Inspection on 05/12/06 for Spring House

This inspection was carried out on 5th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 but made no statutory requirements on the home.

Other inspections for this house

Spring House 27/01/08

Spring House 18/10/05

Spring House 11/05/05

Spring House 05/10/04

Spring House 27/04/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE Spring House Peter Tavy Tavistock Devon PL19 9NP Lead Inspector Helen Tworkowksi Unannounced Inspection 09:30 5 December 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Spring House DS0000003807.V316322.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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Spring House Address Peter Tavy Tavistock Devon PL19 9NP 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) 01822 810465 01822 810465 shresidential@aol.com Mrs B Luckham Care Home 25 Category(ies) of Dementia - over 65 years of age (25), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (25), Old age, not falling within any other category (25) Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 18/10/05 Brief Description of the Service: Spring House provides care for up to 25 older people in the small village of Peter Tavy, three miles from the market town of Tavistock. The home offers care and support to older people including people with dementia and mental health needs. All of the bedrooms expect two are single, and all have en-suite toilets and hand basins, nine also have en-suite showers. There is a stair lift to the first floor. There is an open plan lounge/ dining room, a large new lounge, and a small private lounge. There is a large paved garden at the front of the house, and has a number of seating areas and a pergola for shade. The garden is enclosed though and has level access. Spring House is registered to care for people with a range of needs including dementia and mental disorder. The home is staffed 24 hours per day; at night there is a waking night staff and a sleep in staff. The home employs cooks who prepare all the meals in the home. The fees are between £400 and £800 per room. The fees do not include hairdressing, chiropody, toiletries and transport and support for appointments at Derriford Hospital. A copy of the Service Users Guide and Statement of Purpose are available at all times from the office. Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an unannounced key inspection, looks at all the most important aspects of the service. The inspection included two site visits: 5th December 06 (11.30am to 5.30pm) and 6th December 06 (9.30am to 5.15pm). During this visit the inspector looked around most areas of the building, looked at records relating to people’s needs, the care provided, health and safety, medication and to recruitment and training. The inspector looked in greater depth at the care of four individuals, talking with them, speaking with their relatives and looking at the paperwork relating to contracts and care. In addition the inspector had lunch with the Service Users, participated in an activity session and interviewed four care staff and spoke with senior care staff and managers. As part of this inspection surveys were sent to local GPs (seven were returned). Ten surveys were sent to care staff, three were returned. Ten surveys were sent to service users four were completed and returned. As part of this unannounced inspection the quality of information given to people about the care home was looked at. The relatives of people who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus) and the complaints procedure. These finding will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report with be published in May 2007. Further information on this can be found on our website www.csci.org.uk. What the service does well: Spring House provides a home where service users and their relatives feel at home. Service users are treated with respect and dignity, and are able to make decisions about their daily lives. One relative when asked about the care of her mother said that she would give Spring House 100 and a gold star! Another relative said that “the care is great”, and that “the staff are very kind to her, they are very sensitive if she is upset”.. Service Users are offered a range of activities both at Spring House and in the community. Social Service staff and relatives said that they felt that the service users settled well because they are treated with respect and had plenty to do. A Social Services care manager commented that people are treated as individuals Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 6 Spring House is well staffed and staff feel well trained. They feel that they have sufficient time to provide care as well as spending time talking, with Service Users. Meals are of a good standard, fresh ingredients are used and there is a choice at each meal. Consideration is given to making food more palatable- for example porridge is made with cream. Where support is needed by individual service users, this is given. Visitors are welcomed and cans stay for meals. The building is clean and warm, and individuals are encouraged to feel that Spring House is their home. 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. Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users and their representatives are provided with clear information about the care home and any costs. Service Users needs are known to staff before they move, so that they can have confidence that they will be met. EVIDENCE: Spring House has a Service User’s Guide and Statement of Purpose, the Service User Guide tells people about what they can expect if they choose to come to live at Spring House. This document was clearly written and printed in large print to make it easier to read. Mrs Bridgette Luckham said that each Service User has one in their room, and the Inspector saw some of these documents during the tour of the building. The Inspector spoke with relatives of service users about whether they had received information about Spring House. Many of the Service Users have dementia and were unable to confirm this themselves. One Service User’s relative confirmed that Mrs Luckham and her staff had gone through the Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 9 contract and information about the home, with her. She said that it had been a very difficult time and that the people at Spring House had been very clear and supportive. She said that this had helped her to feel confident that Spring House was somewhere where people knew what they were doing. The Inspector looked at copies of the contracts and the terms and conditions that were kept on file. These document were clear- and specified what was included in the fees and what an resident might expect to have purchase on their own behalf. There were also letters that confirmed that needs could be met and the cost of the service and what was or was not included in the fee. Each Service User also had an assessment of their needs on file, this had been completed prior to moving to Spring House. These assessments included information about the person’s physical needs, but contained very limited information about the person’s social needs and background. This is particularly important when a person has dementia. One relative explained that staff from Spring House had visited her mother, and had got to know her. She had been pleasantly surprised how well her mother had settled into Spring House, she put this down to the consistent staff team. Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service User’s needs are known to staff who treat them in a manner that respects their individuality and that maintains dignity. Medication is generally well managed. EVIDENCE: Ten Service Users were surveyed, however only four people were able to comment on the care they received. All four people felt that they received the care they needed. Each person has a Service User Plan; this document explains how each person’s needs will be met and what care staff will need to do. Care staff spoken with said that they had read Service User Plans, and were familiar with each person’s needs. There are also risk assessments which should help manage risks. The Service User Plans had been completed by the key worker for the individual and were generally clear and well written. However there was a lack of information about each Service User’s history and background, this could help staff understand what was important for that person. This is particularly important when people have dementia and are not Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 11 able to explain themselves. Mrs Luckham said that the families of Service Users were now being asked to provide information about their background and things that were significant. It was also noted that that some of the issues identified in the Service User plans were not identified in risk assessments. The inspector spent time talking with Service Users and observing staff providing support, staff had a good knowledge of each person and showed considerable skills at defusing potentially very difficult situations. As part of this inspection seven of the local GPs were surveyed, and all responded that they were satisfied with the overall care provided at Spring House. One GP commented “Spring House is run to a high standard... there is a devoted manager and I have no concerns about the care the residents receive.” Spring House uses a “monitored dose system” for medication. This is where medication is prepared in bubble packs by the pharmacist for staff to administer. The Inspector looked at the system and it was generally in good order. It was noted that there were occasional gaps in signing for medication, apparently where medication had not been needed. The Inspector spoke with the local Pharmacist, who confirmed that medication was generally well managed. Where Service Users have to have medication that is administered by injection, staff must have appropriate training. Staff have had this training however the medical professional who is responsible for prescribing has not confirmed in writing that they are satisfied with the training and the competence of staff. Service Users are treated with respect and dignity. The Inspector observed the way staff spoke and behaved around service users and this was always with respect. Service Users were confident with staff and one relative explained that she felt that her mother had settled in very quickly at Spring House because staff were so kind and that each person was able to express themselves as an individual. The Inspector also spoke with a Social Services care manager who said that she felt that people were treated as individuals at Spring House. Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13, 14, 15 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Service Users are treated as individuals and offered the opportunity to lead active lives, and are given support to overcome their disabilities. Meals are well cooked and Service Users are given the opportunity to share meals with friends and relatives. EVIDENCE: On the first day of the inspection a group of ten service users went out to Tavistock to see the Christmas lights and for fish and chips. Some of the relatives of service users joined in the trip. It was good to see that it was not just the most physically or mentally able who went on the trip, but some of the people with more substantial needs. Those who stayed at Spring House, were also offered things to do, for example on member of staff helped an individual with her knitting. There is a plan of activities and trips on the notice board, and some of the service users spoken to knew about what was happening, such as the carol singers that were to come in the evening. On the second day of the inspection a number of service users were involved in a game of “musical bingo”, and this was managed in such a way by the staff that everyone had a good time and was able to participate, whatever their disability. Both relatives Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 13 and social services staff spoken with said that felt that one of the reasons people settled very well at Spring House, was that there was plenty to do. All of the meals cooked at Spring House are cooked using fresh ingredients, and to a very high standard. There is a menu that offers a choice, and accommodates the vegetarians who live in the house. The Inspector joined Service Users for a meal, and it was well cooked and presented. Where service users needed assistance with eating this was done in an appropriate manner, no one was hurried. One relative commented that it was really nice that she was able to come and eat with her mother. Friends and relatives had been recently invited to a themed evening- where a “restaurant” had been set up in the dining room, so that Service Users could enjoy sharing meals with people they had invited, and were waited on as if they were dining out. As has already been noted good quality ingredients are used, and thought goes into making the food special- for example the porridge is made with cream. Relatives spoken with about Spring House said that they really felt they were able to call in at any time, and that they were always made welcome with a cup of tea, or were welcome to stay for a meal. Staff said that Service Users are not hurried to get up, they can get up when they choose. One of the staff who had worked in other homes commented that she felt that she had time to get people up in a way that suited them, there was no rush to get things done by a certain time. Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users and their representatives feel confident that they will be listened to. There is a culture of respect for individuals at Spring House, and this is one of the ways service users are protected from abuse. EVIDENCE: There is a clear complaints procedure that is in the Service Users Guide. This is given to each Service User. The inspector spoke with relatives about if they felt able to complain, they confirmed that they had been given a copy of the procedure. One relatives felt that she was always made welcome what ever time she went to the home, and that this made her feel that there was nothing to be covered up or hidden from her. The four service users who did respond to the survey all felt that they were able to speak to someone if they were not happy. A record of complaints is kept at the home, and this was seen during the inspection. The three staff who responded to the staff survey all said that they felt that they had the expertise to care for the people at Spring House and that that they were aware of adult protection procedures. The inspector observed staff dealing with difficult situations with service users and staff handled these with considerable skill and understanding. One thing consistently noted by relatives, professionals and the inspector is that staff treat Service Users as individuals, and that there is no expectation to conform, people’s differences are respected. Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 15 Staff spoken with during the inspection confirmed that they had or were to receive training in relation to adult protection issues, and there was a copy of the local guidance in relation to abuse available to all staff. Checks are made to see if prospective employees have criminal records which would make them unsuited to the work with vulnerable people. Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 23, and 26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Spring House provides clean, comfortable and homely accommodation. EVIDENCE: A major extension has been completed at Spring House since the last inspection. This extension has provide a new lounge area, and a private lounge. This means that the existing lounge area is now used as a dining room. The new lounge is spacious and light, Service Users are able to see who is passing by, or who is coming to visit. Staff said that the new small lounge was very useful for private phone calls and for people to meet with relatives or visiting professionals. One further change has been the creation of a new garden area. This area is paved, has ample seating and a shade area. It is secure so that Service Users may use is freely without fear of becoming lost, yet provides a good view of anyone passing in the village. Staff and relatives commented that it was well used over the summer, and provided a great venue for parties. Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 17 Additional bedrooms have been created as part of this extension, these have en-suite showers and are spacious and well furnished. One member of staff commented that is was really good having the shower en-suite for people who have dementia. She was able to show them the shower and there was less confusion about what was going to happen than if they had to use a bathroom down the corridor. As part of the changes to the home a new office has been created, this provides much needed space for staff and managers in the home. The office is used for staff who “sleep in”, who are on call if additional support is needed at night. However the arrangement of the office is such that staff have to move the office furniture to put down the folding bed that is stored in an adjacent room. This is not an ideal arrangement for staff. All areas of the house were found to be clean and there were no unpleasant odours. There is a laundry at the side of the house, and one relatives commented that her mother was always well dressed in clean clothes. Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users are well supported by competent, well-trained staff. EVIDENCE: As part of this inspection the files of three staff who had recently started work at the home, were looked at. These files were well organised, and contained an application form, two references, protection of vulnerable adults checks and criminal records bureau checks. These are some of the ways that employers check that they are employing the right sort of person to work with vulnerable people. One of the ways that recruitment could be improved is by the requiring better information about employment history. There should be a full employment history and any gaps should be accounted for. Checks should also be made on the veracity of references. The staff rota showed that there are generally four care staff on duty in the morning, three in the afternoon and evening, and two staff (one waking, one on call) at night. Staff spoken with confirmed that they had sufficient time to provide care, and that they had time to talk with service users. Service Users were all well cared for, and well dressed, both indicators of sufficient staff. Care staff new to Spring House were in the process of completing an induction, although staff who were not involved in care or had previous worked at the home had not received an induction. All new staff need to have an induction Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 19 that is geared to reflect their needs. Staff spoken with said that they felt well trained. There is chart that gives an overview of staff training received and due, and each person has a record of training received. Staff said that they felt well supported and if ever they had any questions then they felt able to go and ask one of the other staff or managers. One of the comments raised by relatives was that felt that there was a stable staff group with few changes, and this meant that service users and staff got to know each other. Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Spring House is well managed and service users interests are protected. EVIDENCE: Spring House is managed and owned by Mrs Bridgette Luckham. Mrs Luckham has been running Spring House for many years, and has completed her Registered Managers Award. Mrs Luckham works with two other managers who are also well qualified for their role. Spring House has a quality assurance system. The views of service users and visitors to the home are sought on an annual basis, and these views had been taken into account. The most recent feedback forms were discussed with Mrs Luckham during this inspection. Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 21 Some Service Users choose to leave cash with Mrs Luckham. Mrs Luckham keeps an account of this cash, though there are no signatures to authorise these transactions. Receipts are kept. One relative confirmed that she received a regular up date on financial transactions made on behalf of her mother for such items as chiropody and hairdressing, and was happy with this. Spring House is well maintained, and in good decorative order. The fire log indicated that regular checks had been made in relation to fire. There were checks on water temperature in relation to Legionella. When the inspector checked the temperature of water in showers that it possible to turn the water so that it was 48 degrees centigrade, hot water should be no higher than 43 to 45 degrees centigrade. There was a record of checks made on the safety, however not all the risk assessments could be located at this inspection. Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 X 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 4 X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 23 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. 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. Refer to Standard Good Practice Recommendations Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Spring House DS0000003807.V316322.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!