Inspection on 11/10/05 for The Crossings

This inspection was carried out on 11th October 2005.

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 Crossings 23/05/07

The Crossings 01/02/06

The Crossings 07/01/05

The Crossings 30/11/04

The Crossings 03/02/04

Similar services:

Flint House

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

The Cotswold Home

Fairways

Treloar College

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

CARE HOME ADULTS 18-65 The Crossings 108a Aylesbury Road Wendover Bucks HP22 6LX Lead Inspector Barbara Mulligan Unannounced Inspection 11th October 2005 12:30p The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 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 Crossings DS0000023083.V259197.R01.S.doc Version 5.0 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 Adults 18-65. 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 Crossings DS0000023083.V259197.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Crossings Address 108a Aylesbury Road Wendover Bucks HP22 6LX 01296 625928 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) Turnstone Support Limited Mrs Dawn Humphris Care Home 4 Category(ies) of Learning disability (0), Physical disability (0) registration, with number of places The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 4 residents with learning disabilities and/or physcial disabilities Date of last inspection 7th January 2005 Brief Description of the Service: The Crossings is registered to provide 24-hour residential care and support to four people with learning and physical disabilities, who transferred from the NHS Manor Trust to the Community in September 2001. Accommodation is a detached bungalow, which aims to provide a family style environment for the service users. Service users have their own rooms and shared social areas. There is a well kept, safe and accessible garden to the rear of the property and car parking to the front. It is situated in a residential area and close to local amenities. Nursing support is provided as needed from the Community Learning Disability Team and District Nurses attached to the local GP Practice. The home is owned and managed by the Turnstone Support Group Ltd. which is a registered charity. The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the inspection summary of an unannounced inspection carried out at The Crossings on the 11th October 2005 at 12.30pm by Inspector Ms. Barbara Mulligan. The inspection consisted of looking at a number of records, discussion with the registered manager Dawn Humphris, meeting with staff, service users and a tour of the home. At the time of the visit two service users were at home and two service users were out horse riding. What the service does well: What has improved since the last inspection? What they could do better: Protection of Vulnerable Adult training is presently undertaken once every two years. Training records for staff demonstrated that several staff members had not received POVA training since 2003 and it is a requirement of the report that this is updated annually. The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 Page 6 The Service Users Guide needs to be reviewed and changes made as necessary. The registered manager needs to give serious consideration to making the Service Users Guide available in another format suitable for individuals for whom the service is intended. Service users care plans contain a large amount of paperwork and each service users has three personal files. This does not make it easy to access the necessary information required and it is a recommendation that care plans are made more user friendly. 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 Crossings DS0000023083.V259197.R01.S.doc Version 5.0 Page 7 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 Outcomes Statutory Requirements Identified During the Inspection The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 Page 8 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 the following standard(s): 1,2, 3 and 4. The homes Statement of Purpose and Service Users Guide provide service users and prospective service users with details of the services the home provides. However, the Service Users Guide needs to be reviewed, updated and made available in a format suitable for potential service users. Prospective service users have the opportunity to visit the home on an introductory basis, before making a decision to move there, ensuring that service users are able to make an informed choice about where they live. EVIDENCE: The Statement of Purpose is detailed and contains all the necessary information as detailed in Schedule 1. The Service Users Guide needs to be reviewed and changes made as necessary. The registered manager needs to give serious consideration to making the Guide available in a format suitable to individuals who use this service. The home has its own assessment tool. This is comprehensive, and covers key contacts, social networks, communication, health and mobility, personal care, social, leisure and lifestyle needs, behavioural support needs and personal safety. Rehabilitation and therapeutic needs are assessed by physiotherapists and occupational therapists who visit the service users in their home. Families and carers are involved with the service users agreement. All specialised services The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 Page 9 offered are accessed through the Learning Disabilities Community Team. There is evidence that staff training is appropriate to deliver the services and care required of the home. There are no service users with specific religious, social or cultural needs, however the manager was aware of where to obtain relevant information if it is necessary. Communication with service users at The Crossings is through body language and staff have learned how to recognise different signs displayed by service users. The service users files contain a large likes and dislikes folder and this also helps staff to meet the needs of the service users. One service user has an advocate and an advocacy co-ordinator oversees the entire home. The home does not offer respite services. The home has not had a vacancy since the home opened. Therefore, no service users had yet had the opportunity to visit and “test drive “ the home. Emergency admissions have not occurred at The Crossing yet, because this is a long term residential home and there have been no vacancies since the home opened. A further requirement was made that the registered manager will develop a policy and procedure/code of practice for the emergency admission of service users to the home. This had not been complied with, however information is included in the statement of purpose. The manager stated that emergency admissions are not accepted at the Crossings. The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 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 the following standard(s): 6,7, 9 and 10. Care planning documentation contains adequate information that care staff require to satisfactorily meet service users needs. However, these records need to be made more user friendly to make them working documents. Service users make decisions about their lives, with assistance and communication support, that allows them to influence their lifestyle and how the home is run. Service users are supported to take responsible risks within the context of the home’s risk assessments and risk management strategies that ensure service users can have independent lifestyles. Personal information is handled appropriately ensuring that personal confidences are respected. EVIDENCE: The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 Page 11 A random selection of care plans were looked at for service users. These are informative and comprehensive, covering a wide range of needs. However, each service user has three files and these contain an excess of documentation, making it difficult to access information. Care plans do not appear to be working documents due to the extent of their contents. It is recommended that care plans are made more user friendly by reducing their contents to necessary information only. This will then make it easier for care staff to access information and make the care plans working documents. There is evidence that service user’s families are involved in the care-planning process if the service user wishes them to be. The home operates a key worker system. The home uses Aylesbury Vale Advocates, and one service user has an advocate. Service users have regular, monthly meetings and an advocate chairs these meetings. Records are kept of the meetings and these were looked at. Staff are able to demonstrate how individual choices are made through service user meetings. Service users are unable to manage their own finances, but are involved with support, and these are managed by the registered home manager and the care staff. Limitations on facilities, choice or human rights to prevent self-harm or self neglect, are documented in the service users care plans and the inspector saw evidence of this. Risk assessments are kept in service users care plans and these cover a number of areas such as participation in domestic living skills, daily activities, missing persons, bathing and choking. There was evidence to demonstrate that risk assessments are reviewed regularly. Confidentiality training is carried out during staff induction. There is a policy on confidentiality and the Statement of Purpose contains information regarding confidentiality. All confidential records are stored securely. The inspector was assured that information given in confidence is not shared with families/friends against the service users wishes. The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 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 the following standard(s): 17 The dietary needs of service users are well catered for with a balanced and varied selection of food available that meets service users tastes and choices. EVIDENCE: Service users are offered a choice of suitable menus. This takes the form of staff knowing what the likes and dislikes of service users are, and this is well documented in each individuals care plans. A six weekly rotating menu has been introduced taking into account the likes and dislikes of the service users. An alternative meal can be offered if the service user does not like the day’s menu. The home offers drinks and snacks throughout the day in accordance with needs of the service users. Service users take part in shopping for food for the home and can take their meals in their rooms if they wish. A lunchtime meal was observed to be relaxed, flexible and staff were assisting service users to eat their meals in a sensitive and supportive manner. The nutritional needs of the service users are assessed and regularly reviewed. Visits to Manor House hospital are undertaken on a three-to-six monthly basis so that service users can be weighed. The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 Page 13 The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 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 the following standard(s): These standards were not assessed during this inspection. EVIDENCE: The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 Page 15 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 the following standard(s): 22 and 23 The home has effective complaints procedures to ensure that service users or their representatives are listened to. Staff have a good knowledge and understanding of Adult Protection issues which protect service users from abuse. However, POVA training is presently inadequate and this needs to be addressed. EVIDENCE: The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 Page 16 The complaints policy includes guidelines for relatives and service users to make complaints, and who to contact if the complaint cannot be resolved. A summary of the complaints procedure is included in the Statement of Purpose and the Service Users Guide. This includes information on how to refer a complaint to the commission. The home has a dedicated book for the recording of complaints. The home has received no complaints since the previous announced inspection. There is a Turnstone Support protection of vulnerable adults policy. This is wide-ranging and instructive. There are guidelines about the prevention and management of violence, and this includes risk assessments, training of staff, physical restraints and personal safety. There is also a Buckinghamshire interagency procedure dated March 2001. The home needs to acquire the updated version of this policy. There is a whistle blowing policy and Turnstone provides training for staff on non-violent crisis intervention. The home has had no complaints of abuse since it opened. The homes policies and procedures regarding service users money and financial affairs ensure service users have access to their money, valuables and safe storage of valuables. Each service user has a vanity unit in their own room that is lockable, where valuables can be locked away for safekeeping. Training records show that POVA training for some staff has not been updated since 2003. This needs to be undertaken by all care staff on an annual basis. This is a requirement of the report. The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 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 the following standard(s): 24, 25, 26, 27, 28, 29 and 30. The standard of the environment within this home is good, providing service users with an attractive and homely place to live. The staff sleepover room is due to be replaced in the very near future. The overall quality of the furnishings and fittings is good ensuring the safety and comfort of service users. The garden is regularly maintained to keep it safe and accessible for service users. EVIDENCE: The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 Page 18 Each service user has their own bedroom, and these exceed the requirements as detailed in standard 24. Each room is brightly decorated and service users are encouraged to bring/purchase their own individual belongings to personalise their own rooms. Bedrooms are lockable, but at the time of the inspection the manager told the inspector that there were no service users who were able to use a key. However this could be facilitated if a request was made. The home has one bathroom that contains a specialist bath and an electrical changing bench. One service user has her own commode and one toilet is situated in the bathroom that has a support frame. There is room to accommodate wheelchairs in the bathroom. There is another single toilet with a hand basin that is spacious and able to accommodate wheelchairs. The toilet and the bathroom are lockable, but staff can use an override device only as indicated by a service users risk assessment. Shared spaces in the home include a large lounge/diner, a kitchen, toilet and bathroom. These are all spacious and well decorated. The kitchen is domestic in character, and laundry facilities are sited in a separate utility room. Service users are able to meet with visitors in the privacy of their own room if they wish to. There is a staff sleep in room that also doubles as an office. This room is very small, with no washing facilities available for the staff. Plans are being drawn up to provide a more appropriate staff sleep in area with washing facilities. There is specialist equipment in place for moving and handling. A specialist bath and changing bench are in the bathroom. All bedrooms have a call alarm system in place, and the manager stated that the service users in the home at the time of the inspection are unable to use them. However, this is a facility that can be made available if needed. One service user has a water-bed in their room and a risk assessment is in place for this. The laundry facilities are situated in the homes utility room and ensures soiled articles, clothing and infected linen are not carried through areas where food is stored, prepared, cooked or eaten and do not intrude on service users. Hand washing facilities are prominently sited in the toilets, bathroom and the utility room. The laundry floor finishes are impermeable and these and wall finishes are readily cleanable. There is a policy for infection control and this covers all areas for the safe handling and disposal of clinical waste, dealing with spillages, the provision of protective clothing and hand washing. The home has a sluicing facility in the utility room. Services and facilities comply with the Water supply Regulations 1999. The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 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 32, 34 and 35 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, 32 and 33. Service users benefit from a staff team who are appropriately trained to ensure that service users are cared for by skilled staff at all times. Service users benefit from clarity of staff roles and responsibilities ensuring continuity of care. Staffing numbers are adequate to ensure that the assessed needs of the service users are met. EVIDENCE: The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 Page 20 The manager felt the staff team are aware of, and support the aims and values of the home, and this was confirmed during discussions held with staff. Staff are aware of the organisations policies and procedures and understand how their work, and that of other staff, promotes the main aims of the home. Staff job descriptions are linked to achieving service users individual goals as set out in the Service User Plan. Staff moved with the service users to The Crossings when Manor House Hospital closed. There is evidence in service users plans of care and through discussions held with staff that individual needs were met, with particular attention to gender, age, culture and personal interests. Staff are aware of their limitations and, when questioned, are able to give examples of how and when to involve someone else, with more specific expertise in the care of service users. Staff have the skills and experience necessary for the tasks they are expected to do. The care staff are able to communicate with the service users at the home by reading their body language and having a good understanding of their likes and dislikes. New staff undertake an induction to the home and the organisation. This covers areas regarding understanding physical and verbal aggression and self harm, cultural and religious needs and the role of the multi-disciplinary team. Further training by staff includes First Aid, Basic Food Hygiene, Moving and Handling and Fire Awareness. Two staff members have completed NVQ level 3 and another staff member is undertaking level 3 training. The registered manager has completed NVQ level 4 training and the senior carer is in the process of undertaking NVQ level 4 training. The use of agency staff is kept to a minimum. The numbers and skill mix of the staff team ensure that uninterrupted work with individuals can be carried out, the administration, organisation and day to day running of the home are carried out effectively and also allows for the management of emergencies. The ratios of staff to service user is determined by the needs of the service users and the inspector saw evidence of this in the duty rota’s and the care plans. Staff turnover has been low, with just 2 leavers in the last 12 months and staff sickness is low. Staff sickness levels are monitored monthly. Staff meetings occur monthly. There are recorded minutes of the staff meetings and there is evidence that issues raised in the staff meetings are actioned. At the time of the inspection there were no staff under the age of 18 years working in the home. The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 40 and 41. The manager is supported well by the staff team in providing clear leadership and demonstrating an awareness of their roles and responsibilities to the benefit of service users. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. EVIDENCE: The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 Page 22 The registered manager of The Crossings is an Enrolled Nurse and has worked with people with learning disabilities for 17 years. She has recently completed her Registered Managers Award. Further training undertaken by the registered manager has included interviewing skills and management and service users finances. The registered manager has the overall responsibility for ensuring the homes written aims and objectives are achieved, the homes budget is properly managed, policies and procedures are implemented, certificate’s are displayed and that the home complies with the Care Standards Regulations. All policies and procedures are kept in the office, and are accessible to all staff working in the home. The organisations policies and procedures are appropriate to the home and the service users. Those looked at were signed and dated by the home manager. Staff and service users have limited involvement in developing or formulating policies and procedures. Records and home records were observed to be up to date, stored securely and in good order. All records were constructed, maintained and used in accordance with the Data Protection Act 1998. The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 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 2 3 3 3 x Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 3 3 LIFESTYLES Standard No Score 11 x 12 X 13 X 14 X 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 3 3 X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Crossings Score X X X X Standard No 37 38 39 40 41 42 43 Score 3 X x 3 3 X x DS0000023083.V259197.R01.S.doc Version 5.0 Page 24 No Are there any outstanding requirements from the last inspection? 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 1 Regulation 5 Requirement Timescale for action 2 23 10.1 The registered manager is required to ensure that the Service Users Guide is reviewed 30/11/05 and changes made to include all the necessary information as detailed in Regulation 5 of the Care Homes Regulations. The registered manager is required to ensure that all care 30/03/06 staff are provided with Protection of Vulnerable Adults annually. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard 1 6 Good Practice Recommendations It is recommended that The Service Users Guide is made available in another format more suitable for service users. It is recommended that care plans are made more user friendly by removing excess documentation thereby making it easier to necessary information. The Crossings DS0000023083.V259197.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR 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 Crossings DS0000023083.V259197.R01.S.doc Version 5.0 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!