Inspection on 20/05/07 for The Old Deanery

This inspection was carried out on 20th May 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 Old Deanery 03/06/09

The Old Deanery 26/01/06

The Old Deanery 24/06/05

The Old Deanery 17/02/05

The Old Deanery 12/08/04

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 The Old Deanery Deanery Hill Bocking Braintree Essex CM7 5SR Lead Inspector Jane Greaves Key Unannounced Inspection 29th May 2007 09:40 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 Old Deanery DS0000017972.V342072.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 Old Deanery DS0000017972.V342072.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Old Deanery Address Deanery Hill Bocking Braintree Essex CM7 5SR 01376 328600 01376 344278 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) Anglia Retirement Homes Limited Mr Clive Ansell-Jones Care Home 70 Category(ies) of Old age, not falling within any other category registration, with number (70) of places The Old Deanery DS0000017972.V342072.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 70 service users) 26th January 2006 Date of last inspection Brief Description of the Service: The Old Deanery is a large listed building, with a new extension built in August 2000. The home is on two floors and offers single bedroom accommodation, with the exception of one companion room. The majority of bedrooms have en suite facilities. The home offers accommodation to seventy service users who are aged 65 and over. The home is set in large well maintained gardens with an enclosed courtyard provided. Car parking is available and security gates are provided at the entrance to the home. The Old Deanery is situated in the village of Bocking, which is within easy reach of the town of Braintree and surrounding facilities. There is furnished accommodation, for independent living, in a two bed roomed flat on the third floor. Clear criteria are set with regard the tenancy and a separate contract states that tenants access to the home is limited to flat access only, unless invited to visit. Tenants only receive housekeeping provision. A copy of the most recent inspection report issued by the Commission for Social Care Inspection was available in the entrance hall of the home. The fees charged for care and accommodation at The Old Deanery range from £565 to £665, this information was provided by the registered manager on 29/05/07. The Old Deanery DS0000017972.V342072.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 took place on the 29th May 2007, lasting seven hours. The inspection process included: • • • • • • • Discussion with manager Physical tour of the home Inspection of a sample of records and policies Conversations with six staff members Conversations with 13 residents Feedback questionnaires from residents Feedback from relatives This report also takes into account all the information CSCI had received about The Old Deanery since the last inspection including information provided by the service and the views of people living at the home and their families. The overall care and well being of the residents was the focus of the inspection. 21 Standards were assessed, and the outcomes for the people living at the home against these standards were all good. There were no requirements made. The home continues to provide a consistently good level of care and support. What the service does well: What has improved since the last inspection? • • • Evidence is included in the care plans of individuals living at the home to show where they are involved in planning their care. Arrangements have been made to provide an equal standard of service and support in both dining areas. The provider continues to maintain the very high standard of the premises through an ongoing redecoration programme. The Old Deanery DS0000017972.V342072.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Old Deanery DS0000017972.V342072.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 Old Deanery DS0000017972.V342072.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): 3 and 6. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People considering moving into The Old Deanery can be confident that admission processes ensure that the home can meet their needs. EVIDENCE: The Old Deanery provides a comprehensive package of information for people considering moving into the home. The home has a website containing plenty of information and photographs to provide an overview of life at the home and the facilities available. The manager assesses prospective residents before they come to live in the home, and a record of a pre-admission assessment showed that appropriate issues were considered. Discussions with the people living at the home during this visit confirmed they felt they had received enough information about the home to enable them to decide if it was the right place. The Old Deanery DS0000017972.V342072.R01.S.doc Version 5.2 Page 9 Significant time and effort is made making the process of admission into the home personal and well managed. A series of training sessions have been developed to provide the staff with the necessary skills to support new residents and their family members through the process of moving into the home and settling in. All those consulted felt that they received the care and support they needed, and relatives who provided feedback all felt that the home meets the needs of individuals and gives them the support the relative expected. All individuals spoken with felt that whatever the circumstances of their admission to the home, it had been a positive move. One family member said, “we looked at many homes along with other family members, The Old Deanery was a unanimous choice” The home does not provide intermediate care. The Old Deanery DS0000017972.V342072.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 and 19. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. EVIDENCE: The Care plans relating to four of the people living at the Old Deanery were examined at this visit to assess how the service understands the way in which it should meet their needs. The care plans contain a variety of assessments that identified the level of support the individuals require in their daily lives. Plans are regularly reviewed and updated to show changes, with clear review notes maintained. Evidence of individuals involvement with developing their own plan of care is available through monthly quality assurance questionnaires and within the care plans. The health care of people living at the home is monitored through the documents contained in care plans; these include health professional visits and their outcomes, monitoring sheets for weight and dietary intake etc. The Old Deanery DS0000017972.V342072.R01.S.doc Version 5.2 Page 11 All people providing feedback confirmed they receive the medical support they need, with one saying “the staff are always prompt when I have any medical needs, calling my doctor when needed and ensuring my medication is correct”. Aids and equipment are provided to encourage and promote independence for people living at the home and the risk management framework supports individuals to maximise their independence. The service arranges training on healthcare topics that are relevant to the people they support. One example given was external instruction being provided for staff to maintain and change batteries in hearing aids. The registered manager was able to report that the home receives good support and enjoys excellent relationships with varied healthcare professionals that are involved with the home such as the falls co-ordinator and community pharmacist. Medication is administered from trolleys that are stored securely when not in use. The daily administration of medication is well recorded with no gaps evident. A Pharmacist has undertaken a recent audit of the home’s medication practices including administration, storage of medicines, disposal of medicines and staff training. The report of this audit stated that the team worked to a very high standard. People living at the Old Deanery made many positive comments about the staffs’ attitude towards them. They felt that their dignity and privacy were respected. Good practice was observed during this site visit for example, staff were seen to knock on doors before entering a room and ensured that doors were closed when attending to residents’ personal care needs and discrete, sensitive assistance was provided at mealtimes. Comments received from the people at the home included “I found it difficult to let someone carry out personal care for me but they always make sure that they help me discretely and keep me covered as much as possible, they provided me with dignity”, “The staff are wonderful, nothing is too much trouble and they do things the way I ask them to”. A family member reported, “We are confident that my relative is treated with respect and dignity.” The Old Deanery DS0000017972.V342072.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 and 15. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people living at The Old Deanery are able to make choices about their lifestyles and the social, cultural and recreational activities meet their expectations. EVIDENCE: Central to the ethos of the home is the promotion of peoples’ rights to live fulfilling lifestyles. People living at the home are encouraged to enjoy a stimulating life with a variety of leisure activities and opportunities to choose from. Examples of these include: Playing croquet (whilst enjoying a glass of Pimms), Mini Golf and a hog roast where families are invited. The home has installed a computer for the use of the people living there and this includes a ‘web cam’ enabling families to keep visual contact with their relatives. The registered manager reported efforts to find a care home in France to make contact with to give individuals the opportunity to have pen pals via the computer. The home has advertised for volunteers to visit with individuals to chat over past life experiences and ‘bring the community into the home’. Various indoor activities take place daily such as reminiscence sessions, baking and potting plants. On the day of this visit a group of people were enjoying a Sky television is game of table skittles with an activities co-ordinator. The Old Deanery DS0000017972.V342072.R01.S.doc Version 5.2 Page 13 available in all bedrooms. The service employs 2 people dedicated to providing entertainment and leisure activities, known as ‘entertainment hosts’. One of these people has attended NVQ training in this area and it was reported that this had provided many more ideas of activities to undertake with individuals. Three visitors were spoken with during the course of this visit. All were very positive about the care and support provided for their friends and relatives living at the home. The home has an attractive ‘banqueting’ room on the first floor that can be booked for special occasions and parties. The home also offers a menu, with a charge, for residents and families to use for large parties and events. It was reported that residents have had many private parties with their friends and family using this facility. There is a kitchenette on the first floor to enable people living at the home and their visitors to make drinks when they wish. The people living at the home were happy to talk with the inspector about their experiences of living at The Old Deanery. Everyone consulted confirmed that their lives were arranged around their personal wishes such as what times they went to bed or rose, when they bathed/showered and what they chose to do with their time during the day. The home provided the services of a ‘mobile shop’. This provided individuals with the ability to choose and purchase toiletries, birthday cards and sweets etc themselves. One person consulted was able to describe how choices had been offered when new curtains had been ordered for a bedroom and evidence was available to demonstrate where family members had been involved in decisions regarding refurbishment of their relative’s bedroom. One family member said when consulted: “my relative has the freedom to come and go when they please and be independent, that is so important” The home has two pleasantly appointed dining areas, these rooms were not large, and consequently lunch was served in two sittings. The manner in which the meal was served was dignified and respectful, the atmosphere was sociable and pleasant. There was some segregation noted with the people that were less able to eat without assistance eating separately from more able individuals. The staff team ate their lunch in the dining room, with the agreement of the diners, and were therefore on hand to provide assistance sensitively where necessary. The people living at the home were largely complementary regarding the meals at the home. They enjoyed the large choice of desserts and the offer of a cooked breakfast everyday. The menu is displayed outside both dining rooms and offers a good choice of healthy meals. The cook prepares several desserts each day that are displayed on trolleys. Family members reported “The food has always been excellent” and “we have eaten at the home with our relative and the meal was lovely” The Old Deanery DS0000017972.V342072.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 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at The Old Deanery are able to express their concerns with the confidence that they will be listened to and taken seriously. EVIDENCE: The service has a complaints procedure that contains appropriate information to ensure the people living at The Old Deanery or other interested parties know what to do if they need to make a complaint, including timescales for response and contact details for the Commission for Social Care Inspection. All the people consulted as part of this visit said that they knew who to speak to if they were not happy, and knew how to make a complaint. Those spoken to were confident to speak up if they had any concerns, and felt that any concerns would be listened to and acted on. Relatives spoken with all knew how to make a complaint, and were happy that the service responded appropriately to any issues raised. The home had a compliments folder that contained many and varied items of positive feedback from families, people staying at the home for respite care, students undertaking work experience etc. The service has a policy and procedure for dealing with the Protection of Vulnerable Adults. The registered manager reported that the service has a member of staff who is qualified to deliver Protection of Vulnerable Adults The Old Deanery DS0000017972.V342072.R01.S.doc Version 5.2 Page 15 training. Age Concern provides advocacy services for any individual living at the home or family members that may wish to seek advice. The registered manager is on the county adult protection committee and so very aware of the need for training and vigilance with regard to adult protection. The Old Deanery DS0000017972.V342072.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): 19 and 26. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The people living at The Old Deanery benefit from a safe, well-maintained and comfortable environment. EVIDENCE: The home is very well maintained and attractive with a variety of communal space available for residents to use. There is a selection of communal areas both inside and outside the home so that people living at the home have a choice of place to sit quietly or meet with family and friends. The bedrooms are mainly single and provide adequate space for the recommended furnishing including armchairs. The rooms were pleasantly laid out with low windows to enable residents to see out when seated, and had been personalised with resident’s choice of décor and belongings. The Old Deanery DS0000017972.V342072.R01.S.doc Version 5.2 Page 17 The bathrooms were easily accessible to all people living at the home and were decorated to a good standard, pleasantly tiled and well equipped. One contained a Jacuzzi bath, which was a particular favourite with many of the people living at the home. Laundry trolleys and pad bins, whilst it is accepted that they are necessary, marred the appearance of these facilities. Discussion was held with the registered manager about his plans to ‘disguise’ this equipment in line with the high standard of ambience in the rest of the home. The home employs a maintenance person who keeps the home and gardens safe and in good repair. Grounds were well maintained. Maintenance and decoration records were not viewed on this occasion, however it was evident from a physical tour of the building that the service is very proactive in this area. The kitchen and laundry were clean, organised and efficient. The Old Deanery DS0000017972.V342072.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 and 30. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The care staff in the home are trained, skilled and employed in sufficient numbers to provide effective personal and healthcare support to the people living there. EVIDENCE: The home operates a sound recruitment procedure ensuring the safety and welfare of the people living at the home. Recruitment is selective with the employment of the right person for a position being more important than filling a vacancy. The registered manager reported instances where people living at the home had been involved in interviewing potential staff members, it was reported that the individuals had thoroughly enjoyed this experience. People living at the home and their relatives gave very positive feedback about the calibre of staff employed to work at the home. “Staff have always been polite” and “Staff are lovely and seem to stay a long time” are an example of the comments received. The home maintains staffing levels appropriate to the needs and number of people living there. Individuals consulted felt that there are always sufficient staff available when they need them, and relatives consulted felt that staff have the right skills and experience to look after residents properly. Throughout the inspection visit the atmosphere was calm and peaceful with The Old Deanery DS0000017972.V342072.R01.S.doc Version 5.2 Page 19 none of the hectic movements associated with activities such as mealtimes. People consulted also commented that they did not feel rushed at any time of the day, they were given time to get up and did not feel that staff were overly stretched. The staff interacted with residents in a respectful and pleasant manner. Discussion with the registered manager and scrutiny of records confirmed that the service is proactive in its staffing, recruitment and training, with planning for the potential needs of people who may use the service in the future. Staff are provided with relevant training that is targeted on improving outcomes for people living at the home. The registered manager maintains a checklist to ensure that all staff training/refresher training is delivered promptly. A ‘staff profile’ folder is available in entrance hall at The Old Deanery for the people living at the home, their family members and other members of the staff team to access. This contains details of the individuals on the staff team such as photographs, their qualifications and training attended and any interests they have. Evidence was available to confirm that staff meetings and staff supervision take place regularly. Heads of department meetings take place weekly where training, activities, new staff and policies and procedures are some of the things discussed, the outcomes of these meetings are cascaded through individual departments to ensure good communication throughout the service. The Old Deanery DS0000017972.V342072.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 and 38. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The management and administration of the home is based on openness and respect EVIDENCE: The Manager is very experienced, a dual qualified registered nurse and has completed the Registered Manager’s Award. The manager demonstrates an active and ongoing commitment to developing the home. It was good to learn through discussion with the registered manager and two of the care managers that there is good awareness of current Commission for Social Care Inspection guidance such as the Key Lines Of Regulatory Assessment (KLORA) and good knowledge of the National Minimum Standards. The Old Deanery DS0000017972.V342072.R01.S.doc Version 5.2 Page 21 The service operates a constant system of monitoring ‘customer’ satisfaction including sampling a small random selection of residents monthly so that ‘survey fatigue’ doesn’t occur. Responses indicated a high level of satisfaction of the care and services provided at the home. The service maintained cash balances for very few people living at the home, these were kept securely and checked and agreed at this visit. It was reported that where individuals who did not look after their own monies wished to purchase items from the mobile shop, have their hair done or participate in outings the service supported this and a monthly invoice was sent to family/representative providing a breakdown of where monies had been spent. Health and safety policies and procedures were not specifically inspected on this occasion, but it was noted that the manager had revised many policies. The home appeared well-maintained and safe, and information submitted to the CSCI prior to the inspection showed that routine servicing and checks were up-to-date. The Old Deanery DS0000017972.V342072.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 X X 4 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 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X X X X 4 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 3 The Old Deanery DS0000017972.V342072.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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Old Deanery DS0000017972.V342072.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ 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 Old Deanery DS0000017972.V342072.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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