Inspection on 25/01/06 for Wellington House

This inspection was carried out on 25th January 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 2 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Wellington House 19/04/07

Wellington House 19/10/06

Wellington House 12/07/05

Wellington House 01/03/05

Wellington House 03/11/04

Wellington House 30/01/04

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

CARE HOME ADULTS 18-65 Wellington House 371 Dover Road Walmer Deal Kent CT14 7NZ Lead Inspector June Davies Announced Inspection 25th January 2006 09:30 DS0000023123.V268623.R01.S.doc Version 5.0 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 DS0000023123.V268623.R01.S.doc Version 5.0 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. DS0000023123.V268623.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Wellington House Address 371 Dover Road Walmer Deal Kent CT14 7NZ 01304 379950 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) Robinia Care South East Ltd Miss Sharon Anne Head Care Home 12 Category(ies) of Learning disability (12) registration, with number of places DS0000023123.V268623.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 12 People with learning disabilities over 18 years of age. Date of last inspection 12th July 2005 Brief Description of the Service: Wellington House is a large detached house in the village of Walmer. The home is registered for12 younger adults with learning difficulties. The home is situated on the main Dover to Deal road, with local public transport services, and a variety of shops and a public house nearby. A car parking area is situated at the side of the house and there is a small secure garden to the rear. All the clients in the home have their own bedrooms, with bathrooms and toilets facilities in close proximity. Communal facilities comprise of a lounge/dining room, and lounge on the ground floor and a small quiet room situated on the first floor. On the ground floor next to the dining room is a large modern kitchen. Storage areas and the laundry room are situated in the basement of the home. DS0000023123.V268623.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an announced inspection taking place over a period of six hours. During the inspection the inspector was able to talk to five of the clients, three members of staff, and the registered manager. The inspector viewed documentation relating to the clients, staff and the home, and toured the building. Most of the morning was spent with three clients who were working on the personal development planning books. Some of the clients were excited by the prospect of moving into a newly set up satellite home in the coming week. Other clients spoke to the inspector about their desire to move into more independent living in the future. What the service does well: What has improved since the last inspection? DS0000023123.V268623.R01.S.doc Version 5.0 Page 6 Some communal toilets and bathrooms have been redecorated since the last inspection. Radiator covers have been fitted. The staff office is in the process of being redecorated and refurnished. 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. DS0000023123.V268623.R01.S.doc Version 5.0 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 DS0000023123.V268623.R01.S.doc Version 5.0 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): 1, 2, and 4 The statement of purpose and service user guide provides prospective clients with the information they need to make a decision about moving into the home. Each client is aware of their role and responsibilities in the home. Clients move into the home knowing that their needs can be met and that their independence will be maximised and promoted. Clients know that their goals and aspirations will be supported by the home. EVIDENCE: Wellington House is a home owned by the Robinia Care Group, the head office of this company produce the Statements of Purpose and Service User Guides for each individual home in the group. These documents are regularly reviewed and are updated as and when required. Any prospective clients is stringently assessed prior to admission into the home, these assessments would be made by Care Managers, Joint Community Learning Disability Teams, psychologists and psychiatrists with a further preadmission assessments carried out by the management of Wellington House. Evidence of these assessments is kept on each individual clients care plan. The home has a prospective client, who has been able to visit the home on many occasions. This prospective client has been able to get to know the other clients in the home and the staff team. They have also been able to discuss colour schemes for their bedroom and are also actively involved in purchasing their own soft furnishing for their room. Provision has already DS0000023123.V268623.R01.S.doc Version 5.0 Page 9 been made for the activities and leisure interests this client wishes to pursue when moving into the home. DS0000023123.V268623.R01.S.doc Version 5.0 Page 10 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, 8, 9, and 10 Clients know that their personal goals are reflected in their individual plans and that potential risks are managed. Clients know that their views are listened to and that their records will be kept securely maintaining confidentiality. EVIDENCE: Each client’s care plan is written with full knowledge of the client and is originally based on the pre-admission assessments. The Care Manager, other multi disciplinary teams, registered manager; key worker and the client regularly review the care plan to ensure the assessed needs of the client are truly reflected. The inspector viewed the care plans of four clients living in the home; all contained very detailed information relating to every aspect of the clients’ lives. Evidence was also available to show that clear risk assessments are carried out, and that regular reviews take place with clients signing their reviews to show they are in agreement with any changes that have been made. Clients are given every opportunity to make decisions in relation to their lives, and staff assist the client in this decision-making and ensure that appropriate risk assessments are carried out where an element of risk is involved. Where there is evidence of decisions being made by others this is DS0000023123.V268623.R01.S.doc Version 5.0 Page 11 discussed with the client and recorded in the care plan. All clients in the home have their own finances paid into their personal bank accounts, and clients are able to withdraw monies from these accounts as and when they wish to. Clients request that money withdrawn from bank accounts is looked after by the home. This cash is kept in a separate cash box for each client and when money is requested the client signs their own individual cash sheet as a record of cash withdrawal. Clients are very involved in the day to day running of the home, they are actively encourage to meet with new staff and to voice their opinions. New staff are always requested to attend trial shifts so that clients are able to form their own opinions. Clients are involved in quality assurance questionnaires, both for the forthcoming inspection and for the homes personal quality assurance checks. All care plans are kept securely in the staff office, and can only be accessed by the staff team, to protect the privacy and confidentiality of the clients. Any other confidential information regarding the clients is kept securely in the manager’s office in a locked filing cabinet. DS0000023123.V268623.R01.S.doc Version 5.0 Page 12 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): 11, 12, 13, 14, 15 16 and 17 Clients are given every opportunity to follow, college course, work experience of their choice, the links with local community are good and support and enrich clients social and educational opportunities. The meals in the home are good offering both choice and variety and catering for special diets. EVIDENCE: On the morning of the inspection the inspector was able to spend time with three clients who were working on their personal development plans. Each personal development plan reflected the clients likes and dislikes, how they wished their lives to develop, what they would like to do, their choices in regard to clothing and hair fashion, photographs of outings and activities they had been involved in to mention but a few. The clients spoke quite openly about their own personal development plans, and were proud of the items that they had included within them. Many of the clients in the home pursue college courses of their own choosing; most attend Thanet College for these courses. Some clients have take part in work experience, such as working at the Guinea Pig farm, working with DS0000023123.V268623.R01.S.doc Version 5.0 Page 13 rescued horses, carrying out domestic work in one of the Robinia Care’s other homes, and a paper round to name but a few. All clients are able to access the local community, in some cases this can involve going to the local shops on their own but this would depend upon risk assessment and mood on the day. Some clients are able to go by public transport into Deal and Dover; these clients carry a mobile phone and are in regular contact with the home. All clients are able to visit local pubs, cinemas, leisure centres and churches. Any trip made outside the home is risk assessed on the day of the outing, and staff escort depending upon the level of risk, and assessments within the care plans. Clients take part in leisure activities of their choosing, which may include music lessons, baking, keeping pets, music, videos, C.D’s, Karaoke. A masseuse visits the home on a weekly basis, to carry out foot, hand and Indian head massage, many of the clients said how much they enjoy their massage. The registered manager and staff team, ensure that the clients maintain regular contact with their families. Clients are able to make visits to their family homes, and extra staff are brought in to escort them on these visits. The inspector found that clients had been able to develop intimate personal relationships, and clients spoke openly with the inspector about these relationships. The registered manager and staff confirmed that where these relationships develop, appropriate information and guidance is given to ensure that clients can make informed decisions in their relationship. It was evident during the course of the inspection that staff respect the privacy and dignity of the clients and knock on clients doors before entering their bedrooms. Each client can lock their bedroom door if they wish to. Due to some of the challenging behaviour displayed from time to time, the clients do not have free access into or out of the home because staff need to be aware of where clients are, and need to risk assess trips out of the home. Clients have regular housekeeping tasks that they are expected to carry out, and can earn incentive money for doing these tasks, but where a client chooses not to do an allocated task they are able to make that decision only to the detriment of their incentive payment. The inspector was shown the homes menus. These are four weekly menus, one set of menus is designed for those clients who wish to take a healthy eating option, and the other set is designed for clients who wish to eat nondietary food. During the course of the inspection the inspector was able to witness and talk to staff and clients who were preparing the evening meal for the home. Clients were able to tell the inspector about the menus, that their choices had been taken into consideration, and how much they enjoyed helping to cook meals. Both menus and food being prepared was seen to be nourishing and balanced. DS0000023123.V268623.R01.S.doc Version 5.0 Page 14 DS0000023123.V268623.R01.S.doc Version 5.0 Page 15 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 The health care needs of clients are well met with evidence of good multi disciplinary working taking place on a regular basis. The systems for medication administration is good but attention to detail is needed, to ensure appropriate records are kept. EVIDENCE: Clients requiring assistance with personal care would receive this in the privacy of the bathroom or their own bedroom. Many of the clients require prompting by staff in regard to personal hygiene. Meals in the home are flexible and clients are able to take meals according to their activities on the day. The inspector witnessed this, with clients coming and going over the lunch time period. Clients are able to have choice as to when they go to bed at night, but their getting up times are mainly regulated by the activities they are choosing to do on the day. All clients in the home are able to purchase their own choice of clothes and regularly make trips into town to do so. Evidence was available on care plans and through conversation with the clients that the home constantly reviews health issues with each client. Clients have regular contact with dentists, opticians and chiropodists. Where there are DS0000023123.V268623.R01.S.doc Version 5.0 Page 16 areas of concern in relation to a client’s health this is referred via the G.P to a hospital consultant or appropriate health care specialist. The home has up to date policies and procedures for the administration of medication. The inspector evidenced that clients who wish to, can be selfmedicating and the care plans contained signed declarations of selfmedication. Within the MAR sheet folder there were signed declarations from the clients G.P.’s regarding homely remedies. While the inspector witnessed that medication is appropriately handled, the inspector did notice that some medications being received by the home is not always appropriately recorded on the MAR sheet, and a requirement has been regarding this issue. The home does not use controlled drugs. The inspector was shown the returned medication book, and this showed that unused medications are returned to pharmacy in a timely way. DS0000023123.V268623.R01.S.doc Version 5.0 Page 17 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 The home has a good complaints system; with clear guidelines for the clients in the home should they wish to complain. Staff have a good knowledge and understanding of adult protection issues, which protects the clients from abuse. EVIDENCE: Wellington House has an up to date complaints policy and procedure that is written in an easily understood format and picture illustrated to give clear guidelines for the clients in the home if they wish to make a formal complaint. No complaints have been received in the home since the last inspection. The home has up to date policies and procedures in place relating to POVA, and whistle blowing. Staff are made aware of the protection of vulnerable adults during the induction programme. The inspector was given the training programme for the next six months, and this shows that POVA training has been organised for staff. Staff spoken to on the day of inspection were aware of POVA and whistle blowing policies and procedures. DS0000023123.V268623.R01.S.doc Version 5.0 Page 18 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, 26, 27 and 28 The standard of the environment within the home is good providing clients with an attractive and homely place to live. EVIDENCE: Wellington House is suitable for its stated purpose; generally the home is well maintained. The home is situated within easy walking distance of the local shops and public transport facilities. All furniture and fittings are of good quality and domestic in character. On the day of inspection the home was clean, tidy and free from offensive odours. Letters were available to show that the home meets the requirements of the fire safety officer and environmental health officer. The inspector was able to view all the clients’ bedrooms, which were well furnished, comfortable and homely. All bedrooms reflected individual personal interests. Some of the clients are able to keep pets in their bedrooms and this has been risk assessed. All clients can lock their bedroom doors if they wish to; staff in the case of an emergency can override these locks. The home has twelve clients, two bedrooms have en-suite facilities, and in addition there are a further two bathrooms, two shower rooms and three toilets. The inspector did note during her tour of the building that a bathroom DS0000023123.V268623.R01.S.doc Version 5.0 Page 19 and a shower room on the first floor were in need of maintenance. The bathroom needs tiles replacing at the head of the bath and just outside the shower unit, the shower room has black mould on the tiles just above the shower tray, therefore a requirement has been made for this to be attended to. The home has three communal lounge areas, one of these areas are lounge/dining area. All communal areas have good quality furnishings and fittings, and are in good decorative order. There is a small communal lounge on the first floor that can be used by the clients when they have visitors. The front lounge on the ground floor is fitted with an extractor fan and can be used by any of the clients who wish to smoke. DS0000023123.V268623.R01.S.doc Version 5.0 Page 20 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, 33, 34 and 35 Staff are enthusiastic and work positively with the clients to improve their whole quality of life. Staff are multi skilled ensuring good quality care and support. Recruitment processes in the home are good, and ensure that clients receive care from appropriately vetted staff. The induction programme is good and staff have a clear understanding of their roles. EVIDENCE: At the time of inspection 53 of staff have NVQ level 2 or above qualification. The inspector witnessed that staff are always available to the clients and have good communication skills with them. The inspector viewed the work rotas and these reflected that sufficient staff were rostered for duty on each shift of the day to meet the assessed needs and activities of the clients in the home. Extra staff are brought on duty as and when the activities and or risk assessments of clients justify this. The inspector was able to view four staff personnel files, all showed application forms; depending on date of recruitment POVA first checks were in place and there was evidence on each file that CRB checks were in place, two written references were available on each file. Each prospective member of staff is required to spend up to two trial shifts in the home, where they can get to know the clients and other staff. Clients then are able to voice their views in regard to the prospective new member of staff. DS0000023123.V268623.R01.S.doc Version 5.0 Page 21 From the certificates in staff personnel files and from talking to some members of staff, there was evidence that the majority of staff have up to date mandatory training certificates. Evidence was also available to show that training planned for the first six months of this year covers mandatory training, and this will enable newly recruited staff to be trained. DS0000023123.V268623.R01.S.doc Version 5.0 Page 22 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, 38, 40 The registered manager has a good understanding of what needs to improve in the home and is providing clear leadership to the staff in the home. EVIDENCE: The registered manager has completed and is awaiting certification for NVQ Level 4 and RMA. She has many years experience at management level within Wellington House. The registered manager updates her work related training as and when suitable training courses are available. During the course of the inspection the inspector witnessed an open door policy, where the registered manager is available to members of staff and clients throughout the day. Clients were able to speak openly in regard to future activities, and were able to speak openly about issues that were concerning them. The Robinia Care Group, head office writes the policies and procedures for each home, these policies and procedures are reviewed on a regular basis. Where policies and procedures are relevant to the clients in the home, they are DS0000023123.V268623.R01.S.doc Version 5.0 Page 23 written in simple form and picture illustrated. policies and procedures file. All staff have access to the All records are maintained to a high standard within the home. The clients have access to their own individual care plans, and personal development plans. Care plans are kept securely in the staff office, and are only available to the staff working with the clients. Other documents required for the running of the home are kept securely under lock and key in the manager’s office. The home has up to date health and safety policies and procedures in place, the majority of staff have received mandatory health and safety training, and newly recruited staff are due to undertake this training within the next six months. The inspector was able to view up to date maintenance certificates for all appliances used in the home, the environmental fire risk assessment, risk assessments for Legionella control, and the asbestos survey for the whole building. Evidence was also seen to show that the fire call points are checked weekly, emergency lighting is checked monthly and the nurse call system is checked three weekly. Hot water in the home is stored at 60°C and delivered through hot taps in the home at 43°C. All windows have window restrictors in place. All radiators have recently been covered. All external doors have number locks in situ, to ensure that the premises are secure. All accidents and incidents are recorded appropriately. The inspector noted when viewing staff personnel files that all staff receive health and safety induction within the first six weeks of their employment. DS0000023123.V268623.R01.S.doc Version 5.0 Page 24 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score 3 3 X 3 X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 3 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 3 X 3 2 3 X X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 3 3 X DS0000023123.V268623.R01.S.doc Version 5.0 Page 25 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 YA20 Regulation 13 Requirement All medication received, should be entered onto the MAR sheet, with the amount of medication, initials of staff member receiving the medication and the date. Maintenance is required in first floor shower room and first floor bathroom. Timescale for action 13/02/06 2 YA27 23 01/03/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations DS0000023123.V268623.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU 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 DS0000023123.V268623.R01.S.doc Version 5.0 Page 27 - 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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