Inspection on 10/05/07 for Scope - The Hollies

This inspection was carried out on 10th May 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 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

Scope - The Hollies 10/08/06

Scope - The Hollies 06/12/05

Scope - The Hollies 14/06/05

Scope - The Hollies 21/02/05

Scope - The Hollies 18/08/04

Scope - The Hollies 22/02/04

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

CARE HOME ADULTS 18-65 Scope 1 ,2 and 3 The Hollies Halton Brook Avenue Halton Brook Runcorn Cheshire WA7 2FU Lead Inspector Maureen Brown Unannounced Inspection 10 May 2007 09:15 Scope DS0000005179.V332544.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 Scope DS0000005179.V332544.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. Scope DS0000005179.V332544.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Scope Address 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) 1 ,2 and 3 The Hollies Halton Brook Avenue Halton Brook Runcorn Cheshire WA7 2FU 01928 590168 SCOPE Martyn Swindell Care Home 9 Category(ies) of Physical disability (9) registration, with number of places Scope DS0000005179.V332544.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 9 residents in the category of PD (Physical disability) 10th August 2006 Date of last inspection Brief Description of the Service: The premises of 1 - 3 The Hollies are owned by Liverpool Housing Trust, and are managed by Scope. The home is located in the Halton Brook area of Runcorn with easy access to local amenities and facilities. The Home is comprised of three bungalows accommodating nine residents who are physically disabled. Each bungalow provides three bedrooms and a shared kitchen/dining area, lounge, bathroom, separate shower room, a utility room and brick built outdoor shed. The staff team consists of the registered manager who is supported by two senior support workers and seventeen support workers. The fees at The Hollies are between £36,975 and £49,638 per annum. Optional extras include CD’s, Videos, DVD’s, holidays, magazines, decoration of own bedroom, clothing, toiletries and hairdressing. Scope DS0000005179.V332544.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced visit took place on 5 May 2007 and lasted six hours. This visit was just one part of the inspection. Before the visit the home was also asked to complete a questionnaire to provide up to date information about services at the home. Questionnaires were also made available for residents, relatives and other professionals to find out their views. Other information since the last key inspection was also reviewed. During the visit various records and the premises were looked at. A number of residents and staff were also spoken with and they gave their views about the service. Twenty-four out of forty-three standards were assessed and all were met. All the key standards were assessed. Feedback was given to the registered manager at the end of the site visit. What the service does well: The home had an established staff team who were keen for high standards to be maintained. Residents’ plans of care and individual case notes were well documented and reflected each resident’s needs. Residents are encouraged by the staff team to choose what activities they want to do each day. Residents commented “The staff always treat me well”, “The home is always fresh and clean”, “My bedroom is very nice, I like it a lot” and “I wouldn’t stay here if the staff didn’t treat me well”. A relative commented, “The manager has been most efficient and we are told more about our relative’s welfare”. Care managers commented, “Records appear up to date”, “Resident was happy and content”, “Good evidence at last review that resident is attending regular healthcare appointments” and “Review attended was person centred and focused around the resident”. GP’s commented, “No complaints, good satisfactory care”, “Excellent standard of care given”, “The Hollies meet the residents healthcare needs” and “The residents privacy and dignity are respected”. Scope DS0000005179.V332544.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Scope DS0000005179.V332544.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 Scope DS0000005179.V332544.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): 1 & 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Sufficient information is provided for residents to make a decision about moving into the home. EVIDENCE: The statement of purpose and resident guide was available to residents and prospective residents. Changes had taken place since the last visit and these documents were reviewed in April 2007. A copy was available in each resident’s bedroom. Residents confirmed they were aware of the residents guide and statement of purpose. The manager has started to look at producing the statement of purpose and residents guide in a picture format for residents benefit. It is recommended that this be continued. Within each resident file a pre-assessment document was available which detailed their needs. All the residents had lived at the home a long time from sixteen to thirty-four years. During discussions with staff it was evident they were aware of residents needs and from the residents files it was noted that families confirmed their involvement in care planning and reviews. Scope DS0000005179.V332544.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): 6, 7 & 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ health, personal and social care needs are met by the staff team who enable them to maintain their privacy and dignity. EVIDENCE: Three out of nine residents files were examined. These contained the care plan, risk assessments, daily record sheets, twenty-four hour care summary, reviews of care plans and contract. All the information necessary to ensure that resident’s needs are met was available. The care plans were well written and gave a clear picture of the support needed. Other records seen relating to the residents included the social services reviews and terms and conditions of residence. All these documents were up to date with appropriate recordings. The daily records were very good and staff noted changes to residents, activities undertaken and the details of visitors were also recorded. All files examined had up to date resident plan reviews. Scope DS0000005179.V332544.R01.S.doc Version 5.2 Page 10 Observations made during the site visit included seeing staff knock on the bedroom door before entering and staff interactions with residents during the tour of the home. The staff were attentive to residents needs and helped them when required. Residents confirmed that staff helped and supported them when they needed it, such as with personal care tasks and that staff “usually listen to what I say”, “The home is kept tidy by the staff”, “I like all the staff that work with me and get treated well” and “I wouldn’t stay here if the staff didn’t treat me well”. The general atmosphere within the home was warm and friendly. Care managers commented, “There was an incident where my client was involved and the staff acted appropriately providing the client with support”, “the resident was happy and content” and “Correspondence has always been clear. The review attended was person centred and focused around the resident”. Other comments included, “Support staff are very competent and sensitive to residents needs. They encourage residents to be as independent as possible. A service improvement would be more training and supervision”. Scope DS0000005179.V332544.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): 12, 13, 15, 16 & 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The range of activities provided fulfils Resident’s lives. Residents have opportunities to maintain personal relationships and develop new ones. EVIDENCE: Each resident has three sessions a week at “lifestyles” provided by Scope. Activities include going to “Sutton Fields” community centre, bowling, going to the allotment, cooking, crafts and flower arranging. Other activities, which could be on an individual basis with staff or in small groups, included going out shopping locally and to local attractions. Residents commented, “Depends on transport and staff whether I can go out or not”, “Would like to visit the pub more”, “Bit restricted on social activities in the evenings. I do go out to shows, theatres but I would like to go out a lot more.” and “I would like to get out more at weekends”. Scope DS0000005179.V332544.R01.S.doc Version 5.2 Page 12 It is acknowledged that residents would like to go out more at weekends and in the evenings. It was noted that leaflets regarding forthcoming local shows were available and some residents were going out this evening to see “Meatloaf”. Other shows planned include “Riverdance”, “Guys and dolls”, “Fame”, “Rod Stewart” concert and “Singing in the rain”. Also three residents are travelling to London to see “Dirty Dancing” next month. Residents confirmed that they usually go out mid afternoon, have a meal out and then go onto the shows. It was noted that the shows tended to be during the evenings and at weekends. The activities provided reflect normal life practices however, to further improve outcomes for service users the manager should look at staffing levels for evenings and weekends and ensure that transport and a driver are available. The manager stated that the building used for lifestyle sessions is due to be reviewed and alternative accommodation is being considered. Also extra sessions for each resident are also being discussed. Visits from families and friends were recorded in the daily record sheets and these were seen during the site visit. A relative stated, “The manager has been most efficient and we are told more about our relative’s welfare”. Samples of menus were seen during the site visit. These showed that a diet that had a variety of meat, fish and cheese was provided to the residents. Following a previous recommendation regarding fresh vegetables and fruit, improvements had been made in the meals provided and this recommendation had been met. A previous requirement regarding no menus on occasions and sometimes a resident refused lunch or dinner with no records produced or any other action taken had been addressed. The improvements made in food provided means that the outcomes for residents has increased, in that healthier diets with a wider choice is now provided. Residents said “the meals are good here, plenty of variety and we choose the menus for the week” and “If you don’t like what is on then an alternative meal is offered”. During the tour of the bungalows fresh fruit was seen available in the kitchen areas and yogurts were available within the fridge. Scope DS0000005179.V332544.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): 18, 19 & 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The residents’ health, personal and social care needs are met by the staff team who enable them to maintain their privacy and dignity. EVIDENCE: Each resident had a visiting professional sheet that detailed visits made regarding all areas of health care needs. The information included visits to GP, chiropodist, opticians, dentist and medical appointments. Following a previous recommendation visits from the chiropodist had been addressed and regular contact had been resumed. Following a previous requirement annual checks for all residents for the dentist and optician had been addressed and were evident on residents files. The outcome for residents has improved with the development of better systems of recording healthcare appointments and annual checks being carried out. Scope DS0000005179.V332544.R01.S.doc Version 5.2 Page 14 Five GP comment cards were received and it was stated, “The Hollies meet the residents healthcare needs. The residents privacy and dignity are respected”, “Excellent standard of care given”, “No complaints, good satisfactory care” and “Very satisfied with all aspects of care”. One GP also said, “Good standards of care in all aspects”. All the GPs commented “they were satisfied with the overall care provided”. A social worker commented “Good evidence at last review that the resident is attending regular healthcare appointments”. The medication system is kept in a locked steel cupboard within each bungalow. This was located within the bathroom. A monitored dosage system was used and all medication was stored appropriately. The medication administration sheets seen were signed and up to date. Unused drugs are returned to the pharmacist on a monthly basis. Staff are trained in medication awareness and staff files showed training undertaken. By having good medication administration systems and staff appropriately trained residents are protected by the systems in place and therefore their medication needs are being met. Scope DS0000005179.V332544.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): 22 & 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The views of residents and relatives were taken seriously, they were listened to and rights were promoted. Clear policies were in place to ensure that residents were protected from abuse, neglect and self-harm. EVIDENCE: On examination of two staff files it was evident that recent Protection Of Vulnerable Adults training had taken place following a previous requirement. On discussions with the staff team they were able to explain what abuse was and that they would let the manager know if they were concerned about any resident. The manager was able to demonstrate his knowledge of Halton’s “No Secrets” and Scopes Abuse Policy. These were available for the staff to read. The manager and staff confirmed that they had received awareness training in Protection Of Vulnerable Adults. Scopes policy on Adult Protection was dated November 2002 and following a previous requirement the manager had reviewed this in September 2006. The complaints procedure was seen and this contained details of the Commission and the ombudsman. Following a previous recommendation Scopes complaint form was now being used. Scope DS0000005179.V332544.R01.S.doc Version 5.2 Page 16 Neither the home nor the Commission had received any complaints since the last inspection. Residents spoken with confirmed they would contact the manager if they had any problems. This was also confirmed through resident surveys and relative’s surveys. Scope DS0000005179.V332544.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): 24 & 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides a clean and comfortable environment for the people to live in. EVIDENCE: A full tour of the communal areas and a selection of bedrooms were seen. The home was found to be fresh, clean and odour free. Bedrooms had been personalised by the residents with their own furniture, pictures and mementoes. Some residents had purchased their own furniture, flooring and paid for personalised decoration of their own bedrooms. Residents confirmed that they liked their bedrooms and “My bedroom is very nice, I like it a lot. I am getting some new furniture shortly”, “I like my bedroom and house” and “My room has recently been redecorated and I like it a lot better”. Scope DS0000005179.V332544.R01.S.doc Version 5.2 Page 18 The home was light, airy and was warm. On discussions with residents it was confirmed that the home was warm enough for them. One resident is currently arranging for laminate flooring in his bedroom and one bedroom has been redecorated. During the tour it was noted that the bedrooms and lounges were decorated to a good standard however on entry to the bungalows the corridor walls and doorways were in a poor state of repair. This was due to damage by the wheelchairs and unfortunately this gives a poor impression of the home to the visitor, therefore a recommendation was made. Scope DS0000005179.V332544.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): 32, 34, 35 & 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are protected by the homes recruitment policy and practices. EVIDENCE: The staff rotas showed the staff on duty over the week. This appeared to meet the needs of the residents. Residents confirmed that enough staff were around to help them and observations made during the site visit showed staff were attentive to residents needs. Two staff files were examined. These were well documented and had all preemployment checks in place. Scope DS0000005179.V332544.R01.S.doc Version 5.2 Page 20 All records seen had up to date appraisals and the supervision log clearly noted when these had taken place. Supervision records were seen and all staff had received supervision during February and March 2007, following a previous recommendation regarding this. A requirement had been made during the last visit regarding the manager keeping copies of his supervision notes and this had now been met. The outcomes for residents have improved by staff being better supported by the manager. Staff felt supported and this impacted on the support they gave to residents in a positive way because the staff team felt valued. Staff meetings take place on a regular basis usually every month. The last meeting was held on 23,24 & 25 April 2007 and issues discussed included residents, staff and health and safety. The previous meeting was held on 26 & 27 February 2007. Following a previous recommendation regarding meetings held at the same time each session, improvements had been made and the same meeting is now held over several days and at different times. Staff had undertaken training on NVQ level II, medication, fire training, health and safety, risk assessments, colostomy and stoma care, adult protection, moving and handling and food hygiene. Mandatory training had improved following a previous requirement and this has had a positive impact on the staff team, they feel better equipped to complete they role and have more confidence and this therefore has a positive impact on the work carried out with the residents. Out of nineteen staff, ten had NVQ level II, both seniors were NVQ assessors and the manager has also completed NVQ level IV Registered Managers Award. Scope DS0000005179.V332544.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): 37, 39 & 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health, safety and welfare of the residents are protected. The views of residents are obtained and used to influence the running of the home. EVIDENCE: Day to day and individual supervision and support from the manger was good and was confirmed by the staff team. A selection of policies and procedures were examined. These were up to date. Scope DS0000005179.V332544.R01.S.doc Version 5.2 Page 22 A quality assurance process was in place. Discussions regarding this were held with the manager. The process was undertaken in January and February 2007. An analysis of this information had been produced recently and circulated to residents and staff. The manager had designed a survey for families and visiting professionals and was due to send this out with a copy of the analysis where appropriate. The previous requirement had been addressed. Regular house meetings were held with records kept. The manager stated that he discusses the outcomes of meetings with all residents who do not attend. Safe working practices were in place. Up to date fire safety checks on the fire system were in place. A weekly sound test of the system was recorded. Fire doors and emergency lights were checked on a monthly basis and staff had received fire safety awareness training. Up to date gas safety and electrical wiring safety certificates were available. All wheelchairs and hoists were regularly serviced. Portable Appliance Testing had been carried out in November 2006. The accident record book was seen. All copies are kept separately to the book with only the seniors and manager having access. The manager has worked for Scope for twenty years and as manager for four years. He is the Designated Adult Protection Advisor, has the BTEC in Management Studies, ICSC (in service course for social care) and has completed the NVQ level IV Registered Managers Award. Scope DS0000005179.V332544.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 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 3 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 X 3 X 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 Scope DS0000005179.V332544.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. 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. 2. Refer to Standard YA1 YA24 Good Practice Recommendations The registered person should continue to explore other formats for the residents guide and statement of purpose and function. The registered person should ensure that the slight damage to the doorframes and corridor walls are attended to. Scope DS0000005179.V332544.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT 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 Scope DS0000005179.V332544.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. 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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