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Inspection on 13/06/06 for The Dales Care Home

Also see our care home review for The Dales Care Home for more information

This inspection was carried out on 13th June 2006.

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

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

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The resident`s files were well organised providing easy access to information. The personal service plans were clear and reviewed regularly as was all of the documentation in resident`s files. The resident`s spoke very positively about the quality of the care they received from the staff team, and comments included: the staff team "are very helpful" and "the home is good". Another resident stated, "we are well looked after here". The residents also spoke positively about the Registered Manager and the way she manages the home and provides clear and effective leadership. The staff team commented that they felt supported by the Registered Manager and felt that they had "really good training opportunities at the home". The residents have access to a variety of activities and can access the day service if they require. The garden areas are well maintained and in full bloom, there is the provision of patio areas for the residents to enjoy the warmer weather. The staff team are experienced, motivated and committed to their roles and to ensuring that the residents receive a good standard of care. The residents live in a safe environment, as the Registered Manager ensures that all aspects of health and safety are addressed, reviewed and records maintained.

What has improved since the last inspection?

The medication fridge has been defrosted to ensure safe storage of medicines, and two people now sign all handwritten medication instructions. The Registered manager has implemented a new system for storing tables that need to be disposed of and the dispensing labels on the medication are not removed from there original container. All of the staff have now received training on safeguarding adults and the training records were up to date and accurate. The inspector observed safe working practices being maintained by the staff team.

What the care home could do better:

The requirement made by the Environmental Health Officer needs to be addressed to ensure safe working conditions are maintained in the kitchen area due to the high temperatures during the summer period. It is recommended that the staff team ensure that all personal service plans are dated on implementation, and that the action taken in response to a high score on the tissue viability form is recorded on this tool. The resident`s logs should reflect consistency in care so that when monitoring is required a record is made about the resident`s condition. The staff team should return residents toiletries to their bedroom and not leave them in the bathroom areas. The menu displayed should be the same week as the menu being followed by the catering staff so that residents do not become confused. The staff files should reflect that a full employment history has been obtained and gaps explained to ensure safe recruitment procedures are being followed.

CARE HOMES FOR OLDER PEOPLE Dales, The Care Home Fisher Close Repton Derbyshire DE65 6GS Lead Inspector Claire Williams Key Unannounced Inspection 13th June 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 Dales, The Care Home DS0000036259.V298706.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. Dales, The Care Home DS0000036259.V298706.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Dales, The Care Home Address Fisher Close Repton Derbyshire DE65 6GS 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) 01283 238200 01283 238203 Derbyshire County Council Yvonne Cara McComish Care Home 22 Category(ies) of Old age, not falling within any other category registration, with number (22) of places Dales, The Care Home DS0000036259.V298706.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 14th November 2005 Brief Description of the Service: The Dales is registered for 22 older people, and is a purpose built, single storey building. The home is set in its own grounds, and residents have access to a number of garden areas. It is located in a residential area in the village of Repton, close to local amenities. All 22 bedrooms are single occupancy. The building is laid out in wings, each with its own lounge and dining space. Toilet and bathroom facilities are on each wing. A resource centre is attached to the home. Residents living in the home are able to make use of the facilities provided at the resource centre. The fees for the home commence from £289.70 per week. Dales, The Care Home DS0000036259.V298706.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over a six hour period. The inspection involved assessing key areas as identified by the CSCI. The inspector spoke with 2 relatives and 6 residents and examined three files using the Case tracking methodology. A tour of the building was undertaken and time was spent observing residents and staff interaction. The inspector spoke with 2 staff members and examined three files. The Registered Manager was present and assisted with the inspection. A number of records were examined, including risk assessments and care plans, and health and safety documentation. An assessment was also made of the progress by the registered persons to address the requirements made at previous inspections. Following discussions with the people living at the home and the staff and management team it was agreed that for the purpose of this report those living here would be collectively termed as “residents”. What the service does well: What has improved since the last inspection? The medication fridge has been defrosted to ensure safe storage of medicines, and two people now sign all handwritten medication instructions. The Registered manager has implemented a new system for storing tables that need to be disposed of and the dispensing labels on the medication are not removed from there original container. All of the staff have now received Dales, The Care Home DS0000036259.V298706.R01.S.doc Version 5.2 Page 6 training on safeguarding adults and the training records were up to date and accurate. The inspector observed safe working practices being maintained by the staff team. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Dales, The Care Home DS0000036259.V298706.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 Dales, The Care Home DS0000036259.V298706.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): 1, 3, 4 and 5 (Standard 6 not applicable) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home provides information about the service to prospective residents and invites them to visit the home prior to admission. Resident’s needs are assessed prior to admission and the home can demonstrate that they are able to meet these needs. EVIDENCE: The inspector examined three files and these demonstrated that a care needs assessment had been completed on these individuals prior to their admission. The information obtained was detailed and enabled the home to make a decision on whether they are able to meet the individual’s needs. All prospective residents are given copies of the Statement of purpose and Service user guide. The inspector spoke with some residents; majority of these had visited the home for a respite period, which enabled them to “check the home out” before they made a decision about moving into the home permanently. One resident informed the inspector that their family members had visited on their behalf and then she came for a trial visit, which enabled her to make an informed decision about moving into the home. Dales, The Care Home DS0000036259.V298706.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. The care planning systems ensures that resident’s needs are detailed and met. The medication practices were satisfactory. Residents felt respected by the staff team, and confirmed that their privacy and dignity is upheld. EVIDENCE: The residents care files that were examined were well organised making it easy to access the required information. Each file contained a personal service plan, which had been regularly reviewed. The plan covered all aspects of resident’s personal, health and social care needs in adequate detail to enable the staff team, to deliver the required support. There was evidence to confirm that these plans had been developed with the resident or their representative. The inspector noted in one residents file that the plan had not been dated. The files also contained a detailed sheet of the individuals preferred routine, which enables the staff team to work to these respecting individual’s preferences. Each resident had daily notes recorded about their well being, as required and these were generally well completed, however the inspector did note that one log requested for a residents foot to be monitored, but the following log did not mention any progress or deterioration in this area. Dales, The Care Home DS0000036259.V298706.R01.S.doc Version 5.2 Page 10 The files contained the required risk assessments in relation to Moving and handling, falls and tissue viability. All of which had been reviewed on a regular basis. The inspector noted that in one residents file the tissue viability tool had been completed and the score had triggered therefore requiring some action to be taken, however it was not clear on the tool what action was taken in response to this high score. There was evidence that monthly and annual reviews are undertaken and changes to the personal service plan were made accordingly. Residents weight was monitored regularly in accordance with the nutritional assessments that were in place. The medication practices at the home were examined and the issues that were identified in the previous inspection report had been addressed. The fridge had been defrosted, and dispensing labels are not removed from the original containers, two staff members had signed all of the hand written medication instructions. The Registered manager had reviewed the storage of loose tablets waiting to be disposed of, and a new system has been implemented. All other aspects of the medication storage and administration were satisfactory. The Registered manager is currently devising an assessment / checklist in order to assess the competency of all of the staff that administer medication, to ensure they comply with the procedures. Residents that spoke with the inspector commented on how “they enjoyed living at the home”, and that the staff team were “good”, “caring” “attentive” and always treated them with dignity and respect.” Other residents who had visited on short basis stated, “I always enjoy coming here and having a good rest”. Dales, The Care Home DS0000036259.V298706.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 have the opportunity to access recreational activities of their choice, and are encouraged to maintain contact with their family and friends. Residents exercise choice and control over their lives. EVIDENCE: The home has a day resource centre attached to it that individuals from the community use and which residents can access. There is a computer and paint room and crafts and art sessions are facilitated. The inspector was informed that the activities post has now been filled and the staff member works closely with the day centre staff to facilitate a range of activities. Residents spoke of the recent “potting up of plants” they had done, and there was pictures displayed and a calendar that the computer group had completed. Residents also have access to a small library. It was evident from the records and conversations that contact with individuals family and friends is encouraged and maintained. The inspector spoke with two relatives who were visiting their mom who was undertaking a short stay period. They had previously used another home, which had since closed down. They commented on how “professional the staff team were, and how they always felt welcomed when visiting”. Positive comments were made about the Dales, The Care Home DS0000036259.V298706.R01.S.doc Version 5.2 Page 12 quality of the care delivered, and how “well looked after” they felt their mom always looked. The relatives stated they “had piece of mind and could enjoy their rest whilst their mom was staying in this home. The discussions and observations confirmed that residents were encouraged to exercise their personal choice and autonomy in the home. Residents choose how they wish to spend their day, and stated that routines are flexible within the home. The inspector joined the residents for their lunchtime meal, which was relaxed and which the residents stated that had enjoyed. The menus contained choices of food for each mealtime and were displayed by each lounge area. The inspector did note that the menu displayed was not the correct week that was being followed in the kitchen. A brief tour of the kitchen was undertaken, and all food was stored appropriately and fridge and freezer temperatures were recorded daily. The Environmental Health Officer inspected the home last year and all of the requirements and recommendations had been addressed apart from one requirement, which was to fit an extractor fan into the kitchen due to the high temperatures of the kitchen especially during the summer period. This had not been addressed due to the cost to undertake this work. Dales, The Care Home DS0000036259.V298706.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): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents felt that their complaints and concerns were listened to and acted upon. Staff had a good awareness of their responsibilities in safeguarding adult’s procedures from abuse. EVIDENCE: The home has a complaints procedure and recording system in place. The inspector was informed that no complaints had been received since the previous inspection. The residents spoken with were aware of the procedure and informed the inspector that they would not hesitate to raise any concerns they had with the staff or the Registered manager The home has a Safeguarding Adults policy in place that links in with the Derbyshire Vulnerable adult’s procedures. All of the staff apart from two new employees had undertaken some form of abuse training either internally or through their NVQ training. The two new staff have covered abuse awareness training within their induction and they will attend a more detailed course in the near future. The Registered Manager informed the inspector that there have been no incidents at the home this year. It was evident from the discussions held with staff members that they were aware of their responsibilities in the event of observing a potential abusive situation. Dales, The Care Home DS0000036259.V298706.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, 20, 21, 22, 23, 24, 25, and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is furnished and maintained to a satisfactory standard and offers homely and spacious facilities for residents to enjoy. EVIDENCE: The inspector undertook a tour of the environment. All areas of the home are decorated to a satisfactory standard and were free from any odours. At the time of the inspection the home was having one of the corridors decorated and the Registered manager confirmed that the residents had been consulted and had chose the colour. The garden areas at the front and rear had been well maintained and were very colourful due to all of the plants and hanging baskets they have been displayed. This gave a welcoming impression to the home. The Registered manager informed the inspector that the home would be entering into a garden competition. The residents had access to small patio areas in which to sit and enjoy the warm weather. Dales, The Care Home DS0000036259.V298706.R01.S.doc Version 5.2 Page 15 The inspector was invited to view some of the bedrooms by the residents. All bedrooms were personalised with resident’s own belongings, and had the appropriate fixtures and fittings available. The staff team confirmed that they had access to equipment to assist with moving and handling of individuals, and a bathroom had been renovated and a shower fitted and an accessible toilet. The inspector did note that there were toiletries left in one of the bathrooms. Dales, The Care Home DS0000036259.V298706.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected 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 adequate. This judgement has been made using available evidence including a visit to this service. A stable experienced and competent staff team support residents. The Recruitment procedures safeguard residents although the staff files did not fully reflect this. EVIDENCE: The inspector examined three staff recruitment and training files. The original copies of the recruitment checks undertaken are kept at the providers Human Resource department and copies are then sent to the home. Each file did contain the required information, however the application forms in these files did not have a full employment history recorded. The Registered manager did confirm that any gaps are explored at interview and the information is then recorded on the interview sheets. But this information is stored at the Human Resource department. It was advised that this information should be evidenced on their application form or verification should be contained in the files to confirm that these checks have been undertaken. The Registered Manager informed the inspector that the staff team have attended the mandatory training and the records confirmed this. Information supplied in the pre-inspection questionnaire confirmed that 10 staff members had completed the National Vocational Qualification (NVQ) to level 2. Residents spoke very positively about the staff team and the standard of care received. The home has had a period of short staffing due to some vacancies and holidays, but these have been covered by the existing staff or by relief Dales, The Care Home DS0000036259.V298706.R01.S.doc Version 5.2 Page 17 staff and the positions have now been filled. The staff members spoken with confirmed that on the whole they were able to meet individuals needs with the staff complement provided but did state that this can be compromised by the dependency needs of individuals that visit on a short term basis. The Registered manager should monitor this and provide additional staffing during peak times if it is required. The staff team felt that some of the management team would assist them in their work if this were requested. The day centre staff and the management team continue to provide cover during the shift change following lunch when only one member of staff is working with residents for an hour before the afternoon member of staff arrives. Dales, The Care Home DS0000036259.V298706.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected 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. The home is managed in the best interest of the residents. Resident’s finances are safeguarded by clear and effective systems that are in place. EVIDENCE: The Registered Manager is experienced, competent and provides clear leadership and has good management skills. The inspector received positive feedback from both residents and staff on how supportive and approachable the Registered Manager was. She ensures that the home is managed in accordance with the best interests of the residents. There was evidence to confirm that the staff team have access to supervision with one of the management team. Dales, The Care Home DS0000036259.V298706.R01.S.doc Version 5.2 Page 19 The inspector checked the financial records and the money held in safekeeping for four residents. All of the resident’s money was stored separately in individual bags. All money held cross-referenced to the balance recorded on the transaction sheets. Receipts are obtained for purchases made on behalf of the residents, and two staff members countersign, majority of the transactions made. The residents have access to regular meetings in order to discuss any issues they may have about the running of the home. The provider also sends out an annual quality assurance questionnaire in order to obtain their feedback, and a report is then published. The Registered Manager undertakes regular audit checks of the systems within the home to ensure that everything is up to date and completed satisfactory. The Registered manager had completed the pre-inspection questionnaire and the inspector obtained this during the inspection. The information supplied confirmed that all of the required health and safety checks had been undertaken and the Registered manager did confirm this at the time. Records confirmed that night staff had received Fire training twice a year as require. Observations of the staff confirmed that safe working practices were being maintained. A service manager had arrived at the beginning of the inspection to undertake an unannounced inspection in accordance with regulation 26 requirements. Due to the inspector being present he left and confirmed that he would undertake his visit on another day. The home had reports from the previous visits undertaken and the most recent ones were dated January and March 2006. Dales, The Care Home DS0000036259.V298706.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 3 3 N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Dales, The Care Home DS0000036259.V298706.R01.S.doc Version 5.2 Page 21 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 OP15 Regulation 16 (2) (j) Requirement The outstanding requirement made by the Environmental Health Officer must be addressed. Timescale for action 01/10/06 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. Refer to Standard OP7 Good Practice Recommendations The residents personal service plans should be dated when implemented. The staff team should record the progress or deterioration of individual’s condition especially when this has been requested in their daily records. The action taken in response to a high score on the tissue viability monitoring tool should be recorded on this tool. The menu on display should be in accordance with the menu being followed in the kitchen. Resident’s toiletries should be removed from the bathroom area and taken to their bedroom following the use of the facilities. DS0000036259.V298706.R01.S.doc Version 5.2 Page 22 2. 3 4. OP8 OP15 OP21 Dales, The Care Home 4. 5 OP29 OP33 The staff files should contain evidence that staff members full employment history has been obtained and all gaps explained. A delegate of the provider should visit the home on a monthly basis and complete a detailed report, which should be available at the home. This is in accordance with regulation 26. Dales, The Care Home DS0000036259.V298706.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Dales, The Care Home DS0000036259.V298706.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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