Inspection on 07/08/06 for The Cedars

This inspection was carried out on 7th August 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Cedars 03/08/07

The Cedars 26/01/06

The Cedars 16/09/05

The Cedars 13/12/04

The Cedars 21/09/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE The Cedars Sudbury Road Halstead Essex CO9 2BB Lead Inspector Jane Greaves Key Unannounced Inspection 7th August 2006 09:30 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 Cedars DS0000017957.V307794.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 Cedars DS0000017957.V307794.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Cedars Address Sudbury Road Halstead Essex CO9 2BB 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) 01787 472418 01376 334892 Mr Balkrishna N Patel Mrs Anjana Balkrishna Patel Mrs Anjana Balkrishna Patel Care Home 24 Category(ies) of Dementia - over 65 years of age (24), Old age, registration, with number not falling within any other category (24) of places The Cedars DS0000017957.V307794.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th January 2006 Brief Description of the Service: The Cedars is situated in Halstead, Essex, close to the town centre and local communities. The home has retained many of its original features and has large well maintained gardens, with a patio area and a sunroom. The home was built in the 18th century and has had a newer annex built onto the rear of the premises. The Cedars is a two storey building with access to the first floor by chair lifts in both parts of the building. The home is registered to provide care for 24 older people over the age of 65 with dementia. The home provides 24 hour personal care and support. The home is well furnished, decorated to a good standard and offers a homely and caring environment to the service users who live there. It was reported that the Commission for Social Care Inspection report is maintained on the home’s notice board for a few weeks post inspection and then stored in the office and made available on request. The fees charged at The Cedars ranged from £426.00 to £475.00 not including personal items such as hairdressing and chiropody services. The Cedars DS0000017957.V307794.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on 7th August 2006 over 6 ½ hours. 21 of the 38 National Minimum Standards were assessed during this inspection process, 14 were met. A physical tour of the building was undertaken, documents were sampled and views of the service provision were gathered from residents and visitors as part of this inspection process. The inspector appreciated the assistance and co-operation received at this inspection site visit from the residents, staff, management team and visiting family members and healthcare professional. Overall the standard of care provided for the residents at The Cedars was good. What the service does well: What has improved since the last inspection? What they could do better: Residents’ health, safety and well being would be better protected by the staff team receiving training and annual refresher training in the safer handling and The Cedars DS0000017957.V307794.R01.S.doc Version 5.2 Page 6 administration of medicines and the Protection of Vulnerable Adults from Abuse. Residents’ dignity would be better protected if medical examinations were arranged to take place in their private rooms. A programme of leisure and recreational activities inside and outside the home specifically developed for persons suffering with dementia would provide the residents with the opportunity for stimulation according to their individual needs. As mentioned earlier in this report it was noted that the NVQ training programme had progressed since the last inspection visit, residents’ health safety and welfare would be further promoted by continued efforts in this area. The development of a training matrix providing information regarding which training courses staff had attended and when would enable the registered manager to monitor the staff training provision and requirements. 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 Cedars DS0000017957.V307794.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 Cedars DS0000017957.V307794.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New residents to the home could be confident that their needs had been assessed and would be met. EVIDENCE: Care plans sampled at this visit contained pre-admission assessments undertaken by the registered manager before individuals move into the home. These assessments covered all aspects of the prospective resident’s daily life and personal, social and spiritual well-being and formed the basis of the ‘plan of care’. The registered manager reported that assessments would be undertaken at the prospective resident’s own home where possible. The Cedars did not provide intermediate care. The Cedars DS0000017957.V307794.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care and support was delivered in an appropriate manner to meet residents’ assessed needs, however, medication procedures did not always protect residents’ health and safety. EVIDENCE: Care plans provided evidence of the personal care and support offered and provided for the residents at The Cedars. Records showed that, where possible, individuals were prompted and encouraged to maintain their independence with personal hygiene including oral care. One visiting family member commended the management and staff team for the way their loved one had been supported to regain a great deal of the independence that had been lost prior to entering the home permanently. Care plans sampled did not include evidence of the resident or their families/representatives involvement with developing the plan of care. The registered manager was able to describe many instances where family members were involved with decision making however there was not always documentary evidence to confirm this. There was evidence to confirm that care plans were reviewed on a monthly basis by The Cedars DS0000017957.V307794.R01.S.doc Version 5.2 Page 10 the manager and the relevant key worker and were amended where necessary to meet residents’ changing needs. Care staff reported any changes in the residents’ health or well being to the senior on duty and recorded the detail in the individual’s daily record. Each care plan sampled at this visit contained evidence of healthcare professional visits and subsequent actions to be taken by care staff. Records showed that the registered manager ensured that relatives were kept informed of any matters affecting the health or well being of their loved ones and this was confirmed during conversations with visitors to the home on the day of this inspection site visit. A dentist visited the home twice yearly to undertake regular routine dental checks for individuals. Records of optician appointments and chiropody treatment were in the care plans. A visiting healthcare professional reported that the care and support provided for the residents at The Cedars was of a good standard. There were no residents with pressure sores at this visit, the registered manager was able to confirm that staff had received training in tissue viability and that the home had a good relationship with the GP surgery and the district nursing team. The home had a robust medication policy and procedure that was subject to regular review. Only designated staff members were responsible for the administration of medicines. External medication training had been provided; this had not included a competency assessment and annual refresher training had not been provided. The registered manager maintained records of medication received into the home and returned. A pharmacist undertook an annual medication review of the home. The registered manager reviewed residents’ medication monthly and if there were any concerns the GP was consulted. On the day of this visit it was observed that daily practice did not reflect the policies and procedures of the home. Liquid medications were taken around the home en masse on a tray to the respective residents. The staff member and management demonstrated awareness that the practice was not in accordance with the home’s policies and procedures for the safer administration of medicines. Discussion took place with the registered manager around a safe but practicable system of medication administration and the involvement of a community pharmacist in the home to provide competency-assessed training for the staff team. Observation of practice on the day, discussion with residents, family members and staff provided evidence that overall the residents’ privacy and dignity was respected. However, it was noted that one resident was taken to the manager’s office to be seen by a doctor. It was reported that this was not uncommon practice as it was “a lot easier for the doctor”. Whilst the resident’s privacy had been respected the individual had not been given the option of having the consultation in their private room and their dignity had not been considered. The Cedars DS0000017957.V307794.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents were encouraged to maintain contact with family and friends and were supported to exercise some autonomy over their lives, however the home did not provide a programme of meaningful recreational activities for the residents. EVIDENCE: This residents group did not generally have the cognitive awareness to make informed decisions about their daily life and choices. Family members spoken with during this inspection site visit confirmed that there was a choice of two cooked meals daily and that residents were asked what time they wished to go to bed. Daily rising times followed a mixture of routine and personal choices. The registered manager and staff reported that each resident chose the clothes they wore with support to co-ordinate their outfits. Relatives and visitors reported they were always made welcome at the home and they were satisfied with the care and support provided for the residents. One visitor said “ I can’t say enough nice about the place, they really look after the residents well”. The registered manager did not maintain residents’ personal monies. Families/representatives were invoiced monthly for personal items not covered by the fees such as hairdressing and chiropody. The Cedars DS0000017957.V307794.R01.S.doc Version 5.2 Page 12 Residents were encouraged to bring personal possessions into the home with them. One family praised the home for the support provided when bringing a resident’s own furniture into the home. Menus provided evidence that 2 meal choices were offered; it was reported that each resident was asked their preference shortly before the meal was to be served. Some residents were able to confirm they had chosen their lunchtime meal. Residents enjoyed their meal with support provided where needed. Regular visitors to the home reported that their loved ones were content with the menu and the quality of food provided. Residents were able to have drinks when they chose however they did not have the facilities to make drinks independently. Discussion was held with the registered manager regarding risk assessing around daily activities and providing support for individuals to maximise their independence through the risk management process. Care plans contained information about residents’ leisure interests pursued prior to entering the home; there was no evidence that this had been explored with individuals to develop appropriate activities and recreation. As found at the previous inspection visit the activities offered did not provide stimulation for the residents. After lunch the majority of residents sat quietly with music playing in the background. Staff members were supporting a resident to do a jigsaw, another to throw a ball and then chatting with individuals. A discussion was held with the manager regarding the provision of specific activities both inside and outside the home for people with dementia in order to offer stimulating pastimes. The Cedars DS0000017957.V307794.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 inspected at least once during a 12 month period. 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. Residents and their representatives could be confident their views and concerns would be listened to and taken seriously however staff training in the Protection of Vulnerable Adults would further protect the residents’ safety and welfare. EVIDENCE: The home operated a robust complaints policy and procedure. One concern had been received by the commission since the previous inspection visit and had been forwarded to the home. The registered manager had investigated the matter under the complaints policies and procedures and the concerns were found to be unsubstantiated. The elements of this concern were assessed as part of this key inspection visit with the same conclusion. Policies and procedures relating to the Protection of Vulnerable adults had been developed and kept under review however training/refresher training in this area had not been provided for all the staff team. The registered manager had secured a training pack and demonstrated the awareness of the importance of this training provision. The manager reported this training would take place imminently. Staff members spoken with demonstrated knowledge of adult protection. Three staff files sampled at this visit provided evidence that the registered manager had obtained enhanced criminal record Bureau disclosures before new staff members commenced work at the home. The Cedars DS0000017957.V307794.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a clean and well maintained environment. EVIDENCE: An unaccompanied tour of the home was undertaken and it was found to be clean, tidy and well maintained throughout. Since the previous inspection visit the hall and porch floor had been replaced with practical washable flooring giving a fresh and bright appearance. A discussion was held with the registered manager regarding the many certificates of staff competence displayed on the wall in the entrance hall, the manager reported the intention to remove the certificates to create a more homely and inviting ambience. The registered manager reported that the first phase of planned building works were due to start with the addition of a larger laundry room, an ironing room, a second office, a staff room, a sluicing facility and toilets. There was evidence to confirm staff attendance at Infection control training. The Cedars DS0000017957.V307794.R01.S.doc Version 5.2 Page 15 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, 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. Residents’ health, safety and well being were protected by robust recruitment practices and the provision of regular refresher training courses for staff would further ensure their welfare. EVIDENCE: The staff rota provided evidence of which staff members were on duty at any time and in what capacity. Records showed that extra staff members were on duty at peak times of the day. Residents and their families reported that the staffing levels appeared to meet the needs of the residents with the exception of recreational activity time. The previous inspection identified that the National Minimum Standard that 50 of care staff should achieve NVQ level 2 had not been met. At this visit it was noted that good progress had been made towards compliance with this standard, 8 of the 18 care staff had achieved NVQ2, 3 were enrolling at the time of this visit and one staff member had enrolled to take the NVQ3 qualification in care. The home’s recruitment policies and procedures served to protect the health, safety and well being of the residents. The registered manager confirmed, and sampled files provided evidence that no person started to work at the home until two written references and a completed enhanced criminal records Bureau check had been received. The Cedars DS0000017957.V307794.R01.S.doc Version 5.2 Page 16 Some staff training and refresher courses had been provided together with some resident specific training however; refresher training for those staff had received training/ refresher training in the Protection of Vulnerable adults from Abuse. The registered manager was not able to demonstrate that there was a planned staff training and development plan. A discussion was held with the manager regarding developing a matrix to identify the home’s training and development needs at a glance. Staff supervision records provided evidence that training needs were discussed on a one to one basis. The Cedars DS0000017957.V307794.R01.S.doc Version 5.2 Page 17 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): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A competent management team protected resident’s health, safety and well being. EVIDENCE: The manager had been registered with the commission since 1996 and had completed the NVQ 4 qualification in management. The registered manager reported undertaking periodic training to keep updated with current regulations and legislation. A clear line of accountability was evident within the home. Residents reported they were aware of the manager and her role and visitors confirmed feeling comfortable approaching the management or staff with any issue at any time. The registered manager undertook an annual quality review of the home; it’s facilities and the care and support provided. This was achieved by surveying the residents, families, visitors, healthcare professionals and other The Cedars DS0000017957.V307794.R01.S.doc Version 5.2 Page 18 stakeholders. A summary was produced identifying any shortfalls in the service provision and an action plan was developed accordingly. A copy of the results of this quality assurance survey had been made available to the Commission for Social Care Inspection. The home did not handle money on behalf of individual residents. The registered manager reported that families or representatives of the residents maintained all personal finances. Monthly invoices were issued for items such as hairdressing, chiropody services and personal items. Care plans contained inventories of personal items brought into the home by the residents. The registered manager was able to demonstrate that staff training had taken place for areas such as moving and handling, the control of infection, fire safety, first aid and food hygiene. Staff training/refresher training in the Protection of Vulnerable Adults and the safer administration and the storage of medicines had not been provided for all staff. Policies and procedures were in place for the Control of Substances Hazardous to Health (COSHH), information sheets on all COSHH items used within the home, including the corresponding risk assessments, were accessible to staff members. The registered manager was able to demonstrate that the boilers, heating system, electrical system, electrical portable appliances and hoists were regularly services and maintained. The registered manager reported keeping up to date with the relevant legislation and was able to give instances where advice had been sought from professional bodies such as environmental health. Environmental risk assessments were available for such areas as entrances/exits, the cellar steps and the kitchen. These assessments contained evidence of regular reviews and amendments where appropriate. The Cedars DS0000017957.V307794.R01.S.doc Version 5.2 Page 19 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 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 The Cedars DS0000017957.V307794.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP9 Regulation 13(2) Timescale for action The registered person shall make 30/11/06 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. This specifically refers to the provision of competency assessed training and refresher training for staff members responsible for the administration of medicines and a review of daily practice. The registered person shall make 07/08/06 suitable arrangements to ensure that the care home is conducted in a manner, which respects the privacy and dignity of service users. This specifically refers to residents’ medical examinations and treatment. The registered person shall 30/11/06 having regard to the size of the care home and the number and needs of the service users consult service users about the programme of activities arranged DS0000017957.V307794.R01.S.doc Version 5.2 Page 21 Requirement 2 OP10 12(4)(a) 3 OP12 16(2)(n) The Cedars 4 OP18 13(6) 5. OP28 18(1)(a) on or behalf of the care home, and provide facilities for recreation including, having regards to the needs of service users, activities in relation to recreation, fitness and training. The registered person shall make 31/12/06 suitable arrangements, by training staff or by other measures, to prevent service users being harmed or suffering abuse, or being placed at risk of harm or abuse. The registered person shall, 31/12/06 having regard to the size of the care home, the Statement of Purpose and the number and needs of resident, ensure that at all times suitably qualified, competent and experienced persons are working at the care home, in such numbers as are appropriate for the health and welfare of residents. This is a repeat requirement and specifically refers to NVQ level 2 training and the need to continue progress in this area. 6 OP30 OP38 18(1)(c) The registered shall having regard to the size of the care home and the number and needs of the service users ensure that persons employed to work at the care home receive training appropriate to the work they are to perform. This specifically refers to the provision of medication and PoVA training/refresher training. 30/11/06 The Cedars DS0000017957.V307794.R01.S.doc Version 5.2 Page 22 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 OP7 2 OP30 Refer to Standard Good Practice Recommendations It is a recommendation of good practice that the registered manager develops a system to document the involvement of relatives/representatives with residents care plans. It is a recommendation of good practice for the registered manager to develop and maintain a matrix in order to easily identify staff training requirements for mandatory and service specific training. The Cedars DS0000017957.V307794.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Cedars DS0000017957.V307794.R01.S.doc Version 5.2 Page 24 - 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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