Inspection on 17/01/06 for The Beeches

This inspection was carried out on 17th January 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

The Beeches 16/10/06

The Beeches 04/08/05

The Beeches 30/12/04

The Beeches 22/07/04

The Beeches 13/11/03

Similar services:

The Vicarage

Fairfields Country Rest Home

7 Hyde Road

5 Seafield Road

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

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

CARE HOMES FOR OLDER PEOPLE The Beeches St Georges Road Hayle Cornwall TR27 4AH Lead Inspector Ian Wright Unannounced Inspection 17th January 2006 08:30 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 The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 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. The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Beeches Address St Georges Road Hayle Cornwall TR27 4AH 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) 01736 752725 01736 754324 Mr Peter Ian Pool Mrs Lesley Jennifer Pool Mrs Marian Rich Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28), Physical disability (5), Terminally ill (5) of places The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Accommodation can be provided to service users aged 50 years and above who have a physical disability or terminal illness. 4th August 2005 Date of last inspection Brief Description of the Service: The Beeches registered providers are Mr P I Pool and Mrs L J Pool. The registered manager is Mrs Marian Rich. The providers are registered to provide accommodation and care, with nursing, for up to 28 older persons. The home is in a pleasant residential area of Hayle. There are 22 single rooms and three shared rooms. All the bedrooms in this home have en suite washbasins and toilets. In regard to access for people with mobility problems, there is a small step at the main front door, but a portable ramp is available for wheelchair users. The ground floor is level and there is a passenger lift to the first floor. Communal space comprises a large dining room, a lounge and a conservatory. There are attractive and spacious gardens providing areas accessible to service users. The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in just over nine and a half hours. The inspection was carried out on an unannounced basis. The inspection focused on previous statutory requirements and recommendations, and standards, which were not assessed on the last inspection. The inspector was able to speak to many of the service users, and some of the staff on duty. The inspector examined the business, staff and care records, and inspected the building. What the service does well: What has improved since the last inspection? What they could do better: The registered provider’s death and dying policy needs expanding to state what support service users will receive when they are dying. Practices however seem to be to a good standard. Some improvements to the care home environment need addressing. For example privacy and security in one of the shared rooms must be improved. Other bedrooms are however to a good standard. All bathrooms and toilets need to have a lock. Access to the nurse call system for example by one of the toilets needs to be improved. The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 Page 6 Health and safety precautions also require improvement. Testing of the fire alarm system must be completed on a weekly basis. A health and safety risk assessment system needs to be set up. This must include what precautions are taken regarding the prevention of Legionella. Any control measures outlined in risk assessments must be implemented. 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 Beeches DS0000008967.V268528.R01.S.doc Version 5.1 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 The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 4, 5 Suitable information is provided to service users regarding facilities and services offered. The registered provider satisfactorily demonstrates service users needs can be met e.g. through links with external professionals. Service users and their representatives can visit before formal admission is arranged. EVIDENCE: The registered provider has written a suitable statement of purpose, and service user guide. These give satisfactory information regarding services provided. The registered provider said the service user guide is given to all prospective service users when an enquiry is made about a vacancy. It is recommended the registered persons provide information how to contact organisations providing advocacy services such as Age Concern. This information could be given in the appendix to service user guide. Copies of residential contracts are given to privately funded service users when formal admission is arranged. Service users receiving nursing care are also given a supplementary agreement stating nursing costs will be reimbursed. The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 Page 9 Service users who receive payment via social services receive a social services contract. The Commission for Social Care Inspection (CSCI) has previously written to Cornwall County Council stating the contract needs to be updated as some of the information is out of date (e.g. registration and inspection arrangements), but this format is still being issued to service users and their families. Service users are also given a personalised copy of the Statement of Terms and Conditions of Residency if funded by health / social services. The registered provider and other care staff satisfactorily demonstrate they can meet service user needs. For example at least one member of the nursing team is on duty throughout the 24-hour period. The registered provider and senior staff said appropriate support is given to update knowledge regarding nursing and care issues. The registered provider has a satisfactory approach to ensuring staff can train to receive a National Vocational Qualification in care. Good relationships are developed with social and health care professionals outside the home. The registered provider said service users and their representatives are able to visit the home before formal admission is arranged. The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 10, 11 Service users care plans are generally satisfactory although a minority may require updating. Staff and external professionals meet service users health care needs appropriately. Service users are cared for with respect and dignity. The death and dying policy requires expansion to outline care given before a service user passes away. EVIDENCE: All service users have a satisfactory care plan. These are regularly reviewed. One service user needs to have a plan of care outlining how their palliative care needs will be addressed. Nursing staff said they would address this issue. Social care and nursing staff ensure service users health care needs are met. As the inspector is not a nurse, nursing care could not be assessed but practices observed did not give any cause for concern. An inspector who is a nurse will accompany the lead inspector on a forthcoming inspection. Nursing staff and the registered provider said there are well-developed and positive links with community and district nurses, social workers and other professionals involved with service users’ care. Any nursing / social care interventions are appropriately documented. Nursing staff said their practices were regularly updated. The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 Page 11 Service users said staff respected their privacy and dignity. The inspector also observed practices were appropriate. Staff appeared to be kind, caring and professional in their approach. The registered provider has developed a death and dying policy. This adequately outlines the procedures staff should follow when a service user dies. However the policy should be expanded to reflect care practices when a service user is dying / receiving palliative care. Information regarding this is outlined in NMS 11. This appears to be the practice as outlined by management and care staff the inspector spoke to. For example the registered provider said extra care is provided to sit with a service user when they are dying-if this is appropriate. Relatives are also able to stay with their relative if the service user wishes for this. Nursing staff acknowledged that a care plan could have been improved outlining palliative care needs as outlined above. The death of a service user has historically always been appropriately reported to the Commission and other agencies as required. The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Routines and activities are appropriate for the service user group. Visiting arrangements are flexible. Suitable arrangements are made to enable service users to have autonomy and choice. Meals, and support for service users with eating, are to a good standard. EVIDENCE: The registered provider said activities are arranged for service users. For example a ‘Beetle Drive’ was advertised on the notice board. Other activities such as bingo, singsongs and keep fit are also arranged. A storyteller also visits. Staff spend time talking informally with service users and assist them with manicures etc. The registered provider said service user likes and dislikes are considered when assisting them to develop their daily routines. The registered provider said rules are minimal. Service users can get up and go to bed when they wish, and personal care routines are individualised. The registered provider said visiting times are open so service users families and friends can visit when they wish. Monthly church services (C of E) are arranged within the home. One service user said she would like to re-establish The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 Page 13 links with a society she belonged to before moving to the home. She should, if possible, be enabled and encouraged to do this. The registered provider said staff will assist service users and their relatives to find legal support e.g. to arrange Power of Attorney arrangements. However contact details of advocacy services, e.g. through organisations such as Age Concern, should be provided e.g. in the Service User Guide. Staff said some moneys are held on behalf of service users. Records and receipts are kept regarding these. No staff act as appointees for service user moneys. The inspector shared a meal with service users. This was to an excellent standard. Support for service users during the meal was to a good standard. Service users said they enjoyed the food. For example staff supported service users who required assistance with eating calmly and professionally. Special diets are catered for. A menu is in place. The main meal of the day is usually displayed on the notice board although this was not the case on the day of the inspection. The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 17, 18 The registered persons have a satisfactory complaints procedure. There is satisfactory protection of service users legal rights, although information regarding advocacy services could be improved. Adult protection policies and procedures are satisfactory. EVIDENCE: The registered persons provide service users with a suitable complaints procedure. It would be beneficial if a copy of the complaints procedure was displayed on a residents notice board, and in the hallway of the home for example by the visitors book. The registered persons keep a record of complaints, and this seems to reflect a culture where service users and their relatives feel confident in expressing their concerns, however minor, to the staff. Although appropriate action following most complaints is satisfactorily recorded, this could be improved in a minority of cases. The registered provider described satisfactory arrangements for protecting service users’ legal rights for example service users receive a postal vote when there is an election. Information regarding advocacy services e.g. from Age Concern should be made available. The registered provider has a satisfactory adult protection procedure. There has been one adult protection investigation regarding care of one service user. The allegations were unsubstantiated. However the service user expressed The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 Page 15 concerns again to the inspector regarding the incident. The person later retracted these concerns when the registered provider spoke to her. The Commission wrote to Cornwall Social Services regarding the matter, but they do not feel it is appropriate to investigate the matter any further. The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19-26 The registered persons provide a clean, pleasant, comfortable and homely environment for service users. Room sizes are satisfactory. Facilities are generally to a good standard although privacy and security in one of the downstairs bedrooms and bathrooms / toilets must be improved. EVIDENCE: The building was inspected. The inspector was able to view many bedrooms in the process of talking to service users. These mostly appeared to be pleasant, well furnished and decorated according to individual tastes. Bedrooms at least have an en suite toilet, and some have an en suite bath-although baths have only limited access for those with mobility problems. All bedrooms offer satisfactory space. However one double bedroom downstairs adjacent to the dining room does not offer adequate privacy to one service user i.e. there is a clear view of the bed space from the dining room. The door being left open at the request of the other service user does not help this situation. This also could put the service user’s personal possessions and valuables at risk although the registered The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 Page 17 provider said each bedroom has a lockable drawer. The registered provider must review this arrangement to improve service user privacy and security. Currently only some of the bedrooms are lockable. Individual risk assessments have been written stating individual service users would be unsafe if there was a lock on their bedroom doors. Service users however must be able to have a lock on their bedroom doors if they have the capacity. There is also no facility for service users to make a personal phone call in their bedrooms unless the user installs a telephone connection. Staff however said service users could make and receive calls from the office phone. Service users are able to bring their own possessions and furniture into their bedrooms. Consequently bedrooms are homely and individual. There is a lounge and a dining room. The dining room is also used as a sitting area. There are two staircases and a lift to enable service users to get to the first floor. Decorations in some of the communal areas, and hallways are starting to look like they need redecorating. The registered provider said this issue would be addressed. Toilet and bathroom facilities are generally satisfactory. For example there is a new ‘Parker’ bath with a hydrotherapy facility. Other assisted bath facilities are also available. However the call bell facility in at least one of the bathrooms needs an additional point, as service users cannot use this if they are sitting on the toilet and need assistance. A requirement for this has been made although the registered provider has acknowledged this problem and will address the issue. At least one toilet door is not lockable. The registered provider said this was due to the safety risk. However locks with an overriding facility must be fitted. The home was warm with satisfactory light on the day of the inspection. Kitchen and laundry facilities are to a good standard. Two sluices are available. The home was clean, hygienic and there were no unpleasant odours on the day of the inspection. The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 30 Staffing levels meet the needs of service users. Staff induction arrangements are appropriate. EVIDENCE: Suitable records regarding staff hours worked / to be worked are kept. The registered provider said there are 2 nurses on duty from 7:30-16:00, and one nurse on duty for the remainder of the 24-hour period. There are five care workers on duty during the mornings until 14:00, and from 16:00 to 20:00. There are four care workers on duty from 14:00 to 16:00. Two waking care assistants are on duty from 20:00 to 07:00 working alongside a registered nurse. Two cooks and two domestic staff are also employed. The inspector felt there were suitable numbers of staff on duty throughout the inspection. Currently the home is fully staffed. The majority of the staff work over 30 hours a week. The registered provider said staff turnover is relatively low. The home has an appropriate recruitment policy and procedure. Staff records regarding staff recently recruited were satisfactory. The registered persons were still awaiting a disclosure for one member of staff for a Criminal Records Bureau / Protection of Vulnerable Adults check. The registered provider and senior staff however assured the inspector the person was appropriately supervised in line with current guidance. The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 Page 19 When staff start working there is a comprehensive induction checklist, which is completed. The inspector examined several of these for staff who have started since the previous inspection. There were some gaps in the completion of the induction; although senior staff on duty said these would be fully completed shortly. Other aspects of the training standard (NMS 30) were inspected on the previous inspection and were met. The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, 36, 38 Service users benefit from a positive management culture. Any monies kept by staff on behalf of service users are satisfactorily maintained. Day to day staff supervision arrangements are satisfactory. Some health and safety precautions are poor and must be improved. EVIDENCE: All staff and service users the inspector spoke to were very positive about management within the home. Management appears to be approachable. The management structure appears to be well organised e.g. Team Leaders to Deputy Manager to Registered Manager to Registered Provider, and delegation arrangements appear appropriate. Staff appeared to work well together. Documentation showed there are some staff and service user meetings although the frequency of these could be improved. The inspector witnessed a formal staff handover at the beginning of the afternoon shift. This was well organised and ensures continuity of care. The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 Page 21 There is always a nurse (and senior staff) on duty. The registered provider is also based at the home during office hours. Day to day supervision arrangements appear to be appropriate. Staff look after some service user moneys. Suitable records are kept. The registered provider has a health and safety policy. Testing for gas and portable electrical appliances is satisfactory. Staff test fire equipment for example lights and call points. However the frequency of call point testing has been incorrect. Instead of being tested monthly they must be tested weekly. Moving and handling equipment and the lift appear to be regularly tested. However the filing of service records needs to be reorganised so audit is more straightforward. A health and safety risk assessment system needs to be set up as required under the Management of Health and Safety at Work Regulations 1999. This should include testing of hot water temperature regulators. Similarly a risk assessment to prevent Legionella needs to be in place. Appropriate control measures must subsequently be implemented. Information regarding these issues can be obtained from the Health and Safety Executive. Compliance with health and safety training requirements was not assessed, although on the previous inspection this was met. Accident records are well maintained, and appropriate measures put in place regarding issues identified (e.g. service users having regular falls). The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 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 X 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 3 3 2 2 2 2 3 3 STAFFING Standard No Score 27 3 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 3 X X 3 3 X 1 The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 Page 23 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 OP11 Regulation 12 Requirement Timescale for action 01/05/06 2 OP23OP22 OP10 3 OP22OP21 4 5 OP22OP10 OP21 OP38 The registered provider is required to update its death and dying policy to reflect care practices. Guidance is given in NMS 11 12, 16, 23 Review and improve arrangements regarding the bedroom adjacent to the dining area. Privacy and security must be improved 16, 23 Service users must have appropriate access to nurse call points in all rooms in the home. Access to the nurse call point in the downstairs bathroom / toilet must be addressed as outlined in NMS 19-26 12, 16, 23 Locks with (if necessary) an overriding facility must be fitted to bathroom and toilets. 13, 23 Health and safety precautions must be improved: • Call points for the fire system must be tested at least weekly. • Improve filing arrangements for equipment service records. • A health and safety risk DS0000008967.V268528.R01.S.doc 01/05/06 01/03/06 01/03/06 01/05/06 The Beeches Version 5.1 Page 24 • assessment system must be set up, and control measures put in place for any risks identified. A risk assessment to prevent Legionella must be developed. Appropriate control measures must subsequently be implemented. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP12 OP17OP14 Good Practice Recommendations The registered manager should assist service user to rejoin society the person belonged to before moving to the home. Information regarding Age Concern (and/ or other organisations providing advocacy services) should be included in the service user guide / displayed on the notice board. A summary of the complaints procedure should be displayed e.g. either on the notice board or by the visitors book. 3 OP16 The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection St Austell Office John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 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 The Beeches DS0000008967.V268528.R01.S.doc Version 5.1 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!