Inspection on 07/08/06 for Sandiway Manor

This inspection was carried out on 7th August 2006.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Sandiway Manor 23/12/09

Sandiway Manor 29/08/07

Sandiway Manor 15/11/05

Sandiway Manor 06/05/05

Sandiway Manor 20/01/05

Sandiway Manor 06/08/04

Sandiway Manor 18/02/04

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Sandiway Manor Norley Road Sandiway Northwich Cheshire CW8 2JW Lead Inspector Sue Dolley Key Unannounced Inspection 09:15 7th August 2006 X10015.doc Version 1.40 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 Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 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 Older People. 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. Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Sandiway Manor Address Norley Road Sandiway Northwich Cheshire CW8 2JW 01606 883008 01606 301764 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) Cheshire Residential Homes Trust Mrs Jacqueline Gregson Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. No more than 29 service users, within the category of old age (OP) may be accommodated 15th November 2005 Date of last inspection Brief Description of the Service: Sandiway Manor is a care home owned by the Cheshire Residential Homes Trust, a charitable organisation that runs three care homes for older people. Each home is independently run by a committee. The fees at Sandiway Manor are £385.00 per week. The home is in the village of Sandiway, approximately three miles from Northwich. There are a number of shops, a church and other facilities located in the village. There are adequate car parking facilities available at the home. Sandiway Manor was formerly a private house that has been renovated and extended for use as a care home. Sandiway Manor is a three-storey building; residents are accommodated on the ground floor and first floors only. Access between floors is via a passenger lift or the stairs. There are 28 single bedrooms, for residents and all of these rooms have toilet facilities and washbasins fitted. A further bedroom is available as a guest room. This room does not have toilet facilities. Day space consists of 2 lounges and a dining room. There are sufficient numbers of toilets to meet the required standard. There are aids throughout the home to help residents remain independent, including bath hoists, grab rails and in an emergency call bell system. There are large enclosed mature and pleasant gardens with walkways and sitting areas available to residents. Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection process of Sandiway Manor included a site visit to the home which was unannounced and completed in one day. Time was spent sitting and talking with people who use the service and observing the day-to day routines of the centre and care staff as they provided support. A tour of the building was undertaken to assess its suitability to provide a comfortable, homely and safe environment for residents. The tour included several bedrooms, shared areas such as lounges and dining areas, bathrooms, toilets and the kitchen and laundry areas. The registered manger contributed to the inspection process and three residents were spoken with and commented on the services provided. What the service does well: What has improved since the last inspection? Staff members continue to train to achieve appropriate qualifications and to improve their understanding and knowledge base. Recent and future training plans show a continued commitment to undertake relevant training and staff are enthusiastic and keen to learn. Since the last site visit a great deal of redecoration work has taken place to further improve the environment. Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 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. Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2,3 4 and 6 Quality in this outcome area is good.This judgement has been made using available evidence including a visit to this service. The manager meets prospective residents, their families and others to assess whether identified care needs can be met at the home. EVIDENCE: Residents are issued with a statement of terms and conditions to agree the services provided and the rights and responsibilities of the resident and provider. One example was seen for a resident recently admitted, one further example could not be located during the site visit. The management undertook to locate this. The manager meets prospective residents and their families to assess whether identified care needs can be met at the home. The assessment identifies the individual’s needs and a Care Plan is developed. The level of care and support is agreed with each resident and their carers. Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 9 The staff members help to assess developing and personal needs and encourage rehabilitation and independence at all times. The care home provides a supportive setting in which residents can maintain and regain abilities and build confidence. The care files for two recently admitted residents were checked and were well organised. Each contained a thorough assessment of needs, which had been undertaken prior to the residents moving into the home. Each care file contained an initial plan of care for daily living and initial assessments had been signed by the registered manager. The care plans had been reviewed at least monthly and more often as and when the health and treatment of a resident changed. Key workers had documented all changes to care needs and the level of care had been adjusted accordingly. The daily reports are held in one collective file along with a basic information sheet for each resident. Information is stored in room number order to aid retrieval of information. Some improvement in the recording was evident although some recording was a little scant and did not accurately reflect the high level of care provided within each twenty -four hour period of care. Written instruction had been provided to staff members regarding the need to complete daily records. Some staff members may need more guidance about the expected level of content and detail to be recorded to provide evidence of the level of care delivered. Intermediate care is not provided at the care home. Occasionally when space has been available, convalescence care has been offered and provided to enable individuals to maximise their independence and regain strength and abilities. Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 and 11 Quality in this outcome area is good.This judgement has been made using available evidence including a visit to this service. Health and personal care needs are assessed, addressed and met and residents are referred to health professionals as appropriate. Greater care could be taken in the completion of ongoing records and staff members need to discuss and record residents’ wishes regarding terminal care and arragments after death to ensure residents’ wishes are met and their death is handled with propriety. EVIDENCE: The two care plans checked were positively written to identify strengths and abilities. Care needs were fully explained and care difficulties were sensitively handled. The intervention required was fully explained and the expected outcome was recorded. Care plans had been agreed with residents and their relatives and risk assessments were in place as appropriate. All changes to health had been noticed at an early stage and appropriate action had been taken to alert health care professionals and gain support. The care files contained good information about past medical conditions and all contact from health care professionals was thoroughly recorded with outcomes shown. Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 11 The medication administration records for the period 31.07.08 to 07.08.06 were checked. The standard of recording relating to the administration of medication was much improved from the previous site visit and staff members had recorded administration accurately and used omission codes appropriately. Two small anomalies were found and were discussed with the registered manager and advice was given. Several residents were enabled to continue to self medicate and this was well documented and managed. During the site visit care staff were seen to encourage residents to retain their independence and to support them. It was clear that there was a genuine concern for the health and welfare of residents. During the site visit care staff were observed to be attentive and interactions with residents were friendly, respectful, kindly and reassuring. Three residents spoken with confirmed that they felt well cared for and many positive comments were received regarding the quality of care experienced. A clear policy provides guidance to staff in the event of a death occurring, including any special religious considerations. The registered manager continues to try to seek sensitive information from residents and their relatives regarding residents wishes on terminal care and arrangements after death. The two files checked did not contain details of wishes regarding terminal care and arrangements after death. Upon further checks there was nothing recorded about wishes regarding death and dying/ funeral arrangements for 18 of 28 residents. Each resident should be encouraged to express their wishes about what they want to happen as death approaches and to provide instructions about the formalities to be observed after they have died. Their cultural and religious preferences should be recorded and observed and residents should feel assured that their death will be handled with dignity and propriety. See Recommendation 1. (This recommendation has been made repeatedly). Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. There are opportunities for leisure and recreational activities to suit residents’ expectations, preferences and capacities. Residents are enabled to exercise choice in relation to routines of daily living and are provided with varied and wholesome food, which they enjoy. EVIDENCE: Individual and group activity is encouraged and a range of social activities are arranged to enable residents to pursue their hobbies and interests. There is an active art group at the care home. This group meets each Monday. There are many examples of residents’ artwork on display in the conservatory. There is a well- stocked library of books to select from and many of the books have larger print. There are regular sessions of chair aerobics for residents and occasionally musical entertainment is arranged. Local choirs have visited and regularly there are games of bingo and cards. Residents are encouraged to keep up their interests in the local community. Several residents visit local churches and church representatives visit the care home to offer communion or to undertake services. Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 13 Residents have hairdressing and chiropody visits and newspapers are delivered to residents as required. A pay phone is available in the entrance hall to enable residents to maintain contact with those important to them. Family members and visitors were observed to receive a warm and friendly welcome and as a consequence there are many visitors to Sandiway Manor and relatives continue to share the care with staff. Family members are often invited to events within the home and visitors can request to have a meal with residents. Events are advertised on a notice board within the home. The next event is a Summer Luncheon to be held on 22nd August 2006 and residents can invite a guest to this. During the site visit three residents spoken with provided positive comments about the quality and range of food provided. The menus for the day are shown on the notice board. Residents are offered a choice of home made food with alternatives available. Several residents said food was enjoyable, well presented and plentiful. Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service.Arrangements for responding to residents and relatives concerns are satisfactory. No complaints had been received since the last site visit. Staff members are alert to the potential for abuse to help protect service users. EVIDENCE: The care home has a written complaints procedure included in the residents’ information folders. The home’s management aims to deal with any concerns prior to these developing into complaints. Each month a different committee member visits to speak with residents about their thoughts on the standard of care provided. The findings are reported to the chair of the committee and at friends meetings to ensure satisfaction. Residents confirmed that they knew what to do if they had a complaint and said that staff members respond quickly to any matters raised. No complaints had been received since during the last site visit. Staff members have a basic awareness of adult protection and have the Department of Health guidance ‘No Secrets’ available to refer to. A whistle blowing policy is available to staff to enable them to respond appropriately to any suspicions or evidence of abuse. Of 18 care staff 8 have received training in the protection of vulnerable adults. Further training is planned to take place to raise staff awareness about the abuse of older people. Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. The premises are clean, well furnished and equipped for the comfort of residents. Sandiway Manor provides a safe, well-maintained environment in which to live. EVIDENCE: Sandiway Manor is well maintained and clean. A tour of all the communal areas and two of the bedrooms was undertaken. A high level of redecoration work has taken place since the last site visit and the care home is well presented, comfortable and homely. Much of the redecoration was undertaken in May this year and this included the main hall, the communal lounges, corridor areas, the kitchen, the laundry, some office accommodation, several bathrooms and toilet areas and 7 bedrooms. Much of the communal space was redecorated during the night to cause least disruption to residents. Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 16 The attractive grounds are accessible to residents and several of the residents enjoy walking around the well -planted grounds. The building complies with the requirements of the local fire service and environmental health department. A shaft lift, grab rails and other aids have been provided to enable residents to have access to all parts of the home. There was evidence to show that the lift had been regularly services. A call bell is available in all rooms. Throughout, the premises were clean and fresh and residents confirmed that staff members always work hard to maintain a high standard of cleanliness and housekeeping. Advice was given as some bar soap and personal toiletries had been left in some communal bathrooms. Liquid soap and paper towels were available at most water outlets to promote hygiene. All bedrooms are en-suite with hand basin facilities. Accessible toilets throughout the premises and bathrooms are well equipped. A separate toilet area to the older part of the building contains two toilets. This does not have satisfactory wash hand facilities. The wash hand facilities are reached via two steps and by aid of a handrail. This area could present a risk to hygiene and would benefit from refurbishment and improvement. See Recommendation 2. Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. Staffing levels are generous and staff members are keen to undertake appropriate training to ensure they atre competent and confident in their roles. EVIDENCE: Examples of staffing rotas were checked. All staff shifts had been covered and staffing levels were generous to ensure the needs of the residents could be met. Some shifts had been covered by agency workers due to some longerterm staff sickness. Five agency staff members are regularly used and are well known to residents. Staff members are well qualified. 11 of 18 care staff have achieved NVQ qualifications. 5 of the 11 have achieved NVQ Level 3, 1 is a trainer and 3 are assessors. Some of those staff at Level 2 are now progressing to Level 3 and a high percentage of the staff members have shown a willingness to further their training and to gain qualifications. Three recruitment files were checked and provided evidence of thorough recruitment procedures and practices in place, with all necessary recruitment checks undertaken and references provided. Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 18 Staff members were observed to have the necessary skills and competence to undertake the work they perform and were confident and kindly in their interactions with residents. There was evidence of a wealth of training provided and arranged to promote staff awareness and competence. The senior staff members have recently completed further training in the administration of medication. Six staff members completed training in dealing with challenging behaviour in July this year. Future planned training includes, first aid, manual handling, medicines awareness, food hygiene, abuse awareness and training regarding health and safety. A training record is kept and was seen and provided evidence that 16 staff had recently had fire safety training. The overall training matrix could include training related to medication, adult protection and NVQ training to give a collective account of all training undertaken. Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including visits to this service. The registered manger is experienced in the care of older people and continues to update her skills and knowledge. The residents and staff benefit from a clear leadership and management approach within the home, which promotes their health, safety, welfare and interests. EVIDENCE: The registered manager is a qualified nurse. She is competent and experienced and updates her skills and knowledge and completed the Registered Managers Award in June 2005. The registered manager is supported by, a deputy and the staff team and management committee. Residents have a high level of contact with the management of the care home, which promotes satisfaction from all parties. Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 20 The processes of managing and running the home are open and transparent. The registered manager is approachable and suggestions for improvement within the home are encouraged, welcomed and acted upon. The possible introduction of a quality assurance survey was discussed to ensure all service users have the opportunity to express their views about the service and care provided and to ensure that the care home is meeting its aims and objectives and statement of purpose. The registered manager plans to regularly supply residents and their supporters with questionnaires to seek their views and to make the results known to existing and prospective residents. The administrator was able to supply a sample questionnaire to be used. During the site visit, seversl examples of service users’ balances of personal monies held for safekeeping were checked along with the related records. All balances and records were accurate with receipts kept as appropriate.The management of service users’ balances had been regularly and thoroughly checked to ensure service users money was safeguarded. Since the previous site visit a system of regular staff supervison has been being put into place and there was evidence of planned supervison sessions for staff. Formal supervsion is being introduced and is currently being discussed with senior staff. Each member of staff will have a supervsion contract. The manger and deputy will supervise senior staff and in time, senior staff will each supervise a range of care and domestic staff. The registered manger recently attended a training course which highlighted the benefits of supervision and explained the function and methods of supervision. This training proved to be be informative and beneficial. The management team endeavours to ensure the health, safety, and welfare of residents and staff are promoted and protected. Mandatory training, for example moving and handling, health and safety, and first aid training, is avaialble for all staff members as necessary. The accident records from 15th November 2006 onwards were checked all were thoroughly recorded. The fire precautions record book was checked and all main fire safety checks and evacuations had been undertaken, as apropriate and emergency lighting checks had been completed. Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X 3 3 3 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 X 3 Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 22 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP11 Good Practice Recommendations Residents wishes concerning terminal care and arrangements after death should be discussed and recorded and carried out. (This recommendation was made at five previous site visits.) Improvements should be made to the identified toilet /hand washing facility to promote hygiene. (This recommendation was made at the previous site visits on 6th May and 15th November 2005). 2. OP21 Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Sandiway Manor DS0000006605.V294268.R01.S.doc Version 5.1 Page 24 - 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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