Inspection on 17/04/07 for The Lilacs

This inspection was carried out on 17th April 2007.

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

The inspector 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 Lilacs 18/08/09

The Lilacs 16/04/08

The Lilacs 20/04/06

The Lilacs 15/11/05

The Lilacs 28/06/05

The Lilacs 25/01/05

The Lilacs 19/08/04

The Lilacs 03/02/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Lilacs (The) 121 Chalkwell Avenue Westcliff On Sea Essex SS0 8NL Lead Inspector Pauline Marshall Unannounced Inspection 17th April 2007 09:10 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 Lilacs (The) DS0000015447.V332343.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. Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lilacs (The) Address 121 Chalkwell Avenue Westcliff On Sea Essex SS0 8NL 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) 01702 712457 b.watersbassa@aol.com Mr Barry Norton Waters Ms Fazlee Painchun Ms Fazlee Painchun Care Home 17 Category(ies) of Dementia - over 65 years of age (17), Old age, registration, with number not falling within any other category (17) of places Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 20th April 2006 Brief Description of the Service: The Lilacs provides care and accommodation for up to seventeen older people who may also have dementia. The home is situated in a residential area close to the sea front and a short distance from Chalkwell railway station. The home is a large residential style home on three levels. All areas of the home are accessible by a shaft lift. There is limited parking at the front of the home. There is a good-sized garden at the rear of the home. All prospective residents are provided with a Statement of Purpose and Service User Guide that supplies them with up to date information on the home. Fees range from £360.00 to £450.00 and there are additional charges for hairdressing, chiropodist, papers, and toiletries. The registered manager and registered person are closely involved in the daily management of the home. Both have experience of residential care. Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection that lasted for seven hours and fortyfive minutes. A return visit was made on 19th April 2007 to collect further contact details and to inspect financial records that were not inspected on the 17th April 2007. The process included a tour of the premises, a random selection of resident and staff files and discussions with residents, staff and a visiting relative. As part of this inspection surveys were sent to eleven residents, six relatives, three General Practitioners and eleven of the homes staff. At the time of writing this report all eleven residents surveys had been returned and were positive, however each one had been completed with the assistance of the Lilacs care staff. Eight of the eleven staff surveys were returned and included comments that the home was of a high standard and offered its residents lots of choice in activities, food and all matters relating to them. Staff also commented on how well the home cares for its staff and they felt that the activities offered that included walks to the seafront and reminiscence sessions were really worthwhile and that residents benefited from them. Staff also said in their surveys that they felt that the Lilacs is a very warm and friendly home. One relatives survey was returned and contained comments that the care was of the highest standard at all times and that they were always kept informed and that staff were friendly and that The Lilacs is a home from home. No other surveys were returned. Twenty-three of the thirty-eight standards were inspected. What the service does well: The home has a homely feel and residents are able to choose what they want to do with their time. The home and its staff demonstrate a good rapport with residents and their relatives. The staff team are well trained and communication between them is good. Residents’ bedrooms are filled with their own personal possessions and residents said that they choose what they want to do. Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 6 The home offers a good choice of fresh home cooked food and the cook will vary the menu to suit the needs of the residents on request. What has improved since the last inspection? 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. The summary of this inspection report can be made available in other formats on request. Lilacs (The) DS0000015447.V332343.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 Lilacs (The) DS0000015447.V332343.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home carries out a full pre-admission assessment of needs and provides prospective residents with sufficient information to enable them to make an informed choice. EVIDENCE: The homes Statement of Purpose and Service User Guide were reviewed in January 2007 and contain up to date information on the services that the home provides. The home manager has acquired a pre-printed assessment report that will be used in all new admissions from 17th April 2007. In addition to covering health and personal care needs the report documentation includes religious and Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 9 cultural needs and personal relationships and social interests and hobbies. The care files examined contained the older style of pre-admission assessment forms that covered all the necessary information. The Lilacs does not provide intermediate care. Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The homes care plans contain the information required to meet the resident’s needs. Health care needs are fully met and the new medication system will provide a better method for auditing. The home does not have written instructions for administering PRN (as and when medication). Residents are not always treated with respect and their privacy upheld. EVIDENCE: The care files examined contained all the relevant information and set out each residents individual care needs and how they were to be met, each of the care plans examined included evidence of regular review having taken place. The manager intends to implement a new care plan format for all admissions after 17th April 2007, this format improves upon the one currently used. Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 11 The home keeps a record of all health care visits and records the outcomes in the individuals care plan. The care files examined contained good information on health visits including follow up actions that were needed. Residents spoken with confirmed that they regularly attended clinics and out patient appointments. One of the care files examined indicated that the resident had not seen a health practitioner since 30/12/05; the manager said that staff might have removed this documentation whilst undertaking NVQ work and that they must have returned it to the wrong place. The residents care notes indicated that health visits had taken place for this individual. Resident’s private notes are confidential and must not be removed from the care file. The home is using a new medication system that comprises of weekly deliveries in individual trays; this system has been in effect since 16th April 2007 and staff are in the process of learning the new system. As the new system came into effect just one day prior to the inspection, the home was still holding quite a lot of old and unused medication which was due for return. The proprietor said that the medication returns book could not be located and that he believed it was still with the pharmacist since the last returns were made. All unused and out of date medications must be returned to the pharmacy and a receipt obtained. The proprietor made a list of this medication and returned it to the pharmacy during the inspection and provided the inspector with a copy of his signed receipt. There were no PRN (as and when medication) protocols in place. All as and when required prescribed medications must have clear instructions of why, when, and how they should be administered. Staff were observed to treat residents respectfully addressing them by their preferred names and explaining tasks to them in a manner that was dignified. Residents and a relative spoken with confirmed that staff always treated residents with respect and dignity. On the day of the inspection one of the residents was very confused, was hard of hearing and sitting in the bedroom inappropriately dressed and a piece of plastic was being used to protect the seat. The manager explained the reasons for this but should have used alternatives to the clothing chosen. Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents experience a lifestyle that matches their needs and they are encouraged to maintain contact with their family and friends and have as much choice and control over their lives as possible. Residents receive a wholesome appealing balanced diet in pleasant surroundings. EVIDENCE: The home offers a range of activities and residents spoken with said that they liked the reminiscence sessions and playing softball. The home also provides a singer and dancer occasionally and a person that does poetry readings. None of the current resident group actively practice their religion, however, the manager said that should anyone wish to do so in the future it would be arranged for them. The home encourages open visiting and a relative spoken with said that they visit weekly and are always made to feel welcome. Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 13 Residents are consulted daily to enable the home to provide services that the residents want. The home also holds regular residents meetings where issues are debated and solutions found and recorded. The proprietor of the home is the main cook and provides residents with a varied menu of balanced healthy home-cooked meals. Residents spoken with commented on the high quality of the food provided and the fact that they get “plenty of it”. The home keeps nutritional records that show the choices that were offered, however the records do not show what was actually chosen. The proprietor said that these will be amended to show the actual choice made. The proprietor has undertaken the food hygiene “Safer Food Better Business” course and is in the process of completing the required documents. The last food hygiene inspection was carried out on 6th March 2006 and stated that the home had a good standard of cleanliness. Some of the opened packets of foods were not adequately labelled with dates of opening. The dining area is small but well laid out, the tables were nicely laid and the atmosphere throughout the meal was happy and relaxed with some residents enjoying a singsong. Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints are acted upon swiftly and all issues are taken seriously by the home. Residents are protected from abuse. EVIDENCE: There were two complaints made to the home since the last inspection and the records evidenced that they were dealt with appropriately. The home has a clear complaints policy that is in need of review to ensure that it meets the current requirements. The home has policies on physical restraint, the Protection of Vulnerable Adults and whistle blowing; all of these policies were reviewed in January 2007. Staff spoken with was aware of all of the homes policies and how to implement them. All staff has received training in the Protection of Vulnerable Adults. Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The home is in need of general repairs and redecoration, items are not stored appropriately and could present a risk to residents and staff. The garden is untidy and not equipped for residents to enjoy. Some areas were clean and there was no unpleasant smells, however the old and faulty equipment in use was not clean and hygienic. EVIDENCE: The patio door in the dining room would not open fully; the manager said that this was on the list for the handyman to repair when he next visited. Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 16 Hairdressing was being carried out in the lounge area in full view of others; residents spoken with said that they enjoyed watching the process and the residents receiving the service said that they did not mind having their hair done in front of others. There was an unused washing machine stored in the hallway outside a resident’s bedroom; the resident is partially sighted and the storage of this machine is inappropriate and could present a safety risk. The proprietor said that the washing machine would be removed immediately and stored elsewhere. The homes laundry cupboard was overflowing and the doors would not shut properly. All of the washing is dried outside on the line and in bad weather on racks within the home. The home does not have a tumble dryer and should consider purchasing one, as it is not good practice to have damp washing laying around the home at any time. Several of the commodes used within the home were found to be in a poor state of repair; one was found to have rusty fittings and a stained and ill-fitting bowl. The proprietor replaced this immediately. The sleep-in room, which is used by staff daily, contains stored items such as toilet rolls. The manager said that these would be removed and stored in the shed. One of the wardrobe doors could not be shut. The proprietor said that all of the maintenance tasks would be carried out this week when the handyman visits. A discussion took place around the need to record all identified repair jobs in the maintenance book prior to the handyman’s visit to ensure that important jobs do not get forgotten, especially as the handyman only visits when called in. The staff toilet did not have a handle attached to it and the boiler lid (in staff toilet) was left open and the controls exposed. The garden area contains a large amount of old furniture, fittings and garden waste. This must be cleared to ensure that residents are able to access the garden safely. The garden shed contained incontinence pads, a lawn mower, new commodes and garden furniture. It was very untidy and difficult to access because of it Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 17 being so untidy. The manager said that this would be tidied immediately to enable further storage of the toilet rolls and other items currently stored in the sleep-in room. Four of the fence panels had recently fallen down due to bad weather and the proprietor said that they were waiting for contractors to carry out the repair. The repair was carried out before my second visit on the 19th April 2007. The freezer was in need of being defrosted, as there was a large amount of ice around each compartment, which could make it less effective. There was no liquid soap available in communal bathrooms and the bath mat was black with mould. Two sets of teeth were found in a pot in the downstairs bathroom and the proprietor and manager did not know whom they belonged to. The outside of the kitchen window was in a poor state of repair and needs to be either repaired or replaced. The manager said that the handyman would be looking at this on his next visit. The hallway upstairs and one of the bedrooms has been decorated; the proprietor said that when rooms are vacated they are generally refurbished before being re let. Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff are well trained, competent and supplied in sufficient quantities to meet residents needs. The homes recruitment policy and practice generally protects residents, however the practice of using CRB checks undertaken by previous employers may place residents at risk. EVIDENCE: The home has a stable staff group; some of the staff has worked at the home for many years, agency staff are rarely used and staff turnover is low. The duty rota reflected the staff on duty and staff was of a good skill mix. Two staff has completed their NVQ training in the past twelve months and three staff are in the process. Half of the homes staff is now NVQ trained. Staff spoken with said that they have enjoyed the NVQ training. All of the documents required under Schedule 2 of the Care Standards Act were in place with the exception of one reference for a member of staff that Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 19 had been employed by the previous owner many years ago. Two of the care files examined contained CRB clearances from a previous employer. A discussion took place around the portability of CRB documents. All of the staff files examined contained evidence of good staff training that includes mandatory and service specific training. Staff spoken with confirmed that the training opportunities were good at the Lilacs. Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 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 well managed and run in the best interests of its residents and their financial interests are safeguarded. The health, safety and welfare of the residents is promoted and protected. EVIDENCE: The manager is one of the proprietors of the home and is a Registered Nurse with many years experience and has also qualified to NVQ level 4 in management. The management team undertakes regular training and has recently completed dementia, Parkinson’s disease and difficult behaviour training in addition to updates of the mandatory subjects. Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 21 Te home has a quality assurance system that includes residents meetings and a quality questionnaire that is completed by relevant people. The manager evaluates the returned survey forms and devises a report on the findings; a copy is provided to the residents and to the CSCI. Resident’s cash is kept in the safe; the cash transaction records examined was all correct and receipted. All safety certificates are in pace and the homes health and safety policies and procedures are up to date and staff spoken with confirmed that these were put into practice. Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 22 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 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 1 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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 OP8 Regulation 17 (1) (b) Requirement The registered person shall ensure that all residents’ records are kept securely in the care home. Timescale for action 30/06/07 2. OP9 13 (2) This refers to the resident’s health appointment record that could not be located. The registered person shall make 30/06/07 arrangements for the safe administration of medicines received into the care home. This refers to the need to have PRN (“as and when” medication) protocols. The registered person shall ensure that the care home is conducted in a manner that respects the dignity of residents. This refers to the inappropriate use of plastic sheeting and items of clothing. The registered person shall provide adequate facilities for the laundering of clothing. This refers to the need for the 3. OP10 12 (4) (a) 30/06/07 4. OP19 16 (2) (e) 30/06/07 Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 24 5. OP19 13 (4) (a) home to provide a tumble dryer. The registered person shall ensure that all parts of the home used by the residents is free from hazards to their safety. 30/06/07 6. OP26 13 (3) This refers to the unused washing machine outside a bedroom door and the overflowing cupboards in the laundry room. This requirement also refers to the household waste that is stored in the garden. The registered person shall make 30/06/07 suitable arrangements to prevent infection, toxic conditions and the spread of infection. This refers to the mouldy bath mat and the unidentified false teeth found in the bathroom and also the damaged and stained commodes. The registered person shall not employ a person to work at the care home unless he has obtained all the documents required under Schedule 2. This refers to the need to obtain a fresh CRB check for all new employees. 7. OP29 19 (b) (i) 30/06/07 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 OP16 Good Practice Recommendations The complaints policy should be reviewed to ensure that it contains up to date information. Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 25 2. 3. OP19 OP19 The patio door should be repaired to enable it to be fully used. The freezer should be defrosted at regular intervals to ensure the safety of the foodstuffs stored in it. Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Lilacs (The) DS0000015447.V332343.R01.S.doc Version 5.2 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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