Inspection on 24/11/05 for Rose Cottage

This inspection was carried out on 24th November 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report. 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

Rose Cottage 05/09/07

Rose Cottage 02/06/06

Rose Cottage 15/04/05

Rose Cottage 18/11/04

Rose Cottage 19/07/04

Rose Cottage 12/06/03

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 Rose Cottage Grange Road Bursledon Southampton SO31 8GD Lead Inspector Ms Wendy Thomas Unannounced Inspection 24th November 2005 11:45 Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 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 Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 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. Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Rose Cottage Address Grange Road Bursledon Southampton SO31 8GD 02380 407048 02380 407048 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) Wessex Regional Care Limited Miss Trudy McKnight Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th April 2005 Brief Description of the Service: Rose Cottage provides a residential service for up to four people who have a learning disability and have behaviour that is challenging to service providers. The home is in a rural location. The home has a vehicle for service users to get out and about. There are currently three service users living at the home. Rose Cottage is a bungalow with four single bedrooms, a sleeping-inroom for staff, a lounge, kitchen and dining area, utility room and office. There is a bathroom and a shower-room each with a toilet. There is a good-sized enclosed garden. Wessex Regional Care have three homes in the area, another one in Hampshire and one in Southampton. Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Regulatory inspector Pat Trim accompanied the home’s inspector, Wendy Thomas on this inspection. The inspectors were in the home from 11:45 to 17:00 on Thursday 24 November 2005. There are currently three service users living in the home. The inspectors joined two of the service users and staff for lunch where life in the home was discussed. One service user spoke with one of the inspectors and showed her around the home. The inspectors looked in depth at two service user plans and viewed the home’s policies and procedures pertinent to the areas they were inspecting, they also spoke with one member of staff about various issues and with another specifically about an aspect of their training. Much of the inspection process involved the home’s manager. At the time of the previous inspection one of the service users living in the home was presenting challenges to the staff in the home to the extent that they could not meet their needs. This person has now left the home. The inspectors were of the view that life for all at the home is starting to settle down again. There was a warm welcoming atmosphere and routines and activities were being re-established. What the service does well: What has improved since the last inspection? Records show that service users are involved in a range of activities outside of the home including college, a specialist workshop, arts and crafts, leisure and recreational, doing household and personal shopping etc. The home now has a permanent manager after a difficult interim of eight months. She is identifying issues and working to improve the quality of care in the home. Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 Page 6 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. Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 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 Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 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. Procedures and documents are in place to assist the management in making their assessment of the suitability of the home for meeting a potential service user’s needs. EVIDENCE: Since the last inspection one service user has left the home. There are no immediate plans to fill the vacancy, however, the home has an admissions and discharge policy which meets the standard. It allows for potential service users to visit the home and become familiar with the situation, staff and other service users before moving in. A blank pre-admission assessment document was seen. This provides the opportunity to assess potential service users needs enabling the home to decide whether they can meet the needs of the individual. Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 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 and 9. Detailed guidance regarding the use of physical intervention for individual service users would provide them with greater safeguards and more consistent care. In other areas, support plans and risk assessments enable service users’ needs to be met. Service users are provided with opportunities and support that enable them to make decisions about their lives. EVIDENCE: The inspectors spent a considerable amount of time looking at service user plans. Personal profiles have been developed for all the service users, which asked them about their needs, aspirations, how they spend their time, their health, their relationships, their likes etc. The manager informed the inspectors that service users were fully involved in completing these. Similarities between them suggested to the inspectors a possible greater influence by staff than had been intended. The manager reported that the home would soon be having training in person centred planning. The inspectors hope that this will help the staff build on the good start that has been made. Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 Page 10 Each service user had a number of individual support plans detailing their specific needs. It was reported that these were re-evaluated by the service user and their key workers monthly, with a more detailed review every three months. All those seen had been reviewed in October 2005. The manager had just completed the review and re-writing of one service user’s risk assessments. This was not the case for the other two where some risk assessments had not been reviewed to the standard the home had set itself of monthly. Some were not recorded as having been reviewed for over a year. The manager reported that she was working on the reviewing and rewriting these. The manager explained that she was setting up new patterns of key working. This would include the regular re-assessment of care plans, and times when service users and key workers would meet together discuss progress, possible changes, service user satisfaction etc. The inspectors were able to track a number of issues through the personal profile, individual support plans, risk assessments and additional information in the file, which provided a clear rationale for strategies set out in the individual support plans (i.e. keeping certain substances locked away). The inspector’s are concerned that some information they would expect to find in some service user files is not there. Rose Cottage provides a service for adults with learning disabilities who may behave in ways that are challenging to service providers. For a service user with whom it had been necessary to use physical intervention twice in recent weeks, there was no care plan or procedure to indicate that this may be necessary, or when and how this should be done. Some good work had been done in identifying triggers and there were “guidelines to support x in the management of their tendency towards aggressive behaviour” with some helpful strategies. There were no guidelines as to what action should be taken if these failed, as has happened. The home has a two page restraint policy which rightly stresses the need for non-physical interventions and attempts to de-escalate the situation, however it does not refer staff to individuals’ service user plans where it would be expected that appropriate techniques are detailed for each individual who my exhibit such behaviour. The manager reported that individuals are supported to make decisions about their lives through their monthly meetings with their key workers. There are also weekly service user meetings in the house where they can contribute to the running of the household. Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 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): 11, 13, 14, 15, 16 and 17. Service users benefit from support to attend a variety of activities in and out of the home and to meet people other than their housemates. The work being done to promote rights and clarify responsibilities will benefit the service users. Failure to maintain accurate records of food eaten, meant that the manager could not monitor whether service users had a balanced diet or were regularly offered choice. EVIDENCE: The inspectors were informed that one service user goes to college one day a week and another for half a day a week. One service user attends a workshop for people with learning difficulties carrying out mechanical work and was there during the inspection. They also enjoy gardening and work in the garden of another Wessex Regional Care Ltd. home. As a group the service users regularly attend pottery decorating. One service user goes swimming, another is about to restart horse riding and all have enrolled for a keep fit course for people who have learning disabilities. When the inspectors arrived one of the Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 Page 12 service users was out doing the shopping with a member of staff, and during the afternoon another service user went to have their hair done at a local hairdressers. Service users help with the household shopping and there are one off trips to special events such as the New Forest Show and a concert by UB40. Service users’ records showed that they are engaged in a variety of activities and go out most days. Service users are also expected to take a role in the running of the house and the household chores. Records showed that on an occasion when a service user had not wanted to do the chore they were rostered to do, staff insisted they complete it. The manager acknowledged that most of the in-house activities related to domestic shores, however she was seeking to address this. Each service user’s file contained comprehensive daily records giving a clear picture of what life was like for that person. The service users are part of the local community in that they use local shops and go for walks in the locality and slightly further afield. One service user’s file showed that they liked to go to church. One service user has links with a relative that are very important to them. They were also reported to be developing friendships at one of their regular daytime activities and rekindling old friendships with some of the people they had lived with in the past. Another service user was reported to be developing friendships at college. The manager explained that she was planning to discuss with the staff, service user’s rights and what responsibilities could be expected of service users, as she had identified this as a training need. The inspectors joined the service users and staff for lunch, which was egg sandwiches. The service users were offered fruit or yoghurt for dessert but declined. The inspectors found that the records of food eaten were incomplete with many meals and alternatives chosen by individuals not being recorded. The manager, would therefore, not be able to monitor whether service users were having a balanced diet. The manager and inspectors discussed ways to improve menu planning and recording, and the manager agreed to take this forward. Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 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 and 19. Service users benefit from having their personal support, medical needs and appointment outcomes well recorded. EVIDENCE: A member of staff explained to the inspectors that the service users were largely independent in there personal care needs, with verbal prompts and a little physical help being needed in some cases. If service users were unhappy with the support they were being given the member of staff said that they would communicate this. Individual support plans outline the support required by service users. One of the service users confirmed to one of the inspectors that they received support as described in their support plan. Medical issues and reports of visits to medical practitioners are well recorded with comprehensive notes of what occurred and any action to be taken. In order to help one of the service users recognise and manage their anger a scoring system had been worked out for the person to use. They were being supported to keep this record up to date in their file. Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 Page 14 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 and 23. Staff training and a company policy protect service users from abuse. Service users utilise the home’s complaints procedure when seeking to have matters of concern addressed. EVIDENCE: The manager explained that the service users were familiar with the complaints procedure and had used it. These complaints were seen recorded in the complaints log. The manager said that she was working on a pictorial format of the complaints procedure to further clarify it for the service users. The manager described a complaint made verbally by the relative of a service user. This had not been recorded. Although the issue had been resolved satisfactorily through discussion, the details should still appear in the complaints log. It was reported that two of the service users have an independent advocate. The manager reported that training in the protection of vulnerable adults from abuse was ongoing. Staff training records showed that all support workers had received training. The manager explained that there was a need for continuing training as she thought that staff were still not clear when to act and what course of action to follow when allegations of abuse were made. The procedure is also discussed during staff supervision and staff meetings. The manager reported that if allegations are made the home liaises very closely with social services. Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 Page 15 The manager explained that the Wessex Regional Care Ltd policy for the protection of vulnerable adults had recently been updated. She said that the home also had a copy of the Department of Health guidelines, “No Secrets”. Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 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, 27 and 30. Once work to repair recent damage has been completed, the service users will benefit from a comfortable and homely environment in which to live. The lack of a lock on the bathroom door compromises service users’ privacy and dignity. Service users benefit from a high level of cleanliness in the home. EVIDENCE: Prior to the departure of a service user from the home some physical damage was sustained. This is being addressed and the inspectors were informed that new dining chairs had been ordered, a new lounge carpet was expected after Christmas and at least on of the lounge chairs would be replaced. The vacated bedroom was in the process of being redecorated. One of the existing service users was going to be moving into this room and had chosen the colour scheme. Another service user told an inspector that their bedroom had been redecorated, and that they had chosen the colours. They also explained that they had bought some new lights for the room, which would be put up for them. Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 Page 17 One of the service users showed one of the inspectors around the home and showed them their bedroom. It was noted that the ceiling in the bathroom was stained and flaking in places, and in need of attention. The manager agreed that this would be done. It was not possible to ensure that service users’ privacy and dignity could be maintained in the bathroom, as there was no lock. This clearly had an impact on service users, as there was a complaint about the lack of a lock recorded in the complaints log. The manager said she had meant to arrange for one to be fitted and gave an assurance that this would now be done Service users had locks on their bedroom doors they can use if they wish. However they did not have facilities in their rooms to lock away personal valuables and money. This should be provided. The home was clean and hygienic at the time of the inspection. A satisfactory cleaning schedule for the home was seen, as was the rota of service users’ responsibilities for household chores. Disposable gloves were seen to be available. Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 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 and 35. The training that staff have received equips them to meet the needs of service users. The homes recruitment practices promote the protection of service users and the identification of personnel who are able to support service users needs. EVIDENCE: In order to meet the needs of the service user who has now moved on, the staff team had been supplemented by agency staff for several months. This is no longer necessary. The home has been involved in recruiting staff, and with several applications currently being processed the team will soon be up to strength. The staffing structure consists of a manager, deputy manager and five support workers. The manager is in the process of setting up a key working structure. Of the seven members of staff two are currently completing NVQ 2 in care and one NVQ 3. One member of staff has completed NVQ 2 and the manager is studying for NVQ 4. Most staff have attended the following training; health and safety, first aid, moving and handling, fire, food hygiene, behaviour training, abuse, speech therapy, and the management of violence including control and restraint. Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 Page 19 Additional courses that have been attended in relation to service users’ specific needs included diabetes and epilepsy. Staff records were examined. It was noted that staff complete an application form including a statement about their fitness to carry out the job and a rehabilitation of offenders’ declaration. The need for references to be obtained by the provider was discussed with the manager, as some staff had generic ones they had brought with them. She was aware of this requirement and was able to show the procedure she had followed to obtain references for two recently appointed staff. The inspectors were assured that a robust procedure was now being followed. The home obtains Criminal Records Bureau and POVA (protection of vulnerable adults) list checks for new employees. Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 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 and 42. The manager is working on improvements to the running of the home, which will benefit the service users. Consulting service users ensures that their views are taken into account in planning developments for the home. Health and safety issues are attended to, providing a safe environment for service users. EVIDENCE: Since the last inspection a new manager has come into post putting to an end the disruption and uncertainty encountered during the eight months when there was no permanent manager. It was reported that stability was returning, that staff were feeling supported, and that service users were going out more and feeling more settled following a difficult period with a service user who has now moved on. The manager described changes she plans to introduce, which will benefit all. This is an ongoing process and she has Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 Page 21 identified issues that need further work. A member of staff asked, said that she was approachable and supportive. Service users are consulted about the running of the home. This is included in their one-to-one sessions with their key-workers and in the service user meetings. The manager says that she encourages service users to add issues they want to the staff meeting agenda. Service users could attend part of the staff meetings if they wished. She was aware that service users and their key workers had recently been involved in preparing information about their care to be included in the company’s annual report. The manager reported that there is an annual quality assurance cycle with service users completing a (different) quality assurance questionnaire every six months, from which an annual quality assurance document is drawn up. This, again, feeds into the company’s annual report. The manager then uses the home’s quality assurance document to identify action needed to improve quality during the next year. In the pre-inspection questionnaire the manager reported that all necessary health and safety checks, tests and services were being carried out. This was confirmed by the records being sampled by an inspector, which verified that the fire fighting appliance servicing was in order as was employers liability insurance and recoding temperatures at hot water outlets. Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X 3 X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 2 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X X 2 X X 3 LIFESTYLES Standard No Score 11 3 12 X 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 X 2 3 X CONDUCT AND MANAGEMENT OF THE HOME 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Rose Cottage Score 3 3 X X Standard No 37 38 39 40 41 42 43 Score 3 X 3 X X 3 X DS0000012072.V268795.R01.S.doc Version 5.0 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 YA6 Regulation 13 (7) Requirement Timescale for action 16/02/06 2 3 YA17 YA27 Where restraint may be necessary there must be clear individualised guidelines as to when and how this may be carried out. 17(2)Sch.4 Food records must be kept. (13) 23(2)(d)12 Service users’ must be able to (4)(a) lock the bathroom door. The bathroom ceiling must be made good. 29/12/05 16/02/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 Rose Cottage DS0000012072.V268795.R01.S.doc Version 5.0 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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