Inspection on 05/01/06 for The Douglas Arter Centre

This inspection was carried out on 5th January 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Douglas Arter Centre 09/05/06

The Douglas Arter Centre 04/08/05

The Douglas Arter Centre 18/01/05

The Douglas Arter Centre 01/06/04

The Douglas Arter Centre 02/03/04

Similar services:

The Vicarage

7 Hyde Road

5 Seafield Road

Trevaylor Manor

12 Orchard Mews

Stallcombe House

Stepping Stones

Cornerstones

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

CARE HOME ADULTS 18-65 Douglas Arter Centre (The) Odstock Road Salisbury Wiltshire SP5 4JL Lead Inspector Alison Duffy Unannounced Inspection 5th January 2006 09:50 Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 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 Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 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. Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Douglas Arter Centre (The) Address Odstock Road Salisbury Wiltshire SP5 4JL 01722 320318 01722 421537 douglas.arter@scope.org.uk 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) SCOPE Mrs Susan Janet Brown Care Home 9 Category(ies) of Physical disability (9) registration, with number of places Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th August 2005 Brief Description of the Service: The Douglas Arter Centre is a residential care home registered to care for nine adults with a physical disability. The home is situated on the outskirts of Salisbury near the citys hospital. The home is managed by SCOPE and the Registered Manager is Mrs Susan Brown. The Douglas Arter Centre is purpose built and also consists of an integral day centre. All areas on the ground floor provide full disabled access. Offices, staff rooms and the sleeping in room are located on the first floor. The home has nine single rooms, which are all personalised and individual in style. There is a small lounge although service users are also able to use the main lounge in the day centre as required. There are specialised bathing facilities and a range of specialist equipment including overhead hoists in bedrooms. During the week, staffing levels are maintained at a minimum of five staff in the morning and four in the evening. At weekends this reduces to a minimum of four within the morning shift. At night one member of staff undertakes a waking night and another provides sleeping in provision. An on call management system is also available. Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 5th January 2006 from 09.50am 3.30pm. On arrival at the home all service users were within the day centre area undertaking various activities. One service user later had a rest in their room due to being unwell. A number of service users were spoken with and various interactions with staff were observed. All service users appeared settled, animated and contented and staff were seen to readily involve individuals in discussion and general activity. A tour of the accommodation was made and various records were viewed. Such information included care-plans and daily records, staffing rosters, the accident and fire log book and complaint information. Mrs Mary Collier, Pharmacy Inspector also attended to examine the medication systems. Mrs Brown, Registered Manager was in a meeting on arrival at the home and therefore the staff on duty assisted as required. Hospitality was evident and those staff spoken with provided information with efficiency and enthusiasm. Mrs Brown soon arrived and assisted throughout the remainder of the inspection. What the service does well: What has improved since the last inspection? The environment has been enhanced through the redecoration of a number of rooms and the main residential corridor. The use of throws and the new large screen television enables the residential lounge to be more homely and appealing. Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 6 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. Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 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 Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 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): 2 The home has a detailed organisational admission policy that assures appropriate, well-managed placements. EVIDENCE: As all service users have lived at the home for a number of years it was not possible to view recent assessment documentation. All placements at this time are successful and therefore any changes are not expected. The above standards were therefore not assessed in detail during this inspection. It was evident however that SCOPE has a detailed systematic admission procedure, which is followed as required. All prospective service users would almost certainly have a care manager and through discussion it was apparent that documentation is extremely important to Mrs Brown in order to ensure the safety and wellbeing of service users. Admitting a service user without sufficient assessment would therefore conflict with the home’s culture of good practice. Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 9 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 Care planning is of a very good standard yet consideration needs to be given to the reviewing process in order to ensure all are up to date and consistent in levels of content. EVIDENCE: A comprehensive care-planning format has been developed which gives a holistic view of service users’ needs. A number of plans were viewed and all except one contained a high level of detailed up to date information, which demonstrated the key worker’s knowledge of the service user. The plans were well written and clearly detailed preferred routines and key themes. Guidelines were in place regarding the use of specialised equipment and in some instances photographs had been used for easier reference. Various programmes to address aspects such as communication and eating and drinking were in place. These programmes had been developed through specialised assessments and were noted to be detailed, comprehensive and easy to follow. All plans also contained a high level of carefully considered risk assessments, which demonstrated the individuality of service users. The care plans are clearly working tools and are used as an integral part of formal review settings. Monthly key worker summary formats are also completed which identify key themes such as illness and social activity. These formats are Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 10 used as a form of review as well as summarising information for easy reference. All care plans demonstrated involvement from service users and/or their representative. Involvement from specialised services was also apparent. Although care plans contained detail, one plan had suggestions for additions highlighted within handwritten form. The content of the plan had not however been developed and much of the information had not been reviewed. Monthly key worker summary formats had also been missed since July 2005. Discussion took place with Mrs Brown regarding the standard of this particular plan, as it appeared significantly different from the others. Mrs Brown reported that she would investigate the matter and address issues as required. Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 11 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): 12, 13, 14 and 17 Service users are assisted to undertake meaningful activity and be an integral part of the community. Meal provision is mainly provided from the local hospital, although all food appears satisfactory and meets service users’ needs. EVIDENCE: Through discussion and viewing documentation it was apparent that service users continue to attend the integral day service and college placements. All remain successful and meet individual need. As well as purposeful activity, service users continue to have access to a wide range of specialist input such as physiotherapy, music therapy, speech and language therapy and occupational therapy. Service users are also encouraged to assist with matters such as cooking lunch on a Tuesday and general housekeeping tasks including removing cups to the kitchen. Staff positively engage with service users and many positive interactions were seen. Such instances included general conversation, informal banter and assistance with viewing a magazine. Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 12 The Douglas Arter Centre is located next to Salisbury District Hospital and therefore additional neighbours are limited. The home has its own transport, which is linked to individual need. Mrs Brown reported that public transport including buses and taxis are also regularly used in order to increase independence and enhance community involvement. At the last inspection, a number of feedback cards commented on the need for more external outings. A recommendation was therefore made to monitor such and now an activities diary is maintained. This demonstrated a range of activity, which increased significantly over the Christmas period due to involvement in community events. Mrs Brown reported that staff consider external events as part of their role and therefore often assist service users with trips out. A key worker system is maintained and key worker days take place on a regular basis. On the day of the inspection one service user was going over to the hospital with a member of staff to take their specimen for testing. Another service user went out for a walk with a member of staff and then undertook some shopping. Mrs Brown and the staff team fully promote service users rights and aim to improve quality of life. Additional funding has been applied for, in some instances, in order to provide an annual holiday or a day out equivalent. Staff believed all service users to be registered on the electoral role although Mrs Brown reported she would confirm this. Mrs Brown reported that there have been no recent changes to the meal arrangements. Food continues to be sent over from the hospital in special trolleys although on a Tuesday, service users assist with cooking their own lunch. Staff also cook at weekends. Service users are able to choose from a range of options and specialised diets are catered for as required. Service users have a detailed eating and drinking plan within their care plan. This is in a detailed, easy to read format, which highlights any special requirements or equipment. Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 13 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): 18 and 20 Detailed documentation demonstrates a high level of personal support, which is delivered, with advice gained as required from specialised services. The home has a clear policy for the handling of medication although the competency of staff to carry out this duty safely should be routinely checked. EVIDENCE: Service users continue to receive full assistance from staff in all aspects of daily living. This is clearly detailed within care planning information. A range of individualised equipment is in place and procedures for such are clearly stated. Some service users are unable to express how they wish their care to be delivered. In such instances staff rely on gestures, facial expressions, general contentment and individual communication systems. Advice is gained on a regular basis from specialised services and staff also work closely with family members. The home operates a key worker system and facilitates one-to–one work with service users. Daily records demonstrate that staff are very attentive and recognise any unusual signs or symptoms of ill health. Within such documentation however, Mrs Brown was advised to ensure staff number the daily recording sheets, as a few were disorganised and therefore difficult to follow. Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 14 Service users, due to complexity of need are not able to self-medicate. Medication is stored securely and appropriate records are maintained. Care plans are in place for the use of ‘as required’ and emergency medicines. Staff receive training in medication handling and extended training for more complex tasks. Discussions were held with Mrs Brown regarding reducing the potential for error during the drug round. The home is a busy environment with many visitors and distractions. Staff administering medicines should therefore be able to concentrate solely on that task. Their competency should also be regularly assessed. Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 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 a clear, well-managed complaint procedure that encourages views to be raised in order to develop practice and ensure the well being of service users. Adult protection policies are readily instigated yet current systems of notifying the manager of incidents, is inadequate in order to ensure full protection. EVIDENCE: Some service users are able to raise their concern or dissatisfaction yet others rely on staff, family members or representatives for identification of such. As noted at the last inspection, the home has a detailed and comprehensive complaints procedure devised by SCOPE. The complaints procedure is well managed and documentation demonstrates appropriate investigation of matters. Mrs Brown appears committed to listening to individuals and believes in addressing matters honestly, in order to develop service provision. Mrs Brown aims to be approachable and meet with relatives on a regular basis. Any apparent issues are also discussed within formal review settings. The CSCI has not received any formal complaints regarding the service. The home has detailed adult protection policies, which are satisfactorily instigated as required. A recent incident was immediately referred to the Vulnerable Adults Unit and a thorough investigation was undertaken. As a result of the investigation, specific guidelines have been developed and are in the process of being agreed with the service users’ care manager. The guidelines are currently located within the individual’s plan of care. It was recommended however that the guidelines should be specifically related to each situation, which may provoke such an incident. Mrs Brown agreed to investigate this option. Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 16 Through viewing documentation it was evident that staff appear aware of possible abusive situations. For example documentation was in place, which identified the purpose of an arm splint so that its usage was not associated with any form of restraint. Within a daily record it was evident that a member of staff had noted bruising on a resident and an incident form had been completed. Generally, incident forms are placed on Mrs Brown desk for authorisation before filing although on this occasion, Mrs Brown had not seen the report. The matter was therefore not investigated. Mrs Brown identified the shortfalls within this situation and reported that the process of reporting such would be addressed with the staff team. Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 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): 26, 28 and 29 The home is conducive to service users needs and contains a high level of specialised equipment. Private accommodation is decorated and furnished to a high standard, with emphasis on individuality and personal preference. All areas of the home are well maintained, cleaned to a good standard and odour free. EVIDENCE: The Douglas Arter Centre is a large purpose built building, which includes a day service and a residential area. The residential area has nine single rooms, bathroom facilities and a small sitting room. The ground floor provides full disabled access and there is a range of specialised equipment in place throughout the home in order to meet individual need. All equipment is regularly serviced and monitored in relation to the suitability of its usage. Service users’ private accommodation is decorated and furnished to a high standard. All rooms are individual in style and demonstrate service users’ preferences. Since the last inspection a number of rooms and the main corridor have been redecorated. The requirement made at the last inspection to Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 18 address an area of damage through the use of the hoist, has been addressed. All areas of the home were noted to be clean, odour free and well maintained. The residential area has a small lounge, which has recently been enhanced through throws and a new large screen television. Service users are also able to use the day centre area for general relaxation. The day centre dining room is generally used for all meals, as greater space is available. Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 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): 33 Staffing levels are maintained as agreed by the previous Registration Authority. EVIDENCE: Staffing rosters demonstrate that the home continues to operate at a minimum of five staff on duty during the morning. During the evening there are a minimum of four. At night one member of staff undertakes a waking night and another provides sleeping in provision. An on call management system is also available. The home currently has a number of vacancies, which will be advertised shortly using a new advertisement format. The centre has a large staff team. Some staff have specific areas of work and are responsible for either the residential area or day centre. Many staff however, work across both services. Although not assessed on this occasion, staff meetings and formal supervision are established systems. Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 20 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): 39 and 42 The home does not at this time have a detailed quality assurance system, yet this will be developed in the near future through anticipated changes of CSCI. Accident reporting and fire safety are well managed therefore reducing the risks to service users. EVIDENCE: Mrs Brown has recently requested feedback of service provision from family members and interested professionals. This was undertaken through various questionnaires, which the organisation devised. The home does not have a further quality assurance system and Mrs Brown was not aware of an additional organisational format. A requirement would normally be made to address this, although in light of future changes with CSCI, additional quality assurance measures will almost certainly be instigated in the future. There have been no significant accidents since the last inspection. The accident book contained clear factual accounts and regulation 37 notifications have been completed as required. Mrs Brown monitors all accidents and applies Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 21 control measures if possible, in order to minimise any further occurrences. In the event of an accident involving equipment, a referral is made for an urgent specialist review, in order to ensure the suitability of the equipments’ usage. The fire log book was found to contain an up to date record of required checks. These included the fire alarm systems and emergency lighting as well as a visual check of the means of escape and the fire extinguishers. A fire drill had taken place in each identified period and staff instruction was up to date. Mrs Brown was advised however to ensure that all staff sign to demonstrate their receipt of instruction. Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 22 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 Standard No Score 1 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 X 25 X 26 3 27 X 28 3 29 3 30 X STAFFING Standard No Score 31 X 32 X 33 3 34 X 35 X 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 X X X X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 X 16 X 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 X 3 X X X 2 X X 3 X Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 23 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 YA6 Regulation 15 Requirement The Registered Person must ensure that all care plans are regularly updated and therefore portray an accurate reflection of individual need. The Registered Person must ensure that incident reporting is reviewed and a protocol devised, so that any potential adult protection issue is brought to the attention of the manager to be fully investigated. Timescale for action 28/02/06 2 YA23 13(6) 28/02/06 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. 2. 3. Refer to Standard YA13 YA18 YA20 Good Practice Recommendations The Registered Person should ensure that all service users are registered on the electoral role. The Registered Person should ensure that daily records are numbered in order to give continuity and an organised approach. The Registered Person should ensure that all staff who administer medicines are regularly assessed in relation to DS0000028497.V275595.R01.S.doc Version 5.1 Page 24 Douglas Arter Centre (The) 4. YA20 5. 6. YA23 YA42 their competency of the task. The Registered Person should ensure that service users, visitors and other members of staff are encouraged not to distract the staff member administering medication during the medicine round. The Registered Person should ensure that any behavioural management guidelines are clearly stated in relation to the circumstances, which may provoke such behaviour. The Registered Person should ensure that all staff sign and date the fire log book in order to demonstrate their receipt of fire instruction. Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB 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 Douglas Arter Centre (The) DS0000028497.V275595.R01.S.doc Version 5.1 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. 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