Inspection on 28/02/07 for Priors Piece

This inspection was carried out on 28th February 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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

Priors Piece 11/01/06

Priors Piece 13/07/05

Priors Piece 25/11/04

Priors Piece 18/05/04

Priors Piece 02/03/04

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

CARE HOME ADULTS 18-65 Priors Piece Priory Drive Totnes Devon TQ9 5HU Lead Inspector Graham Thomas Unannounced Inspection 28th February 2007 9:30am Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Priors Piece Address Priory Drive Totnes Devon TQ9 5HU 01803 865473 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) enquiries@comae.org.uk Mr Simeon James Antony George Ramsden The Very Rev Archpriest Benedict Ramsden, Katherine H L Finnigan, Mrs Lilah Ramsden Vacancy Care Home 3 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (3) of places Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th January 2006 Brief Description of the Service: Priors Piece is a small, single storey residential home on the outskirts of Totnes providing care for up to three service users with mental health problems. The home is part of the Community of St. Anthony and St. Elias which has a number of homes in the Plymouth and South Hams areas. For ease of reference this will be referred to as the Community throughout the report. Each service user has a single bedroom and access to a kitchen and lounge / dining room. There is a small garden. Parking is limited as canoes and vehicles belonging to the Community are stored at the site. The Community provides a well-established outdoor activities programme for service users. Arts activities are also organised through the Communitys own arts co-ordinator. Other local opportunities for the maintenance and development of life skills in the home and local community are provided. At the time of this inspection the home was being managed by the manager of a neighbouring home also run by the Community. Her application to register as manager has been received by the Commission. Current charges range from £1646 to £1714 per week Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Before the inspection visit, the manager completed a questionnaire. Written feedback was received from two relatives. Surveys were sent to three professionals involved with service users but none was returned. The Inspector spent 6 hours at the home. During this time he toured the premises and spoke informally with all three service users. Three staff were interviewed and the Inspector observed their interactions with service users. Records were examined including care plans, staff records and documents concerning health and safety. The home’s system for the administration of medicines was also inspected. What the service does well: What has improved since the last inspection? A new floor has been laid in the hall and corridor. Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 6 Daily recording has been improved to show how the care plan is being carried out. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 Quality in this outcome area is good. Prospective service users can feel confident that their needs will be thoroughly assessed and understood before they move into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Only one of the service users had been admitted to the home since the last inspection. This person had been resident in other homes run by the Community since 2002. Care plan records showed a satisfactory process concerning the move to Priors Piece. Previous inspection has demonstrated a thorough assessment process. This includes meeting a prospective service user in their current placement, gathering information from referring authorities and visits to the home. Clear care plans have been produced for each service user based on their needs and goals. Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6, 7 and 9 Quality in this outcome area is excellent Service users’ needs and goals are well understood by staff and clearly recorded in individual plans. Staff support service users well in making choices about their lives. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All three service users’ plans were examined. These were clear and well organised. Each plan set out the individual needs and goals of the service user. All the plans covered social, personal, family and healthcare needs including psychological needs. The plans had been reviewed regularly and had been signed by service users. Some service users’ freedoms were restricted. Where this was the case, the reasons were clearly stated in the care plans. Individual files included details of work undertaken by other professionals working with the service user concerned. In addition to the care plans a new system of daily recording had been introduced. These daily records were detailed and clearly linked to the needs and goals set out in the care plans. It was therefore easy to see how individual plans and goals had been followed through. Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 10 During the inspection staff were observed offering choices and enabling service users to make decisions about their daily activities. Examples included walking into the nearby town or participating in a music activity. Individual service users’ decisions were respected and recorded. One care plan showed how support was being given to a service user in order to maintain interest and motivation so that their range of choices were maintained. This was confirmed in discussion with staff and the manager. One service user’s need for support had recently increased. This had been accompanied by behaviour which challenged the staff team. The changes were well documented and understood by the staff. During the inspection, the Inspector observed how staff were managing these challenges. The issue was also discussed with staff. It was clear that the staff group understood the individual’s needs well and how to respond to the challenges without escalating any conflict. At the time of this inspection the ability of one service user to make decisions concerning healthcare was under discussion. Correspondence seen on this service user’s file demonstrated that issues concerning decision-making and consent were being properly considered in the light of new legislation. Clear, well structured risk assessments and management plans were seen in each file. Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 15, 16 and 17 Quality in this outcome area is excellent. Service users are very well supported to make choices about their lifestyle. Excellent support is given to service users to maintain and develop their interests and activities. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Community provides a range of activities for service users living in its homes. A timetable of activities was on display in the home’s office and there were records as to which activities service users had joined. The available activities include arts and crafts, music, sports, outdoor activities, and local trips. Co-ordinators who are skilled and qualified in these areas are employed by the Community. On the day of the inspection one service user was offered a music activity which was declined. Another took a trip to the local shops. A visit to sports facilities in Plymouth was also planned. Individual service users confirmed that they were able to maintain interests in music, guitar playing and cricket. Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 12 The Community also provides support for voluntary and paid work placements. At the time of this inspection, no service users were able to take advantage of these opportunities. In written feedback, a relative commented that “..they help arrange …outings in and around Devon which contribute greatly to (my relative’s) well being..”. Another remarked “They help (my relative) live as part of the community and he can live an active and happy life with their support” Service users receive support, including transport, to maintain contact with their families. One relative commented. “I see (my relative) often. I go and see (my relative) sometimes at very short notice. They bring (my relative) to see me and we talk 2 or 3 times a week on the phone. Another commented on the support given to a service user to attend a family funeral and to visit at Christmas. This support was confirmed in care plans and in discussion with staff. Issues of individual rights and responsibilities were examined. Service users all have locks on their room doors and were seen to be able to spend time alone if they wished. Interactions between staff and service users were sensitive and respectful. This respect was also reflected in the daily notes and records. During the inspection, an individual’s choice not to participate in an activity was respected, though appropriate encouragement was offered. As mentioned above, correspondence showed that the implications of consent regarding treatment for one service user were being seriously considered in the light of new legislation. A rota had been produced concerning individual service users’ responsibilities for everyday chores in the home. Menus supplied by the manager and seen in the home showed a varied and balanced diet. Service users were actively encouraged to make decisions about meals. The content meals was monitored by the manager who reviews and sign the menus and comments if necessary. Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18, 19 and 20 Quality in this outcome area is excellent. Service users receive a high standard of personal and healthcare support. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The three service users at the home were being supported by three staff on the day of the inspection visit. Rotas showed that three or four staff were routinely on duty. A high degree of individual support and attention was therefore routinely provided. All three staff were interviewed. In interview the staff demonstrated a very sound awareness of the support needs of individual service users and how these were being met. One service user’s behaviour was challenging during the inspection. The support given by staff to this service user was sensitive and reflected an awareness of the person’s fluctuating needs. Staff had received training in deescalation and were evidently putting these skills into practice. No service user wished to speak to the Inspector on this occasion. However, one relative commented in written feedback “(My relative) has been in a number of institutions since becoming ill but this is the first and only one to have made a material improvement in (my relative’s) condition” Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 14 All three care plans revealed that both routine and specialist healthcare treatments had been made available to service users. Specialists had been engaged where necessary. For example, dental care had been provided by a dentist experienced in working with people with additional support needs. The Community has its own Consultant Psychiatrist whose specialist input was shown in care plan documentation. The care plans also demonstrated that the home is very active in maintaining relationships with external mental health professionals. The home’s system for the administration of medicines was examined. All medicines were securely stored in the home’s office. A monitored dosage system was in use. Records concerning the medicines brought into the home and administered were up to date. Changes to service users’ medication were covered by notes from a medical consultant. At the time of inspection there were no controlled drugs in use in the home. The homely remedies in use were covered by an approved list. During the inspection the Inspector discussed with the manager some potential improvements to staff guidance concerning “as required” medication. All staff receive training concerning medication and evidence of this was seen in training records. The medication for one service user was discussed with a member of staff. This staff member demonstrated a clear understanding of the medication, its purpose and side effects. Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23 Quality in this outcome area is good. Service users can feel assured that their concerns will be listened to and acted upon. There are sufficiently robust systems in place to protect service users from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The high degree of staff support in the home means that service users’ concerns can be dealt with immediately before they escalate. Care plans and daily records demonstrated how service users’ views had been listened to and acted upon. Clear policies and procedures were in place concerning, complaints, protecting vulnerable adults from abuse and whistle-blowing. Copies of the complaints procedure were available for service users. Records were seen of accidents and incidents in the home. These had been reviewed and commented upon by the Community’s senior staff. Staff files contained evidence of recruitment checks including criminal records and the national protection of vulnerable adults list. All staff receive training in the protection of vulnerable adults from abuse as part of their induction. Training is also given to staff on diffusing and managing aggression. Good practice in this area was observed during the inspection. Written confirmation has been received by the Commission that the banking arrangements for service users safeguard their monies. Records were Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 16 examined in the home regarding service users’ “weekly allowances”. Detailed records were available for inspection and these were supported by receipts. Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30 Quality in this outcome area is good. Priors Piece provides a sufficiently clean, safe, and comfortable home for service users This judgement has been made using available evidence including a visit to this service. EVIDENCE: Priors Piece is a bungalow close to the centre of Totnes where there are shopping and recreational amenities. There are three bedrooms, a bathroom and toilet, kitchen office and utility room. Sleeping-in and separate toilet facilities are provided for two staff. Communal space includes a lounge and dining area and gardens to the rear of the property. Parking is limited by local restrictions and the necessary use of the home’s driveway by staff. Furnishings and décor throughout were of a comfortable domestic style. On inspection, the home was found to be generally clean and free from offensive odours. A new floor had been laid in the hall and corridor leading to bedrooms and there was evidence of some recent decorative work. The office required some refurbishment, including the carpet. Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 18 The home’s laundry has cleanable floors and walls. Clinical waste arrangements were in place to cater for the specific needs of one service user. The fire log showed that routine checks were being carried out. Evidence of other maintenance and safety checks was seen. This included, for example, up to date electrical wiring and gas checks and routine first aid box checks. The manager of the home has recently completed a fire warden’s course. She and the Community’s health and safety officer plan to use this knowledge to ensure that the home and the Community generally is aware of the requirements of new fire legislation. A first aid box was available and the manager has recently completed a four day course on “First Aid at work”. Risk assessments were seen concerning environmental hazards such as the risk from hot water. Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32, 34, 35 and 36 Quality in this outcome area is good. Service users are supported by a sufficient number of competent staff to meet their individual needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: As mentioned above there are usually three to four staff on duty during the day time. This provides 1 to 1 support for service users. Two staff sleep in at night. The staff team is drawn from a pool of staff used flexibly by the Community. Staff rotate between the homes. Some spend longer periods in each home to provide a degree of consistency. Training is organised centrally by the Community. Of the staff group of six, only two currently held a National Vocational Qualification in care at level 2 or above. However, a thorough induction and foundation training programme is provided for which the Community has recently won a regional training award. The induction training includes various elements concerning understanding mental health and other topics relevant to service users’ needs. Discussion with staff and individual files also confirmed that staff have access to training in health and safety topics including, for example first aid updates. Some staff were due for update training in first aid and fire safety. Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 20 During the inspection, staff demonstrated skill and good judgement in managing challenging behaviour and their general interactions with service users. Evidence was seen of staff putting their training into practice. All the staff understood the particular needs of the individuals they were supporting. In discussion with the Inspector one member of staff demonstrated a very clear knowledge and understanding of a particular service user’s medication. The Community has agreed with the Commission that staff records could be held centrally but produced at the home on the request of an Inspector. Staff files were seen in the home which showed evidence of sound recruitment practice. This included a formal application, interview and the taking up of references and criminal records checks. In discussion, staff confirmed they had been recruited through this process and had been invited to a “taster day”. This involved a visit to one of the Community’s homes to meet staff and service users. Staff stated that they had received details of the terms and conditions of their employment. A system for staff supervision and appraisal was in place. The Inspector examined supervision records discussed the frequency of staff supervision with the manager. Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37, 39 and 42 Quality in this outcome area is good. Service users and staff benefit from living in a generally well managed home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection, the Registered Manager has left to take up professional training. At the time of this inspection, the home was being overseen by the manager of a neighbouring home belonging to the Community. She was registered to manage the neighbouring home and had applied to the Commission for registration as Manager of Priors Piece. This application was being processed. The applicant holds an National Vocational Qualification in care at level 4 and the Registered Managers Award. She is experienced in care and has managed the neighbouring home successfully. In addition to her existing qualifications evidence has been seen of training updates she has undertaken to maintain her knowledge and skills. Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 22 The Community has developed a framework for a system of quality assurance in all its homes. Questionnaires had been prepared for service users, relatives and others about the service. These had yet to be sent out. Health and safety issues were examined. Clinical waste arrangements were in place to cater for the specific needs of one service user. The fire log showed that routine checks were being carried out. Evidence of other maintenance and safety checks was seen. This included, for example, up to date electrical wiring and gas checks and routine first aid box checks. The manager of the home has recently completed a fire warden’s course. She and the Community’s health and safety officer plan to use this knowledge to ensure that the home and the Community generally is aware of the requirements of new fire legislation. A first aid box was available and the manager has recently completed a four day course on “First Aid at work”. Risk assessments were seen concerning environmental hazards such as hot water. There were also detailed records concerning accidents and incidents in the home. These had been reviewed and commented on by the Community’s senior staff Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 X LIFESTYLES Standard No Score 11 x 12 4 13 3 14 X 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 4 3 x 3 X 2 X X 3 X Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 24 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 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 2 3 Refer to Standard YA32 YA36 YA39 Good Practice Recommendations The Community should take steps to increase the proportion of care staff who hold a nationally recognised qualification in care. The manager should ensure that there is regular and consistent supervision of staff. The system of quality assurance for the home should be fully implemented. Priors Piece DS0000003781.V324628.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Priors Piece DS0000003781.V324628.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. 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