CARE HOME ADULTS 18-65
Pia - Milverton Terrace, 4 4 Milverton Terrace Leamington Spa Warwickshire CV32 5BA Lead Inspector
Sheila Briddick Unannounced Inspection 1st February 2006 12:30 Pia - Milverton Terrace, 4 DS0000004224.V282589.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 Pia - Milverton Terrace, 4 DS0000004224.V282589.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. Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Pia - Milverton Terrace, 4 Address 4 Milverton Terrace Leamington Spa Warwickshire CV32 5BA 01926 882831 02476 640146 dkelly@people-in-action.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) People in Action Deborah Charlotte Kelly Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: 1. That the extra bedroom is only to be used by a service user coming to live at the property for a contracted period of six months or less. Service Users residing in this bedroom must not use any other bedroom in the property during their stay in the home. 10th August 2005 Date of last inspection Brief Description of the Service: Milverton Terrace is a registered care home providing short-term care with the aim of supporting people with learning disability wishing to live, with support, in their own home and wider community. The parent company, People in Action provide 24-hour care and support for service users living in the home. The home is a large converted house, close to the town centre of Leamington Spa. Shared accommodation consists of a lounge, dining room and kitchen. There is also a bathroom, toilet, laundry and office on the ground floor. There are two service user bedrooms on the ground floor, which are suitable for wheelchair users. Other service user bedrooms and the staff sleep in room, and a shower/toilet facility are located on the first floor. There is a large garden to the rear of the property. There is limited access to the front of the property for car parking. Entrance to the home at the front is via a series of steps up to the front door. There is wheelchair access to the property however at the side of the building. Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 1st February 2006 between the hours of 12:30 P.M. and 4:30 P.M. During this time the inspector had the opportunity to meet with the people living and working in the home and their views are included in this report. The interactions between the people living there, staff and their environment, were observed and a tour of the home took place. Documents relating to service users and the management of the home were examined. This included care plans, risk assessments, medication records and staffing files. What the service does well: What has improved since the last inspection?
Significant progress has been made in the development of care planning and risk assessment. This process includes a regular reviewing system of both care plan needs and risk assessment and involves the service user. The assessment process now ensures that service user’s needs are identified more quickly so that staff have sufficient information as soon as is possible regarding the individual needs, wishes and choices. Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 Page 6 This includes supporting service user’s independence when managing their specific health care needs if necessary. Service users spoken with confirmed that they are able to contribute their views and concerns about lifestyle in the home, especially at times when their lifestyle may be restricted as part of keeping other people safe. Cleaning schedules are now in place and this ensures that people always have a warm and welcoming place in which to live however, requirements have been made in this inspection regarding maintenance that is necessary to further enhance the environment and keep people safe from possible harm. New flooring has been installed where necessary in individual bedrooms, all bed linen was seen to be in good condition and bathrooms and toilet windows now have curtains fitted to ensure privacy. A small kitchen no longer used has been refurbished and now provides a quiet place in which service users can sit and meet with visitors. 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. Pia - Milverton Terrace, 4 DS0000004224.V282589.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 Pia - Milverton Terrace, 4 DS0000004224.V282589.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): 2 Steady progress is being made to ensure that the admissions procedure is robust enough for proper assessment of need to take place prior to people moving into the service to ensure that the respective service user’s care needs are compatible with those of existing service users EVIDENCE: Only elements relating to the requirement made against this Standard at the last inspection visit were examined. The registered manager is making steady progress in reviewing the home’s Service Level Agreement with Warwickshire Social Services and it is intended that this process will be completed shortly. An amended timescale for the outstanding requirement was agreed. The inspector was informed that staffing level agreements will be included in this review and a good practice recommendation was discussed regarding setting care need review dates of prospective service users prior to their coming to live in the home and that reviews should also consider the impact the needs of the new service user may be having on existing service users and staffing levels. Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 and 9. There is significant progress being made in this home to ensure that the views of the people living there are sought and acted upon to ensure that the lifestyle in the home continues to maintain and promote their freedom and choice. EVIDENCE: Staff spoken with felt that they were offering choices regarding daily activities and respecting the individual choices service users were making. They spoke of this being a trial and error process by giving people opportunity to try new things. Staff spoken with recognised that offering opportunity to try new things should be based on effective risk assessment. Success in offering people new leisure activities included holidays and short breaks, which for some people was a totally new experience, with positive outcomes achieved. During the visit staff were out supporting service users with shopping, walking and swimming activities. Staff spoken with confirmed that service users and staff are sitting together to talk and are including people who find it difficult to communicate or mix with
Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 Page 10 people easily. A service user spoken with said that staff ‘listened’ to them and talk about where we want to go. The service user also confirmed they had their own money to spend, on what I want. Regular meetings are taking place with service users to discuss areas of the service provision and a record is maintained. There is documented evidence to show service users are being involved in any risk assessment strategy concerning them. Risks are being reviewed at least monthly and at team meetings. Staff carrying out risk assessment do not do so unless they have completed appropriate training. The manager has developed an effective risk management assessment tool which is clear in directing staff to the need for specific guidelines to be in place to ensure that needs are met appropriately and safely and that the views of the service user have been sought during the risk assessment process. Service user spoken with said they felt safe living in the home and appeared happy and comfortable with the people supporting them. Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 17. The people living in this home are being involved in decisions being made in risk assessment processes that may impinge on their rights and choices when accessing shared areas of the house. The meals in this home are good and offer both choice and variety and cater for special dietary needs. EVIDENCE: The risk management process includes the use of kitchen facilities and shared areas of the home. This can still mean the kitchen area is restricted at times due to specific risks for individual service users however, during the visit it was noted that the kitchen is accessible when staff support can manage any risk. At the time of this visit there were sufficient staff supporting service users and people were seen to be able to access the kitchen area, and other shared areas of the home, readily and easily. Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 Page 12 The food provision has been reviewed since the last inspection visit. Previously service users chose their menu and this was cooked individually for them. Staff spoken with a said that generally the choices service users were making at that time were not healthy and included lots of ready meals, take-away meals and chips. Staff spoken with discussed the healthy eating approach being offered to service users now through informed choice. Breakfast and evening meals are planned with service users and how the evening meal is now a social time when everybody eats together rather than as previously with the single meal choices. Service users talked about their involvement in cooking activities in the home and choosing menus and shopping for food. The individual dietary needs of service users have been identified and the support of speech and language services is being sought in care planning for specific needs. Where a soft diet it is recommended there are good photographic examples on display in the kitchen of soft diet menus for staff to follow. Pia - Milverton Terrace, 4 DS0000004224.V282589.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 The health and medication needs of service users are well met with evidence of good multi-disciplinary working taking place on a regular basis. EVIDENCE: Examination of care plan records show that a requirement made at the last inspection for care plans to be in place for diabetes care management, when necessary, has now been met and this includes assessing the individuals ability to manage their condition when able. There was no one doing so at the time of this visit. District nurses are fully involved in supporting the staff team to meet specific health care needs, including diabetes care and deep vein thrombosis (DVT) care and are making regular visits to the home. Occupational Therapy advice is being sought regarding the individual support needs of service users and this includes advice on equipment that may be necessary to promote mobility and health. Care plans were in place for the management of these conditions and include guidelines for staff to follow. Service users spoken with confirmed that they are having appropriate support from nurses regarding their specific needs and liked the doctor – ‘she’s a lady and she is nice’, and see the chiropodist regularly. Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 Page 14 Medicine management continues to be generally good. Staff are keen to ensure records of medicine held in the home are documented appropriately and good practice recommendations were discussed regarding records held on MAR Charts. These records do not currently record the amount of as required (PRN) medicine held in the home. A record of all medicines coming into the home each month however is being documented elsewhere as the home maintains its own system for recording medicines in stock alongside MAR chart records. Administration times for medicine is colour-coded on the MAR chart to correspond with the colour coding on the medication dispensing system. When using this system staff may not always refer to the written instruction on the Mar chart and a good practice recommendation was discussed with the registered manager. Pia - Milverton Terrace, 4 DS0000004224.V282589.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): These standards were not assessed on this occasion. EVIDENCE: Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, and 27 There has been some progress made to improve the appearance of shared areas of this home however the standard of décor generally in many areas remains poor with little evidence of future planning for improvement. EVIDENCE: A tour of the environment showed that work has satisfactorily taken place to meet some requirements made at the last visit. This included replacing carpets that had become worn and needed replacing, ensuring bathrooms and toilet windows had curtains fitted for privacy and for cleaning schedules to be identified for all areas of the home. All external areas of the environment had been cleared of condemned furniture and equipment and a small kitchen and had been nicely refurbished. This now provides a quiet place for service users to sit and/or meet relatives and friends, other than their bedroom or shared area of the home. The dining room and lounge areas of the home are bright, cheerful and were clean at the time of the visit. Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 Page 17 Service user bedrooms in general reflected the interests of individuals however two bedrooms were quite cluttered and did not appear to have sufficient storage space for personal items. The registered manager said that furniture was on order for one of these bedrooms and delivery was expected shortly. There is some concern regarding a water leak from the upstairs shower room, which is causing damage to a service user’s bedroom ceiling below, and water has at times leaked directly onto the bedroom floor. The registered manager said this had been bought to the attention of the South Warwickshire Health Authority, who are responsible for the maintenance of premises but no action had yet been identified for the repair to the shower facility or the ceiling. Paintwork and plasterwork throughout the building is showing signs of damage from general wear and tear and use of wheelchairs around the building. Repairs to some areas remain outstanding from the previous inspection visit and this includes repairs to chipped worktops in the kitchen and flaking paintwork in the shower room. The backdoor is rotten at the base and worn away. The enamel in the downstairs bath has worn away in one area, this has the potential to cause skin damage to a person when bathing and possible infection as the area cannot be satisfactorily cleaned. The windowsill in the downstairs toilet requires repainting as it is badly chipped and therefore cleaning cannot be effective. The lift was out of order and not being used at the time of the visit however satisfactory action was taking place for the repair to be completed. Pia - Milverton Terrace, 4 DS0000004224.V282589.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): 33 and 35 The staff team in this home is enthusiastic, well trained and is working positively with service users to improve their whole quality of life. EVIDENCE: Staff spoken with demonstrated an awareness of the individual needs of the people living in the home and the importance of reviewing the success and progress of meeting needs and objectives as part of the care planning process. Staff also demonstrated knowledge of the importance of ensuring all goals service users had were achievable. Staff generally felt communication between themselves, and with service users, is much improved since the last visit, and that having a team leader on at each shift has given more structure to the service and ensure supervisory support is always available. The manager said that there is a good team now and communication is good and regular Team Building Away Days is supporting this”. Training for staff is developing well, ensuring that staff can gain the necessary skills to meet the specific and complex needs of the people they are supporting. The individual training needs of staff is monitored and staff spoken with had had training Learning Disability Award Framework (LDAF), Administration of Medicine, Communication, Diversity and Equality, Positive Reinforcement in Challenging Behaviour and where either working to, or had achieved an NVQ in Care. Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 Page 19 A service user spoken with said that staff treated them well and that they felt well cared for and could talk to staff if they felt unhappy. Throughout the time of the visit staff were seen to be supporting service users sensitively and appropriately. Choice was being promoted and effective communication was taking place between service users and staff. Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 39 and 42 The manager has a clear development plan and vision for the home and she is effectively communicating this to service users, staff, professionals and relatives. The quality of the décor in many areas is poor and some structural damage in places is potentially dangerous and places service users and visitors of risk of injury or harm. EVIDENCE: Systems have been developed for seeking the views of service users during monthly meetings, in the risk assessment process and care planning review system. The views of service users are required to be documented on all records relating to risk management and care planning. The registered manager is actively seeking the views of professionals and family members on the service provision. Comments received from speech and language therapists made positive reference to improvement of communication between the two services. Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 Page 21 Reference has been made in this report regarding maintenance issues that are necessary to promote a warm and welcoming environment in which people can live and work. It was also noted during the tour of the environment that the flight of concrete steps to the front door of the property are beginning to show signs of wear and tear. The concrete is beginning to crack and edges of the steps have chipped away and this could cause serious injury if fell upon. Handrails are positioned on the right-hand side of the steps only and as the steps are wide this would not always promote safe support for a person with a right-sided physical disability. Health and safety checks are routinely carried out and fire safety records were found to be up to date and in good order. Records for monitoring fridge and freezer temperatures however had not been regularly maintained up to date. The manager demonstrated a commitment to ensuring that the health and safety of people is promoted and maintained however to manage this role effectively sufficient resources must be made available to them. Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 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 2 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 X 23 X ENVIRONMENT Standard No Score 24 2 25 X 26 2 27 2 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 3 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X 3 X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 3 X X X 3 X X 2 2 Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 Page 23 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 YA2 Regulation 12 Requirement Timescale for action 30/03/06 2. YA24 23 3. YA24 23 A copy of the reviewed service level agreement must be forwarded to the Commission for Social Care Inspection when completed. The registered manager must 30/03/06 ensure that the water leak from the upstairs shower room is repaired and this includes all damage to the bedroom ceiling immediately below. (Previous timescale of 30/10/05 not met) The registered provider must 30/05/06 ensure that all areas in the home showing signs of damage from general wear and tear are repaired and made good and this includes redecoration to bathrooms, toilets and corridors where paintwork is flaking or has been damaged, repair to plasterwork that is showing signs of damage from general wear and tear, replacement of the side door and replacement of the downstairs bath. Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 Page 24 4. YA26 16 5. YA30 23 6. YA42 13.4(a). 23.2(b) 7. YA42 16.2(j) 8. YA43 25 The registered manager must ensure that service users have adequate storage space for their belongings. Chipped worktop areas in the kitchen must be repaired so that effective cleaning can take place. (Previous timescale of 30/10/05 not met). The registered provider must make arrangements for the repair to the concrete steps at the front door of the property and ensure it is safe for people to use by the provision of handrails at both sides of the steps. The registered manager must ensure that the record of fridge and freezer temperatures is maintained up to date. The registered provider must ensure that sufficient funds are made available to ensure that the environment is maintained to a standard necessary to achieve the aims and objectives are set out in the statement of purpose for the home. 30/03/06 30/03/06 30/04/06 28/02/06 30/05/06 Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 Page 25 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. Refer to Standard YA2 YA20 Good Practice Recommendations It is recommended that the impact a new service user has an existing service users lifestyle in the home and staffing levels is routinely reviewed at the first review. It is recommended that the practice of colour coding MAR charts against the corresponding dispensing package is discontinued and that a record be maintained on the Mar chart of all medicine held in the home that is to be given as required. Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 Page 26 Commission for Social Care Inspection Leamington Spa Office Imperial Court Holly Walk Leamington Spa CV32 4YB 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 Pia - Milverton Terrace, 4 DS0000004224.V282589.R01.S.doc Version 5.1 Page 27 - 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!
