Inspection on 03/10/06 for Tregarland Care Home

This inspection was carried out on 3rd October 2006.

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 found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Tregarland Care Home 08/10/08

Tregarland Care Home 01/03/06

Tregarland Care Home 09/08/05

Similar services:

2 Perhaver Park

The Vicarage

7 Hyde Road

St George`s

5 Seafield Road

Credence House

Radfords

Trevaylor Manor

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

CARE HOME ADULTS 18-65 Tregarland Care Home 51 Whitchurch Road Tavistock Devon PL19 9BD Lead Inspector Helen Tworkowski Unannounced Inspection 3rd October 2006 11:00 Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 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 Tregarland Care Home DS0000064169.V309890.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 Adults 18-65. 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. Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Tregarland Care Home Address 51 Whitchurch Road Tavistock Devon PL19 9BD 01752 310603 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) Tregarland Limited Mrs Caroline Maria Hay Care Home 20 Category(ies) of Learning disability (20), Physical disability (20) registration, with number of places Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 1st March 06 Brief Description of the Service: Tregarland provides residential care for 20 people with a learning disability, who may have additional physical disabilities. The home consists of a pair of semi-detached houses called individually Tregarland North and Tregarland South. Each house operates as a completely separate unit, each with its own staff and communal areas including kitchens and laundries. Tregarland North has level access on the ground floor with wheelchair access through the rear entrance. In both houses there are two ground floor bedrooms. The other eight bedrooms in each house are spread over the first and second floors. There is a large garden to the front of the houses. The home is within walking distance of Tavistock town centre. A mini bus with a tail lift is available to support the mobility of the service users. The feel level for the home is £251.76 upwards. Additional charges are made for: hairdressing (£5-10), chiropody (£5), toiletries (£1-5), Extra holidays, activities, and papers and books. Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included two site visits to Tregarland on the 3/10/06 and 16/10/06. The Registered Providers had completed a Pre- Inspection Questionnaire prior to the inspection. Fifteen Service User and fourteen staff survey forms were received and the results included in this report. Survey forms were also sent to local GP’s and to local social services department. The site visits included a tour of both houses; time was spent talking with individual service users, staff and the Registered Manager, Mrs Hay, and the Responsible Individual, Mr Hay. As part of this inspection records were examined, these included those relating to: individual service users, staff, health and safety and medication. What the service does well: What has improved since the last inspection? A “personal development review” or appraisal system has been set up. This clearly identifies what staff need to be able to do, and how well they are doing it. The training of staff has been improved and further training has been organised. Mrs Hay said that the management structure has been reviewed and a new senior care worker appointed so that that there can be better management support in the home. Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 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 the following standard(s): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users can feel confident that their needs will be known, prior to a move to Tregarland. EVIDENCE: One new Service user has been admitted to the care home since the last inspection. The inspector was advised that this admission was made at short notice, and that this had limited the assessment process. Staff from Tregarland had not been able to assess the Service User in their existing accommodation. However the Service User had had the opportunity to visit Tregarland on a number of occasions prior to a move. This had given the Service Users and staff at Tregarland to get to know the individual, and for the prospective Service User to get to know them. An assessment had been made during these visits. There was information on file about the individual’s needs and information from the previous provider. This information had been used to develop a Service User Plan. Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 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 the following standard(s): 6, 7, and 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service User needs and aspirations are clearly identified in Service User plans. Service Users feel that staff listen and act up on what they say. EVIDENCE: The files of four service users were looked at during this inspection. There was good information about what each person’s needs were and how they were to be met. There were a number of documents- one containing basic information for new care staff; another more in depth which gave detailed information about the individual and their needs. There were also records of discussions with Service Users about their needs, and a record of involvement- for example about a move of a new service user to the home. Some of the information used a “widget” system; this uses symbols to aid communication. The Inspector and Registered Manager discussed this system and how other methods of communication might be more appropriate to the needs of service users. The Service User Plan should be in available to the Service User in a format they can access, whether that is in written text, symbols, pictures or Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 Page 10 through discussion. It is up to the provider to find the way that suits each individual. There were good records of visits to health care professionals and there were risk assessments in place. Risk assessments help ensure that service users are not exposed to unnecessary risk and where are risks that they are managed. The Inspector spoke with a member of staff about the needs of service users they key-worked. The member of staff understood the needs of the individuals. There was a record of what each service user might expect to do each week, and a record of what they actually did. The Inspector spoke with service users about what sort of activities they were involved in, some of the Service Users are no longer attending the local Social Services Day Centre as frequently as in the past, and alternative activities are being sought. Service Users are consulted and are able to make decisions about their life and choices. One person had recently moved to Tregarland and had chosen their room colour, care and thought had gone into how the individual could make an informed choice. Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 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 the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are well supported to follow interests and to occupy their time in meaningful ways. EVIDENCE: Service users bedrooms reflect their hobbies and interests at home: watching the TV, listening to music, horse riding, etc. There is a computer that Service Users can use, one person uses it to play cards games. When the Inspector arrived some of the Service Users were in Tregarland South were involved in a card game, whilst others were involved in moving rooms. Later in the day Service Users were involved in shopping and putting away the purchases. On the second day of the inspection some service users were visiting an adult education service for a taster class, others were out shopping or on errands. Service User records indicate a number of individuals have some sort of work, including in local pubs and other care homes. Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 Page 12 Of the fifteen Service Users’ surveys returned ten responded that they could always make decisions about what they do each day, whilst the other 5 stated that they sometimes could. The surveys also indicated that 12 of the people could do what they wanted in the evenings and during the day, whilst all but one said that that they could do what they wanted at weekends. Comments from individuals included: “I love the things I do and I hope to try new things in the future”, and “I always got to choose with my key worker what I do on structure week”. The Inspector spoke with Service Uses about the meals at Tregarland- Service Users said that they enjoyed the food, and expressed clear views about what food they enjoyed and what they did not like. One Service User told the Inspector when there was food she did not enjoy then alternative was found. The particular needs of the service user means that the preparation and storage of food is closely monitored. Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 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 the following standard(s): 18, 19, and 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service Users are well supported in relation to their health and personal care needs. The systems for the management of medication are good. EVIDENCE: A monitored dose system is used at Tregarland to manage medication. A member of staff showed the Inspector how this system worked. There were clear administration sheets showing that the correct medication was administered. There were also records of the amounts of medication received and ordered so that an audit could be done of the stock held. There was information on file about different medications and potential side effects. The Inspector was told that all staff receive training from the Manager to ensure that they are familiar with how to administer medication. Staff are also completing a distance learning course should improve their understanding of medication, and receive training from the local pharmacist. Service Users were spoken with about the how the staff treated them. Comments about staff included “staff are nice”, and “It’s the best home I have lived in. Other Service users comments from the survey included “You can Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 Page 14 have your independence in a lot of things and they consider your rights as well, and they respect you in what you want to do”. Fourteen out of the fifteen surveys showed that staff always listened to what Service users said, whilst the fifteenth stated that staff usually listened. The Inspector observed staff with service users, and staff treated Service users with respect. The Manager discussed with the Inspector a stay in hospital by one of the Service Users. Staff from the home had provided twenty-four hour support to the individual during that stay, to ensure their safety and well being, so that they could access the health care they needed. Service User Plans contained good information about service users health care needs and visits to health services. The Inspector discussed with the Manager, Mrs Hay, the need for proper systems to be in place to manage challenging behaviour that might require physical intervention. Mrs Hay confirmed that many of the staff, though not all, had had training to enable them to manage such situations, and further training was planned. The Inspector emphasised the need for the Care Home to follow the relevant Department of Health Guidance on Physical Intervention. Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 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 the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service Users are protected from abuse and their views are heard. The systems for management of Service Users finance are inappropriate, and need to be reorganised. EVIDENCE: The Commission for Social Care Inspection has not received any complaints since the last inspection. The Manager has received one complaint, and this was dealt with under the home’s own procedures and not substantiated. All fifteen Service Users responding to the survey said that they knew who to speak to if they were not happy and thirteen of the fifteen said that always knew how to make a complaint. Staff records show that staff have received training in relation to the Protection of Vulnerable Adults and the survey of staff showed that all fourteen people responding were aware what would happen if an allegation were to be made about them and that they were all aware of child and adult protection procedures. When the Inspector asked to see a copy of the local Social Service guidance in relation to adult protection, the guidance could not be found in the staff office of either Tregarland North or South. When two staff were asked about what they should do in relation to reporting any possible abuse they were very clear about what they should do. One of the ways that Service Users can be protected from abuse is the by the completion of Criminal Records Bureau Checks, and Protection of Vulnerable Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 Page 16 Adults list checks. There are good systems in place at Tregarland to ensure that these checks are made. The majority of Service Users at Tregarland need assistance with their finances. Service Users benefits are currently paid into the Care Homes own accounts, and the element that each individual is entitled to is then paid to the Service Users. The Care Home Regulations require that no monies belonging to the Service Users are to be paid into the Care Home’s account. The Inspector has no concerns that money is being misappropriated however is requiring that Service Users monies, including benefits, is paid to Service User accounts. It is then for the Care Home to make any charges to the Service User for that proportion of the fee to which the Care Home is entitled. The Inspector was told that only two Service Users received Disability Living Allowance Mobility Component, and that this money is considered by Social Services to be part of the assessed income and part of the fee. The Inspector requested that this be investigated further; DLA Mobility Component should not be considered part of any assessed income. The Home does not charge for the use of transport, this is included as part of the fee. Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 Page 17 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 the following standard(s): 24, 25 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Tregarlands provides a good standard of clean, comfortable and wellmaintained accommodation. EVIDENCE: The Inspector looked around the communal areas of both houses, and was shown some of the bedrooms by Service Users. The lounge and dining areas are homely, spacious, well furnished and comfortable. All of the bedrooms are of a good size and many have views over the surrounding countryside. Service Users have been encouraged to choose the décor of their rooms, so that each room is a reflection of the individuals’ tastes and preferences. The majority of Service Users have keys to their bedrooms and they can choose to lock their doors. Tregarland North- has disabled access; ramps have been fitted so that Service Users who use wheelchairs have access to the ground floor. All areas of the house were clean and there were no offensive odours. Each of the houses has a laundry and there are washing machines that are capable of Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 Page 18 dealing with the soiled linen. Both house were found to clean and there were no offensive odours. All fifteen of the Service User surveys returned said that the home was always fresh and clean. Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 Page 19 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 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34, and 35 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are reasonably good recruitment systems in place, staff are well trained and in sufficient numbers to meet the needs of service users. EVIDENCE: The files of four care staff recently employed in the home were looked at, during this inspection. Each of the care staff had an application form, there was a record of an interview, and there were two written references had been taken. The checks completed before an individual starts work at the home also included a Protection of Vulnerable Adults Check and a Criminal Records Bureau check. The Inspector discussed with the Mrs Hay (Registered Manager) and Mr Hay (responsible individual) how the recruitment system could be further improved by checking gaps in employment history and by ensuring that references are taken from relevant previous employers. The Regulations have recently been amended in this area. Each employee’s file seen had evidence of an induction being completed and there was also a record of training that had been completed since induction such as first aide, moving and handling, fire training, and epilepsy training. Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 Page 20 The Manager said that some of the training was completed by watching a training video, but additional “hands on” training was also sought to ensure that the person was competent in areas such as moving and handling. The Inspector discussed with the Manager the Learning Disability Awards Framework that should be underpinning all knowledge for progress to National Vocational Qualifications. Mrs Hay said that she was aware of the LDAF but was waiting till the system was more fully developed before implementing it. The Pre-Inspection Questionnaire indicated that 60 of the care staff had NVQ2 or above. There were records of staff appraisals or personal development reviews. Feedback from the staff survey was that all fourteen staff responding to the survey felt well supported to do their job well and that all had also received one to one supervision. Comments from Staff included: “The management and staff always put the welfare and safety of all the service users as of paramount importance”. There are generally three staff on in Tregarland North and three staff on duty in Tregarland South, during the day. Staff spoken with thought that this was sufficient. The Inspector observed that Service Users were busy and occupied throughout much of the day, and there was no indication of staff shortages. Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 Page 21 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 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Tregarland is well managed and there are good systems in place to ensure that the service users and staff are kept safe. EVIDENCE: Mrs Hay, the Registered Manager, confirmed that she had completed the Registered Managers Award. Mrs Hay had attended regular training sessions to keep her knowledge up to date and to check the quality of training provided to staff. There is a quality assurance system in placed, this is based on seeking the views of service users and of people who have contact with the home. The Inspector was shown copies of these documents that were completed earlier this year. Mr Hay, the Responsible Individual confirmed that where comments are received with regard to the service these are acted upon. Mr Hay discussed Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 Page 22 how he planned to develop the quality assurance system further, looking at different aspects of the service, for example in relation to personal development plans for staff. Service users spoken with confirmed to the Inspector that they had regular meetings and that their views were taken into account. The Inspector looked at a number of risk assessments for the general environment. These were clear and well organised and had been reviewed. There were records of fire checks and other checks in relation to fire safety. The tour of the building had confirmed that the building was in a good state of repair, well decorated and safe. Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 X 2 X 3 3 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 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 YA23 Regulation 20 Requirement Service Users monies must not be paid into any account related to the running of the business. Appropriate arrangements must be made for service users finances. Timescale for action 01/02/07 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. Refer to Standard YA6 YA18 YA23 YA34 Good Practice Recommendations Service users’ ownership of their own plans should be promoted by providing a user-friendly version of the main points for individuals. Department of Health Guidance on Physical Intervention should be available, and where necessary implemented. A copy of the guidance in relation to the Protection of Vulnerable Adults should be available. All gaps in employment history for prospective staff should be accounted for. References taken should be related to the most recent periods of work with vulnerable people. Tregarland Care Home DS0000064169.V309890.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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 Tregarland Care Home DS0000064169.V309890.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!