Inspection on 18/10/06 for REACH Lower Cippenham Lane

This inspection was carried out on 18th October 2006.

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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

REACH Lower Cippenham Lane 13/10/05

REACH Lower Cippenham Lane 10/05/05

REACH Lower Cippenham Lane 05/10/04

REACH Lower Cippenham Lane 25/05/04

REACH Lower Cippenham Lane 27/01/04

REACH Lower Cippenham Lane 12/08/03

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

CARE HOME ADULTS 18-65 178 Lower Cippenham Lane Cippenham Slough Berkshire SL1 5EA Lead Inspector Jill Chapman Unannounced Inspection 18th October 2006 10:00 DS0000011286.V308477.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 DS0000011286.V308477.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. DS0000011286.V308477.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service 178 Lower Cippenham Lane Address Cippenham Slough Berkshire SL1 5EA 01628 666132 01628 666132 cippenham@reach-disabilitycare.co.uk Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (If applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) R.E.A.C.H. Limited Post Vacant Care Home 12 Category(ies) of Learning disability (8), Learning disability over registration, with number 65 years of age (3), Mental disorder, excluding of places learning disability or dementia (1) DS0000011286.V308477.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users not to be admitted over the age of 65 years. Date of last inspection 13th October 2005 Brief Description of the Service: 178 Lower Cippenham Lane offers twenty-four hour residential care to twelve, male and female service users who have a diverse range of learning and associated disabilities. The house is a large two-storied detached building with accommodation on both floors. The home is situated in a residential area of Slough, the town is accessible via the public transport system and the home has its’ own vehicle. There are local shops and amenities within walking distance, and the home is an integral part of the community. The building is owned and the care is provided by REACH Ltd. Although the home is relatively large, staff ensure that its’ domestic ambience is retained. The current fees for the home range from £706.29-£1546.35 per week. DS0000011286.V308477.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Commission has, since the 1st April 2006, developed the way it undertakes its inspection of care services. This inspection of the service was an unannounced ‘Key Inspection’. The inspector arrived at the service at 10 am and was in the service for 6 hours. It was a thorough look at how well the service is doing. It took into account detailed information provided by the service’s owner or manager, and any information that CSCI has received about the service since the last inspection. The inspector asked the views of the people who use the services and other people seen during the inspection or who responded to questionnaires that the Commission had sent out. The inspector looked at how well the service was meeting the standards set by the government and has in this report made judgements about the standard of the service. The inspector had the opportunity to speak with nine service users during the inspection. A tour of the communal areas of the home and garden was carried out and three service users bedrooms were seen. Discussions took place with two staff on duty, the manager and the operations manager who visited during the inspection. Service user, staff and health and safety records were sampled. The manager who was in post at the time of the last inspection has left and a new manager has been in post since June 2006. What the service does well: The home makes sure it can meet the needs of new service users. Service users get information to help them decide to whether to live in the home. Service users have the opportunity to make choices about their care and have a key worker who helps them with their personal shopping. The home is excellent at helping service users to enjoy community facilities and to improve their independence skills. The home has a positive and caring culture in the home, which recognises the diverse needs of the service users and accepts their individuality. Staff help service users to keep in contact with their families and support them if they choose to have a special relationship. Service users are involved in choosing their meals and can help with the shopping and cooking. DS0000011286.V308477.R01.S.doc Version 5.2 Page 6 The routines of the home are flexible to meet the differing needs and choices of the service users. Staff help service users keep healthy and to take their medication. Service users know who to talk to if they are not happy and staff know how to deal with complaints. Staff are trained to know how to protect service users from being abused. The home is well looked after and improvements are planned. Service users are supported by a staff team that are trained to meet their needs. The organisation is helping staff from overseas improve their English and to look at cultural issues, which will further improve their work with service users. Good recruitment practice helps keeps service users safe. Regular health and safety checks help keep service users safe. The new manager is looking at ways to improve the service. 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. DS0000011286.V308477.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 DS0000011286.V308477.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. Service users needs are assed to make sure the home can meet their needs and they are given enough information and contact with the home to help them decide to live there. This judgement has been made using available evidence including a visit to the service. EVIDENCE: In discussion with managers it was found that the home follows the company’s Admissions Policy when admitting new service users. This includes carrying out a full assessment of need and a gradual introduction to the home to make sure that the home is suitable for the prospective service user. There have been no recent admissions however service users files seen show that regular reviews are held to make sure that the home continues to meet their needs. It was seen that reviews address any concerns service users have about their placement. From service users surveys it was seen that they and sometimes their families were involved in choosing this home. They said that they received enough information to help them make this choice. DS0000011286.V308477.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is adequate. Service users care needs and risks are identified and met but improvements in recording these would further protect service users. This judgement has been made using available evidence including a visit to the service. EVIDENCE: Service users files were sampled and these show that each service user has a Person Centred Care Plan, which is reviewed regularly. Some of the care guidelines seen were in need of updating and to be made more specific to reflect the current good practice being carried out. The new manager said she is in the process of carrying out this work. The home operates a key worker system and staff were confident about this role. They said they are given written guidance to help them. Service users spoken with know who their key workers are and spoke about how they help them with personal and clothes shopping. DS0000011286.V308477.R01.S.doc Version 5.2 Page 10 In discussion with service users and staff and from observing practice it was clear that service users could make choices in their daily routines. One service user said he would prefer to be able to go out on his own but knows that staff accompany him for safety reasons. This decision needs further clarification in guidelines and risk assessments. The reason for the use of a monitoring device for another service user also needs to be documented. It was seen that there are a variety of appropriate risk assessments in place for individual service users. These have not been updated or made more detailed as recommended at the last inspection. They need more written information to help staff know how to reduce the risks. The new manager is aware that this work needs to be carried out. DS0000011286.V308477.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15,16 & 17 Quality in this outcome area is excellent. Service users are supported to have a good quality of life in the home and in the community. They are encouraged to develop their independence skills. There is a positive and caring culture in the home and service users diverse needs are recognised They are supported to enjoy family and appropriate personal relationships. Service users benefit from a healthy and varied diet, which they help chose and prepare. This judgement has been made using available evidence including a visit to the service. EVIDENCE: DS0000011286.V308477.R01.S.doc Version 5.2 Page 12 The home has good links with East Berkshire College and service users talked enthusiastically about college courses they attend several times a week. They said they enjoy cooking and gardening. During the inspection a tutor from the local college came to the home to hold a session with some of the service users. The REACH Operations Manager had attended a planning meeting with the college tutors in the morning and visited the home to tell the manager of the outcome. An activity plan is kept and daily diaries show activities and outings that have occurred. Discussion with service users and staff shows that they enjoy good access to the local community. Most service users said they like clothes and personal shopping and some like to help with the food shopping. Some like going out for meals and to the pub. There is a home’s vehicle and local taxis are used. Service users said they are pleased that staff have helped them get free bus passes. Service users are encouraged to pursue in house hobbies and games. Some said they like going out to social clubs, bingo and line dancing. Larger group outings often take place on a Saturday. Service users are supported to have an annual holiday and showed photos of past trips. Some had purchased new clothes for a holiday the following week. Service users told how they are helped to keep in contact with their families and friends. There are REACH guidelines for staff on how to support service users who choose to have a relationship. A couple have a shared bedroom and a separate lounge for their sole use or to entertain friends. Two other service users have a close friendship and staff are supporting them to have a meal out to celebrate a birthday. There is a friendly, supportive and respectful atmosphere in the home. The inspector witnessed several instances of service users supporting or comforting each other and being concerned about each other’s well being. It was seen that staff treat service users with respect and that their privacy is maintained. Service users are free to move about the home as they wish, some chose to spend time in their own room and others use the communal space. The service users have a pet dog that keeps them company in the communal areas and alerts them when visitors arrive. Menus were sampled and show that a variety of appetising meals are provided. Service users help plan the menus and some like to help shop for and prepare the meals. Food stocks were good and a lunchtime meal was a sociable and relaxed occasion. Some service users chose to have sandwiches instead of the planned omelette and salad. None of the service users have any special dietary needs but regular weight checks are recorded and advice given if needed. DS0000011286.V308477.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good. Service users receive care and support in the way they prefer and according to their diverse needs. They are encouraged to be individuals within the large group setting. They are helped to keep healthy and to take their medication. This judgement has been made using available evidence including a visit to the service. EVIDENCE: The home cares for a large group of service users with diverse needs. There are care guidelines in place which cover areas such as bathing, cross gender care, personal care and domestic tasks. The guidelines are detailed and give the reasons for the actions needed. The manager has identified that although the guidelines are still current the paperwork needs updating. In discussion with service users it was clear that their personal preferences are taken into account but this was not always evident in the paperwork. Service users told how the routines of the home are flexible to their needs and choices. For instance the majority of service users like to get up early and have DS0000011286.V308477.R01.S.doc Version 5.2 Page 14 breakfast together but some prefer to have breakfast later on. Some like to help with household jobs such as laying the table and helping with the washing up. One service user likes to pick the post up every day. It was noticeable that service users are encouraged to maintain their individuality in this large group. They are supported to choose appropriate and fashionable clothes and to use local hairdressers. Health care needs and appointments were well documented in files sampled. A service user he told how he is supported to attend appointments with his psychiatrist and that his Community Nurse visits the home to give him medication. The home has a suitable system for making sure that service users are given their medication safely. Staff attend a training course run by Slough Borough Council and they are not allowed to give medication until assessed to be competent. Medication is clearly documented in service users files and on the record sheet. It is delivered in Nomad packs made up by the pharmacist and is checked to make sure it is correct. Two staff take part in the administration process to ensure accuracy. Stock is checked for accuracy once a month. Medication storage is mostly satisfactory but current Nomad packs are stored in a locked box in the same cupboard as the cleaning materials. The inspector has sought advice from the Commissions Pharmacy Inspector who has said that they should be stored separately from the cleaning materials to avoid the possible risk of cross contamination. DS0000011286.V308477.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good. Service users know who to talk to if they are not happy and staff know how to respond to complaints. Staff are trained to identify poor practice and to protect service users from potential abuse. This judgement has been made using available evidence including a visit to the service. EVIDENCE: In discussion with staff it is clear that they are familiar with the complaints procedure and how to deal with a complaint. Service user surveys show that they know who to talk to if they are not happy. The manager said that the Complaints Procedure is being produced in a pictorial format to make it easier for service users to access. There has been one complaint about the service since the last inspection, which has been investigated and resolved. The commission has received no information concerning complaints made about the service from service users or their representatives. In discussion with staff and from sampling staff records it was seen that staff are trained to know how to protect service users from potential abuse. Staff spoken with knew that they should report any concerns about poor practice. The manager said that some staff have not had vulnerable adult training yet and she is arranging this. DS0000011286.V308477.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 & 30 Quality in this outcome area is good. Service users benefit from a clean, well looked after and comfortable home. Accommodation is flexible to meet the diverse needs of the group. Planned decoration and improvements to the premises will further improve service users accommodation. This judgement has been made using available evidence including a visit to the service. EVIDENCE: A tour of the communal areas of the home was carried out and the home was found to be clean and well cared for. The home employs a cleaner Monday to Friday. REACH employs a maintenance person who visits the home once a week. The manager said that redecoration of the communal areas and new lounge furniture is planned. Service users were aware that they would help choose colour schemes and the furniture. The bathrooms are in need of refurbishment and the manager said that this is planned for this year. There are also plans to DS0000011286.V308477.R01.S.doc Version 5.2 Page 17 provide a walk in shower to meet the mobility needs of some service users. The garden is well kept and new garden furniture has been purchased. Five service users were willing to show the inspector their bedrooms. These are large and well furnished. They are personalised according to service users choice and interests. One service user showed the new bedding he had recently chosen. There is an infection control policy in place and there are no specific hygiene needs in the home. DS0000011286.V308477.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 35 & 36. Quality in this outcome area is good. Service users are supported by a staff team that are trained to meet their needs but more staff need to achieve nationally recognised training. The organisation is helping staff form overseas with their English and to look at cultural issues, which will further improve their work with service users. A robust recruitment procedure helps make sure only suitable staff are employed. Staff are regularly supervised to help them in their work with service users. This judgement has been made using available evidence including a visit to the service. EVIDENCE: There are two team leader vacancies in the staff team at present and these jobs are to be advertised. There are a minimum of three staff per shift and some one to one hours are deployed for certain service users. Staffing levels also vary to support particular activities. Staff said that the staffing levels are suitable for the current service users; the majority are able to communicate well and to see to their personal needs with prompting from staff. DS0000011286.V308477.R01.S.doc Version 5.2 Page 19 Service users were positive about the support they get and it was seen that there are good relationships between service users and staff. It was seen that staff praise service users skills and helpfulness and knew how to comfort them if they were distressed. The staff team is of mixed culture and this seems to be mostly positive. One service user had concerns that he could not understand the accents of some staff and it was seen the REACH have sent certain staff on a training course to improve their English. The manager said that staff have recently attended a cultural awareness day to look at how different cultural attitudes can influence the way they work with service users. It was seen from records and in speaking to staff that they receive induction and core training. They also receive training is specific to the needs of individual service users. Only three staff have NVQ qualifications and this is an area that needs further development. There is a recruitment procedure in place and this was verified by speaking to staff and sampling recruitment records. References, Criminal records checks and employment histories are followed up prior to appointment. A previous requirement to ensure that staff are adequately supervised has been met. Staff and records confirmed that a programme of individual supervision is underway. Staff also confirmed that they have had an annual appraisal. DS0000011286.V308477.R01.S.doc Version 5.2 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 & 42 Quality in this outcome area is good. There is a competent manager in post but the company must support the manager to apply for registration. The home seeks the views of service users in the development of the service. There are systems in place to ensure the health and safety of service users and staff. This judgement has been made using available evidence including a visit to the service. EVIDENCE: There is an outstanding requirement that the newly appointed manager apply for registration. At the last inspection it was identified that the home has been without a manager who has been registered for several years. DS0000011286.V308477.R01.S.doc Version 5.2 Page 21 Since the last inspection there has been another change of manager who has been in post since June 2006. She said she anticipates being able to apply for registration when her probationary period comes to an end. She is has relevant past experience as a registered manager and working with service users with a learning disability. She has a National Vocational Qualification level 4 in management and is due to start her NVQ Level 4 in Care. Records sampled show that the manager is carrying out the management task. Service users and staff were positive about her approach. A requirement to make sure that the Quality Assurance system and proprietors visits are carried out has been met. Regulation 26 visits have been carried out monthly and an Annual Development Plan was seen. Regular service users meetings are held. Health and safety records were sampled and show that regular health and safety checks and servicing of equipment are carried out. These include Fire safety, Hot Water temperatures, Accident records and monthly checks of service users electrical appliances. DS0000011286.V308477.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 x 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 x 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 x 2 x LIFESTYLES Standard No Score 11 x 12 4 13 3 14 3 15 4 16 4 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 3 2 x 3 x x 3 x DS0000011286.V308477.R01.S.doc Version 5.2 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 YA37 Regulation 8 Requirement The organisation must apply for registration of the newly appointed manager. This is outstanding from 01-12-05 2 YA9 13 The responsible individual must ensure risk assessments are appropriately detailed and up-todate. The responsible individual must ensure that medication is stored separately from cleaning materials. 18/12/06 Timescale for action 18/12/06 3 YA20 13.2 18/12/06 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 YA35 YA7 Good Practice Recommendations The programme of NVQ should be developed further. Restrictions to service users choice should be documented. DS0000011286.V308477.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Berkshire Office 2nd Floor 1015 Arlington Business Park Theale, Berks RG7 4SA 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 DS0000011286.V308477.R01.S.doc Version 5.2 Page 25 - 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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