Inspection on 10/02/09 for Southview

This inspection was carried out on 10th February 2009.

CSCI found this care home to be providing an Poor service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Southview 13/09/07

Southview 22/11/06

Southview 24/01/06

Southview 22/09/05

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

Extracts from inspection reports are licensed from CQC, this page was updated on 08/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Southview 34 Yew Tree Close Fair Oak Eastleigh Hampshire SO50 7GP zero star poor service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Craig Willis Date: 1 0 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.csci.org.uk Information about the care home Name of care home: Address: Southview 34 Yew Tree Close Fair Oak Eastleigh Hampshire SO50 7GP 02380601805 02380695473 southviewhome@tiscali.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Milbury Care Services Ltd care home 6 Number of places (if applicable): Under 65 Over 65 6 0 learning disability Additional conditions: The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Learning disability (LD). The maximum number of service users to be accommodated is 6. Date of last inspection 1 3 0 9 2 0 0 7 A bit about the care home The property is a two-storey domestic detached home located near the centre of Fair Oak, about half a mile from local shops and other amenities. There is a house car, which provides transport for people. People have their own bedroom with their own bath or shower. The manager reported that the weekly fees for a place in the home range from 1599 to 2413 pounds, based on assessed needs. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home We visited the home on 10 February 2009. During the visit we spoke with one person who lives in the home and observed the way staff treated other people. We spoke with the manager, operations manager for the provider and staff on duty during the visit. We looked at the rooms in the home that people share and records kept by the staff. What the care home does well People are able to visit before they move into the home. Staff treat people with respect and help them to keep in touch with friends and family. There are good systems to safely manage people’s medication. The building is well maintained and provides a clean and comfortable home for people. What has got better from the last inspection What the care home could do better The care plans need to have more detail in them and be regularly reviewed. This will give staff the information they need to provide the right support and keep people safe. The home must report incidents where people have been hit and ensure action is taken to keep people safe. The manager needs to make sure there are always enough staff working in the home to meet peoples needs. The manager needs to make sure all staff have received the training they need to be able to safely meet peoples needs. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Craig Willis The Oast Hermitage Court Hermitage Lane Maidstone Kent ME16 9NT If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line - 0870 240 7535 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . There are systems in place to assess peoples needs before they move into the home. Evidence: The records of three people who live in the home were inspected during the visit. Each person had documents which set out their assessed needs. The home is in the process of transferring these documents into a new format, which had been completed for one of the records seen. The new format clearly links the assessed needs to the care / support plan and risk assessments. The previous manager reported in the last annual quality assurance assessment completed in July 2008 that new service users are offered introductory visits and overnight stays at the home as part of their needs assessment. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The care planning and risk assessment systems do not contain sufficient information to support people to meet their assessed needs and keep them safe. Evidence: The records of three people who live in the home were inspected during the visit. Each person had a set of care plans and risk assessments; however, they were not all clear or easy to understand. Some of the care plans for one person had not been reviewed since November 2007. One persons plan states they may at times present challenges within the community, however there were no details of what these challenges were. The control measures in place were all staff NVCi (non violent crisis intervention) trained. Management guidelines to be used. (Service user) to be brought back to the home if he presents challenges. The manager reported that this person does not currently have any behaviour management guidelines in place. The same persons mobility support plan states they should never sit behind the driver whilst travelling in a vehicle, but does not state why this is necessary and there is no risk assessment in place covering this. One of the plans inspected contained a goal to be more independent with life skills but only had very vague information about how this should be achieved, for example staff to support and empower me and staff to maintain a consistent approach. There was no specific information about the support staff should provide or what they were trying to achieve. The plans for one person have been transferred into a new format that the manager said is being introduced in all their services. This sets out the persons assessed needs, the plan for how this support should be provided and an assessment of any risks relating to this area of support. The plans for this person were generally clear, with Evidence: detailed information about the support they need, how it should be provided and how any risks relating to this area should be managed. This person currently uses an audio monitor in their bedroom with a receiver in the lounge for staff to respond to any seizures. There is no information in the plan about why this equipment is used or an assessment of whether other methods could be used that do not infringe the persons privacy. The home has locked external doors, controlled by keypads that only staff have the number for. None of the plans inspected contained any details as to why this restriction was in place. There have been a number of incidents in the home where one service user has hit other people who live there. None of the plans seen contained any assessment of the action that was needed to keep people safe in these circumstances and how staff should provide it. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People have an individual plan of activities that staff usually support them with, although this is sometimes not possible due to staffing levels. Staff treat people with respect and provide good support to maintain contact with family and friends. Evidence: Each person has an individual programme of activities that has been developed from their likes and dislikes. Examples seen included college courses, using the homes sensory room, cooking, swimming, cinema, theatre, bowling, social clubs and life skills sessions. One person who lives in the home was spoken with during the visit. This person reported he takes part in a range of activities and particularly enjoys going to college, playing computer games, watching films and playing basketball. One staff member spoken with reported there were lots of activities that people participate in during the week, although it can be more difficult to support people at the weekends due to staffing levels. The staff member said additional activities were undertaken in house when this happens, although it can increase incidents of challenging behaviour for one person. The staff rotas for the week of the visit were inspected and there were not sufficient staff planned for the following weekend to enable people to go out. The manager said she would get additional staff to ensure people could go out. People are supported to maintain contact with family and friends, with visitors welcome in the home at any time. During the visit staff were observed interacting with people in a friendly and respectful way. Peoples wishes about participating in activities were respected, for example one person chose not to take part in their planned activity as they were not feeling well. Evidence: The home has a planned menu, with two choices for lunch and dinner. The manager reported that there were no specific dietary needs that they were currently catering for. Peoples likes and dislikes are recorded as part of their care plans. The manager also reported she planned to produce the menus in a pictorial format to help people understand them and support people to be more involved in the shopping and preparation of meals. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has good systems to safely manage peoples medication, however, people are not receiving the medical support they need after being hit. Evidence: The care plans seen contained details of the personal care support people need and how it should be provided, however, as reported in the individual needs and choices section these plans have not all been regularly reviewed and updated. We spoke to one person who lives in the home during the visit. This person reported that staff treat them well and provide the support needed. During the visit staff were observed responding to requests for support from people who live in the home. We inspected the records of three people who live in the home during the visit. These records indicated people were supported to see a range of health professionals, for example GP, dentist, neurologist and community nurse. There have been a number of incidents in the home in which people have been hit, punched, kicked and scratched. The general response to these incidents did not include an assessment of any injuries by their GP or other health professional. In one of the incidents a person who lives in the home was hit on the head with a riding helmet, yet did not see their GP for approximately six weeks, and only then as a result of an action from a safeguarding meeting. This was discussed with the current manager, who said her expectation was that if anyone was assaulted in an incident staff would support them to seek a medical assessment of any injuries. Medication is stored in a locked cabinet in a locked room and most tablets are supplied in blister packs to aid administration. A record is kept of medication coming into the home and returned to the pharmacist for disposal. The medication administration records for the current month were inspected and had been fully completed. Staff who support people to take their medication have received training. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has not taken appropriate action to ensure people are protected from abuse, which has placed people at risk. Evidence: The home has a complaints procedure, which is supplied to all people who live in the home and their relatives in the service users guide. This document has been produced in a pictorial format to aid peoples understanding of it. We spoke with one person who lives in the home during the visit. He said he would talk to senior members of staff if he was not happy about something in the home. The home has not received any complaints since the last inspection. The home has safeguarding and whistle blowing procedures in place, however they did not have a copy of the Hampshire County Council local safeguarding procedures. The manager said she would obtain a copy. There have been allegations of abusive practice that are currently being investigated by Hampshire Adult Services and the police under the safeguarding procedures. There have also been a number of incidents in which people who live in the home have been hit, kicked and punched by another service user. These incidents were not routinely reported to adult services under the safeguarding procedures, the police or to us, as is required. There was one incident in which someone was hit on the head with a hard riding helmet, yet no medical assistance was sought after the incident. Some of the people who live in the home need staff to physically intervene at times to prevent them harming themselves or other people. As a result all staff working in the home are assessed as needing to have the non violent crisis intervention training. All staff have now completed this training, however, there was an incident requiring physical intervention in November 2008 when staff providing the intervention had not received the training. This resulted in an unapproved method of restraint being used, which placed the person at risk of injury. The current manager demonstrated a good understanding of what constituted abuse, the correct reporting procedures and reported that she has addressed the issues of concern about safeguarding and reporting of incidents through the team meeting. Two staff members were spoken with during the visit. Both demonstrated an understanding of what constitutes abuse and said they would report any concerns they had. All Evidence: fourteen staff have now completed training in the procedures for keeping people safe from abuse. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is well maintained and provides a clean and comfortable environment for people. Evidence: All of the homes communal areas were viewed during the visit. The home is well maintained, with good quality domestic furniture and fittings. People living in the home have access to a lounge, dining room, kitchen, sensory room and garden. There is a planned maintenance and renewal programme. Each person has their own room with en-suite toilet and bath or shower. The home has a separate laundry room that is fitted with machines capable of washing soiled clothing. The home is clean throughout. Hand washing facilities are suitably situated in the kitchen, laundry and toilets. The home has infection control procedures. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Staff have not received suitable training and supervision to ensure they are able to safely meet peoples needs, although this is now being addressed. There are not always sufficient staff on shift to allow people to go out, which means staff are not able to meet their needs. Suitable checks are being carried out on staff before they work in the home, which helps to keep people safe. Evidence: The manager reported that 6 of the 14 staff have completed the National Vocational Award (NVQ) at level 2 or above. The staff rotas for the current week were inspected during the visit. These demonstrated that there were four staff on each day shift during the week and three at the weekend. The manager reported that two people who live in the home were away for the weekend which is why staffing levels had been reduced. Of the three people who were due to be at the home over the weekend, one required one to one support at all times in the home and two to one support when out in the community and one required one to one support at all times. The planned staffing levels meant it would not be possible for people to go out of the home without their staffing levels being below what they were assessed to need. Following discussions about this with the manager, additional staffing was planned for the weekend. Two staff members were spoken with during the visit. One person reported that the staffing levels dont always allow the assessed ratios for support. This will occasionally mean people dont go out and that more activities will be planned in the home. The staff member reported that this can cause some challenging behaviour for one person who lives in the home. The other staff member spoken with said having only three staff on a shift was difficult. The manager must ensure there are always sufficient staff to meet peoples assessed needs. The records of two recently recruited staff members were inspected during the visit. These demonstrated that the home had obtained a criminal records bureau disclosure about them, written references from previous employers and confirmation of their Evidence: identity. As part of the investigations into the safeguarding concerns it was identified that not all the staff had completed the training necessary to provide the support people need. The manager has put together a list of all the training staff have completed and planned to fill in the gaps where necessary. Additional physical intervention, report writing and safeguarding training was provided to staff during January 2009 in response to the concerns. All fourteen staff have now completed the physical intervention and safeguarding training. Nine of the staff have completed the advanced physical intervention training and the manager reported she planned for the other five staff to complete it but a date was not yet booked. Eleven of the staff have not completed their fire safety refresher but the manager has booked them to do it on 18/2/09. One of the staff members has not yet completed their first aid training. All of the staff who are administering medication to people have completed training. Other courses include moving and handling, food hygiene, health and safety, person centred planning and epilepsy. Staff members spoken with said they felt more able to meet peoples needs following the additional training they completed, particularly the advanced physical intervention training. The manager reported that staff had not been receiving regular supervision from the previous manager. In the three weeks that the manager has been in the home she has met with seven of the staff for formal supervision and has meetings planned with the others. Both staff members spoken with said they felt they were very well supported by the current manager. One of the staff members said she had worked in the home for approximately a year and a half and had only had two supervision meetings, one with the current manager. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home has not been effectively managed and people have not been protected from abuse. Evidence: The home has not had a registered manager since the manager resigned following a period of absence in July 2008. The home was managed by the deputy manager until a new manager was appointed in November 2008. The manager appointed in November 2008 has subsequently left the home and a temporary manager was appointed approximately three weeks before the inspection. Staff spoken with reported they had not felt well supported under the previous manager, but were very positive about the current manager. The operations manager reported that she was in the process of recruiting a permanent manager for the home. At the current time the manager is being supported by the operations manager, who visits the home each week. The operations manager reported that this arrangement will continue until a new manager is in post and the service is running effectively. The operations manager visits the home under regulation 26 of the care homes regulations and produces a report of the findings. These reports were inspected as part of the visit and there were only four reports since July 2008 in the home. The reports are required to be completed each month. The reports that were in place contained some actions that were required of the manager, however, this did not ensure that appropriate action was taken where there were concerns about the safety of people living in the home or address the concerns raised in this report about lack of detail in care plans, inadequate staffing levels, lack of staff supervision and the failure to report incidents. Since these issues have been raised as part of adult services safeguarding procedures the provider has developed an action plan of how they are going to resolve the issues identified. Evidence: Records of the servicing and testing of the fire alarm, fire fighting equipment, gas and electrical systems were inspected. These were mostly up to date, although there were no weekly checks of the fire alarm recorded for December 2008. Following the inspection we have been informed by the providers Managing Director that the concerns highlighted in this report have been taken seriously and addressed. Full details of the action that has been taken are available from the provider. We will assess the action taken at the next inspection of the home. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 6 15 The registered person must 31/03/2009 ensure peoples assessed needs are set out in clear care and support plans. The plans should include details of any restrictions on people, who has been involved in making the decision and why a restriction is necessary. This will provide information to staff about how they should meet peoples needs. 2 9 13 The registered person must 31/03/2009 ensure that an assessment is completed for activities people participate in and there is a plan to manage any identified risks. This will provide information to staff about how they can support people to manage the risks they face. 3 19 13 The registered person must 31/03/2009 ensure people receive, where necessary, treatment from a health care professional. This will ensure people do not have any undiagnosed injuries. 4 23 37 The registered person must 31/03/2009 ensure any incidents which adversely affect the wellbeing or safety of people who live in the home are reported to the Commission for Social Care Inspection. This will help to ensure that incidents affecting peoples well-being are being appropriately managed. 5 33 18 The registered person must ensure that there are sufficient staff working at all times to meet peoples assessed needs. 31/03/2009 This will help to ensure people receive the support they are assessed as needing. 6 35 18 The registered person must 31/03/2009 ensure that people working in the home are provided with training suitable to the needs of the people they are supporting. In particular, staff should not provide any physical interventions or restraint unless they have completed training in the methods assessed as safe to use. This will help to ensure staff have the skills and knowledge necessary to meet peoples needs. 7 39 26 The registered person must 31/03/2009 ensure that they or their representative visits the home each month to assess the standard of care provided. A report of the visit must be produced and be available at the home for inspection at all times. This will ensure that the provider is monitoring the quality of care provided in the home and ensure action is taken to address any issues. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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