Inspection on 28/08/07 for Sisserou

This inspection was carried out on 28th August 2007.

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

Sisserou 14/08/06

Sisserou 29/09/05

Sisserou 01/04/05

Sisserou 20/07/04

Sisserou 19/04/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

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

CARE HOME ADULTS 18-65 Sisserou Sisserou 196 South Esk Road Forest Gate London E7 8HD Lead Inspector Lea Alexander Unannounced Inspection 28th August 2007 10:00 Sisserou DS0000030770.V347280.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 Sisserou DS0000030770.V347280.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. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Sisserou Address Sisserou 196 South Esk Road Forest Gate London E7 8HD 020 8586 7812 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) theresa.john1@tiscali.co.uk Sisserou Mrs Theresa John Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can accommodate one (1) named service user over the age of 65 years. 14th August 2006 Date of last inspection Brief Description of the Service: The Sisserou is a small residential care home for three people with learning disabilities. It is situated in a quiet residential street but close to public transport and other amenities in Forest Gate area of East London. There is a garden at the back of the house and unrestricted parking is available on the street. The home is owned and managed by Mrs Theresa John. She also owns and manages another home for three people with mental disorder that is located next door to the Sisserou. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One Inspector carried out this inspection over the course of two half days. This was the Inspectors first visit to the home, and the last key inspection took place on the 14th August 2006. During the course of the inspection the Inspector met with the Registered Manager, the care worker on duty and spoke privately with the three people who use the service. The Inspector also sampled a range of records relating to the running of the home. One Inspector visited the home to find out what it was like to live there. They spoke with the Manager and staff. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 6 The Inspector also talked to people who live in the home. What the service does well: The home supports women from different backgrounds and different ages. People who use the service told the Inspector that they “get on alright with staff” and that “the meals are nice”. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 7 The home makes sure it can support the needs of new residents before they move in. Residents have their own care plan. People who use the service are supported to engage in community, occupational and leisure interests they enjoy. Residents are supported to stay in contact with their families. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 8 People who use the service choose meals, and they like the food provided. The home supports residents to access healthcare appointments. The home listens to the people who live there. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 9 The home keeps people who use the service safe. The home provides a comfortable, safe environment. The staff are well trained. The Manager is qualified and experienced. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 10 The home has good health and safety. What has improved since the last inspection? The home checks the Blood Sugar levels for a resident who has diabetes. The home keeps proper records of safeguarding issues. The way the home recruits staff makes sure that residents are safe. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 11 The home makes sure that staffs get proper supervision to do their job. The home has had its gas appliances properly tested. What they could do better: Resident’s plans should be more person centred and address all their needs. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 12 Plans must be reviewed at least every six months, or as needs change. Any potential risks to residents should be properly assessed. Service users should be supported to engage in community activities of their choice during college holidays. The homes medication policy and procedure must be available to staff at all times. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 13 All medication must be listed on the Medication Administration Record. Some minor repairs must be carried out in the bathroom. All staff must receive a minimum of five days training each year. The results of the homes annual satisfaction survey must be published and shown to people who use the service and their families. The home must improve its food-handling practise. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 14 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. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 15 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 Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 16 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): 2. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are only admitted to the home when their needs have been properly assessed. EVIDENCE: There have been no new admissions to the home since the last inspection. The Inspector sampled the personal files for two people who currently use the service. These evidenced that both were assessed by the home prior to their moving in. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 17 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 adequate. This judgement has been made using available evidence including a visit to this service. The home develops individual plans with people who use the service, however these plans only address basic information necessary to deliver care and are not person centred. Potential risks are not subject to regular risk assessment. EVIDENCE: The Inspector sampled the personal files for two people who use the service. This evidenced that the home had developed and agreed an individual plan with each. The Inspector noted that for one person who uses the service their individual plan had been developed in September 2003, and annotated to evidence review in October 2004, November and September 2005 and January and September 2006. This plan addressed areas such as general appearance, diet and diabetes, medication and general health and community activities. The Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 18 Inspector was of the view however that only brief information was recorded in each section, and when reviews had identified changes hand written alterations were squeezed into the existing plan. A second person that uses the service had an individual plan dated January 2006, with no evidence of subsequent review. The plan addressed a range of health and social care issues including relationships, community activities, personal care and activities of daily living. However, the plan also referred to speech and language therapy and psychology guidelines but the Inspector was unable to locate on these on the personal file. For one service user the home had developed a plan to address their challenging behaviour. Sampling of the individual plans evidenced that these did not include significant life events or people, or past achievements in occupational or educational activities, and the home could develop its practise by making individual plans more person centred. Both of the resident’s case tracked by the Inspector receives assistance with managing their finances. The home securely holds small amounts of cash for each resident. For every deposit or withdrawal the date, amount and details of the transaction is recorded, and the resident and staff member on duty sign this. The Inspector noted that the home had developed a risk assessment for both residents sampled. These addressed a range of potential risks identified in the individual plan. However, the plans were dated July 2005 and March 2006 respectively with no evidence of recent review. For one person who uses the service issues relating to their aggressive behaviour had not been addressed in the homes risk assessment. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 19 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): 11, 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. People who use the service are involved in meaningful daytime activities of their choice and are supported to develop and maintain personal and family relationships. EVIDENCE: Discussion with the Registered Manager, people who use the service and sampling of activity records evidenced that two people who use the service are currently attending communication, creative movement and music classes at the local college. A third person that uses the service has been supported in the past to attend a work experience programme. All three people who use the service are supported to engage in the local community. They choose to attend bingo club, youth club, the local cinema, Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 20 and bowling. Two residents told the Inspector that during college holidays they would like more opportunities to go shopping. People who use the service are also supported to fulfil their spiritual needs, and at present one resident regularly attends church. Discussion with people who use the service and sampling of daily logs evidenced that each person who uses the service is supported to maintain contact with their families and friends. During the course of the inspection staff were observed to interact with residents who chose when to be alone or in company, or when to join in an activity or not. A previous inspection in August 2006 had recommended that the home develop ways to encourage residents to have a more nutritious and varied diet. Discussion with the Registered Manager and sampling of the homes meal log evidenced that staffs encourage residents to make healthier meal choices and that these are accurately recorded. Feedback from people who use the service was that they are satisfied with the meals provided and are able to choice the meals appearing on the homes menu. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 21 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. People who use the service are supported to access appropriate healthcare services. However the home must ensure that its medication policy is available at all times and that it addresses shortfalls in its medication practise. EVIDENCE: Discussion with people who use the service evidenced that times for getting up, going to bed, meals and other activities are flexible. People who use the service also choose their own clothes, hairstyle and make up, and their appearance reflects their personality. The two personal files sampled by the Inspector evidenced that the home supports people who use the service to access a range of healthcare services. Residents were evidenced as having recently visited the Optician, Dentist and GP, and a range of specialist services including Chiropody, Speech and Language Therapy and Psychology. A previous inspection in August 2006 had required the home to ensure that blood sugar monitoring (BSM) for one service Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 22 was recorded in accordance with the District Nurses instructions. Sampling of this residents BSM records evidenced that monitoring was now occurring in line with these instructions. On the first day of the inspection the Inspector asked to view the homes medication policy. They were shown a “Handling Medicines” policy but this did not address the receipt, storage or administration of drugs or guidance on selfmedication or controlled drugs. The Inspector sampled the actual medication available and the Medication Administration Records (MAR) for two people who use the service. The Inspector was advised that the Pharmacist loads tablets into a dossett box, and delivers these to the home with a MAR sheet. The Inspector noted that whilst a prescribed cream for one resident had been added to their MAR, a prescribed shampoo and cream for another had not. As required (PRN) paracetomol medication was also not listed on the MAR. During discussion with the Registered Manager they advised that one resident is partially self-medicating as they apply their own prescribed creams. The Inspector noted that there was no risk assessment for this activity in their personal file and no information relating to self-medication in their individual plan. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 23 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 home listens to people who use the service and has developed good practise in addressing adult protection issues by attending safeguarding meetings and implementing their recommendations. EVIDENCE: The home has produced a complaints policy and procedure that includes the timescales within which it aims to respond to complainants. The inspector also viewed the homes complaints log and noted that a record of the date, nature of complaint, action taken and outcome were recorded. A previous inspection had required the home to maintain appropriate records of adult protection incidents. The Inspector noted that since the last inspection there had been one adult protection concern relating to a residents aggressive and threatening behaviour towards staff. Records available for inspection evidenced that the home had taken appropriate action and that a multi agency strategy meeting had been convened to address the issue, and that as a result of this a management plan had been implemented within the home. The previous inspection had also recommended that the home address the periodically difficult relationship between two service users and the Registered Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 24 Manager advised the Inspector that they were liaising with the local authority safeguarding team to provide training to staff and residents in this area. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 25 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 pleasant, safe place to live with a choice of communal rooms and a private bedroom for resident. EVIDENCE: The home is situated in a terraced house in a quiet residential street in Forest Gate. On the ground floor there is a communal lounge with a range of comfortable seating, a computer, stereo and TV. There is a large kitchen diner and a large downstairs bathroom. A small lawned garden is accessible to the rear of the house, and one service user also has their bedroom on this level. Access to the first floor is via a staircase and on this level there is a staff office and sleep in room and two service users bedrooms. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 26 Some minor repairs were identified in the bathroom, however the Inspector found the home to be suitable for its purpose, comfortable and generally well maintained. On each of the days the Inspector visited the home the premises were clean, hygienic and free from offensive odours. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 27 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. The home operates a robust recruitment procedure and provides staff with regular supervision. There are sufficient staffs that are qualified, competent and experienced. EVIDENCE: In addition to the Registered Manager the home employs 5 care workers. At the time of this inspection three of these staff had completed NVQ level 2 or above. Another staff member is a qualified nurse, and the fifth staff member is studying for their Diploma in Social Work. The Inspector sampled the personnel files for two staff members. This evidenced that each had completed an application form, received a copy of their job description and their employment terms and conditions as part of the recruitment process. The home had obtained two satisfactory references and an enhanced level Criminal Records Bureau check as part of its pre Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 28 employment checks. The home had also established the potential employees entitlement to work. The Registered Manager advised the Inspector that since the last inspection all staff had been given the opportunity to undertake NVQ level 3 studies and that two had attended a challenging behaviour course. They also advised that Adult Protection, Medication Refresher and Food Hygiene refresher training would be provided to staff in the next few months. Sampling of the available supervision records for two care workers evidenced that four supervision sessions had been provided to each in the current year, and the home appears to be on target to provide a minimum of six supervision sessions each year. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 29 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 home benefits from an experienced and qualified Registered Manager. The home has complied with the majority of health and safety requirements and has an established quality assurance process. EVIDENCE: The Registered Manager has many years experience running this home and a separate mental health residential care home. They have successfully completed NVQ level 4 studies. The Registered Manager told the Inspector that easy to read picture-based feedback surveys had been completed by residents July 2007, and family Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 30 members had also been canvassed for their views. At the time of this inspection however the feedback had not been collated or outcomes published. The Inspector sampled a range of health and safety records the home is required to maintain. A gas appliance-testing certificate was obtained in March 2007. Fire alarm call point testing occurs on a weekly basis as do water temperature checks. The recorded temperatures are within acceptable parameters. Sampling of the homes fridge and freezer contents evidenced that one started processed food item had been retained past its manufacturers use by guidance. The Inspector viewed the homes record of fridge and freezer temperatures and this evidenced that daily temperatures had been recorded and that these were within acceptable parameters. Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 31 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 2 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 3 12 3 13 2 14 X 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 Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes. STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA6 Regulation 15 Requirement The home must ensure that all individual plans are person centred and appropriately address personal, social and healthcare needs. Timescale for action 30/01/08 2. 3. YA9 YA13 13 16 4. YA20 13 & 17 Plans must be reviewed at least every six months, or as needs change. The home must ensure that 30/01/08 potential risks are appropriately assessed. Service users should be 30/01/08 supported to engage in community activities of their choice during college holidays. The homes medication policy and 30/12/07 procedure must be available to staff at all times. Self-medication by people who use the service must be subject to a risk assessment. All prescribed medications including “as required (PRN) medication must be listed on the MAR sheet. The following repairs and maintenance must be DS0000030770.V347280.R01.S.doc 5. YA24 13 23 & 39 30/01/08 Sisserou Version 5.2 Page 33 undertaken in the bathroom: A blind must be fitted at the window (ii) A toilet seat must be fitted. All staff must receive a minimum of five days training each year. The Registered Person must ensure that the results of service users’ and their representatives’ satisfaction surveys are published and made available to them and other interested parties, including the Commission. (i) 6. 7. YA35 YA39 18 24 30/01/08 30/12/07 8. YA42 13 This is a restated requirement. The previous targets of the 31/12/05 and 30/11/06 were not met. Started, processed foods must 30/12/07 be used by or disposed of within the timescales identified by the manufacturer. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ilford Area Office Ferguson House 113 Cranbrook Road Ilford London 1G1 4PU 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 Sisserou DS0000030770.V347280.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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