Inspection on 13/02/09 for Vine, The

This inspection was carried out on 13th February 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Vine, The 25/02/08

Vine, The 05/05/06

Vine, The 29/11/05

Vine, The 30/06/05

Vine, The 15/03/05

Vine, The 24/09/04

Vine, The 05/02/04

Similar services:

Ashlong House

Norbury Crescent (30)

Edenvale

Wadham Avenue

Chatsworth Care - Dawson House

Cowden Road, 52 - 54

Chatsworth Care - Tudor Lodge

Foxley Lane (121a)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/06/2011.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Vine, The 58-60 Rosendale Road London SE21 8DP One star adequate service The quality rating for this care home is: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Sonia McKay Date: 1 3 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area Outcome area (for example: Choice of home) These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 03000 616161 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Internet address www.cqc.org.uk Information about the care home Name of care home: Address: Vine, The 58-60 Rosendale Road London SE21 8DP 02086709248 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): vine_60@yahoo.co.uk L`Arche Lambeth Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 7 Number of places (if applicable): Under 65 Over 65 7 0 learning disability Additional conditions: The registered person may provide the following category of service only: Care Home Only (CRH - PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - Code LD The maximum number of service users who can be accommodated is: 7 Date of last inspection A bit about the care home The Vine is located in a residential road in West Norwood close to the organisations workshops, high street shopping and transport networks. Two houses are joined together to create one large home and back garden. The Vine is registered to accommodate seven adults with a learning disability some of whom may also have a physical disability. All of the residents require varying degrees of support and assistance in their daily lives. The home is one of five residential care homes in Lambeth and Southwark, which are part of the local LArche community. The aim of the community is to create an environment that welcomes people with learning disabilities. Fundamental principles of the community are that each person has a right to friendship, a spiritual life and to live in an environment that fosters personal growth. Prospective residents receive an information pack that contains the Statement of Purpose and Service Users Guide and a copy of the most recent Commission inspection report is available on request at the home. Current fees range between £435.22 and £519.20 per week and depend on the support needs of individuals placed. Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: One star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home How we did our inspection: This is what the inspector did when they were at the care home This is how I did my inspection. I visited the home and spoke with residents, staff and a visitor. I looked at the information that the home manager sent us before the inspection. I looked at records and had a tour of the home. We also sent surveys to the home and two of the residents were supported by staff to complete them. What the care home does well What has got better from the last inspection There is better information about the fees charged and what they are used for. Staff are keeping better records of what residents spend their money on. Staff are keeping better records when they give someone medication. This makes it safer for the residents. The equipment used for lifting people with a mobility need is checked more often by a professional company. This makes the equipment safer to use. A new refrigerator has been purchased. Staff meet with a manager more often to talk about how well they are doing their job. What the care home could do better Staff must get better at keeping care plans up to date and looking at any risks that residents may be exposed to. The service could help the staff improve in this area by telling them what areas of care and support should be recorded in written plans. Staff must get better at arranging routine health checks for people. This will give people better access to preventive health care. Staff must be better trained to meet the health needs of one resident who is prescribed a type of medication to be used in an emergency. Staff are not trained to administer the prescribed medication and this may cause delay in getting appropriate emergency treatment. The kitchen could be made more accessible to people who use a wheelchair. Staff must keep better records of the valuable items that are looking after for the residents. Fire safety must be improved. The people who run the home must do more to make sure that recruitment checks are satisfactory before the new member of staff moves into the registered home. If you want to read the full report of our inspection please ask the person in charge of the care home If you want to speak to the inspector please contact Sonia McKay Caledonia House 223 Pentonville Road London N1 9NG If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line - 03000 616161 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Prospective residents have opportunity to experience life in the home before making a decision to move in for a trial period. The residents guide is produced in picture format making it more accessible to residents who might find a text only document difficult to understand. They should be better information about placement fees and how they are used and the registered provider should continue to develop this area. Evidence: There is an informative statement of purpose and service users guide. Emphasis is placed on making the guide accessible to people with a learning disability and it contains colour photographs, symbols and plain language. During the previous inspection a requirement was made for additional information about fees to be added to the guide. There is some progress in providing more information about how fees are spent but it is recommended that the registered provider continue to develop this aspect of information further. New residents are admitted on the basis of a full assessment of their needs. Only longterm placements are are offered and there is a lengthy placement process involving visits and overnight stays. This allows prospective residents to get to know staff and other residents and to experience life in the home before making a decision to move in for a trial period. Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents are encouraged and supported to contribute their goals and aspirations to their annual life planning meetings. The associated plans written by the staff have improved but there would be benefit in reviewing all of the plans and risks assessments after each planning meeting and also at regular intervals in between. Evidence: Staff maintain files of written information about each resident. Records relating to two residents were examined during this inspection. The files contain plans relating to how each person needs to be cared for. Each resident has an annual planning meeting and there is evidence that the views of the resident are recorded and listen to. The goal planning meetings do not necessarily result in a systematic review of the written plans although the plans seen during this inspection have improved because they have been signed and dated by the author. They also now cover a wider range of topics including cultural needs. A set of plans for one resident have not been reviewed since January 2008. Plans and risk assessments must be reviewed at least twice a year or when a persons needs change. Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents are able to take part in a range of activities and are part of their local community. Staff support residents to maintain and to develop relationships and friendships.Residents enjoy the meals and a healthy diet is offered. More could be done to ensure that kitchen equipment is accessible to the people living in the home. Evidence: LArche is a faith based community that includes four registered care homes. The homes are all in close proximity and residents see each other at community functions and meetings. The Vine is one of these homes. Residents living here engage in therapeutic workshop placements that focus on weaving, candle-making, arts and crafts or gardening. There is also a community relaxation group and a small team of day service staff arrange community based activities for individuals and small groups with shared interests. Some residents also attend courses at a local college. Residents are supported to maintain their family links and to develop new friendships and relationships, with support and education being accessed from local specialist teams if needs be. Residents said they enjoy the food and food stocks were adequate and fresh. The home is registered to accommodate people with a physical disability and there are two people who use wheelchairs currently living in the home. Consideration should be given to changing the cooker as it is an old fashion range type that is not easy to use if you use a wheelchair or if you are learning how to cook as part of gaining greater Evidence: independence. Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Residents receive personal care support in the way that they prefer and require. Physical and emotional health needs are adequate but residents would benefit from better health care planning as some residents have not attended the full range of health care checks that they require. There is also a need to ensure that staff are suitably skilled to meet the health care needs of a resident. Evidence: Staff support residents to maintain their personal care and appearance in accordance with their needs. Some residents need full assistance to bathe and this is given by staff of the same gender as the resident. The nature of support required during personal care is described in personal care plans. One set of plans is overdue for review. A new resident needed a different type of bathroom and new equipment has been installed to ensure that suitable personal care facilities are in place. All residents are registered with a local group practise of doctors. Records relating to health care show that there is good reactive health care, for example staff make appointments and seek emergency treatment as required. Staff also maintain good records of what advice is given at doctor and hospital appointments. However, more must be done to plan health care properly as it is noted that one resident has not seen a dentist for over a year. An assessment also mentions poor eyesight but it is unclear what is being done about this. This can be addressed by developing thorough health action plans and regularly reviewing them to make sure that preventative health care is accessed as well. Medications are stored in a locked metal cabinet. During the last inspection it was noted that staff had been signing the medication administration records using a pencil. This did not create a permanent record and a requirement was issued. Examination of recent medication administration records show that staff are now completing the Evidence: records properly. There is also concern that one resident requires emergency medication in the event of a prolonged epileptic seizure. Staff have not been trained to administer this particular medication and this places the resident at risk. The current procedure is for staff to call an ambulance. The decision to withhold this treatment has not been disused with the placing authority in a best interests meeting. The manager must seek advice about getting training from a qualified professional. During the last inspection it was noted that staff were not recording the weight of each resident. A requirement was issued and records seen during this inspection indicate that staff are now making the necessary recordings. This improves health monitoring. Staff are trained in safe administration during their induction and they are not allowed to administer medication until they have been trained. There is a file for medication information and recording. There is sample signature list of trained staff available. Each resident has a medication profile that includes a photograph and information about each prescribed medication and possible side effects to look out for. Justified stock checks take place and all medication received or returned to the pharmacy is recorded. A small quantity of over the counter remedies are also available and the suitability of these items is checked with each persons doctor. One resident is supported to take his medication himself and a record that he finds easy to use is in place. Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The service handles complaints well and residents can be confident that their concerns will be list ended to and acted upon. Staff know how to safeguard residents but more must be done to ensure that valuables are properly accounted for when they are being looked after by the staff. Evidence: There is a complaints policy and procedures for how complaints will be addressed. As most residents are unable to read complicated documents there is a more accessible version, with pictures and photographs of people who residents can talk to if they have a complaint. There are also regular house meetings where residents can raise concerns. The staff keep a record of each complaint and what has been done to address it. The record shows that complaints and concerns are acted upon properly. Abuse awareness is part of staff induction training and there is a copy of the local authority adult safeguarding procedures available for staff reference. The manager is aware of the need to recognise and refer safeguarding issues to the local authority for investigation. A record of people visiting the home is maintained in the reception area. All of the residents require support to manage their finances, budget and save. There are procedures for how this is done and staff keep receipts for the purchases made by each resident. There is a record of money held in the safe keeping of staff. These records and receipts are checked regularly by a a financial controller from head office. A sample check was carried out during this inspection and the records and receipts tallied as they should. It is noted that staff also hold valuable documents and foreign currency left over from holidays in safe keeping and these items are not recorded. This is unsafe because items could go missing without it being noticed. A requirement is made in this regard. Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The home is clean and comfortable and there is a good amount of communal space. Bathrooms have been improved and made more accessible for one resident, but the needs of another resident are not yet addressed and advise must be taken about suitable adaptations required. Residents would also benefit from a more accessible kitchen. Evidence: The large home is suitable for its stated purpose and the building is in keeping with other homes in the residential area. It is within walking distance of high street shopping and transport links. There is ramped access to a small rear garden. There is a cyclical programme for re-decoration in place and the exterior window frames and some of the bedrooms have been painted since the last inspection. Two of the ground floor bathrooms are adapted to meet the needs of the residents using them and a connecting doorway between communal rooms has been widened to make it easier for people who use a wheelchair or other aids to use. The kitchen is not fully accessible and improvements in this area would be of benefit to current residents. During the last inspection it was noted that records of professional safety checks on one of the bathroom hoists could not be found. A requirement was issued and the hoist was checked. Records of these checks are now available. One resident has a bedroom on the ground floor but has to use one of the bathrooms upstairs. Discussion with the manager indicates that she has some difficulty getting in and out of the bath to use the shower in the bathroom upstairs. The resident told me that she prefers to have shower than a bath. The information provided before the i9nspection indicates that advice has been taken and there are plans to improve the ground floor bathroom. There is a clinical waste removal contract in place and clinical waste is stored appropriately before collection. The home is clean and tidy and there are adequate hand washing facilities. There were no unpleasant room odours noted during this inspection. Evidence: During the last inspection it was noted that the refrigerator in the kitchen was too warm. Staff take regular temperature readings and record the results. A new refrigerator was purchased as a result. Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . Staff turnover is high and residents have to get to know new staff often. This reduces the impact of a training programme and the continuity of care. Recruitment procedures do not currently provide adequate safeguards and must be improved to ensure safety. Evidence: Staff are called assistants and they are provided with board and lodgings. Some staff live on premises. LArche is a Christian community of people with and without a learning disability. Assistants are required to be part of all aspects of Larche community life. Staff take turns to be on duty and records are kept of who has worked on each day as required. There are meant to be ten assistants but there are currently two vacancies and these shortfalls are being covered by use of agency staff and staff from other Larche homes in the area. Staff turnover is high, with assistants often staying for only a year. This does not provide good continuity of care. High turnover has also reduced the impact of a training and development programme and only two staff have attained a vocational qualification in care. Discussion with the manager indicates that the provider is planning to assist two of three of the staff to start the new vocational qualification for people working with residents who have a learning disability later this year. All new staff undertake induction training and during their first year they complete foundation training. This is a programme of mandatory and service specific training. Staff are taught how to use equipment such as hoists during their first few weeks of induction. Records relating to the recruitment of two of the new staff were looked at. A human resources officer co-ordinates the recruitment of new staff. As staff live on premises and are often recruited from overseas the POVA first checks (a check against the list of people who are not allowed to work with vulnerable adults because of previous concerns or convictions) and British criminal records check cannot be done until the prospective member of staff arrives in the UK. The provider has increased the number Evidence: of checks undertaken before the person arrives. Overseas criminal records checks are obtained along with three references. When the member of staff arrives the British checks are taken up straight away. New staff do not work alone with residents until these checks are done and the results are satisfactory. This is not ideal and the provider must do more to ensure that new staff are not accommodated in registered premises until they have obtained satisfactory checks in the UK. During the last inspection it was noted that staff had not met with their manager for supervision meetings often enough. Supervision records seen during this inspection indicate that he frequency of the meetings has increased and the requirement is therefore met. Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . The manager is experienced and qualified and able to provide clear leadership. Fire safety and quality assurance must be improved. Evidence: The new manager is experienced and qualified and was registered as manager for another of the LArche homes in the area until recently. This means that the manager knows the residents and the wider LArche community well. The manager is in the process of registering as the manager for The Vine. A representative for the registered care provider visits the home each month to do a small inspection of the quality of service being provided. A report of the outcome of these visits is sent to the manager. A wider quality assurance plan is needed to take the views of all stakeholders. Fire authorities visited the home recently and have advised of changes needed to improve fire safety. Many areas are yet to be addressed. Small electrical appliances have not been tested regularly and fire doors need additional fittings. The system for training a member of staff to conduct small electrical appliance tests is not working well. There have been five fire evacuation drills in 2008, but all have been conducted during the daytime. The service should also night evacuation drills on occasion. Are there any outstanding requirements from the last inspection? Yes  No  Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No Standard Regulation Requirement Timescale for action Requirements and recommendations from this inspection Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No Standard Regulation Description Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set No Standard Regulation Description Timescale for action 1 6 15 All care plans must be 02/07/2009 reviewed twice each year or more often if an area of care need changes in any way. To ensure that staff know how to deliver all care currently required by each resident. 2 9 13 All risk assessments must be 02/07/2009 reviewed at least twice each year or more frequently if risk changes in any way. To ensure that residents are given the correct amount of support to maintain their safety and to develop their skills. 3 19 12 The health care needs of all residents must be assessed and recognised and procedures must be put in place to address them. 03/07/2009 To ensure that residents have access to the full range of health care services that they need. 4 20 13 The registered person must make arrangements for the safe administration of all prescribed medications. 03/05/2009 To ensure that the resident will receive appropriate emergency treatment. 5 23 17 There must be a record of all 05/05/2009 money and other valuables held in safe keeping. To protect residents from financial abuse. 6 34 19 New staff must be thoroughly vetted before they are accommodated in the registered home. 10/05/2009 To ensure that residents are protected. 7 42 23 The service must improve fire safety as advised by fire authorities. 10/05/2009 To ensure that staff and residents are adequately protected and trained in the event of a fire. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 The provider should continue to develop information relating to fees and how they are used. This information must be added to the service users guide in sufficient detail to enable people to understand how placement fees are used. Care planning documents should be standardised to ensure all areas of care and support are recorded and to make reviewing the information more systematic. The range style cooker should be replaced with a model of cooker that is easier to use and more accessible to people who have a learning and physical disability. 2 6 3 17 Helpline: Telephone: 03000 616161 or Textphone : or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. - 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!