Inspection on 03/08/05 for Prince of Wales House

This inspection was carried out on 3rd August 2005.

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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Prince of Wales House 11/04/08

Prince of Wales House 23/04/07

Prince of Wales House 03/05/06

Prince of Wales House 04/01/06

Prince of Wales House 07/10/04

Prince of Wales House 28/04/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Prince of Wales House 18 Prince of Wales Drive Ipswich Suffolk IP2 8PY Lead Inspector Jane Offord Unannounced 3 August 2005 rd 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 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. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Prince of Wales House Address 18 Prince of Wales Drive, Ipswich, Suffolk, IP2 8PY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01473 687129 01473 604869 None The Partnership in Care Limited Post vacant. Care Home 43 Category(ies) of Dementia - 10, Older People - 33 registration, with number of places Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 19/1/05 Brief Description of the Service: The home is situated in a residential area of Ipswich about three miles from the town centre. There is a parade of local shops nearby and regular buses into the town. The accommdation is on two floors with a passenger lift access for people unable to manage stairs. On the ground floor is a special needs unit for ten residents with dementia. There is a large enclosed garden which is accessible by separate doors from the special needs unit and the main house. The bedrooms are single occupancy with bathrooms and toilets placed throughout the home within easy reach. There is a large lounge and dining room on the ground floor and smaller quiet lounges available if preferred. The special needs unit has a lounge, dining area and kitchen, with access to an enclosed part of the garden. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on a weekday starting at 8.30 and finishing at 17.30. The manager and deputy manager were both unavailable so the service was being overseen by Alison Lovelock, Area Manager for Partnership in Care, and Sarah Kopferschmitt, Quality Assurance Manager who were both present throughout the day and assisted the inspector with information and files needed. During the inspection three residents’ files and four staff files were seen. The inspector spoke to three residents and a visitor, five staff plus the two visiting managers and had a tour of the main building and the special needs unit. Policy folders, menus and staff rotas were also made available. The medication storage and Medication Administration Record sheets (MAR) were seen. On the day of inspection the home was found to be clean and tidy. There was a relaxed and friendly atmosphere. Individual requests for help were responded to rapidly and appropriately. There were workmen on the premises attending to an upgrade of the hot water system. During the day the soldering activity set off the heat detectors four times. The staff responded calmly and rapidly each time and returned to residents to reassure them and explain what was happening. What the service does well: The admission assessments are comprehensive and generate full physical needs care plans, which are reviewed regularly. Assessments related to pressure area protection such as the Waterlow score and weight maintenance are completed and reviewed regularly. The residents have choice about how or where they spend their time. Meals are served in their rooms if they choose. Visitors are welcome at any time and can see residents in private if they wish. The choice of food is wide and varied. The meal served on the day of inspection looked appetising and was hot. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 6 People who use this service can expect to have their needs assessed and assurance that they can be met prior to admission. People who are referred for intermediate/transitional care can expect the service to assist their passage home. EVIDENCE: The personal records seen had documented pre-assessment forms that covered a wide area of care needs. Areas such as, bathing, eating, communication, continence, sensory abilities, medication and past medical history were routinely recorded. There were also assessments for manual handling, falls, sleeping and cognition. Care plans seen reflected these headings and had generated risk assessments for management of hot water, falls and mobility. Discussion with the Area Manager clarified that the service offered by the home is ‘transitional care’ not ‘intermediate care’. The home does not offer a rehabilitation package but accommodation while a care package is prepared to allow a resident to return to their own home. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 9 The service liaises closely with the Transitional Care Co-ordinator and the Social Worker to maintain momentum for the resident. There can be difficulties in recruiting carers to get someone home, particularly in rural places, which can mean that some residents become permanent. A pre admission assessment for transitional care is undertaken by a senior member of the care staff who visits the prospective resident, usually in hospital, prior to admission. The areas of need covered are similar to those for permanent admission. There are plans to use specific documentation for transitional care records that would detail the planned package of care for the return home. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9, 10, 11 People who use this service can expect that they will be treated with respect, their right to privacy maintained and that their care plan will cover their health and medication needs. They can also expect that their final wishes will be managed with sensitivity. EVIDENCE: Personal records for residents listed visits/appointments by health care professionals. The district nurse visits for any wound dressings, the GP visits when requested and one file had the record of an assessment undertaken by the Osteoporosis Nurse. One resident said that they have regular appointments with a chiropodist of their choice. Staff were observed talking respectfully to residents, offering help and choices and knocking on toilet and bedroom doors prior to entry. Residents said that they were able to choose same sex carers for personal care if they wanted to. This choice was confirmed by staff and the manager. MAR sheets seen were all correctly completed with signatures or codes for nonadministration. The Controlled Drugs (CD) record was correct and the drugs check tallied. There were photos of residents on the MAR sheets for identification. Drug disposal protocol was adhered to properly. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 11 The drug trolley and the drug storage area were both locked and the keys were kept with the senior carer of the shift. There was a detailed policy for the administration of ‘homely remedies’ that was agreed with the GP. There was evidence in the documentation that final wishes of residents can be recorded. The manager said that staff sometimes found this a difficult area to approach with residents, particularly on admission. Sometimes other members of the family are encouraged to assist in obtaining the information. One record seen had recorded that a brother had passed on information on behalf of the resident. The manager agreed that this was an area that would benefit from some training input. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14, 15 People who use this service can expect to have a choice of diet, control over their life and be encouraged to maintain contact with family and friends as they wish. EVIDENCE: During the tour of the home the kitchens were visited and there was evidence of a wide selection of food in the store cupboards and freezers. The menus seen offered a choice of main courses and in addition, the cook said, there is always the alternative of omelette, a fish dish or salad if a lighter meal is preferred. The temperature recording for all the refrigerators and freezers was up to date and showed that food was being stored at safe temperatures. There was evidence that staff were using the refrigerators to store their sandwiches for lunch. It was recommended that these be stored routinely in the staff refrigerator provided in the staff rest room. Lunch on the day of the inspection was a choice of chicken curry and rice or eggs, ham, chips and peas. There were vegetable dishes and jugs of squash on each table for residents to help themselves. Carers were observed offering a choice of condiments such as vinegar or salad dressing. Some carers were discreetly helping residents with their meal. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 13 Residents spoken with in their rooms said they could take any meals in their rooms and the carers served and cleared away promptly. They were also able to keep some snack food in their rooms like biscuits and fruit. One resident had a mini refrigerator in their room that the family had bought to keep chocolate fresh. Residents were able to choose how to occupy themselves during the day. Some residents spent some time in the garden using the benches out there. Two residents spoken with preferred to spend time in their rooms but said they visited other residents on the same corridor. One resident said that their room had a lovely view of part of the Orwell river and the bridge which they enjoyed contemplating. Another resident had moved from their own home in an area of Ipswich which had become ‘dangerous’. They said they felt better off in the home. They ‘didn’t know places like this could be so nice’. The home has an activity co-ordinator who works with the day care people mainly but is available to offer activities to residents as well. The activity programme showed a lot of Bingo but the inspector has spoken to the manager since to raise the issue of increased choice of activity for the residents. The manager said that a variety of other activities take place on an ad hoc basis. For residents to make a clear choice of how they wish to spend their time a clearly defined programme of activity and interests should be available. External activities and visits take place with the use of a minibus. There have been ‘Gentlemen only’ outings, shopping trips and there is a planned visit to Felixstowe imminent, the manager said. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16, 18 People who use this service can expect that their concerns and complaints will be acted on, and steps taken to satisfactorily resolve them, however they cannot be assured that the staff are aware of the correct procedures for reporting potentially abusive situations, under the present training programme. EVIDENCE: Residents and a visitor said that if they had a complaint they could speak to the staff and indicated that they felt that their concerns would be addressed. There was evidence in staff files that a member of staff had had disciplinary action taken against them in response to a complaint that they had spoken ‘harshly’ to a resident. CSCI received a telephone complaint on June 27th 2005. This complaint was discussed with the manager on the day of inspection. The manager was able to explain what steps had been taken to deal with the matter and demonstrate that there was compliance from staff with the new rules. Staff spoken with confirmed the changes in practice that had recently taken place. Although staff were able to identify potentially abusive situations they were less clear about the procedure to follow to report them. One member of staff said they had been booked in for POVA training that had been cancelled and not rebooked. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 15 A discussion with the manager showed that they were aware that there were gaps in the mandatory training for staff but they were trying to address these with a programme over the next few months. It was made clear that for the protection of residents the POVA training must be priority training. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 22, 24, 25, 26 People who use this service can expect to live in a well maintained, comfortable environment with their own possessions around them, however they cannot be assured that up to date policies are in place to control the risk of infection or that the heating and hot water system meets regulation standards. EVIDENCE: The service has complied with requirements from the last inspection, many of which were maintenance issues. The kitchen has been redecorated in line with an Environmental Health Requirement and work has been done to replace old wooden shelving with practical stainless steel surfaces. The filters over the cooking area have been cleaned and there is a rota that has been established for future cleaning. There is a new carpet in the communal lounge and dining area. Gaps on fire doors for some rooms have been reduced to acceptable spaces, and work has Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 17 been done to level the patio and paths in the garden for the safety of residents. Residents’ bedrooms showed evidence of personal possessions and items of individual choice on display. One resident said that they had their own bed linen that their family took care of for them. The inspector was also told that keys for residents’ rooms were available to residents on request. There were grab rails in place along the corridors and a passenger lift between the two floors. Doors to the outside had ramps for wheelchair access. On the day of inspection there were workmen completing work to replace the hot water system. A previous inspection had identified that the water storage did not meet the regulation requirements. There was agreement from the manager that CSCI would be notified when the work was completed so it could be inspected or a certificate of guarantee seen. The home was clean and there were no odours on the day of inspection. One domestic assistant was able to explain the process for managing the risk of infection but said they had not seen a policy. The manager was able to produce the policy but it related to the previous management group and needed to be updated to apply to Partnership in Care. There are plans to undertake a full maintenance review and prioritise the work. This is a big proposal but will benefit the residents and the environment in the future. One piece of work that needs to be done urgently is the replacement of the double-glazing units in the patio doors of the lounge in the special needs unit. The glass is glazed and nearly opaque restricting the view of the garden and probably not functioning properly to insulate the room. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29, 30 People who use this service can expect to be cared for by an adequate number of staff to meet their needs who have been recruited with the correct checks, however they cannot be assured that the present training programme will equip staff to do their jobs. EVIDENCE: The duty rotas were seen and showed that an early shift is covered by one senior carer supported by five others and the late shift has one senior carer and four others. During the day there are usually one or two management staff who are supernumerary to the care team. On weekdays there are also three domestic staff, a handyman, a laundry assistant and carers in the day care area. The night duties are covered by three care staff. All residents spoken with felt that the staffing met their needs. They did not wait for staff to respond if they rang a bell or requested assistance. One member of staff felt that there were occasions when sickness was not covered at short notice but that was infrequent. The staff recruitment files seen showed evidence that recently employed staff had received the appropriate checks prior to starting their job. Older files which belonged to staff taken over from the Local Authority only had one reference due to the Local Authority policy at the time. As referred to earlier in the report the training for POVA needs to be undertaken urgently. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 19 The evidence of staff compliance with fire training was more than adequately demonstrated on the day of inspection. In addition there was formal fire training taking place later in the day. Staff who administer medication receive the ‘Boots’ training for administration. One senior carer spoken with had not received that training but had routinely been doing drug rounds. This omission must be rectified urgently. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 20 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36, 37, 38 People who use this service can expect that their welfare will be their interests safeguarded by the record keeping policies of the they cannot be assured that all other policies will protect them. expect that the staff will receive formal supervision on a regular EVIDENCE: There was evidence in staff records that supervision takes place regularly and staff confirmed that. They said that supervision covered any issues they had concerns about, training and future development. The personal records for the residents were all kept appropriately in a cupboard in the office. There are plans to introduce a computerised care planning system and introduce the practice of giving residents control of their own care plans to make them more accessible and a ‘live’ document. protected and home however They can also basis. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 21 There was evidence in the staff training files that training in Manual Handling, First Aid, Health and Safety, COSHH and fire safety takes place during induction and is updated. Staff spoken with said that all hazardous cleaning agents were stored in locked cupboards. Although hot water taps had individual thermostats, because of the difficulties being experienced with the plumbing system, they also had ‘caution’ stickers as well. The accident/incident record was seen and it was noted that there were no trends in the type of equipment, the resident or the time involved in different incidents. The records were complete with action taken and signatures of staff witnessing or reporting. There was evidence that pressure mats were being used to monitor residents who were at risk of falling or who wandered at night. The use of these mats and the protocol for adopting them should be included in the policy for the use of restraint to ensure they are used for residents’ care and not ease of management. The medication policy does not give guidance on the covert administration of medication. All the residents but especially those with special needs require written protection from this potential for abuse. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 22 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 x x 3 x 3 2 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x x x x 3 3 2 Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 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 9 9.2 Regulation 13 (2) Requirement All staff who administer medication must undertake a recognised training programme before commencing drug administration. All staff must have training in Protection of Vulnerable Adults and be aware of the up to date procedures for referral of incidents. The hot water system must be adequate to protect residents from the risk of Legionaires disease and offer for bathing at a temperature close to forty three degrees Centigrade. The protocol for the use of pressure mats, including risk assessments, must be added to the policy for restraint. Guidance about covert administration of medication must be developed to protect residents. Timescale for action immediate. 2. 18 18.1 13 (6) immediate 3. 25 25.8 13 (3 4) 31/8/05 4. 38 38.5,6 13 (7) 31/10/05 5. 38 38.5 13 (6) 31/10/05 Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 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. 2. Refer to Standard 26 12 Good Practice Recommendations The infection control policy for the service should be reviewed to reflect the management organisation at present not the previous one. The programme of activities should be developed to offer wider choice for residents. Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 Page 25 Commission for Social Care Inspection 5th Floor, St Vincent House 1 Cutler Street Ipswich Suffolk, IP1 1UQ 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 Prince of Wales House I54-I04 S29240 Prince of Wales House v242909 050803 Stage 4.doc Version 1.40 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. 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