Inspection on 03/10/05 for The Copse

This inspection was carried out on 3rd October 2005.

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

The inspector 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 Copse 03/12/07

The Copse 20/02/07

The Copse 19/04/06

The Copse 07/04/05

The Copse 11/10/04

The Copse 14/06/04

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 The Copse Beechmount Close Old Mixon Weston-super-Mare BS24 9EX Lead Inspector Nicola Hill Announced 3 & 4 October 2005 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Copse Address Beechmount Close Old Mixon Weston-super-Mare North Somerset BS24 9EX 01934 811448 01934 811352 thecopse@shaw.co.uk Shaw Healthcare Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Terina Noke Care Home 24 Category(ies) of 1. Learning disabilities. registration, with number of places 2. Physical disabilities. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1. Twenty-four adults with learning difficulties which can include 14 physically disabled persons. 2. The manager must be a RN Parts 3, 5, 13 or 14 of the NMC register. 3. Staffing levels as detailed in the notice of registration dated 1st September 2004 apply. Date of last inspection 7 April 2005 Brief Description of the Service: The Copse is care home with nursing for younger adults with learning disabilities and physical disabilities. It is situated on the outskirts of Weston super Mare. The home is arranged into four small units each with their own communal areas. The residents at the home can also access a minibus. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The announced inspection for The Copse took place over two days, and included time spent by the inspector observing the residents. The manager and staff at the home were involved in giving their views of the service. The residents have limited communication, and were unable to participate fully in the inspection process. Comment cards had been sent to the home for completion prior to the inspection. The overall impression from the observation of residents in their home was that there were opportunities to follow personal choices about where to be, for example, one resident preferred to move around their accommodation, whilst others were content to remain in their flats. The interaction between staff and residents was good and the atmosphere was calm and relaxed. The staff team are very attentive towards residents and consistently communicate with the residents to establish rapport with them. The inspector spoke directly with two residents, and was introduced to the others. Approximately eight members of staff spoke with the inspector and discussed the developments at The Copse. The Regional Manager was also available on the second day of the inspection. The manager is working with the staff team to change the culture of the home and develop a service, which is resident focussed and not run for the benefit of the staff team. The organisation has recognised the difficulties in the management of change and supported the manager with this task. What the service does well: The residents have well furnished rooms. The manager and staff spoken to during this visit felt that the residents are treated as individuals and their individual characteristics recognised by the staff team. The inspector observed this during the inspection. The in-house activities have increased considerably and the residents benefit from aromatherapy on a twice weekly session. The home always has a staffing level in excess of the staffing notice. The service provides a structured environment for the residents, and has the potential to offer opportunities for development of the individual. The home do not use physical restraint, and the staff work together with the residents with a variety of strategies that defuse difficult situations, and so promote dignity and a positive self image for the residents. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 6 What has improved since the last inspection? What they could do better: Care planning at the home has not developed enough to provide a person centred plan for each resident, and therefore evidence of residents making choices and being involved in decision making is absent. Progress has been made in some areas, and the manager is aware that this is an area for development. The manager recognised that the communication between staff and residents could be improved by developing proper systems using terms of reference and sign language, photographs etc to promote understanding. The physical environment is limited by its original design in that there are no electronic doors despite many of the residents being able to mobilise independently. This limits their access to all areas of the home and also restricts the interaction between residents in different flats. The sliding door access to the flats is raised and should be reviewed in order to make it more accessible. The upstairs flats are accessed though the ground floor flats; this means that staff and visitors must walk through the residents’ communal areas. This is direct contrast to the idea that it is the residents own home. There has been a recent spate of errors in the administration of medication. The trained nursing staff retain responsibility for the medication system at home. As an interim measure two trained nurses must undertake the administration medication. The home has a system of delegated responsibility for the supervision of staff. Currently the supervision of staff does not take place on a regular basis. The team leaders will be attending training so that staff supervision is meaningful and takes place on a regular basis. The manager has recently been appointed, and is in process of developing the leadership skills of the team leaders. This will allow the manager to delegate some responsibilities to the team leaders. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 7 Recruitment to the home has been difficult over recent years, however the residents need a familiar and regular staff team, and the organisation must review their employment practises to ensure that the home is staffed with regular employees. 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 Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,4 The introduction of user-friendly information would enable potential residents to have a greater understanding of services offered at the home. EVIDENCE: The homes statement of purpose and service user guide has been revised since the last inspection. There has been one admission to the home and ccurrently there are no vacancies for permanent residential care. The service user information is not in an accessible form easily understood by the target client group. The newest resident spoke with the inspector about coming to The Copse. He stated that he had moved in, as he did not like where he was before. He also stated that he had not visited the home prior to moving in. The acting manager confirmed that preadmission visits were undertaken. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8 The staff team at the home need to change their approach and the culture of the home so that there is evidence that residents at The Copse are pivotal to the daily activity of the service. EVIDENCE: The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 11 The care files reviewed by the inspector contained an amalgamation of basic care information, some of which has been recently reviewed. There is inconsistency of information and use of assessment tools, differing paperwork etc. Some of the specific care plans written by staff were very poor and indicated a lack of understanding of client care need and a deficit of basic English skills. This was discussed with the manager who explained that progress with care planning had been slow, and was still in the process of identifying the plans which best suited clients and needs, and usable by the staff team at the home. There were some pictoral files which staff have worked with residents, their families and carers to compile, and include personal plans which identify the day to day event that are essential to the residents well being. As the residents have varying abilities of communicating their wishes, some of the information in the plan has been obtained by observation of the resident in different situations but must be recorded as such. However, Shaw has provided a specific trainer to work with staff to improve this area of the service. The large resident group means that time should be allowed to complete the task to ensure that it involves residents and is meaningful. It was observed as part of the inspection, that the staff interacted well with residents, and responded to them appropriately. All staff addressed service users by their preferred name. The residents were offered limited choices in such a way as to ensure understanding, and not confuse residents with too much information. However use of specific communication aids was not evident. The inspector discussed how residents were involved in the day to day running of the home. The daily routine was focussed around resident need, and residents could attend the monthly “flat meeting”, but there is no system for obtaining user views. The daily records kept on residents were read and information case tracked through care files. Some of the records were clear and informative, others were not objective and were unprofessional. It was clear from discussion with the manager that although a hand over sheet is used, information was not always passed to the next shift, consequently things were not followed up effectively. The risk assessments were discussed with the manager who is working with staff to move them on from using the risk assessment process just for hazard identification, toward using them to support residents taking risks and widening their life experiences. For example, one resident wishes to attend a football match, and so he is going to be supported to attend Sunday league football and gradually build up to a Premier league match. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,14,16,17 Residents are able to access varied activities, social and educational opportunities are limited but were possible are used. EVIDENCE: The residents were observed to have opportunities to access community facilities, and benefit from a planned programme of activities in and outside the home. The community day-care team and staff from the home support this. In addition to planned events the residents are taken out either in the bus or for walks to enjoy the local area when staff levels are sufficient. The residents have a weekly activity sheet, which includes in house activities. During the inspection the following were observed to be happening around the home: Individual physiotherapy exercises. Residents taken out on a one to one basis. Day care support from Brandon day services. In house activities e.g. Painting, music. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 13 The cook produces good quality meals, which are planned to meet the preferences of the residents. The kitchen was in the process of being deep cleaned and workstations replanned to suit the workflow. Staff commented that the food had improved in quality, quantity and choice. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 The health care needs of the residents are well met with evidence of access to various health care providers. The medication administration at the home must be accurately administered in order to promote good health. EVIDENCE: The personal care support for each individual is identified and known to the staff team. The residents have primary care needs met by the local GP practice, and specialist care needs met by the CLDT. The individual personal files have information on then indicating that the health care needs of individuals is monitored and any action needed is taken. The Copse meets a wide variety of health care needs, currently 15 of the residents suffer from epilepsy; the older residents have developed illnesses associated with old age such as osteoarthritis and heart disease, as well as the onset in some of the symptoms of dementia. None of the residents at The Copse are able to administer and take control of their own medication. There has been a recent spate of errors in the administration of medication. The trained nursing staff retain responsibility for the medication system at home, all of which have undertaken recent training The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 15 and assessment for competence. As an interim measure the administration medication must be undertaken by two trained nurses, however, this is not a long-term solution. The manager is currently investigating the incidents of drug errors, and will be taking disciplinary action against the member(s) of staff identified as being responsible. At the time of the inspection the medication at the home was stored correctly and all the medication checked by the inspector was accurate. The manager was advised that all “When required” medication must have a clear protocol indicating when it should be used. The staff have been working closely with the GP to reduce the amount of prescribed medication given to residents. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 Complaints and concerns relating to the protection of vulnerable adults are acted upon appropriately. EVIDENCE: The organisation has a rigorous complaints procedure; two complaints have been received since the last inspection. Both of these complaints have been investigated appropriately and any necessary remedial action taken. All staff at the home have undertaken training to enable them to recognise abusive practice, and the action to take to report any concerns. The continued errors in the administration of medication can be considered to be abusive and neglectful. The home must be able to demonstrate that the residents are safe, and that the staff are competent to take responsibility for administration of medication. Disciplinary action must be taken if the investigations into the errors identified the person responsible. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,30 The residents at The Copse have a safe environment that requires regular maintenance and redecoration due to the demand made on it by the residents. EVIDENCE: A brief tour of the building did not indicate any areas where there were any health and safety risks to either the residents or staff team. However, the physical environment is limited by its original design, and there are areas, which could be improved to make the home more accessible to people with physical disabilities. For example there are no electronic doors despite many of the residents being able to mobilise independently. This limits their access to all areas of the home and also restricts the interaction between residents on different flats. The sliding door access to the flats is raised and should be reviewed in order to make it more accessible. The upstairs flats are accessed through the ground floor flats; this means that staff and visitors must walk through residents’ communal areas. This is direct contrast to the idea that it is the residents own home. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 18 There has been a programme of work at the home to replace flooring etc, and the manager is proposing that the nonslip flooring in the flats be extended to the dining areas. The dedicated domestic staff team at the home carry out all the domestic duties, the home was clean and free from any offensive odours. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32,36 The manager is establishing a stable staff team at the home to provide a continuity of support to the residents. EVIDENCE: Staff consulted had a clear understanding of their role and duties, the newest staff also confirmed that they had attended the corporate induction and had been enrolled in the LDAF. NVQ training is ongoing with several members of staff working toward level two/3. It was stated by staff that some of the residents do not respond well to staff changes, and use of agency staff can cause agitation. It was felt by staff that the residents would benefit from a settled and stable staff team who understand their needs and know them well enough to form good relationships with them. Recruitment of quality staff has been an issue at the home, currently there are vacancies for support workers and the organisation will be trying to recruit local staff. The staff rota has been planned to ensure that there are two staff available on each flat during the daytime. The rota provided by the manager demonstrated how this worked. The home always has a staffing level in excess of the staffing notice. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 20 The home has a system of delegated responsibility for the supervision of staff. A programme of staff supervision sessions has been planned, and the majority of staff have undergone an appraisal. However, Currently the supervision of staff does not take place on a regular basis. The staff consulted stated that a felt able to approach the manager and have their comments and suggestions regarding service provision listened to, but were quite vague on the purpose and outcomes of supervision sessions. The manager is aware of this and has taken action so that the team leaders will be attending training to ensure that staff supervision is meaningful and takes place on a regular basis. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,42 Residents’ known preferences and support needs are beginning to influence the day-to-day running of the home. The acting manager is providing clear leadership throughout the home in order to provide a safe and supportive environment for residents and develop the service. EVIDENCE: Terina Noke was appointed as manager at The Copse, an application to CSC I for registration has recently been submitted. The staff at the home were very happy to have her in charge, and stated that they felt she would improve the way the home was run. The positive comments received from staff during the inspection about the success of the new manager were given as part of the inspection feedback. Regular staff meetings are held approximately 6 weekly and staff commented that there was good communication and use of a communication book/diary. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 22 There appears to be team cohesion and willingness to work together to benefit the residents. The internal quality audit system is being implemented, and action taken to ensure that standards are met. There is also a business development, which has identified targets to be met in respect of use of agency staff, and staff recruitment. The inspector checked the cash tins for three residents, all of which were found to be correct. There is a daily visual health and safety audit of the home. The fire log book was inspected and evidenced regular checks. The accident/incident book was reviewed and it was noted that the majority of incidents recorded were minor falls; any accidents requiring treatment have been notified to the Commission. The fire alarm system maintenance records were available, and there was evidence of portable appliance testing. At the time of the inspection there are no areas of health and safety implementation that are of concern to the inspector. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 x x 3 x Standard No 22 23 ENVIRONMENT Score 3 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 2 2 x x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x x Standard No 11 12 13 14 15 16 17 x 3 3 3 x x 3 Standard No 31 32 33 34 35 36 Score x 3 x x x 2 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Copse Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 2 x x x 2 x D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 24 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 Regulation Requirement The care plans need to be updated, and information held on residents reviewed so that it reflects their current situation. Person centred planning must be progressed so that the potential of the residents is maximised and that they can express choices and decisions about their lifestyle. The organisation have a duty of care toward the residents and must ensure their safety and welfare by employing staff who are competent and capable of administering medication. The home develops a systems for communicating effectively and consulting with residents so they have more influence in the day to day running of the home. The manager must ensure that team leaders must fully implement a system of meaningful supervision for their delegated staff group. staff recuritment must be undertaken to reduce the disruption to residents of using agnecy staff. Timescale for action 4/4/06 6,7,8,11,14 14,15 2. 20,32,42 18,19 4/10/05 3. 8,32 16,24 4/4/06 4. 32,36 18 4/12/05 5. 32 18,19 4/12/05 The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. Refer to Standard 1 14,32 38 24 24 Good Practice Recommendations The introduction of user friendly information would enable potential residents to have a greater understanding of services offered at the home. Appropriate training for the activity organiser so that residents can take part in activities which aid their personal development. The team leader must undertake appropriate training to ensure they are confident and competent to provide leadership when in charge of the home. A review of the physical layout of the home to reduce the flats being used as access routes. The home should have an assessment of the physical environment in respect of its accessibility for disabled people. The Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 26 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier, Taunton TA1 4AL 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 Copse D53_D02 S20375 The Copse V244631 3&41005 Stage 4.doc Version 1.40 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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!