Inspection on 12/04/07 for Pilgrim Homes Milward House

This inspection was carried out on 12th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Pilgrim Homes Milward House 14/02/06

Pilgrim Homes Milward House 02/11/05

Pilgrim Homes Milward House 16/03/05

Pilgrim Homes Milward House 02/09/04

Pilgrim Homes Milward House 06/10/03

Pilgrim Homes Milward House 22/05/03

Similar services:

Old Hastings House

The Shelley

Springfield House

Sutton Lodge Nursing Home

St Helier`s Residential Hotel

St Joseph`s

Ridgemount

Wingham Court

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

CARE HOMES FOR OLDER PEOPLE Pilgrim Homes Milward House 6 Madeira Park Tunbridge Wells Kent TN2 5SZ Lead Inspector Gary Bartlett Key Unannounced Inspection 12th April 2007 8:45 X10015.doc Version 1.40 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 Pilgrim Homes Milward House DS0000026193.V334079.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 Older People. 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. Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Pilgrim Homes Milward House Address 6 Madeira Park Tunbridge Wells Kent TN2 5SZ 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) 01892 528115 01892 518802 milward@pilgrimhomes.org.uk www.pilgrimhomes.org.uk Pilgrim Homes Mrs Ruth Meltz Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home can accommodate up to, but not exceeding 7 service users with Dementia over the age of 65 - DE(E) Care may be provided for 1 additional person that is resident within the sheltered housing scheme that is part of Milward House. This care may be provided for up to a maximum of 48 hours. It may not be provided for consecutive periods. The provision of this care must be notified to C.S.C.I. Under Regulation 37. 14th February 2006 Date of last inspection Brief Description of the Service: Milward House is owned and operated by Pilgrim Homes. It provides personal and nursing care and accommodation for older people with Christian beliefs. Consequently, the Home has a strong Christian emphasis and regular prayer meetings and devotional services are a feature of life within the Home. Milward House is located in a residential area of Tunbridge Wells. The usual facilities of a large town are approximately ¾ mile away with the nearest rail and bus services ½ mile away. Accommodation is over three-storeys, with a passenger lift. Milward House has twenty-four single rooms and two shared rooms. The home employs care staff, working a roster, which gives 24-hour cover. The home also employs other staff for maintenance, catering and domestic duties. The home is adjacent to sheltered housing accommodation that is also provided by Pilgrim Homes. Current fees range from £474 to £795 per week. Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key unannounced inspection was conducted by Gary Bartlett, Regulatory Inspector, who was in Milward House from 8.45 a.m. until 3.45 pm. During that time the Inspector spoke with 8 residents, 5 visitors and some staff. Parts of the Home and some records were inspected and care practices observed. Residents and their visitors spoke very highly of the home. Individual statements are quoted throughout the report. A large number of comment cards were received from people who use the service, their relatives and health care professionals prior to the inspection. Feedback was positive and included the statements: • “Provides a safe Christian home to live in”. • “The standard of personal care is very high”. • “Most helpful and eager to help with any problems that arise”. • “Good caring environment”. • “High quality nursing care in a homely environment”. • “I am very happy here”. The Manager and staff gave their full co-operation throughout the inspection. Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: Residents and staff safety would be better promoted if there were more adequate storage areas for equipment such as lifting hoists and wheelchairs when not in use. Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 7 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 2, 3, 4, 5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can be confident that they are appropriately placed due to good preadmission assessments and benefit from being able to visit the home prior to admission. The home does not provide intermediate care. EVIDENCE: The Manager described how a pre-admission assessment is made of each prospective resident to ensure the home can meet his or her needs. Records show that prospective residents, their families, advocates, and relevant health care professionals are involved in the assessment process. Specialist advice is sought from external sources where required. Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 10 Residents said they or their families had been able to visit Milward House before moving in. They also said staff are very helpful in assisting them to settle in. Some relatives who were visiting confirmed this. To protect their interests, every resident is given a contract of terms and conditions. There were various contracts available to be used according to the funding arrangements for individual residents; for example privately funded or local authority funded residents etc. The contracts clearly state the roles and responsibilities of the interested parties. Intermediate care is not offered at Milward House. Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 and 11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ personal health needs are assessed and maintained through their individual care plans and with good liaison with relevant health care professionals. Residents are protected by staff adhering to good practice guidelines in the storage and administration of medicines. Staff treat residents with respect and maintain their privacy and dignity. EVIDENCE: During the inspection comments made by residents included: • “The care is excellent and I feel well looked after”. • “They make sure I stay as well as possible”. Each resident has a care plan and three were inspected in detail. They are comprehensive, clearly identify individual’s care needs and how they are to be Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 12 met. The plans are regularly reviewed. Consequently staff referring to them have a good knowledge of how to give residents the care they need. Daily records are informative and of a generally high quality. The Manager is aware that staff must be diligent in ensuring risk assessments are written to help safeguard residents. The Manager described how they offer all residents and/or their relatives the opportunity to be involved in the writing and review of care plans but some do not want to. There is a key worker system to facilitate a good exchange of information about residents. Visiting relatives said staff are very good at keeping them informed. Accidents records seen are appropriately completed and correlate with the daily records of care that show appropriate action is being taken. The Duty Room is clean and well maintained. Medications are stored in accordance with their instructions. Records indicate that all staff administering medications are trained and signed off as being competent to do so. The Medication Record Administration Record (MAR) sheets are completed appropriately and there are systems to monitor this. Records show the Home continues to have a good working relationship with the specialist and local health care professionals. This greatly assists in supporting residents in their health care needs. Care plans indicate referrals are made as necessary. Residents said they can have access to their G.P. and other services such as dental, hearing and sight etc. when they need to. Residents feel that staff are kind and gentle and this is confirmed by observation. Staff are very considerate of the age and dignity of residents and treat them with courtesy. Training in the care of the dying and the management of bereavement is available to staff. Many funeral services are held at the home, enabling other residents and staff to participate. If not, a thanksgiving service is conducted instead. The need to support staff at such times is well recognised Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents can enjoy a fulfilling lifestyle with good outside links maintained and have as much choice and control over all aspects of their lives as their individual abilities allow. Dietary needs of residents are well catered for with a balanced and varied selection of food that meets their tastes. EVIDENCE: The Manager stated residents are supported to manage their own affairs for as long as they wish and are able. Staff spoken with are aware of the rights of residents to have the opportunity to have choice in daily routines and activities. In accordance with its Christian ethos, prayer meetings and devotional services are pivotal to the routine of the home and are provided every day. Many residents continue to be involved with local churches and associated events. Residents described how their inks with the local community are maintained according to their wishes and take account of their needs. Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 14 From Monday to Saturday inclusive, activities are held at 3.00 pm in the lounge and include reminiscing, quizzes, games, exercises etc. These are conducted by care staff and enjoyed by those who choose to participate. During the inspection a number of visitors were seen in the Home and the visitors book records regular visits by families, friends and others. Residents can meet with visitors in a designated room, various communal areas or in their bedrooms. Residents are happy with the arrangements. Visitors said they can visit at any reasonable time and are always made very welcome by staff. They particularly appreciate being able to make hot drinks etc. in the refurbished ground floor kitchenette. Staff were observed to be very accommodating to a group of relatives that arrived during lunchtime. Meal times are set for practical reasons but can be flexible to accommodate activities when necessary. Residents were complementary of the food served and said their tastes are met as best possible with a choice of menu always being offered. The meals are generous in portions and look appetising. Mealtimes are relaxed; staff are patient and helpful and allow residents the time they need to finish their meal comfortably. Residents said fresh fruit and hot and cold drinks are available through out the day, as well as snacks. Staff have a good awareness of meeting special dietary needs. The Environmental Health Officer had inspected the kitchen in January 2006 and awarded the Gold Hygiene Award in recognition of the high standards. Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents and their relatives know their complaints are listened to and acted on. There are systems to protect residents from abuse. EVIDENCE: The complaints procedure is readily available to residents and their relatives. They said they feel confident that they would be listened to and any necessary action would be taken. A resident said: • “If you have a worry it is always quickly resolved”. The Home keeps a record is of all complaints received by them. The Pre Inspection Questionnaire showed 12 complaints had been received by the home in the last 12 months, 3 of which had been substantiated. All complaints have been dealt with and acted on in a timely fashion. The Commission has not received any complaints about the home. There are procedures for responding to suspicion or evidence of abuse or neglect to ensure the safety and protection of residents. The Manager and other staff spoken with have a sound understanding of adult protection Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 16 procedures. Any allegation of abuse would be referred to the concerned agencies without delay. Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 24, 25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy an attractive and homely place in which to live. EVIDENCE: Comments made by residents and their visitors included: • “It’s very comfortable and a lovely place to live”. • “Every time I visit, it is very clean, warm and welcoming”. Milward House is situated in a quiet residential area of Tunbridge Wells. It provides spacious accommodation over three floors, with a passenger lift to each floor. Since the last inspection, the lift has been replaced and residents find this easier to use and consequently have more independence. Residents can readily get to all parts of the home they wish to. Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 18 The Manager is particularly attentive that residents’ care needs can be met in the bedrooms they occupy. Residents said they have all they need and are very happy with their bedrooms. The bedrooms seen are comfortably furnished and some contain the residents’ own furniture and effects. All bedroom doors are fitted with locks and lockable facilities are provided in every bedroom for residents to secure personal items and money. Many residents have televisions and some have their own telephones. For those residents who share a double room, there is curtain screening between the beds so their privacy can be maintained. The Home is accessible for wheelchair users and a range of equipment and aids is used to provide support for those with reduced mobility and to promote independence. More residents are physically frail with a consequent increase in use of lifting hoists. Observation and discussion with residents and staff indicate a possible need for additional equipment to maintain efficient working and to ensure residents do not have to wait too long before they can receive assistance. Storage space is at a premium and staff are having to be very careful that wheelchairs and hoists do not cause obstruction when not in use. The standard of equipment is carefully monitored, although part of the frame of one hospital style bed is rusted and would benefit from repair or replacement. Everywhere is very clean and there are no offensive odours. There is an ongoing programme of redecoration and refurbishment. Staff and residents consider the bathing facilities to be suitable for their needs. Hot water taps are fitted with thermostatic control valves and radiators are guarded to ensure residents’ safety. The laundry is well maintained and adequate for the purposes of the home. All fire-doors are fitted with automatic closure devices. Residents spoke of how they like to use the well kept grounds in more clement weather. Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Recruitment processes are robust and offer protection to people living at the Home. The Home provides induction and training for staff so they have a clear understanding of their roles and the skills to meet the residents’ needs. EVIDENCE: Residents spoke very highly of staff. • “They are very kind and patient…” • “Nothing is too much for them.” Residents benefit from a relatively low staff turn over. The recruitment processes are sufficiently robust to ensure only properly vetted people are employed at the Home. Commendably, these checks are made in respect of volunteers as well. There are some staff vacancies and occasionally agency staff are used. When this happens a record is kept of the first day induction completed by agency staff member to show they have been shown the home’s core policies and procedures such as emergency procedures, medications etc. The Manager or a senior staff member is always on call. Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 20 The staff roster inspected does not show anyone working long consecutive shift patterns could compromise staff competency through fatigue and thereby put residents at risk. All new staff are required to undertake an induction programme and do not work unsupervised until deemed competent. A comprehensive training programme is available to staff and NVQ training is encouraged. Some staff spoke of the support they receive in this. There is a training matrix for easy monitoring of staff members individual training/update requirements. Staff were seen to be attentive and demonstrated a commitment to meeting residents’ needs. Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents and staff benefit from the sound and effective management of the home. The home regularly reviews aspects of its performance through a programme of self-review and consultations, which includes the opinions of residents and relatives. Residents’ financial interests are protected. Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 22 EVIDENCE: The Manager is a registered nurse and has a postgraduate qualification with many years experience in the care of older people in a senior capacity. She has also obtained NVQ level 4 and Registered Manager’s Award qualifications. The management approach to Milward House creates an open, positive and inclusive atmosphere in which people who live there are able to influence the way in which the home is run. Residents, their visitors and staff consider the management team to be approachable, understanding and supportive. The running of the home is greatly assisted by a very able administrative staff member who has been able to update systems and implement new ones with a professional acumen. The Home encourages residents to manage their own financial affairs or to have assistance from their families / representatives. Where the Home holds cash on behalf of residents, there are very good systems for recording amounts, which facilitates ease of monitoring. These records are audited regularly. A commendable touch is the inclusion of a photograph of the resident on their money wallet. The amount of monies held on behalf of four residents was checked and these balanced with the records. Milward House operates a comprehensive quality assurance system based on seeking the views of residents, their relatives/representatives and other concerned parties to measure the success in meetings the aims and objectives of the home. Appropriate insurance cover is provided for the home and a current insurance certificate is displayed. Staff receive supervision every other month, including an annual appraisal, when their training and development needs are identified. Staff spoken with have a sound understanding of emergency procedures. The Manager described a system of ongoing environmental risk assessments. The Pre Inspection Questionnaire indicated that all records of maintenance and safety checks are up to date and that policies and procedures are regularly reviewed by a competent individual to ensure they comply with current legislation and good practice advice. Records seen are kept in a manner that preserve confidentiality. Pilgrim Homes Milward House DS0000026193.V334079.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 Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 2 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 4 4 X 3 3 3 3 Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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. Standard Regulation Requirement Timescale for action 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 OP22 Good Practice Recommendations It is recommended the hospital style bed with partially damaged framework and any other equipment in a similar state be made good or repaired as so as practicable to protect residents and staff. It is recommended appropriate storage space is provided for aids and equipment to minimise trip hazards. It is recommended a review be undertaken to assess if there is an adequate number of lifting hoists so that residents do not have to wait for unduly long periods of time when requiring assistance. 2. 3. OP22 OP22 Pilgrim Homes Milward House DS0000026193.V334079.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT 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 Pilgrim Homes Milward House DS0000026193.V334079.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. 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!