Inspection on 10/10/07 for The Shrubbery

This inspection was carried out on 10th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 Shrubbery 11/09/08

The Shrubbery 03/05/07

The Shrubbery 12/05/06

The Shrubbery 11/10/05

The Shrubbery 05/05/05

The Shrubbery 19/11/04

The Shrubbery 13/05/04

The Shrubbery 03/02/04

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 Shrubbery 66 College Street Higham Ferrers Northants NN10 8DZ Lead Inspector Judith Roan Unannounced Inspection 10th October 2007 08:30 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 Shrubbery DS0000012910.V352627.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 Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Shrubbery Address 66 College Street Higham Ferrers Northants NN10 8DZ 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) 01933 317380 01933 317380 claire@rochmills.co.uk Rochmills Limited Natalia Emilia Mychajlyszyn Care Home 45 Category(ies) of Dementia (8), Old age, not falling within any registration, with number other category (31), Physical disability over 65 of places years of age (6) The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Shrubbery care home is registered to provide personal care for male and female service users whose primary needs fall within the following categories: Old age, not falling within any other category (OP) 18 Dementia - over the age of 65 years DE(E) 8 Physical disability - over the age of 65 years PD(E) 6 Mental disorder - excluding learning disability and dementia - over the age of 65 years MD(E) 13 Service users accommodated within the MD(E) category should only be admitted to the Churchill Wing of The Shrubbery. The maximum number of persons to be accommodated at The Shrubbery is 45. 3rd May 2007 2. 3. Date of last inspection Brief Description of the Service: The Shrubbery situated in Higham Ferrers is near to local facilities and amenities including shops. There are public transport links to the neighbouring towns of Rushden and Wellingborough. The home provides personal care for up to 45 people over the age of 65 years; within this they are registered to provide care for up to 8 residents who have dementia or a history of mental health and 6 with a physical disability. Fees are indicated in the information available from the home and are according to the level of care required. Accommodation is provided over two floors with a passenger lift and staircase for access to the first floor bedrooms. On the ground floor there are several communal rooms including two dining rooms, three lounge areas and a conservatory. There are gardens and level access to the main entrance with ample car parking for visitors. There are 33 single rooms of which 29 have ensuite facilities and 6 double rooms with 3 of these being ensuite. Information about the home can be found in their Statement of Purpose and Service User Guide. The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care Inspection (CSCI) is upon outcomes for people who use the service and their views of the service provided. This process considers the services capacity to meet regulatory requirements, minimum standards of practice; and focuses on aspects of service provision that need further development. The primary method of inspection used was ‘case tracking’ which involved selecting three people who use the service and tracking the care they receive through review of their records, discussion with them, the care staff and observation of care practices. The homes registered manager completed an Annual Quality Assurance Assessment (AQAA), a questionnaire required to be completed by CSCI. The inspection was unannounced and was undertaken during the morning and afternoon and lasted 6 ½ hours. As part of the inspection the inspector used the short observational framework for inspection assessment tool (SOFI) to look at the well being and communication needs of residents. The information gathered is used in support of other evidence gathered at the time of the inspection. The observation lasted for two hours. What the service does well: What has improved since the last inspection? There has been some improvement in the information gathered as part of the assessment process for new residents. Medication profiles have improved. Specialist dietary needs of residents are being met. All staff working at the home have now undertaken mandatory training as set by the National Training Organisation The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 6 A quality assurance system is in place and sets out future development plans for the service. The fire system at the home has now been tested and meets the immediate requirement made at the last inspection. Most health & safety checks and records are now completed. What they could do better: The assessment process for new residents needs to ensure that full details are recorded so that person centred care plans are developed. Care plans and practices need to ensure that the needs of people who use the service that have a dementia or mental health diagnosis are fully met. Care plans need to clearly state how the healthcare needs of residents are to be met to ensure that residents well being is maintained. The menu at the home needs to offer more choice and be wholesome, appealing and acceptable to residents. Sufficient carers need to be working at the care home to ensure that resident’s needs are fully met. Previous timescale of 01/07/07 met in part. The Registered manager must submit to the CSCI how staffing levels have been determined in relation to the dependency levels of people who use the service. Care staff must receive training in Mental Health & dementia care to be competent in meeting the needs of residents cared for at the home. Previous timescale of 01/09/07 not fully met. Sufficient numbers of assisted bathing areas should be provided to meet the identified needs of people resident at the home Records must ensure that there is clear monitoring of residents healthcare needs to demonstrate how they are protected. The emergency lighting system needs to be tested and records kept to meet the Health & Safety regulations. Residents with a diagnosis of dementia should have care plans in place to address their mental health needs. These plans should focus on their strengths as well as weaknesses. The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 7 It is recommended that residents with a diagnosis of dementia should be cared for in a dedicated area of the home in order that both their specialist needs and the needs of other resident groups may be met. The problem of excessive heat in the conservatory should be addressed. Evidence should be available that staff receive formal supervision at least six times a year. Activities need to be based on individual personal preferences, social histories and be person centred. Residents who do not have the mental capacity to make informed decisions need to be protected by an independent advocate working on their behalf. Management structures within the organisation need to delegate sufficient responsibilities to enable the Registered Manager to fulfil their role. 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 Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 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 Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The assessment process for new residents does not give a comprehensive picture on how their needs are to be met. EVIDENCE: In viewing the assessment process undertaken at the home there has been some improvement in the information gathered on the needs of new residents prior to admission. However the forms used were not fully completed and did not set out how their needs were to be met. In one record it indicated that there was a risk of poor nutritional intake, yet the resident was not weighed on admission and no weight monitoring system had been set up within the care file. In another record it indicated that the resident had previously had regular chiropody but did not state how this was to be met in the future. Some records were good and set out the needs clearly, but there was inconsistencies with documentation. Experiences for residents were mixed with some people saying that it had been a good admission but other said that they were not always kept informed. The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are not person centred and fail to fully met the needs of residents. EVIDENCE: Care plans admitted to record all the information necessary to meet the needs of people who use the service. As information was lacking from assessments care plan gaps in how needs were to be met. Senior carers who in the main complete care plan have not received formalised training on how these should be written to ensure that they meet National Minimum Standards. Some basic risk assessments were missing for example on the use of bed rails, as were agreements to have them in place from the resident or their advocate. Another residents file failed to record weights that were an essential part of the nutritional risk assessment. In one file there was no agreement from the resident or their advocate that due to health and safety reason they needed to be supported in the communal area. In these circumstances records need to demonstrate how the decision was made with supporting risk assessments & show that the resident gave up their right to personal choice. The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 11 During the SOFI assessment part of the inspection the inspector observed carers to be respectful and responsive to the needs of residents in the home. Outcomes indicated that although carers do communicate well with residents it was not totally person centred. One resident was withdrawn or displayed negative responses of wellbeing during most of the observation. Another had limited eye contact and was withdrawn over the lunchtime period. Communication with another was general and although positive was not personally directed towards them. Work has been undertaken to improve information around medication. On the files viewed profiles were evident and indicate the reasons for the medication The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care practices at the home do not always ensure that residents have choice and control over their lives. There is a warm and friendly atmosphere at the home where relatives are encouraged to maintain frequent contact with residents. The menu is limited and does not reflect the choices and needs of residents. EVIDENCE: There is no activity organiser during the morning at the home and carers try to work with groups of residents. On the morning of the inspection a reminiscence game was undertaken which appeared to be enjoyed by those who participated. Activities during the morning are dependent on carer’s availability to undertake these. A church service is undertaken within the home on a regular basis with residents having the choice to participate. Families are made to feel welcome at the home and are always kept up to date with changes in needs of their family member. Most residents said that they were assisted to make choices during their day and felt that their preferences were respected. However they did say that the menu choices were limited and that at times the food was not to their liking. On the day of the inspection residents had a The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 13 sausage roll, baked beans, a tomato and tinned peas for lunch. Several people had difficulty in cutting the food and it did not look that appealing. Some resident did not eat their main course but did have the sweet that was tinned fruit and ice cream. At teatime residents had a choice of sandwiches or spaghetti on toast. The orange drink, a cordial was very diluted and tasted only of a hint of fruit. There was a lack of fresh vegetable and fruit available throughout the day. These issues were brought to the attention of the registered manager who again stated that they were limited on what food could be ordered through food suppliers. Some foods were however bought locally. The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents do not always feel that their views are heard and that concerns are not listened to. EVIDENCE: Residents and their relatives are fully aware of how to have their concerns/complaints addressed. One relative however felt that their views were not always taken on board. Carers have undertaken safeguarding/ abuse training and would feel confident in using the whistle blowing procedures if a resident was being harmed. There have been no formal complaints received since the last inspection. A resident who previously lived at the home has been supported to move to a new service where their needs can be fully met thus protecting their right’s and choices. The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21,26 Quality in this outcome area is Adequate This judgement has been made using available evidence including a visit to this service. The home was seen to be clean, safe and maintained to an acceptable standard. EVIDENCE: On the day of the inspection the home was clean and being maintained by a team of housekeeping staff. General maintenance has improved but the organisation is slow to respond to problems identified within the environment. The home only has one operational bathroom that offers lifting equipment to support residents with bathing. One resident’s needs cannot be met with the bath hoist in situ and the showering facilities make it unsafe for a mobile shower chair to be used. A mobile hoist could not be used within the bathroom to enable transfer to a static shower chair. The provider must make alternative arrangements so that all residents can be offered a choice in bathing. The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Recruitment processes ensure that residents are protected. Shortfalls in staff at key times in the day do not fully support the needs of residents. Training available does not equip staff with the skills to provide a person centred service to residents. EVIDENCE: The outcomes of the SOFI assessment indicated that carers were in the main supportive to residents throughout the inspection but were lacking in the skills that could influence the communication from general to being really person centred. The lack of training in this area supports this assessment. Some staff had a natural ability to communicate well with all residents and to include them within the activities of the home, others were less confident, although the SOFI observation may have had some influence to this outcome. At the time of the inspection there were six carers on duty in the morning, which, reduced to five in the afternoon. An additional cook has been appointed at teatime to assist carers with the provision of a cooked meal in the evening. Staffing levels need to reflect the dependency levels of people who use the service. The provider is therefore asked to provide evidence of how they have determined the levels. Families who completed the surveys did support the view that staff numbers were low and that there were often staff shortages for absences. Mandatory training has been undertaken and carers confirmed that they were up to date on manual handling, first aid and fire safety. Some carers have The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 17 undertaken a short course in dementia but this has not given them the breadth of training to deliver a service that is person centred. Evidence of this was that over lunchtime people who were being supported did not have the carer’s individual attention that would have made the experience individual to them. Carer’s files that were reviewed during the inspection contained the appropriate mandatory documentation. The recruitment procedures are robust and protect people who use the service. The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Limited management autonomy restricts the service being run in the best interests of people who use the service. EVIDENCE: The registered manager is limited in carrying out their managerial duties in running the home, as they do not have the ability to sanction the use of additional staff when required due to absences and or the ordering of urgent maintenance tasks. This does therefore limit their ability to discharge their responsibilities as the registered manager under the Care Home Regulations. The provider has responded to the immediate requirements made at the last inspection with most health and safety checks being undertaken and recorded. The emergency lighting checks however remains outstanding and a requirement is made for this to be completed. The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 19 Quality assurance systems are in place with surveys being undertaken annually with the results being reflected in a development plan for the service. People who use the service rely mainly on relatives to assist them with their finances when appropriate. In a few situation the homes administrator keeps valuable and has a good recording system to protect residents. The management of records needs to be quality checked to ensure that important records especially relating to the health and well being of residents are maintained. An example of this shortfall was the lack of information for one resident who had a nutritional assessment to confirm their weight on a regular basis and what food intake had been achieved. The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 20 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 2 X X X HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 2 X 1 X X X X 2 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 1 The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 21 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 OP3 Regulation 14 (1) Requirement All residents must have their needs fully assessed prior to admission. The assessment needs to demonstrate whether the staff have the skills in meeting identified needs. Previous timescale of 01/07/07 not fully met. All residents must have plans of care formulated to guide staff on meeting their needs. These care plans must be individual and specific to the resident, be regularly reviewed and have evidence of the resident or their advocate having input into them. (Previous timescale of 14/06/06, 01/11/06 and 01/07/07 not met) Care plans need to clearly state how the healthcare needs of residents are to be met to ensure that residents well being is maintained. The menu at the home needs to offer more choice, and be wholesome, appealing and acceptable to residents. Sufficient carers need to be working at the care home to DS0000012910.V352627.R01.S.doc Timescale for action 31/12/07 2. OP7 15(1) 31/12/07 3. OP8 12 13 (1) 31/12/07 4. OP15 16(2)i 31/12/07 5. OP27 18 (1) 31/12/07 The Shrubbery Version 5.2 Page 22 6. OP27 18 7. OP30 18 (1) ensure that resident’s needs are fully met. Previous timescale of 01/07/07 met in part. The Registered manager must 30/11/07 submit to the CSCI how staffing levels have been determined in relation to the dependency levels of people who use the service. Care staff must receive training 31/12/07 in Mental Health & dementia care to be competent in meeting the needs of residents cared for at the home. Previous timescale of 01/09/07 not fully met. Sufficient numbers of assisted 31/12/07 bathing areas should be provided to meet the identified needs of people resident at the home Records must ensure that there 30/11/07 is clear monitoring of residents healthcare needs to demonstrate how they are protected. The emergency lighting system 30/11/07 needs to be tested and records kept to meet the Health & Safety regulations. 8. OP21 23 9. OP37 17 10. OP38 23 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 OP7 Good Practice Recommendations Residents with a diagnosis of dementia should have care plans in place to address their mental health needs. These plans should focus on their strengths as well as weaknesses. It is recommended that residents with a diagnosis of dementia should be cared for in a dedicated area of the home in order that both their specialist needs and the needs of other resident groups may be met. DS0000012910.V352627.R01.S.doc Version 5.2 Page 23 2. OP8 The Shrubbery 3. 4. 5. 6. OP25 OP38 OP12 OP17 The problem of excessive heat in the conservatory should be addressed. Evidence should be available that staff receive formal supervision at least six times a year. Activities need to be based on individual personal preferences, social histories and be person centred. Residents who do not have the mental capacity to make informed decisions need to be protected by an independent advocate working on their behalf. Management structures within the organisation need to delegate sufficient responsibilities to enable the Registered Manager to fulfil their role. 7. OP31 The Shrubbery DS0000012910.V352627.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Shrubbery DS0000012910.V352627.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. 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!