Inspection on 24/08/05 for Tile House

This inspection was carried out on 24th August 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

Tile House 29/11/06

Tile House 12/12/05

Tile House 11/02/05

Tile House 20/10/04

Tile House 05/03/04

Similar services:

St Vincents

The Cotswold Home

Newbeech House

Winton House

Rush Court

Hillyfield Rest Home

The Maypole Nursing Centre

The Briars

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

CARE HOMES FOR OLDER PEOPLE Tile House 34 Victoria Avenue Shanklin Isle of Wight PO37 6LS Lead Inspector Mark Sims Unannounced 24 August 2005 th 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 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. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Tile House Address 34 Victoria Avenue, Shanklin, Isle of Wight, PO37 6LS 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) 01983 862762 Island Healthcare Ltd Carol Ann Barker Care home 21 Category(ies) of Dementia - over 65 years of age (DE/E) Old registration, with number age, not falling within any other category (OP) of places Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11/2/2005 Brief Description of the Service: The home is located in Victoria Avenue, Shanklin and is only a short distance from the amenities and facilities of the main town. The local bus company operates a regular scheduled service, which runs past the premises. The nearest stop is situated within a few metres of the premises. The building itself is a period town house, offering accommodation to 21 people, across three floors, access to both the lower ground floor and the first floor are achieved via a series of stair-lifts. The home is presently registered in respect of 21 people under the following categories of registration: dementia (elderly) DE(E) – 6, Older Persons OP 15. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted unannounced and lasted approximately 4.5 hours, considering a number of issues including records, tour of the premises, discussions with service users, observations of practice, views of visitors. What the service does well: What has improved since the last inspection? What they could do better: The tour of the premises revealed a minor issue which was brought to the acting manager’s attention and involved locks on communal toilets not working correctly. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 6 This was immediately brought to the attention of the maintenance staff, who undertook to address the problem as soon as possible that day. The inspector also noted that several issues affecting the wellbeing of service users had been documented within the running records, etc. but not transferred across to the care plans, as would be expected. This lapse in practice is important to address, as the care plans are the working documents staff refer to for guidance when delivering care and therefore if inaccurate the care delivered may not be correct. 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. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 3, St 5. The management team ensure all prospective service users are assessed prior to the offer of accommodation at Tile House Residential Home being made. Service users or representatives are encouraged to visit the home prior to accepting the offer of accommodation. EVIDENCE: The company has produced a wealth of corporate documentation, which includes a pre-admission assessment tool, designed specifically to gather information specified under the National Minimum Standards and any personal requests of the service user. The assessment tool created complements the care planning system of the company, and is a central facet of the entire service user planning process, gathering vital information prior to the person being offered accommodation and used in the initial production of any care plans. Three pre-admission assessments were viewed during the inspection of the care plans, each assessment having been completed by the manager during Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 9 either a visit to the service user’s home address or hospital ward and contained information relevant to the person’s health and social care needs. Copies of pre-admission assessments are maintained on the service user files and are used not only when creating the initial care plan but also as benchmarking tools for future assessments. In conversation with numerous service users it was evident that they felt the home met their needs and that the pre-admission process, including for some visits to the home, had been a useful process. Other people discussed how they had attended day care prior to becoming permanent residents and had a very good understanding of the home and the service it provided. Where people had been able to visit the home prior to accepting the offer of accommodation, they said they had been impressed by the environment and welcome of the staff. Where people had not been able to visit the home, families or representatives had visited and had decided the home would provide a service that would meet their relation’s needs. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 7, St 8, St 9. Each service user is provided with an individualised care plan, which contains a large amount of relevant information. However, the information is not always being used to update the care plans, some of which also have no review dates or evidence of having been monitored. Details of all health and social care contacts/visits, etc. are documented within a separate file, although they are recorded on an individualised basis. The home’s general approach to the management of residents’ medications is good, although a recent incident whereby a service user was presented with the wrong medication must be learnt from. EVIDENCE: Three service user plans were inspected during the visit and found to contain details of the pre-admission assessment, contact sheets with specific details relevant to the service user, photo identification for the individual, relative contact sheets and information, risk assessment documents, care planning documents and index and running records tied to the delivery of care. These documents were found to be well structured, clear and user friendly with key information readily available and written in a plain and concise manner. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 11 Evidence was also available, in the form of a specific monitoring sheet, that regular monthly care plan reviews were taking place, although the value of these reviews could be questioned, as information relevant to the care of service users was found not to be being appropriately updated. An example being that of a service user, whose moving and handling needs have altered dramatically over recent weeks, as evidenced both visually and through the records maintained but whose care plan/risk assessment had not been updated accordingly. The inspector followed through the changing needs of this particular service user, reviewing the medical and health related documentation, as part of the inspection process. The records for all health and social care contacts are held separately from the day-to-day care plans, although each service user has an individualised record sheet, which is transferred to their main file on completion. The information contained within this particular person’s file evidenced that both health and social care services had been kept informed of their changing needs and that both the local general practitioners and district nurses had visited in recent weeks. As a consequence of this person’s changing health care needs and discussions between all relevant parties, it had been decided that the service user should consider moving into a more supportive environment, arrangements having been made for a nursing home to undertake a review of the person’s needs. On talking to the resident involved, it was apparent that they accepted that their needs had progressed beyond the ability of the home to safely maintain their health and wellbeing and that both they and their family acknowledged that a move might be best, although a reluctance remained to leaving a home where they felt cared for. Whilst visiting with the resident the staff came to the room to fit bedrails, which they hoped would ensure the person’s safety was maintained and/or promoted throughout the remainder of their stay. It is important given the failure to update other records associated to this person’s changing needs, that a risk assessment and care plan are produced for the use of the bedrails, which can if fitted incorrectly or used inappropriately lead to injury and harm. A review of the home’s medication system was undertaken, although at a very basic level, as the intention of the inspector is to visit the home later in the year and review the home’s approach to the management of medicines with the manager, who was absent. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 12 However, given a recent incident which led to a service user being given the wrong medication the inspector felt it prudent to undertake a review of the medication system, the medication records and the actions taken to remedy the recent error. The home’s medication policy was noted to be readily accessible to staff, as a copy is maintained on the policies and procedures file within the main office, the information contained within the file is both informative and insightful. The records of medicines received into the home, administered to service users and returned for destruction were reviewed and found to be well maintained and accurate. Medications were appropriately stored and secured and the normal arrangements for administration should ensure service users are safeguarded from taking wrong medications. The incident that did occur would seem to have been largely the result of an accident, the staff member responsible for the medications setting the tablets down on a tray and these unfortunately being taken to the wrong resident before it was noticed. Since this incident the staff member involved has been undertaking medication rounds under supervision and the home has reviewed its working practices to ensure a similar mistake should not reoccur. Medication training is provided in house, although consideration should perhaps be given to using external sources of medications training if errors persist. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 12, St 13, St 14, St 15. A varied activities schedule is available within the home, which meets the needs of the service users and was endorsed by relatives. Service users are appropriately supported in the maintenance of contact with families and friends. The risk assessment and care planning process are used to support people in exercising and retaining control over their own lives. The service provides residents with wholesome, nutritious and varied diets that take into consideration individual preferences, likes and dislikes. EVIDENCE: Evidence from the service users is that a varied and interesting activities programme is available. People spoke at length about the various external performers who visit the home and describing how ‘Sue and Dave’ from ‘Independent Arts’ would be in later in the afternoon and how they actively involve people in the musical performances put on. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 14 The responsibility for arranging many of the activities undertaken by the service users is the activities co-ordinator who plans and arranges both internal and external entertainments for service users. Whilst the activities co-ordinator was not available herself during the inspection visit, the records she maintains on an individualised basis were accessible and clearly documented the type of activity people had been party to and whether or not they enjoyed the entertainment provided. People spoken with during the inspection not only discussed the activities they participated in internally but also external events, several of the ladies discussing a recent outing to ‘Marks & Spencers’, where they shopped and partook of refreshments at the ‘Café Revive’. Trips out according to the service users were regular events that took in various locations and local events and were made easier to access because of the transport provided by the home. It also became apparent during conversations with the service users that members of their families visit regularly and often spend time socialising in both the communal areas of the home, the quiet or sun lounge and/or their own bedrooms, depending on what is occurring. Visiting hours within the home are not set and people were noticed coming and going throughout the inspection, with people stopping to talk or chat with staff on their way to visit their relative and other service users they have befriended. One family was noted to spend some time with their relative within the dining room during the visit, although this was largely due to the renovation work ongoing within the main lounge, which resulted in the quiet room having to be shut off whilst work progressed. In conversations with the staff it appeared commonplace for visitors to be present within the home, the interactions observed supporting the fact that the staff are friendly and welcoming, remarks made via the comment card system used by the Commission. All service users spoken with praised the cooks for providing consistently good meals which were wholesome, nutritious and appetising. The varied menu was felt to contain a wide selection of meals and provided ample choice for service users, some of whom found that even the soft and pureed meals were sensitively and attractively served. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 15 In conversation with the catering team it was established that the kitchen is staffed from 08.00hrs to 15.30hrs to cover the preparation of all meals, although a kitchen assistant serves tea. During the inspection visit food stocks were being replenished with a delivery from ‘Tesco’ arriving whilst the inspector was in the building, the food supplies delivered were varied and diverse. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 16. The complaints process established by the home is well set out and structured and provides clear information on the role of the home and the Commission in investigating and resolving people’s complaints/concerns. EVIDENCE: Details of complaints made to the home are recorded using the home’s complaints logging system, which also documents outcomes and resolutions to complaints addressed internally. In conversations with several of the residents it was clear that their understanding of the complaints process was rudimentary, people stating that they would speak to the manager, etc. if they had any issues to raise or complaints to make. This process appears to work well with evidence within the home’s complaints file indicating that where concerns are raised with staff these are appropriately documented, that investigations are undertaken and outcomes provided to complainants either in writing or verbally. The willingness of service users, etc. to approach staff, the senior on duty or the manager should ensure the right people are informed of any concerns or problems. The comments of relatives received via comment cards also confirmed that people generally understood the complaints process, although no one had needed to use it. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 19, St 20, St 21, St 26. The home is extremely well maintained both internally and externally and is decorated to a high standard throughout. A range of well maintained and comfortable communal facilities is provided both internally and externally. Service users have access to sufficient numbers of clean and well maintained toilets. Cleanliness and hygiene issues are well managed by the domestic staff team and care staff team, all of whom have completed infection control and health and safety training. EVIDENCE: Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 18 The tour of the premises revealed that the property is well maintained both internally and externally, with work ongoing to update and refurbish the main lounge, new showering facilities created and evidence of redecoration throughout both communal areas and service users’ bedrooms. Externally the rear patio has been levelled to provide a seating area for residents, the gardens have been planted out and the lawns cut and tidied. Service users and staff both confirmed that the patio area had been extensively used this year and that chairs, tables and umbrellas were available for sitting out. The service users also passed comment on the redecoration of the lounge, stating that the maintenance men were doing a good job and that the disruption was minimal. Adequate toileting and bathing facilities exist on each floor with work already completed on the refurbishment of an existing bathroom and the installation of a new shower unit on the lower ground floor. Separate WCs are accessible on both the upper ground floor and the first floor with the lower ground floor served by the combination WC and shower room, although two of the four rooms on this floor are en-suite. It was noted during the tour of the premises that the locks installed in the first floor WCs were not working effectively, a situation brought to the attention of the acting manager, who quickly arranged for the maintenance men to attend to the problem. In conversation with service users the fact that the locks were not operating effectively on the toilets appeared not to be a concern, although people’s rights to privacy and dignity should be promoted at all times. The tour of the premises also confirmed that the domestic staff’s approach to cleanliness is good, with no signs of dust, cobwebs or any offensive odours to be detected anywhere around the home. All staff are provided with access to infection control procedures and toileting areas, etc. are supplied with paper towels and liquid soaps. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 27, St 29. The duty roster identifies that sufficient staff are on duty to meet the needs of the service users. The home’s recruitment and selection procedures are robust and thorough. EVIDENCE: A review of the home’s staffing rota identified that staff are deployed across three shifts per day, starting with a morning shift when 3 care staff are available, afternoons when 2 care staff are on duty and nights when 1 sleep-in and 1 wakeful are available. In addition to the care staff the manager and company director(s) are often available within the home and catering, maintenance, domestic and the activities co-ordinator are also employed. At no time during conversations with the service users did anyone raise concerns with regards to the numbers of staff available, with most comments about the staff being very positive and praiseworthy. Service users describing the staff as very nice and kind and stating that they were generally very happy with life at the home and the continually improving service and environment. During the visit the inspector reviewed a number of staffing files and considered the policies and procedures available to the management team when recruiting new staff. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 20 It was evident, given the files inspected, that the home’s general approach to the recruitment and selection of new staff is both robust and consistent, with tracking or monitoring forms used by the administrator to ensure each new staff member’s recruitment follows a very similar pattern and that all relevant information is applied for and received. All prospective staff are required to complete an application form as part of the process, the application form designed to obtain details of the person’s employment history, educational history, medical history and references, etc. Once the application has been submitted the manager arranges to meet with the applicant for the purposes of interview and retains information relating to the outcome of the interview on file. Once an applicant has successfully completed the preliminary stages of the recruitment process they are issued with written confirmation and, subject to the successful return of their references and Criminal Records Bureau check and POVA check, are invited to attend for induction. Also evident on each staff member’s file and again co-ordinated by the administrative staff are details of training events completed, training updates to be attended and additional courses undertaken, i.e. NVQs which are generally designed to increase knowledge, skills and competence. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 21 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) St 33. The company is committed to ensuring the best interests of service users are promoted at all times. EVIDENCE: The manager was unfortunately not available during the inspection, although the acting manager was available throughout the inspection and was able to discuss the home’s recent attainment of the Investors in People Award. It was clear from the acting manager that achieving the award had not been easy and that a lot of hard work had gone into the successful achievement of the award from the Investor’s team. In addition to the Investors in People process undertaken by the company an in house quality auditing system, which is overseen by a member of the company’s management team, is also available and widely used in the process consisting of Regulation 26 visits and reporting, service user satisfaction Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 22 surveys, internal auditing of the home against the standards, audits of records and record keeping and policy and procedure production and review. In conversation with service users, it appeared that a large percentage of the company’s quality assurance process is unfamiliar to them, although some people recalled filling in questionnaires about the service, staff and facilities. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 23 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 2 15 4 COMPLAINTS AND PROTECTION 3 4 2 x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x 3 x x x x x Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard Standard 7 Standard 21 Good Practice Recommendations Information contained within the service users files should be appropriately transferred to the care plans. The locks on the toilets should be regularly checked to ensure they continue to work effectively. Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 Page 25 Commission for Social Care Inspection Mill Court Furrlongs Newport PO30 2AA 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 Tile House H55H04_S55596_Tile House_V218202_240805 Stage1.doc Version 1.40 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. 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