Inspection on 24/10/06 for Templemore

This inspection was carried out on 24th October 2006.

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

Other inspections for this house

Templemore 31/01/06

Templemore 04/08/05

Templemore 17/11/04

Templemore 11/06/04

Templemore 27/01/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE Templemore 121 Harlestone Road Northampton Northants NN5 6AA Lead Inspector Mrs Helen Wilson Unannounced Inspection 24th October 2006 09:50 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 Templemore DS0000012938.V315724.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. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Templemore Address 121 Harlestone Road Northampton Northants NN5 6AA 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) 01604 751863 01604 588638 B & M Care Limited Vacant post Care Home 73 Category(ies) of Dementia - over 65 years of age (55), Old age, registration, with number not falling within any other category (18) of places Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. Two current named Service Users within the category of (MD) Mental Disorder continue to be accommodated in the main house. Residents within the category of (OP) Older People reside in the main house only and do not exceed eighteen. Residents in the category of (DE) (E) Dementia in the main house do not exceed fifteen. Cedars 1 accommodates Residents in the category of (DE) (E) only and does not exceed twenty two. Cedars 2 accommodates Residents in the category of (DE) (E) only and does not exceed eighteen. Date of last inspection Brief Description of the Service: Templemore is a care home providing personal care for seventy three older people the majority of whom have care needs from varying degrees of dementia. The home is owned by B&M Care who have one other home in Northamptonshire and other homes in different parts of the country. Close to parkland, Templemore is an old listed building full of character and with easy access via local transport to the town centre. There are three units within the home on two floors, the main house accommodates residents in the categories of older people (OP) and dementia (DE)(E). There are also two dementia care units accommodating residents with varying levels of dementia. There are sixty two single bedrooms of which forty five have en-suite facilities. The home has five double rooms with four of these having en-suite facilities. A passenger lift provides access to those bedrooms on the first floor. The home has attractive enclosed gardens, which include a courtyard sensory garden. The current fees range from £340.00 to £460.00 per week. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is on outcomes for Service Users and their views of the service provided. This process considers the home’s capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of the service that need further development. No-one at the home knew that a visit had been planned. Two visits were carried out one on 24 October 2006 and one the following day. Discussions were held with the Acting Manager, care staff and catering staff and selected records were examined relating to the running of the home. Prior to the visits the inspector had looked at written documentation about the home including any reports of incidents, accident and complaints. Comment cards from two medical practitioners gave positive mention to the care given by staff to the dependent service users currently at Templemore. Comment cards were also received from five families all of whom made positive feedback about the level of care provided. The primary method of inspection used was ‘case tracking’ which involved selecting five service users and tracking the care given to them by reviewing selected records. During a partial tour of the premises, the inspector made observations of the interaction between the service users and staff. Although short conversations were held with two service users, due to the current condition of most service users’ health, direct discussion was not widely possible and some of the judgements made at this inspection are based on general observations and discussion with the managers and staff. It was useful to be able to discuss and explain directly the findings of the inspection with the Acting Manager and reach agreement on the way any identified issues can be resolved. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? There were no requirements made at the last inspection. The Acting Manager stated that since her arrival in post in August 2006 she has held regular staff meetings, revised some house procedures to further guide staff and had begun to monitor staff diligence in operating the administration of medication. She has also updated the staff training records and prepared the training programme for the year. Seven new care staff have been recruited and are undergoing basic induction training in care practices, abuse awareness and moving and handling practices Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 7 whilst waiting their disclosure checks from the Criminal Records Bureau and before starting on shift at the home. Staff supervision has been infrequent in past recent months and a new revised programme of formal one-to-one supervision sessions has started. 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. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 8 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 Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information available to service users and their families is sufficient to judge the suitability of the home. Service user’s individual needs have been reassessed. EVIDENCE: People are provided with an information pack including the agency’s Statement of Purpose, information on staff training, contact numbers for use in an emergency, guidance on what to do if they are unhappy with the service and wish to complain, including the contact number and address of the Commission. Staff have access to copies of the home’s Statement of Purpose and the Service User Guide. Staff members who were interviewed demonstrated knowledge and understanding of the needs of the people they support and Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 10 were familiar with how personal care tasks were undertaken with each particular resident. Families, in their comment card responses, have confirmed that contracts stating the home’s terms and conditions have been exchanged with them. The admission process includes visits to the home for a meal and time spent in assessing the potential service user’s needs. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 11 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 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home ensures that service users are helped to access healthcare services appropriately. The home has failed to ensure that service users received medication to meet the instructions of the prescribing health professionals and therefore service users are potentially at risk. EVIDENCE: Records confirmed that regular updates of care plans for each service user are undertaken and these involve the families’ views on the care needed. It was identified from observation and through discussion with the Acting Manager and experienced senior staff that one service user requires more staff involvement than the home can provide and therefore care needs are not being met. The Acting Manager has arranged to hold an urgent review and reassessment of this person’s care needs with the family concerned to plan for appropriate placement of the service user. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 12 Each service user is registered locally with GP, dentist, optician where necessary and receive other specialist healthcare where identified. The home has made appropriate contact with the local GP surgery for the referral of service users to other health care professionals such as the continence advisor, the cardiac consultant, psycho-geriatricians and community/hospital consultants. No-one holds their own medication and all supplies are locked away for safety. All records relating to service users are locked away securely. Receipt, administration and disposal of controlled drugs are recorded in a register with all stock held in a separate metal cabinet to comply with current safety standards. Errors were found in the medication system operated at Templemore. From checking Medication Administration Record Sheets (MARS) and medication stock held for three service users the following issues were identified : In relation to one service user, two tubes of prescribed cream were held in stock, one dated 8.09.06 and one dated 20.09.06, neither of which had been booked into the home’s medication system, had not been included on the service user’s MARS, had remained unopened stock items and therefore had not been administered to the service user to comply with the dispensing instructions. In relation to one service user, the MARS for the month of October 2006 shows various staff signatures for the application of prescribed cream to this service user in the first two weeks of the month however staff could not evidence stock of a prescribed cream being recently used and could only confirm recent practice that a commercially bought moisturising cream was being applied when thought appropriate by staff. For one service user, one bedtime tablet was missing from the premeasured blister pack and there was no staff signature to confirm that this dose had been administered. For one service user, prescribed cream in a pump action container has not been signed off as being administered for the whole of October 2006 despite senior staff confirming that this cream was being applied every day to the service user. For one service user, a new pharmacy dispensing label dated 13.10.06, that reduced the regularity of the application times to once daily, had been stuck over the original typed application instruction on the MARS in place prior to the beginning of the month of October 2006. Staff had ignored the change of GP instructions and had continued to apply the cream three times daily. For one service user additionally, there was no casefile record of a consultation visit with health professionals to confirm changes to the medication prescription and no alterations had been made to the medication profile for this service user. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 13 An Immediate Requirement was made for compliance by 27 October 2006 : The Registered Providers of the home run at Templemore must operate a safe system for the receipt, handling and administration of medication to service users. and Only staff members assessed as being competent to receive, handle and administer medication are to be delegated these tasks in order to ensure that service users are provided with and offered prescribed medication to meet the instructions of the prescribing health professionals. The Acting Manager and a senior representative of B and M Care have subsequently confirmed in writing that staff have been identified who are considered competent and urgent re-training courses have been set up to give further direction to other staff. The Acting Manager confirmed that all staff will then be monitored for a further period to confirm their ability to administer medication within the home. Comment cards were received from some families prior to the inspection. One person made reference to the “calm and kind manner the staff show to the residents”. Another said “ the staff work extremely hard to assure the comfort of the residents”. All staff were friendly and helpful with residents. Observations of staff interaction with service users indicated that care was being given in a way that maintained personal dignity and independence. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 14 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The general routines of the home are satisfactory however activities for individual service users need to be further developed and person-centred. EVIDENCE: There is an Activity Organiser employed by the home and a range of daily group activities are advertised to interest service users. Music and reminiscence activities were reported as well attended. One particular service user felt that activities provided at the home were of no interest and that hobbies and leisure interests remained unaddressed. From observations it was clear that the capacity for social activity varies considerably according to the individual service user and many service users with high support needs due to their level of dementia were noted to need considerable support and assistance from staff to take part in the activities of daily life. The Acting Manager in discussion said that all care plans were to be Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 15 reviewed to make the plans and activities more person centred and suited to individuals. Visitors and families are present at the home. Service users who can still walk unaccompanied are often out for walks in the neighbourhood. The kitchen is well organised and experienced catering staff prepare and serve a range of home cooked traditional meals every day. Alternative choices for each meal are available and the main meal seen at lunchtime was appetising and of appropriate quantity. The cook is to maintain a record to detail all main alternative meals provided to individual service users each day. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 16 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. Appropriate action is taken to protect service users from harm. EVIDENCE: There have been no complaints raised to the Commission for Social Care Inspection about Templemore in recent months. Three care staff interviewed during the inspection confirmed that they had attended training sessions concerning abuse awareness. Three incidents between service users had not been reported to external agencies using the Protection of Vulnerable Adults procedures however the home’s acting manager initiated this process immediately once this was drawn to her attention. Northants County Council Care Managers considered that appropriate action had been taken within the home by providing additional staff supervision in order to give protection to the people concerned. The Acting Manager promptly amended the home’s procedures to ensure staff know what type of incidents must be reported and will reinforce these processes with all staff. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 17 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): 19,20,23,24,25 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is homely and service users appear comfortable in their surroundings. EVIDENCE: Lounges, dining rooms and corridors were clean, well furnished and decorated and people enjoy making use of these areas. Outside seating areas encourage service users to use the garden. Bedrooms were clean, well furnished including small items of furniture, ornaments and framed photographs belonging to individual residents and pleasantly decorated. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 18 The environment of the home is maintained to a good standard, giving service users a pleasant, homely environment with good quality furniture and decoration. The home generally was clean, tidy and fresh. There were no unpleasant odours in the home. Domestic staff were observed cleaning all areas of the home in an efficient way without disruption to the service users. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 19 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 and 30 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 process for staff to ensure that service users are given good care and are protected from potential harm. EVIDENCE: Separate discussions were held with senior carers and the Acting Manager regarding the high care needs and level of staff input necessary for the supervision and care of one specific service user. Following this discussion it was agreed that the Acting Manager would urgently discuss with B and M Care the need for one to one staffing levels to be put in place to provide this specific person with appropriate care and support. Service users were seen to have a warm interaction with staff and appeared able to be relaxed when involved with other people living at the home. Due to the level of dementia conditions, conversation with several people was seen to be difficult and staff showed interest and patience in establishing choices. Observations of staff interaction with service users indicated that care was being given in a way that maintained personal dignity and independence. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 20 Three staff files were examined and these evidenced that robust recruitment had taken place and files included evidence of satisfactory Criminal Record Bureau disclosure checks. A comprehensive training programme is followed for all care staff and this is considered by staff to be thorough. The Acting Manager stated that since her arrival in post in August 2006 she has held regular staff meetings, revised some house procedures to further guide staff and had begun to monitor staff diligence in operating the administration of medication. She has also updated the staff training records and prepared the training programme for the year. Seven new care staff have been recruited and are undergoing basic induction training in care practices, abuse awareness and moving and handling practices whilst waiting their disclosure checks from the Criminal Records Bureau and before starting on shift at the home. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 21 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): 31,32,33,36,37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a clear style of management and atmosphere in the home that values and engages with staff, service users and families. EVIDENCE: An application for registration of the new acting manager will be shortly submitted to the Commission for Social Care Inspection following the period of induction and probation at Templemore. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 22 From checking three staff files there is no evidence of a regular supervision programme for staff. The Acting Manager has already started a programme of regular supervision to give opportunities for staff discussion of training, feedback on work performance and as support for each staff member. An in-house quality assurance review has been held in September 2006 to obtain the views of service users on how the daily care provided is meeting the expectations of people receiving care. Result show that people are satisfied generally with the services of the home. The Acting Manager informed the inspector that B and M Care as the Registered provider at Templemore also intend to begin a formal quality assurance review in November 2006 that will ask other stakeholders such as families, care managers, medical professionals, etc, for their views and opinions on any developments needed in the service provision. Medication records were not satisfactory: Medication Administration Record Sheets were not accurate and medication history profiles not kept up to date with details of new medication supplies/changes to dosage/details of GP visits and instructions. The Acting Manager evidenced that staff receive training in safe working practices such as moving and handling, fire safety, first aid, food hygiene and infection control to ensure that service users are cared for safely. The inspector asked that staff were reminded of safe wrapping and disposal of used incontinence products. The maintenance records of the home evidenced the regular servicing and checking of boilers and central heating systems, portable electrical appliances, water temperatures, use of window restrictors, servicing of kitchen equipment, and security devices installation. New coded security locks have been installed to main doorways to alert staff to the movements of frail service users. The home is due to have the water storage system checked for risk of Legionella. During the inspection a glass panel in a door was noted to be cracked and this was made safe by the maintenance person prior to the end of the visit. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 X X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 3 X X 3 3 3 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 2 X X 2 2 2 Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 12(1) 13(4) Requirement The Registered Providers of the home run at Templemore must operate a safe system for the receipt, handling and administration of medication to service users. This was an Immediate Requirement made during the inspection on 25 October 2006 Only staff members assessed as being competent to receive, handle and administer medication are to be delegated these tasks in order to ensure that service users are provided with and offered prescribed medication to meet the instructions of the prescribing health professionals. This was an Immediate Requirement made during the inspection on 25 October 2006. The record of all medicines kept in the home for service users and the administration of medication must be accurate. Timescale for action 27/10/06 2. OP9 12(1) 13(4) 27/10/06 3. OP37 17(1)a 15/11/06 Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 OP27 2. 3. OP12 OP33 Good Practice Recommendations The review of the care needs of a specific female service user should be carried out to determine staffing levels and determine if Templemore can provide appropriate care and support for this person’s placement at the home. The process of drawing up person-centred care plans and activities should be completed. The quality assurance systems should be further developed. Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Northamptonshire Area Office 1st Floor Newland House Campbell Square Northampton NN1 3EB 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 Templemore DS0000012938.V315724.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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