Inspection on 24/10/07 for Russell Hill (7)

This inspection was carried out on 24th October 2007.

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 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Russell Hill (7) 16/11/05

Russell Hill (7) 18/08/05

Russell Hill (7) 07/02/05

Russell Hill (7) 24/06/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Russell Hill (7) 7 Russell Hill Purley Surrey CR8 2JB Lead Inspector James Pitts Key Unannounced Inspection 24th October 2007 10:50 Russell Hill (7) DS0000043125.V350661.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 Russell Hill (7) DS0000043125.V350661.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. Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Russell Hill (7) Address 7 Russell Hill Purley Surrey CR8 2JB 020 8763 4301 020 8763 4396 NO EMAIL www.caretech-uk.com CareTech Community Services Ltd 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) Mr Neil Parker Care Home 11 Category(ies) of Learning disability (0) registration, with number of places Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 16th November 2005 Brief Description of the Service: 7 Russell Hill is divided into three separate services, a one-bedded service, a two-bedded service and an eight bedded service. Three of the rooms in the eight-bedded service have a bedroom with en-suite facilities. Prospective service users in the eight-bedded service have large bedrooms with easy access to nearby bathroom and toilets. In the two-bedded service; service users have their own bedrooms but share a bathroom, living room and kitchen, in the one-bedded service the service user has the use of a private bathroom, bedroom, kitchen and living room. The homes purpose is to work specifically with people who have complex needs and require a high level of support in order to live their lives. Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection encompasses information that was obtained not only on the day of the key inspection visit but also from two random inspection visits that occurred after the key inspection last year. The registered care manager was present for this visit. No surveys were received from people who use this service, relatives or other stakeholders prior to this visit. However a two of the people who use this service have given their views about the home during visits. These comments did not indicate that there are any concerns about the standard of care at the home and indeed positive remarks were made and relaxed interactions were observed. A number of records were also examined, including care plans, assessments, management records and those, which relate to medication handling and administration. A tour of the building also took place. What the service does well: What has improved since the last inspection? The organisation has improved upon its staff recruitment practices. Should there be successful completion of the background checks for more recent appointees this will result in the home having a largely permanent staff team. A person of more senior responsibility in the organisation than the home’s manager now carries out regulation 26 visits. Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Russell Hill (7) DS0000043125.V350661.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 Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standard 2 was assessed at this inspection visit. The people who use this service can feel confident that the home will only care for people that the staff are trained and able to care for. The people who live here, their families and placing authority are told about how much it costs to live at the home and whenever this amount changes all of the people who need to know are told. EVIDENCE: As there have been no new admissions to the home this key standard does not necessitate any comment at this stage. This standard will be assessed again at such time as any new service users may be admitted to the home. Mr Parker, Manager, who I met during both the previous random inspection and this visit, again informed me that it is intended to keep the single vacancy in the two bedroom flat and that no new service user will be admitted there. It is in fact intended that this flat become a part of the supporting people service rather than remain as a service that is offered directly by the home. I advised Mr Parker of what the organisation would need to do if it is intended to permanently reduce the registered level of occupancy. Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 6, 7, 8, 9 & 10 were assessed at this inspection visit. The people who use this can still feel confident that the staff know what they need. They can also be assured that the staff will try their best to make sure that each person who lives at the home is allowed to live the sort of life that they choose. EVIDENCE: Four care plans, which are known as “ Individual Support Requirements “, were looked at in detail during the three visits that have occurred since the previous key standards inspection. These are continuing to be written in a way that makes it look as though these are about what the service user thinks as the words that are used are things like “how staff assist me with personal care” and “how staff treat me and my communication needs”. Physical care support, activities of daily living, social and leisure activities and the right to adhere to Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 10 personally held values and beliefs are reflected in each care plan. One thing that was raised, as a concern by a placing authority recently was that agreed action from a review had not taken place. I would appear that there was disagreement about one particular referral that was asked to be made to a specialist service at the time. This has subsequently happened and an assessment is taking place. As has been reported at previous inspection visits none of the people who use this service could meaningfully sign their care plan to agree to what is written in it, however, family members and care managers continue to be are closely involved with the home when these are written and when they are reviewed. Since the new area care director for the home was appointed a programme of full care plan evaluation and assessment has begun to be undertaken and it is expected that this will be completed in the next few weeks. Consultation with the people who use this service continues to be evidenced by means of notes by keyworkers about their views. Although it remains true to say that many of the people who live at Russell Hill do find it difficult to become meaningfully involved or to respond to questionnaires or specific complex questions, evidence of maximising these opportunities has previously shown signs of improvement and continues to do so. The care plans also include risk assessments that tell staff and other people about anything that may harm anyone who lives here and anything that the person might do that might hurt themselves. Copies of risk assessments are kept in each person’s individual file and cover a variety of situations from accessing community activities to learning skills and activities within the home. Risk assessments continue to be reviewed regularly, and all of those that were seen during visits over the course of the last year had been reviewed. The home has very clear procedures for staff about making sure that the personal information of the people who live here remains confidential. These procedures are designed to ensure that information is not shared with anyone who does not have a right to know. Each member of the staff team signs a record to confirm that they have read, understood and will abide by the confidentiality policy. Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 12, 13, 15, 16 & 17 were assessed at this inspection visit. The people who use this service can continue to feel confident that the staff of the home will provide opportunities for everyone to develop their personal and social skills. This includes active support for each person to participate in the community both in terms of the activities of daily life and leisure interests. The opportunity for each person to develop and maintain personal and family relations is also offered and is actively supported by the staff team. EVIDENCE: The people who use this service continue to be supported to make use of a wide range of community based facilities. These can be anything from regular shopping trips, whether for food for the home or personal shopping, to attendance at local clubs run by particular organisations. The home has two Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 12 people carrier (type) vehicles that are regularly used although this does not prevent the use of public transport where circumstances and the needs of individuals would allow. A social activities diary is completed for each person who lives here to show which activities each engage in and to provide details of the range and frequency of these activities. The staff team are able to demonstrate a clear understanding of the cultural and religious practise preference that each person who uses this service chooses to adhere to. The home’s staff group continue to encourage and support the maintenance of relationships with family members and virtually all of the people who live here do have at least some family contact. There continues to be an open visitors policy. Family and friends are invited to social events at the home as well as reviews. The home has a key worker system and it is part of the key worker role to keep family members informed of progress made, where appropriate. Visitors can be seen in the communal areas, of which the home has a range, or bedrooms if it is thought to be appropriate and safe to do so. One relative wrote a letter complimenting the home about the increased range of choices and activities that their son has since coming to live at the home. The daily routines of the home continue to be flexible within reason. Staff were seen on each of the visits since the previous key inspection to interact appropriately. The people who live here have the liberty to make their own choices about where they spend time in the home and whether they wished to be alone or in company. The home has all appropriate policies and practices on maintaining people’s dignity and rights. The home has a keypad entry system to the front door, garden side entrance and fire escape exits, the locks for which disengage automatically if the fire alarm is activated. All of the people who live here would be at risk if the left the home without being accompanied by at least one member of staff. As reported at previous inspections, the reasons for the entry and exit door locking system are fully documented and the appropriate measures continue to be in place to secure everyone’s safety in using this. Individual preferences for the food that people like to eat are given due consideration. The menus show that appropriately varied and nutritious meals are available. Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 18, 19 & 20 were assessed at this inspection visit. The people who use this service can remain confident that they will get the right support to take care of their personal and healthcare needs. Anyone who needs to take medicine regularly to help them stay well will get the proper support from staff to make sure that this happens properly and safely. EVIDENCE: Russell Hill has a large staff team and this is required in order to provide the very high level of support that is needed by the people who live here. The methods of supporting each individual continue to be clearly written down in a way that focuses on the unique preferences and personality of each person. Each staff member is still required by the home to sign a confirmation that they have read the individual plan and will put it into practise. Staff who have spoken with the Inspector during visits over the last year still seem clear that Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 14 their responsibility includes being sensitive and flexible in providing personal support. The people who live here continue to make use of the range of community health services. Each person’s unique health care needs continue to be reflected in their care plan. A full medical profile is compiled which details the reason for prescription medicines and any risks that might arise about the use of the medication. The outcome of all medical appointments is also written down. One person who lives here continues to suffer from insulin dependent diabetes. The staff team have received appropriate guidance and training from the local specialist diabetes community nurse about giving this medication by means of an insulin pen. The insulin is kept in a locked refrigerator in the senior support workers office and used insulin pens are being stored properly in a sharps box prior to their disposal. Risk assessments continue to indicate that none of those who live here are able to take their medication without the staff supporting them. The home has detailed written policy and procedure guidelines for the handling and administration of medication. All staff members responsible for administering medication have been trained to do so. A monitored dosage system is used with all records being well and accurately kept. The home receives training and advice from their local chemist in regards to all medication. It is once again positive to note that additional medication is not given unless it is absolutely necessary (This is also known as PRN medication). Even when this type of medication is administered it continues to be on only very rare occasions. Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 22 & 23 were assessed at this inspection visit. The people who use this service can feel increasingly confident that the staff team at the home know what to do if there are complaints or concerns about abuse. The home has clear guidance for staff about the procedures to be followed in either of these circumstances, and continued staff training is increasing the awareness across the whole staff team. EVIDENCE: The home had previously been aware that the Commission received a number of complaints from particular staff team members last year, all of which were fully investigated by both the London Borough of Croydon and the Commission. These complaints were not proven although recommendations for improvement in areas of practice were made at that time. No subsequent complaints have been made and the relationships between the staff and management team would appear to be continuing to achieve the significant improvement that had previously been required. One of the people who lives here made two complaints about noise levels at night as waking night staff were going about their duties. As a result of this the procedures for these duties were changed to ensure that no one would be disturbed overnight. Continued updated training in the local authority protection of vulnerable adults procedures is occurring. The manager previously received a letter advising him of the current contact arrangements with the London Borough of Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 16 Croydon that should be used in order to secure future training, particularly for newer members of staff. Due to the limited number of places available on this course, which is run on a cyclical basis, it will take time to achieve training for 100 of the staff team. However, all senior staff have attended this course so at all times there is someone on duty that would know what to do if a concern were to be raised. No protection of vulnerable adults concerns have been raised with the geographical and placing authorities or with the Commission since the previous key standards inspection. Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Standards 24 & 30 were assessed at this inspection. The people who use this service cannot feel confident that they are living in an efficiently well maintained home, as there are still delays in addressing repairs and refurbishment when these are identified. The home is, however, kept clean and hygienic. EVIDENCE: At the time of the random inspection that occurred in April of this year there had been significant problems with the boiler system that resulted in a short period where heating and hot water were not available. This problem has now been resolved. The home has experienced delays in getting repairs actioned and specific items for use by people who live here obtained. One example of this is mirrors that are resistant to being broken that can be used in people’s bedrooms. During this key inspection visit the manager said that a Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 18 restructuring of the maintenance within the organisation should result in more efficient action to resolve repairs and obtaining necessary equipment. The registered provider must ensure that unnecessary delays in responding to these issues achieve a more permanent resolution. The personal and shared living space that is used by the people in residence generally remains comfortable and suitable to each person’s individual needs and preferences. The home was also found to be clean and hygienic. Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 32, 34, 35 & 36 were assessed at this inspection. The people who use this service can feel confident that there is an increasingly effective staff team to meet their needs and that these staff are safe people to support them. EVIDENCE: As reported at previous inspections all staff undertake a six month foundation course that is linked to the learning disability award framework. A requirement for staff in passing their probationary employment period is that they complete this course. One of the senior staff has recently become an accredited NVQ assessor, which should make it far easier to support staff that are undertaking this qualification. With the successful completion of the 5 newly appointed staff background checks the home will achieve a largely permanent staff team as was previously required. Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 20 During the course of the visits that have been made to the home since the previous key standards inspection a number of newly recruited staff personnel files have been seen. It is noted that the correct background and pre employment procedures have been followed for each of these staff. It is also noted that newly appointed staff are receiving appropriate induction and foundation training and that evidence of achievements in training is kept on file. The home’s manager was again able to show that dates for staff supervision are on record and that this is achieving the required frequency, as was required at the previous key standards inspection. Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Standards 37, 39 & 42 were assessed at this inspection. The people who use this service can feel increasingly confident that they are living in a home that has internal and external management, is being run with their best interests at heart and that their rights are respected. EVIDENCE: The home’s registered manager, Mr Parker, successfully completed the registered managers award earlier this year and displays his qualification certificate in the administrative office of the home. Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 22 It is noted at the random inspection last April that after the previous Area Care Director for the home had left that the most recent Regulation 26 visit at that time was carried out by the manager of another Caretech home. It was required that a person of more senior responsibility in the organisation than the home’s manager should carry out regulation 26 visits. The new Area Care Director that was appointed in June of this year is now carrying out these visits. The following health and safety checks have been carried out within the last year: Fire Alarm System: 27/03/07 Gas Safety Check: 30/07/07 Portable appliance check: 12/02/07 Electrical Installation: 03/09/03 Legionellosis: 02/08/07 Regular tests of the fire alarm system and fire drills are also occurring. Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 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 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 X 3 X X 3 x Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 YA24 Regulation 23 (2) (b) & (d) Requirement The registered provider must ensure that unnecessary delays in responding to these issues achieve a more permanent resolution. Timescale for action 24/01/08 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 Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Russell Hill (7) DS0000043125.V350661.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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