Inspection on 28/12/05 for The Limes Care Home

This inspection was carried out on 28th December 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Limes Care Home 17/12/07

The Limes Care Home 09/08/06

The Limes Care Home 26/10/05

The Limes Care Home 08/03/05

The Limes Care Home 08/06/04

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, Care Home Park Road Mansfield Woodhouse Nottinghamshire NG19 8AX Lead Inspector Jayne Hilton Unannounced Inspection 28th December 2005 10:20 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, Care Home DS0000008710.V275465.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 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, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service The Limes, Care Home Address Park Road Mansfield Woodhouse Nottinghamshire NG19 8AX 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) 01623 632 681 01623 622644 Mr Ahmad Ally Toorabally Mrs Nazeera Toorabally Carol Ann Wilewski Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40) of places The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th October 2005 Brief Description of the Service: The Limes is a care home providing personal care and accommodation for 40 service users who are over 65 years of age in the category of Older People (OP). The home is owned by Mr and Mrs Toorabally who oversee the conduct of the home. The Limes is a purpose built home with bedrooms and lounges located on both floors. A passenger lift provides access to the first floor. The home is situated in well-maintained grounds in Mansfield Woodhouse close to local shops and amenities. All forty bedrooms are single and ensuite with the opportunity to utilise adjoining doors in two sets of rooms for couples where required. In addition to the ensuite facilities there are two assisted baths, two toilets and one shower on each of the two floors. All rooms have a telephone point available. Bedrooms are tastefully decorated and furnished, they can be personalised where required. Service users have access to sufficient communal space to meet their needs with a choice of lounge including one for smokers and sufficient dining space to accommodate everyone. The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out on 28th December 2005, between 10.20am and 12.50pm by Regulation Inspector Jayne Hilton. The methodology used for the assessment of services provided included a part tour of the building; the examination of a sample of service users care plans and other associated records were examined, for example, Statement Of Purpose, Service User contract, accident records, complaint records and staff training records. The provider, the manager and one staff member were spoken with and four service users. The inspection focused on the previous requirements and recommendations set at the last inspection. Most of the requirements set had been met. One requirement has been carried forward with the original target date. There are no new requirements set from this inspection. What the service does well: Service users live in a home which is well managed and run in the best interests of service users, Their financial interests are safeguarded and staff are appropriately supervised, Record keeping is good and overall service users are protected by good systems for health and safety. Service users have their needs assessed and are confident that their needs are met. On speaking with four service users, it was confirmed that service users felt their needs were being met and praised the registered provider, registered manager and staff team. The registration certificate was displayed and the service users assessed needs reflected the criteria of the registration. The service users health personal and social needs are generally set out in a care plan and these are agreed by the service user or their representative and kept secure. Service users say that privacy and dignity is respected. Service users find that the lifestyle in the home matches their expectations and preferences regarding cultural, religious and recreational interests and needs and they maintain contact with family and friends, are generally helped with making choices and enjoy a varied and nutritional diet. Service users are confident about making complaints and feel their rights are respected. A part tour of the premises was carried out during this inspection and the Inspector noted that the home is decorated and maintained to a good standard and comfortably furnished. The home is purpose built and all rooms are of a good size. The home is set within its own grounds and has car parking. Service users benefit from a safe, The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 6 clean and well - maintained environment, which is pleasantly decorated. Service users are happy with their rooms and all services. The outcomes for service users are very positive. What has improved since the last inspection? What they could do better: The training programme needs improving to ensure all staff have regular updates in mandatory training. Although there was some progress noted ,there was still no second option offered on the actual written menu, therefore alternatives can only be provided for those service users who are able to advocate for themselves. It is recommended that second options are offered and that staff actually ask service users each day which option they prefer and this be documented. Cleaning routines and systems should be reviewed to ensure any mal odour is eradicated. Several good practice recommendations have been made for the home to enhance and further develop on the standards of service already provided. The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 7 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 Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 8 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, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4 The statement of purpose and terms and conditions documents meet requirements and therefore service users have all of the information they need to make a choice about where they live. Service users have their needs assessed and are confident that their needs are met. EVIDENCE: The statement of purpose was assessed and found to now meet the regulation fully as specified under Regulation 4 schedule 1. The terms and conditions document was also evident and satisfactory. Copies of the service user guide are provided in each bedroom. At the previous inspection assessments for service users were reviewed. A copy of the community care assessments had been obtained prior to admission and the home had also carried out an assessment of needs and these were found to be reviewed. The homes assessment meets with the requirements of The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 10 standard 3.3, however not all of the service users needs [identified in Community Care assessments] had been fully identified, either in the homes assessment or care plans, such as depression/low mood. There was now evidence at this inspection, that this had been addressed. The inspector and registered manager discussed the section for the assessment of the mental state of service users on the homes document, which currently is being used to identify if the service user is orientated, rather than addressing any wider psychological or mental health needs. The NMS wording is mental health and cognition. The registered manager agreed to review the way that these needs were identified and addressed. There was evidence of medication details and medication reviews and declarations regarding furniture and equipment, lockable facilities and bedroom door keys. On speaking with four service users, it was confirmed that service users felt their needs were being met and praised the registered provider, registered manager and staff team. The registration certificate was displayed and the service users assessed needs reflected the criteria of the registration. The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10,11 The service users health personal and social needs are generally set out in a care plan, which further development is required to ensure all of the service users health needs are fully met and service users say that privacy and dignity is respected. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. EVIDENCE: Care plans were in place and reflected the assessed needs, identified from assessments and provided clear direction for staff in how the needs of service users will be met. Care plans were signed by service users or their representative and reviewed monthly. It is recommended that an evaluation summary is included in the care plan, which, outlines progress of service users and reviews their holistic needs. The healthcare needs of service users appear to be well met, service users confirmed prompt attention from staff when not feeling well and access to GP etc. Routine health checks are documented but these would be better separated out into the specific healthcare needs, for example separate record The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 12 sheets for GP visits, chiropody, hospital appointments etc rather than being grouped together. Details of the reason for the appointment should be documented on the record sheet, to provide easy access and a running history of input and medical issues, rather than having to look back through the daily progress records. Risk assessments and assessment tools were in place for tissue viability, manual handling, nutrition, dependency levels and where service users have specific risks such as use of a mobility scooter, smoking, and wandering. Authorisation sheets are used where service users require bedrails. Continence issues appear to be well managed. Where service users present challenging behaviour care plans are in place. The care plan format could be improved by a running record of history of falls being included. Currently this is being documented within the manual handling risk assessment but it is advisable that evidence should be provided of evaluation and where necessary care plans implemented for mobility/risk of falls. Risk assessments are reviewed monthly. Service users reported that their privacy and dignity is respected at all times and that staff speak to them in a respectful manner. Service users reported that on the whole staff knock prior to entering rooms, Service users confirmed the facility of a telephone, which is sited in the reception area and confirmed they receive mail unopened. Policies and procedures are in place for dealing with service users who may be dying and after their death. These need to be consolidated and to clarify that the home is not registered to provide Terminal Care for service users and what arrangements need to be in place should a service user wish to remain in the home for the end of their life in these circumstances. The policy also needs to instruct staff of maintaining the security of the service users possessions until relatives or friends can collect them. The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,15 Service users find that the lifestyle in the home matches their expectations and preferences regarding cultural, religious and recreational interests and needs and they maintain contact with family and friends, are generally helped with making choices and enjoy a varied and nutritional diet. EVIDENCE: An activities co-ordinator is employed 16 hours a week over 5 days and the activities usually provided are bingo, dominoes, cards, games and sing-a longs and the occasional outside artist. The manager reported that the daily activities organised are starting to be more varied an include 1:1 shopping outings and which are documented by the activities co-ordinator and who actually participates; the record was examined at this inspection. Social assessments are obtained as part of the initial assessment and the topic had been discussed with service users in a resident relatives meeting held in May 05. Service users confirmed that they could request alternative meal options should they not like what is offered on the menu. A menu is provided in each service users room and is devised over a 4-week cycle, however there is no second option offered on the menu, therefore alternatives can only be provided for those service users who are able to The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 14 advocate for themselves. It is recommended that second options are offered and that staff actually ask service users each day which option they prefer and this be documented. The menu available offers a varied and nutritional diet for service users and service users reported that the quality and quantity of food was satisfactory. The manager reported that second options had been started and showed the inspector a selection list. The menu did not contain information yet of these second options. The manager also reported that she was working on a selection and record sheet for daily recording of service users options but this was not yet implemented. The inspector advised about nutritional values of food and vegetarian options being considered when providing meal options. A service users survey may assist in helping with service users preferences of what types of meals and second options they may like. The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 Service users and their relatives are confident about making complaints and feel their rights are respected. EVIDENCE: A complaints procedure is displayed in the entrance and in the service user guides provided in each service users rooms. Those service users spoken with confirmed they would feel confident to make a complaint should they have one. They also confirmed that the manager deals with any concerns promptly and that they have never had reason to make a formal complaint. There were no complaints recorded since the last inspection. The homes complaints procedure has been further developed to include a template for documenting complaints, response date and include a follow up. Complaints outcomes however should identify whether the complaint has been upheld or not upheld or unresolved etc. The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19-30 Service users benefit from a safe, clean and well-maintained environment, which is pleasantly decorated. Service users are happy with their rooms and all services. EVIDENCE: A part tour of the premises was carried out during this inspection and the Inspector noted that the home is decorated and maintained to a good standard and comfortably furnished. The home is purpose built and all rooms are of a good size. The home is set within its own grounds and has car parking. The outdoor facilities were not inspected at this visit due to the weather conditions on the day. The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 17 Rooms were not measured during this inspection however Inspectors observations indicated that communal space is sufficient to meet Service Users needs. At the time of the inspection the home had vacancies and the communal space on the first floor was not being fully used. The location of lounge and dining areas on both floors provide the flexibility to alter the way in which they are used according to Service Users needs. Assisted bathroom and toilet facilities are provided and grab rails and call alarms are sited throughout. Bathrooms and toilets would benefit from some personalisation. The Inspector was informed that all bedrooms are en-suite. The previous inspection report identifies that in addition there are two assisted baths, two toilets and one shower on each of the two floors. The Inspector saw most of the bathrooms during this inspection and noted that they were clean and very spacious allowing plenty of space for Service Users requiring movement and handling equipment and staff assistance. Liquid soap and paper towels are available in communal bathing and toilet facilities to comply with infection control. The home is set within its own grounds and has car parking. A passenger lift provides access to the first floor. The suitability of the premises in relation to a possible future application for registration for the category of dementia care was discussed and advice given to access information on current research into the impact of the environment on Service Users with dementia. All forty bedrooms are single and en-suite with the opportunity to utilise adjoining doors in two sets of rooms for couples where required. A random sample of bedrooms was seen during this inspection and noted to be decorated and furnished to a good standard. Rooms appeared comfortable and contained Service Users personal items. Hand washing liquid, hand towels and protective clothing were readily available. All areas of the home were clean and no offensive odours were noted. The laundry facilities were ample and meet the standard fully. The home has a policy for infection control and staff have been trained in infection control. There was some slight mal odour present in the ground floor lounge, despite the manager reporting that this is regularly cleaned and the carpet shampooed. It is recommended that cleaning systems be reviewed to ensure that the mal odour is eradicated. The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 18 The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,30 Service users needs are met by the numbers and skill mix of staff. Staff are generally trained and competent to do their jobs but further evidence is needed that all staff have regular updates. EVIDENCE: The rotas were examined and found to be satisfactory for the 30 service users currently in residence. Records for staff training were examined and this evidenced training in fire safety, health and safety, food hygiene, first aid, manual handling, challenging behaviour and continence promotion and adult protection and dementia care. However not all staff have undertaken all of the above and action should be taken to ensure all staff hold training certification in the subjects above. Infection Control training has now also been provided. Training topics should also be provided in relation to the identified needs of service users, for example diabetes, stoma care, dealing with seizures and older persons complex needs etc. The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,34,36,37,38 Service users live in a home which is well managed and run in the best interests of service users, Their financial interests are safeguarded and staff are appropriately supervised, Record keeping is good and overall service users are protected by good systems for health and safety. EVIDENCE: The manager is registered with the Commission and is to register to undertake the Registered manager’s award in the near future. The management systems in the home appeared to be well organised and the manager was reported to be open and approachable by service users and staff. The registered provider Mr Toorabally was also praised. The manager reported that she has an open door policy and is highly committed to endure service users living at The Limes enjoy a high standard of care. The inspector found the manager open to advice and keen to comply with the ethos of The Care The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 21 Standards Act 2000, Care Home Regulations, 2001 and the Associated National Minimum Standards. Staff appeared to be well supervised and equipped to undertake their roles and responsibilities. The certification for appropriate insurance cover was seen. Evidence was seen regarding supervision of staff on a regular basis, the arrangements in place were discussed and advice was given by the inspector of how the manager could further develop this process. Several records were examined. Care plans are stored securely. Health and safety policies were examined. Evidence was provided of a fire safety risk assessment provided. All health and safety practices for COSHH [Control of Substances Hazardous to Health, Accident recording, induction training were all satisfactory. There was no business and financial plan available and the provider and the inspector discussed some issues to resolve this. The Registered Provider confirmed the home is currently viable and agreed to provide evidence of financial viability to CSCI shortly. The Limes, Care Home DS0000008710.V275465.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 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 3 3 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 X 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 X 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 3 X 3 X 3 3 3 The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 23 Are there any outstanding requirements from the last inspection? Yes 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 OP2 Regulation 18 Requirement Ensure that all staff receive training in mandatory topics [carried forward] Timescale for action 26/02/06 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 4 5 6 7 Refer to Standard OP3 OP7 OP8 OP8 OP11 OP12 OP15 Good Practice Recommendations Review the wording regarding mental state in the assessment Implement evaluation reviews within the care package to ensure the holistic needs of service users are formally evaluated and met. Use separate record sheets for each health need check, e.g. Chiropody, GP visits, hospital appointments Practice Nurse visits. Include a running history sheet which details events of falls and use this for the evaluation process Review the policies and procedures for dealing with service users who are dying and after death. Develop the activities program and be more innovative regarding the types of activities organised Offer a second option of meals on the menu and provide DS0000008710.V275465.R01.S.doc Version 5.1 Page 24 The Limes, Care Home 8 9 10 11 OP26 OP30 OP30 OP31 evidence of this being implemented. Review the cleaning systems to ensure any mal-odour is eradicated. Sign and date each topic in the induction process for the relevant day the issue is actually covered. Provide training for staff in topics related to service users identified needs, e.g. diabetes, older persons complex needs, seizure management etc The registered manager needs to complete the Registered managers award to meet the standard fully. The Limes, Care Home DS0000008710.V275465.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Limes, Care Home DS0000008710.V275465.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. 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!