Inspection on 07/06/06 for Saltram Crescent, 91 & 99

This inspection was carried out on 7th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 8 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Saltram Crescent, 91 & 99 08/06/07

Saltram Crescent, 91 & 99 13/03/06

Saltram Crescent, 91 & 99 21/06/05

Saltram Crescent, 91 & 99 06/01/05

Saltram Crescent, 91 & 99 02/08/04

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

CARE HOME ADULTS 18-65 Saltram Crescent, 91 & 99 91 & 99 Saltram Crescent London W9 3JS Lead Inspector Ffion Simmons Unannounced Inspection 7th June 2006 10:15 Saltram Crescent, 91 & 99 DS0000010872.V292448.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 Saltram Crescent, 91 & 99 DS0000010872.V292448.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. Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Saltram Crescent, 91 & 99 Address 91 & 99 Saltram Crescent London W9 3JS 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) 020 8964 8154 020 8968 1983 Lookahead Housing & Care William Berkye Care Home 12 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (36) of places Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th March 2006 Brief Description of the Service: Saltram Crescent is a Registered Care Home that operates in two, three storey houses (No 91 and No 99). The service is registered to provide accommodation for 12 residents who have a mental disorder. Each home accommodates six residents and both houses are managed from number 91. The care is provided by Look Ahead Housing and Care Ltd. The homes are situated in the Queens Park area with good access to public transport and local services. Each service user has a single bedroom and both houses have a kitchen/diner, lounge, adequate bathroom space and attractive patio garden area to the back of the two houses. Currently No 99, where there is one vacancy, has only male service users. There are two female and four male service users at No 91. A prospective service user would need to be made aware of the high level of smoking in communal areas. In each house the bedrooms are on the first and second floors making the service unsuitable for anyone with a physical disability. The current scale of charge for the service as obtained from the pre-inspection information is £577 per week. Magazines, papers and toiletries are payable by the service users themselves. Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key inspection took place between 10:15 and 17:45 on the 07/06/06. The inspector spent time talking to service users, staff, the Manager and checking records and documentation. On the whole service users were satisfied with the care they receive. What the service does well: What has improved since the last inspection? What they could do better: There are nine requirements within this inspection report. ongoing and/or repeated from the last inspection report. Six of which are All staff must receive training in the protection of vulnerable adults and in the safe administration of medication. Training needs analysis and training plans Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 6 should be in place including a system for identifying when training updates are required. The home’s quality assurance systems must be improved to ensure that they are effective in assessing the quality of the service offered. Some shortfalls were noted in the health and safety systems in the home. 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. Saltram Crescent, 91 & 99 DS0000010872.V292448.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 Saltram Crescent, 91 & 99 DS0000010872.V292448.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): 1,2,4,5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users and prospective service users have detailed information for making a decision about where they would like to live. Service users’ needs are fully assessed before moving into the home, which ensures that the placement is appropriate for meeting their needs. Contracts are clearly written and are up to date. EVIDENCE: The home’s statement of purpose and service user’s guide is available and includes a good level of information including the services provided, relevant Look Ahead policies and details about the accommodation itself. Informative leaflets prepared by Look Ahead, provide information on the maintenance department, customer charter, harassment including racial harassment and complaints. These were found to be accessible to service users in the hallways. The personal files of three service users were looked at. Copies of an assessment were available on each file. Staff confirmed that prospective service users are given the opportunity to visit and see the home prior to making a decision about moving in. Up to date contracts, signed by the service user and Manager were also seen on each file. Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,9 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users are involved in the care planning process and are enabled to make their own decisions about their lives. Risk assessments are in place but some work is still required to ensure that all risks are identified and risk management strategies agreed. EVIDENCE: Support plans were seen on each of the three files checked. They had been compiled with the service user and were regularly updated and reviewed. Records of monthly key working sessions were also on file reflecting how the service users are working towards the goals set within the support plans. Daily contact notes are also maintained. Risk assessments are carried out in relation to the support plan. Two of the three plans contained details for managing risk. Some work is still needed to ensure the risk assessment on the third file contains sufficient detail. All risks need to be identified and risk management strategies agreed. Residents meetings take place every 2 weeks. Agendas of meetings are available and minutes of these meetings are typed and kept on file. Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 16 & 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Routines are flexible, providing service users with the freedom to make their own decisions about their lives and their daily activities. Service users are supported to take part in a range of activities and to maintain links with friends and families. Service users are offered a healthy diet. EVIDENCE: Two of the three service users case tracked during the inspection attend cookery classes. The aim is to develop their independent living skills and in preparation for moving to more independent accommodation. One service user also attends a day centre. A range of in-house activities is arranged for service users, which includes bingo, gardening club, pottery and cooking classes. Each lounge has a TV and music system for service users to use freely. Holidays and days out are also arranged for those who wish to go. One of the staff members are currently organising a holiday for interested service users in July. Discussion about activities is a standing item on the agenda of residents’ meetings. A service Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 11 user has expressed an interest in chairing the residents’ meeting and staff are encouraging the service user to do so. Service users spoke about their visit from family members and that relationships are maintained wherever possible. The routines in the home are flexible with service users choosing when they get up and go to bed and leave the home. Staff support service users to attend any appointments that they may have. Mealtimes also appeared relaxed and flexible. The home employs a cook who caters for all residents including vegetarian diets during week-day evenings. A service user who is Muslim, confirmed that they are satisfied that their religious and cultural needs are being met with regards to meals. The cook demonstrated an awareness of service users’ specific requirements. Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users receive personal support through a key working system, which ensures continuity of care and support for meeting their needs. Some improvements have been noted in the medications management in the home, but the need for staff training remains. EVIDENCE: Service users are mainly self-caring with their personal care needs but benefit from some prompting by staff regarding their appearance and personal hygiene. Each service user has a key worker to ensure consistency and continuity of support. Monthly key working meetings are arranged. Service users are registered with General Practitioners and have access to Community Psychiatric Nurses, District Nurses and other members of the multi-disciplinary team. Staff support and encourage service users to attend their appointments. The medication records were checked in one of the houses. These were found to be well completed. Twice daily checks are undertaken on the medication balances to ensure that they are correct. One of the service users is currently self-medicating. A consent form was on file, signed by the GP and selfmedication was included in the service users’ risk assessment. A medication Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 13 policy was available on file. The Manager confirmed that he is currently arranging refresher training for all staff in the administration of medication. This requirement is therefore ongoing. Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 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): 22,23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A clear and accessible complaints policy and procedure is available. A comprehensive policy is also in place for protecting adults from abuse. EVIDENCE: The home has a complaints policy which was found to be accessible to service users in the hallways. The home has received one complaint within the last 12 months relating to a service user who no longer resides at the home. Service users are given the opportunity to express their views during resident meetings. A copy of the local multi-agency policy and procedures was available on the day of the inspection. Staff training records indicate that all except one staff member has attended Adult Protection training. Steps have been taken to arrange training for this staff member. Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of environment is good and provides service users with a homely and comfortable home. Ventilation is poor due to the high percentage of smokers among service users. Ongoing work is required to improve the ventilation in communal areas to reduce the risk to other service users and staff. EVIDENCE: Both house number 91 and 99 are considered suitable for their purpose and are well located and close to public transport and local amenities. The houses are well maintained and are indistinguishable from others in the street. Each service user has a single bedroom, with a washbasin. There is an attractive patio/garden area to the back of both houses and the service users gardening group help maintain both gardens. New laminate flooring has been laid in house 99 in the office, lounge and hallways. The washing machine and dryer at No 99 are sited in the kitchen/diner. It remains a requirement, in view of the risk of cross infection, that both machines should be moved elsewhere. In the meantime service users are being reminded to put washing straight into the machine and not place any items on the worktops or floor. Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 16 The home was clean and hygienic during the inspection. Since the last inspection, a pedal bin has been purchased for the main kitchen so that the Cook does not have to touch the lid. Service users spoke about the daily chores rota, which was on display in the kitchen and explained that they are given certain household chores including cleaning communal areas. The level of smoking among service users is high creating a very smoky atmosphere in communal areas. This is an ongoing issue but steps have been taken to introduce no-smoking times, which include resident meetings and key working sessions. Staff have consulted the Primary Care Trust to invite a spokesperson to come in and talk to service users about the risk of smoking. The home is waiting a date for this meeting. The option of purchasing air purifiers is currently being explored. Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 17 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, 33, 34, 35, Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The percentage of staff with qualifications in social care is low but steps are being taken to improve this percentage. EVIDENCE: The Pre-inspection information indicates that approximately 28.5 of staff have achieved a NVQ2 or above in social care. Since the last inspection, one staff member has commenced management foundation training and three staff have enrolled on NVQ level 2 training course in care. It is anticipated therefore that the home will achieve the minimum requirement of 50 of care staff qualified to NVQ level 2 or above by 2007. The Manager confirmed that all staff are required to completed induction training. Since the last inspection, steps have been taken to set up a staff training file. It is a recommendation that training needs analysis and training plan be in place in the home and a system for identifying when training updates are due. Staff rotas allow for a minimum of 3 staff on duty at any time including weekends. Staff regularly work a 10AM to 11PM shift followed by a sleep-in. Staff have been consulted with regarding possible changes to the rota, but the Manager said that it appears that staff prefer the rota this way. This is a long shift and should be kept under review. Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 18 The inspector sat in on the morning handover and it was noted that sufficient time was available for discussion. A shift plan takes place and there is a shift leader allocated to manage the shift. The recruitment of staff is co-ordinated by the head office of Look Ahead. The Manager confirmed that staff records including application forms, references and CRB and POVA checks are kept at the head office. The Manager confirmed that a copy of references and a confirmation of satisfactory CRB and POVA checks are forwarded to the Manager prior to a new member of staff commencing work at the home. Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The Manager is experienced but the home would benefit from the appointment of a Deputy Manager. The home’s quality assurance systems must be improved to ensure that they are effective in assessing the quality of the service offered. Some shortfalls were noted in the health and safety systems in the home. EVIDENCE: The Manager is completing NVQ4/RMA and is experienced in working with people with long-term mental health problems. Within the last year he has attended training updates in Health and Safety and recruitment and selection training. Look Ahead have not employed a deputy manager as per the recommendation of previous inspection reports and remains a recommendation. The last person in control visit on behalf of the registered provider was undertaken in November 2005. The visits are thorough but do not take place monthly as per the regulations. Look Ahead must ensure that visits are undertaken monthly and unannounced by a person that is not directly involved Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 20 with the project as per the regulations. A full audit of the service was completed in August 2005. The report identified areas of good practice but also some areas requiring improvement. It is a recommendation that the report draws out clearly what action is required and an improvement plan should be put in place for improving the service. A system of seeking service users views both at residents’ meetings and through twice yearly questionnaires is in place, but the inspector could not see the results of these surveys. Staff carry out regular health and safety checks of the building and take water temperatures and fridge and freezer temperatures. Since the last inspection, a new fridge has been purchased and the temperatures are now satisfactory. Weekly fire alarm test and weekly emergency lighting checks are completed. Fire drills take place on a monthly basis. The time of the drill and names of staff present should be recorded, along with other information such as the time taken to evacuate the building. This remains a requirement from the last inspection report. The fire detection system and fire fighting equipment are regularly serviced. A fire risk assessment has recently been completed on the building and a visit from the London Fire brigade was undertaken on the 30/05/06. The inspector noted that some of the fire doors in the home were being propped open with wedges. An immediate requirement was made outlining that the Manager must ensure that all wedges are removed from the fire doors and that fire doors are not restricted or obstructed. Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 21 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 X 4 3 5 3 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 2 STAFFING Standard No Score 31 X 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x 3 X 2 X X 2 X Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 22 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 YA9 Regulation 13 Timescale for action Risk assessments should be 31/07/06 comprehensive and include strategies for managing identified risks. Original timescales of 31/05/06 not fully met. This requirement is ongoing. Further steps should be taken to 31/07/06 improve the recording and administration of medication including staff training. Original timescales of 31/05/06 not fully met. This is a repeat requirement. The Ventilation in communal 31/08/06 areas used by service users who smoke must be improved to reduce the risk to other service users and to staff. This requirement is ongoing. The washing machine and dryer 31/08/06 located in the kitchen/diner at No 99 must be re-sited to prevent cross infection. Original timescale of 31/05/06 not met, this is a repeat requirement. The Manager must ensure that 31/08/06 the results of service user surveys are published and made DS0000010872.V292448.R01.S.doc Version 5.2 Page 23 Requirement 2 YA20 13 3 YA24 13 4 YA30 13 5 YA39 25 Saltram Crescent, 91 & 99 6 YA39 26 [2] [3] 7 YA42 23 [4] available to service users and other interested parties including the CSCI. The visits on behalf of the 31/07/06 registered provider must be undertaken monthly and unannounced by a person that is not directly involved with the project as per the regulations. The Manager must ensure that 07/06/06 all wedges are removed from the fire doors and that fire doors are not restricted or obstructed. Immediate requirement The time of fire drills and names 31/07/06 of staff present must be noted. Original timescale of 31/05/06 not met. This is a repeat requirement. 8 YA42 23 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard YA35 YA37 YA39 Good Practice Recommendations Training needs analysis and training plans should be in place including a system for identifying when training updates are due. A Deputy Manager should be recruited to assist with the running of the home. The audit report should draw out clearly what action is required and an improvement plan should be put in place for improving the service. Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hammersmith Local Office 11th Floor, West Wing 26-28 Hammersmith Grove London W6 7SE 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 Saltram Crescent, 91 & 99 DS0000010872.V292448.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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