Inspection on 17/10/06 for Rosamar

This inspection was carried out on 17th 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 no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Rosamar 18/12/07

Rosamar 20/12/05

Rosamar 04/08/05

Rosamar 01/11/04

Rosamar 15/03/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Rosamar 81 Locking Road Weston Super Mare North Somerset BS23 3DW Lead Inspector David Francis Key Unannounced Inspection 17th October 2006 09:30 Rosamar DS0000008089.V311739.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 Rosamar DS0000008089.V311739.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. Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosamar Address 81 Locking Road Weston Super Mare North Somerset BS23 3DW 01934 633397 01934 633397 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) Mrs Belinda Jane Dachtler Mrs Geraldine Ann Coles Mrs Belinda Jane Dachtler Care Home 12 Category(ies) of Learning disability (12), Learning disability over registration, with number 65 years of age (12) of places Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 30th August 2006 Brief Description of the Service: Rosamar is registered to provide personal care to up to 12 people with a learning disability. At present 11 service users live in the home. Most are nearing or have reached retirement age. All are over the age of 40. Some residents continue to attend local day centres or colleges but those who have retired can participate in the good schedule of activities laid on by the home. Four of the bedrooms are registered as doubles and four as singles. There is a pleasant lounge on the ground floor at the front of the house and a dining room with seating area at the rear. The home is situated close to the town centre, within easy reach of local amenities and the sea front. Ten service users placed by Social Services at a fixed rate of £386.35 per week. The other service user has a private fee arrangement with the home. The maximum fee is £600 per week. Copies of this report can be obtained from the CSCI office at Taunton (tel: 01823 345960) or can be downloaded form the CSCI website www.csci.org.uk Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector made two visits to the home. The first visit was on one afternoon from 3.30pm to 6.00pm. During this visit he carefully observed how people who live at Rosamar spend their time in the home and how staff give them support. The manager was aware the inspector would be visiting. The second visit was the main inspection visit and lasted from 9.30am until 5.00pm. This was six weeks later and nobody knew the inspector would be visiting. He interviewed the manager and one member of staff in private. He interviewed two people who live at Rosamar and also spoke to three others. He had difficulty in obtaining their views about the support they received. The inspector looked at all the rooms and the garden and also checked a range of records in the home. He looked at previous reports and letters received since the previous inspection. The inspector spoke to two relatives on the telephone and to two social workers. He also received two survey forms from social workers (including one he had spoken to). The inspector considered the care given to three people in detail. He compared what he saw and what they were able to tell him with the records and comments by staff, social workers and relatives. What the service does well: Staff support people when making the choice about whether to live at Rosamar. For example people can stay over night and visit for tea. There is a good website with great pictures of the people living at Rosamar. People living at Rosamar live in a happy atmosphere. Staff are very friendly and caring. People can help out in the home and enjoy looking after the pets. Rosamar provides trips out and takes groups out to the local pubs and cafes. People are encouraged to be part of the local community. Rosamar provides good food which helps people to stay healthy. Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 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. Rosamar DS0000008089.V311739.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 Rosamar DS0000008089.V311739.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): The overall rating for Choice of Home is GOOD. This is based on all the information available. Prospective service users are given good information about the service and opportunities to try the service before making a decision. This enables them to make an informed choice. EVIDENCE: The home has a clear and useful Statement of Purpose and has invested in developing an informative website; www.rosamarcarehome.co.uk This includes a lot of information, the aims and objectives of the home and staff training. There are lots of photos of residents taking part in the life of the home. The home’s standard fee is set by Social Services (£386.35 per week). This includes toiletries, group activities and trips out in the minibus, although residents pay for meals if eaten when on a trip. There has been one new admission since the past inspection. The new person told the inspector he was able to visit Rosamar beforehand. His relative confirmed this. She said the person had stayed overnight and visited the home for tea before making a decision. There was a record of the person’s admission on his file, including notes of a planning meeting which the person and his relative attended. There was also a detailed care plan prepared by social Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 Page 9 services. The person told the inspector that the home had been very flexible and allowed him to come and go as he pleased. This was observed during the inspection and confirmed by his relative. Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 Page 10 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): The rating for Individual Needs and Choices is ADEQUATE. This is based on all the information available. People are able to take part in many aspects of life in the home and some support is available to help them to develop an independent lifestyle. EVIDENCE: The inspector looked at the plans for people living at the home and compared them with his observations of the care and support people needed and how staff responded. The records included personal profiles about people’s histories, their likes and dislikes, and details of their skills. In some cases it was not clear how people living at the home had contributed to their plans or how up to date the plans were. The daily records varied in detail but where close attention was needed the records were very detailed. A social worker explained that she had particularly asked the home to do this in one case as the person concerned had high needs. Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 Page 11 When the inspector interviewed a member of care staff, she had good insight into people’s needs and was well informed. She told the inspector she looked at the care plans and daily notes. The social workers told the inspector that they felt the home provided only limited individual support and felt most activities were group based. This was confirmed by the member of staff who felt she would like to spend more time supporting individuals e.g. taking them to do their own personal shopping. The manager accepted this and explained that the home is very restricted by the level of funding available. She has approached Social Services for a fee increase. Social workers confirmed that this is being considered or some people using the service as they have become more dependant. When observing the support being by given staff, the inspector noted that there was a wide range of dependency in the home. Some people had very significant emotional, communication and mobility needs. He noted that those people who demanded more attention received this but others who were quieter or more withdrawn tended to be left to get on with things for themselves. They seemed content but may have benefited from more one to one encouragement. The home has made efforts to support the communication needs of one person. The manager is attending evening classes on sign language and staff have had weekly sessions from the local social work team on basic signing. The manager told the inspector that the home’s policy was to treat each individual as an individual. In respect of cultural needs she explained it was important not to make assumptions and that Rosamar worked on the basis of how a person saw themselves. This was evident when looking at how some people were supported. Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 Page 12 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): The rating for lifestyle is GOOD. This is based on all the information available. Within the funding available people are given some opportunities for personal development. The home actively uses nearby cafes and pubs so that people feel part of the local community. EVIDENCE: On both days most people living at the service were seen to be busy within the home, either with their own interests or helping out, feeding the cat, walking the dog, laying the table or helping to prepare the meal. There was a strong feeling of a happy and busy community. There are no restrictions and some people come and go as they please. One person has his own front door key. People living at Rosamar told the inspector they go to the local pub and staff confirmed this. There is a strong emphasis on group outings (on the second day there was a trip to Street). People appear to enjoy this and came back very happy. Some were able to tell the inspector they liked going out. Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 Page 13 Strong emphasis is placed on healthy eating, as the manager is concerned that people with learning disabilities can be overweight. Fresh ingredients were evident in the kitchen, Staff know people’s preferences and one person was offered a peanut and jam sandwich for tea (his favourite) as an alternative. Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 Page 14 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): The rating for Personal and Healthcare Support is ADEQUATE. This is based on all the information available. Staff ensure that healthcare needs are met, but medication records occasionally fail to demonstrate that all medication has been given. EVIDENCE: One social worker spoken to confirmed that staff have been very supportive in creating health action plans for the people living at Rosamar and individual and yearly health care checks were available in people’s records. Files sampled had detailed records of medical appointments and the advice given and any follow up or treatment. Both relatives said that they were kept well informed about any health care matters. Discussion about particular people living at the service with both the manager and staff members demonstrated that staff were alert to the psychological and emotional needs of people living at the service. The home has adopted a new medication policy. The records were generally in good order but 3 gaps were noted in the daily sheets. It is important that these are filled in and any reasons for non-administration coded to ensure people receive the medication they require. It appeared the medication had been given as the “blister packs” were empty. Rosamar DS0000008089.V311739.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): The overall rating for Concerns, Complaints and Protection is GOOD. This is based on all the information available. The people living at Rosamar are listened to and staff respond to their concerns. EVIDENCE: The home’s complaint records indicated that no complaints had been received since 2003 and no complaints had been made to CSCI. One relative spoken to say there were things she wanted to raise with the manager but she felt quite confident she would be listened to and action would be taken. The manager said that staff were very aware of people’s moods and whether they were unhappy. One recent example was because a person living at the home being upset because their family had not kept up contact. The inspector noted a member of staff responding quickly to person who was upset by another person at the mealtime. The staff member said “What’s the matter, lets talk about it in the kitchen”, and later arranged for the person to eat quietly on their own in the lounge. The manager was able to show the inspector a copy of a recent “No Secrets” audit she had completed for North Somerset Council. She had a folder, available to staff, with a number of different articles about abuse in care home. She had copies of the most recent local council No Secrets leaflet which she had just received and was circulating to staff. Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 Page 16 A member of staff said she had not had Adult Protection training but she would either go to the manager or to CSCI if she had any concerns. A recent situation, which had arisen outside of the home, demonstrated that the manager was confident in working with other agencies when concerns arose. Rosamar DS0000008089.V311739.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The rating for environment is ADEQUATE. This is based on all the information available. Although Rosamar is homely, safe and in reasonable repair, the building does not meet modern standards. As a result people have limited opportunity to have their own rooms and cannot chose to have a bath. People with mobility problems face difficulty getting around the building. EVIDENCE: The inspector toured the building and one or two minor faults were immediately put right during the inspection. This gave the inspector the chance to meet the handyman / electrician who told the inspector he was often called to the home and that he undertook routine maintenance checks. The home was generally clean and tidy. One outside gutter was noted to be leaking causing a potential damp problem within the home. There was evidence on ongoing investment in the home; the kitchen is being redecorated and a new ceiling was partially installed. This will improve the atmosphere for people living in the home, as the kitchen is an important Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 Page 18 meeting point. A new television had been provided in the front lounge so that people have a large bright screen to watch. The home has steps on the ground floor and access to bedrooms is only by stairs. The building is not well suited to the needs of less mobile people. A social worker told the inspector that this had been a cause of concern for one person living at the home but following an assessment the decision was that the person should remain at Rosamar for the time being. Six people at Rosamar share rooms, but most have done so for many years. The double rooms are quite small and hard to personalise. Although screens had been put in place these were no longer in use. It was hard to find out what the people thought themselves, but a staff member said she did not see sharing rooms as a problem. She felt the people concerned liked having company and were used to it as they had shared rooms for many years. Two people who had their own rooms told the inspector they liked their rooms. They both appeared at home in their rooms amongst their personal possessions. There are three showers at Rosamar but no baths. This limits the choice available and one relative felt that a “having a back scrub in a bath” would be beneficial. The manager/owner told the inspector that she recognised shortcomings of the building. However it had been the home for many residents for the past 20 years or so after leaving long-stay hospitals. The layout of the building did not allow for extensions or redevelopment and without increased funding, losing double rooms would threaten the home’s viability. Rosamar DS0000008089.V311739.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The rating for Staffing is ADEQUATE. This is based on all the information available. The quality support staff give to people living at Rosamar is high, so that people at the home feel valued and respected. However the staffing levels only allow for limited one to one support so that people have limited opportunity to develop independence and individual lifestyles. EVIDENCE: During the inspector’s visits there were a minimum of two care on duty; other staff supplement the shifts when activities require this or people require additional support e.g. to attend appointments. The manager and the member of staff interviewed said that this staff ratio limits the opportunity to provide one to one support to people living at the home. However the inspector did note that some people were offered individual support on occasions. When the inspector observed staff supporting people he noted staff offering a high level of positive contact with people living at the home. There was a lot of encouragement, warmth, humour, holding hands and “hugs”. The people living at the home really seemed to enjoy and respond to this. There was a lot of smiling, eye contact and banter, and everyone appeared very relaxed. Staff Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 Page 20 were respectful for example asking “Can I move your chair over?”. The inspector noted that staff always responded to people when they initiated contact and did not ignore them. He also noted that staff varied their responses to residents (both in terms of what they said and physical contact), so that individuals received attention appropriate to their needs. When he discussed this with the manager she confirmed that this was deliberate. For example some people needed greater intimacy and reassurance. Whereas others might mis-interpret this. There is emphasis on in-house staff training and the home has had input from the social work team on sign language and managing challenging behaviour. Staff training and induction records showed that most staff had received essential training. The member of staff interviewed had achieved NVQ level 3 in care and had received a range of other statutory training. She said that there were no formal supervision or staff meetings, but that staff relied on informal contact with the manager. She felt this worked but felt she could offer more to people living in the service if she was given more responsibility. The home does not have a key worker system. Two staff recruitment files were checked. Each had an application form and CRB clearance but both had only one written reference, (not two as required). Although the new staff had been interviewed, people could be at risk if the recruitment process is not thorough. The manager explained that two references had been sought (letters confirmed this) but in each case only one had been returned. The inspector advised that two satisfactory written references should be obtained. The staff team at Rosamar is stable and many staff have worked at the home for many years. This means that people living at the service have consistent care and are supported by people who know them well. Rosamar DS0000008089.V311739.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The rating for Conduct and Management of the Home is GOOD. This is based on all the information available. People benefit from an ethos, leadership and management approach which is person centred. The home is well run and the health, safety and welfare of people living at Rosamar is promoted. EVIDENCE: The manager has NVQ4 and the Registered Manager Award. She has been involved in running the home since it was first registered in 1983. She takes a strong role in determining the day-to-day management of the home and in promoting a person centred approach. As a result people living at the service are recognised and valued as people. A number of staff policy and procedure folders included articles on care and demonstrated that she is seeking and open to new ideas. People living at the Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 Page 22 service benefit from this, for example, from her insight into the need for people with learning disability to have a healthy diet. A number of records were checked, and generally the office was well organised and recording found to be up to date. A manual contain details of hazardous chemicals is now available. The fire records were up to date but there was no evidence of any fire drills. The staff member interviewed could not recall the last fire drill. Resident finances are carefully recorded but the balances did not match the cash in the tins. (This was only a matter of pence and appeared to result from a lack of change being available). Rosamar DS0000008089.V311739.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 3 2 3 3 3 4 3 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 3 26 1 27 1 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 3 34 2 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 3 2 3 2 3 x Rosamar DS0000008089.V311739.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. 1 Standard YA42 Regulation 23(4)(e) Requirement The registered person must, after consultation with the fire authority, ensure by means of fire drills at suitable intervals that the persons working at the care home and, as far as practically possibly people living at the care home, are aware of the procedure to be followed in the event of a fire. (This relates to the lack of any evidence that fire drills are taking place at Rosamar). The registered person must make arrangements for the recording and safe administration of medicines received into the home. (This relates to the occasional gaps) noted in the daily MAR sheets) Timescale for action 17/12/06 2 YA20 13(2) 17/12/06 Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA16 Good Practice Recommendations There should be discussion in the staff team about how best to ensure people’s individual wishes and needs are known supported by the staff team. Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 Rosamar DS0000008089.V311739.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!