Inspection on 25/07/07 for The Limes

This inspection was carried out on 25th July 2007.

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

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

Other inspections for this house

The Limes 18/05/06

The Limes 21/02/06

The Limes 27/04/05

The Limes 18/11/04

The Limes 11/05/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE The Limes Main Street Scopwick Lincoln Lincs LN4 3NW Lead Inspector Roger Harrison Unannounced Inspection 25th July 2007 09:00 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 The Limes DS0000002448.V341292.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. The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Limes Address Main Street Scopwick Lincoln Lincs LN4 3NW 01526 321748 01526 321516 thelimes.1@tiscali.co.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) Ablegrange (Lincoln) Limited Mrs Jacqueline Mandy Burrows Care Home 40 Category(ies) of Dementia (2), Old age, not falling within any registration, with number other category (38) of places The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Conditions of Registration A condition of registration is that the maximum number of service users in each category is as follows:Up to 2 DE, 63 years and over. Up to 38 OP. Date of last inspection 18th May 2006 Brief Description of the Service: The home, a single storey building, was originally a school and is situated in the village of Scopwick. There are no local shops but the home is close to the main Sleaford to Lincoln bus route. There is a railway station in Metheringham, approximately three miles away. There is a public house, a church and a small community centre nearby. The home provides personal care for people over the age of 65, with two rooms for people with dementia over the age of 63 years. There are thirty-one single bedrooms, sixteen en suite, and three double bedrooms, all of on the ground floor. Ablegrange Ltd owns the home and an established registered manager runs it on their behalf. Fees range from £348.00 to £431 per week. Services such as hairdressing, chiropody, toiletries, magazines and newspapers, transport and recreational opportunities are charged separately. The home is advertised in hospital predischarge information packs, supplied to patients and their families by the United Lincolnshire Health Trust and in British Legion information literature. The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was undertaken by an inspector reviewing all the previous inspection records available, looking at information provided by the manager about The Limes, and by undertaking a visit to the home, with the inspector using a method of inspection called “case tracking”. The inspection visit was completed over a period of six and a half hours and involved identifying individual residents who currently live at the home and tracking the experience of the care and support they have received during the time they have lived there. The inspection was also used to check that information provided by the manager before the visit matched the individual experiences of residents. This was done by talking to the manager, residents, family carers and care staff whilst observing day-to-day care practice within the home. Since the last key inspection an additional random inspection visit was made to check on progress regarding outstanding requirements from the previous inspection. This visit will be referred to where appropriate in the following report. What the service does well: What has improved since the last inspection? What they could do better: There is a need to keep reviewing and taking action to improve the overall maintenance needs of the home. The home-owners do not visit the home regularly to talk to residents and staff in order to monitor and provide written monthly reports on the quality of care being provided by the manager and care team. The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 6 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. The Limes DS0000002448.V341292.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 The Limes DS0000002448.V341292.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): Standard 3 [Standard 6 N/A] Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager completes an assessment of residents’ needs and provides information to confirm that their needs can be met before any admission to the home takes place. EVIDENCE: Before this inspection visit took place the manager provided copies of the homes service user guide and statement of purpose, which set out clearly what residents should expect from the care team and their responsibilities as residents of the home. During the inspection visit the manager showed that copies of the user guide and statement of purpose are available for residents at any time in the reception area of the home. Copies of the user guide were also available in The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 9 resident’s rooms. Residents said that they were aware of this information and some residents said they had their own copy. The manager provided information on care plans for residents who live at the home showing that an assessment had been completed before admission took place and that information from the assessment had been used to create a care plan. The manager said that trial visits and reviews had been used together with residents and family carers to ensure that changing needs could be met. Residents sent written comments to the Commission before making the inspection stating that they had been given information and received an assessment of their needs before deciding to move in. During the inspection visit residents and family carers made positive comments about their experience of planning and moving into the home. One resident said that “I came to look round and found it a warm and friendly place to come to” and “They told me all about the home before I came so it helped me to know where I was coming to” One family carer said “Mum came from hospital and we got the chance to talk, receive information and to visit the home while planning the move”. The Limes does not provide an intermediate care service. The Limes DS0000002448.V341292.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): Standards 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. Residents’ health and personal care needs are set out in an individual care plan and their health needs are met. There are policies and procedures in place, which staff follow in order to support residents with their medication needs. Residents are treated with respect and are supported to maintain their dignity. EVIDENCE: During the inspection visit the manager provided copies of individual care plans, which were set out in separate sections showing how the assessment completed at the time of admission is used to create the overall care plan. Care plans contained risk assessments, with records to show they had been reviewed each month. Reviews had been completed in detail showing who was involved and were signed to show they had been agreed with. The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 11 Care plans showed residents’ likes and dislikes and staff team members were observed throughout the inspection visit showing that they had a good understanding of each resident’s individual health and social care needs. Care plans contained details of individual life profiles, which the manager said is sought and used to enable them to offer the right support to residents. Residents said they had the choice to provide information or not about their personal history and made comments about their care plans which ranged from, “I know they have to use the information about my care needs to make sure I’m safe and I do feel this is the case” to “They are reviewing my care needs together with other workers and myself to find out what support I might need when I go home” Care plan information also contained details about the support given to people with their medicines. Storage was secure and records matched the details provided on care plans about how medication needs should be met for each person. One senior member of staff was observed using the procedure in place for helping residents with their medicine needs. The staff member was supporting a resident to take his medication in a way, which kept him in control of the overall actions needed. The staff member used gentle communication and showed an understanding of how the resident liked to be supported. The Limes DS0000002448.V341292.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): Standards 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 are supported to take part in activities within the home and community and feel that they have control over their own lives. Residents receive a varied, balanced and nutritious diet. EVIDENCE: During the inspection visit the manager introduced the new activity organiser for the home, who said that she had recently started at The Limes and is working together with residents to make sure they are supported to make choices and take more control over their activity decisions. One resident said, “The best thing is being able to go out, I love to shop and the activity person has taken some of us out together. We plan transport and go for it” another resident said, “We talk about the things we want to do and activities are arranged to suit our likes and dislikes”. The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 13 Care records contained individual profiles, which the activity organiser said she has started to use to get to know about each resident and their needs. A newsletter is produced regularly which details residents group meetings, entertainment events at the home, when church services are being held, community activities and the latest issue included details about a planned trip to Skegness. Residents were observed coming and going out into the community and receiving visitors as they said they wished. Residents said that they had a choice whether to get involved in the planned activities at the home or not and that they liked the activities available. One resident said, “I’m going bowling today, I go regularly and it helps keep me active”. Residents who have dementia care needs were observed being supported in a sensitive way by staff members to take part in individual activities. For example the manager and staff members were observed taking time and using gentle encouragement to maintain one person’s mobility and freedom to walk around the home and in doing so, his independence. Care plans contained information about what people liked to eat and whether they were on special diets. The cook described how this information is used to help her to plan the menu. Residents said that they enjoyed the food and that they had a choice about the meals received. Menu plans showed a variety of options, which residents said were available to them. The manager said menus had been improved using her quality assurance questionnaire, which enabled residents to make comments about what they would like to see change. One resident said, “The food has got better and I like what we have”. During the inspection visit the cook described how special diets are provided for those who need them and residents made positive comments about their experience of the food available, which ranged from, “If I want a change I just let them know and its sorted out” to “the food is just right for me” The Limes DS0000002448.V341292.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): Standard 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager and care team take complaints seriously and wherever possible involve residents and carers in resolving issues as soon as they are raised. The manager and care team know how to act in order to protect residents from abuse. EVIDENCE: Before the inspection visit took place the manager provided a copy of the home’s statement of purpose, which contained information about what to do and who to speak to if people have concerns. During the inspection visit, information about how to raise concerns was readily available at the entrance to the home. The manager said that she always keeps a record of any formal concerns or complaints received and confirmed that she keeps a complaints log. No formal complaints have been made about the services provided since the last inspection. One informal concern has been raised since the last inspection, which involved a disagreement between two residents. The manager showed and described how she used the care plan review process and risk assessments together with The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 15 the individuals involved to help to resolve the situation whilst maintaining the right to make decisions for both residents. Residents and visiting family carers commented that they felt happy to raise any concern direct with the manager and one family carer said, “I don’t live nearby but the staff keep me in touch and they have helped with all aspects of mums care, I am very happy with the outcome of her living here”. The manager and staff members described how they had received training in order to identify and know how to report concerns and take action in order to protect people from abuse. A copy of the adult protection policy and procedure for Lincolnshire was available in the home. One staff member said, “The training helped us to understand the importance of reporting all concerns direct to the manager so she can take action”. The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 16 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): Standard 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is clean and the environment is set out to ensure residents can access all areas safely. The home is in need of a decorative update. Parts of the building are in need of appropriate maintenance to ensure that the needs of all residents can be met. EVIDENCE: Since the last key inspection a further random inspection visit was made to check on improvements made regarding the homes environment. During this visit the manager showed that she was working toward achieving the improvements required and before making this inspection visit the manager provided some written information showing areas of the home environment which been improved. The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 17 During the inspection visit the building was observed to be clean and tidy. The manager showed that she had completed work to make sure the bathing areas could be used by residents who need special equipment to keep them safe. Water temperatures are now adjusted using a new system to help keep water at the right temperature so that it is safe for residents to use. New sluice facilities are also being used to ensure that resident’s health needs are fully maintained. The manager has also introduced a no smoking policy to the home and showed how residents who do smoke are being supported to do so with appropriate outside cover. The residents who use this facility said that they agreed with the arrangements in place. The manager did recognise that some parts of the home are in need of ongoing decoration and maintenance to make sure that the upkeep of the home environment is maintained. For example, a ceiling had leaked in one resident’s room, which meant the resident needed to move to another room while the repairs were being planned. The resident had been supported move safely to a room near his own room and indicated that he was happy with the way he was being cared for but did want to get back to his room as soon as he could. The manager showed she had acted straight away and obtained quotes for the repair work and was waiting for agreement from the home-owners so that she could start the work. Contact was made with the home-owner during the inspection visit and it was agreed the work could start immediately. One family carer also commented, “the only thing that let’s the home down is the decoration. It’s a bit dated and it would benefit from being done”. Plans for improving the overall environment were discussed with the manager and home-owner who confirmed they had received a grant to improve the environment further to include upgrading the existing shower room to a “wet room” to help promote greater independence for residents and would be using the grant to maintain fire safety and improve the garden areas of the homes grounds. It was confirmed that this work is about to be started. The manager also confirmed she would be carrying out a full environmental and decorative audit, which she would share with the home-owners in order to provide a structured maintenance plan, which includes timescales for work needed to be carried out. The Limes DS0000002448.V341292.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): Standards 27,28,29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are currently sufficient numbers of safely recruited care staff available at the home with appropriate training and skills to meet the needs of residents. EVIDENCE: Before the inspection visit took place the manager provided information about who works at the home, and during the visit the manager described how the staff team work together, using their different skills as a team to provide appropriate levels of support for residents who live at the home. One staff member said, “We work well as a team and all get on together, it’s a settled group and we have staff meetings and all know how to work together to support on another” The manager stated that all staff are recruited using proper checks to ensure residents are safely supported, and staff files held by the manager contained information, which showed that staff have been recruited safely. A staff teammeeting calendar was also available in the manager’s office showing staff meetings for the year. The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 19 During the inspection visit a group of staff members met with the inspector and described how they had been provided with an induction and had undertaken nationally recognised qualifications in order to develop their skills in supporting people to be independent. They also described equality and diversity training, which they said had helped them to recognise the need to support people as individuals. One staff member said “It’s about seeing the person for who they are” and another said, “The residents have the right to live in the way they wish and we make sure their dignity is respected when giving personal care”. Staff files showed details of their induction and training. The manager confirmed that training has been provided to make sure staff know how to provide support for residents. Training events were detailed on the managers training plan and included; adult protection, fire safety, moving and handling, food hygiene, equality and diversity and dementia training. Staff members were able to describe how they apply their training to the work they do. The Limes DS0000002448.V341292.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): Standards 31,32,33,35 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 has a manager who supports the staff team to care for residents safely and encourage them to be as independent as possible. The manager encourages feedback from residents and staff and there is a formal system in place for consulting residents and family carers about the quality of care provided. The home-owners do not visit the home regularly enough to provide support for the manager in order to plan and agree the future development of the home together. The manager safeguards residents’ financial interests. The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 21 EVIDENCE: The manager is registered to manage the home and provided information to show that she has a wide range of experience in the management of care services. Residents and family carers said they trusted the manager and felt able to speak with her whenever they needed to. Comments made by residents ranged from “The manager is very good, she is easy to talk to” to “The manager always makes sure the staff look after me well” One family visitor said “I visit the home regularly and I can tell you the manager is excellent at what she does”. The manager has a quality assurance system, which she said she uses to ask residents about the quality of care provided by the home. A new questionnaire is in the process of being produced and circulated to residents and the manager said she would be placing copies in the reception area of the home for so that visitors can also make comments. A suggestion box is used for daily comments and the review process used by the team provided further information about how residents are consulted about their care needs. The manager said that the home-owners could be contacted if there are any concerns that she needs to discuss. However, records available in the managers office showed that the home-owners do not visit the home to provide support for the manager or spend enough time making visits to monitor and report on the quality of the care being provided by the home overall. Some records were available to show that visits had been made but did not show that residents and staff had been given an opportunity to meet and talk to the owners about how things are. Staff members did say they would like more opportunities to talk to the owners about their ideas for the ongoing development of the home and to receive feedback about their work. It was clear through discussions with the manager that she had worked hard to try to encourage the owners to visit more regularly to monitor performance, provide recognition for achievements made and to highlight any improvements that might be needed together, but that her efforts had not been successful. This issue was discussed home-owner and the manager confirmed that a meeting had been arranged to make sure plans were put in place for regular visits to commence. Residents said that they are able to manage their own financial arrangements either individually or with support from family members. The manager confirmed that when requested she does have arrangements in place to help support residents to make sure that they have access to their own day-to-day The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 22 money. The manager said that whenever she is asked for support with managing daily finances she keeps a detailed record to make sure she knows how much money each resident has. A check made during the inspection visit showed these records were accurate. The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 23 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 X X 3 X X 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 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 2 3 X 3 X X 3 The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 24 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 OP33 Regulation OP26(a) (b)(c) Requirement The registered person must visit the home every month, unannounced, to get and record the views of residents and staff on the standard of care provided. Timescale for action 25/09/07 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 OP19 Good Practice Recommendations It is strongly recommended that the registered provider carries out an internal environmental audit together with the registered manager in order to produce a clear action plan with timescales, which fully identify and address all the environmental needs of the home. The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 The Limes DS0000002448.V341292.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!