Inspection on 07/08/07 for The Beeches

This inspection was carried out on 7th August 2007.

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 11/11/08

The Beeches 24/08/06

The Beeches 04/10/05

The Beeches 14/06/05

The Beeches 08/02/05

The Beeches 06/08/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE The Beeches Beech Road Armthorpe Doncaster South Yorkshire DN3 2DZ Lead Inspector Janet McBride Key Unannounced Inspection 7th August 2007 10:45a 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 DS0000007985.V346679.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. The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Beeches Address Beech Road Armthorpe Doncaster South Yorkshire DN3 2DZ 01302 300312 01302 835980 beechesdoncaster@schealthcare.co.uk www.schealthcare.co.uk Southern Cross Care Centres Limited 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) Samantha Barclay Care Home 32 Category(ies) of Old age, not falling within any other category registration, with number (32) of places The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 24th August 2006 Brief Description of the Service: The Beeches is a care home providing residential care and accommodation for 32 older people. The home is located in the village of Armthorpe and is surrounded by shops, pubs, churches and a library all within walking distance of the home. The home was purpose built in 1990, set in its own grounds with a pleasant garden area and seating for people who use the service and visitors to the front and rear of the home, car-parking area to the rear of the home. The two-storey home has thirty two single rooms, nine bedrooms on the ground floor, three of which had patio doors to the garden, twenty three bedrooms on the first floor, which can be accessed via a passenger lift or stairs. Fees range from £380:62 to £452:00 plus a ten-pound top up fee per week, as at August 2007. Additional charges are made for hairdressing, chiropody, toiletries, magazine, newspapers and transport/taxi, these costs are variable. For further information contact the home. The Statement of Purpose and the Service User Guide, was available on request, this contained information about the services available at the home. The homes past published inspection reports were available in reception, along with a range of information that may be useful to people using the service or their relatives. The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. One inspector carried out this Key Unannounced Inspection, which took place on the 7th and 15th August 2007 for seven hours. An additional inspection was carried out on 15/05/2007. This inspection was to check some issues that had been raised in an adult protection meeting. The home is registered for thirty two places, at the time of inspection thirty people were receiving services at the home. Prior to the inspection the manager submitted an Annual Quality Assurance Assessment giving information regarding the home and services provided. Pre-inspection work was carried out on the information received and other relevant documentation, for example analysis of statutory notifications and complaint records. During the inspection documentation and records were examined, for example medication, complaints, accident records, staff rotas and staff training files. Case tracking of three care plans which were cross-referenced with other relevant documentation relating to those people who use the service. A tour of the premises and direct observation of staff interaction with people who use the service was carried out throughout the visit. Information was gathered from as many different individuals as possible, including individual interviews with the manager, members of staff and visitors. Surveys were sent out prior to the inspection from the Commission for Social Care Inspection (CSCI). Eight were sent to people who use the service within the home, four were received back. Three were sent to relatives, two were received back, and three were sent to professionals who had contact with the home and two were received back. They were asked to comment on the standard of care, staff skills, attitude, and how the needs of people using the service needs were met. The inspector would like to thank all the staff, relatives and people receiving services within the home for their co-operation in the inspection process. Any issues or concerns that were raised were discussed with the manager at the end of the inspection. What the service does well: The atmosphere within the home was good and people that use the service were very happy with the care received and were complimentary about the staff within the home. They said they “feel safe within the home” and “the staff are available when you need them” and “feel they are treated well”. The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 6 Lunchtime and breakfast were observed on two separate days, menus were available, for both mealtimes. These were found to be were unhurried and relaxed with staff in attendance if needed. All people spoken to were happy with the meals provided, saying there was always a choice and meals were nice. Staff were observed to carry out their duties in a professional manner and showed consideration for peoples individual needs. Family and friends were able to visit at most times, they said they were made welcome and all comments received on the day and from surveys were very positive about the home and the care delivered. 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. The Beeches DS0000007985.V346679.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 The Beeches DS0000007985.V346679.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. People who use the service experience Good outcomes in this area. This judgement has been made from evidence gathered during the inspection. This included a visit to this service and seeking the views and experiences of people who use the service. People that use the service had information about the home and services provided. People were individually assessed prior to admission to ensure their needs would be met. EVIDENCE: Three care plans were case tracked and a number of staff spoken to with reference to care plans and their involvement in this process. Records showed that people that use the service were fully assessed prior to moving into the home, with other professionals involved if required. Surveys received from people within the home said they had received information before moving into the home and were able to visit the home before moving in. The manager said that people using the service were issued with a contract/statement of terms and conditions these contain a scale of charges and any extras that people had to pay for, all of which is documented in this report. The registration certificate was displayed in the home and found up to date with the current services provided. The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 9 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 &11. People who use the service experience Good outcomes in this area. This judgement has been made from evidence gathered during the inspection. This included a visit to this service and seeking the views and experiences of people who use the service. Care plans provided staff with the information they needed to meet the care needs of people that use the service, this ensured that the majority of peoples needs were identified and met. EVIDENCE: Three care plans were case tracked of people that use the service, these care plans were cross-referenced with medication records, accident records and any other relevant information. Health, personal and social care needs were set out in an individual plan of care, including the wishes and arrangements that people wanted in the event of their death. Care plans were developed shortly after admission, using the initial assessment of need and any other relevant information gathered by professionals, family and friends. Some people said they were involved in their care plan and family members were able to contribute. Key workers were able to describe care needs of people, or when they required the input of either GP or district nurses. The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 10 Care plans seen were generally found to be comprehensive concise and easy to follow, with legible records kept. All accident records were completed when either service users had a fall or an incident had occurred. Records were completed and found to be legible and concise records, with the manager completing monthly analysis reports, which identify if risk assessment need reviewing. The district nurse provided the main link to all medical services including pressure area care, continence advice and general health checks as required by the G.P. Comments from district nurses surveys said “staff appear to respond to the different needs of people within the home”. “ Staff ensures peoples privacy when we visit all are seen in own bedrooms.” Medication policy and procedure were discussed with the manager and records checked. A number of issues were highlighted on the random inspection on the 15th May 2007; these were discussed with the manager. The manager said she completed medication audits on a weekly basis and found an improvement in documentation since the audits began. Staff responsible for the administration of medication had completed the accredited medication training, including night staff that previously did not administer medicines. Examination of records, storage, recording and observation of a member of staff administering medicines to people within the home was carried out. All were found to be satisfactory with a big improvement of the handling of medicines and record keeping. All the issues raised on the random inspection had been addressed. The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 11 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. People who use the service experience Good outcomes in this area. This judgement has been made from evidence gathered during the inspection. This included a visit to this service and seeking the views and experiences of people who use the service. People were able to enjoy a lifestyle that suits their individual preferences, the home provided stimulation and interest for those people within the home. They were offered a wholesome and appealing balanced diet with a varied selection of food available to meet people’s tastes and choices. EVIDENCE: Information was available in care plans of people’s hobbies, life events, likes and dislikes. Activities within the home were varied, and people spoken to on the day and comments in surveys gave examples, such as bingo, quizzes, sing- a -longs and light exercise. A new activities coordinator had been recruited; who appeared very enthusiastic and said she was hoping to develop a more person centred social profile for each person within the home. She gave examples of the activities at present, roll a ball, bingo, quizzes and dominoes. Some one to one work on a family tree for one person, other people within the home prefer chatting on a one to one basis. A bus is available for trips out, there was a planned trip to the seaside in two The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 12 weeks. Throughout the morning some of the people in the home were taking part in a quiz, others were occupying themselves by reading the newspaper or chatting to other people within the home. Comments received were very positive “there are always activities arranged for us to take part in”. People within the home said they could have visitors at any time and those relatives spoken to said they were made welcome, and staff always offered to make them a tray of tea for them to have with their relative. People within the home had links with the community and visited local shops, churches and the library, as some of the people go out independly to local shops. A number of people spoken to said they had a choice and control over a number of daily living needs and gave examples; “I can get up when I want and go to bed when I want” “take part in activities” “choice at meal time”. Menus were varied and nutritionally balanced (and each person is nutritional assessed and weighed) menus were displayed on a board in the dining area. Tables were nicely set with table clothes, napkins, cutlery and condiments. Breakfast and lunch was observed on different days, both were unhurried and relaxed with staff in attendance if needed. Comments received from people within the home and on surveys said they were happy with the food at the home, choice, quality and quantity of food was excellent. The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 13 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 &18. People who use the service experience Good outcomes in this area. This judgement has been made from evidence gathered during the inspection. This included a visit to this service and seeking the views and experiences of people who use the service. The homes complaints procedure was accessible and displayed within the home. Policies and procedures were in place on adult protection, this promoted and protected people who use the service. EVIDENCE: The home had a comprehensive complaints procedure, which was on display in the home. People using the service and relatives said they were aware of the complaints procedure and if they were unhappy or had any concerns they would talk to their key worker or the manager. Complaint records showed three complaints since the last inspection. These had been recorded, responded and investigated in an efficient and thorough manner. Policies and procedures were in place regarding the protection of vulnerable adults. Staff confirmed they were aware of abuse polices and procedures, and staff were able to verbalise the action they would take on receiving any allegations. The manager had been proactive in referring two incidents to adult protection, these had been investigated and responded to in a satisfactory manner. The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 14 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): 19,24 & 26. People who use the service experience Adequate outcomes in this area. This judgement has been made from evidence gathered during the inspection. This included a visit to this service and seeking the views and experiences of people who use the service. The home was clean and tidy, but did have an unpleasant odour in various areas. However people who use the service felt they lived in a comfortable and accessible environment. EVIDENCE: A tour of the premises found the reception area contained a notice board with photos of the members of staff and forth coming activity events. A lot of information was available on the notice board for people within the home, relatives and visitors. This included statement of purpose, service users guide and complaint procedure and the most recent Inspection report. The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 15 Communal rooms were comfortable, bright and cheerful and looked very homely with pictures and ornaments around the home. Most areas within the home were clean and tidy, however there was an unpleasant odour in some areas. A number of comments were received on the surveys about the homes cleanliness e.g. “leaves a lot to be desired” “the home is clean and tidy sometimes” ““When we visit care staff are always going round with fresh air sprays”. A complaint was made about the cleanliness of the bedroom although this was addressed immediately the family said bedrooms should always be clean. Cleaning and domestic hours were discussed with the manager, who had started to look at the homes cleaning regime to bring the required improvements, that would ensure that the home is clean at all times of the day. The manager will discuss these issues with the company’s operations manager. Those bedrooms seen were clean, tidy and homely. There was an unpleasant odour in two bedrooms, and carpets were in need of replacing in two other bedrooms. Evidence was seen that these had been identified and were going to be replaced as soon as possible. People in the home said they were encouraged to bring personal items, most bedrooms had been personalised with pictures, photos and ornaments. The home had a call system in each bedroom, call cords were left within reach of people’s beds, and the function of the system was tested on a regular basis. Other areas checked within the home were, the designated room for smoking, this was clearly signposted as a smoke room and contained a ventilation system to prevent smoke drifting into other communal areas of the premises. Laundry facilities, which were upstairs, these were found to be clean and tidy with appropriate washing and drying facilities. The outdoor garden area was kept in good order with furniture for people using the service and visitors to sit and enjoy the garden. The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 16 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. People who use the service experience Good outcomes in this area. This judgement has been made from evidence gathered during the inspection. This included a visit to this service and seeking the views and experiences of people who use the service. Staff had undertaken basic and induction training, which ensured that they were skilled and knowledgeable. This ensured people at the home were supported and protected. EVIDENCE: Staffing was discussed with the manager and the duty rota examined, this clearly identified staff within the home and their role, including ancillary staff. Staffing had improved since the random visit and observation on the day, checking of duty rotas confirmed there were sufficient staff to meet the needs of people who use the service. However domestic hours need to be reassessed due to the issue of odours highlighted by this visit and comments received on surveys. The staff team were observed to carry out their duties in a professional manner and showed consideration for peoples individual needs. Comments from relatives said, “staff seem to have the skills and experience to look after my relative”. Comments from district nurses said that staff appear to respond to the different needs of people. When nurses visited they said staff were helpful and follow their advice. The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 17 The homes recruitment procedure was discussed with the manager and records of three new members staff files were checked. This established that the homes process for recruitment meets all the requirements of legislation and employment law. Two references, Criminal Record Bureau (CRB) Protection Of Vulnerable Adults (POVA) checks were made prior to staff being employed. Each member of staff had an individual training file, these were examined and training opportunities were discussed with the manager and staff who said that training was offered on a regular basis Records indicated that a number of the staff team had achieved National Vocational Qualification level 2 in care (NVQ) with other members of staff continuing to work towards attaining NVQ levels in care. There was an improvement in staff training, records showed that a number of staff had received updates and undertaken various training courses since the last inspection, this was confirmed by staff members. The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 18 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 &38. People who use the service experience Good outcomes in this area. This judgement has been made from evidence gathered during the inspection. This included a visit to this service and seeking the views and experiences of people who use the service. People who use the service were protected by sound management practises. The financial interests of people were safeguarded, good health and safety procedures ensured they were protected. EVIDENCE: Management structure at the home consisted of a registered manager and two team leaders and four senior carers. Since the last inspection the manager had completed the Registered Managers Award. She said she operated an open door policy, to discuss any concerns or queries people may have. There is a comments box available at the front entrance and a weekly managers surgery should anyone wish to have a meeting or discussion. The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 19 Quality assurance systems were in place and the manager could evidence they monitor the quality of care and services within the home. Surveys were sent out to gain the views of people who lived at the home. Surveys are also sent to relatives and visitors. The last surveys suggested that the manager was very approachable, and stated their satisfaction with the home and care provided. Very positive comments were received throughout this visit about the home, care provided and staff members. A number of audits were competed by the manager on a monthly basis e.g. care plans, medication and accident reports. The manager does an out of hours visit and completes a report on her findings. Regulation 26 visits are completed by the operations manager who sends a copy to the local Commission for Social Care Inspection office. The financial interests of people were discussed with the manager and records checked. All people within the home complete a personal allowance contract; this informs the home what they can purchase on behalf of the person in the home receiving their services. Some people within the home had their own bank accounts these people were assisted with their finances by relatives. Other monies were in a non-interest account, with records of accounts and receipts available for each individual person. The administrator completed a monthly audit of finances, which is sent to the company, who also complete a yearly audit on finances. Maintenance and service records examined, these were up to date with current certificates. The required Health and Safety policies and procedures and the relevant notices were displayed throughout the home. Fire safety procedures were in place, records examined showed they were current and up to date. The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 20 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 X 18 3 3 X X X X 2 X 2 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 The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 21 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 OP26 Regulation 23(2)(d) Requirement The premises should be kept clean, hygienic and free from offensive odours throughout the home. Cleaning regime should ensure that the home is clean at all times of the day. The home should ensure that carpets that are identified as requiring replacement, should be done as soon as possible to assure comfort that meets the assessed needs of people within the home. Timescale for action 01/09/07 2 OP24 23(2)(b) 01/10/07 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 The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Sheffield Area Office Ground Floor, Unit 3 Waterside Court Bold Street Sheffield S9 2LR 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 The Beeches DS0000007985.V346679.R01.S.doc Version 5.2 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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