incorporate the new laundry plans and identify areas for refurbishment and redecoration. Fire safety records show that regular checks are carried out on fire equipment, and that the requirements made by the fire safety officer, highlighted at the last inspection, have been met. Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 & 35: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have their needs met by a competent and supported staff team. EVIDENCE: Staff members confirmed that a comprehensive induction period is provided. The organisation uses the Skills for Care induction standards to ensure that new staff are familiarised with the procedures, practices and standards that inform their work. All staff have completed the NVQ level 2 qualification, and some are now working towards NVQ level 3. The manager is making good progress in updating staff personal development plans and is having regular one to one meetings with each member of staff to ensure the needs of the residents are being appropriately met. Regular mandatory refresher training is provided, and staff members have received training in adult protection as required at the last inspection. As 50 of the staff have worked at the home for less than a year and are still getting to know the residents, it would of benefit for staff to receive training directly related to the specific needs of each resident. This would ensure that Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 19 consistent and suitable communication and behaviour strategies are being used by every staff member. In respect of staffing levels, there are two members of staff on duty during the morning and evening, and three for part of the day. One waking and one sleep-in staff members cover the night. One of the residents has needs that require constant and close supervision. Staffing levels should be reviewed to ensure that these needs are met and that the staff numbers available to support the other residents are not compromised. Outreach houses do not usually keep detailed staff recruitment information within each home. This information is kept in a central office. The CSCI therefore undertook a random sample of staff personnel files in June 2007 to check on the vetting arrangements for care staff working in Outreach properties. These checks confirmed that the recruitment procedures were robust and safe and promoted equality and diversity. Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 20 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 & 42: Quality in this outcome area is adequate.This judgement has been made using available evidence including a visit to this service. The structure and quality of support that residents receive is being gradually improved by a competent and experienced manager. EVIDENCE: Since the last inspection the registered manager has left the organisation, and the service is being managed by the registered manager of another property within the Outreach scheme. The manager has successfully completed the Registered Managers Award and she therefore has qualifications in both care and management. As she needs to oversee practice and developments at two houses, assistance is provided by a senior support worker, also having responsibility for the two services. It is recommended that a senior support worker is employed at each service, so that day to day management is always available in the absence of the manager. Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 21 It is clear that the manager has recognised the areas that require improvement and is actively taking steps to address them. Staff members feel supported and that the manager runs the home in an open and inclusive way. The service does not currently have a quality assurance system that is largely based on the views of residents and their relatives to measure their success in meeting the home’s aims and objectives. This needs to be addressed. Information provided by the service, and random sampling of records showed that the home’s equipment is properly and safely maintained. Checking of the home’s fire precautions book showed that the fire alarm system is checked and tested at the required weekly intervals. Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 22 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 3 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 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 3 2 X 2 X 2 X X 3 X Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 23 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 YA6 Regulation 15 Requirement Timescale for action 01/03/08 2. YA20 13(2) Plans of care must reflect each person’s needs, choices, goals, support requirements and risk assessments to ensure that the full range of residents’ needs are addressed. Training must be provided to 19/11/07 staff to ensure that all staff understand and follow the correct medication administering and recording procedures and residents get their medication when needed. There must be a quality assurance plan that shows residents and their relatives how their views are used to improve the service to residents. 01/03/08 3. YA39 24(3) Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 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 Standard YA18 Good Practice Recommendations Written information in plans should include each resident’s likes, dislikes and preferred routines so that all the staff know how each person makes their needs and wishes known, and how to respond, so that residents get the best type of support from every staff member. One of the residents has needs that require constant and close supervision. Staffing levels should be reviewed to ensure that these needs are met and that the staff numbers available to support the other residents are not compromised. It is recommended that a senior support worker is employed so that day to day management is always available in the absence of the manager. 2. YA35 3. YA37 Outreach Community & Residential Services DS0000008445.V347444.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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 Outreach Community & Residential Services DS0000008445.V347444.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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