Inspection on 25/04/05 for The Willows

This inspection was carried out on 25th April 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 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 Willows 19/06/08

The Willows 27/06/07

The Willows 22/06/06

The Willows 13/09/05

The Willows 19/10/04

The Willows 04/05/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Willows 72 Boreham Road Warminster Wiltshire BA12 9JN Lead Inspector Roy Gregory Unannounced 25th April 2005 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Willows Address 72 Boreham Road, Warminster Wiltshire BA12 9JN 01985 215757 01985 215554 thewillows@exalon.net Exalon Care Homes Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Karen Jane Wilkinson Care Home 8 Category(ies) of 8 LD Learning Disability registration, with number 1 LD(E) Learning Dis - over 65 of places The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1 The maximum number of service users who may be accommodated at any one time is 8. 2. Only the male service user referred to in the variation application dated 10 November 2004 may be aged 65 years and over Date of last inspection 19th October 2004 Brief Description of the Service: The Willows is registered to provide care to up to eight people with a learning disability. It is owned by Exalon Care Homes Limited. Karen Wilkinson has managed the home since April 2004 and was registered in September 2004.The Willows is a sizeable detached Victorian property with a large enclosed garden to the rear. Two lounges, a dining room, kitchen, utility and office accommodation are on the ground floor, whilst the service users’ bedrooms are located on the first and second floors, together with shared bathrooms with toilets. The home is situated a walk away from the centre of Warminster, with shops and amenities close by. As well as the home having its own car for the use of residents, there are very good public transport links to neighbouring towns and further afield. The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place between 9:40 a.m. and 5:20 p.m. on Monday 25th April 2005. The inspector spoke at length with five residents, including one who had only recently moved in. The registered manager, Karen Wilkinson, was available throughout the day and made documentation available. Additionally there were conversations with a team leader and two care staff. The inspector selected a number of care plans to compare observations of care and residents’ perceptions with written records. Other records consulted included those relevant to recruitment, staffing and medication, and a new company policies and procedures manual. All communal areas of the building were visited and an individual room was seen with the consent of its occupant. Also at the home on the day of inspection was Susie Tudgay, operations manager for the provider company, who joined the inspector’s closing session with the manager. What the service does well: What has improved since the last inspection? What they could do better: Although care plans have developed, they do not show much evidence of residents’ own input to them. Some residents said they did not know of the content or purpose of care plans. This shows a role for key workers to involve service users more in care planning. This must be matched by better recordkeeping, such that records are more meaningful and linked to what residents, through their care plans, are aiming to achieve. The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 6 The home environment was not inspected in detail, but there were very poor standards of cleaning in high-risk areas, i.e. bathrooms and the kitchen. The stairways were in need of cleaning and there were some holes in walls. Some service users commented on these shortfalls. The company aims to extend and improve the home during the coming year, but meanwhile there needs to be a plan to identify where hygiene is at risk, and to ensure cleaning is adequate. 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 Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1, 2, 3 & 4 There is a clear assessment and admissions procedure, in which prospective residents are fully involved. Good quality information is made available, with pictorial content. Visits are facilitated prior to moving in to ensure prospective residents have had a chance to meet other residents and staff before making a decision to move in. EVIDENCE: The provider company has a comprehensive admission policy and procedure, which includes use of a recently developed needs and dependency analysis. The inspector spoke with a resident who had recently come to live at The Willows. This person felt they had been given good information, in the form of the home’s brochure and service user guide, also a recent newsletter that gave an indication of the lifestyle currently pursued by residents. A visit to the home was arranged prior to actual admission. Whilst feeling they actually had little area of choice in their wider personal situation, the resident concerned was confident the home would help them realise longer-term aims. Their admission represented a move from another home run by the same provider company. There was evidence of good co-operative working between staff and management of the two homes, including an assessment visit by Willows staff to the resident at the other home. The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6, 7, 8 & 9 Individual plans direct care, and incorporate individual goal-setting, for which there is evidence of review. However, residents do not participate sufficiently in the care planning process. There are good systems in place for consultation with residents about every-day and special events in the home, resulting in a culture of participation. On an individual level there is appropriate support to risk-taking and to making decisions. EVIDENCE: Care plans were in place for all residents, including the recently admitted person, who saw their plan as reflecting immediate and longer-term needs and aspirations. Other residents seemed to feel distanced from care planning, seeing it as something done for rather than with them, although each care plan commenced with objectives that were clearly identified by residents themselves. These in turn were subject to recorded review. The ordering and content of care plans owed much to the manager, who agreed the inspector’s view that key workers now need to take more responsibility for additions and reviews. Sections of care plans were headed by first person statements, but contents did not continue like that, showing scope for opening the care planning process to more direct involvement by service users where this is possible. There was also a lack of detail in plans. For example, where a service The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 10 user’s wish for assistance with money management had been recorded, there was no indication of what aspects they found difficult, or the nature of assistance that had been decided. There was much evidence that service users were supported in decisionmaking. For example, bath and laundry arrangements had been negotiated individually between some residents and staff, and written up as agreed plans of action. There was plentiful evidence of sign-posting of residents to external resources, and support in using these. As a group, residents participate in meetings to share ideas and opinions about everyday and special issues in the home. Minutes showed there had been six meetings in a three-month period. They could be improved by beginning each meeting with a review of how issues from the previous meeting have been addressed. Records of provider monthly unannounced visits always demonstrate consultation with service users, including contact with those without verbal skills. Support to residents’ skills development and participation in community contact is backed by a range of tailored risk assessments. The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 &16 Service users are offered a range of organised and spontaneous activities, including support to access community resources. There is evidence of an appropriate balance being found between rights and responsibilities. EVIDENCE: Continuing involvement in preferred activities figured in residents’ own care plan goals, with evidence of achievement. The home has built up resources such as camping and fishing equipment, which appeal to some residents, and the garden showed evidence of use by residents for a variety of purposes. Effort is made to provide at least one organised activity per day; two residents were involved in a dice game with two care staff during the afternoon. Service users are engaged in a variety of day activities provision in the community, including employment for one, and objectives in this respect were evident in care plans. Spontaneous access to the community is also the norm, subject to risk assessment. Staffing is at a sufficient level to allow for individual opt-outs from arranged activities and excursions. Residents considered staff respected their privacy and that they were in charge of their own daily routines. Many service users have signed agreement to receipt of support with management of medication or finances. In respect of those service users in need of greater levels of support, the inspector observed The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 12 sensitive care being offered, with choices facilitated. There was also evidence of support being offered to meet service users’ wishes in respect of voting at the forthcoming general election. The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18, 19 & 20 Staff offer personal support that matches service users’ needs and preferences. Healthcare needs are clearly recorded and managed, with full use of external consultation and guidance. Medication practice is competent and shows a pro-active approach that protects service users’ interests. EVIDENCE: Service users considered staff to have a good understanding of their preferences about personal support. For those with greater skills deficits, staff exhibited competence and sensitivity. Care records and service users indicated much on-going liaison by the home with external professionals concerning physical, emotional and psychological health matters. A specialist epilepsy nurse had given a training session to staff, and a service user was fully included in this. Monitoring records are kept where desired by external professionals, with service user agreement. A behaviour nurse who visits the home has told the inspector of her high regard for the ability of the staff to seek and act on advice. At the time of inspection there were no service users administering their own medication, with the exception of some inhaler use, due to a combination of choice and risk assessment. The storage and recording of medication were orderly, with previous requirements having been accorded with. Administration was in accordance with the home’s medication policy. There was much evidence that the home staff are pro-active in seeking reviews of medication; The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 14 recently a request for review of a long-term medication had resulted in change to “as needed” use, backed by a letter of guidance from the prescribing doctor. The administration record showed the medicine in question now to be scarcely used. The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 22 & 23 Complaints are handled objectively and competently. Service users’ concerns are recorded and acted on. Vulnerable adults procedures were in place but not up to date. Staff and management practice in respect of incidents of potential harm are sound. EVIDENCE: There is a complaints policy that service users are encouraged to consider using when dissatisfied with any aspect of the home’s functioning. Four out of the five complaints on record concerned service user complaints regarding behaviours by other service users. These had been fully investigated and had led, among other outcomes, to decisions about allocation of staff to help minimise areas of possible conflict. The fifth complaint concerned how a staff task was being done, and had been satisfactorily addressed. Combined with other channels of communication, service users considered they could raise issues easily, and that concerns were responded to. In looking at some of the home’s policies and procedures it was necessary to draw attention to a discrepancy between the policy on “service user abuse” and local procedures, despite a review date of January 2005. However, service users felt the home provided for their safety. Notifications from the home to the Commission have indicated that situations that have arisen have been handled professionally, putting service users’ safety first, and with police liaison if necessary. All staff have received training in physical intervention as a last resort strategy, and there was a comprehensive new policy on “prevention and management of challenging behaviour.” One service user said they trusted the home staff to understand their behaviour patterns and to have the time and knowledge to work with these. The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 25, 26 & 30 Service users have well-proportioned, locking rooms that lend themselves to being made personal and private. Cleaning standards were unsatisfactory, posing a risk of compromising infection control standards in high risk areas. EVIDENCE: In view of imminent plans for alterations and an extension to the building, the inspector did not concentrate upon environmental considerations at this inspection. Residents said they were content with their respective individual rooms, for which all hold and use keys. The recently admitted person looked forward to making their room more to their taste, whilst considering the basic provision to be good. The inspector saw this room by invitation, and found it to be spacious and with adequate furniture; the wash hand basin was awaiting connection. Some service users complained of the poor state of the bathrooms and toilets, which are shared. The inspector considered these rooms to be presenting extremely poorly; in two, toilet brushes were lying on the floor rather than being safely stowed in holders, and in one there was no toilet seat, a matter that had been flagged in a residents’ meeting. There were other cleanliness issues in the home, particularly with regard to the kitchen, where staff effort did little to offset the badly deteriorated state of the environment. The stairs were also in need of thorough vacuum cleaning, whilst elsewhere cobwebs The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 17 were noted, and some holes in walls. Staff meeting minutes showed there was awareness of these issues. The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 34 & 35 Staffing is sufficient in numbers and quality to ensure service users are safely and consistently supported. Staff are trained to carry out tasks required of them, linked to service users’ assessed needs. Recruitment practice is safe. EVIDENCE: Rotas showed that consistently four staff are on duty through the day (10a.m. to 8p.m.), three between 8a.m. and 10a.m., and two at other times. Staffing is organised on a team basis, each team having a leader on shift. The team leaders in turn meet weekly to promote continuity of care provision to residents. The home benefits from a stable staff group, and from a bank of relief staff, again ensuring continuity of staff that know the resident group well. One of the team leaders was completing the registered managers award and three staff members have completed NVQ level 2 in care. The home has a wellmaintained staff training and development plan, which showed achievement of planned training in emergency aid, food handling, the drugs administration system, and manual handling. The manager showed a variety of other training leads being actively followed up, including more in-depth medication training. The inspector saw a new policy on “professional boundaries”, which represented a good underpinning for the values staff bring to their work. The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 19 There had been only one new member of staff recruited since previous inspection, in respect of whom all required documentation was in place to demonstrate that background checks had been carried out. The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37 - 43 There is clear leadership and direction from the provider company, the registered manager and team leaders. Quality assurance systems are centred around service users, producing data that are used to improve the service, as are developments in the policies and procedures to which the company requires the home to work. Health and safety matters receive attention, although not to a sufficient degree in respect of hygiene. Record-keeping is secure and orderly, but contents of care records do not reflect the care plan basis of support provided, and care plans themselves do not amplify many needs identified. EVIDENCE: Karen Wilkinson has been in post as manager of The Willows for a year, whilst during the same period of time the provider company has demonstrated commitment to development of the home. Accordingly, both residents and staff expressed clarity and confidence about the home and its future. There are plentiful channels of communication at various levels, including purposeful recorded provider visits, and externally verified quality assurance. A twiceyearly questionnaire exercise is backed by rigorous analysis, leading to actions The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 21 to improve the service. There was evidence of both recent and ongoing work on the development of policies and procedures; those sampled showed a strong emphasis on the safeguarding of residents’ best interests. Record-keeping was well organised, but the quality of care records was often “thin”. Daily care records could be highly subjective and did not relate well to care plan guidance or residents’ own objectives. Many care plan components would have benefited from more detail, and from evidence of service user input, especially at review. Several inserts in care plans were neither signed nor dated. Staff conveyed a good appreciation of health and safety awareness, although awareness of poor cleaning standards needed to be translated into action to reduce compromises of hygiene. All matters identified for attention by the Fire Officer in 2004 had been brought up to standard. In connection with this, it was the opinion of many staff that awareness of service users, and availability to them, could be enhanced by the fitting of electromagnetic closers to a few key doors on the ground floor, linked to the fire alarm system, thus allowing the doors to be ordinarily open. The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 3 3 x Standard No 22 23 ENVIRONMENT Score 3 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 2 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score x 3 3 x x x 1 Standard No 11 12 13 14 15 16 17 x 3 3 3 x 3 x Standard No 31 32 33 34 35 36 Score x x 3 3 3 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Willows Score 3 3 3 x Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 2 2 3 D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 23 NO Are there any outstanding requirements from the last inspection? 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. 2. Standard 6, 41 23 Regulation 15 (2)(c,d) 12 (2) 13 (6) Requirement Care plans must show evidence of ongoing service user involvement. The homes policy on response to suspected or alleged abuse must accord fully with up to date local inter-agency procedures. There must be an internal audit of cleaning and hygiene equipment needs, with reference to recognised infection control standards, resulting in a written plan for cleaning, and provision of equipment, to address identified shortfalls. All additions to written records must be signed and dated. Records relating to care must be objective and linked to care planning aims. Timescale for action 1st June 2005 1st June 2005 1st June 2005 3. 30. 42 13 (3) 4. 5. 41 41 17 (3)(a) 12 (1)(b) 1st June 2005 1st June 2005 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 8 Good Practice Recommendations Minutes of residents meetings should should show how D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 24 The Willows 2. 42 matters raised at previous meetings have been addressed. Consideration should be given to the possible benefits and feasibility of fitting automatic door closers, linked to the fire alarm system, at strategic locations. The Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 Page 25 Commission for Social Care Inspection Avonbridge House Bath Road Chippenham Wiltshire SN15 2BB 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 Willows D51_S28543_WILLOWS(THE)_v200009_250405Stage4.doc Version 1.30 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!