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Inspection on 20/10/06 for The Withins Residential Home

Also see our care home review for The Withins Residential Home for more information

This inspection was carried out on 20th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

What has improved since the last inspection?

The last inspection identified Quality Assurance systems as an area for improvement. The manager has begun to address this, but this remains an area for further improvement. A record of complaints is now maintained, but consideration should also be given to where informal "grumbles" are recorded to show what action has been taken to address issues.

What the care home could do better:

Staff undertaking assessments should be suitably trained to do so. The home must operate within its conditions of registration. Falls should be recorded and accident reports completed. The use of lap belts should be assessed by an appropriate professional and monitored. The staff should receive training in psychological health and report writing. Medication must be administered correctly. A stock count should be kept of the paracetamols in the home. When residents participate in organised social activities this should be recorded on their daily record sheet. All complaints either written or verbal should be recorded and fully investigated. The staff should receive training in adult protection and understand their role in adult protection issues. All lighting in the building should work and be suitable to meet the needs of the residents. Recruitment procedures must be robust. The home should take up a POVA listing check and CRB check in respect of any new staff commencing employment at the home. Staff working at the home should be appropriately supervised.

CARE HOMES FOR OLDER PEOPLE Withins Residential Home 38-40 Withins Lane Breightmet Bolton Lancashire BL2 5DZ Lead Inspector Lynn Sharples Unannounced Inspection 20th October 2006 09:30 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 Withins Residential Home DS0000009310.V308224.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. Withins Residential Home DS0000009310.V308224.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Withins Residential Home Address 38-40 Withins Lane Breightmet Bolton Lancashire BL2 5DZ 01204 362626 01204 381240 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) Withins (Breightmet) Limited Mrs Janet Carr Care Home 65 Category(ies) of Old age, not falling within any other category registration, with number (65) of places Withins Residential Home DS0000009310.V308224.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should at all times employ a suitably qualified and experienced manager who is registered with the National Care Standards Commission. 30th January 2006 Date of last inspection Brief Description of the Service: The Withins is a large, purpose built, private residential home providing personal care and accommodation for up to 65 older people. The home is privately owned and registered under the company name of Withins (Breightmet) Limited. The home is located in a residential area in Breightmet, about 2 miles from the centre of Bolton and may be reached by public transport. There are shops, pubs and other amenities nearby. Accommodation is provided on three floors and there is good wheelchair access throughout the home. All bedrooms are single and have en-suite facilities. There is a passenger lift. Garden and patio areas are well maintained and accessible to residents. The fees for the home are £344.73 per week. Withins Residential Home DS0000009310.V308224.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. There were 63 people residing at the home at the time of the visit. The home did not know about the visit that took eight hours. The inspectors spent time with the residents, care staff, deputy manager and the manager. Files relating to the residents and the home were read and a full tour of the premises took place. What the service does well: What has improved since the last inspection? What they could do better: Withins Residential Home DS0000009310.V308224.R01.S.doc Version 5.2 Page 6 Staff undertaking assessments should be suitably trained to do so. The home must operate within its conditions of registration. Falls should be recorded and accident reports completed. The use of lap belts should be assessed by an appropriate professional and monitored. The staff should receive training in psychological health and report writing. Medication must be administered correctly. A stock count should be kept of the paracetamols in the home. When residents participate in organised social activities this should be recorded on their daily record sheet. All complaints either written or verbal should be recorded and fully investigated. The staff should receive training in adult protection and understand their role in adult protection issues. All lighting in the building should work and be suitable to meet the needs of the residents. Recruitment procedures must be robust. The home should take up a POVA listing check and CRB check in respect of any new staff commencing employment at the home. Staff working at the home should be appropriately supervised. 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. Withins Residential Home DS0000009310.V308224.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 Withins Residential Home DS0000009310.V308224.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): 1,2,3,4,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The homes Statement of Purpose is complete providing service users and prospective service users with details of the services the home provides. The lack of staff training in assessment leaves the residents at risk of harm. EVIDENCE: The home’s Statement of Purpose and Service User Guide are up to date to ensure that prospective residents have some knowledge of the home before they decide to move in on a permanent basis. Each resident has a contract and a copy of the statement of the terms and conditions of the home and this makes sure that they are informed about their rights and obligations. Community care assessments are in place for residents placed by the Local Authority and pre assessments were included in the care files. When a referral is made to the home the manager or a senior staff member carries out the Withins Residential Home DS0000009310.V308224.R01.S.doc Version 5.2 Page 9 assessment to ensure the home can meet prospective resident’s needs. The file of a resident includes an initial assessment, summary care plan, information relating to social interests and family history and risk assessments. There are several residents who have complex medical conditions and the staff records do not indicate that the staff have been trained to conduct assessments particularly relating to mental health. The home currently has several residents, who are inappropriately placed due to their medical condition; the home is therefore in breach of their conditions and should write to the CSCI to inform them of their plans to address this issue. This should be done as a matter of urgency. The home does not provide intermediate care. Withins Residential Home DS0000009310.V308224.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): 7,8,9,10,11 Quality in this outcome area is poor This judgement has been made using available evidence including a visit to this service. The health needs of service users are set out in care plans, but further work could be done to monitor progress and care needs of individuals. EVIDENCE: The resident’s files contained care plans that contained an assessment of need in a range of areas. These included personal care, diet, social and environment, mobility, spiritual. The care plans are reviewed monthly. The home has begun a falls recording chart. From reading the care files some falls are recorded in the daily sheets and not always on the chart and an accident report is not always completed. The home should also ensure that a falls risk assessment is completed and amended if necessary. The care plans included details of opticians, oral health, weight and records of visits from health professionals. Whilst weight is recorded, a separate file is used for Input/Output chart to record what residents have eaten. These were filled in but no evidence of this being monitored by the manager. It would be Withins Residential Home DS0000009310.V308224.R01.S.doc Version 5.2 Page 11 beneficial if this were included in the care plan. The language used in the care files indicates that the staff team have a limited understanding of psychological health and would also benefit from some training in report writing. The home has a written disclaimer in the care files relating to lap belts used with residents who use a wheelchair. These should be removed and all residents who are subject to this form of restraint should have a multidisciplinary meeting to ascertain the reason for such restraint, guidelines for its use and it should be monitored regularly, to ensure it is effective and not creating further risks. During the tour of the premises, it was noted that information relating to residents was visible for all to read; such notices should be removed and stored in the residents care file. None of the current service user’s in the home self medicate. Senior care staff in the home administer all medications for residents. It was noted that on a medication round that the member of staff did not dispense the medication correctly or give adequate fluid to ensure medication is swallowed easily. The controlled drugs are well managed. The home has a stock of paracetamol and this is not recorded. It is recommended that medication that is returned is counter signed by the home and the organisation collecting the medication. Residents said that the staff in the home were always courteous, respectful, and strove to maintain their privacy and dignity when assisting residents with personal care. The care staff were observed interacting appropriately with the residents and knocking on doors before entering. In the care files there is a section on planning for and dealing with death. Withins Residential Home DS0000009310.V308224.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 good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to exercise choice and to have flexibility how they spend their day in the home. They also pursue leisure activities according to their choice and preferences. This allows independence and individuality for each resident. Residents receive a varied nutritious diet that is in accordance with their preferences. EVIDENCE: The home employs an activities coordinator who ensures that there are planned activities for the residents to join in with if they wish to. On the day of the visit residents were involved in various activities including indoor bowls and a sing a long. One resident said that they enjoyed the activities and liked going on trips, eager to tell the inspector where they had been, and which trips were there favourites. Church services take place in the home for those residents who wish to attend. The activity coordinator has a book where activities are recorded. When Withins Residential Home DS0000009310.V308224.R01.S.doc Version 5.2 Page 13 residents participate in social activities, it must be recorded in their daily health record sheet, how they participated in the activity. This is to ensure that there is recorded evidence of how the resident coped/responded in the activity, and to their mood, emotions, physical dexterity. The recordings of the resident activities helps to complete a “full picture” of the resident’s progress, or even identify developing care needs. There has only been one recorded resident meeting this year, issues discussed included activities and outings. These were on display as was a newsletter. There were also photographs of residents on various trips out; there had been a recent trip to see Blackpool lights. The home has open visiting arrangements and on the day of the visit it was noted that visitors were present in the home in the residents bedrooms. The residents spoken with said that they enjoyed the food at the home and that there was a good choice and the food was tasty. At lunchtime the meals served were either fish and chips or another hot meal alternative or sandwiches; the meal was well prepared and well presented. This helps to ensure that mealtimes are a meaningful social occasion. Therapeutic diets can be catered for in the home for residents with a medical condition. The four weekly menus indicated that residents receive a varied and nutritious diet. Withins Residential Home DS0000009310.V308224.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. The home should give further consideration to the recording of complaints particularly informal complaints. The lack of staff knowledge regarding adult protection leaves the residents at risk of harm. EVIDENCE: The home has a complaints procedure, however, the home has no complaints recorded, after discussion with the manager it was apparent that the home only records written complaints made to the home. It is important that any verbal complaints are recorded and dealt with. The staff team have attended training regarding adult protection, and an adult protection policy is in place, however, staff who were interviewed by the inspector were not able to demonstrate a depth of knowledge about adult protection, and relied a lot on telephoning the manager of the home for advice. This issue should be discussed at staff meetings and during supervision to ensure that the staff have a good understanding of the issues relating to adult protection. Withins Residential Home DS0000009310.V308224.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): 19,20,21,24,26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The standard of the décor within the home is good. The home is comfortable and homely environment for residents. EVIDENCE: Withins Residential Home DS0000009310.V308224.R01.S.doc Version 5.2 Page 16 The home maintains good physical standards and is suitable for purpose. Carpets, furniture and furnishings are of a good quality throughout. The home employs a maintenance man who ensures any repairs are addressed efficiently. The lights in the dining room on the first floor did not work and should be fixed to ensure that the residents are able to eat their meals with the assistance of good lighting The building complies with the requirements of the fire and environmental health departments. The grounds are safe and accessible to all service users. There were communal rooms on each floor and a dining room on each floor. The outdoor area is accessible to residents who use a wheelchair and this overlooks a well maintained garden area. The lighting in some areas of the home, particularly the dining room on the lower floor and the corridors was not sufficiently bright to ensure the safety of the residents. This must be addressed as a matter of urgency. The bedrooms are all en suite and there are clearly marked accessible toilets on each floor. The sluices are separate from the residents’ toilets and bathing facilities are well maintained. All bedrooms are furnished to a high standard and colour coordinated. The bedrooms are personalised and well maintained. Locks are fitted to all doors and keys provided as appropriate. One service user requests that staff lock his door whilst he is in his room, this situation must be explored further and a multi-disciplinary decision should be reached. The laundry facilities are located on the lower floor and consist of washing machines and driers. The washing machines have the specified programming ability to meet disinfection standards. On the day of the visit the home was clean and free from malodour. There are a number or service user’s resident in the home, with various levels of dementia. The manager should give consideration to the “best use” of the various floors of the premises, in order to provide consistent care appropriate to the needs of the individual with appropriately trained staff. Withins Residential Home DS0000009310.V308224.R01.S.doc Version 5.2 Page 17 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. The standard of vetting and recruitment practices is inadequate with failings in ensuring all the required checks are undertaken. This places the residents at an unnecessary level of potential risk. A staff team that has benefited from training would enhance the care within the home. EVIDENCE: The rotas indicated that nine staff are on duty in the morning and eight in the evening and four staff are on duty during the night. There are also domestic staff, a laundress, kitchen staff and a handyman to ensure that standards relating to food, meals and nutrition are met and that the home is maintained in a clean and hygienic state. The home employs 34 care staff, 19 members of staff have achieved the NVQ level 2 or above. The manager plans the raining for staff over a twelve month period, however, this would be improved if individual supervisions were completed to ensure that training is planned in line with individual needs or identified performance issues. Withins Residential Home DS0000009310.V308224.R01.S.doc Version 5.2 Page 18 Staff files were examined and some discrepancies were found, one new member of staff did not have an application form on file and only one reference. The member of staff started work at the home in August and their Criminal Records Bureau (CRB) check was returned in October, there was no record of a Protection Of Vulnerable Adult (POVA) listing check. This was an issue highlighted in the last report. Withins Residential Home DS0000009310.V308224.R01.S.doc Version 5.2 Page 19 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): 31,33,35,36,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The manager must take appropriate action to ensure that the care needs of service users are within the conditions of registration for the home, to ensure that the home is run in the best interests of service user’s. Staff are not receiving regular supervision or appraisals. EVIDENCE: The registered manager has been in post for several years and has completed the Registered Manager’s Award. The staff spoken with said that they were approachable and supportive. Withins Residential Home DS0000009310.V308224.R01.S.doc Version 5.2 Page 20 There were examples of where staff had not completed paperwork properly, with no evidence that the manager reads the care files or monitors staff progress or work at the home, again this is an for development. There has been one residents meeting this year and no evidence that feedback is sought from residents, family, stakeholders in the community. There are only four recorded visits by the owner this year. As discussed earlier in the report, this is information that can be beneficial in developing effective quality assurance systems. Safe and secure arrangements are in place for administering and managing residents’ day to day finances. The staff files indicate that staff supervision is inadequate. One member of staff has worked at the home for two years and has no record of supervision. Staff spoken with said that they had not received formal supervision. It is important that the staff team receive regular recorded supervision so that the manager can discuss all aspects of practice and the philosophy of care in the home and career development needs. The home has current certificates in respect of electrical and gas safety. A certificate of employer liability was displayed. Withins Residential Home DS0000009310.V308224.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 2 2 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 3 X X 3 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 1 X 3 Withins Residential Home DS0000009310.V308224.R01.S.doc Version 5.2 Page 22 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 18 Requirement The registered person must ensure that staff undertaking assessments are suitably trained to do so. The registered person must ensure that the home operates within its conditions of registration. The registered person must ensure that accident reports are completed, and risk assessments updated. The registered person must ensure that the use of lap belts are assessed by an appropriate professional and its effectiveness monitored. The registered person must ensure that the staff receive training in psychological health and report writing and adult protection. The registered person must ensure that medications are administered safely. The registered person must ensure that all complaints either written or verbal are recorded and fully investigated. DS0000009310.V308224.R01.S.doc Timescale for action 01/12/06 2 OP4 Care Standards Act 2000. 13 01/12/06 3 OP7 01/12/06 4 OP8 13 01/12/06 5 OP8 18 01/12/06 6 7 OP9 OP16 13 22 01/12/06 01/12/06 Withins Residential Home Version 5.2 Page 23 8 OP19 23(2) 9 OP29 18 The registered person must ensure that the lighting in the building is suitable to meet the needs of the residents. The registered person must ensure that recruitment procedures must be robust. The home needs to take up a POVA listing check and CRB check in respect of any new staff commencing employment at the home. (This requirement remains unmet timescale 01/03/06). The results of quality surveys need to be collated and summarised in an annual development plan for the home. (This requirement remains outstanding timescale 01/06/06 not met). 01/12/06 01/12/06 10 OP33 24 05/02/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 5 OP36 Withins Residential Home Refer to Standard OP8 OP8 OP9 OP36 OP12 Good Practice Recommendations It is recommended that all information relating to the residents are kept in their care files and not displayed on notice boards. It is recommended that all charts relating to the residents be kept in their care files, particularly input/output charts. It is recommended that the monthly returns of medication to the pharmacist are counter signed by the home and the pharmacy. It is recommended that the care staff receive formal recorded supervision at least six times a year. The registered person must ensure that when residents participate in organised social activities that it is recorded on their daily record sheet. The manager should provide regular supervision and DS0000009310.V308224.R01.S.doc Version 5.2 Page 24 6 appraisal for all staff, as individuals and or groups. Withins Residential Home DS0000009310.V308224.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG 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 Withins Residential Home DS0000009310.V308224.R01.S.doc Version 5.2 Page 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!